Integrated medical-psychiatric care of a dying borderline patient: a case of dynamically informed "practical psychotherapy".
Combined training in family practice and psychiatry is relatively new and consists of equal proportions of each specialty intermixed throughout a 5-year period. This blending of two distinct skill sets and patient populations creates opportunities to provide unique patient care. An understanding of psychodynamic principles is vital to treating patients with comorbid medical and psychiatric illnesses in a primary care setting. The patient presented in this article had several medical and psychiatric problems and was treated by a combined family practice-psychiatry resident who cared for her medically and psychiatrically until the time of her death from cancer. Complex patients such as this defy the use of purely applied school-specific psychotherapies. Rather, they require the creative application of integrated psychotherapeutic strategies. Integrated approaches to psychotherapy have been increasingly advocated in recent years. In keeping with terminology used by Carl Jung, this approach may be thought of simply as practical psychotherapy.
Lacy
Timothy J
TJ
Mental Health Flight, Andrews AFB, MD 20762, USA. timothy.lacy@andrews.af.mil
Higgins
Michael J
MJ
D001293:Attitude to Death; D001883:Borderline Personality Disorder / Q000523:psychology* / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007373:Interinstitutional Relations; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010348:Patient Care Team; D011320:Primary Health Care; D011575:Psychoanalytic Therapy / Q000379:methods*