The author describes the therapeutic problems that can arise on a
family-oriented psychiatric inpatient service. The stress emerging from the
therapeutic demands on and changes in the internal structure of the family
may cause the family to seek to reestablish its internal equilibrium by
changing the hospital staff and structure at the ward level, department
level, and the hospital administration level. These transactions between
the hospital and families, which are complex, are extremely important to
recognize because they can undermine the therapeutic process.