ABSTRACT
General practice can seem ‘like the therapeutic contract from hell’, the perfect place for ‘ultra brief, ultra long therapy’ (Launer 1996). People can come any time, as often as they like, but there is never enough time to see them properly. Patients that present primarily with emotional problems can be a struggle. We may be tempted to label them as having ‘mental health issues’. You may even find yourselves using words like ‘functional’ or even the curious term ‘supra-tentorial’, implying that these symptoms are imagined or somehow less real because you cannot identify the pathology, the damaged tissue. These patients often feel particularly demanding, and we may wish to refer them on, first to the practice counsellor or, better still, to some specialist psychologist or psychiatrist elsewhere. Some of us may even tell ourselves ‘I don’t do mental health problems’. However, between 30 and 60 per cent of all consultations in general practice are either directly about mental distress or contain significant psychological issues. And it has repeatedly been shown (Balint 1957, Elder and
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primary care. It provides new and useful insights, but it can also be very time consuming and there is a temptation to leave such work to the ‘experts’. Nothing would seem more overwhelming to an already pressurised front-line clinician than having to listen endlessly to a patient’s unpacking of their entrenched problems – and this within the confines of a ‘10 minutes per patient’ time slot. It is hardly surprising that primary care workers generally avoid such activities. But it is not an impossible task to connect usefully with our patients’ personal or relationship distress. All that is needed is a framework and appropriate techniques that can be adapted to primary care settings.
