Various forms of reform in mental hospitals are under way. Despite many sources of resistance there is a growing tendency to embrace a psychotherapeutic ideology. The author focusses on the problems around the organization of individual, group and family-therapy with psychotic patients. The importance of a new type of training, for nursing staff is stressed, particularly the promoting of assistent-therapists. Criticisme on the mental hospital, its structure and procedures has been and will remain with us. Despite this criticisme and formidable problems the mental hospital has to cope with, present-day reform and some aspects of the challenge to meet are positively stressed and elaborated upon.