A methodological proposal of integration: The Psychological Scaffolding for the healthcare relationship

Abstract

The authors discuss principles of a model of psychological intervention in the healthcare, from some considerations on current social and cultural changes that are redirecting the practice of medicine. The increasing successes of medicine are accompanied by new challenges for healthcare relationship (i.e. self-determination, autonomy, skills acquisition, sharing of decision-making). The realization of these values requires that the focus of intervention is not addressed to single individuals, but to the whole relationship, as unit of analysis and intervention in its performance and in the pursuit of its objectives. The model proposed is an Intervention of the Psychological Scaffolding to the healthcare relationship, understood as a relational field that makes possible the realization of semiotic processes of sensemaking and their transformation through dialogic and translational processes. The intervention of Scaffolding can sustain the relationship during all the steps of transition and transformation (diagnosis, prognosis, consultation, therapy, etc.) – in which there occur large margins of uncertainty and unpredictability – by introducing a psychological function of thought and by integrating emotional tasks and operational tasks. This model is based on the transformation of key components of the healthcare relationship in psychological tasks: 1) The Ownership of the healthcare relationship from a mere use to the development of subjectivity within a relationship; 2) From the informed consent as disclaimer to the construction of the Cum-Sensum, namely the development of a resource of sense; 3) From the therapeutic adherence to the shared decision-making and to the Concordance. Some of the principles of Scaffolding are: the gradual learning towards the acquisition of new competences, the support for the development of the processes of sensemaking, the integration of many different trajectories of meaning, the gradual removal of psychological support when the relationship has acquired expertise.