Hospital psychiatry in transition. From the therapeutic community toward a rational eclecticism

Concepts derived from the paradigm of the therapeutic community have provided the main organizing principles for general inpatient psychiatry in the past 20 years. Increasingly, however, scientific studies have thrown doubt on the efficacy of current hospital practices. Changes in the broader social milieu have occurred as well since the therapeutic community was originally conceptualized, which raise questions about the "fit" between milieu therapy principles and current psychiatric needs. No current therapeutic paradigm is sufficient to encompass current inpatient psychiatric practice. There is a need for flexibility in utilizing various organizing principles for various aspects of the problems at hand. The paradigm of "problem-solving," derived from the research findings comparing group vs individual problem-solving, is an example of one way of examining and organizing data that could be applied to certain aspects of hospital care.