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In an intensive study of sixty requests for psychiatric consultation on a medical service, it was found that countertransference played a significant role. In one case the countertransference phenomena seemed to result from the psychiatrist's
anxiety and in several others from his overdetermined affective responses, both contributed to by certain aspects of the consultation situation, particularly a distortion of the consultant's perception of the situation.
The consultant psychiatrist in a hospital practices under a difficult physical environment and a disturbed psychological setting. Lacking the technical and manipulative aspects of the nonpsychiatric clinician's function, which frequently shield the consultant from the anxiety-producing aspects of chronic or terminal illness, he is forced to react to and evaluate a situation that may cause him personal anguish and distress. Patients may be referred who have not sought psychiatric treatment, frequently after having been subjected to frustrating experiences. It is understandable that the psychiatrist might be influenced by their feelings of hopelessness and pessimism. However, a persistent effort to explore the patient's difficulties may lead to a more optimistic outcome when the consultant's own attitudes change. In some cases the psychiatrist's own frustrations and guilt over his inability to help the patient will result in a delay of referral to a social worker, or some agency that might better assist the patient.