The unit houses up to 10 males at any one time. The first 30 youths treated on this unit had committed murders, rapes, assaults, and other violent crimes; were hospitalized for severe psychiatric disorders; often had learning difficulties; and came from families with little structure or support. The staff initially tried to establish a form of therapeutic community with patient participation in some program components and decisionmaking. However, the sociopathy, distrustfulness, paranoia, and tendencies to become aggressive rapidly prevented this approach. Instead, the staff structured the life of the patients on a 24-hour basis with clear guidelines, constant supervision, intolerance of rule transgression, and clear definitions of the conditions for the attainment or loss of privileges. Group therapeutic approaches trying to develop interactions to decide rules failed because of sociopathic behavior. In addition, even educational and therapeutic group approaches were often sociopathically undermined. Efforts focused on maintaining a safe, secure, well-structured setting to permit programming appropriate to the youths' psychiatric and developmental needs as well as special characteristics. Individual psychotherapy with psychotropic medication was attempted as needed, although many youths were unwilling to take medication. Staff have found that reducing the more acute psychiatric symptoms must accompany with efforts to address the antisocial and characterologically disturbed aspects of the youths themselves. 20 references.