The general hospital psychiatrist as "compleat" therapist

Four case histories have been presented to illustrate the range of therapeutic modalities which the liaison and consultation psychiatrist may be called upon to employ in the routine treatment of patients in the general hospital. These include analytically oriented insight and supportive psychotherapy, intervention with the family, collaboration with the medical and nursing staff, resolution of staff countertransference difficulties, pharmacotherapy, the turning of hospital and community resources to therapeutic account, and follow-up treatment and referral. Other more specialized modalities such as hypnosis (Frankel, 1978), amytal interview (Naples and Hackett, 1978) electroconvulsive therapy (Glaser, 1953), biofeedback and behavior therapy (Fordyce, 1978), and group therapy (Rahe, O'Neil, Hagan, and Ransom, 1975) have also proven useful. The synthesis of these skills into an individualized, coherent treatment approach is the challenge posed to the consultant by the 20 to 60 percent (Lipowski, 1967) of patients admitted to the general hospital with treatable emotional disorders. Because the vast majority of these disorders relate directly to the illness for which the patient was admitted and to the treatment rendered (Torem, Saravay, and Steinberg, 1979) they comprise a unique spectrum of psychiatric illnesses which often demand timely intervention (Solomon, Saravay, and Steinberg, 1980) before complete information is available. To effectively meet these challenges, the general hospital psychiatrist strives toward the ideal of the "compleat" therapist--creatively synthesizing an individualized approach from a varied therapeutic repertoire for each of the patients he is called upon to treat.