PubMed · 7452597
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1980. Difficulties with dependency.. https://pubmed.ncbi.nlm.nih.gov/7452597/
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This article explores how group-dynamic interventions can be used to teach health professionals to counter impulses to make clients dependent on them. The basic assumption, derived from Kohut's work on narcissism, is that dependence-making behavior is connected with deep-rooted feelings of insufficiency resulting from a defective autonomy. A part of the standard Dutch General Practice (GP) training program, experience-sharing in groups of 12 GP trainees, offers opportunities to explore these feelings. The format of this experience-sharing (well-defined boundaries, minimal structure, facilitating leaders) often evokes behavior in which the peculiarities of the dependence-making behavior of the GP's vis-à-vis patients are mirrored: that is, dependent behavior. In order to analyze and influence this behavior, use can be made of Levine's model of group psychotherapy, which focuses on enhancing autonomy. In this paper we show, by means of four group cases, how Levine's framework can be used to enhance autonomy, lessen dependence, and thus diminish the tendency of GP's toward dependence-making behavior.
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By way of introduction the concepts 'helpful-supportive' (in analytical psychotherapy) and 'exclusive-supportive' psychotherapy are defined. Then the indications and the patients' characteristics (marked ego weakness, dependency wishes) concerning exclusive-supportive psychotherapy in psychosomatic medicine are outlined. After this we describe the three interview and treatment steps of supportive psychotherapy in psychosomatic patients which particularly include the patients' motivation for conflict-enlightenment psychotherapy. Furthermore some effectiveness criteria are presented. Apart from this motivation work, there exists an indication for supportive long-term psychotherapy in psychosomatic patients. Exclusive-supportive psychotherapy in chronically medically ill patients is founded upon the instability of the psychic adaptation processes (particularly the labilized denial work) following the manifestation of chronic disease. The characteristic intervention techniques deal with the patient's secondary frustration-aggression following, on the one hand, his idea 'Why am I so ill and not the others'. On the other hand, supportive-psychotherapeutic handling of the patient's acute or long-lasting handling of the patient's acute or long-lasting conflict situations prevails. Additional systemic psychotherapeutic procedures are highly recommended in psychosomatic and chronically ill patients, for these procedures are well suited to promoting the effectiveness of individual supportive psychotherapy.