The Functions of a Psychotherapy unit in a Psychiatric Hospital — Refracted Through the Lenses of Trainee Psychiatrists

Only a small proportion of patients seen at a psychiatric hospital such as the Maudsley Hospital are referred for an assessment for psychoanalytic psychotherapy. In this study, junior doctors were interviewed regarding forty-two consecutive referrals to the Maudsley Psychotherapy Unit. In many cases there was a strong sense of identification between referring doctor and referred patient, and in almost all cases the patients referred evoked a strong countertransference reaction in the referring psychiatrists. A disproportionate number of referrals were made as psychiatrists were about to rotate from one ward to another. Referrals to the Psychotherapy Unit seem to represent a complex mix of strong countertransference feelings evoked in the referrer, institutional factors including interpersonal rivalries, and patient characteristics. The majority of patients referred to the Psychotherapy Unit were thought to have both a mental illness and a personality disorder by their referring psychiatrists; and, in the majority of cases, the referring doctors believed that no treatment other than psychodynamic psychotherapy would help the patient.