Dependence and caring in clinical communication: the relevance of attachment and other theories.
OBJECTIVE
Clinical relationships are usually asymmetric, being defined by patients' dependence and practitioners' care. Our aims are to: (i) identify literature that can contribute to theory for researching and teaching clinical communication from this perspective; (ii) highlight where theoretical development is needed; and (iii) test the utility of the emerging theory by identifying whether it leads to implications for educational practice.


METHODS
Selective and critical review of research concerned with dependence and caring in clinical and non-clinical relationships.


RESULTS
Attachment theory helps to understand patients' need to seek safety in relationships with expert and authoritative practitioners but is of limited help in understanding practitioners' caring. Different theories that formulate practitioners' care as altruistic, rewarded by personal connection or as a contract indicate the potential importance of practitioners' emotions, values and sense of role in understanding their clinical communication.


CONCLUSIONS
Extending the theoretical grounding of clinical communication can accommodate patients' dependence and practitioners' caring without return to medical paternalism.


CONCLUSIONS
A broader theoretical base will help educators to address the inherent subjectivity of clinical relationships, and researchers to distinguish scientific questions about how patients and clinicians are from normative questions about how they should be.
Salmon
Peter
P
Division of Clinical Psychology, University of Liverpool, Liverpool, UK. psalmon@liv.ac.uk
Young
Bridget
B
D000533:Altruism; D001291:Attitude of Health Personnel; D001318:Authoritarianism; D003142:Communication; D003858:Dependency, Psychological; D004517:Education, Professional; D004644:Emotions; D004645:Empathy; D006801:Humans; D007206:Individuality; D009013:Morale; D009769:Object Attachment; D026706:Paternalism; D010358:Patient Participation; D011287:Prejudice; D024382:Professional Role / Q000523:psychology; D011369:Professional-Patient Relations; D011582:Psychological Theory; D012201:Reward; D012449:Safety