Issue 1 Vol. 35 1993

Social aspects of resistance in psycho-therapy

MÜLLER, A.

The authoress decribes two differing doctor-patient relationships, which she simplifies in a typology (and here she means an artificial confrontation) and which she terms as a) the specialist-providing-a-service model and b) the authority model. The latter is characterised through this, that the doctor is regarded as a parental key-figure: obedience is a pre-requisite for the success of the therapy; if this is missing, disappointment or rather more accusations follow. The doctor that is like a specialist providing a service, confronts the patient rather like a customer or client, who expects for his fee professional competence. If success is not forthcoming, the reaction is not so much one of disappointment, but is more a matter of depreciation, the doctor has not been worth his fee. A second fundamental difference is, that with the specialist - as apposed to the doctor as a parental key-figure - moral authority is not necessarily ascribed to him, his own economic interest is adequate motivation for his purpose.

What does this typology tell us in respect of doctor-patient relationship? The split of the patient as decribed above, between himself as an object or rather "subject" of the treatment is essentially more complicated in the case of psycho-therapy than in the case of physical medicine, as a psycho-somatic understanding of the doctor could be questionable in the extreme. A further point deals with the sub-conscious dynamics of both of these types: on the surface the specialist-providing-a-service relationship might seem to be emancipated progress, instead of subordination an equilibrium exists. However the reaction, in the case of failure of the therapy - that of depreciation of the doctor - is on the analytical side to be evaluated on a narcisstic level and is far more difficult to deal with. The real intention of this elucidation - the question as to whether these relationship types can be used in a comparison between experience in East Germany and West Germany in psycho-therapy and its posing problems - in the meantime is now regarded with more scepticism and has here been quickly sketched as stimulation for thought.

In conclusion there exists the wish for the type of relationship in which the doctor accompanies the patient, makes him aware of pitfalls, but does not indicate a particular direction.

Keywords: doctor-patient relationship, resistance in psycho-therapy

Short Title: Müller, A. (1993) PsyBeit 1:68

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