Flight from autonomy: problems of social change on an adolescent inpatient unit
This paper reports on a period of social change in an adolescent inpatient unit. The primary aim was the redefinition of ward staff roles and functions designed to encourage more autonomous functioning. The staff were to be able to function on their own when confronted with day to day clinical problems. A related aim was that ward staff would play an effective role in helping determine the overall direction of the milieu. Such a change would provide, for the adolescent patient, models for identification with adults behaving in an independent, autonomous, and rewarding way. Ward staff dependent on and subservient to parental surrogates, in the form of clinicians, or alternatively in rebellion against such surrgogates, provide a countertherapeutic model for the adolescent. The ward staff's modes of resistance to functioning with more professional autonomy mirror the adolescent's struggles over assuming personal autonomy. The understanding of these resistances promotes more effective milieu treatment.