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A model of psychotherapy based on a 'dramatic look' is presented. It is an aspect developed from the demotorization of psycho-drama reduced to two actors Dialogue - in the sense of Plato and Buber - is looked at as action and dealt with accordingly. A pre-step of interpretation: confrontaion is used 'in flagranti' within the framework of here and now. The patient is continuously confronted with his 'action'.
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In this discussion we have presented findings from a study of patient acceptance of a nurse-midwife. The significance of the initial encounter for patient acceptance has been interpreted in terms of a primacy effect. The negative effect of the obstetrician's presence during initial encounters between patient and nurse-midwife has been discussed in terms of expectation theory. The theory leads us to predict that the patient's perceptions of competence of the nurse-midwife were more favorable when the obstetrician was absent from the initial encounter than when he was present. Finally we have interpreted the overall ease of communication between the nurse-midwife and patients as a result of mutual participation, and complementary rather than crossed interactions. This ease of communication is a major factor accounting for the general enthusiasm of patients for the nurse-midwife in the provision of office care. The importance of interpersonal relationships between health professionals and patients for effective patient care cannot be overstated. Romano has stressed the importance of the doctor-patient relationship in obstetrics and gynecology because of the many anxieties and concerns of women concerning their health problems. Hopefully, our findings will encourage physicians to explore the role of mid-level health professionals and particularly nurse-midwives in enhancing the overall quality of health care for women.
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What is a clinical discourse, and what elements of the patient-doctor encounter are most important for the outcome in medical practice? I approach these questions by using the notion of narratology and some key concepts from discourse analysis: interaction, transaction and context. Traditionally, clinical discourse is either consultative or psychotherapeutic. I argue for a third approach to the patient-doctor discourse, a "narrative dialogue". In the narrative dialogue, the patient-doctor-interchange is supposed to be less structural, more flexible, more individualistic than what has traditionally been the case. The doctor is supposed to be visible as a person more than as a professional persona, and the patient is encouraged to participate in the dialogue with his or her own personal narrative as a substantial contribution to the consultation.
In a somehow playful creative "living-learning-process" a rich and differentiated "material" of more or less useful forms of communication will appear. After that, possibilities of a better, up to optimal and individual patterns of communication will be operated. Thereby, the following items will have a central position: 1. personality-/character-structural factors, 2. correlated individual tendencies and basic forms of anxieties, and 3. early considered availability of special Ego-functions.
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The purpose of this study is to clarify the relationship between toddler temperament and developmental delay, and to examine whether the result could be adapted to the health practice of mother and child. As the conceptual framework, we used A. J. Sameroff's transactional model. Questionnaires concerning toddler temperament, rearing environment and toddler development were sent to mothers whose children were scheduled to receive 1 year and 6 months child health examinations, and collected 306 responses. We assessed the developmental status of 41 children among the 306 by means of the Japanese edition of the Denver Developmental Screening Test. All 306 children were classified into either the developmental delayed group (30) or the normal group (275). The data analyses were conducted both quantitatively and qualitatively with the following results. Compared with normal children, developmentally delayed children showed these characteristics: (1) The temperamental category scores of adaptability and persistence were higher, indicating low adaptability and persistence. The prevalence of difficult child, slow to warm up (STWU) child and intermediate high child was relatively higher, with STWU child the highest. (2) The score for the rearing environment was lower. (3) There were cases where disagreement between a child's temperament and the mother's rearing behavior had an influence on the child's development. As a conclusion, these results indicate that a child's temperament must be considered developmental and child-rearing counseling in child health examinations.