Treatment Setting and Context

The Place of Hospitalization in PRP

The Menninger Foundation was founded in the 1920s as The Menninger Clinic, a psychoanalytic sanatorium in which sick people could receive the intensive psychoanalytic treatment which they needed within a supportive and protective sanatorium environment, on the model originally established by Ernst Simmel at Der Tegel outside Berlin (see Simmel, 1929). Within such a setting, intensive analytic treatment could be provided to individuals who, by reason of their character structure and/or illness picture, could not be maintained successfully in intensive treatment in the usual private practice outpatient setting. And it was also possible then to develop within that setting a conjunction of therapeutic planning between the specific psychotherapeutic treatment mode and the concomitant psychodynamically planned impact of the hospital environment and milieu. This conjunction was guided by William Menninger into the Menninger-created concepts of psychoanalytically based “milieu treatment.”

In its operation, the early clinical reputation of The Menninger Clinic grew out of just this rationale and this context, which were widely written up in both theoretical and clinical terms in many articles in the scientific literature by Karl and Will Menninger, by Robert Knight, and by their coworkers. (Many of these articles appeared in the Bulletin of The Menninger Clinic, established in 1937.) A significant milestone in this development was the series of articles by Knight (1937a, 1937b, 1938) on the psychodynamics of alcohol addiction and its psychoanalytic treatment within a sanatorium setting. It was this central feature of the history and the institutional setting of The Menninger Foundation that led so logically, in the setting up of PRP in the 1950s, to two decisions: (1) the theoretical (or the research) intent to explore the limits of the potential for far-reaching and reconstructive character change and i