Adaptation of residents to consultation-liaison psychiatry. II. Working with the nonpsychiatric staff.

When working with the staff in a general hospital, psychiatry residents may be overly competitive, solicitous, or detached. These defensive reactions often arise because of the special challenges of performing a consultation, including the skepticism about the value of psychiatry and the demeaning or unrealistic expectations about what the psychiatrist can do. Furthermore, the psychiatry resident feels even more challenged if the attitudes and behavior of the staff must be changed for the patient's benefit. To affect this influence on the staff the psychiatry resident may need to assume a "liaison stance." This stance involves not only establishing a collegial alliance but also using modified therapeutic maneuvers to alter staff behavior. By applying psychodynamic knowledge to understand and potentially to influence the staff, psychiatry residents, as participant observers, can feel less helpless and frustrated by difficult liaison situations.