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Viederman, M. (2018). The Anatomy of the Therapeutic Consultation: Islands of Resilience. Psychodyn. Psych., 46(4):585-600.

(2018). Psychodynamic Psychiatry, 46(4):585-600

The Anatomy of the Therapeutic Consultation: Islands of Resilience

Milton Viederman, M.D.

The objective of this article is to describe how one may change the emotional state and experience of a patient in a brief consultation, a 45-minute clinical case conference.

This approach can be used in other teaching and therapeutic situations as well. Case illustrations will be presented. The therapeutic benefit can be understood conceptually in the context of the psychoanalytic theory of behavior. It rests on a very specific and defined method of engaging the patient and further by rediscovering islands of resilience, situations during which the patient has been able to value himself or herself in the past, now re-evoked to effect a change in the patient's current experience. By therapeutic effect I mean: (1) the relief of symptoms with the restoration of equilibrium in the context of crisis; (2) the engagement of the patient emotionally and the establishment of an emotional bond with him or her; (3) the creation of a motivation for therapy if indicated. This is a useful teaching method and one that will encourage trainees to develop skills in actively imagining and understanding the patient's experience and learning how to use this to relieve distress in patients confronted by crisis.

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