Over the last two decades, doctors and psychologists have attempted to construct models of the consultation which give insight into the complex interactions between doctors and patients.1 Even earlier, methods of effective counselling had been developed which greatly enhanced communication within a consultation.
The first attempt to categorize consultations grew out of good counselling practice and concerned the different types of intervention doctors could make (Heron, 1975). Interventions were broadly grouped as either authoritarian or facilitative, the former representing the more traditional medical behaviour and the latter being more patient-centred. Authoritarian interventions comprised prescriptive (‘the IUCD is a good method for you’), informative and confronting categories. Facilitative interventions were grouped into: (1) cathartic, that is, allowing release of emotion; (2) catalytic, encouraging the client in his train of thought (‘Go on’, ‘Hmm’ and so on from the doctor); or (3) supportive (‘I understand’ or a nonverbal nod of the head).
*332/197/1*
