Relationships, reality, and reciprocity with therapeutic environments: a historical case study

This historical case study considers the reciprocity between interpersonal relationships and the immediate, structural, and demand-laden therapeutic environment in which they occur. This study draws its data from the daily diaries kept between 1814 and 1840 by the lay superintendents of the Friends Asylum for the Insane in Philadelphia. The demands of a therapeutic environment for stability and productivity, in addition to demands for safety and healing, fundamentally altered the nature of the individual relationships between patients and staff. Therefore, current practitioners must not assume the stability of their later 20th century formulations about therapeutic relationships. Rather, they must perform a careful calculus of risks and rewards as they consider the intersection of relationships, reality, and therapeutic environments.