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Attaching a New Understanding to the Patient-Physician Relationship in Family Practice

From the Department of Psychiatry and Behavioral Sciences (DT, PSC), University of Washington, Seattle

Correspondence: Address reprint requests to Darren Thompson, MD, Box 356560, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195

Background: As a result of continuity of care with patients and their families, family physicians are uniquely poised to form enduring clinical relationships with their patients. The degree of collaboration in and satisfaction with the patient-provider alliance has been shown to have important implications for treatment outcomes across a range of medical problems. Providing optimal care can require family physicians to appreciate the sequelae of having clinically relevant aspects of past relationships emerge in the health care relationship, both in their patients and in themselves. A conceptual model is essential to assist in recognizing these key aspects.

Methods: A literature search was conducted using MEDLINE. Key words entered were "illness" and "attachment theory." Thirty-five English-only articles appeared from which further relevant references were gathered.

Results: Attachment theory serves as a useful model for highlighting important features of physician-patient relationships, which can affect treatment outcome in the family practice setting. It posits that everyone has an innate need to form strong attachment bonds to their earliest caregivers. To ensure survival, the child adapts its bonding to the caregiver’s attachment style. With time, the maturing person develops a style of relating in subsequent caregiving relationships based on these early, and to some extent later, close relationships. Insecure attachment styles that can develop—dismissing, preoccupied, and fearful—have been shown to affect the clinical relationship and medical treatment outcomes often in important and predictable ways.

Conclusion: Family physicians can more easily adopt an understanding, compassionate, and flexible treatment stance by recognizing patients’ unique attachment relationship patterns, thereby improving medical treatment outcome.

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