An Intervention Model of Psychological Scaffolding for the Doctor–Patient Relationship

The authors provide guidelines for a model of psychological intervention in healthcare contexts. They begin by discussing the social and cultural changes underlying current shifts in medical practice, noting that medical breakthroughs are arising in increasingly fast succession, producing new challenges for the doctor–patient relationship. In addition, new values are emerging in the doctor–patient relationship, such as the patient’s right to self-determination, autonomy, competence acquisition, and shared decision-making. Delivering on these values demands focusing not merely on isolated individuals, but also on the very relationship between the physician and patient (in its practice and objectives) as the unit of analysis and intervention. Accordingly, the authors propound a psychological scaffolding intervention model for the doctor–patient relationship, understanding it as a relational field that is conducive to sense-making processes, and transforming them by dialog and translation. The scaffolding intervention is designed to support the relationship through all phases of change and transition (diagnosis, prognosis, counseling, and therapy), which are characterized by high uncertainty and unpredictability. The intervention introduces a cognitive psychological function and aims to integrate an emotive side into the operative role of the doctor–patient relationship. Some of the scaffolding principles discussed are as follows: gradual learning of new relational competences, support for the development of sense-making processes, integration of the different trajectories of meaning emerging in the doctor–patient relationship, and gradual withdrawal of psychological support once the relationship has acquired competence.