Institutional Psychotherapy in Terms of Maintaining the Subjectivity of an Individual

Posted: 29 Apr 2019

See all articles by Vitalii Lunov

Vitalii Lunov

Bogomolets National Medical University; G.S. Kostyk Institute of Psychology, NAPS of Ukraine; Deva Clinique; House of Educations & Research Limited

Date Written: March 27, 2019


Institutional psychotherapy is one of the most productive therapies in terms of maintaining the subjectivity of an individual. It should be taken not as much as a practice or a direction, such as, for example, Adlerian, cognitive, behavioral, transfer-oriented therapy, etc.

The key motive for institutional therapy is the idea that, first of all, the treatment itself is necessary. In essence, the movement itself of the modern French school begins with criticism of the hospital as a closed space, a space deprived of the opportunity to confirm the individuality.

Such an understanding implies a cardinal change in the system of values, rules and traditions of psychological assistance, as such. At present we are dealing with the constancy of the situation described by Hermann Simon about the problems: inaction, pathogenic atmosphere in modern clinics, prejudices of perception of the mentally ill, as incapable of taking responsibility.

Institutional therapy supports and confirms the subjectivity of all participants in the therapeutic process, preventing the possibility of the participants transitioning into rigid role-playing positions of classical hierarchy therapy. This applies to both patients with certain mental, neurological, somatic statuses, and clinic staff (the attending physician is the one who determines not so much the treatment strategy as the patient's stratification, head of department, head doctor, orderly, guard, etc.). d.).

Subjectivity is lost with the transition to role-based interaction, regulated by cultural traditions of attitude towards patients (stigmatization, leading either to an infantile-lenient attitude, or to the devaluation and depersonalization of the patient, or to an attempt at sadistic control and ambivalence).

The habitual model of the patient's behavior - broken by the pressure of external restraints (system, pharmacotherapy, regimen), in many respects, deprives him of the status of an active participant in attaining his own subjectivity, as opposed to his mental structure. And this is a mass of evidence, known to us in the framework of studies of antipsychiatric sense and movement.

Patients with much greater adaptive potential and safety of higher mental functions show stable behavioral and role transformations, which is interpreted by representatives of the classical medical (behavioral) approach as the effectiveness of treatment. However, quite often, we see regression as individuals socialize in the post-rehabilitation period. And, finally, the only explanation for this outcome is, as a rule, the intractability of one or another method of treatment and its inevitable replacement with another, more complex, intensive, pharmacotherapeutic. In such a situation, the role behavior of both the doctor, the patient and relatives becomes situationally determined and justified, at least this reduces the anxiety of uncertainty for all participants in the rehabilitation.

Institutional therapy, in its essence, is a philosophy, in a sense, an ideology of organizing work in an institution (treatment institution, rehabilitation center, etc.)

We proceed from the fact that any institution is a reflection of the dominant model of relations in society, the assessment of statuses, the so-called “secret places” - the methods of realization of power functions and professional identification functions. Any institution implies a system of interventions in the life and activities of individuals that are included in it and, accordingly, the systems of relations that form in it. And this requires a special philosophy. I would say the transition from treatment technology to the philosophy of the organization of space, which is most conducive to supporting the subjectivity of individuals.

In this regard, the most important criteria ensuring institutionalization will be:
1. - transversality, instead of the universality of the system;
2. - acceptance of the fact of institutional transfer, which, in my opinion, can be considered as a manifestation of a symbolic order;
3- microdiscourse - as accounting for patient discourse;
4. - anti-process as opposed to the process of depersonalization;
5. - joint action research;
6. - development and research;
7. - consideration of explicit, latent and deep levels of subjectivity;
8. - availability of consent;
9. - release of the statement;
10. - the opportunity to open another;
11. - appropriation of own suffering;
12. - consideration of attempts to recreate the subjectivity of the psychotic;
13. - constellation as an aggregate of invested people;
14. - multi-investment;
15. - taking into account the fact that an institution can become a place for recreating the psychotic's subjectivity;
16. - freedom of movement - as the basis of activity and subjective;
17. - heterogeneity of spaces;
18. - creating events;
19. - confidence in the ability of new knowledge and experience to influence the subjectivity and physicality of participants in the process;
20. - Replacing authority with knowledge;

As a result, we can conclude about the priority of space and processes over any technologically formalized method of therapy. This model is effectively implemented in the Atelier model (a transitional space in which “something can happen”), allowing to organize the space so that the psychotherapeutic technique is not so much specific techniques focused on the patient’s fantasy world, but rather an emphasis on the patient’s specific activity.

Keywords: institutional psychotherapy, therapeutic process, transversality, role-based interaction, rehabilitation

Suggested Citation

Lunov, Vitalii, Institutional Psychotherapy in Terms of Maintaining the Subjectivity of an Individual (March 27, 2019). Available at SSRN:

Vitalii Lunov (Contact Author)

Bogomolets National Medical University ( email )

Peremohy Ave
Kyiv, 01601

G.S. Kostyk Institute of Psychology, NAPS of Ukraine ( email )

Pankivska street


Deva Clinique ( email )

4, Pochainynska St

House of Educations & Research Limited ( email )

Shelton Street, Covent Garden
United Kingdom

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