ABSTRACT
This chapter focuses predominantly on Chestnut Lodge and the factors that contributed to the practice of psychoanalytically oriented psychotherapy for each individual inpatient. The hospital based approach at Chestnut Lodge has been described as a bifocal model that emphasises the dual relationship between analyst and patient, with technical alterations to the psychoanalytic classical method for the treatment of psychosis, in a highly protected institutional environment. Frieda Fromm-Reichmann considered herself a psychoanalyst in her practice of intensive psychodynamic psychotherapy in psychiatry and that her orientation was based on the training she received at the Berlin Psychoanalytic Institute, her analysis with Hans Sachs and her supervision by Sandor Ferenczi. Detailed studies of staff and inpatients within the social system of a psychiatric hospital were relatively rare prior to Second World War. An illustration of the unacknowledged chronic and intense conflict that occurred between staff was when a nurse took special interest in a patient, defensively justifying the patient's need for special attention.
