Wednesday, November 30, 2005

Underground DSM-IV -- Oppositional Treatment Design

Oppositional treatment design is remarkably accurate in an acute psychiatric setting. If you want to sleep, we want you to get up. If you want to be up, we want you to sleep. If you want meds, you probably shouldn’t have them, but if you don’t want them they are likely to be exactly what you need. If you want to leave, we make you stay. If you want to stay, we make you leave. If you’re blaming yourself, you should stop that. If you’re blaming others, you should start blaming yourself. It’s not as stupid or mean as it sounds. People usually come to the hospital because of a particular point of contention with the usual flow of life. That inability or refusal to change is usually the central difficulty getting along in the world.


SC&A said...

So, how do you get the patients to walk in a clockwise circle?

OK, I'll stop now.

Retriever said...

AVI, spot on! As the depressed kid's MD has been known to exclaim in a fit of countertransferential pique: "If you don't start following my advice and doing more and getting out of the house, I shall just have to hospitalize you!" The kid was down, but not so down as not to chortle with glee as she recounted laterhow she was dying to retort "Yes, Mom, I'll go pick up my room now!" to her.