The integration of behavioral principles and a psychodynamic viewpoint in the treatment of adolescents on an intermediate inpatient unit.

This paper describes an approach to setting up an inpatient intermediate-term unit integrating behavioral methods with a psychodynamic viewpoint to facilitate the treatment of severely disturbed adolescents. The need to provide a safe and structured environment for these youngsters is critical to the establisment of what Erikson has described as basic trust. The milieu needs to feel safe and predictable to provide a synergistic relationship with other modalities of treatment. This can usually be accomplished by utilizing behavioral principles within the milieu. Case examples are provided in which interventions on the unit can provide increased feelings of security which then translate into the patient being able to understand, express and work through feelings and decrease the probability of acting these feelings out. An important consideration is also given to intra and inter-staff dynamics and countertransference reactions which impede the exploration of feelings and encourage patients to act out the staff's forbidden unconscious impulses.