[Patients who are difficult to help. Attachment perspectives]

Attachment theory and research show that a patient's attachment pattern, shaped in close relationships, affects A) the ability to describe symptoms in a structured and detailed manner, and B) the ability to trust physicians' conclusions and concerns. If physicians are observant of patients' unstructured, intense or avoidant communication during consultation, they can adjust their communication accordingly and avoid misunderstandings and excessive health care consumption. A patient with insecure ambivalent attachment needs initial empathic listening, whereas a patient with insecure avoidant attachment benefits from a respectful distance. Since insecure attachment is associated with lack of trust combined with difficulties understanding own psychical and psychological symptoms, physicians need to fill in the gaps more carefully than usual. Understanding attachment theory will be of help and is discussed in the article.