Coping with the negative therapeutic response in psychosocial problems in family medicine

Four brief case reports are presented from a series of Balint-type seminars on psychosocial problems at a university Family Medicine Centre. These cases illustrate the difficulties encountered by family practitioners when faced with a negative therapeutic response. When confronted by this outcome, it is important for the physician to define the dependency relationship which exists between himself/herself and the patient. It is often necessary to negotiate an explicit therapeutic contract. In doing so the physician should consider his own limitations of time, expertise and inclination and gather enough information to allow him to identify the focus of therapy and to consider his options for dealing with that specific focus.