Training primary physicians as psychotherapists

Abstract

Thrown back on his own resources, the doctor, often shamefacedly, prescribes some placebo, and gives advice or a “reassuring” pep talk…. Then there are the advocates of “common-sense” psychology who advise the patient to take a holiday, to change his job, to pull himself together, not to take things too seriously, to leave home, to get married, to have a child, or not to have any more children but to use some contraceptive, etc. None of these recommendations is necessarily wrong, but the fallacy behind them is the belief that an experienced doctor has acquired enough well-proved “common-sense” psychology to enable him to deal with his patient's psychological or personality problems…. But minor surgery, for instance, does not mean that a doctor can pick up a well-proved carving-knife or a common-sense carpentry tool and perform minor operations. On the contrary, he has to observe carefully the rules of antisepsis and asepsis, he must know in considerable detail the techniques of local and general anaesthesia, and must have acquired skill in using scalpel, forceps, and needle, the tools of the professional surgeon. Exactly the same is true of psychotherapy in general practice. The uses of empirical methods acquired from everyday life are as limited in professional psychotherapy as are carving-kinfe and screwdriver in surgery. 1