Korenis Panagiota, Billick Stephen Bates
Bronx Lebanon Hospital Center, Affiliated with Albert Einstein College of Medicine, Bronx, NY, USA,
Psychiatr Q. 2014 Sep;85(3):377-82. doi: 10.1007/s11126-014-9298-2.
In psychiatry, pregnancy introduces an element into the treatment setting that is complex and may require exploration. Often, in the psychotherapeutic relationship, the psychiatrist may use therapeutic techniques and provide no self disclosure to the patient by Tinsley (Am J Psychiatry 160(1): 27-31, 2003). The patient reveals all of their innermost thoughts. This can bring about curiosity for the patient about the clinician's life and result in asking personal questions which can at times be uncomfortable for the therapist, particularly for those still in training. This may feel like a boundary crossing which can pose a therapeutic challenge. The clinician is challenged to further enhance the therapeutic relationship and further help the patient on their journey to self exploration. While it is inevitable that patients will have reactions to their therapists, this can be played out in a number of ways, both at the conscious and unconscious level. While numerous studies have looked at the impact of the therapist's pregnancy on the patient and their treatment, there is no information about the effect of a therapist having a negative pregnancy outcome. Negative outcomes include the therapist having a miscarriage, delivering a still-born or both the therapist and baby dying. This case report describes a clinical scenario in which a psychiatry resident in training delivered a stillborn baby at 37 weeks and the impact of that on a long term psychotherapy patient.
在精神病学领域，怀孕给治疗环境引入了一个复杂且可能需要探究的因素。通常，在心理治疗关系中，精神科医生可能会运用治疗技巧，且如廷斯利所述（《美国精神病学杂志》，2003年，第160卷第1期，第27 - 31页），不会向患者透露自身情况。患者会倾诉他们所有内心深处的想法。这可能引发患者对临床医生生活的好奇，进而导致他们提出一些私人问题，这有时会让治疗师感到不适，尤其是对那些仍在接受培训的治疗师来说。这可能会让人感觉像是跨越了界限，构成一种治疗挑战。临床医生面临的挑战是进一步加强治疗关系，并在患者自我探索的旅程中给予更多帮助。虽然患者对治疗师产生反应是不可避免的，但这种反应可以通过多种方式在意识和无意识层面表现出来。尽管有许多研究探讨了治疗师怀孕对患者及其治疗的影响，但关于治疗师出现不良妊娠结局的影响却没有相关信息。不良结局包括治疗师流产、分娩死胎或治疗师与婴儿均死亡。本病例报告描述了这样一个临床场景：一名正在接受培训的精神科住院医生在37周时分娩出一名死胎，以及这对一名长期接受心理治疗的患者所产生的影响。
