[Reflections and perspectives on institutional therapy in neurotic depressions]

We have found that an institutional psychothérapy for neurosis could benefit by using elements of the work of Winnicott as well as of the bioenergetic and existential movements. This corresponds to a more and more explicit request from depressed patients who are expecting more from their stay in the hospital than simply to recharge their energy. We thought that our department, because of its size, type of patients, staff and its own orientation would be well adapted to an experience of this kind. In our hospital we try to facilitate in the patient: --regressive experiences; --the perception of "being"; --the symbolic and emotional feeling of the reality of time and place and particularity of the body; --the capacity to repair himself; --playing in the sense of Winnicott: playing with the in and the out (of onesself), the positions of the body, verbal play, play of alternation. --Centering on desire on the interior space, with the capacity to be "alone in the presence on another"; --the discovery of "responsability" and "compassion", also in the sense of Winnicott. We must take into consideration that in order to benefit from this type of therapy, there must be a good enough integration and a pain that is authentically experienced, that is, not acted out, not sutured, and without too many defenses. The results can be appreciated only very subjectively, since improvement is of a qualitative order, in the area of development of being serious existentially. We can perhaps envisage another future for the depressed patient than the interminable repetition of relapses or of beign treated indefinitely. This consists of discovering another way of being, more global, more serious, more authentic (real-self), considering the difficulties involved in the engagement of the realself in an already structured existence.