The Role of the Consultant in the Case Conference: Some Neglected Aspects

The case conference is a staple of academic life in psychiatry. Ostensibly, it provides the teaching hospital with a forum for considering issues of diagnosis, treatment, and interview technique. On an inpatient service, the case conference also holds the potential for uncovering the covert dynamics at work in the treatment setting; it is the task of the consultant who leads the conference to see that this potential is met. A major part of the consultant's work is bringing to life the hidden agendas of the conference. These hidden agendas are usually unconscious needs or wishes of the staff which are played out in relation to the consultant. Staff members attempt to influence the consultant to fulfill one of three basic wishes: the wish that the consultant ally himself with a certain faction; the wish that he sanction a position that has already been adopted; the wish that he expose or punish those whom the staff members are afraid to confront directly. These agendas provide the key to identifying central conflicts which obstruct therapeutic work. Although most often these conflicts appear between staff and patient, they also arise among staff members as well as between the unit staff and the hospital administration. This paper will examine examples of the dynamics of these hidden agendas and show how they reflect the influence which the patient has on the staff.