Institutional psychotherapy

Domain I · Psychodynamic & depth psychology · Tosquelles, Oury, Daumezon · 1952 · France

What it is

Institutional psychotherapy is not a manualised therapy. It is a way of organising a care setting (hospital ward, clinic, day hospital, residential unit, club) so that the setting itself works as the treatment, mainly for psychosis. The clinician treats the patient and also treats the institution,…

Format

• Not a phased protocol. None of the sources sets out phases, session counts or transition criteria. Oury says the term now covers practices that differ between regions and establishments, and Tosquelles held that institutional psychotherapy "does not exist" as a finished thing: institutional…
• Institutional diagnosis. Goal: identify segregating and depersonalising features such as uniforms, locked circulation, crowding and rigid hierarchy. Format: open meetings that include all staff categories. Move on when there is a shared list of concrete barriers and a group willing to work on them.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• sedation used to replace the work of the institution.
• staff taking restraint as indifference. Tact is active attention.
• the fund being run as charity rather than as a decision of peers.
• burnout; cynicism; the founders' charisma standing in for structure.
• outings that are tourist trips; families treated only as a source of information.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.