Creating a positive therapeutic alliance.

Abstract

M r. Ortega, age 32 and of Costa Rican heritage, arrived for an appointment with the physician in his company’s outpatient clinic. In fluent English with a Costa Rican accent, he explained that during the past 5 months he had had pains in his stomach, had not eaten well, and had lost about 20 pounds. The physician, a European American man in his 60s, did a thorough medical exam and then asked Mr. Ortega if he was experiencing some stress in his life. Mr. Ortega said yes, that he and his wife had not been getting along, that she had gone back to Costa Rica with their daughter to visit her family, and that he was afraid they might not return. The physician responded that this sounded like a very stressful situation. He went on to explain that Mr. Ortega’s problem appeared to be “heartburn” (esophageal reflux), which can be aggravated by stress. While writing a prescription for a medication, the physician asked Mr. Ortega if he would be willing to see the “nurse practitioner therapist” for a few minutes “to talk about stress and diet in relation to