The inpatients and staff large group: From a therapeutic space to a therapeutic milieu. A personal experience

Many psychiatric units hold weekly large group sessions that bring together both staff and patients from the ward. These sessions serve a distinct purpose among various therapeutic activities, each with its own focus and objectives. However, participating in this form of therapy is challenging and requires significant effort and dedication from all involved, particularly the therapists. This paper will explore my extensive experience in several units that follow this approach. Additionally, I will reference theoretical writers whose work I find relevant to the complexities of this activity. The interactions within the large group reveal multiple contradictions that warrant examination. For example, while the group is intended to represent freedom and democracy, this stands in stark contrast to the highly regulated atmosphere experienced by patients. Furthermore, staff members’ reluctance to engage in open dialogue often hinders patients’ ability to express themselves freely. Creating a truly open dialogue presents significant challenges for therapists. Some of these difficulties stem from discomfort—or even fear—when confronted with psychotic states. Additionally, therapists may hesitate to actively participate in discussions, seeking instead a form of psychological retreat