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, how they delivered talking therapy, how time influenced GPs' dealing with emotional and psychological problems, 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 choose 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.