Making "connexions": enhancing the therapeutic potential of patient-clinician relationships

Ann Intern Med. 1993 Jun 15;118(12):973-7. doi: 10.7326/0003-4819-118-12-199306150-00010.


Healers must try to understand what the illness means to the patient and create a therapeutic sense of connection in the patient-clinician relationship. A favorable climate for "connexional" experiences can be created through the use of various interviewing techniques. Attending to rapport, silencing internal talk, accessing unconscious processes, and communicating understanding can help clinicians enhance their sensitivity to the subtle clues on which issues of meaning and connection often depend. Several risks are associated with the establishment of closer patient-clinician relationships, including dependence and power issues, sexual attraction, and deeper exposure of the clinician to the patient's pain. Prepared with an awareness of these risks and techniques to address them, clinicians are encouraged to deepen their level of dialogue with patients, to compare their experiences with those of other clinicians, and to thereby develop a more systematic understanding of therapeutic relationships.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Communication Barriers
  • Disease / psychology
  • Humans
  • Medical History Taking / methods
  • Patients / psychology
  • Physician-Patient Relations*
  • Stress, Psychological
  • Unconscious, Psychology