Susana Auteri

The emotional, integral and social relationship are  facts that result from the encounter between the therapist and the patient in a specific environmental context (office, room, home, etc.), with a common goal: the remission of the disease.

It is a relationship because it is a "human interaction that conveys an amount of conscious and unconscious information through verbal, preverbal analogical language, and in which each participant tries to determine the nature of the relationship and each responds with your own definition of it, which you can confirm, reject or modify that of the other ".

It is emotional: as in all relationships, the emotional exchange known as "transference-countertransference" occurs. The transference is understood as several series of relieved psychological experiences, not as belonging to the past, but referring to the person of the doctor in the present moment; and as a countertransference to the set of emotions that are mobilized in the therapist by the stimulus that the patient constitutes and that, in the strict sense, is defined as the doctor's prejudices.

It is comprehensive because it must be understood that both the doctor and the patient are total people, whose fears, beliefs, anxieties, skills and ignorances will determine, with greater or lesser effectiveness, their roles as technician or patient. When the doctor focuses exclusively on the disease for which he is consulted, he usually experiences the encounter with his patient as a fight in which he feels obliged to win, through an accurate diagnostic blow. When this happens, their anxiety decreases, but at the same time, there is a double alienation, that of the patient with the doctor (since he was only related to a part of the patient), and that of the patient with his disease (he ends up doing the same ailment that he sees the doctor do, isolates and attacks). Doctor, patient and disease are alienated as three different realities.

It is social, in turn, since it is a social relationship in which the socio-family group of which the patient is the carrier and spokesperson is present, and on the other hand, due to the characteristics of the doctor-doctor relationship, that the patient The treating person has with -the professional who referred the patient or with those professionals who assisted him previously.

Leaving out the family group, which is itself involved in the illness of one of its members, it is possible to marginalize possible allies and collaborators in the understanding and remission of the disease, and is to expose oneself to disintegrating behaviors, by the family, the doctor-patient relationship.

The definition mentions that they have a common goal. There are times when the unconscious objective pursued by the patient does not coincide with that of the doctor. For example: when he attends the interview to perpetuate his ailments and confirm that they have no solution, thus maintaining the primary and secondary benefits of his illness; or when he only communicates the symptom that he considers important according to his self-diagnosis, so that the doctor can get it right and "confirm" what he thinks, keeping his real illness hidden, etc.

The goal is remission of the disease. Many times the suppression of the symptoms for which the patient is consulted is not synonymous with remission of the disease. Think of cases of displacement of ailments, or of "magical" cures by effects of suggestion, or because the satisfy the neurotic demands of the patient disguised in organic symptoms.

If accepted. that the disease is a decompensation of the personality, even when it is something as concrete as a fracture, a fractured person is being treated in which conflicts may occur due to the impediments that arise, or that may have been fractured by conflicts previous that led to fracture; Therefore, a personalized relationship is established, where the remission of the disease will be the fruit of collaboration and a shared responsibility, the result of guiding, guiding the patient to the recovery of freedom (of health) and best level of social and labor reintegration that may occur in that particular case.

Types of doctor-patient relationship. They can be as varied as there are doctors and patients, and they tend to change as the encounters are repeated, since every relationship is the result of a process. For a better understanding and for didactic purposes, Schavelzon's classification will be taken in the form of a description of extreme cases, although they rarely occur in their pure state.

1. The great distance. This doctor is characterized by affective coldness, objectification or partialization of the patient. Only assess the physical exam; he is always busy with other important things that feed his narcissism, thus blocking his therapeutic capacity by leaving the patient with his problem alone, and instilling panic, he does not give explanations or does so in an inappropriate way (with technical terms), etc. His patients often request only effective remedies from him and may even avoid the interview by calling.
2. Exaggerated proximity. This doctor allows himself to be invaded by the patient's problems, blocking himself to recognize physical facts. Faced with the anguish that this produces, he may present phobic reactions (referral to another professional) or counterphobic (urge to repair the disease as if it were a family member, compulsive requests for analysis and studies). “You take the problem home”. The patient assumes a dependent and docile role, recognizing himself as powerless, and he and his family use the doctor as a repository for all their problems, requesting repeated requests for consultation.
3. Critical or operational distance. This doctor recognizes himself as a man (he is neither a wise man, nor a father, nor God), adjusting his expectations of therapeutic success to the reality of the patient as a whole person and to his own possibilities; recognize what your problem is and what the patient's; and he restrains his omnipotence by changing the tendency to "tell the patient" to "ask the patient." He is responsible for his illness. and is recognized as powerful.