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
part 2

If medical care is defined as modelling of cure and care systems, we can observe in the Netherlands that the medical care for psychiatric clients has a tendency to support cure models. Not because of a renaissance of the 'healing optimism" but from the requirement to operate at a lower cost. And also because of the wish of the therapists to control en simplify the problems of the client.
In other words, Prozac is fashion, talking about feelings is rubbish or, cure is efficient, care is carbage. Focussing on symptoms is better than looking at the human being as a complex entity of biological and personal factors also influenced by situational and social factors.

The consequence of the sometimes almost unlimited subscription of anti-depressives, anti-anxiety drugs, behavioural therapy etc. might in future cause new, uncontrollable problems for the personal behaviour and society. Penny wise can be pound foolish.

The mental care has a closer resemblance to a care system compared to a cure system. The oscillation between cure and care is reflected in the relation between physician and nurse and the relation between nurse and client.
In a cure system the inequality can be explained due to the difference in professional expertise between therapist and client. In a care system this inequality cannot be justified in this way, especially when we are working with persons who were involved with (organised) violence.

Sociotherapists, occupied with the coaching of these victims try to work based on a fundamental equality with the client.
During my work with victims of World War 2, I frequently observe that cure, in the meaning of complete recovery, is not possible. Next to that it is difficult to resist the temptation to abuse your formal and educational advantage in complex situations during interaction with the client. In this presentation I will try to explain how sociotherapists in Centrum '45, the national centre for medical and psychological treatment of victims of World War 2 (and active participants of the resistance) try to establish high quality care. This raises questions as:

What is sociotherapy and what can sociotherapists offer in relation with treating traumatisation, more specific coaching of people with traumatic experiences acquired during World War 2.

Sociotherapy is involved with the following basic principles. The key principle is the methodological creation of an environment for the clients. An environment, meaning a new social system with an equal set of basic rules for all participants. Sociotherapists deal with the actual situation, here and now.

Negotiation with colleagues and clients is the most important tool to establish change. The methodological approach and the mentioned principles are necessary to reach the goals for changing the situation of each individual patient.

Sociotherapy is not a therapy to be applied for only a limited time per day, or meant for a few clients. Sociotherapy is a vision to create an environment where exchange of information and negociation, between everyone in the Clinic, are the determining factors.

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