Psychological Scaffolding in the Healthcare Relationship: A Methodological Proposal

Psychological scaffolding in healthcare relationships allows the system to guarantee a gradual and progressive way to meet medical goals. From a psychological point of view, you cannot separate these goals from how they are reached and from the experience the patients have within the clinical relationship. Ownership is another important concept, and it is marked by patient empowerment within the clinical relationship. The owner of a relationship is not the patient who passively awaits and accepts treatment. In any medical dialogue, everyone can “own” a point of view or a proposal that can influence the dynamics of the clinical relationship. Active ownership and partnership are not prerequisites for the relationship but come about as the relationship progresses. Consensus involves moving from a passive attitude of informed consensus and medical authority to the possibility of bringing together different points of view, evaluation perspectives, and ways of describing the illness. Consensus can take place when ownership of the technical, pragmatic, cognitive, emotional, cultural, and social contents is integrated. Bringing different points of view together leads to the sharing, development, and experience of new ways of integrating meaning (consensus) of the illness and its treatment (Freda et al., 2014; Gleijeses & Freda, 2009; Zaccaro & Freda, 2011). Consensus implies a continual exchange between the health system and the patients and their families (Jankovic & Masera, 2012). In dealing with concordance, we look at ways of dealing with one of the most difficult aspects of the clinical relationship: uncertainty. Accepting uncertainty and negotiating between reality and hope can be problematic. Decision making allows us to make decisions for the future. By sharing the process of decision making, the healing process is shared in the longer term (including past, present, and future). In doing so, we move away from events and actions and towards processes. Thanks to ownership and consensus, the future is no longer seen in terms of diagnostic probability but as shared meaning in which both the biological outcomes and the subjective, social, cultural, and economic outcomes of the healthcare relationship are considered. By understanding the multidimensional and multitemporal aspects of the illness (Freda, De Luca Picione & Martino, 2015), choices and responsibilities that were once taken for granted can become shared. Psychological intervention does not limit itself to creating a harmonious atmosphere between doctors and patients but rather works towards greater competency and autonomy in all participants through dialogue and the semiotic translation of all meaningful aspects of the relationship. Psychological scaffolding is a dynamic process where new ways of organizing and developing the relationship can be tested, so that effective decisions and communication can be made taking into account medical, physiological, and personal issues.