Allen J G, Colson D B, Coyne L, Dexter N, Jehl N, Mayer C A, Spohn H E
Psychiatry. 1986 Nov;49(4):350-8. doi: 10.1080/00332747.1986.11024334.
In a previous report, the authors identified four dimensions of patient pathology associated with treatment difficulty: withdrawn psychoticism, character pathology, violence-agitation and suicidal-depressed behavior. In a subsequent study, they linked these dimensions to patterns of countertransference. The present research extends the two prior reports by examining the relations of the patient pathology dimensions to staff members' dissatisfaction with four areas of treatment: interpersonal approaches, structure and control, quality of teamwork, and medication. The major findings are: withdrawn psychoticism primarily relates to dissatisfaction with interpersonal treatment approaches; character pathology entails dissatisfaction with the level of structure and control; violence-agitation poses particular problems for teamwork; and suicidal-depressed behavior is unrelated to dissatisfaction with any dimension of treatment. The authors propose that these various problems in treatment are, in part, mediated by patterns of countertransference which they described in the prior paper. These findings should help staff members to focus their attention on areas of treatment in which problems are bound to arise in work with different types of difficult patients.
在之前的一份报告中，作者确定了与治疗难度相关的患者病理的四个维度：退缩性精神病态、性格病理、暴力-激越和自杀-抑郁行为。在随后的一项研究中，他们将这些维度与反移情模式联系起来。本研究通过考察患者病理维度与工作人员对治疗四个方面的不满之间的关系，扩展了之前的两份报告，这四个方面分别是：人际治疗方法、结构与控制、团队合作质量和药物治疗。主要研究结果如下：退缩性精神病态主要与对人际治疗方法的不满有关；性格病理导致对结构和控制水平的不满；暴力-激越给团队合作带来了特别的问题；而自杀-抑郁行为与对治疗的任何维度的不满均无关。作者提出，治疗中的这些各种问题在一定程度上是由他们在前一篇论文中描述的反移情模式介导的。这些发现应有助于工作人员将注意力集中在与不同类型的难治性患者工作时必然会出现问题的治疗领域。
