I’ve enjoyed spending the early stages of my PhD mapping out the major themes and sub-themes of my research. One of these themes is the therapeutic alliance between young people and general practitioners. But what exactly is meant by therapeutic alliance? It seems a very slippery term, that has it’s roots mostly in the psychology field. And does therapeutic alliance mean the same for young people as it does for older adolescents?

Unpacking this, emerging sub-themes include trust, confidentiality, feeling judged and rapport. However, I hadn’t really considered the potential to feel shame (which, on reflection, is of course closely related to feeling judged). An interesting blog post reported on upcoming research that found that almost 1 in 4 young people had an encounter with their GP that made them feel ashamed, most commonly for weight, sexual activity and teeth. In the older group 52% felt guilt after a doctor’s visit.

While the validity and reliability of the research is unclear, I can’t help but think that any such trend is rather alarming and disturbing – particularly considering that a negative help-seeking experience makes young people less willing to seek help in the future (Rickwood, et al., 2007). It makes me wonder – is there an emotion that is as disabling as shame, particularly when considering seeking help?

The other major finding of the study is in how young people interpret the behaviour. If they see the problem as a behaviour that can be changed, rather than assuming that it means they are a bad person, they will be more likely to make positive changes (not surprising really, why bother trying to change if it seems like it’s simply a representation of your core being).

It means that GPs can play a critical role in reducing shame, by helping young people understand the behaviour is just that – a behaviour that can be changed. In terms of my research, it means that I need to be mindful of ensuring that as well as facilitating disclosure there are systems in place to support GPs to identify and address feelings of guilt and shame.