Pastoral relationships and holding work in primary care: affect, subjectivity and chronicity

Abstract

Objectives: To understand family doctors' constructs of long-term therapeutic relationships with patients in primary care. Methods: Semi-structured interviews were administered to general practitioners with >5 years of experience ( n=28) working in an English semi-rural district, and the results were subjected to constant comparative qualitative analysis. Results: Participants identified pastoral relationships as long-standing patterns of doctor—patient interaction aimed at providing reliable supportive care indirectly concerned with clinical medicine. Holding work was identified as a technique for structuring and delivering care within pastoral relationships. Pastoral relationships and holding work were seen as valuable in the affective management of people with long-standing chronic illness, especially mild-to-moderate depression and anxiety. Discussion: At a time when primary care is undergoing significant structural change, respondents in this study laid emphasis on personal and continuing relationships with patients who had diffuse needs connected with the experience of complex and chronic problems, and their accounts intimately connected life events with health status. Importantly, these accounts suggest that such relationships are hard to define and therefore hard to measure, but have important therapeutic purposes.