The Anxious Patient

The rules of therapeutic dialogue

2 points to remember

  1. Neurosis is not an illness.
  2. Psychotherapy is not a treatment.

7 rules of how to tackle the situation

  1. Situations, not symptoms: neurotic symptoms appearing in the situation.
  2. Keywords: repeat the patient’s last words, or other words in the sentence.
  3. If you don’t know what to say, keep quiet.
  4. There is only one way of interrupting a pause: “what are you thinking?”
  5. Never answer questions.
  6. Never give advice.
  7. Get the patient to repeat and summarise.

7 wrong thoughts

  1. What is the diagnosis?
  2. What shall I say the next time the patient inhales?
  3. Is my rapport with the patient good enough?
  4. Am I clever enough for all this?
  5. Could it be dangerous for the patient?
  6. Could it be dangerous for the doctor?
  7. Spending time trying to avoid the other six.

7 examples of secondary gain

  1. The reassurance: however, it is permissible to say s/he will not die of symptoms or go insane.
  2. Nerve pills.
  3. Somatic over-investigation.
  4. The patient insists on being accompanied.
  5. Discussion with others: must not.
  6. Time: keep limits strict and defined.
  7. Patient manipulates doctor eg: not obeying the rules.

7 practical tips

  1. Time and duration: weekly, strictly defined.
  2. Choose the right patient.
  3. Let the patient write a letter to you about everyday life and problems.
  4. Starting dialogue: silence or professional noise.
    Ending dialogue: “time up”
  5. Rituals: sit in different seats etc.
  6. ?Don’t talk to the relatives.
  7. ?Use a tape recorder.

7 couple rules

  1. Last should be first: concentrate primarily on the one who came last – address the “start” to him.
  2. Nobody is the patient.
  3. “Tell it to our spouse”
  4. TV and kitchen, not sex.
  5. “But you were happy…”
  6. Don’t join in their game, you are an amateur.
  7. What are you going to change?


Source: Torben Bendix – the Anxious Patient


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