I do not consider my assessment of a new patient adequate until I have at least sketched out as many of the elements contributing to his or her distress as I can.
What about a patient’s symptoms?
An objection to a biopsychosocial/systemic approach is that some patients will resist attempts to redirect attention away from their presenting complaints. This very objection explains why you need to understand what forces underlie a patient’s “death grip” on his or her symptoms, while refraining from concluding that the patient has a treatment-resistant depression, requires ever more sophisticated polypharmacy, or is “untreatable.”
Finally, patients with a serious illness almost invariably experience a predicament—whether recognized or not—and it may render the clinical outcome less than satisfactory if you do not identify its elements and bring them into therapy when appropriate. Regardless of presenting symptoms or diagnosis—and independent of your theoretical orientation—experience suggests the usefulness of assuming every new patient is in a predicament. If you cannot address the predicament early in therapy, it is usually possible to do so after you and the patient develop a therapeutic relationship and you have used other interventions to lower the intensity of the target symptoms.
By helping patients understand more fully their unique predicaments, you can reduce their burdens, foster realistic hopefulness, and be gratified by having truly connected with what patients experience as serious threats to their sense of self.
Related resource
- Reiser D, Rosen D. Medicine as a human experience. Baltimore, MD: University Park Press; 1984 (an excellent reference on George L. Engel’s biopsychosocial concept, the care of patients, and the doctor-patient relationship).
Disclosure
Dr. Cowell reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.