Psychotherapeutic Approach to the So-called Troublesome Psychosomatic Patients : Simultaneous Approach to the Attending Psysicians and the Patients

Abstract

We psychosomatists are sometimes confronted with extremly difficult cases that are often given up by the attending physicians because of the patients' pertinacious somatic complaints and their lack in co-operative attitude. In this paper the author reported on the treatment of two such patients, the result of which, contrary to the initial anticipation, turned to be very satisfactory. This treatment consisted of simultaneous psychotherapeutic approach to the doctor and the patient. Case 1. was a 46-year old single laboror. His complaints were palpitation and fatiguability. Case 2. a 34-year old male clerk. His complaints were diarrhea and fatiguability.Throughout consultation on the treatment of these cases, the author took sympathetic and supportive attitude toward the attending physicians in order to restor their subjectivity which was a vital necessity in a therapist. Only after this, some concrete advice on the treatment was presented to the physicians in concise and concrete terms. At the same time, the author promised the doctors to take over their cases in the out-patient clinic after their discharge.After the discussion, doctors fully encourged, went on to carry out the concrete treatment. Other staffs became spontaneously co-operative. After this, the confused therapeutic atmospher gradually disappeared and the patient's attitude as well as pertinacious complaints were slowly improved.In the author's opinion, consideration over the doctor-patient relationship is sometimes necessary in troublesome patients, and in fact, psychotherapeutic approaches to the attending psysician as well as to the patient were very effective.