[Steps toward a therapeutic community in a psychiatric hospital (author's transl)]

The psychiatric hospital is conceptualized as a social organism with its own development. Every important change or new development follows certain laws. When those steps of phases of development are known their unfolding can be guided more easily. Resistance must be expected and tends to hinder the planned development. There is also a risk of wrong or defective development, endangering the overall goal. The different systematic phases, resistances or risks in changing a psychiatric hospital from a traditional-custodial to a milieu-active institution are summarized in a table. The described milieu therapy is that of a therapeutic community; its conceptualization is briefly discussed. Milieu therapy as a term is at the same time understood in a inclusive and in a complementary way: Inclusive in so far as all therapeutic procedures in a hospital are coordinated via milieu therapy; complementary in the sense that all activities which take place beside the classical therapies (pharmacotherapy; psychotherapy, etc.) are understood as therapeutic activities.