This paper describes a successful day treatment program that provides
four months of intensive psychodynamic group-oriented milieu treatment for
patients with long-standing personality disorders, who commonly experience
recurrent major depression, dysthymia, and excessive anxiety. The authors
outline three factors that have contributed to the success of the
program--optimal treatment-patientmatching, judicious use of authority in
milieu therapy, and careful attention to maintaining close working
relationships with referral sources. They provide an overview of the
historical evolution of day treatment programs from earlier day hospital
model to show day programs' neglect of these factors may have led to
treatment failures. Such failures may have spurred recent suggestions that
psychiatric day treatment programs should be replaced entirely by assertive
community treatment. The authors argue that such a move could amount to
abdication of psychiatry's responsibility to provide intensive milieu
treatment that can be effectively offered only on a day treatment
basis.
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