The history of the present illness as treatment: who's listening, and why does it matter?

BACKGROUND: The history of the present illness (HPI) is examined as a narrative communication that has the potential to be therapeutic.
METHODS: The general principles that influence the therapeutic potential of the HPI are induced from participant observation of personal experience and natural observations of conventional social interaction. These principles are corroborated by evidence from cross-cultural healing practices, clinical experience, and experimental psychology.
RESULTS: To facilitate a therapeutic HPI, the clinician should convey a sense of safety, sensitivity, affective competence, and cognitive competence. Furthermore, the effective clinician joins the patient in coprocessing the illness experience.
CONCLUSIONS: The (HPI) is not simply a diagnostic formulation. When skillfully negotiated, it can be therapeutic because it helps patients make cognitive sense of their illness, and it serves as a vehicle for sharing the affective burden with the physician. There is therapeutic potential in each of the three overlapping operations of the HPI: (1) establishing a physician-patient relationship through the process of gathering a database, (2) transforming the database into an etiologic narrative, and (3) using the narrative to coprocess the experience of illness with the patient. The therapeutic potential can be actualized by specific clinical applications.