Hizen Psychiatric Center has the first ward for Severe Behavior Disorder in Japan which has the highest number of severe cases. We have many specialized ways to intervene over the years, Habilitation, TEACCH Pharmacotherapy and Behavior therapy. On the otherhand, most of patients have traits (such as difficulty in communicating, severe self and other harming, pica) are easy to make their carer feel rewardless, conflict.

To have adequate understanding and give specialized supports for carer, we focus on experiences of care-giving, and analyze the process about formation of care-giving, what kind of rewards they acquire.

Half-constructed Interview with 10 Nurses at the ward and Qualitative Analysis based on Grounded Theory Approach.

5 Upper Categories are produced

(Shock) (Disgust) (Conflict) (Change) (Acceptance)

and those can be the steps. This process is not linear and each nurse has each pattern of achievement and time.

We found the steps of care-giving formation even there are difficulty of interaction. To achieve (Change) (Acceptance)

individually, we can suggest the way to make them feel rewarding. Carer (including Staff and Parent) are important environments for patients. It needs to empower them not to be anti-factor of care-giving.