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Citation |
Dawson D. Psychiatr. Ann. 2004; 34(6): 482-490. |
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Copyright |
(Copyright © 2004, Healio) |
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DOI |
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PMID |
unavailable |
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Abstract |
Relationship management was conceived as a strategy that could be used by clinicians in all settings, to first reduce iatrogenic harm, then to reduce chaos, and finally to provide a context in which borderline clients may give up harmful ways of negotiating control and learn productive ways. It works moment-to-moment, as attested to by many clinicians who have witnessed the switch in behavior. No long-term studies exist, although I have had the experience of watching many patients with BPD give up their self-harmful behavior and never look back. A few others, with lengthy histories, give up their factitious psychiatric symptoms only to turn to surgeons, family physicians, and internists with multiple suspect physical illnesses. One program was developed to apply relationship management in totality to a specific population of referred patients with BPD from within a psychiatric hospital. A yearlong study of this program found greatly reduced bed use, reduced use of seclusion and restraints, and no incidents of self-harm during the period of study. 3 To return to our initial case examples, Mr. W was discharged the Monday following his elopment from and return to the hospital and was seen as an outpatient for a year. My approach to the woman in the ICU was to joke about her lack of success with suicide. She looked puzzled at first and then smiled at the way I had disqualified her opening gambit. Following that, we had a lively and productive discussion about what she might do to change her untenable situation, which she proceeded to enact over the next few months. She made no further mention of suicide. Language: en |
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Keywords |
human; social interaction; psychotherapy; suicide attempt; hospitalization; comorbidity; review; treatment planning; interpersonal communication; automutilation; human relation; child parent relation; doctor patient relation; social behavior; borderline state |