chapter  32
16 Pages

Toward A Theory for Milieu Treatment of Hospitalized Borderline Patients

A tradition of long-term psychotherapy for schizophrenic and borderline patients was established at the Gaustad Hospital in 1962. I have continued this tradition by attempting with friends and co-workers) to work out an inpatient setting where a combination of long-term psychotherapy and milieu treatment for these patients can take place. As part of this work, I have attempted to formulate the basic ideas of milieu treatment for teaching purposes. Two of the main inspirational sources for these ideas can be found in the work of Klein and Bion as developed through the annual lectures presented by Dr. Donald Meltzer. We have also received ideas from other visiting teachers. 2 Important elements of our ideas about milieu treatment include: an emphasis on the work group3 of ward staff members, continuously sharing and developing ideas about psychopathology and emotional growth, and a shared epistemological attitude. This attitude can be expressed as follows: We continue to learn and understand more about the patient all the time. New learning often occurs unexpectedly, but only when we are emotionally ready for it, even if our understanding has accumulated over a long period of time. We accept our ignorance, both in the present and in the future. Reality, whatever that may mean, is different from our knowledge of it. Wanting to know, believing one knows, pretending to know, knowing one

does not know-all this is part of processes where the tendency for mental pain (conflict) is to be transformed by symbols, to more elaborate mental products.