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6 - Understanding and managing relationships with patients

from Part II - The main principles of one-to-one interviewing

Published online by Cambridge University Press:  06 September 2009

Robert Poole
Affiliation:
University of Liverpool
Robert Higgo
Affiliation:
University of Liverpool
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Summary

Interactions between psychiatrists and their patients occur in the context of a therapeutic relationship. Sometimes the relationship is very brief. Sometimes the relationship lasts for many years. These relationships can go wrong. When they do, the problems usually have their origins in the beginning of the relationship, but only become evident far later.

All doctors have a responsibility to contain their relationship with their patient within distinct boundaries. This is a legal and ethical obligation. It is also crucial to the therapeutic effectiveness of the relationship. There are dilemmas in maintaining boundaries that cannot be resolved, but must be actively managed. On the one hand, the doctor must be concerned for, and interested in, the patient. He must be sufficiently giving of himself so that the patient feels able to trust him. On the other hand, the doctor must maintain a professional distance and bring a dispassionate objectivity to the relationship. He cannot let the patient enter his personal life. He must refrain from giving advice outside of his expertise. He must not let the patient's dependency grow to unmanageable proportions. Above all, he must not allow the therapeutic relationship to develop in such a way that it primarily serves his needs and not the patient's.

There are processes that operate within all therapeutic relationships that generate threats to the maintenance of boundaries. These threats include:

  1. Transference reactions

  2. Dependency

  3. Identification

  4. Breaches of confidentiality

  5. The urge to rescue patients

  6. Compromised truthfulness

  7. Abuses of power

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Publisher: Cambridge University Press
Print publication year: 2006

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