Internal and external reality in inpatient psychotherapy. The treatment ofsevere personality disorders at the Cassel Hospital

On the basis of Steiner's theory of 'psychic retreats' and O'Shaughnessy's concept of 'enclaves the author argues that inpatient treatment is always a t risk of turning into an unhelpful refuge. He describes the concept of the Cassel Hospital where work on the internal reality in psychoanalytic psych otherapy is combined with psychodynamically based work on external reality in 'psychosocial nursing'. This concept is put in context with the literatu re on inpatient psychotherapy. Using various case material, the author show s how a patient's internal dynamic can present itself on these two differen t levels and can simultaneously be worked on in very different ways. Crucia l in this concept is the cooperation of staff and the understanding of the dynamics between staff and patients and between members of staff. The autho r concludes by looking at the mutual influences within the institutional dy namics of the hospital.