
- Psychiatric Times Vol 24 No 14
- Volume 24
- Issue 14
More on Violence Against Mental Health Professionals
I was very pleased to read Robert Langs' letter ("Violence Against Mental Health Professionals," Psychiatric Times, July 2007), in the wake of Dr Fenton's death.
I was very pleased to read Robert Langs' letter ("
In his letter, Dr Langs pointed out psychotherapists' strong resistance to recognizing the possible contribution of a therapist to patient violence. In my experience, analyses within our professions of disastrous or even simply unsuccessful therapy outcomes usually reflect "one-sided thinking." Those involved in the discussion of such cases tend either to identify with the therapist and focus only on aspects of the patient's neurochemistry, psyche, and behavior that contributed to the poor outcome or to identify with the patient and focus only on objectionable aspects of the therapist's behavior, such as gross boundary violations.
A particularly narrow viewpoint I have witnessed involves a rigid employment of the medical model. I have seen colleagues who use this approach object to any analysis of the therapeutic relationship at all. For example, I have witnessed colleagues objecting to a discussion of the therapeutic relationship in the case of a patient's suicide. They argued that since a significant percentage of bipolar patients commit suicide, it is an outcome of the disease. They objected to psychiatrists "wringing our hands" over the consequences of illness, when those in other medical specialties would not. Of course, what is missing in such an assessment is an understanding of the nature of psychotherapy as an interactive therapeutic tool. Probably equally lacking is a tolerance for our uncomfortable existential position in being practitioners ofsuch a tool.
As psychotherapists, after a disastrous outcome we can never honestly say that everything possible was done. We may say that the therapist's behavior was reasonable, but we can never say that everything possible was done. On further reflection, with further consultation, and especially in retrospect, we should always be able to see new angles that could have been pursued in psychotherapy and that may have averted disaster or even led to progress. We cannot know for sure, and this lack of certainty can be uncomfortable, but we have a duty to ourselves, our colleagues, and our patients to reflect on and learn from these cases. Such reflection must use multiple perspectives, including an interactional perspective.
References:
References
1.
Langs RJ. Therapeutic misalliances.
Int J Psychoanal Psychother.
1975;4:77-105.
Articles in this issue
almost 18 years ago
Treating Catatonia in Autismalmost 18 years ago
New Drug Evaluation Workshops Focus on Improving Psychiatric Researchalmost 18 years ago
Antidepressants Not Linked to Adult Suicidealmost 18 years ago
Correctional Psychiatry: Room for Improvementalmost 18 years ago
Making Psychotherapy Work: Collaborating Effectively With Your Patientalmost 18 years ago
Ethics in Psychotherapy and Counseling: A Practical Guide, 3rd ed.almost 18 years ago
Confessionalmost 18 years ago
A Reluctant Journey Into Consciousnessalmost 18 years ago
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