A sociotherapeutic milieu in inpatient treatment or coaching
Lecture given at the 4th European Conference on Traumatic Stress in Paris
Nico van Tol, Paris, May 1995

In the Netherlands, over the last decennia, nurses were educated in one of three disciplines:

1. those involved in the treatment of somatic diseases
2. those involved in the treatment of mentally disabled people
3. those involved in the treatment or coaching of people with psychiatric problems

I prefer, concerning sociotherapy, the term coaching instead of treatment.

During the last few years education of nurses is changing to a more all-round basic education with a specialisation on physical, psychichiatric and mental issues, during the last part of the training.

Historically, the nurses function(ed) as an extension of the physician's policy. Coinciding with the evolution of the technical side of medical care and the increased professional identity, a trend towards more independent operational responsibility of nurses is observed.

Due to the historical situation of the professional nurse, where hierarchical relations may be observed between physician and client, between nurse and physician and between the nurse and the client, special features can be observed in these relationships.

One of the characteristics of the relation between physician and nurse is the dependability of the nurse, which is based on "inequality". Inequality in sharing the same rights and values as a person.The recognition and acceptance of this "inequality" is important for the development of the sociotherapy.

The inequality between physician and nurse is expressed in:

• the difference in apparent competence
   
• the difference in position in the "care- and cure centre"
   
• the difference in involvement in treatment therapy
   
• difference in salary and other ways of compensation
   
• difference in social status and position
   
• difference in organisation level
   
• difference in juridical protection of the profession

The relation between nurse and client shows identical signs of "inequality". This inequality is, in my opinion, induced/caused by the principle "inequality" between physician and nurse, as if the "power gap" between nurse and physician is copied to the relation between nurse and client.

The group of nurses identifying the "power gap" as a possible obstacle during coaching of clients with psychological and psychiatric problems are the sociotherapists.
A methodological approach to the clinical environment, as a social system, is for sociotherapists very important to induce successful coaching.
The sociotherapists are commonly trained or educated to be nurses with a specialisation in psychiatry. Consensus has been reached among this group on the opinion that active participation of the clients during coaching might be of use only when there is "equality" between client and therapist.

deel 1 * |  deel 2 | deel 3 |  deel 4
Kopieer deze tekst