Book contents
- Frontmatter
- Contents
- Acknowledgements
- Introduction
- Part I What am I trying to find out here?
- Part II The main principles of one-to-one interviewing
- 5 Office-based psychiatric assessment
- 6 Understanding and managing relationships with patients
- Part III The difficult interview
- Part IV Self-awareness
- Part V Out of the clinic
- Part VI Drawing it all together
- Afterword: getting alongside patients
- References
- Index
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
- Frontmatter
- Contents
- Acknowledgements
- Introduction
- Part I What am I trying to find out here?
- Part II The main principles of one-to-one interviewing
- 5 Office-based psychiatric assessment
- 6 Understanding and managing relationships with patients
- Part III The difficult interview
- Part IV Self-awareness
- Part V Out of the clinic
- Part VI Drawing it all together
- Afterword: getting alongside patients
- References
- Index
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:
Transference reactions
Dependency
Identification
Breaches of confidentiality
The urge to rescue patients
Compromised truthfulness
Abuses of power
- Type
- Chapter
- Information
- Psychiatric Interviewing and Assessment , pp. 80 - 96Publisher: Cambridge University PressPrint publication year: 2006