1
|
Norman UA, Truijens F, Desmet M, De Smet M, Meganck R. Impact of personality style changes on CBT and PDT treatment responses in major depression. Acta Psychol (Amst) 2024; 246:104295. [PMID: 38701624 DOI: 10.1016/j.actpsy.2024.104295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
This study examines the influence of depressive personality styles on treatment responses in patients with major depression receiving cognitive behavioural therapy and psychodynamic therapy. We assessed changes in personality styles, including dependency, self-criticism, sociotropy, and autonomy, and their association with treatment response. Both treatment modalities led to significant reductions in self-criticism and sociotropy scores. Depressive symptom severity decreased overall, with a more pronounced reduction observed in the cognitive behavioural therapy group. Notably, reduced self-criticism and sociotropy were associated with better treatment outcomes in the cognitive behavioural therapy group. Our findings highlight the role of personality styles in influencing treatment outcomes for major depression. The study suggests an association between changes in personality styles and the reduction of symptoms. Our results support the idea that unique pathways of change are activated depending on the therapeutic intervention. These insights are critical in tailoring treatments to individual needs, addressing the central question of 'what works for whom'.
Collapse
Affiliation(s)
| | - Femke Truijens
- Department of Psychology, Education & Child Studies/Clinical Psychology, Erasmus University Rotterdam, Netherlands
| | - Mattias Desmet
- Department of psychoanalysis and clinical consulting, Ghent University, Ghent, Belgium
| | - Melissa De Smet
- Department of Methodology, Tilburg School of Social and Behavioural Sciences, Tilburg University
| | - Reitske Meganck
- Department of psychoanalysis and clinical consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
2
|
De Smet MM, Acke E, Cornelis S, Truijens F, Notaerts L, Meganck R, Desmet M. Understanding "patient deterioration" in psychotherapy from depressed patients' perspectives: A mixed methods multiple case study. Psychother Res 2024:1-15. [PMID: 38319980 DOI: 10.1080/10503307.2024.2309286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/12/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliable symptom increase pre-to-post treatment. METHOD An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre-post outcome evaluation of self-reported depression symptoms and qualitative analysis of patients' interviews. In a Randomized Controlled Study on the treatment of Major Depression, three patients showing reliable increase in symptom severity on the BDI-II pre-to-post therapy were selected. An interpretative phenomenological analysis (IPA) was performed on individual interviews conducted pre-, peri- and post-treatment. RESULTS Cross-case outcome experiences were: (1) uncontrollable complaints; (2) remaining questions and uninternalized insights and (3) persisting interpersonal difficulties. Within-case idiosyncratic differences revealed that the statistical classification of "deterioration" not necessarily corresponds to a "deteriorated experience," nor univocally indicates unwanted therapy effects. Our findings point at the influences of the patient's (lack of) agency in the process, a discrepancy between patients' expectations and the therapy offer, the therapeutic relationship, interpersonal difficulties, and contextual influences. CONCLUSION The meaning of symptomatic deterioration should be interpreted within a patient's idiosyncratic context. The multi-faceted nature of deterioration requires further research to rely on multiple perspectives and mixed methods.
Collapse
Affiliation(s)
- Melissa Miléna De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
- Research Foundation Flanders, FWO, Brussels, Belgium
| | - Emma Acke
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Femke Truijens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Liza Notaerts
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
3
|
Coppens S, Somville A, Hoogma DF, Dewinter G, Neyrinck A, Desmet M, Vandebroek A, D'Hoore A, Wolthuis A, Bislenghi G, Fieuws S, Rex S. The effect of anterior quadratus lumborum block on morphine consumption in minimally invasive colorectal surgery: a multicentre, double-blind, prospective randomised placebo-controlled trial. Anaesthesia 2024; 79:54-62. [PMID: 37970976 DOI: 10.1111/anae.16177] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
We investigated the efficacy and safety of a bilateral anterior quadratus lumborum block in patients undergoing minimally invasive colorectal surgery. This was a two-centre, double-blind, prospective, randomised, placebo-controlled trial including 150 patients undergoing laparoscopic colorectal surgery (left- or right hemicolectomy, sigmoidectomy) who were enrolled in the institutional abdominal enhanced recovery programme. Before induction of anaesthesia, patients received a bilateral anterior quadratus lumborum block in the left and right lateral decubitus position under ultrasound guidance and were allocated randomly to receive 30 ml of ropivacaine 0.375% (n = 75) or placebo (saline 0.9%) (n = 75) bilaterally. Postoperatively, all patients received multimodal intravenous analgesia including paracetamol, ketorolac and patient-controlled analgesia with morphine. The primary outcome was morphine consumption during the first 24 h after tracheal extubation. Secondary outcomes included severity of pain; presence and extent of sensory block; incidence of postoperative nausea and vomiting; and hospital duration of stay. We also investigated the need for, and dose of, rescue analgesia. Safety outcomes included the incidence of adverse events. Mean (SD) 24-hour morphine consumption was no different between patients allocated to ropivacaine and placebo (28.6 (22.3) mg vs. 28.4 (22.5) mg, p = 0.966, respectively). While a sensory block could be detected in significantly more patients allocated to the ropivacaine group, no differences were detected in pain scores or other secondary or safety endpoints. Patient satisfaction scores were high in both groups. In laparoscopic colorectal surgery, adding a bilateral anterior quadratus lumborum block to a standard multimodal analgesia regimen did not reduce opioid consumption or improve pain scores.
Collapse
Affiliation(s)
- S Coppens
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - A Somville
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
| | - D F Hoogma
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - G Dewinter
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - A Neyrinck
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - M Desmet
- Department of Anesthesiology, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | - A Vandebroek
- Department of Anesthesiology, AZ Groeninge Kortrijk, Kortrijk, Belgium
| | - A D'Hoore
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - A Wolthuis
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - G Bislenghi
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Department of Abdominal Surgery, University Hospitals of Leuven, Leuven, Belgium
| | - S Fieuws
- Biomedical Sciences Group, Leuven Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Leuven, Belgium
| | - S Rex
- Department of Anesthesiology, University Hospitals of Leuven, Leuven, Belgium
- Biomedical Sciences Group, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| |
Collapse
|
4
|
Meganck R, Desmet M, Van Nieuwenhove K, De Smet M, Hennissen V, Truijens F, De Geest R, Hermans G, Bockting C, Norman UA, Loeys T, Inslegers R, Van den Abeele T, Baeken C, Vanheule S. The Ghent Psychotherapy Study: A Pragmatic, Stratified, Randomized Parallel Trial into the Differential Efficacy of Psychodynamic and Cognitive-Behavioral Interventions in Dependent and Self-Critical Depressive Patients. Psychother Psychosom 2023; 92:267-278. [PMID: 37562373 DOI: 10.1159/000531643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Different types of psychotherapy are effective for treating major depressive disorder across groups yet show large within-group differences. Patient personality style is considered a potentially useful variable for treatment matching. OBJECTIVE This study is the first experimental test of the interaction between therapeutic approach and patients' dependent versus self-critical personality styles. METHODS A pragmatic stratified parallel trial was carried out with 100 adult patients diagnosed with DSM-IV-TR major depressive disorder. They were randomly assigned to short-term (16-20 sessions) cognitive behavioral therapy (CBT) or short-term psychodynamic psychotherapy (STPP). Patients were assessed at baseline, during therapy, post-therapy, and at 3- and 6-month follow-up. Primary outcome is depression severity measured by the Hamilton Rating Scale for Depression posttreatment. Primary analysis was by intention to treat. This trial is registered with the ISRCTN registry (www.isrctn.com), number ISRCTN17130982. RESULTS The intention-to-treat sample consisted of 100 participants; 40 with self-critical and 60 with dependent personality styles were randomized to either CBT (n = 50) or STPP (n = 50). We observed no interaction effect (-0.34 [-6.14, 5.46]) between therapy and personality style and found no evidence for a difference in effectiveness between the treatments in general in terms of symptom reduction and maintained benefits at 6-month follow-up. CONCLUSION We found no evidence that dependent versus self-critical personality styles moderate the relation between treatment and outcome in depression. Research using individual patient data could gain further insight into why specific therapeutic approaches work better for specific patients.
Collapse
Affiliation(s)
- Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Gent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Gent, Belgium
| | | | - Melissa De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Gent, Belgium
| | - Vicky Hennissen
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Gent, Belgium
| | - Femke Truijens
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Rosa De Geest
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Gent, Belgium
| | - Goedele Hermans
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Gent, Belgium
| | - Claudi Bockting
- Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Tom Loeys
- Department of Data-analysis, Ghent University, Gent, Belgium
| | - Ruth Inslegers
- Department of Wellbeing and Society, OCMW, Antwerpen, Belgium
| | - Tim Van den Abeele
- Laboratory of Medical Biochemistry and Clinical Analysis, Ghent University, Gent, Belgium
| | - Chris Baeken
- Department of Head and Skin (UZGent), Ghent University, Gent, Belgium
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Gent, Belgium
| |
Collapse
|
5
|
Norman UA, Truijens F, Desmet M, Meganck R. Depressive personality traits and temperament and character personality traits in a clinical sample: Results from regression and network analyses. Acta Psychol (Amst) 2023; 234:103860. [PMID: 36774773 DOI: 10.1016/j.actpsy.2023.103860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Personality and psychopathology are highly relevant and easily relatable constructs. The current study investigated the relationships between dependency and self-criticism, sociotropy and autonomy depressive personality traits, and Cloninger's temperament and character personality traits postulated as vulnerability factors for depression, in relation to depressive and general psychopathology symptoms in a clinical sample of 100 patients diagnosed with major depressive disorder. The results showed that self-directedness, a character trait of the temperament and character model, was positively associated with dependency, self-criticism, sociotropy, and autonomy. Applying more in-depth analyses with regression models revealed associations between self-directedness and depressive personality styles dependency and sociotropy, and general psychopathology symptoms was a significant clinical indicator in these relationships. Going beyond the regression models, network analysis showed that self-directedness is associated with self-criticism, sociotropy, autonomy, and general psychopathology symptoms. The relationship between self-directedness and sociotropy, self-criticism and autonomy suggests that these depressive personality traits may be attributable to aspects of self-determination, maturity, responsibility, discipline, and self-acceptance. General psychopathology research informed by literature incorporating personality traits has far-reaching implications for understanding individual differences as well as increasing efforts to contribute to the amelioration of disabling psychological disorders like major depressive disorders.
Collapse
Affiliation(s)
| | - Femke Truijens
- Department of Psychology, Education & Child Studies, Department of Clinical Psychology, Erasmus University Rotterdam, Netherlands
| | - Mattias Desmet
- Department of psychoanalysis and clinical consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- Department of psychoanalysis and clinical consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
6
|
Truijens F, De Smet M, Vandevoorde M, Desmet M, Meganck R. What is it like to be the object of research? On meaning making in self-report measurement and validity of data in psychotherapy research. Methods in Psychology 2023. [DOI: 10.1016/j.metip.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
|
7
|
Hennissen V, Van Nieuwenhove K, Meganck R, Dulsster D, Krivzov J, Desmet M. The self-critical patient in clinical supervision: a qualitative study of therapists’ alliance struggles and emotional reactions in short-term psychodynamic psychotherapy for depression. Counselling Psychology Quarterly 2022. [DOI: 10.1080/09515070.2022.2050676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Vicky Hennissen
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Dries Dulsster
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Juri Krivzov
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
8
|
Meganck R, Krivzov J, Notaerts L, Willemsen J, Kaluzeviciute G, Dewaele A, Desmet M. The single case archive: Review of a multitheoretical online database of published peer-reviewed single-case studies. Psychotherapy (Chic) 2022; 59:641-646. [PMID: 35191723 DOI: 10.1037/pst0000431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Case study methods are increasingly recognized as crucial methods to enhance understanding of the complexity of psychotherapy processes and as way to bridge the science-practice gap. The Single Case Archive (SCA) was constructed to facilitate access to the existing field of case study research for academic, clinical, and educational purposes. Cases were selected through systematic screening of relevant peer-reviewed journals in the field of psychotherapy research and rigorous snowball sampling. All cases meeting inclusion criteria were inventoried using the Inventory for Basic Information in Single Cases that maps study, patient, therapist, and therapy characteristics. About 3,471 cases from 175 peer-reviewed journals published between 1955 and 2019 were included in the SCA database. The SCA comprises cases from different theoretical backgrounds, discussing patients from different age categories, with different presenting problems going through a diversity of psychotherapeutic treatments that are studied using a range of methods. Cases differ strongly with respect to the amount of information that is present in the case study, and the field should pay more attention to ethical considerations like informed consent and providing relevant basic descriptive information. An online platform makes the SCA database searchable by researchers, clinicians, and students. In conclusion, the SCA is a unique resource that makes case studies more easily accessible, facilitates meta-studies and reviews of case studies, and stimulates methodological developments in the field of case study research. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Juri Krivzov
- Department of Psychoanalysis and Clinical Consulting
| | - Liza Notaerts
- Department of Psychoanalysis and Clinical Consulting
| | | | | | - Alexis Dewaele
- Department of Experimental, Clinical and Health Psychology
| | | |
Collapse
|
9
|
Schiepek G, Felice G, Desmet M, Aichhorn W, Sammet I. How to measure outcome? A perspective from the dynamic complex systems approach. Couns and Psychother Res 2022. [DOI: 10.1002/capr.12521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Günter Schiepek
- Institute of Synergetics and Psychotherapy Research Paracelsus Medical University Salzburg Austria
- Psychotherapy and Psychosomatics University Hospital of Psychiatry Paracelsus Medical University Salzburg Austria
- Department of Psychology Ludwig Maximilian University of Munich Munich Germany
| | - Giulio Felice
- Xenophon College University of Chichester Chichester UK
- Department of Clinical Psychology Sapienza University of Rome Roma Italy
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting Ghent University Ghent Belgium
| | - Wolfgang Aichhorn
- Institute of Synergetics and Psychotherapy Research Paracelsus Medical University Salzburg Austria
- Psychotherapy and Psychosomatics University Hospital of Psychiatry Paracelsus Medical University Salzburg Austria
| | - Isa Sammet
- Institute of Synergetics and Psychotherapy Research Paracelsus Medical University Salzburg Austria
- Psychiatric Hospital Schloss Freudental Freudental Germany
| |
Collapse
|
10
|
De Smet MM, Von below C, Acke E, Werbart A, Meganck R, Desmet M. When ‘good outcome’ does not correspond to ‘good therapy’: Reflections on discrepancies between outcome scores and patients’ therapy satisfaction. European Journal of Psychotherapy & Counselling 2021. [DOI: 10.1080/13642537.2021.1923049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Melissa M. De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | - Emma Acke
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Andrzej Werbart
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
11
|
Cornelis S, Desmet M, Meganck R, Van Nieuwenhove K, Willemsen J. Extending Blatt's two-polarity model of personality development to dissociative identity disorder: a theory-building case study. Res Psychother 2021; 24:505. [PMID: 33937112 PMCID: PMC8082534 DOI: 10.4081/ripppo.2021.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/24/2021] [Indexed: 12/03/2022]
Abstract
In this theory-building case study, we investigate Blatt's two-polarity model of personality development according to which psychopathology is a consequence of an unbalance between the two developmental lines of interpersonal relatedness and self-definition. Anaclitic psychopathology, such as schizophrenia, histrionic, dependent, and borderline personality disorders, is associated with an excessive and rigid emphasis on interpersonal relatedness. In this theory-building case study, we examine whether this model can be extended to dissociative identity disorder (DID). The patient is a 23-year old Caucasian man who suffers from periodic episodes of dissociation. Consensual qualitative research for case studies is used to quantitatively and qualitatively describe the interplay between symptomatic and interpersonal evolutions throughout 41 sessions of supportive-expressive psychoanalytic psychotherapy. In line with the two-polarity model of personality development, close associations between symptoms of dissociation and dependent interpersonal dynamics were observed. Psychoanalytic interventions focusing on elaboration of the subjective meanings of (past and anticipated) dissociations, and on working through core interpersonal conflicts, are followed by transformations in the patient's interpersonal stances and subjective well-being. No new dissociative episodes were reported during the follow-up assessment three and a half years after the completion of treatment. This case study demonstrates that DID is a form of anaclitic psychopathology as it is associated with a predominant tendency to interpersonal relatedness.
Collapse
Affiliation(s)
- Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent
| | | | - Jochem Willemsen
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| |
Collapse
|
12
|
Truijens FL, Van Nieuwenhove K, De Smet MM, Desmet M, Meganck R. How questionnaires shape experienced symptoms. A qualitative case comparison study of questionnaire administration in psychotherapy research. Qualitative Research in Psychology 2021. [DOI: 10.1080/14780887.2021.1886383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Femke L. Truijens
- Erasmus University Rotterdam, Erasmus School of Social and Behavioral Sciences, Department of Psychology, Education and Child Studies, Rotterdam, The Netherlands
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Kimberly Van Nieuwenhove
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Melissa M. De Smet
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- , Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
13
|
Desmet M, Van Nieuwenhove K, De Smet M, Meganck R, Deeren B, Van Huele I, Decock E, Raemdonck E, Cornelis S, Truijens F, Zeuthen K, Schiepek G. What too strict a method obscures about the validity of outcome measures. Psychother Res 2021; 31:882-894. [PMID: 33539266 DOI: 10.1080/10503307.2020.1865584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective: To assess the outcome of psychotherapeutic treatments, psychotherapy researchers often compare pre- and post-treatment scores on self-report outcome measures. In this paper, the common assumption is challenged that pre-to-post decreasing and increasing outcome scores are indicative of successful and failed therapies, respectively.Method: The outcome of 29 psychotherapeutic treatments was evaluated by means of quantitative analysis of pre- and post-treatment scores on commonly used outcome measures (such as the Symptom Checklist-90-R, the Inventory of Interpersonal Problems, and the General Health Questionnaire-12), as well as through consensual qualitative research.Results: Overall, a moderate to low convergence between qualitative and quantitative evaluations of outcome was observed. Detailed analyses of six cases are presented in which pre-to-post comparisons of outcome measures proved misleading.Conclusions: It is concluded that psychotherapy outcome research might benefit from assessment strategies that are sensitive to the singularities of individual treatments and to the complexity of the phenomenon of therapeutic outcome. Furthermore, classical psychometric evaluations of the validity of outcome measures might be supplemented with less-systematic evaluations that take any contingent source of information on outcome into account.
Collapse
|
14
|
Knol ASL, Koole T, Desmet M, Vanheule S, Huiskes M. How Speakers Orient to the Notable Absence of Talk: A Conversation Analytic Perspective on Silence in Psychodynamic Therapy. Front Psychol 2020; 11:584927. [PMID: 33364999 PMCID: PMC7750524 DOI: 10.3389/fpsyg.2020.584927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Silence has gained a prominent role in the field of psychotherapy because of its potential to facilitate a plethora of therapeutically beneficial processes within patients’ inner dynamics. This study examined the phenomenon from a conversation analytical perspective in order to investigate how silence emerges as an interactional accomplishment and how it attains interactional meaning by the speakers’ adjacent turns. We restricted our attention to one particular sequential context in which a patient’s turn comes to a point of possible completion and receives a continuer by the therapist upon which a substantial silence follows. The data collection consisted of 74 instances of such post-continuer silences. The analysis revealed that silence (1) can retroactively become part of a topic closure sequence, (2) can become shaped as an intra-topic silence, and (3) can be explicitly characterized as an activity in itself that is relevant for the therapy in process. Only in this last case, the absence of talk is actually treated as disruptive to the ongoing talk. Although silence is often seen as a therapeutic instrument that can be implemented intentionally and purposefully, our analysis demonstrated how it is co-constructed by speakers and indexically obtains meaning by adjacent turns of talk. In the ensuing turns, silence indeed shows to facilitate access to the patient’s subjective experience at unconscious levels.
Collapse
Affiliation(s)
- A S L Knol
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Tom Koole
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Health Communication Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
15
|
Van Nieuwenhove K, Meganck R, Acke E, Cornelis S, Desmet M. The Influence of Interpersonal Patterns on the Therapy Process in a Case of Childhood Trauma. Psychol Belg 2020; 60:362-380. [PMID: 33178438 PMCID: PMC7597588 DOI: 10.5334/pb.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/12/2020] [Indexed: 11/20/2022] Open
Abstract
Research concerning the influence of core interpersonal patterns related to childhood trauma on the therapeutic process is scarce. We investigated interpersonal patterns at the start of treatment, changes in interpersonal patterns as treatment progressed, and the change process in a mixed-methods single case study of a supportive-expressive psychodynamic psychotherapy with a 33-year-old female with a history of childhood trauma. The patient showed a pervasive inability to open up towards others throughout the entire treatment, which is closely associated with others' actual or anticipated rejection, disrespect and disinterest. Excessive use of expressive interventions, which target interpersonal change, initially led to a worsening of the patient's condition. Via supportive and general interventions, symptom stabilization was achieved. The findings of this study suggest a thorough understanding of dominant interpersonal patterns is necessary to recognize their influence on the therapy process.
Collapse
Affiliation(s)
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, BE
| | - Emma Acke
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, BE
| | - Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, BE
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, BE
| |
Collapse
|
16
|
Desmet M, Bindelle S, Breebaart M, Camerlynck H, Casaer S, Fourneau K, Gautier P, Goffin P, Lecoq J, Lenders I, Leunen I, Van Aken D, Van Houwe P, Van Hooreweghe S, Vermeylen K, Sermeus I. Guidelines for the safe clinical practice of peripheral nerve blocks in the adult patient. Acta Anaest Belg 2020. [DOI: 10.56126/71.3.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Peripheral Nerve Block working group of the Belgian Association for Regional Anesthesia has revised and updated the “Clinical guidelines for the practice of peripheral nerve block in the adult” which were published in 2013.
Collapse
|
17
|
Hennissen V, Meganck R, Van Nieuwenhove K, Krivzov J, Dulsster D, Desmet M. Countertransference Processes in Psychodynamic Therapy with Dependent (Anaclitic) Depressed Patients: A Qualitative Study Using Supervision Data. Psychodyn Psychiatry 2020; 48:170-200. [PMID: 32628578 DOI: 10.1521/pdps.2020.48.2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although Blatt's two-polarity model of depression has suggested that patients' interpersonal styles may shape countertransference phenomena in psychotherapy, empirical research on this topic has remained scarce. This article provides an in-depth study of countertransference processes in clinical work with dependent (anaclitic) depressed patients using a qualitative methodology. Thematic analysis of narrative material of psychodynamic therapists discussing patient cases during supervision (n = 7) resulted in four recurrent themes: "empathy, compassion, and support," "anxiety, feeling overwhelmed, and protection," "frustration, irritation, and confrontation," and "inadequacy, incompetence, and fatalism." We found that these countertransference processes mainly revolved around perceived adaptive and maladaptive aspects of patients' relational functioning. Regarding clinical practice, our study suggests that therapists can use countertransference to determine in which position they are maneuvered by patients, although we caution against the exclusive use of subjectively informed data as a benchmark in the diagnostic and treatment process. We conclude that further in-depth research on countertransference and personality styles is needed to identify pitfalls in the treatment of depression.
Collapse
Affiliation(s)
| | | | | | | | | | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
18
|
Axelsson M, Schønning V, Bockting C, Buysse A, Desmet M, Dewaele A, Giovazolias T, Hannon D, Kafetsios K, Meganck R, Ntani S, Rutten K, Triliva S, Van Beveren L, Vandamme J, Øverland S, Hensing G. Lived experiences: a focus group pilot study within the MentALLY project of mental healthcare among European users. BMC Health Serv Res 2020; 20:605. [PMID: 32611345 PMCID: PMC7329529 DOI: 10.1186/s12913-020-05454-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 06/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mental healthcare is an important component in societies' response to mental health problems. Although the World Health Organization highlights availability, accessibility, acceptability and quality of healthcare as important cornerstones, many Europeans lack access to mental healthcare of high quality. Qualitative studies exploring mental healthcare from the perspective of people with lived experiences would add to previous research and knowledge by enabling in-depth understanding of mental healthcare users, which may be of significance for the development of mental healthcare. Therefore, the aim of the current study was to describe experiences of mental healthcare among adult Europeans with mental health problems. METHOD In total, 50 participants with experiences of various mental health problems were recruited for separate focus group interviews in each country. They had experiences from both the private and public sectors, and with in- and outpatient mental healthcare. The focus group interviews (N = 7) were audio recorded, transcribed verbatim and analysed through thematic analysis. The analysis yielded five themes and 13 subthemes. RESULTS The theme Seeking and trying to find help contained three subthemes describing personal thresholds for seeking professional help, not knowing where to get help, and the importance of receiving help promptly. The theme Awaiting assessment and treatment contained two subthemes including feelings of being prioritized or not and feelings of being abandoned during the often-lengthy referral process. The theme Treatment: a plan with individual parts contained three subthemes consisting of demands for tailored treatment plans in combination with medications and human resources and agreement on treatment. The theme Continuous and respectful care relationship contained two subthemes describing the importance of continuous care relationships characterised by empathy and respect. The theme Suggestions for improvements contained three subthemes highlighting an urge to facilitate care contacts and to increase awareness of mental health problems and a wish to be seen as an individual with potential. CONCLUSION Facilitating contacts with mental healthcare, a steady contact during the referral process, tailored treatment and empathy and respect are important aspects in efforts to improve mental healthcare. Recommendations included development of collaborative practices between stakeholders in order to increase general societal awareness of mental health problems.
Collapse
Affiliation(s)
- Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25 – F416, SE-205 06 Malmö, Sweden
| | - Viktor Schønning
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Health Promotion, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Claudi Bockting
- Amsterdam UMC, Department of Psychiatry (AMC) and Institute for Advanced Studies, University of Amsterdam, Amsterdam, the Netherlands
| | - Ann Buysse
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Alexis Dewaele
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | | | - Dewi Hannon
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | | | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Spyridoula Ntani
- Department of Psychology, University of Crete, Rethymno, Crete Greece
| | - Kris Rutten
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Sofia Triliva
- Department of Psychology, University of Crete, Rethymno, Crete Greece
| | - Laura Van Beveren
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Joke Vandamme
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Simon Øverland
- Department of Health Promotion, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
19
|
Van Beveren L, Rutten K, Hensing G, Spyridoula N, Schønning V, Axelsson M, Bockting C, Buysse A, De Neve I, Desmet M, Dewaele A, Giovazolias T, Hannon D, Kafetsios K, Meganck R, Øverland S, Triliva S, Vandamme J. A Critical Perspective on Mental Health News in Six European Countries: How Are "Mental Health/Illness" and "Mental Health Literacy" Rhetorically Constructed? Qual Health Res 2020; 30:1362-1378. [PMID: 32249686 PMCID: PMC7307005 DOI: 10.1177/1049732320912409] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In this study, we aim to contribute to the field of critical health communication research by examining how notions of mental health and illness are discursively constructed in newspapers and magazines in six European countries and how these constructions relate to specific understandings of mental health literacy. Using the method of cluster-agon analysis, we identified four terminological clusters in our data, in which mental health/illness is conceptualized as "dangerous," "a matter of lifestyle," "a unique story and experience," and "socially situated." We furthermore found that we cannot unambiguously assume that biopsychiatric discourses or discourses aimed at empathy and understanding are either exclusively stigmatizing or exclusively empowering and normalizing. We consequently call for a critical conception of mental health literacy arguing that all mental health news socializes its audience in specific understandings of and attitudes toward mental health (knowledge) and that discourses on mental health/illness can work differently in varying contexts.
Collapse
Affiliation(s)
| | | | | | | | - Viktor Schønning
- University of Gothenburg, Gothenburg,
Sweden
- Norwegian Institute of Public Health,
Bergen, Norway
| | | | | | | | | | | | | | | | | | | | | | - Simon Øverland
- Norwegian Institute of Public Health,
Bergen, Norway
- University of Bergen, Bergen,
Norway
| | | | | |
Collapse
|
20
|
Triliva S, Ntani S, Giovazolias T, Kafetsios K, Axelsson M, Bockting C, Buysse A, Desmet M, Dewaele A, Hannon D, Haukenes I, Hensing G, Meganck R, Rutten K, Schønning V, Van Beveren L, Vandamme J, Øverland S. Healthcare professionals' perspectives on mental health service provision: a pilot focus group study in six European countries. Int J Ment Health Syst 2020; 14:16. [PMID: 32165920 PMCID: PMC7060571 DOI: 10.1186/s13033-020-00350-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 02/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it. Methods Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners. Results The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative ‘chain of care’. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence. Conclusions The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people’s needs throughout their lives is an essential aspect of optimal care provision.
Collapse
Affiliation(s)
- Sofia Triliva
- 1Department of Psychology, University of Crete, 74100 Rethymno, Crete, Greece
| | - Spyridoula Ntani
- 1Department of Psychology, University of Crete, 74100 Rethymno, Crete, Greece
| | | | | | - Malin Axelsson
- 2Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Claudi Bockting
- 3Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.,4Institute for Advanced Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Ann Buysse
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- 6Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Alexis Dewaele
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Dewi Hannon
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Inger Haukenes
- 7Research Unit for General Practice, NORCE-Norwegian Research Centre, Bergen, Norway.,8Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gunnel Hensing
- 9Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Reitske Meganck
- 6Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Kris Rutten
- 10Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Viktor Schønning
- 9Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,11Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Laura Van Beveren
- 10Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Joke Vandamme
- 5Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Simon Øverland
- 11Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway
| |
Collapse
|
21
|
Knol ASL, Huiskes M, Koole T, Meganck R, Loeys T, Desmet M. Reformulating and Mirroring in Psychotherapy: A Conversation Analytic Perspective. Front Psychol 2020; 11:318. [PMID: 32194480 PMCID: PMC7066200 DOI: 10.3389/fpsyg.2020.00318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Abstract
The conversational actions of reformulating and mirroring constitute some of the core intervention techniques of psychotherapy. The purpose of the present study was to investigate the way in which therapists in cognitive-behavioral (CBT) and psychodynamic therapy (PDT) use reformulating and mirroring strategies to return patients’ prior talk and how their differential usage can be viewed in light of the respective manualized recommendations. A mixed methods approach was applied using qualitative data that derived from a RCT. The data collection consisted of 200 excerpts assembled from both treatment conditions. The method of Conversation Analysis was used to determine the practices that accomplished instances of reformulating and mirroring, and to examine their distinct implications for subsequent talk. The quantitative analysis revealed that cognitive-behavioral therapists are significantly more likely to use reformulations, which is in harmony with what is suggested in CBT’s treatment manuals. Psychodynamic therapists’ frequent use of transformative formulations is, by contrast, unexpected in regard to the suggestions of the treatment protocol, as these interventions steer toward topical closure. Compared to the CBT condition, psychodynamic therapists were still significantly more likely to rely on mirroring strategies, which are in line with PDT’s theoretical preference. Our findings raise the question whether alleged differences in treatment styles, as they are imposed by RCT methodology, are actually tangible in manual-guided clinical practice.
Collapse
Affiliation(s)
- A S L Knol
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.,Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
| | - Mike Huiskes
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
| | - Tom Koole
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,Health Communication Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Tom Loeys
- Department of Data-analysis, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
22
|
De Smet MM, Meganck R, Truijens F, De Geest R, Cornelis S, Norman UA, Desmet M. Change processes underlying "good outcome": A qualitative study on recovered and improved patients' experiences in psychotherapy for major depression. Psychother Res 2020; 30:948-964. [PMID: 32022647 DOI: 10.1080/10503307.2020.1722329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research.
Collapse
Affiliation(s)
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Femke Truijens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Rosa De Geest
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
23
|
Gunst E, Watson J, Willemsen J, Desmet M, Loeys T, Vanhooren S. A quest for self-soothing: A systematic case study into emotion-focused therapy with an emotionally avoidant client who committed sexual offenses. J Clin Psychol 2019; 76:676-687. [PMID: 31777086 DOI: 10.1002/jclp.22906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current study is part of a multiple case study that investigated the emotional change in individuals who have committed sexual offenses (ISOs). This case study highlights how one client used sex as a maladaptive coping strategy to suppress negative emotions. METHOD A mixed-methods design was used to track changes in the client's affect regulation (AR) during four phases, including a baseline (Phase A), treatment as usual (Phase B), treatment with an emotion-focused therapy (EFT) component added (Phase C), and follow up (Phase A). RESULTS The qualitative description with verbatim clinical vignettes, revealed deeper insight into some important steps and hindrances and the impact of specific EFT-interventions. Quantitative analysis of self-report and observational measures showed a significant improvement in the client's AR across different phases of treatment. CONCLUSIONS The study improves our knowledge of the emotional change in ISOs during treatment and illustrates some key interventions, steps, and hindrances.
Collapse
Affiliation(s)
- Ellen Gunst
- FIDES, Psychiatric Center Sint-Amandus, Beernem, and University of Ghent, Ghent, Belgium
| | - Jeanne Watson
- Applied Psychology and Human Development, OISE, University of Toronto, Toronto, Canada
| | - Jochem Willemsen
- Psychological Sciences Research Institute, Université catholique de Louvain, Louvain, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, University of Ghent, Ghent, Belgium
| | - Tom Loeys
- Department of Data-Analysis, University of Ghent, Ghent, Belgium
| | | |
Collapse
|
24
|
Gunst E, Willemsen J, Desmet M, Watson JC, Loeys T, Vanhooren S. Into the Wild, Out of the Woods: A Systematic Case Study on Facilitating Emotional Change. Int J Offender Ther Comp Criminol 2019; 63:2586-2610. [PMID: 31387425 DOI: 10.1177/0306624x19866977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cognitive and behavioral treatment programs for individuals who have committed sexual offenses (ISOs) have shown significant but small effect sizes. A growing body of research points toward the importance of difficulties in affect regulation (AR) as a risk factor for sexual recidivism. On this basis, it seems important to target difficulties in AR in treatment. The current systematic case study investigates the potential contribution of emotion-focused therapy (EFT) to changing problematic AR in ISOs. Kevin was a high-risk offender with a traumatic history who met the diagnostic criteria of pedophilic and borderline disorders, with serious AR difficulties. Self-report outcome measures, observation measures, and a biomarker were used to track changes in AR, psychological symptoms, and distress during baseline (Phase A); treatment as usual (Phase B); treatment with an EFT component added (Phase C); and follow-up (Phase A). Statistically significant change was found in AR, psychological symptoms, and distress during treatment (Phase B + C); however, it is not possible to attribute these changes causally to EFT. An examination of the qualitative process data provides deeper insights into how the client reacted to specific EFT interventions. Verbatim clinical vignettes are included to clarify key interventions, hindrances, and mechanisms of change. This study provides preliminary support for the role of therapy to facilitate emotional change in ISOs.
Collapse
Affiliation(s)
- E Gunst
- Psychiatrisch Centrum Sint-Amandus, Beernem, Belgium
- Ghent University, Belgium
| | | | | | | | | | | |
Collapse
|
25
|
Mourier B, Labadie P, Desmet M, Grosbois C, Raux J, Debret M, Copard Y, Pardon P, Budzinski H, Babut M. Combined spatial and retrospective analysis of fluoroalkyl chemicals in fluvial sediments reveal changes in levels and patterns over the last 40 years. Environ Pollut 2019; 253:1117-1125. [PMID: 31434189 DOI: 10.1016/j.envpol.2019.07.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
Bed sediments and a dated sediment core were collected upstream and downstream from the city of Lyon (France) to assess the spatial and temporal trends of contamination by per- and polyfluoroalkyl substances (PFASs) in this section of the Rhône River. Upstream from Lyon, concentrations of total PFASs (ΣPFASs) in sediments are low (between 0.19 and 2.6 ng g-1 dry weight - dw), being characterized by a high proportion of perfluorooctane sulfonate (PFOS). Downstream from Lyon, and also from a fluoropolymer manufacturing plant, ΣPFASs concentrations reach 48.7 ng g-1 dw. A gradual decrease of concentrations is reported at the coring site further downstream (38 km). Based on a dated sediment core, the temporal evolution of PFASs is reconstructed from 1984 to 2013. Prior to 1987, ΣPFASs concentrations were low (≤2 ng g-1 dw), increasing to a maximum of 51 ng g-1 dw in the 1990s and then decreasing from 2002 to the present day (∼10 ng g-1 dw). In terms of the PFAS pattern, the proportion of perfluoroalkyl sulfonic acids (PFSAs) has remained stable since the 1980s (∼10%), whereas large variations are reported for carboxylic acids (PFCAs). Long chain- (C > 8) PFCAs characterized by an even number of perfluorinated carbons represent about 74% of the total PFAS load until 2005. However, from 2005 to 2013, the relative contribution of long chain- (C > 8) PFCAs with an odd number of perfluorinated carbons reaches 80%. Such changes in the PFAS pattern likely highlight a major shift in the industrial production process. This spatial and retrospective study provides valuable insights into the long-term contamination patterns of PFAS chemicals in river basins impacted by both urban and industrial activities.
Collapse
Affiliation(s)
- B Mourier
- Univ Lyon, Université Claude Bernard Lyon 1, ENTPE, CNRS, INRA, USC 1369, UMR5023 LEHNA, F-69518, Vaulx-en-Velin, France.
| | - P Labadie
- UMR 5805 EPOC, Université de Bordeaux I, 351 crs de la libération, F-33405 Talence, France
| | - M Desmet
- Université de Tours, EA 6293 GéHCO, Parc de Grandmont, F-37200 Tours, France
| | - C Grosbois
- Université de Tours, EA 6293 GéHCO, Parc de Grandmont, F-37200 Tours, France
| | - J Raux
- Université de Tours, EA 6293 GéHCO, Parc de Grandmont, F-37200 Tours, France
| | - M Debret
- UMR 6143 - M2C, Université de Rouen, Place E. Blondel, Bat. IRESE A, F-76821 Mont St Aignan, France
| | - Y Copard
- UMR 6143 - M2C, Université de Rouen, Place E. Blondel, Bat. IRESE A, F-76821 Mont St Aignan, France
| | - P Pardon
- UMR 5805 EPOC, Université de Bordeaux I, 351 crs de la libération, F-33405 Talence, France
| | - H Budzinski
- UMR 5805 EPOC, Université de Bordeaux I, 351 crs de la libération, F-33405 Talence, France
| | - M Babut
- IRSTEA, RIVERLY Research Unit, Lyon-Villeurbanne Center, 5 avenue de la Doua - CS 20244, F-69625 Villeurbanne Cedex, France
| |
Collapse
|
26
|
De Smet MM, Meganck R, De Geest R, Norman UA, Truijens F, Desmet M. What "good outcome" means to patients: Understanding recovery and improvement in psychotherapy for major depression from a mixed-methods perspective. J Couns Psychol 2019; 67:25-39. [PMID: 31204837 DOI: 10.1037/cou0000362] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study explored the meaning of "good outcome" within and beyond the much-used statistical indices of clinical significance in standard outcome research as developed by Jacobson and Truax (1991). Specifically, we examined the experiences of patients marked as "recovered" and "improved" following cognitive-behavioral therapy and psychodynamic therapy for major depression. A mixed-methods study was conducted using data gathered in an RCT, including patients' pre-post outcome scores on the Beck Depression Inventory-II and posttreatment client change interviews. We selected 28 patients who showed recovery and 19 patients who showed improvement in self-reported depression symptoms. A grounded theory analysis was performed on patients' interviews, ultimately resulting in a conceptual model of "good outcome." From patients' perspectives, good outcome can be understood as feeling empowered, finding personal balance and encountering ongoing struggle, indicating an ongoing process and variation in experience. The Jacobson-Truax classification of "good outcome" could not account for the (more pessimistic) nuances in outcome experiences, especially for "improved" patients, and did not grasp the multidimensional nature of outcome as experienced by patients. It is recommended that statistical indications of clinical meaningfulness are interpreted warily and ideally contextualized within personal narratives. Further research on the phenomenon of change and good outcome is required, aiming at integrating multiple perspectives and methods accordingly the multidimensional phenomenon under study. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | - Rosa De Geest
- Department of Psychoanalysis and Clinical Consulting
| | | | | | | |
Collapse
|
27
|
Albrecht E, Reynvoet M, Fournier N, Desmet M. Dose–response relationship of perineural dexamethasone for interscalene brachial plexus block: a randomised, controlled, triple‐blind trial. Anaesthesia 2019; 74:1001-1008. [DOI: 10.1111/anae.14650] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2019] [Indexed: 11/29/2022]
Affiliation(s)
- E. Albrecht
- Department of Anaesthesia Lausanne University Hospital LausanneSwitzerland
| | - M. Reynvoet
- Department of Anaesthesia AZ Groeninge KortrijkBelgium
| | - N. Fournier
- Institute of Social and Preventive Medicine Lausanne University Hospital Lausanne Switzerland
| | - M. Desmet
- Department of Anaesthesia AZ Groeninge KortrijkBelgium
| |
Collapse
|
28
|
De Smet MM, Meganck R, Van Nieuwenhove K, Truijens FL, Desmet M. No Change? A Grounded Theory Analysis of Depressed Patients' Perspectives on Non-improvement in Psychotherapy. Front Psychol 2019; 10:588. [PMID: 30971973 PMCID: PMC6443830 DOI: 10.3389/fpsyg.2019.00588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/01/2019] [Indexed: 11/13/2022] Open
Abstract
Aim: Understanding the effects of psychotherapy is a crucial concern for both research and clinical practice, especially when outcome tends to be negative. Yet, while outcome is predominantly evaluated by means of quantitative pre-post outcome questionnaires, it remains unclear what this actually means for patients in their daily lives. To explore this meaning, it is imperative to combine treatment evaluation with quantitative and qualitative outcome measures. This study investigates the phenomenon of non-improvement in psychotherapy, by complementing quantitative pre-post outcome scores that indicate no reliable change in depression symptoms with a qualitative inquiry of patients' perspectives. Methods: The study took place in the context of a Randomised Controlled Trial evaluating time-limited psychodynamic and cognitive behavioral therapy for major depression. A mixed methods study was conducted including patients' pre-post outcome scores on the BDI-II-NL and post treatment Client Change Interviews. Nineteen patients whose data showed no reliable change in depression symptoms were selected. A grounded theory analysis was conducted on the transcripts of patients' interviews. Findings: From the patients' perspective, non-improvement can be understood as being stuck between knowing versus doing, resulting in a stalemate. Positive changes (mental stability, personal strength, and insight) were stimulated by therapy offering moments of self-reflection and guidance, the benevolent therapist approach and the context as important motivations. Remaining issues (ambition to change but inability to do so) were attributed to the therapy hitting its limits, patients' resistance and impossibility and the context as a source of distress. "No change" in outcome scores therefore seems to involve a "partial change" when considering the patients' perspectives. Conclusion: The study shows the value of integrating qualitative first-person analyses into standard quantitative outcome evaluation and particularly for understanding the phenomenon of non-improvement. It argues for more multi-method and multi-perspective research to gain a better understanding of (negative) outcome and treatment effects. Implications for both research and practice are discussed.
Collapse
Affiliation(s)
- Melissa Miléna De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium.,Fonds Wetenschappelijk Onderzoek, Brussels, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | - Femke L Truijens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| |
Collapse
|
29
|
Hennissen VC, Meganck R, Van Nieuwenhove K, Norman UA, Loeys T, Desmet M. Therapists' responses toward dependent (anaclitic) and self-critical (introjective) depressed outpatients: A multilevel approach. ACTA ACUST UNITED AC 2019; 56:193-204. [PMID: 30869971 DOI: 10.1037/pst0000213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Drawing on Blatt's theory about personality styles, we examined therapists' affective experiences toward depressed patients with dependent (anaclitic) and self-critical (introjective) personality styles. In addition, we investigated the relationship between therapists' responses, symptom severity, and therapeutic change. Therapists (N = 8) completed the Therapist Response Questionnaire (TRQ) at 5 time points for 50 dependent (anaclitic) and 34 self-critical (introjective) patients (N = 84) over the course of 20-session therapies. Consistent with our predictions, multilevel regression analyses showed that therapists experience stronger responses on the TRQ dimension "parental/protective" toward dependent (anaclitic) patients than toward self-critical (introjective) patients. However, we found no significant relationships between the personality styles and other TRQ dimensions. Furthermore, we found that cognitive-behavioral therapists reported stronger affective responses than psychodynamic therapists. No significant associations were found between the severity of patients' symptoms at the start of treatment and the general intensity of therapists' initial affective experiences, yet therapists experienced stronger emotional reactions when patients made no therapeutic progress. Although further in-depth research on the relationship between therapist responses and patients' personality styles is needed, this study provides partial evidence for Blatt's assertion that the two personality styles are relevant for understanding transference and countertransference processes in therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University
| | | | | | - Tom Loeys
- Department of Data Analysis, Ghent University
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University
| |
Collapse
|
30
|
Truijens FL, Cornelis S, Desmet M, De Smet MM, Meganck R. Validity Beyond Measurement: Why Psychometric Validity Is Insufficient for Valid Psychotherapy Research. Front Psychol 2019; 10:532. [PMID: 30915008 PMCID: PMC6423000 DOI: 10.3389/fpsyg.2019.00532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/22/2019] [Indexed: 11/17/2022] Open
Abstract
In psychotherapy research, "validity" is canonically understood as the capacity of a test to measure what is purported to measure. However, we argue that this psychometric understanding of validity prohibits working researchers from considering the validity of their research. Psychotherapy researchers often use measures with a different epistemic goal than test developers intended, for example when a depression symptom measure is used to indicate "treatment success" (cf. outcome measurement for evidence-based treatment). However, the validity of a measure does not cover the validity of its use as operationalization of another target concept within a research procedure, nor the validity of its function toward an epistemic goal. In this paper, we discuss the importance of considering validity of the epistemic process beyond the validity of measures per se, based on an empirical case example from our psychotherapy study ("SCS", Cornelis et al., 2017). We discuss why the psychometric understanding of validity is insufficient in covering epistemic validity, and we evaluate to what extent the available terminology regarding validity of research is sufficient for working researchers to accurately consider the validity of their overall epistemic process. As psychotherapy research is meant to offer a sound evidence-base for clinical practice, we argue that it is vital that psychotherapy researchers are able to discuss the validity of the epistemic choices made to serve the clinical goal.
Collapse
Affiliation(s)
- Femke L. Truijens
- Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | | | | | | |
Collapse
|
31
|
Truijens FL, Desmet M, De Coster E, Uyttenhove H, Deeren B, Meganck R. When quantitative measures become a qualitative storybook: A phenomenological case analysis of validity and performativity of questionnaire administration in psychotherapy research. Qualitative Research in Psychology 2019. [DOI: 10.1080/14780887.2019.1579287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Femke L. Truijens
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Belgium
| | - Mattias Desmet
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Belgium
| | - Eva De Coster
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Belgium
| | - Horanka Uyttenhove
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Belgium
| | - Bram Deeren
- Private Clinical Practice, Oostkamp, Belgium
| | - Reitske Meganck
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Belgium
| |
Collapse
|
32
|
Van Nieuwenhove K, Truijens F, Meganck R, Cornelis S, Desmet M. Working through childhood trauma-related interpersonal patterns in psychodynamic treatment: An evidence-based case study. Psychol Trauma 2019; 12:64-74. [PMID: 30714790 DOI: 10.1037/tra0000438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adult interpersonal difficulties are considered 1 of the core consequences of childhood trauma exposure. However, research concerning the nature of interpersonal patterns associated with childhood trauma is scarce. The aim of this case study of a supportive-expressive psychodynamic therapy with a woman with a traumatic background, is to provide a detailed understanding of the nature of interpersonal patterns at the beginning and throughout therapy, and to provide an in-depth investigation of the therapeutic process. METHOD The Core Conflictual Relationship Theme method (Luborsky & Crits-Christoph, 1998) and the Penn Adherence/Competence Scale for Supportive Expressive Dynamic Psychotherapy (Barber & Critis-Christoph, 1996) were applied to study dominant interpersonal patterns and therapeutic interventions, respectively. RESULTS At the beginning of therapy, the patient was unable to safely express herself because others were perceived as critical and rejecting. This relationship pattern originated in her primary (traumatic) childhood relationships and was repeated in her adult relationships. As treatment progresses, the patient aspired more proactively to assert herself and felt more self-confident in interactions, although she consistently perceived the reactions of others in a negative way. The neutral, acknowledging and empowering attitude of the therapist created a new relational experience, through which change (on the interpersonal level) appears to be achieved. CONCLUSIONS We conclude that to adequately address interpersonal difficulties in therapy, it is fundamental to recognize dominant interpersonal patterns and to apprehend their dynamics within the broader context of the case. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Collapse
|
33
|
Affiliation(s)
- K. Van Nieuwenhove
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - R. Meganck
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - S. Cornelis
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - M. Desmet
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
34
|
Cornelis S, Desmet M, Meganck R, Cauwe J, Inslegers R, Willemsen J, Van Nieuwenhove K, Vanheule S, Feyaerts J, Vandenbergen J. Interactions between obsessional symptoms and interpersonal dynamics: An empirical single case study. Psychoanalytic Psychology 2017. [DOI: 10.1037/pap0000078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
35
|
Abstract
Transference implies the actualization of the analyst in the analytic encounter. Lacan developed this idea through the syntagm presence of the analyst. In the course of his seminars, however, two completely different presences emerge, with major implications for how the treatment is directed. In the light of Lacan's idea that the transference is constituted in Real, Symbolic, and Imaginary dimensions, it can be seen how in his early work the analyst's presence is a phenomenon at the crossroads between signifiers and images. From the 1960s onward, however, the analyst's presence comes to necessarily involve the Real. This means it points to the moment at which symbolization reaches its limits. The clinical implications of this later interpretation of the presence of the analyst as incorporating the Real are manifold and affect psychoanalytic practice with regard to the position and the interventions of the analyst. Specifically, interventions targeted at provoking changes in defenses against experiences of excess or senselessness are discussed and illustrated with case vignettes and a published case. With transference considered "the navel of the treatment," the necessity that traumatic material will emerge in relation to the analyst becomes clear.
Collapse
|
36
|
Abstract
According to the WHO (2012), the prevalence of unipolar depressive disorders is rising, even in those places where mental health treatments are widely available. The WHO predicts that these disorders will be the leading contributor to the global burden of disease by 2030. This sobering projection fits poorly with how psychological treatments for depression are presented in the mainstream scientific literature: as highly effective therapies, based upon a sound understanding of the causes of distress. There is a clear discrepancy between the rising prevalence figures on the one hand, and the confident claims of this effectiveness research on the other. This discrepancy prompts a set of complex interlinked questions, which we have called ‘The Depression Conundrum.’ In search of a partial answer, the aim of our study was to critically analyze five meta-analytic studies investigating the effectiveness of psychological EBTs for depression, all of which had been published in high impact factor journals. Our examination established a number of methodological and statistical shortcomings in every study. Furthermore, we argue that the meta-analytic technique is founded upon problematic assumptions. The implications of our analysis are clear: decades of quantitative research might not allow us to conclude that psychological EBTs for depression are effective. The uncertainty and questions raised by our findings might act as a catalyst to broaden the way in which depression and associated therapies are researched. In addition, it might contribute toward a more vigorous and interdisciplinary debate about how to tackle this soon-to-be global public health priority number one.
Collapse
Affiliation(s)
- Jan E Celie
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology, Ghent UniversityGhent, Belgium
| | - Tom Loeys
- Department of Statistics and Data Analysis, Faculty of Psychology, Ghent UniversityGhent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology, Ghent UniversityGhent, Belgium
| | - Paul Verhaeghe
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology, Ghent UniversityGhent, Belgium
| |
Collapse
|
37
|
Cornelis S, Desmet M, Van Nieuwenhove KLHD, Meganck R, Willemsen J, Inslegers R, Feyaerts J. Interactions between Obsessional Symptoms and Interpersonal Ambivalences in Psychodynamic Therapy: An Empirical Case Study. Front Psychol 2017; 8:960. [PMID: 28649214 PMCID: PMC5465402 DOI: 10.3389/fpsyg.2017.00960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/26/2017] [Indexed: 12/02/2022] Open
Abstract
The classical symptom specificity hypothesis (Blatt, 1974) particularly associates obsessional symptoms to interpersonal behavior directed at autonomy and separation from others. Cross-sectional group research, however, has yielded inconsistent findings on this predicted association, and a previous empirical case study (Cornelis et al., in press; see Chapter 2) documented obsessional pathology to be rooted in profound ambivalences between autonomous and dependent interpersonal dynamics. Therefore, in the present empirical case study, concrete operationalizations of the classical symptom specificity hypothesis are contrasted to alternative hypotheses based on the observed complexities in Chapter 2. Dynamic associations between obsessional symptoms and interpersonal functioning is further explored, aiming at further contribution to theory building (i.e., through suggestions for potential hypothesis-refinement; Stiles, 2009). Similar to the first empirical case study (Chapter 1), Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of supportive-expressive psychodynamic therapy. In line with findings from Chapter 1, findings reveal close associations between obsessions and interpersonal dynamics, and therapist interventions focusing on interpersonal conflicts are documented as related to interpersonal and symptomatic alterations. Observations predominantly accord to the ambivalence-hypothesis rather than to the classical symptom specificity hypothesis. Yet, meaningful differences are observed in concrete manifestations of interpersonal ambivalences within significant relationships. Findings are again discussed in light of conceptual and methodological considerations; and limitations and future research indications are addressed.
Collapse
Affiliation(s)
- Shana Cornelis
- Department of Psychoanalysis and Clinical Counseling, Ghent UniversityGhent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Counseling, Ghent UniversityGhent, Belgium
| | | | - Reitske Meganck
- Department of Psychoanalysis and Clinical Counseling, Ghent UniversityGhent, Belgium
| | - Jochem Willemsen
- Centre for Psychoanalytic Studies, University of EssexColchester, United Kingdom
| | - Ruth Inslegers
- Department of Psychoanalysis and Clinical Counseling, Ghent UniversityGhent, Belgium
| | - Jasper Feyaerts
- Department of Psychoanalysis and Clinical Counseling, Ghent UniversityGhent, Belgium
| |
Collapse
|
38
|
Meganck R, Desmet M, Bockting C, Inslegers R, Truijens F, De Smet M, De Geest R, Van Nieuwenhove K, Hennissen V, Hermans G, Loeys T, Norman UA, Baeken C, Vanheule S. The Ghent Psychotherapy Study (GPS) on the differential efficacy of supportive-expressive and cognitive behavioral interventions in dependent and self-critical depressive patients: study protocol for a randomized controlled trial. Trials 2017; 18:126. [PMID: 28292331 PMCID: PMC5351275 DOI: 10.1186/s13063-017-1867-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/27/2017] [Indexed: 12/04/2022] Open
Abstract
Background Major depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, they have received limited research attention. This trial aims at investigating the interaction between therapeutic approach (pre-structured versus explorative) and the personality style of patients (dependent versus self-critical), which is considered a core underlying dimension of depressive pathology. Methods/design This study is a pragmatic stratified (dependent and self-critical patients) parallel trial with equal randomization (allocation 1:1) conducted in Flanders, Belgium. One hundred and four patients will be recruited and randomized to either 16–20 sessions of cognitive behavioral therapy for depression (pre-structured approach) or 16–20 sessions of short-term psychodynamic psychotherapy for depression (explorative approach) conducted by trained psychotherapists in private practices. The primary outcome is the severity of depression as measured by the Hamilton Rating Scale for Depression at completion of therapy. Secondary outcome measures include self-reported depressive and other symptoms, interpersonal functioning, idiosyncratic complaints, and the presence of the diagnosis of depression. Additional measures include biological measures, narrative material (sessions, interviews), and health care costs. Discussion This trial presents the test of an often-described, yet hardly investigated interaction between important personality dimensions and therapeutic approach in the treatment of depression. Results could inform therapists on how to match psychotherapeutic treatments to specific personality characteristics of their patients. Trial registration Isrctn.com, ISRCTN17130982. Registered on 2 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1867-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium.
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Claudi Bockting
- Department of Clinical Psychology, Social and Behavioral Sciences, Universiteit Utrecht, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands
| | - Ruth Inslegers
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Femke Truijens
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Melissa De Smet
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Rosa De Geest
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Kimberly Van Nieuwenhove
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Vicky Hennissen
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Goedele Hermans
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Tom Loeys
- Department of Data Analysis, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 1, Ghent, 9000, Belgium
| | - Ufuoma Angelica Norman
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, K12, Ghent, 9000, Belgium
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| |
Collapse
|
39
|
Willemsen J, Seys V, Gunst E, Desmet M. “Simply Speaking Your Mind, from the Depths of Your Soul”: Therapeutic Factors in Experiential Group Psychotherapy for Sex Offenders. Journal of Forensic Psychology Practice 2016. [DOI: 10.1080/15228932.2016.1172423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
40
|
Desmet M, Vander Cruyssen P, Pottel H, Carlier S, Devriendt D, Van Rooy F, De Corte W. The influence of propofol and sevoflurane on intestinal motility during laparoscopic surgery. Acta Anaesthesiol Scand 2016; 60:335-42. [PMID: 26806956 DOI: 10.1111/aas.12675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Volatile anaesthetics have an influence on small bowel peristalsis during laparoscopic surgery. A recent study concluded that desflurane increased intestinal motility compared to sevoflurane. Hence, a desflurane-based anaesthesia protocol may reduce surgical exposure during intestinal suturing or stapling due to small bowel hyperperistalsis. The effect of propofol on intestinal motility is not well studied. We tested the hypothesis that a propofol-remifentanil anaesthesia increases intestinal contractions in comparison with a sevoflurane-remifentanil anaesthesia. METHODS Patients scheduled for laparoscopic gastric bypass surgery were randomized in this single blind randomized controlled trial to receive remifentanil combined with sevoflurane or propofol (ISRCTN 12921661). Bispectral index monitoring was used to guide depth of anaesthesia. Visual observation of peristaltic waves was performed during 1 min at the planned site of the jejunostomy. Statistical analysis was performed using Wilcoxon two-sample test. RESULTS After obtaining written informed consent 50 patients were included. Groups were similar for demographic variables, and depth of anaesthesia during the observations. The median number of peristaltic waves was lower in the sevoflurane-remifentanil group compared to the propofol-remifentanil group (0 vs. 6, P < 0.001). CONCLUSION Propofol-remifentanil increases intestinal motility compared with sevoflurane-remifentanil during laparoscopic gastric bypass surgery. A sevoflurane-based protocol can help to avoid disturbing peristalsis.
Collapse
Affiliation(s)
- M. Desmet
- Department of Anaesthesiology; AZ Groeninge Hospital; Kortrijk Belgium
| | - P. Vander Cruyssen
- Department Cardiovascular Sciences; KU Leuven; Leuven Belgium
- Department of Anaesthesiology; UZ Leuven; Leuven Belgium
| | - H. Pottel
- Department of Public Health and Primary Care; KU Leuven Campus Kulak; Kortrijk Belgium
| | - S. Carlier
- Department of Anaesthesiology; AZ Groeninge Hospital; Kortrijk Belgium
| | - D. Devriendt
- Department of Abdominal Surgery; AZ Groeninge Hospital; Kortrijk Belgium
| | - F. Van Rooy
- Department of Abdominal Surgery; AZ Groeninge Hospital; Kortrijk Belgium
| | - W. De Corte
- Department of Anaesthesiology; AZ Groeninge Hospital; Kortrijk Belgium
| |
Collapse
|
41
|
Dhivert E, Grosbois C, Courtin-Nomade A, Bourrain X, Desmet M. Dynamics of metallic contaminants at a basin scale--Spatial and temporal reconstruction from four sediment cores (Loire fluvial system, France). Sci Total Environ 2016; 541:1504-1515. [PMID: 26490530 DOI: 10.1016/j.scitotenv.2015.09.146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/14/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
From the 19th century, the Loire basin (France) presents potentially pollutant activities such as mining and heavy industries. This paper shows spatio-temporal distribution of trace elements in sediments at a basin-scale, based on a comparison of archived temporal signals recorded in four sedimentary cores. Anthropogenic sources contributing to sediment contamination are also characterized, using geochemical signatures recorded in river bank sediments of the most industrialized tributaries. This study highlights upstream-downstream differences concerning recorded contamination phases in terms of spatial influence and temporality of archiving processes. Such differences were related to (i) various spatial influences of contamination sources and (ii) polluted sediments dispersion controlled by transport capacity of metal-carrier phases and hydrosedimentary dynamics.
Collapse
Affiliation(s)
- E Dhivert
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| | - C Grosbois
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France.
| | - A Courtin-Nomade
- Université de Limoges, GRESE, 123 Avenue Albert Thomas, 87060 Limoges, France
| | - X Bourrain
- Agence de l'Eau Loire-Bretagne, Avenue Buffon, 45063 Orleans, France
| | - M Desmet
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| |
Collapse
|
42
|
Bertrand O, Mondamert L, Grosbois C, Dhivert E, Bourrain X, Labanowski J, Desmet M. Storage and source of polycyclic aromatic hydrocarbons in sediments downstream of a major coal district in France. Environ Pollut 2015; 207:329-340. [PMID: 26444225 DOI: 10.1016/j.envpol.2015.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/07/2015] [Accepted: 09/09/2015] [Indexed: 06/05/2023]
Abstract
During the 20th century, the local economy of the Upper Loire Basin (ULB) was essentially based on industrial coal mining extraction. One of the major French coal districts with associated urban/industrial activities and numerous coking/gas plants were developed in the Ondaine-Furan subbasins, two tributaries of the upper Loire main stream. To determine the compositional assemblage, the level and the potential sources of contamination, the historical sedimentary chronicle of the 16 US EPA priority polycyclic aromatic hydrocarbons (PAHs) has been investigated. PAH concentrations were determined using gas chromatography/mass spectrometry (GC/MS) in a dated core, sampled in the Villerest flood-control reservoir located downstream of the Ondaine-Furan corridor (OFC). The most contaminated sediments were deposited prior to 1983 (Σ16PAHs ca. 4429-13,348 ng/g) and during flood events (Σ16PAHs ca. 6380 ng/g - 1996 flood; 5360 ng/g - 2003 flood; 6075 ng/g - 2008 flood), especially in medium and high molecular weight PAHs. Among them, typical pyrogenic PAHs such as FLT, PYR, BbF and BaP were prevalent in most of the core samples. In addition, some PAHs last decade data is available from the Loire Bretagne Water Agency and were analyzed using high-performance liquid chromatography with postcolumn fluorescence derivatization (HPLC/FLD). These results confirm that the most highly contaminated sediments were found downstream of OFC (Σ16PAHs ca. 2264-7460 ng/g). According to the observed molecular distribution, PAHs are originated largely from high-temperature pyrolytic processes. Major sources of pyrogenic PAHs have been emphasized by calculation of specific ratios and by comparison to reported data. Atmospheric deposition of urban and industrial areas, wood combustion and degraded coal tar derived from former factories of coking/gas plants seem to be the major pyrogenic sources. Specifically, particular solid transport conditions that can occur during major flood events lead us to emphasize weathering of former contamination sources, such as more preserved coal tar.
Collapse
Affiliation(s)
- O Bertrand
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France; CNRS/INSU, ISTO, UMR 7327, 45071 Orléans, France.
| | - L Mondamert
- Université de Poitiers, UMR 7285 IC2MP, 4 rue Michel Brunet, 86022 Poitiers Cedex, France
| | - C Grosbois
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| | - E Dhivert
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| | - X Bourrain
- Agence de l'Eau Loire-Bretagne, 9 Avenue Buffon, CS 36339, 45063 Orléans Cedex 2, France
| | - J Labanowski
- Université de Poitiers, UMR 7285 IC2MP, 4 rue Michel Brunet, 86022 Poitiers Cedex, France
| | - M Desmet
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| |
Collapse
|
43
|
Willemsen J, Cornelis S, Geerardyn FM, Desmet M, Meganck R, Inslegers R, Cauwe JMBD. Theoretical pluralism in psychoanalytic case studies. Front Psychol 2015; 6:1466. [PMID: 26483725 PMCID: PMC4586353 DOI: 10.3389/fpsyg.2015.01466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/14/2015] [Indexed: 11/13/2022] Open
Abstract
The aim of this study is to provide an overview of the scientific activity of different psychoanalytic schools of thought in terms of the content and production of case studies published on ISI Web of Knowledge. Between March 2013 and November 2013, we contacted all case study authors included in the online archive of psychoanalytic and psychodynamic case studies (www.singlecasearchive.com) to inquire about their psychoanalytic orientation during their work with the patient. The response rate for this study was 45%. It appears that the two oldest psychoanalytic schools, Object-relations psychoanalysis and Ego psychology or "Classical psychoanalysis" dominate the literature of published case studies. However, most authors stated that they feel attached to two or more psychoanalytic schools of thought. This confirms that the theoretical pluralism in psychoanalysis stretches to the field of single case studies. The single case studies of each psychoanalytic school are described separately in terms of methodology, patient, therapist, or treatment features. We conclude that published case studies features are fairly similar across different psychoanalytic schools. The results of this study are not representative of all psychoanalytic schools, as some do not publish their work in ISI ranked journals.
Collapse
Affiliation(s)
- Jochem Willemsen
- Centre for Psychoanalytic Studies, University of Essex Colchester, UK
| | - Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Filip M Geerardyn
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Ruth Inslegers
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| | - Joachim M B D Cauwe
- Department of Psychoanalysis and Clinical Consulting, Ghent University Ghent, Belgium
| |
Collapse
|
44
|
Iscan S, Seybert C, Erhardt I, Desmet M, Levy RA, Ablon JS. An Empirical Comparison of Short-Term Psychodynamic Psychotherapy Processes: Distinctive Process Factors Between Successful and Unsuccessful Therapeutic Outcome Groups. J Am Psychoanal Assoc 2015; 63:NP1-4. [PMID: 26316410 DOI: 10.1177/0003065115602878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sureyya Iscan
- University of Massachusetts Medical School, Worcester
| | | | | | | | - Raymond A Levy
- Massachusetts General Hospital, Department of Psychiatry
| | - J Stuart Ablon
- Massachusetts General Hospital, Department of Psychiatry
| |
Collapse
|
45
|
Vanheule S, Desmet M, Meganck R, Inslegers R, Willemsen J, De Schryver M, Devisch I. Reliability in psychiatric diagnosis with the DSM: old wine in new barrels. Psychother Psychosom 2015; 83:313-4. [PMID: 25116891 DOI: 10.1159/000358809] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/16/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | | | | | | | | | | | | |
Collapse
|
46
|
Desmet M, Vanneste B, Reynvoet M, Van Cauwelaert J, Verhelst L, Pottel H, Missant C, Van de Velde M. A randomised controlled trial of intravenous dexamethasone combined with interscalene brachial plexus blockade for shoulder surgery. Anaesthesia 2015; 70:1180-5. [PMID: 26082203 DOI: 10.1111/anae.13156] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 11/27/2022]
Abstract
We recruited patients scheduled for shoulder rotator cuff repair or subacromial decompression under general anaesthesia and interscalene brachial plexus blockade (30 ml ropivacaine 0.5%). We allocated 240 participants into four groups of 60 that were given pre-operative saline 0.9% or dexamethasone 1.25 mg, 2.5 mg or 10 mg, intravenously. We recorded outcomes for 48 h. The median (IQR [range]) time to first postoperative analgesic request after saline was 12.2 (11.0-14.1 [1.8-48]) h, which was extended by intravenous dexamethasone 2.5 mg and 10 mg to 17.4 (14.9-21.5 [7.2-48]) h, p < 0.0001, and 20.1 (17.2-24.3 [1.3-48]) h, p < 0.0001, respectively, but not by dexamethasone 1.25 mg, 14.0 (12.1-17.7 [2.1-48]) h, p = 0.05. Postoperative analgesia was given sooner after rotator cuff repair than subacromial decompression, hazard ratio (95% CI) 2.2 (1.6-3.0), p < 0.0001, but later in older participants, hazard ratio (95% CI) 0.98 (0.97-0.99) per year, p < 0.0001.
Collapse
Affiliation(s)
- M Desmet
- Department of Anaesthesiology, AZ Groeninge, Kortrijk, Belgium
| | - B Vanneste
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - M Reynvoet
- Department of Anaesthesiology, AZ Groeninge, Kortrijk, Belgium
| | - J Van Cauwelaert
- Department of Orthopaedic Surgery, AZ Groeninge, Kortrijk, Belgium
| | - L Verhelst
- Department of Orthopaedic Surgery, AZ Groeninge, Kortrijk, Belgium
| | - H Pottel
- Department of Public Health and Primary Care, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - C Missant
- Department of Anaesthesiology, UZ Leuven, Leuven, Belgium
| | - M Van de Velde
- Department of Anaesthesiology, UZ Leuven, Leuven, Belgium
| |
Collapse
|
47
|
Dhivert E, Grosbois C, Rodrigues S, Desmet M. Influence of fluvial environments on sediment archiving processes and temporal pollutant dynamics (Upper Loire River, France). Sci Total Environ 2015; 505:121-136. [PMID: 25310887 DOI: 10.1016/j.scitotenv.2014.09.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 06/04/2023]
Abstract
Floodplains are often cored to build long-term pollutant trends at the basin scale. To highlight the influences of depositional environments on archiving processes, aggradation rates, archived trace element signals and vertical redistribution processes, two floodplain cores were sampled near in two different environments of the Upper Loire River (France): (i) a river bank ridge and (ii) a paleochannel connected by its downstream end. The base of the river bank core is composed of sandy sediments from the end of the Little Ice Age (late 18th century). This composition corresponds to a proximal floodplain aggradation (<50 m from the river channel) and delimits successive depositional steps related to progressive disconnection degree dynamism. This temporal evolution of depositional environments is associated with mineralogical sorting and variable natural trace element signals, even in the <63-μm fraction. The paleochannel core and upper part of the river bank core are composed of fine-grained sediments that settled in the distal floodplain. In this distal floodplain environment, the aggradation rate depends on the topography and connection degree to the river channel. The temporal dynamics of anthropogenic trace element enrichments recorded in the distal floodplain are initially synchronous and present similar levels. Although the river bank core shows general temporal trends, the paleochannel core has a better resolution for short-time variations of trace element signals. After local water depth regulation began in the early 1930s, differences of connection degree were enhanced between the two cores. Therefore, large trace element signal divergences are recorded across the floodplain. The paleochannel core shows important temporal variations of enrichment levels from the 1930s to the coring date. However, the river bank core has no significant temporal variations of trace element enrichments and lower contamination levels because of a lower deposition of contaminated sediments and a pedogenetic trace elements redistribution.
Collapse
Affiliation(s)
- E Dhivert
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| | - C Grosbois
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France.
| | - S Rodrigues
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| | - M Desmet
- Université François Rabelais de Tours, EA 6293 GéHCO, Parc de Grandmont, 37200 Tours, France
| |
Collapse
|
48
|
Willemsen J, Inslegers R, Meganck R, Geerardyn F, Desmet M, Vanheule S. A metasynthesis of published case studies through Lacan's L-schema: Transference in perversion. Int J Psychoanal 2014; 96:773-95. [PMID: 24673247 DOI: 10.1111/1745-8315.12179] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/30/2022]
Abstract
Transference in perversion is characterized by specific problems such as a defiant and polemic attitude, erotic transference, projections, and aggression. Such transference poses particular problems in the treatment of perversion and might render analytical work with these patients impossible. The authors propose that Lacan's L-schema can contribute to separating productive from counterproductive aspects of transference as it distinguishes between an Imaginary and a Symbolic dimension in transference. In this meta-synthesis of 11 published case studies on sexual perversion, patterns of transference are analysed. On the Imaginary dimension, the authors found that patients with perversion tend to (un)consciously engage the analyst in a relationship characterized by identification, fusion and rivalry. On the Symbolic dimension, they found that perverse patients are able to question their motives, lapses, symptoms, and subjective identity. The thematic analysis revealed the importance of the position of the analyst in this work, which is described within the L-schema as being the representative of the otherness in the Other. Implications for clinical practice and recommendations for further research are outlined.
Collapse
Affiliation(s)
- Jochem Willemsen
- Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, B-9000 Ghent, Belgium.
| | - Ruth Inslegers
- Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, B-9000 Ghent, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, B-9000 Ghent, Belgium
| | - Filip Geerardyn
- Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, B-9000 Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, B-9000 Ghent, Belgium
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, B-9000 Ghent, Belgium
| |
Collapse
|
49
|
Schindler I, Desmet M, Meganck R, Kächele H. [Psychoanalytic single case studies of children and adolescents: characterisation with the "Inventory of Basic Information in Single Cases"]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:308-321. [PMID: 24804467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Right from its beginning single case studies on children and adolescents have been an highly esteemed means of communication in psychoanalysis; from the view of treatment research time and again critical arguments are brought forward. As single case studies may provide relevant answers for detailed process aspects, in this study we present a methodology for systematizing the reporting culture.
Collapse
|
50
|
Desmet M, Meganck R, Vanheule S. Hysterical and obsessional transference patterns: do they underlie the field of neurotic symptoms? J Am Psychoanal Assoc 2013; 61:NP7-11. [PMID: 24357593 DOI: 10.1177/0003065113516364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|