Apart from the efficacy of an integrated psychosomatic approach there emerge problems with the psychosomaticist’s feeling of professional identity which are delineated and discussed in the light of the authors’ experience. For many years they took part in institutionalizing an approach combining internal and psychological medicine on the basis of a psychoanalytic orientation in a ward setting and an outpatient clinic for hypertensives which were both attached to a university hospital. The core conflict of professional identity in an approach like this is concerned with educational incompatibilities in the different fields, frictions of daily routines, and institutional tensions arising from controversial theoretical backgrounds and faculty policies. Different cognitive and action styles, varying attitudes concerning matters of timing and different necessities of empathy versus distance must be integrated like other polarities. Discussions about the favors of an integrated psychosomatic approach tend to underestimate the outlined problems of professional identity.

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