心身症患者への精神療法的接近 : その治療関係を規定するsettingをめぐって

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Recently, psychosomatic approacn to the patients with psychosomatic diseases have been applied in the field of internal medicine. If the psychotherapeutic principle and method developed mainly in psychiatric setting were directly applied in the field of internal medicine, various difficulties would be encountered in therapeutic relationship. Consequently, the concept of "setting" of M.Balint is important in psychotherapy of psychosomatic diseases. The author has been studying about the psychotherapeutic approach to internal medical patients from the point of view of internist, and recently had an opportunity to learn psychiatric psychotherapy and psychoanalysis in Psychiatric Department of Keio University. The author illustrated four clinical cases of which two were treated in medical setting and the order two were treated in psychiatric setting, and discussed the influences of the difference of two settings to the psychotherapeutic relationship. The author was impressed by discovering the fact the patient-therapist relationship as well as the patient's attitude toward the psychotherapy was influenced very much by the change of setting in which psychotherapy was was carried out. Generally speaking, the contact between therapist and patient was more easily established in medical setting than in psychiatric one in early stage of psychotherapy, and it seemed to have been caused by the fact that patients satisfied their desire to accept any treatment of somatic approach by the therapist. However, in medical setting the development of psychological insight seemed to be more difficult. The author pointed out that the therapist should try to accept the patient's desire on somatic level especially at the early phase of treatment, thus preparing for the formation of desirable therapist - patient relationship in later course of intensive psychotherapy.
日本心身医学会の論文

心身症患者への精神療法的接近 : その治療関係を規定するsettingをめぐって

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