Verbal exchange structure of general practice consultations with patients presenting psychological problems.

The consultations of 88 patients presenting with psychological problems to primary care medical practitioners were tape- recorded, coded, and factor- analyzed to identify their constituent verbal exchanges. A verbal exchange is a set of speech act categories that tend to occur together and are used for some subtask within an encounter. The verbal exchange structure of these consultations replicated that of previously studied medical consultations except that they had some distinctive features in common with previously studied psychotherapy sessions. Patient- centered exchanges called Social Exposition and Emotional Exposition, which may serve psychotherapeutic purposes, were relatively prominent in those consultations rated relatively positively by patients and by external raters.

Psychological treatment of emotional problems by general practitioners.

Since the pioneering work of Balint (1964; Balint & Norell, 1973) there has been little empirical study of general medical practitioners' psychological treatment of patients presenting with emotional problems. In this study 88 patients presenting to GPs for help with emotional problems were interviewed at home about their experiences of their consultations with the GPs. Their audiotaped consultations were then analysed using four different coding systems: a content coding system devised for the study, two verbal response mode systems (Byrne & Long, 1976; Stiles, 1982), and ratings of the doctor's empathic understanding and concern and warmth. Less than half the average consultation was found to comprise psychological treatment broadly defined as any discussion and listening to patients' psychosocial concerns. Although psychological treatment generally was associated with positive patient experiences, the strongest effects found were for listening interactions (where patients described their problems in their own words with non-directive encouragement from the doctor) and for rated doctor empathy. The results are discussed in relation to the work of Balint (1964) and associated findings in empirical studies of psychotherapy.