Stability

Stability

Configuring a stable and consistent treatment setting is analo-gous to the “holding environment” provided by parents in early childhood (Winnicott, 1960). Patients with psychiatric illnesses will find it very difficult to entrust their lives to a psychiatrist whom they perceive to be unreliable. Indicated measures regard-ing stability include formulating an agreement with the patient for a treatment regimen that will take place according to a spe-cific method and schedule, encouraging truthful disclosure and cooperation; establishing a commitment to beginning and ending sessions on time, discouraging interruptions during treatment sessions; offering advance notice as to when the psychiatrist will be absent, providing for coverage by another practitioner when the psychiatrist is off duty, maintaining coherent therapeutic demeanor; and maintaining relative consistency as to who par-ticipates in the treatment situation.

It is generally unwise for a psychiatrist to disparage a patient’s complaints about issues like the doctor’s tardiness in starting sessions or to become defensive when explaining the meaning of the patient’s distress about such complaints. Many psychiatrists experience patients’ demands for consistency as a form of control and imprisonment. Out of anger, they may react to these patients as if their wishes for reliability and concern were infantile and irrational:

Your complaints about my lateness are a reflection of your need to control me.

The psychiatrist’s tardiness might in fact be creating tre-mendous anxiety because it reminds the patients of parents who never took their feelings into account.