The interactional dynamics of violence, Part I: An acute psychiatric ward

The purpose of the following two articles is to shift the emphasis from a strictly patient-centered focus to an interaction-centered focus. Evidence from independent research projects in two different patient care settings demonstrates the interactional nature of violent behavior. One project was conducted on an acute adult psychiatric inpatient unit; the other project was conducted in a juvenile detention facility. Each of these articles describes one segment from two separate and independent parent research projects. Although these clinical research projects were conducted in two very different clinical facilities with very different patient populations, the researchers subsequently discovered common categories and themes regarding the issues of control and the interactional dynamics of violence in the two studies. Interactions between health care providers and patients in the acute psychiatric setting resembled the corresponding interactions in the juvenile detention setting. Both populations had been deprived of power, and all patients/adolescents had some restrictions on their freedom with few choices and opportunities to display positive conduct. Furthermore, the environment in each setting was structured according to the needs of the staff/caretakers, who assumed some degree of control over the individuals in the population being served. Labeling and control issues were identified in the findings from both studies. In the two articles that follow, the specific qualitative research methods used in each study are described. Common themes are discussed from each clinical perspective, using research data and case examples that exemplify the interactional basis of violent behavior.(ABSTRACT TRUNCATED AT 250 WORDS)