Psychotherapie voor medische raadsels

Medisch onverklaarbare somatische klachten blijven een intrigerend fenomeen. Dit zowel voor de medische wereld, maar evengoed voor psychologen. Patiënten worden namelijk vaak na talloze medische onderzoeken doorverwezen voor psychotherapie. Binnen het psychotherapeutische veld blijft het zoeken naar een effectieve behandeling.

Dewi Hannon is beloftevolle klinisch psycholoog van het jaar. In haar masterproef werd een brede verkenning gedaan naar de bruikbaarheid van de concepten deficit en conflict in het begrijpen van medisch onverklaarbare klachten. Hiervoor werden meerdere gevalstudies geconsulteerd via het Single Case Archive (SCA). Hierbij werden zowel psychodynamisch-georiënteerde als cognitief gedragstherapeutische benaderingen in de analyse opgenomen.

Abstract: Medically unexplained symptoms (MUS) are somatic symptoms for which no sufficient organic cause can be found. Different theoretical models try to explain the origin and perpetuation of MUS. Hereby, psychological models can be categorized based on their focus on a deficit or a conflict in the understanding of MUS. The concepts of actual neurosis, (de)somatization, alexithymia, mentalization, attention bias and somatic attribution are briefly explained as deficit-oriented theories, whereas theories on conversion, unconscious phantasy and the psychosomatic family are approached as conflict-oriented. Both elements -deficit and conflict- might be present in various treatment approaches. Several psychotherapies for MUS have already been investigated on their effectiveness, often with promising results. Nevertheless the question still remains which interventions and which mechanisms of change are contributing to a good outcome. The scope of this study was to examine the various approaches being used by therapists in their encounter with patients with MUS and if the concepts of deficit and conflict could be related to these approaches. A meta-synthesis on ten published case studies on the treatment of patients with MUS was conducted. The selected cases were analyzed through a combination of data- and theory-driven thematic analysis and case comparison methodology in order to study the therapeutic process in-depth. Through qualitative theory-building, an integration of deficit- and conflict-elements could provide novel process-oriented insights for treatment of MUS. Findings suggest that both deficit- and conflict-oriented approaches might be useful in the treatment of MUS. Nevertheless most therapists seem to focus their treatment approach on the ‘underlying psychological cause’ of MUS. A hypothetical timeline of what a ‘typical’ treatment process in therapy of MUS could look like is given and limitations of the study and recommendations for further research are discussed.

De masterproef toont de bruikbaarheid van het Archief voor het optimaliseren van psychotherapeutische behandelingen.

Je kan de volledige masterproef hier raadplegen.

Single Case Archive

The Single Case Archive compiles clinical and empirical single case studies on psychotherapies. These case studies were screened by an international group of researchers for basic information on patient, therapist, therapy and research method. The objective of this online archive is to facilitate the study of case studies for research, clinical and teaching purposes.

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