Interpersonal Considerations and Judgements in a Day Hospital

Abstract

There is a body of opinion which regards psychiatrically ill individuals, or at least one great class or subdivision of them, as suffering primarily from disturbances in personal relationships and social interaction processes generally. Sullivan, Horney and Fromm have made the most significant theoretical contributions to this subject, and empirical applications have been reported by Balint (1957), Maxwell Jones (1968), Rapoport (1960) and Laing (1961). These writers have at least this in common, that they take the point of view that since the pathology of the illness lies in social relationships the fundamental treatment process must lie there also—must, in fact, consist of re-experiencing social interaction within a therapeutic re-educative framework. In the past attention has been directed principally to the doctor-patient relationship as a heuristic model of social interaction, but Rapoport has extended the operational range of significant interaction to include all staff-patient, staff-staff and patient-patient encounters. As the recent Subcommittee of the Central Health Services Council has pointed out (1968), little has been written of the nurse as therapist, but a considerable literature has accumulated concerning the role of the social worker or caseworker or counsellor (e.g. Halmos, 1965). Halmos investigates the nature of such relationships, and finds therapeutic utility to be unrelated to intellectual skills. The therapeutic process is adjudged to lie in the relationship, true enough, but the essential qualities have more to do with the interpersonal styles of the therapist, than with his analytical expertise. Such is his conclusion. Apparently social skills are necessary for the professional worker, but intellectual skills for the problems to be unravelled are of little importance, and are largely irrelevant.