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Making Connexions: Enhancing the Therapeutic Potential of PatientClinician Relationships

Dale A. Matthews, MD; Anthony L. Suchman, MD; and William T. Branch Jr., MD
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From the National Center for Chronic Fatigue and the National Institute for Healthcare Research, Arlington, Virginia; Highland Hospital and the University of Rochester School of Medicine and Dentistry, Rochester, NY; Harvard Medical School, Boston, Massachusetts. Requests for Reprints: Anthony L. Suchman, MD, Highland Hospital, 1000 South Avenue, Rochester, NY 14620. Acknowledgments: The authors thank Drs. Howard Beckman, Thomas Inui, Kenneth Olive, and Morton Orman and Ms. Patricia Braus for reviewing this manuscript. Grant Support: Dr. Matthews is the recipient of the George Morris Piersol Teaching and Research Scholarship of the American College of Physicians (1989-92).

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;118(12):973-977. doi:10.7326/0003-4819-118-12-199306150-00010
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Healers must try to understand what the illness means to the patient and create a therapeutic sense of connection in the patientclinician relationship. A favorable climate for connexional experiences can be created through the use of various interviewing techniques. Attending to rapport, silencing internal talk, accessing unconscious processes, and communicating understanding can help clinicians enhance their sensitivity to the subtle clues on which issues of meaning and connection often depend. Several risks are associated with the establishment of closer patientclinician relationships, including dependence and power issues, sexual attraction, and deeper exposure of the clinician to the patient's pain. Prepared with an awareness of these risks and techniques to address them, clinicians are encouraged to deepen their level of dialogue with patients, to compare their experiences with those of other clinicians, and to thereby develop a more systematic understanding of therapeutic relationships.





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