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Increased serum creatine phosphokinase (C.P.K.) levels have been shown in acutely psychotic patients on admission to hospital (Meltzer, 1968). Little is known about C.P.K. activity in non-psychotic (e.g. neurotic) patients admitted under similar conditions. Psychotic patients have not been compared with non-psychotic patients over a period of time following admission. Examination of a single serum sample for C.P.K. activity in non-psychotic patients at the time of admission has shown no abnormality (Meltzer et al., 1969).

An important component of any course of professional training is the process by which a trainee comes to adopt a professional stance in relation to his patient, client or client system. This paper is concerned with the way a professional role model is adopted, maintained and developed, a process that should be clearly distinguished from the acquisition of specific skills appropriate to the profession, such as the use of conceptual schemata, selective attention, the ordering of data, manipulative skills, etc. The point at issue is: how does an amateur become imbued with a sense of identity, a set of values and an attitude to his client that marks him off from his fellows? In so far that in one segment of his social life he comes to have a special kind of relationship with those about him and to live life accordingly, he gives evidence of having been through a very particular socializing experience or conversion process: in one segment of his life at least he has come to look upon himself and those about him differently.Although the ideas presented here derive mostly from experiences in training the so-called helping professions, it may be that they apply to other professions in which the conduct of the relationship between the worker and the client is governed by values other than those that bear upon people's behaviour generally. My focus is upon the management of the client-worker relationship in the service of a job to be done. Although the majority of the observations are derived from the training of doctors and of psychoanalysts together with the training of closely related colleagues, such as social workers, it is probable that the same considerations apply to the professional development of architects and solicitors, for example. What is it that regulates the so-called professional relationship? they need to do together if they are to accomplish the agreed aim of their meeting. If a patient goes to his doctor for the relief of a pain in his abdomen, he may have to allow the doctor to examine him in a way which the doctor thinks is appropriate but which the patient would find quite unacceptable from most other people. There are certainly rational considerations of this sort that bear upon what does go on between these two people and what does not. It is doubtful, for instance, if a patient would agree readily to the doctor paying more attention to the state of his bank balance than to that of his body or mind. But as any doctor knows, what he should or should not do with any particular patient is as much directed by some need to see himself as a good doctor behaving along lines that have been sanctioned by his training as by the application of original thought or strictly rational methods. In addition to all the skills he has acquired in the course of his training much of his behaviour is regulated by rules of conduct that prescribe the kind of relationship that is proper between doctor and patient.What is it, for instance, that prevents a young male doctor from following up the physical examination of an at...

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