Abstract
BackgroundThe biopsychosocial model emphasises the role of human relationships in psychiatric care. Therapeutic relationships that improve treatment outcome and provide containment are desperately needed by patients in distress. Despite the importance of human relationships, they are neglected in an era dominated by biological psychiatry.AimThis qualitative research project explores the experiences, perceptions and subsequent needs of patients. The role of therapeutic relationships, and the factors that patients felt influenced their relationship with their therapists, were examined.SettingA psychiatric training hospital in South Africa.MethodThirty in-depth semi-structured interviews were conducted with 15 inpatients. A qualitative, explorative-descriptive, collective case study design was used. Purposive sampling ensured maximum variation and richness of information. Grounded theory methods were used to analyse transcribed recordings.ResultsPatients valued therapeutic relationships that provide containment and potentially obviate the need for ‘measures of control’. A model of containment was developed to demonstrate the various factors that interact in the attempt to provide containment to patients in a psychiatric training hospital system.ConclusionTraining hospitals should emphasise the role of therapeutic relationships in achieving containment and positive treatment outcomes. In developing countries, severe shortcomings in mental healthcare resources hinder the building of personal therapeutic relationships.
Highlights
In his 1986 lecture to the American Psychiatric Association (APA), Reiser lamented registrars’ lack of curiosity about the patient as a person
In 2012, Shapiro wrote that registrars have learnt to manage their patients instead of listening to them, and that the focus of modern psychiatry is not on relationships but on making a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and prescribing medication.[3]
Engel introduced the biopsychosocial model four decades ago to overcome a narrow biomedical approach and to put the focus on the patient as a person.[4]. He emphasised that the work of the physician is done within an ongoing human relationship
Summary
In his 1986 lecture to the American Psychiatric Association (APA), Reiser lamented registrars’ lack of curiosity about the patient as a person He stated that most of the registrars would learn more about the stranger next to them on a short airplane trip than in formal psychiatric interviews.[1] In 2001, Gabbard, another winner of the Educator Award of the APA, warned that reducing the provision of psychotherapy could reshape psychiatry in a biologically reductionistic direction.[2] In addition, in 2012, Shapiro wrote that registrars have learnt to manage their patients instead of listening to them, and that the focus of modern psychiatry is not on relationships but on making a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and prescribing medication.[3]. Despite the importance of human relationships, they are neglected in an era dominated by biological psychiatry
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