Institutional Transference and Disengagement: A Study of an Outpatient Clinic

Abstract

This paper describes an outpatient clinic where many of the patients are chronic attenders who resist all attempts at discharge. Their dependency needs and the difficulty of one-to-one treatment are outlined. On the one hand there is the almost insatiable demand for magical medications, and on the other the frustration of the therapists trying to deal with this situation. To circumvent these difficulties, the concept of institutional transference was fostered by a policy of disengagement. As a result a flexible therapeutic set up was evolved allowing for the fulfillment of dependency needs and the maintenance of satisfactory morale, not only among the patients but also among the entire treatment staff. The clinic, instead of being viewed as merely a place for difficult and incurable patients, is now seen as a useful alternative in the treatment armamentarium of the outpatient department.