To The Editor: In contemporary psychiatric practice, psychodynamic theory is seldom thought of as being directly applicable in the psychiatric emergency room. Since the 1990s, neurobiological approaches have prevailed, with medications that lead to nearly immediate symptom improvement. One role of psychodynamic understanding in the psychiatric emergency room is to facilitate the development of empathy which can contribute to improved therapeutic alliance and outcomes. Moreover, a psychodynamic understanding complements the neurobiological one in providing a richer and more dynamic view of mental disorders and the human condition. Every encounter between a patient and clinician takes place in a bi-personal field and entails a two-way psychodynamic interaction (1). Gabbard suggests that the goal of the psychodynamically oriented interview is to engage the patient actively as a collaborator in an exploratory process (2). While there is a need in the psychiatric emergency room to make a quick and firm assessment of safety and reach a diagnosis and plan, there is also a corresponding need to empathically connect. Sulkowicz advocates dynamic interviewing, not as a means to obtain detailed past history, but for facilitating the therapeutic alliance and dealing with resistances to speaking freely (3). This makes the emergency evaluation more
Psychodynamic Understanding and the Therapeutic Alliance in the Psychiatric Emergency Room
Abstract
To The Editor: In contemporary psychiatric practice, psychodynamic theory is seldom thought of as being directly applicable in the psychiatric emergency room. Since the 1990s, neurobiological approaches have prevailed, with medications that lead to nearly immediate symptom improvement. One role of psychodynamic understanding in the psychiatric emergency room is to facilitate the development of empathy which can contribute to improved therapeutic alliance and outcomes. Moreover, a psychodynamic understanding complements the neurobiological one in providing a richer and more dynamic view of mental disorders and the human condition. Every encounter between a patient and clinician takes place in a bi-personal field and entails a two-way psychodynamic interaction (1). Gabbard suggests that the goal of the psychodynamically oriented interview is to engage the patient actively as a collaborator in an exploratory process (2). While there is a need in the psychiatric emergency room to make a quick and firm assessment of safety and reach a diagnosis and plan, there is also a corresponding need to empathically connect. Sulkowicz advocates dynamic interviewing, not as a means to obtain detailed past history, but for facilitating the therapeutic alliance and dealing with resistances to speaking freely (3). This makes the emergency evaluation morePreview Only. This article cannot be rented because we do not currently have permission from the publisher.
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Psychodynamic Understanding and the Therapeutic Alliance in the Psychiatric Emergency Room
Warren Lee, Tih-Shih; Hills, Oscar F.
Follow Academic Psychiatry
, Volume 29 (1): 105
American Psychiatric Publishing, Inc (Journal) – Mar 1, 2005
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