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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'.
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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
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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.
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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
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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.
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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
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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.
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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
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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
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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
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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).
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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
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de Felice G, De Smet MM, Meganck R, Schiepek G. Editorial: The Patient's Change: Understanding the Complexity of the Dynamics of Change and Its Precursors in Psychotherapy. Front Psychol 2021; 12:739727. [PMID: 34594285 PMCID: PMC8477581 DOI: 10.3389/fpsyg.2021.739727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/10/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giulio de Felice
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy.,Faculty of Psychology, NC IUL London, London, United Kingdom
| | - Melissa M De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Guenter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
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9
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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
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10
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Krivzov J, Notaerts L, Van Nieuwenhove K, Meganck R, Truijens FL, Goossens A. The lack of failure reports in published psychotherapy case studies: Implications for dis-‘illusioning’ of research and practice. European Journal of Psychotherapy & Counselling 2021. [DOI: 10.1080/13642537.2021.1923051] [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: 10/20/2022]
Affiliation(s)
- Juri Krivzov
- 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
| | - Femke L. Truijens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
- Department of Psychology, Education & Child Studies/Clinical Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Astrid Goossens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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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.
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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
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12
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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
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13
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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.
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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.
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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
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Krivzov J, Baert F, Meganck R, Cornelis S. Interpersonal dynamics and therapeutic relationship in patients with functional somatic syndromes: A metasynthesis of case studies. J Couns Psychol 2020; 68:593-607. [PMID: 32852968 DOI: 10.1037/cou0000529] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with functional somatic syndromes (FSS) often display troubled relationships with health care providers, psychotherapists, and significant others. Research shows that patients' history of trauma, attachment disturbances, and mentalization deficits may result in the emergence of maladaptive interpersonal patterns, which may later contribute to the onset and maintenance of FSS, "doctor hopping," and dropout in psychotherapy. As the nature and therapeutic consequences of such maladaptive interpersonal patterns in FSS cannot be understood sufficiently by quantitative methods alone, there is a need for in-depth qualitative research. To address this issue, we conducted a metasynthesis of 23 published case studies of patients with FSS from various psychotherapeutic orientations. Results show that patients with FSS from our sample perceived others as unreliable, that is, unavailable, overcontrolling, and overprotective. To adapt to such unreliable others, patients attempted to please and to control them. Patients also suppressed their emotional awareness and expression. Although alexithymia could also play a role, the primary reason for emotional avoidance seemed to be interpersonal in nature, that is, patients were avoiding negative emotions in order to please and control the unreliable others. The onset and worsening of FSS were associated with both interpersonal and physical triggers. Showing signs of physical or emotional distress led to more rejection, overcontrol, and overprotection from unreliable others, which could create a "vicious circle." Our results suggest that offering a more interpersonal perspective on emotion regulation difficulties would be beneficial for patients with FSS, counselors, psychotherapists, and other health care professionals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Juri Krivzov
- Department of Psychoanalysis and Clinical Consulting
| | - Fleur Baert
- Department of Experimental Clinical and Health Psychology
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16
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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.
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Affiliation(s)
| | | | | | | | | | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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17
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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.
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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
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18
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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.
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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
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19
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de Felice G, Giuliani A, Gelo OCG, Mergenthaler E, De Smet MM, Meganck R, Paoloni G, Andreassi S, Schiepek GK, Scozzari A, Orsucci FF. What Differentiates Poor- and Good-Outcome Psychotherapy? A Statistical-Mechanics-Inspired Approach to Psychotherapy Research, Part Two: Network Analyses. Front Psychol 2020; 11:788. [PMID: 32508701 PMCID: PMC7251305 DOI: 10.3389/fpsyg.2020.00788] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/16/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Statistical mechanics is the field of physics focusing on the prediction of the behavior of a given system by means of statistical properties of ensembles of its microscopic elements. The authors examined the possibility of applying such an approach to psychotherapy research with the aim of investigating (a) the possibility of predicting good and poor outcomes of psychotherapy on the sole basis of the correlation pattern among their descriptors and (b) the analogies and differences between the processes of good- and poor-outcome cases. This work extends the results reported in a previous paper and is based on higher-order statistics stemming from a complex network approach. Four good-outcome and four poor-outcome brief psychotherapies were recorded, and transcripts of the sessions were coded according to Mergenthaler's Therapeutic Cycle Model (TCM), i.e., in terms of abstract language, positive emotional language, and negative emotional language. The relative frequencies of the three vocabularies in each word-block of 150 words were investigated and compared in order to understand similarities and peculiarities between poor-outcome and good-outcome cases. Network analyses were performed by means of a cluster analysis over the sequence of TCM categories. The network analyses revealed that the linguistic patterns of the four good-outcome and four poor-outcome cases were grounded on a very similar dynamic process substantially dependent on the relative frequency of the states in which the transition started and ended ("random-walk-like behavior", adjusted R 2 = 0.729, p < 0.001). Furthermore, the psychotherapy processes revealed statistically significant changes in the relative occurrence of visited states between the beginning and the end of therapy, thus pointing to the non-stationarity of the analyzed processes. The present study showed not only how to quantitatively describe psychotherapy as a network, but also found out the main principles on which its evolution is based. The mind, from a linguistic perspective, seems to work-through psychotherapy sessions by passing from the most adjacent states and the most occurring ones. This finding can represent a fertile ground to rethink pivotal clinical concepts such as the timing of an interpretation or a comment, the clinical issue to address within a given session, and the general task of a psychotherapist: from someone who delivers a given technique toward a consultant promoting the flexibility of the clinical field and, thus, of the patient's mind.
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Affiliation(s)
- Giulio de Felice
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
- Department of Psychology, NCIUL University, London, United Kingdom
| | | | - Omar C. G. Gelo
- Department of History, Society and Human Studies, University of Salento, Lecce, Italy
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria
| | - Erhard Mergenthaler
- Clinic of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Melissa M. De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Giulia Paoloni
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Andreassi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Scozzari
- Faculty of Economics, Niccolò Cusano University, Rome, Italy
| | - Franco F. Orsucci
- Department of Psychology, NCIUL University, London, United Kingdom
- Psychoanalysis Unit, UCL University of London, London, United Kingdom
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20
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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.
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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
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21
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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.
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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
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22
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Van Nieuwenhove K, Meganck R. Core Interpersonal Patterns in Complex Trauma and the Process of Change in Psychodynamic Therapy: A Case Comparison Study. Front Psychol 2020; 11:122. [PMID: 32116927 PMCID: PMC7027362 DOI: 10.3389/fpsyg.2020.00122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/12/2019] [Accepted: 01/16/2020] [Indexed: 11/13/2022] Open
Abstract
We performed a case comparison study to investigate the nature of interpersonal patterns in childhood trauma and the process of change therein. We analyzed three matching cases of childhood trauma that followed a psychodynamic treatment via a mixed-methods design. We found that (1) the core tendency to avoid negative reactions from others through passive behaviors emerged in all three cases, both in childhood and adulthood, (2) core interpersonal patterns transpired in the interaction between patient and therapist and thereby affected the therapeutic relationship, and (3) change ensued when a repetition of core interpersonal patterns was avoided and a new relational experience occurred. The accumulated findings across cases further resulted in several clinical implications and recommendations, such as the importance of the assessment of patients' (covert) conditions, responsiveness, supervision and facilitating patients' agency, and provided several avenues for further research.
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23
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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.
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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
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24
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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).
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Affiliation(s)
| | | | - Rosa De Geest
- Department of Psychoanalysis and Clinical Consulting
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25
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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.
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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
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26
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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).
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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
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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.
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Affiliation(s)
- Femke L. Truijens
- Faculty of Psychology and Educational Sciences, Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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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
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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).
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De Smet M, Meganck R. Understanding Long-term Outcome from the Patients' Perspective: A Mixed Methods Naturalistic Study on Inpatient Psychotherapy. Psychol Belg 2018; 58:276-296. [PMID: 30479822 PMCID: PMC6196577 DOI: 10.5334/pb.432] [Citation(s) in RCA: 2] [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: 12/18/2017] [Accepted: 09/12/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The complex phenomenon of psychotherapy outcome requires further conceptual and methodological developments that facilitate clinically meaningful research findings. In this study, we rely on an idiosyncratic and process-oriented understanding of treatment effects in order to investigate long-term outcome. A conceptual model of long-term outcome is presented that comprises both a taxonomy of change and explanatory factors. METHOD A mixed methods naturalistic study was conducted in an inpatient psychotherapy setting. Long-term quantitative outcome data are complemented with a data-driven thematic analysis of interviews with 22 participants, five to six years after ending inpatient psychotherapy. RESULTS Long-term outcome findings show improved well-being for the majority of former patients and this until five to six years after treatment. From the patients' perspectives, long-term changes can be situated on different interrelated existential levels: reconnection to others and (the meaning of) life, a revelation, an altered self, life changes, and altered expectations and ideas about recovery and treatment. The complex interplay of the person, the therapy centre, the outside world and the evolution over time helped explain the experienced changes and individual differences. CONCLUSION The findings support the value of an idiosyncratic and process-oriented understanding of outcome and recovery as well as substantiate the importance of multiple methods and perspectives when studying the effects of psychotherapy.
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Affiliation(s)
- Melissa De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, BE
- Aspirant of the Flanders Research Foundation (FWO), BE
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, BE
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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
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Van den Bulcke B, Piers R, Jensen HI, Malmgren J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancelliere L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje EJO, Azoulay E, Meganck R, Van de Sompel A, Vansteelandt S, Vlerick P, Vanheule S, Benoit DD. Ethical decision-making climate in the ICU: theoretical framework and validation of a self-assessment tool. BMJ Qual Saf 2018; 27:781-789. [DOI: 10.1136/bmjqs-2017-007390] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/26/2017] [Accepted: 02/01/2018] [Indexed: 11/04/2022]
Abstract
BackgroundLiterature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU).ObjectivesTo better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates.MethodsUsing a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups.ResultsOf 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner.ConclusionsThe 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians’ behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.
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Meganck R, Inslegers R, Krivzov J, Notaerts L. Beyond Clinical Case Studies in Psychoanalysis: A Review of Psychoanalytic Empirical Single Case Studies Published in ISI-Ranked Journals. Front Psychol 2017; 8:1749. [PMID: 29046660 PMCID: PMC5632659 DOI: 10.3389/fpsyg.2017.01749] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 07/14/2017] [Accepted: 09/21/2017] [Indexed: 11/13/2022] Open
Abstract
Single case studies are at the origin of both theory development and research in the field of psychoanalysis and psychotherapy. While clinical case studies are the hallmark of psychoanalytic theory and practice, their scientific value has been strongly criticized. To address problems with the subjective bias of retrospective therapist reports and uncontrollability of clinical case studies, systematic approaches to investigate psychotherapy process and outcome at the level of the single case have been developed. Such empirical case studies are also able to bridge the famous gap between academic research and clinical practice as they provide clinically relevant insights into how psychotherapy works. This study presents a review of psychoanalytic empirical case studies published in ISI-ranked journals and maps the characteristics of the study, therapist, patient en therapies that are investigated. Empirical case studies increased in quantity and quality (amount of information and systematization) over time. While future studies could pay more attention to providing contextual information on therapist characteristics and informed consent considerations, the available literature provides a basis to conduct meta-studies of single cases and as such contribute to knowledge aggregation.
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Affiliation(s)
- Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Ruth Inslegers
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Juri Krivzov
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Liza Notaerts
- Department of Experimental, Clinical and Health Psychology, Ghent University, Ghent, Belgium
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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]
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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.
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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
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Meganck R. Beyond the Impasse - Reflections on Dissociative Identity Disorder from a Freudian-Lacanian Perspective. Front Psychol 2017; 8:789. [PMID: 28559875 PMCID: PMC5432572 DOI: 10.3389/fpsyg.2017.00789] [Citation(s) in RCA: 2] [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: 01/02/2016] [Accepted: 04/28/2017] [Indexed: 11/13/2022] Open
Abstract
Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID.
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Affiliation(s)
- Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent UniversityGhent, Belgium
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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.
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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
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Abstract
Although evidence with respect to its prevalence is mixed, it is clear that fathers perpetrate a serious proportion of filicide. There also seems to be a consensus that paternal filicide has attracted less research attention than its maternal counterpart and is therefore less well understood. National registries are a very rich source of data, but they generally provide limited information about the perpetrator as psychiatric, psychological and behavioral data are often lacking. This paper presents a fully documented case of a paternal filicide. Noteworthy is that two motives were present: spousal revenge as well as altruism. The choice of the victim was in line with emerging evidence indicating that children with disabilities in general and with autism in particular are frequent victims of filicide-suicide. Finally, a schizoid personality disorder was diagnosed. Although research is quite scarce on that matter, some research outcomes have showed an association between schizoid personality disorder and homicide and violence.
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Debaere V, Vanheule S, Van Roy K, Meganck R, Inslegers R, Mol M. Changing encounters with the other: A focus group study on the process of change in a therapeutic community. Psychoanalytic Psychology 2016. [DOI: 10.1037/a0036862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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.
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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
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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
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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.
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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
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Van Roy K, Vanheule S, Debaere V, Inslegers R, Meganck R, Deganck J. A Lacanian view on Balint group meetings: a qualitative analysis of two case presentations. BMC Fam Pract 2014; 15:49. [PMID: 24655833 PMCID: PMC3994455 DOI: 10.1186/1471-2296-15-49] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/17/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND GPs' subjectivity is an intrinsic instrument in their daily work. By offering GPs a platform to present and discuss difficult interactions with patients, Balint group work be might provide them an opportunity to explore and articulate aspects of their subjectivity. In order to get a more profound understanding of what participation in a Balint group can offer, we focused on the process of change that can be observed during Balint group meetings. To that end, this study scrutinized two Balint group case discussions on a micro-level. METHOD Two cases were selected from a larger data set of 68 audio-taped case discussions in four Balint groups. In order to shed light on the type of change that characterizes the presenter's narrative, we used Lacan's theoretical distinction between imaginary and symbolic modes of relating to the other. RESULTS In both case discussions, the GPs presenting the case initially appeared to be stuck in a fixed image of a situation, referred to as 'imaginary relating to the other.' Through a range of interactions with the group, the presenters were encouraged to explore different subject positions, which allowed them to broaden their initial image of the situation and to discover other issues at stake. This was referred to as a more symbolic way of relating to the other. CONCLUSION This study throws light on the type of change Balint group participation allows for and on the way this might be achieved. We conclude that Balint group work is potentially beneficial to the participating GPs as well as to the relationship with their patients.
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Affiliation(s)
- Kaatje Van Roy
- Department of Psychoanalysis and Clinical Consulting, Ghent University, H, Dunantlaan 2, 9000 Ghent, Belgium.
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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.
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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]
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Desmet M, Meganck R, Vanheule S. Hysterical and obsessive-compulsive symptom patterns: are they associated with anaclitic and introjective interpersonal profiles? J Am Psychoanal Assoc 2013; 61:NP1-7. [PMID: 24357589 DOI: 10.1177/0003065113516363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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]
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Camp I, Desmet M, Inslegers R, Meganck R. Differences in Affect Expressivity between Subtypes of Non-Suicidal Self-Injury. APS 2013. [DOI: 10.2174/2210676611303030008] [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: 11/22/2022]
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