治療的自我(総合医療体系の基幹としての心身医学-その教育)(第17回日本心身医学会総会)

抄録

In our daily practice of psychosomatic treatment, the therapist's personality ('therapeutic self') Plays an essential role. The patient's mind is to be reflected in the mirror of the therapist's mind. The therapist is requested to modify his mind according to a variety of different therapeutic goals.Non-conditional positive regard and empathetic understanding are considered to be the foundation for every kind of psychotherapeutic approach. In practice, however, such an ideal basis for the 'therapeutic self' is rarely achieved. We, therefore, have initiated the following basic training programme for all trainees in our psychosomatic department, for the purpose of developing their 'therapeutic selves'.a) Practice in roleplaying of listening.Simple listening and sincere interest in the patient's problem is most important in initiating real communication with the patient.b) It has been reported that the practice of autogenic training, Zazen and other related methods of altering consciousness, may considerably facilitate the therapist's empathetic understanding and cultivation of a relaxed and accepting attitude.c) In our experience, transactional analysis, a colloquial form of psychoanalysis originated by Eric Berne, which is easily understood by our paramedical staff and even our patients, has been very helpful not only for treatment, but also for the therapist's self-analysis. The therapist's insight into his own personality problems may prevent him from having a distorted understanding of the patient.d)Training in behaviour therapy based on leaning theory (such as systematic densensitization and operant conditioning) may develop the therapist's ability to help the patient change his distorted behaviour patterns.e) The optimal psychotherapeutic doctor-patient relationship shouls not be modelled after the teacher-pupil relationship. Rather, there should be interactive relationship in which the doctor may change along with the patient.f) The therapist guided to develop a general holistic understanding of the human being, in addition to a knowledge of psychotherapeutic psychology.