Creating a Company of Unequals

This study of a hospital-based community mental health center in an urban ghetto found that the dominance of the psychoanalytically oriented psychiatrists and residents over the social workers and paraprofessionals was the result of and was maintained by both negotiative processes and traditional role structures, backed up by bureaucratic rules. The psychiatrists and residents got the best cases, the social workers the average cases, and the minimally trained paraprofessionals the problem cases. The results of this stratification system on therapists and patients are described, and the authors conclude that autonomous clinics are necessary if professionals are to be rewarded for developing modes of treatment appropriate to ghetto patients. However, it is predicted that after the role negotiation process settles down, new stratification systems will emerge.