Danish Medical Bulletin    |    Contact Front page  

 
Mentalization, Narrative and Time
-a qualitative study about psychological interventions in general practice


Annette Sofie Davidsen  


  Download file   (1972 KB)

Accepted by: Health Sciences Copenhagen
Defended on: September 16, 2008
Official opponents: John Nessa, Norway , Marit Hafting, Norway , Lone Schmidt
Tutors: Susanne Reventlow , Dorte Gannik

Published in the PhD Database: September 21, 2008


English abstract
The PhD dissertation is based on a project that was carried out at the Research Unit for General Practice in Copenhagen and the Department for General Practice at the University in Copenhagen.
The aim of the study was to investigate general practitioners¿ (GPs¿) approach to talking therapy, how they experienced the process of understanding the patient and how they delivered talking therapy; how time influenced GPs¿ dealing with emotional and psychological problems; and whether the GPs had the same approach to emotional and psychological problems in everyday consultations as that they reported for talking therapies.
The study was qualitative, based on interviews with 14 Danish GPs followed by observation of consecutive consultations in four of the GPs¿ practices.
In Denmark there is a service called ¿talking therapy¿ in GPs¿ collective agreement. There is, however, no definition for this service concerning the content or which methods should be used in talking therapy. Furthermore GPs can chose not to offer talking therapy.
The participants differed greatly. Those who offered talking therapy mostly used non-specific methods. Different approaches could be described using the concepts of mentalization, narrative and time. Mentalization means the capacity to understand one¿s own as well as others¿ thoughts, feelings and fantasies. Different dimensions of mentalization could be identified. Mentalization always took a narrative form, and in general practice the story got a particular significance. Time was an important factor, both for piecing together the story and as a precondition for the talking therapy, which itself demanded quiet and lack of disturbance if GP and patient should be able to move into a timelessness where they could establish contact with the patient¿s emotional problems. The study showed that GPs used the same approach to emotional problems in everyday consultations as that they had described for talking therapies.
Mentalization is a fundamental capacity that is important in all forms of psychotherapy, independent of therapeutic school. The mentalizing capacity might be trained as part of the non-specific factors that GPs use when they offer talking therapy. Together with narrative and time, mentalization could form a point of departure for a theory and a training programme for talking therapy in general practice. Training in talking therapy could equip the GPs with skills for dealing with emotional problems in everyday consultations, even if the GPs do not want to carry out longer therapeutic sequences. The effect of such a training programme could be investigated by an operationalization of the concept of mentalization.



Danish abstract
Ph.d.-afhandlingen udgår fra Forskningsenheden for Almen Praksis i København og Afdeling for Almen Medicin, Det Sundhedsvidenskabelige Fakultet, Københavns Universitet.

Formålet med projektet var at undersøge, hvordan praktiserende læger forholdt sig til samtaleterapi, hvordan de oplevede forståelsesprocessen med patienten og udførte samtaleterapien; hvordan tid influerede på håndteringen af emotionelle og psykologiske problemer, og om lægerne havde samme tilgang til emotionelle og psykologiske problemer i almindelige konsultationer, som de beskrev for samtaleterapierne.

Studiet var kvalitativt, baseret på interviews med 14 danske praktiserende læger efterfulgt af observation af almindelige konsultationer i fire af lægernes praksis.

I danske praktiserende lægers overenskomst indgår en ydelse for samtaleterapi. Det er ikke defineret, hvad denne ydelse skal indeholde, eller hvilken metode, der skal anvendes i samtaleterapi. Lægerne kan desuden fravælge at tilbyde samtaleterapi.
Deltagerne i undersøgelsen forholdt sig meget forskelligt. De, som tilbød samtaleterapi, anvendte hovedsagelig non-specifikke faktorer. Forskellige tilgange kunne beskrives ved hjælp af begreberne mentalisering, narrativ og tid. Mentalisering vil sige evnen til at forstå såvel egne som andres tanker, følelser og fantasier. Der indgik forskellige dimensioner af mentalisering. Mentaliseringen tog altid form af et narrativ, og i almen praksis fik historien speciel betydning. Tiden var en vigtig faktor, både for at stykke historien sammen og som en betingelse for mentalisering, men også som grundlæggende betingelse for selve samtaleterapien, som krævede ro og uforstyrrethed for at patient og læge kunne bevæge sig ind i en tidløshed, hvor der kunne opnås kontakt med de emotionelle problemer. Undersøgelsen viste, at praktiserende læger anvendte samme tilgang til emotionelle problemer i almindelige konsultationer, som de havde beskrevet for samtaleterapi.

Mentalisering er en grundlæggende bestræbelse, som er vigtig i al psykoterapi, uanset terapeutisk skole. Mentaliseringsevnen kunne med fordel trænes som en del af de non-specifikke faktorer, som praktiserende læger anvender, når de tilbyder samtaleterapi. Sammen med narrativ og tid kunne mentalisering danne udgangspunkt for en teori og et træningsprogram for samtaleterapi i almen praksis. Træning i samtaleterapi kunne give lægerne færdigheder i håndtering af emotionelle problemer i almindelige konsultationer, også selv om lægerne ikke ønsker at udføre længerevarende terapeutiske forløb. Effekten af en sådan træning kunne vurderes forskningsmæssigt ved anvendelse af en operationalisering af mentaliseringsbegrebet.