What do you think the patient was feeling at that moment?
What kind of person is the patient?
What do you know about his/her life situation, his present family, and his family of origin?
What feelings does this patient elicit in us?
How does the patient shape his doctor to his needs and possibilities and vice versa?
Where is there an underlying “disrupted fit” between the patient and his environment and how is this reflected?
How do you think the patient sees his doctor and what does he think of him?
Why did the doctor behave as he did in this situation and what did he want to achieve with this behavior?
Is there something the patient is missing in the doctor and perhaps in his life as well?
What feelings does this patient elicit in us?
How do you think the patient sees his doctor and what does he think of him?
Why did the doctor behave as he did in this situation and what did he want to achieve with this behavior?
Is there something the patient is missing in the doctor and perhaps in his life as well?
Practice
Case Study Follow-up
The group will discuss how the annoyance of the fellow doctor about the patient is to be understood. One idea was to understand the patient’s behavior as an unconscious attempt not to have to respond to unpleasant topics. Encouraged by the free discussion in the group the internist shared her fantasies about the patient: She experienced him like an overflowing trash can on a narrow staircase an elderly gentleman had to struggle with. This was, however, quite contrary to the lively and cheerful entering of the patient into the treatment room.
At the next visit, the internist was brave enough to show the patient the contradiction: “Amazingly, Mr. Miller, you come in here quite cheerful but at the same time I have in my head the picture of an elderly man struggling with a trash can.” The patient then got a very wry face and said, “Have we ever talked about my wife, how she constantly tantalizes me with her cleanliness compulsion, and how she is trying to make me part of her cleaning mania?” He also said that he often eats sweets out of frustration, and he was now embarrassed to talk about it.
At the next meeting with the patient, from the beginning, there was a good atmosphere between doctor and patient. The blood sugar levels have improved over the course of the following week.
Sculpture Work and Balint Group
Sculpture work is a method in couple and family therapy. A sculpture of a system (family, hospital team) enables access to tensions, conflicts, and previously unseen positive and negative relationships within the system. After presenting a case, the presenting colleague first selects persons from among the group participants as representatives of those involved in the case and positions them in the room. He/she plays the role of the doctor. The symptoms or the disease are also personified by a participant. This makes the closeness or distance in the relationship clear.
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