PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – COVERT PRESENTATIONS
This patient had not needed any ‘therapy’; she had the answers within herself but needed a skilful listener to enable her to make the transition from ‘obedient nonsexual child’ to ‘independent sexual adult’. By recognizing that the doctor/patient relationship started as teacher/pupil and by refusing to instruct her, the doctor helped Miss A. to take a more adult role, accept the problem as her own, understand the difficulties and see that she could solve it herself. The skill here lies not in what the doctor did but what she restrained herself from doing in response to the initial doctor/patient interaction.Doctors and nurses unskilled in picking up clues about hidden problems may find some contraceptive consultations baffling and frustrating. The patients who can never find a satisfactory method; this Pill made them sick, that one gave them headaches, the coil made them bleed, they had cystitis with the diaphragm, and there is no chance the partner will use a condom. These patients manage to outmanoeuvre and defeat their advisers. Only by understanding that ‘nothing is right with contraception’ may be a synonym for ‘nothing is right with my sexual life’ can this be untangled (Rogers, 1989). Sometimes specific complaints with contraception can turn out to have quite different causes.
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