The case conference is a staple of academic life in psychiatry. Ostensibly, it provides the teaching hospital with a forum for considering issues of diagnosis, treatment, and interview technique. On an inpatient service, the case conference also holds the potential for uncovering the covert dynamics at work in the treatment setting; it is the task of the consultant who leads the conference to see that this potential is met.

A major part of the consultant’s work is bringing to life the hidden agendas of the conference. These hidden agendas are usually unconscious needs or wishes of the staff which are played out in relation to the consultant. Staff members attempt to influence the consultant to fulfill one of three basic wishes: the wish that the consultant ally himself with a certain faction; the wish that he sanction a position that has already been adopted; the wish that he expose or punish those whom the staff members are afraid to confront directly. These agendas provide the key to identifying central conflicts which obstruct therapeutic work. Although most often these conflicts appear between staff and patient, they also arise among staff members as well as between the unit staff and the hospital administration. This paper will examine examples of the dynamics of these hidden agendas and show how they reflect the influence which the patient has on the staff.

案例会议是精神病学学术生活的主要内容。从表面上看，它为教学医院提供了一个讨论诊断、治疗和访谈技术问题的论坛。在住院服务中，病例会议也有可能揭示治疗环境中工作中的隐蔽动态；领导会议的顾问的任务是确保这种潜力得到满足。

顾问工作的主要部分是使会议的隐藏议程栩栩如生。这些隐藏的议程通常是与顾问有关的员工无意识的需求或愿望。工作人员试图影响顾问以实​​现三个基本愿望之一：希望顾问与某个派系结盟；希望他批准一个已经被采纳的立场；他希望揭露或惩罚那些工作人员不敢直接面对的人。这些议程提供了识别阻碍治疗工作的核心冲突的关键。虽然这些冲突最常出现在员工和患者之间，但它们也出现在员工之间以及单位员工和医院管理部门之间。