Blumenfield Michael
Department of Psychiatry, New York Medical College, Valhalla, New York 10595, USA.
J Am Acad Psychoanal Dyn Psychiatry. 2006 Spring;34(1):83-92. doi: 10.1521/jaap.2006.34.1.83.
Psychodynamic theory can be applied to all aspects of consultation-liaison work. There are various psychodynamic treatment approaches that can have a powerful meaning to the patient. This can include understanding the patient's life trajectory through the elicitation of a life narrative, understanding defense mechanisms, and utilizing the patient's fantasies about illness. Patients who are physically ill regress and want to be understood. When this is achieved through a psychodynamic approach, the patient will be more likely to accept a referral for psychiatric follow-up when it is indicated. The consultation-liaison psychiatrist will also encounter transference and countertransference manifestations. Of particular usefulness can be derivatives of classical countertransference, which can be seen as reactions and identifications by the treating psychiatrist or the medical team to the patient that may interfere with effective care. "Countertransference Rounds" is a technique for examining such manifestations during the C-L team's discussion of patients.
精神动力学理论可应用于会诊 - 联络工作的各个方面。有多种精神动力学治疗方法,它们对患者可能具有强大的意义。这包括通过引出生活叙事来理解患者的生活轨迹、理解防御机制以及利用患者对疾病的幻想。身患躯体疾病的患者会出现退行现象,希望被理解。当通过精神动力学方法实现这一点时,患者在有指征时更有可能接受精神科后续转诊。会诊 - 联络精神科医生也会遇到移情和反移情表现。经典反移情的衍生物可能特别有用,它们可被视为治疗精神科医生或医疗团队对患者的反应和认同,这可能会干扰有效的治疗。“反移情轮值”是一种在会诊 - 联络团队讨论患者时检查此类表现的技术。