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The importance of training in the emotional domain has been stressed since 1950. Balint and his co-workers advocate the conduct doctor-centred seminars (training and research) for better understanding of the contact with patients. The discussions form an understanding of the content of the consultation within the context of the sense and relationship. Balint's method, with its emphasis on the role of psychology in medical care and on the interpersonal relations between the group members and their patients, is a satisfactory answer to the need for communication in the dispensing of health care. The case reports and group discussions attempt to throw a light on the doctor-patient relationship through the identification of its form and content. This diagnosis enables the physician, at times, to intervene therapeutically. An intervention is therapeutic when it brings to the fore an emotional or cognitive factor in the doctor-patient relationship and enables the patient to recognize something new about himself, and in doing so, even to 'change'. The ability to be acquired largely comprises that which is necessary for developing and understanding a doctor-patient relationship. At the same time family groups and psychosocial problems are taken into account. Junior Balint Groups for medical students have now been in existence at various universities. For 25 years general practitioners, clinic doctors, university staff and medical students have met for international seminars in Ascona, known under the name of 'Ascona Model' (WHO) with the intendion of adding medical training and consist mainly of Balint teamwork.(ABSTRACT TRUNCATED AT 250 WORDS)

Konnen wir horen, was der Patient sagen will, aber nicht kann? Konnen wir spuren, was ihn eigentlich leiden lasst — hinter dem korperlichen Symptom? Konnen wir mit ihm zusammen herausfinden, was er brauchte, um besser leben zu konnen?

What are the typical aspects of a therapeutic relation, how does it develop and in what manner might it influence the therapeutic result? Encounter as therapy may open the chance to initiate self regulating forces that seem to be blocked by the 'disease'. The term 'disease' implicates the term 'therapy'. A real encounter demands trust and responsibility, unselfishness and readiness for risks from all persons involved (physicians and/or therapists as well as patients). The opposite terms, lack of trust, lack of responsibility, selfishness and lacking readiness for a risk mark the other side of the encounter, of the process of interaction. Encounter or the process of interaction always take place in time and space while persons define a situation. Rules and roles, patterns and exceptions are further structural characteristics of a situation.

These questions are addressed: What does it mean to be a physician, and how can a physician continue his education? Where is his place in family crises? The psychosomatic point of view of diseases is not a specialty, but a concept, a basic attitude, a global principle encompassing all medical specialties. In particular, disorders of relations and basic needs are discussed in the context of a novel therapeutic access. The doctor as a 'drug' corresponds to a therapeutic alliance, also in group work. The problems of communication, even as a flash, influence the language of the patient and the physician. In the tension between anxiety and trust, psychosomatic thinking and medical intervention come to life also for the experience of disease and in the search for a meaning. The physician is not as much an achiever than a provider.

Der Patient und der Arzt treffen im Sprechzimmer mit unterschiedlichen Voraussetzungen und Erwartungen aufeinander. Wir sollten „be-han-deln“und „Tater des Wortes“werden, nicht nur Horer.

Altern ist nach H. Schipperges schon eine Herausforderung, eine Provokation, die uns immer wieder von neuem herausfordert, in einer notwendig befristeten Existenz Stellung zu nehmen, da zu sein, wach zu bleiben, ohne sich einlullen zu lassen vom tragen Strom der Zeit. Eine Herausforderung verlangt ganz einfach — wenn man den provokativen Ton uberhaupt ernstnehmen will — eine Antwort.

Psychosocial dynamics within the family are first touched upon. Relationships between brothers and sisters play a special part in this respect, as do other factors related to personality development. It is one of the special tasks of the general practitioner to be alert to the first signs of emotional disturbances, for he is in an ideal position to intervene before more serious symptoms of illness appear. The physician has to acquire a valid picture of the family unit, with its physical and psychological strengths and short-comings. Continued flight from pressure of vital issues can lead to family neurosis in the long run. Then, the sick person is not really the carrier of disease in the traditional sense of germ or genetic consation. He is only a 'symptom' of a much more widely encompassing disease unit that has grasped a social cell like the family. Are we physicians and scientists in a position, as a consequence of our training, to see this possibility, or are such modes of thinking to be left to special fields like medical sociology? The isolated, sick person can show signs derived from a disturbed family relationship, particularly through psychosomatic disorders. Our 'psychosomatic confrontation' therapeutical method is introduced.

The "how" of prescribing is an important as what we prescribe. Drugs are part of everyday life for many people. The era of "social chemistry", the "inflation of drug use", or the "social use of drugs" create special difficulties for the "how" of prescribing. It is important that the expectation and fears of the patient are being taken seriously. The manner of prescribing has to depend on whether the patient interprets them negatively, as punishment and violent intrusion. But applications of drugs can also have a passive character, such as is the case with teas and baths. The physician should be aware of the contents of the package inserts, and keep them in mind so as to avoid mistaken interpretations by the patient. The psychological aspects of drug side effects are very important. A further concern is consideration of aspects of human interaction in diagnosis and therapy, also when applying medical drugs. Simplification of medication, written instruction concerning drug therapy addressed to the patient, intensified conversations with the patients on effects and side-effects of drugs are only a few practical examples of how patients can be influenced to the prescribed drugs more regularly.

A patient's symptoms may arise from difficulties in his family life. Relationships between brothers and sisters play a special part in this respect, as do other factors related to personality development. It is one of the special tasks of the general practitioner to be alert to the first signs of emotional disturbance, for he is in an ideal position to intervene before more serious symptoms of illness appear. It is also important to help resolve poor marital relationships, since the constant pressure of daily problems eventually may lead to a neurosis affecting an entire family. Through early psycho-hygienic care (Mental Health Education) a family can be helped to avoid these dangers.

Forschung und Erfahrung haben in der Familie gesundheitsgefahrdende Risikofaktoren erkennen lassen, deren Zahl und Kraft wesentlich durch die Familienstruktur beeinflust werden. Die Kommunikationsnote der Kleinfamilie entstammen dem Bedurfnis nach charakterlichen, seelischen und geistigen Wechselbeziehungen im Eltern-Kind-Verhaltnis. Bereits in unterschwelliger Form konnen sie sich als Bereitschaft zur Neurose und als Quellen psychosomatischer Leiden auswirken. Deshalb sollten diese psychisch und sozial bedingten Erkrankungen vermehrt in den Aktionsbereich praventivmedizinischer Masnahmen einbezogen werden. In der Vielfalt der durch Herkunft, Schulbildung, Beruf und soziale Stellung gepragten Erziehungsstile haben sich bestimmte intrafamiliare Konflikte mit stereotypen Reaktionen gezeigt.

Der Halt, den die Familienmitglieder aneinander finden, scheint das beste Mittel zu sein, um psychischen Storungen vorzubeugen, die durch Umweltschwierigkeiten entstehen konnen.

„Schon in diesem Augenblick, in dem ich hier das Podium betrete und zu Ihnen zu sprechen beginne, entwickeln sich unmerklich Prozesse zwischen uns, die entscheiden werden, ob dieser Vortrag an Ihnen vorbeirauscht oder zu einer Begegnung zwischen uns wird…“(Renate Fruhmann).

Bevor wir mit der eigentlichen Gruppenarbeit begonnen haben, haben wir uns erst einmal daruber unterhalten, was uns die Vortrage, die ja sehr verschieden waren, gesagt haben und was wir daraufhin fuhlten. Die Reaktionen waren sehr unterschiedlich. Sehr viele haben gesagt, es hat uns alles gut gefallen. Andere waren total eingenommen. Aber einige haben doch auch ein starkes Unbehagen geausert, u. a. auch ich, weil wir eine solche Spannung gespurt haben. Da war der Standpunkt, den ich bei Luban-Plozza verbalisiert gesehen habe: Du must nicht alles wissen, du darfst denken. Der Patient ist wichtig und der zentrale Punkt in der Therapie, der Arzt als fuhlender Mensch. Nicht die Worte sind das Wichtige. Fur mich und sicher fur viele andere auch, hat sich eine Spannung ergeben zwischen diesem Standpunkt und der Tendenz in einigen Vortragen, das die Menschen, die Patienten hinter Worten zurucktreten. Diese Tendenz kennt sicher jeder, und ich weis nicht, wie man die Spannung losen konnte. Dieses Unbehagen wollte ich jedenfalls ausdrucken. Man hatte von einigen Vortragen den Eindruck gewinnen konnen, das man nur noch lesen muste. Das ist sicher nicht die Wahrheit, wie das andere auch nicht alleinige Wahrheit sein kann.

Seit 1969 hatten wir in der Psychiatrischen Universitatsklinik Mailand mit Unterstutzung von Prof. C. L. Cazzullo, Direktor der Klinik, Studenten-Balint-Gruppen (von uns „Juniorgruppen“ genannt) ausgebildet. Hiermit sollte den kunftigen Arzten eine psychologische Grundlage fur ihr spateres Werk gegeben werden. Wir hatten dies mit M. Balint mehrmals besprochen. Er war diesem Versuch gegenuber skeptisch gewesen, hatte in ihm aber ein taugliches Forschungsmittel gesehen.

Die psychosomatischen Krankheiten haben in den letzten Jahren wachsendes Interesse hervorgerufen, sowohl bei Medizinstudenten wie auch bei praktizierenden Arzten. Dennoch mus zugegeben werden, das man sich hinsichtlich des tieferen Verstandnisses mancher Symptomentstehung noch immer in der „Stotterphase“ befindet, besonders auch in bezug auf die entspechenden Mittel und Wege der Behandlung. Der praktische Arzt und auch der Spezialist fuhlen sich gegenuber Patienten mit psychosomatischen und psychosozialen Problemen oft machtlos, nicht allein aus Zeitmangel, sondern vielmehr aufgrund einer unzureichenden Ausbildung.

Advantages and methods of treating smoking addiction during hospitalisation are described briefly.

Der Tumorpatient ist kein besonderer Mensch, er bedarf allerdings als Kranker einer besonderen menschlichen Zuwendung.

The "how" of prescribing is an important as what we prescribe. Drugs are part of everyday life for many people. The era of "social chemistry", the "inflation of drug use", or the "social use of drugs" create special difficulties for the "how" of prescribing. It is important that the expectation and fears of the patient are being taken seriously. The manner of prescribing has to depend on whether the patient interprets them negatively, as punishment and violent intrusion. But applications of drugs can also have a passive character, such as is the case with teas and baths. The physician should be aware of the contents of the package inserts, and keep them in mind so as to avoid mistaken interpretations by the patient. The psychological aspects of drug side effects are very important. A further concern is consideration of aspects of human interaction in diagnosis and therapy, also when applying medical drugs. Simplification of medication, written instruction concerning drug therapy addressed to the patient, intensified conversations with the patients on effects and side-effects of drugs are only a few practical examples of how patients can be influenced to the prescribed drugs more regularly.

Bei Viktor von Weizsacker (1886–1957) ging es um eine umfassende Krankheitslehre, die spater einmal die Trennung in leibliche und seelische Entstehungsweisen uberwinden sollte.

Am Monte Verita bestand von Anfang an die Utopie der ideellen Gesellschaft. Gegen Ende des 19. Jahrhunderts, getragen vom Impetus des Jugendstils, stiesen die Junger des neuen Lebensgefuhls auf ihrer Suche nach der „Blauen Blume“ (der Kornblume) auf den spiritus loci des Monte Monescia in Ascona, den sie, im Geiste ihrer Suche nach dem nun gefundenen Ziel, hinfort „Monte Verita“ nannten.

The persons around the psychosomatic patient usually regard him either as seriously ill with some organic disease, or as a trivial case, a hypochondriac or malingerer. The patient’s symptoms are often aggravated as a direct consequence; he feels deserted and alone.