Care and motivation for treatment in the Dutch TBR-system
In the Dutch TBR-system (TBR means: detained by the Government's pleasure) a Commission on behalf of the Minister of Justice has published an interim report about the legal position of the detainees. The author of this article has the opinion that in the report a clear frontier between care and treatment has not been mentioned while a distinction is necessary in case of complaint.
From the penal law in which only care is prescribed, and the constitutional prohibition of forced treatment, care and treatment are defined descriptively as they present themselves in clinical practice.
Care has as criteria: 1. primary prevention; 2. tertiary prevention; 3. aims on actual functioning in the clinical environment; 4. the personnal is fully responsible; 5. no purpose for a permanent change of personality; 6. supporting interactions; 7. ultimate aim: security in the here- and now-situation.
Treatment has as criteria: a. secundary prevention; b. influencing the intrapsychic dynamics; c. the patient has also responsibility for the process; d. aims on personality change; e. anxiety provoking interactions; f. definite aim: security by disappeared delinquency.
This dichotomy is not sufficient to explain all that happens in the social climate of the clinic. Furthermore there are implicit motivating factors inherent to the micro-society of a closed ward in which staff and patients go together along psychotherapeutic basic principles.