THE BALINTIAN APPROACH OF PSYCHOSOMATIC DISORDERS
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THE BALINTIAN APPROACH OF PSYCHOSOMATIC DISORDERS. The medicine called “Doctor”. Csilla Moldovan , Albert Veress , Éva Veress. BALINT ASSOCIATION OF ROMANIA. Michael Balint in his work “The Doctor, his Patient and the Illness”

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THE BALINTIAN APPROACH OF PSYCHOSOMATIC DISORDERS

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The balintian approach of psychosomatic disorders

THE BALINTIAN APPROACH OF PSYCHOSOMATIC DISORDERS

The medicine called “Doctor”

Csilla Moldovan, Albert Veress, Éva Veress

BALINT ASSOCIATION OF ROMANIA


The balintian approach of psychosomatic disorders

Michael Balint in his work

“The Doctor, his Patient and the Illness”

opened new perspectives in understanding psychosomatic disorders and launched the notion of

“The doctor as a medicine”


The balintian approach of psychosomatic disorders

PRESENTING THE “MEDICINE”

„The doctor is an entity for the benefit of others”

(Scripcaru)

The doctor is the MEDICINE

The active substance of this medicine is

THE DOCTOR’S PERSONALITY

conditioned by

biological-psychological-social factors

BPS MODEL of ENGEL

The doctor-patient relationship

is a critical component of the BPS model


The balintian approach of psychosomatic disorders

The Biological System

The biological factors condition

the biological functioning

of the doctor

of the patient


The balintian approach of psychosomatic disorders

The Psychological System

The psychological factors

shape

The personality of the doctors

The personality of the patient

influences

influences

the professional motivation

and his attitude

towards perceiving and

experiencing suffering

the motivation of the

patients attitude towards

their illness


The balintian approach of psychosomatic disorders

THE SOCIAL SYSTEM

THE SOCIAL FACTORS

Influence

The appearance and

the treatment of the illness

THE PATIENT

THE DOCTOR

Expresses and experiences the illness depending on the social, cultural, familial, ethnic customs

His personality is influenced by the way he perceives the role of the doctor


The balintian approach of psychosomatic disorders

THE WAY THE MEDICINE IS PRESENTED

“Each doctor creates a unique atmosphere” M. Balint

The overactive doctor:

authoritarian in the doctor-patient

relationship, leads the treatment

The partner doctor:

equality in the doctor-patient relationship,

treatment goes on in collaboration with the patient


The balintian approach of psychosomatic disorders

All-knowing doctor:

paternalistic, treatment is conducted

by the doctor with a teacher-student-like

subordination of the patient

The friend doctor:

in most cases such a relation does not work

The Balintian doctor:

the best ailment in treating

psychosomatic disorders.


The balintian approach of psychosomatic disorders

THE BALINTIAN DOCTOR

“ The doctor as medicine”

M. Balint

ADVANTAGES

Reveals the pathogenetic effects of psychosomatic disorders

Focuses on PS illnesses as a consequence of poor communication, isolation, and problems of making a living

Satisfies the communicational needs of the patient

Makes a survey of all possible solutions

to the patient`s problems

Reveals new perspectives in solving these problems


The balintian approach of psychosomatic disorders

CHARACTERISTCS AND EFFECTS

Confines to the saying: “NIL NOCERE”

PSYCHOSOMATIC DISORDERS

are considered to be a consequence

and expression of

PROBLEMS OF EXISTENCE and

PROBLEMS OF COMMUNICATION

The best medicine will be the doctor who

satisfies the patient`s need of communication


Characteristics of the doctor medicine and his efficiency

CHARACTERISTICS OF THE “DOCTOR MEDICINE”AND HIS EFFICIENCY

  • Capability of empathy: putting himself into the patient`s situation. The patient expects understanding

  • Capability of listening:bykeeping silence and listening, the doctor will eventually break the patient`s resistance, the first step towards communication

  • Capability of listening without judging: will help assess the objective situation of the patient

  • Tolerance, flexibility and sensitivity with the patient a communicating doctor-patient relationship will be settled


Characteristics of the doctor medicine and his efficiency1

CHARACTERISTICS OF THE “DOCTOR MEDICINE”AND HIS EFFICIENCY

  • Capability of changing his emotions towards the patient: will produce a change in the situation of the patient,the possibility of accepting a terminal situation

  • Capability of intuition and realization of the awareness of the transfer and countertransfer in the doctor-patient relationship : will help the doctor control his emotions towards the patient

  • Capability of accepting that recovery means autonomy: this liberates the patient from the relationship


The balintian approach of psychosomatic disorders

PHARMACOKYNETICS

“The way the doctor offers himself to the patient depends on his personality rather than the needs of the patient”

M.Balint

The doctor as BPS model conditions the doctor-patient relationship

The pharmacological action of the

“Doctor Medicine”

conditions

The quality of Doctor-patient-illness relationship


The pharmacological action of the medicin e

THE PHARMACOLOGICAL ACTION OF THE “MEDICINE”

  • Assessing the doctor patient relationship

  • Assessing the tensions in the life of the patient

  • A good understanding of the complex interpersonal factors such as transfer and countertransfer

  • The correct assessment of the dynamics of the doctor-patient relationship


The balintian approach of psychosomatic disorders

HOW DOES THE “DOCTOR MEDICINE” ACT UPON BPS?

PS symptoms express vital situations of the patient

The patient can not or does not want to deal with these problems

The problems of existence becoming illness-generating problems


The balintian approach of psychosomatic disorders

HOW DOES THE “DOCTOR MEDICINE” ACT UPON BPS ?

In a lucrative relationship, where communication is possible, the doctor can prompt the

“BALINTIAN FLASH”

by spontaneously sharing thoughts, free association and all this will certainly cast light upon the basic problems of the patient

“HERE AND NOW”


The placebo effect

THE PLACEBO EFFECT

  • Depends on the efficiency of the “medicine”

  • trust in the curing doctor

  • the effect can be correlated with the apostolic function of the doctor, who converts the patient to his own ideas

  • The pharmacokinetics of the medicine called “doctor” is also influenced by the way the medicine is administrated

  • This “magic ritual” of administration medicine can have a considerable effect on the patient, increasing the therapeutic efficiency of the medicine


The balintian approach of psychosomatic disorders

THE INDICATION OF THE MEDICINE

The psychosomatic symptoms, which are linked to a vital problem can be the etiopathogenic factors in the genesis of the psychosomatic disorders:

social isolation, lack of communication, job difficulties, lack of satisfaction in love, lack of feelings, collapsing of traditions, uncertain daily existence, no perspectives for the future, accepting and idealizing compromises, moral crisis

In this situation there is nobody to receive the cry for help...

BUT the body of the patient itself, which will turn the problems from outside into somatic inner ones,

and finally the patient will call the doctor.


The balintian approach of psychosomatic disorders

DOSAGE OF THE

“DOCTOR MEDICINE”

Is determined by the:

• Gravity of the PS disorders

• Tolerance towards the medicine

• The development and intensity of side effects

In case of overdosing, the antidote couldbe:

GIVING UP THE RELATIONSHIP!


The balintian approach of psychosomatic disorders

LIMITS IN ADMINISTRATION

The “Doctor Medicine” acts upon the

Patient and his Environment

BPS factors can limit its action

The family is also a BPS system with specific dynamics.

The “Doctor Medicine” can balance this system:

It could be a ”shock absorber “in the system.

Only by being present, he absorbs the negative shocks, making it possible for the others to live along with the problems

The system keeps on going against expectations, even if the problems persist.


The balintian approach of psychosomatic disorders

LIMITS IN ADMINISTRATION

The doctor may experience unpleasant emotions while playing his therapeutic role, thus limiting the efficacy of the „Medicine”

NEGATIVE EFFECTS:

The “medicine” cannot replace the poor social protection the ethnic, cultural and religious beliefs, the financial and social situation of the patient.

POSITIVE EFFECTS:

He could change the thinking of the patient, his status in the family, and could help him get through the emotional experiences due to the PS disorders


The balintian approach of psychosomatic disorders

SIDE EFFECTS OF THE

“DOCTOR MEDICINE”

The countertransfer of the doctor is the result of the influence of the patient on the unconscious mind of the doctor, and this will lead to an improper attitude with the patient:

aggressiveness, anger, indifference, unmotivatedly keeping the patient inside the relation, iatrogenic effects.

The doctor may crave for power(Adler)

This is to hide his inferiority as a medicine, feeling incapable of making a relationship and communicating with the patient. His anxiety, the uncertain diagnosis will only add to it.

“The doctor may become a `little dictator` to the patient”(Lanchland)


The balintian approach of psychosomatic disorders

SIDE EFFECTS OF THE “DOCTOR MEDICINE”

  • Doctor`s self defense is an adverse reaction as a defense against professional frustration.

  • The behavioral stereotypes are:

  • refusing the patient,the doctor will suggest that the patient is in fact not ill at all.

  • endless referrals to other specialists and paraclinical investigations

  • Exaggerating the apostolic function:

  • the doctor tries to convert the patient to his conception about the illness; he feels omnipotent as if he knew all, the doctor is vulnerable to criticism from the patient, and feels hurt if patient leaves him.


The balintian approach of psychosomatic disorders

SPECIAL NOTICE ON USING THE “MEDICINE”

There are three sorts of treatment: prophylactic, therapeutic and maintaining. Use and efficacy of the medicine called “doctor” also depends on the duration of treatment.

The better a doctor is appreciated, the more patients he must deal with.

Consequently, he will have less time to communicate with the patients.

Thus, more patients will leave him for other, possibly less efficient doctors,

but who have more time at their disposal.


The balintian approach of psychosomatic disorders

The End

Sfârşit

Vége

Konec


The balintian approach of psychosomatic disorders

TENC IU

VERI

MACI!!!


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