Training as an Impetus to Ego Development

I am going to put some questions before you which have been going through my mind during the past 15 years while I have been participating in a training program for general practitioners, particularly during the past two years while undertaking a research1 into a sample of randomly chosen cases with a group of experienced general practitioners who have attended our seminars for many years. My inquiries are also relevant to psychoanalytic training, and I will discuss them in that context later in this paper. But it was the changes in the doctors and their reactions to the strains of examining and reconsidering their relationships with their patients during the training that led me to formulate the questions: 1. What happens in a seminar to bring about changes in some of the doctors and not in others? 2. In what kind of doctors can changes occur, and what kind of changes are they? 3. What activity on the part of the leader in the seminar facilitates change?

To discuss these questions, I must first describe the general practitioners' seminars in which our principal aim is to study the doctor-patient relationship, rather than the interactions among the seminar members.

We do not attempt to teach theory but to help the doctors become more flexible observers of themselves and their patients to the end that their therapy is more efficient and reliable. Our discussions emphasize the relationship of a given doctor to a given patient during one particular course of treatment; how the understanding of this relationship helps the doctor understand the patient's illness and the patient himself, and how it may clarify difficulties in the therapy as well as in other relationships in the patient's life. (I might mention here that the varying responses to the considerable strains imposed by such observations parallel those of psychoanalytic candidates.)

Certainly, every course of medical treatment is determined by the patient's illness and personality and by the doctor's knowledge and