Adaptation of residents to consultation-liaison psychiatry. I. Working with the physically ill.

When working with hospitalized physically ill patients, psychiatry residents may impose a pseudoanalytic, rigidly biological, or overly sympathetic approach. These approaches often fail to address the special requirements and altered psychological state of the physically ill. To have a therapeutic impact on such patients, the psychiatrist needs to assume an engaging, more spontaneous "therapeutic stance" and deviate from anonymity, abstinence, and neutrality. In learning how these deviations are dictated by the therapeutic intent by the patient's character style and psychodynamics, the resident acquires a model of influence useful in other areas of psychiatry.