Giving responses where requests are brought: a psychologist in primary care

Journal title RICERCHE DI PSICOLOGIA
Author/s Luigi Solano, Michela Di Trani, Rosa Ferri, Alessia Renzi
Publishing Year 2015 Issue 2015/1
Language Italian Pages 18 P. 237-254 File size 239 KB
DOI 10.3280/RIP2015-001015
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Clinical intervention often takes place either on patent disorders - that is, very late - or by implementing prevention programmes in the absence of any request, this practice being of reduced usefulness and not devoid of risks. It is well known, on the other hand, that 50% of requests brought to family physicians, though expressed as physical symptoms, often derive from relational/existential problems, often at a very early stage, when intervention would be short and easily feasable: quite seldom, however, is the physician in a condition to meet this demand adequately, and so ends up prescribing clinical investigations and drug treatments the usefulness of which the physician herself finds strongly doubious. Progressive differentiation between medicine and psychology makes co-operation through referral to a psychologist quite problematic, in terms of both which patients are referred and the modalities of referral. Acceptance of psychological referral is in any case difficult, due to the social stigma that still surrounds contact with mental health operators. The paper reports an experience implemented by the postgraduate Health Psychology School of the Rome University ‘Sapienza’, entailing joint, direct co-operation between primary care physicians and psychologists through the psychologist’s presence in the doctor’s office during consultations. Such an arrangement allows direct access to a psychologist’s listening and intervention in the absence of any filter and without the need for a formal request on the patient’s part, so overcoming the fear of social stigma. In a small number of cases, more formal consultation with the psychologist was proposed. This setting allowed an exploration of the meaning of any complaint brought by patients (physical or mental) in the context of the individual’s past and/or present relational situation, in a very early phase. The experience, beginning in 2000, has until now involved 18 psychologists for a period of 3 years each: it appeared as entirely feasible, though requiring several months for adaptation; patients have welcomed the presence of the psychologist and, as expected, took a broader approach in reporting their distress. In two cases where data were available, a substantial (17% and 14%) reduction of drug prescription on part of the physician was recorded. A clinical vignette shows how disclosure of a difficult life situation, initially expressed as a physical symptom, not only brought to resolution of the symptom itself, but also facilitated crossing an important stage of the life cycle in an adolescent.

Keywords: Primary Care Psychologist, family physician, somatic symptoms, psychological needs

  1. Balint, M. (1957). The doctor, his patient and the illness. London: Pitman Medical Publishing Co. Ltd. trad. it. Medico, paziente e malattia. Milano: Feltrinelli, 1961.
  2. Bonfiglio, B. (2012). Intervento alla presentazione del lavoro Dal Sintomo alla Persona di L. Solano. Centro di Psicoanalisi Romano, Marzo 2012.
  3. Bass, C., & Murphy, M. (1990). The chronic somatizer and the government white paper (Editorial). Journal of the Royal Society of Medicine, 83, 203-205.
  4. Carducci, C. (2010). Il ruolo dello psicologo in un servizio di endocrinolgia pediatrica: un’esperienza di co-presenza medico e psicologo. Tesi di specializzazione in Psicologia della Salute, Universita Sapienza di Roma. Carollo, M., & Bogoni, G. (2013). Il servizio di psicologia delle cure primarie alla Persona, tra medicina di gruppo e equipe psicologica: l’esperienza all’UTAP del Comune di Carmignano di Brenta. Intervento al Convegno Ordine Psicologi del Veneto: Lo Psicologo del Territorio, Padova, 9 Novembre.
  5. Clark, D.M. (2011). Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: The IAPT experience. International Review of Psychiatry, 23, 375-384. DOI: 10.3109/09540261.2011.606803
  6. Derksen, J. (1982). Psychologische hulp in de eerste lijn [Psychological care in the first line]. Nelissen, Baarn, the Netherlands.
  7. Derksen, J. (2009). Primary care psychologists in the Netherlands: 30 years of experience. Professional Psychology: Research and Practice, 40, 493-501. DOI: 10.1037/a0015743
  8. Fiori, S. (2014). Il sogno degli italiani? Essere ascoltati. Intervista a Eugenio Borgna, La Repubblica, 28 Agosto. Retrived from http://www.repubblica.it/cultura/2014/08/28/news/borgna_il_sogno_degli_italiani_essere_ascoltati-
  9. 94557587/.
  10. Glaser, R., Friedman, S.B, Smyth, J., Ader, R., Bijur, P., & Brunell, P. (1999). The differential impact of training stress and final examination stress on herpesvirus latency at the United States Military Academy at West Point. Brain, Behavior, and Immunity, 13, 240-251.
  11. Katon, W. (1985). Somatization in primary care. Journal of Family Practice, 21, 257-258.
  12. Kiecolt-Glaser, J.K., Garner, W., Speicher, C.E., Penn, G.M., Hollida, Y.J., & Glaser, R. (1984). Psychosocial modifiers of immunocompetence in medical students. Psychosomatic Medicine, 46, 7-14.
  13. Kiecolt-Glaser, J.K., Glaser, R., Strain, R., Stout, J., Tarr, K., Holliday, J., & Speicher, C. (1986). Modulation of cellular immunity in medical students. Journal of Behavioral Medicine, 9, 5-21.
  14. Lacey, K., Zaharia, M.D., Griffiths, J., Ravindran, A.V., Merali, Z., & Anisman,
  15. H. (2000). A prospective study of neuroendocrine and immune alterations associated with the stress of an oral academic examination among graduate students. Psychoneuroendocrinology, 25, 339-356. DOI: 10.1016/S0306-4530(99)00059-1
  16. Lega, I., & Gigantesco, A. (2008). Disturbi mentali Comuni in Italia: Il progetto EPREMED e lo studio ESEMeD. Notiziario dell’Istituto Superiore di Sanità, 21, 11-15.
  17. Luoma, J.B., Martin, C.E., & Pearson, J.L. (2002). Contact with mental health and primary care providers before suicide: a review of the evidence. American Journal of Psychiatry, 159, 909-16.
  18. Magill, M.K., & Garrett, R.W. (1988). Behavioral and psychiatric problems. In R.B. Taylor (Ed.), Family Medicine (3rd ed., pp. 534-562). New York: Springer-
  19. Verlag. Mezzani, L., Casanova, B., Lorefice, E., Milani, S., & Surrenti, E. (2006). Psicologia della Salute negli ambulatori della gastroenterologia. Intervento al Simposio: Tertium non datur? Medico e Psicologo insieme con un paziente. VII Convegno Nazionale Società Italiana di Psicologia della Salute, Cesena.
  20. Palma, L. (2013). Suicidi. Per prevenirli affiancare al medico di base un ‘ascoltatore’. Quotidiano Sanità (online), 10 Settembre. Retrived from http://www.quotidianosanita.it/lavoro-eprofessioni/articolo.php?articolo_id=1688.
  21. Parekh, J., Donna, P., Ankerst, D.P., & Thompson, I.A. (2007). Prostate-Specific Antigen Levels, Prostate-Specific Antigen Kinetics, and Prostate Cancer Prognosis: A Tocsin Calling for Prospective Studies. Journal of the National Cancer Institute, 99, 496-497. DOI: 10.1093/jnci/djk129
  22. Polizzy, S., Bruchi, V., Bolognesi, S., Garosi, S., & Bartolini, S. (2006). L’integrazione delle competenze dello psicologo in una équipe di Pronto Soccorso: l’esperienza pilota di Siena. Intervento al Simposio: Tertium non datur? Medico e Psicologo insieme con un paziente. VII Convegno Nazionale Società Italiana di Psicologia della Salute Cesena.
  23. Rodi, P.M. (2010). Suicide Victims’ Last Contact With the Primary Care Physician: Report From Slovenia. International Journal of Social Psychiatry, 52, 280-287. DOI: 10.1177/0020764009105330
  24. Pirkis, J., & Burgess, P. (1998). Suicide and recency of health care contacts. A systematic review. British Journal of Psychiatry, 173, 462-474. DOI: 10.1192/bjp.173.6.462
  25. Schroeder, F.H. et multi alii (2012). Prostate-Cancer Mortality at 11 years of follow-up. New England Journal of Medicine, 366, 981-90. DOI: 10.1056/NEJMoa1113135
  26. Shaw, J., & Creed, F. (1991). The cost of somatization. Journal of Psychosomatic Research, 35, 307-12.
  27. Smith-Bindman, R., Miglioretti, D.L., Johnson, E., Lee, C., Feigelson, H.S., Flynn, M., Greenlee, R.T., Kruger, R.L., Hornbrook, M.C., Roblin, D., Solberg,
  28. L.I., Vanneman, N., Weinmann, S., & Williams, A.E. (2012). Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. Journal of the American Medical Association, 307, 2400-2409. DOI: 10.1001/jama.2012.5960
  29. Solano, L. (2013). Tra Mente e Corpo: come si costruisce la Salute. Nuova Edizione. Milano: Raffaello Cortina Editore.
  30. Strandberg, T.A., Salomaa, V.V., Naukkarinen, V.A., Vanhanen, H.T., Sarna, S.J., & Miettinene, T.A. (1991). Long-term Mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men. Journal of the American Medical Association, 266, 1225-1229. DOI: 10.1001/jama.1992.03480160041018
  31. Solano, L. (a cura di) (2011). Dal Sintomo alla Persona: Medico e Psicologo insieme per l’assistenza di base. Milano: FrancoAngeli Solano, L. (2014). Through symptoms to subjects: the family physician and the psychologist together in primary care. In R.N. Emde & M. Leutzinger-Bohleber (Eds.), Early parenting and prevention of disorder (pp.309-327). London: Karnac.
  32. Solano, L., Pirrotta, E., Ingravalle, V., & Fayella P. (2009). The Family Physician and the Psychologist in the Office together: A Response to Fragmentation. Mental Health in Family Medicine, 6, 91-98.
  33. Solano, L., Pirrotta, E., Boschi, A., Cappelloni, A., D’Angelo, D., & Pandolfi, M.L. (2010a). Medico di famiglia e psicologo insieme nello studio: un nuovo modello gestionale dove il sintomo diventa attivatore di risorse? Italian Journal of Primary Care, 2, 93-100.
  34. Solano, L., Chiancone, L., Coci, B., Ingravalle, V., Marchina, A., & Onofrio, D. (2010b). Medico e Psicologo insieme nello studio: il sintomo come attivatore di risorse. Arco di Giano, 64, 109-122.
  35. Tomassoni, M., Iacarella, G., & Solano, L. (2002), Psicologia della Salute e Medicina di Base: una collaborazione proficua. Psicologia della Salute, 1, 121-134.
  36. Tomassoni, M., & Solano, L. (2003). Una Base piu Sicura: esperienze di collaborazione diretta tra medici e psicologi. Milano: FrancoAngeli.
  37. Wilt, T.J., Brawer, M.K., Jones, K.M., Barry, M.J., Aronson, W.J., Fox, S., Gingrich, J.R., Wei, J.T., Gilhooly, P., Grob, B.M., Nsouli, I., Iyer, P., Cartagena, R., Snider, G., Roehrborn, C., Sharifi, R., Blank, W., Pandya, P., Andriole, G.L., Culkin, D., Wheeler, T.: Prostate Cancer Intervention versus Observation
  38. Trial (PIVOT) Study Group (2012). Radical prostatectomy versus observation for localized prostate cancer. New England Journal of Medicine, 367, 203-213. DOI: 10.1056/NEJMoa1113162
  39. Zachariae, R., Hansen, J.B., Andersen, M., Jinquant, T., Petersen, K.S., Simonsen, C., Zachariae, C., & Thesturp-Petersen, K. (1994). Changes in cellular immune function after immune specific guided imagery and relaxation in high and low hypnothizable healthy subjects. Psychotherapy and Psychosomatics, 61, 74-92.
  40. Zennaro, A. (2013). Per una psicologia della cure primarie. Simposio presentato al X Congresso Nazionale SIPSA, La ricerca delle buone pratiche in Psicologia della Salute, Orvieto 10-12 Maggio.

Luigi Solano, Michela Di Trani, Rosa Ferri, Alessia Renzi, Offrire risposte dove emerge la domanda: lo psicologo di base nell’assistenza sanitaria primaria in "RICERCHE DI PSICOLOGIA " 1/2015, pp 237-254, DOI: 10.3280/RIP2015-001015