ABSTRACT
The authors identify six ways in which the borderline diagnosis is commonly abused to express countertransference hate, mask imprecise thinking, excuse treatment failures, justify the therapist's acting out, defend against sexual clinical material, and avoid pharmacologic and medical treatment interventions. The paper focuses on diagnostic abuses that trainees present to clinical supervisors and educators. It attempts to show educators how to discern these abuses and turn them into teaching opportunities. These abuses are seen not only in trainees; they also occur in the professional community as a whole. Clinicians should expect the same diagnostic rigor of themselves that they expect of their students.
Subject(s)
Attitude of Health Personnel , Borderline Personality Disorder/diagnosis , Personality Disorders/diagnosis , Psychiatry/education , Teaching , Acting Out , Adult , Countertransference , Defense Mechanisms , Diagnosis, Differential , Female , Hate , Humans , Internship and Residency , Male , Mental Disorders/diagnosis , Mental Disorders/therapy , Physician-Patient Relations , Psychology, Clinical/education , Teaching/standards , Terminology as TopicABSTRACT
The authors present the case of a patient with an institutional transference and point out the existence of institutional countertransference, which confounded his therapy and obscured his potential for change. Confronted with the patient's tradition in the institution, the new therapist had to overcome feelings of unimportance and therapeutic impotence to focus on the patient as a person in his own right. The authors discuss the signs of institutional countertransference and describe how it can seriously hinder clinical assessment of patients with institutional transferences.
Subject(s)
Countertransference , Health Facilities , Mental Disorders/therapy , Humans , Male , Mental Disorders/psychology , Middle Aged , PsychotherapyABSTRACT
It has recently been suggested that patients with mania are often misdiagnosed as having schizophrenia. The authors report a favorable clinical response to lithium carbonate in a father and son with an apparent schizo-affective syndromes may respond favorably to lithium but caution that a favorable response in such cases does not absolutely confirm a diagnosis of mania.