title: [Determine the patient's position towards psychiatric care: a simple tool to estimate the alliance and the motivation].
abstract: OBJECTIVE
  For the brief systemic therapy (BST), the evaluation of the patient's position towards the care is a prerequisite to psychotherapy. Three positions of the patient are described. The "tourist's" position: the patient claims to have no problem and doesn't suffer. Someone asks him to make an appointment, sometimes with threats. The "complaint's" position: the patient claims to suffer, but attributes the responsibility of this suffering to others. These two positions are not good for beginning a therapy. The "customer's" position differs from both previous positions. The "customer" considers that he has a psychological problem which depends on him and he is motivated in the resolution of it. In theory, the "customer" is more motivated and the therapeutic alliance is better. It is for this reason that the BST estimates the position of the patient at first, to bring the patient to the "customer's" position. The objective of this study is to assess an interview which identifies the patient's position towards the care, and to validate the theoretical elaborations of the brief systemic therapy.
  
  
  METHODS
  The study concerns the follow-up of outpatients who consult a psychiatrist for the first time. The evaluation of the patients checks their position towards care using the Tourist-Complaint-Customer (TCC) inventory, how they suffer, the therapeutic alliance (scale Haq-2) and the compliance during care. The evaluation by the psychiatrists checks the suffering perceived, the motivation perceived and the diagnoses according to the DSM.
  
  
  RESULTS
  The typology of these patients is made up of one half "complaint", a quarter of "tourist" and a quarter of "customer". The "customer's" position is correlated with the therapeutic alliance and the motivation perceived by the psychiatrist. The motivation perceived by the psychiatrist is correlated with the therapeutic alliance. These results correspond to the theoretical elaborations of the BST.
  
  
  CONCLUSIONS
  the TCC inventory provides information on the motivation and the therapeutic alliance. If the patient is in "tourist" or "complaint" position, we recommend that the psychiatrist "work" to bring the patient to "customer" position. The evaluation of the position of the patient is simple and rich in information. We recommend that it be given a place in the daily practice of psychiatry.
authors.affiliation: Secteur 59G07, établissement public de santé mentale Lille-Métropole, rue du Général-Leclerc, BP 10, 59487 Armentières cedex, France. Electronic address: cversaevel@epsm-lille-metropole.fr.
authors.forename: C
authors.initials: C
authors.lastname: Versaevel
authors.forename: D
authors.initials: D
authors.lastname: Samama
authors.forename: R
authors.initials: R
authors.lastname: Jeanson
authors.forename: C
authors.initials: C
authors.lastname: Lajugie
authors.forename: L
authors.initials: L
authors.lastname: Dufeutrel
authors.forename: L
authors.initials: L
authors.lastname: Defromont
authors.forename: V
authors.initials: V
authors.lastname: Lebouteiller
authors.forename: T
authors.initials: T
authors.lastname: Danel
authors.forename: A
authors.initials: A
authors.lastname: Duhamel
authors.forename: M
authors.initials: M
authors.lastname: Genin
authors.forename: J
authors.initials: J
authors.lastname: Salleron
authors.forename: O
authors.initials: O
authors.lastname: Cottencin
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003674:Defense Mechanisms; D003717:Denial, Psychological; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D009042:Motivation; D010817:Physician-Patient Relations; D011446:Prospective Studies; D011570:Psychiatry; D011575:Psychoanalytic Therapy; D011614:Psychotherapy, Brief; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Alliance thérapeutique; Motivation; Psychotherapy; Psychothérapie; Therapeutic alliance