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Success in inedical therapeutics depcntls heavily upon whether the doctor and patient adequately communicate their expectations o f one another. Communication serues as the mechanism for the necessary, constant reliegotiation of their interpersonal contract if the therapy is of more than brief duration. This implicit contract is necessary for assuring a sufficiently equitable, gratifying relationship that each will do hi.T part to accomplish therapeutic success. This paper discusses characteristics of effective doctorpatient communication, the process of "spiraling down" or progre,ssive failure of communication, and the manner in which snch a process may be reversed. lmmediate attention needs t o be given to the teaching of communication principles in programs of medical education.A great deal has been written about therapeutic communication by Jurgan also others who are concerned with the psychotherapies. These publications have extensively developed the central theme that communication is the principal tool and the core process by which a professional helps a patient with a psychosocial problem to change his thinking, feelings, and behavior.In this paper we would like to use the term therapcxtic communication in a broader sense. We propose that in the practice of all human therapeutics (including those of medicine and surgery, dentistry, nursing, speech therapy, and others ) the effectiveness of communication between the participants in the system is a major determinant of whether that therapy succeeds. Success in therapy, we also suggest, refers appropriately to attaining not only the goals of the therapist but also those of the patient. Although the doctor-patient relationship has often been considered in detail, the communicative process has received little attention as one of many factors that substantially influence whether the goals of medical therapeutics are likely to be accom. plished.' THE CONTEXT OF' THERAPEUTICSIn all therapies, the central goal is the arrest or cure of a malady, improvement in biological or psychological functioning,

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