ACTING-OUT AND THE INSTITUTIONAL RESPONSE

The responses of institutions to 'acting out' in personality disordere d individuals may perpetuate such behaviour. Inadvertently, such respo nses remove the potential for these individuals to learn from experien ce and to mature psychologically, to individualize. This is because in stitutions, first and foremost, serve the needs of society. In perform ing this wider function, they often do not meet, sufficiently, the the rapeutic needs of the individual. The result is a stalemate in which b oth the individual who acts out and the institution continue to suffer . An awareness of the interaction between the individual and the 'inst itution', and particularly an awareness of the often complementary sty le of their interaction, victim-victimizer, may empower professionals working in institutions to break the therapeutic stalemate. However, t o achieve this requires changes in attitudes and behaviour on the pan of staff and some restructuring of the internal organization of their institutions so as to influence both staff-staff and staff-patient rel ationships. We discuss how some principles of Henderson Hospital's dem ocratic therapeutic community model, which helps to avoid some of the pitfalls which otherwise can lead to therapeutic stalemate, can be tra nslated to institutions which of necessity operate at different levels of security and how they may be applied in non-specialist settings.