OFF THE TRACKS IBD

Sinopse

Psychiatry has much in common with the irresistible little girl HenryáWadsworth Longfellow immortalized in a poem that became aáhousehold nursery rhyme: &ldquo,When she was good, she was very goodáindeed, / But when she was bad she was horrid.&rdquo, The same can be saidáfor the mental health profession.Despite numerous advances in the past century, the treatment ofámental disorders is still in a rudimentary state due to our fundamentalálack of understanding of the complex causes of some of its dauntingáproblems. Most mental health professionals now believe that bothápsychological (psychodynamic) and physical (inherited or biomedical)factors combine in varying proportions to undermine a person&rsquo,s stateáof emotional well-being. Most experts also believe that an optimalácombination of psychological and physical treatments will provide forámany patients the best chance of recovery. Across this wide spectrumáof possible combinations, the one factor that appears to be most crucialáto recovery is the treatment relationship.Many studies of purely psychological treatments have shown thatáthe treatment relationship is the single mostá important variable ináádetermining therapy outcome. &ldquo,The therapy relationship accounts foráwhy clients improve&mdash,or fail to improve&mdash,as much as the particularátreatment method,&rdquo, a major review of &ldquo,Evidence-Based TherapyRelationships&rdquo, concludes. Thousands of qualitative and quantitativeástudies have demonstrated that about 75&ndash,80% of patients who enterápsychotherapy show improvement, a treatment outcome well above thatáof many medical procedures. It is self-evident, then, that the treatmentárelationship must be a powerful force in and of itself. Like anyápowerfuláforce, the management or mismanagement of the treatment relationshipácan bring great benefit or harm to the patient.áOff the Tracks: Cautionary Tales About the Derailing of Mental HealtháCare presents dramatic examples, across a broad range of theoreticaláapproaches to mental health care, where the treatment relationship wasámismanaged in such a way as to harm mentally ill patients. We are notápresenting these examples to condemn psychoanalytic, psychiatric orápsychological treatments, but rather to show how these cautionary talesindicate the necessity of self-monitoring and self-regulation by membersáof the mental health profession. Because we speak here of a relationship,áthe extent to which the personality of the therapist is implicated makesthe requirements of the therapist unique in the world of health care.áWe are not limiting ourselves only to the role of the therapist in purelyápsychological treatments. In the realm of predominantly physicalátreatments of mental disorders, clinicians delivering the treatment areápsychotherapists as well. Clinicians&rsquo, judgments in choosing a physicaláapproach or a pharmacological agent, determining its frequency orádose, or even deciding how often they see their patients, are cl