抄録
The patient was a 10-year and 11-month-old girl who had been hospitalized in five different hospitals for repeated violent abdominal pain and vomiting over a 15-month period.A team approach to her by a psychiatrist and a medical social worker proved to be effective. While arranging the patient's environment by house calls and visits to her school, the social worker played a maternal role supplementing the psychiatrist's approach which was paternal and therapeutic representing"reality". Her family began to grasp her symptoms as a problem of the whole family and appropriately cope with her symptoms. In her relation to the social worker, the patient herself became able to verbalize various sores of her heart which would had been attributable to her parents' divorce, and to be conscious of events which became a trigger for somatization. After voluntary discharge she continued to meet the physician who was representing the outside world, the society, with the social worker as her support. About one year after the therapy, episodes of abdominal pain and vomiting disappeared, her group adaptation became satisfactory, and the rate of school attendance improved to be almost 100%. In this case, the social worker attempted to contact the patient's environment and gave an indirect aid to the physician's treatment. In addition, she also played a therapeutic role in the reciprocal relationship with the physician. To handle efficiently the effect of group dynamics of therapeutic team remains to be a target in psychosomatic medicine.
