Patient, therapist, and supervisor in a psychiatric institution: inner freedom and inner structure

The authors discuss issues concerning the psychotherapeutic process in a psychiatric institution. They develop the concept of the institution as an internalized object in addition to its being an objective object. As such, it has an effect on the inner freedom and the internal structure of the patient, the therapist, and the supervisor. It is claimed that it is crucial for the development of an identity as a psychotherapist that the supervisor be aware of the institution as an inner and real object. The authors raise questions about what kind of "space" is possible in a psychiatric institution and what influence that may have on the therapeutic process. The impact on the therapist's professional identity is discussed. They point to the process of becoming a therapist via supervision and examine some relevant dilemmas. The authors conclude by discussing the duality of inner freedom and internal structure, and their specific manifestations within an institution.