The 'coordinative practitioner': Evolving a treatment space

This article presents an account of conjoint treatment of a severely depressed patient and her family by a family physician, a community psychiatrist, and a nursing team. We describe and analyze parallel efforts by a health care team and community resources in creating a treatment space that is integrated with a family system perspective. After persistent deterioration, despite 5 months in a psychiatric hospital, the patient was returned to her kibbutz infirmary. A new therapeutic team assumed responsibility for the patient, with emphasis on considering the family as a system, and with guidance for the nursing team. One year after her return, the patient continues to live in the infirmary without needing any medication. The patient's rehabilitative process transformed the kibbutz infirmary into her substitute home. As described in this approach, the role of the 'coordinative practitioner,' and the sequence of activities taken by the family physician in the rehabilitative process, can be seen as a guide in the treatment of such severe cases.