Stability at Follow-Up: The Role of the Environment

Nature of the Phenomenon

In a widely influential article, Reider (1953) first applied the concept of “transference to the institution” to the emotional valences established by certain kinds of patients to the institutional setting (hospital or clinic) in which they have their psychiatric treatment, quite apart from those they may have to the individual

therapist who treats them. Such valences can be manifested in a variety of ways: The patients can accept a change of therapist without significant evidence of resentment or sense of loss; they may refer impersonally to their treatment (“I have an appointment at the clinic,” rather than “with Dr. X.”); they may actually come to the clinic at their usual appointed hours even when their therapists are onvacation, claiming momentarily to have forgotten, but being content then just to sit there in the waiting room visiting with the other patients they know who have the same appointment time; they may idealize the institution and accept every offered therapist as surely competent (“Oh, he must be good or he wouldn't be here”); and so forth. For obvious reasons, these kinds of observations were first made in the public hospital or clinic settings to which poor patients were used to coming for their varieties of physical and mental health problems. For the same reasons, such observations would not arise from the usual outpatient therapeutic practice setting, with the isolated office and waiting room, the rare and only chance contact with other patients, and all of the therapeutic transferences focused very clearly onto the person of the therapist (and the very personal extensions of the therapist—office decor, car in the parking lot, etc.).

In these senses, The Menninger Foundation has had a very special character. On the one hand, it has always (especially in the days before at least partial coverage for mental health benefits under comprehensive health insurance plans became widely