Patientperspektivet på læge-patientrelationen i ... - Dagens Medicin

attachment theory: when you are sick or scared, a biological need of attachment is activated
according to psychologist John Bowlby [16]. The attachment theory is part of the evolutionary
psychology and was developed to understand the mother-child relationship [16]. The need of
attachment, however, is general and is activated in adults when they are sick or scared. The first
secure relationship with the mother is the ideal type for all human relationships, and it seems to be
the same kind of ”secure base” [17] many patients are seeking from their doctor. According to
Bowlby, this need for attachment can be activated throughout our lives;”Attachment behaviour is
conceived as any form of behaviour that results in a person attaining or retaining proximity to some
other differentiated and preferred individual, who is usually conceived as stronger and/or
wiser…attachment behaviour is held to characterize human beings from the cradle to the
grave..these forms of behaviour persist as an important part of man‟s behavioural equipment. In
adults they are especially evident when a person is distressed, ill or afraid”[16:129]. The patients
showed attachment behaviour by reason of a biological need for care from an individual who is
”stronger/wiser” than themselves, and the doctor automatically becomes ”caregiver”[16:133] in
the relationship.
The attachment theory has been applied to explain therapeutic relations in psychotherapy [18]. Our
study is the first to use the attachment theory to explain why patients in general practice prefer a
continuous relationship with a doctor. A few studies apply the attachment theory to the doctor-
patient relationship to illustrate how patients‟ different styles of attachment signify compliance [19-
22]. For instance, the GP is to recognise the patient, show understanding, be tolerant and confirm
the patient in order to make patients with an insecure attachment style secure [22]. These factors,
however, do not only create security for patients with insecure attachment. These are factors that,
according to other studies, create a good interpersonal doctor-patient relationship irrespective of the
patient‟s attachment style. [23-26]. The referred studies of attachment styles ignore the general term
of the attachment theory, i.e. that all patients, irrespective of the patient's attachment style, seek
security to some degree. According to this study the extent of attachment is depending on the reason
for encounter, and according to other studies the patient‟s individual attachment style [20-22]. One
may wonder why patients who are humiliated in the doctor-patient relationship [27,28] do not just
change doctor. It may seem irrational, but understood in terms of attachment theory, the doctor-
patient relationship is not a consumer relationship, where the patient can go “doctor shopping”, until
he or she is happy. It is difficult to cut off contact, because the patient is not a rational consumer,
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