The rules of therapeutic dialogue
2 points to remember
- Neurosis is not an illness.
- Psychotherapy is not a treatment.
7 rules of how to tackle the situation
- Situations, not symptoms: neurotic symptoms appearing in the situation.
- Key words: repeat the patients last words, or other words in the sentence.
- If you don't know what to say, keep quiet.
- There is only one way of interrupting a pause: "what are you thinking?"
- Never answer questions.
- Never give advice.
- Get the patient to repeat and summarise.
7 wrong thoughts
- What is the diagnosis?
- What shall I say the next time the patient inhales?
- Is my rapport with the patient good enough?
- Am I clever enough for all this?
- Could it be dangerous for the patient?
- Could it be dangerous for the doctor?
- Spending time trying to avoid the other six.
7 examples of secondary gain
- The reassurance: however, it is permissable to say s/he will not die of symptoms or go insane.
- Nerve pills.
- Somatic over-investigation.
- Patient insists on being accompanied.
- Discussion with others: must not.
- Time: keep limits strict and defined.
- Patient manipulates doctor eg: not obeying the rules.
7 practical tips
- Time and duration: weekly, strictly defined.
- Choose the right patient.
- Let the patient write a letter to you about everyday life and problems.
- Starting dialogue: silence or professional noise.
Ending dialogue: "time up"
- Rituals: sit in different seats etc.
- ?Don't talk to the relatives.
- ?Use a tape recorder.
7 couple rules
- Last should be first: concentrate primarily on the one who came last - address the "start" to him.
- Nobody is the patient.
- "Tell it to our spouse"
- TV and kitchen, not sex.
- "But you were happy..."
- Don't join in their game, you are an amateur.
- What are you going to change?
Source: Torben Bendix - the Anxious Patient