The involvement of nurses in behaviour therapy readily follows the guidelines laid down for the use of the triadic model for parents, as discussed in the preceding two chapters. This is particularly the case in long-stay hospitals, such as psychiatric and mental handicap units, where the nurse has a central role to play in the day-to-day care of patients. Because ·of this long-term involvement, nurses find themselves in a position in many ways similar to the parents' role. For instance, they develop an intimate understanding and shoulder the major responsibility for their patients' psychological growth and development. In many cases this continues over a period of several years. The nature of this parenting relationship is increased still further by the 'total' or self-contained quality of long-stay institutions (Goffman, 1961).