The neglected alliance: the inpatient unit as a consultant to referring therapists.

During two years of work on an inpatient psychiatry unit in a general hospital, the authors became impressed with how often patient-therapist difficulties preceded the need to hospitalize a patient. Difficulties in the therapeutic relationship sometimes precipitated the hospitalization; other times they were complicating factors. Unresolved difficulties in this relationship had to be addressed during hospitalization if inpatient treatment was to be successful. The authors present several typical cases that demonstrate different kinds of difficulties in the patient-therapist relationship and the use of consultation by an inpatient staff in resolving them. They conclude that an inpatient unit with sufficient staff should serve as a consultant to the referring therapist in almost every case.