Chronic patients' power games and the proper setting of limits

The author found that the chronic mental patients at a state hospital aftercare clinic brought for consultation because of lack of therapeutic progress were all engaged in manipulative power games with the staff. The most common games involved medication, attendance and punctuality, and misbehavior. Defiance was the major motive: the patients' ability to frustrate and triumph over the staff created subtle "high" for them in otherwise bleak lives. The staffs were usually unaware of the games. When they recognized them, stopped them effectively, and focused therapeutically on helping the patients examine and change their maladaptive ways of acting and thinking, improvement began to occur. Power games are important in other aspects of psychiatric practice; examples are given.