OVER HET PUBLIEKE BELANG VAN HET BEROEPSGEHEIM
SUR L'INTÉRÊT PUBLIC DU SECRET PROFESSIONNEL
"La relation entre le secret médical et la qualité de la pratique est extrêmement forte. Un patient doit en effet pouvoir se confier à un médecin qu’il a librement choisi. La qualité de la relation entre soignant et soigné ne peut être optimale que s’il existe une confiance totale entre les deux parties, qui s’engagent par un contrat tacite, l’une à tout dire, et l’autre à tout faire, pour répondre à la demande de santé. Dans cette relation, le secret de la confidence est impératif, puisqu’il paraît évident que cacher des antécédents, ne pas se livrer lors de l’anamnèse, oriente le praticien sur de fausses pistes diagnostiques, et fait courir le risque de
traitements inadaptés ou dangereux. "
"...notre société démocratiquement avancée ne peut se payer le luxe d’abandonner le secret professionnel. Les exigences de protection de la vie privée contre les intrusions extérieures, d’où qu’elles viennent et même de l’autorité publique, doivent réaffirmer avec force l’impérieuse nécessité du secret professionnel. Ce n’est que lorsque le citoyen est assuré de la préservation du caractère sacré de son individualité qu’il peut trouver librement sa place dans le corps social, et contribuer, par sa vie, son activité, ses actes, et ses pensées, à la réalisation du bien commun. "
De Toeuf, J. Le secret professionnel du médecin et qualité des soins.
OVER DE RISICO'S VAN DE DIGITALISERING VAN INTIEME GEGEVENS
SUR LES RISQUES DE LA NUMÉRISATION DES DONNÉES INTIMES
"Afin de garantir l’accessibilité aux soins de la santé mentale et la possibilité pour le patient de nouer une relation de confiance, le passage du dossier-papier au dossier électronique, centralisé et partagé ne peut modifier les règles habituelles en matière de partage du secret professionnel.
Une question reste en suspens. Comment convaincre les politiciens, les directions administratives et sans doute certains de nos collègues que, dans notre domaine, « le respect du secret professionnel n’est pas une entrave à l’optimisation des soins, que du contraire. » ?
Comment convaincre que même si une continuité des soins impose le partage de certaines données confidentielles pertinentes, le consentement éclairé du patient est la première des conditions cumulées autorisant ce partage ?"
Monnoye, G. : Secret professionnel et/ou continuité des soins par le dossier patient informatisé… et partagé, un conflit de valeurs
OVER HET ONTERECHT MEDICALISEREN VAN PSYCHISCHE PROBLEMATIEK
SUR LA MÉDICALISATION INJUSTIFIÉE DES PROBLÈMES PSYCHOLOGIQUES
"Pies vertelde dat hij zich enorm boos maakt over de theorie van een ‘ontbrekend stofje in het brein’ als verklaring voor psychische problemen. Zijn grootste ergernis betreft de suggestie dat dit ‘belachelijke idee’ door wetenschappelijk geschoolde deskundigen zou zijn verspreid.
Die ergernis moet Pies dan regelmatig overkomen, want het gewraakte idee komt in allerlei neurobiologische bewoordingen voor. Men heeft het bijvoorbeeld ook over een ‘chemische onbalans’ in de hersenen, of een tekort (soms teveel) aan neurotransmitters, dat – net zoals insulinetekort bij diabetes – met medicatie moet worden gecorrigeerd. Specifieker zegt men dat er een onbalans is in de dopamine-, serotonine- of noradrenaline-huishouding van mensen met ongewenste eigenschappen, emoties of gedrag. Soms volgt nog als aanvulling dat het ontbrekende stofje in iemands hersenen verband houdt met een ontbrekend stukje in zijn of haar dna"
Dehue, T. : Het ‘ontbrekende stofje in het brein’
"For three decades, people have been deluged with information suggesting that depression is caused by a “chemical imbalance” in the brain – namely an imbalance of a brain chemical called serotonin. However, our latest research review shows that the evidence does not support it."
"Although viewing depression as a biological disorder may seem like it would reduce stigma, in fact, research has shown the opposite, and also that people who believe their own depression is due to a chemical imbalance are more pessimistic about their chances of recovery.
It is important that people know that the idea that depression results from a “chemical imbalance” is hypothetical. And we do not understand what temporarily elevating serotonin or other biochemical changes produced by antidepressants do to the brain. We conclude that it is impossible to say that taking SSRI antidepressants is worthwhile, or even completely safe"
Moncrieff, J. & Horowitz, M. : Analysis: Depression is probably not caused by a chemical imbalance in the brain – new study
"For some of us, madness-as-strategy has a liberating and empowering quality. It means that our delusions, our depression, our dissociative episodes, aren’t the byproducts of a defective mind. Instead, they might be ingenious solutions to the problems life has thrown our way.
The point here isn’t to destroy madness-as-dysfunction or to deny its value entirely. Some mental disorders do stem from biological dysfunctions. Lewy body dementia, for example, is caused by malformed proteins in the brain. Both perspectives can comfortably co-exist—as long as they make space for the other.
Instead, the point is to help us adopt multiple perspectives on a complex reality, like the proverbial blind men and the elephant. Recognizing madness-as-strategy as a valid perspective helps us better meet the different needs of those society deems mad."
Garson, J. : Madness: A Philosophical Exploration
"Allen Frances, one of the world's most influential psychiatrists, warns that mislabeling everyday problems as mental illness has shocking implications for individuals and society: stigmatizing a healthy person as mentally ill leads to unnecessary, harmful medications, the narrowing of horizons, misallocation of medical resources, and draining of the budgets of families and the nation. We also shift responsibility for our mental well-being away from our own naturally resilient and self-healing brains, which have kept us sane for hundreds of thousands of years, and into the hands of "Big Pharma," who are reaping multi-billion-dollar profits. Frances cautions that the new edition of the "bible of psychiatry," the Diagnostic and Statistical Manual of Mental Disorders-5 {DSM-5), will turn our current diagnostic inflation into hyperinflation by converting millions of "normal" people into "mental patients. (...) Frances argues that whenever we arbitrarily label another aspect of the human condition a "disease," we further chip away at our human adaptability and diversity, dulling the full palette of what is normal and losing something fundamental of ourselves in the process."
OVER HET BELANG VAN HET SPAARZAAM OMGAAN MET DIAGNOSTIEK
SUR L'IMPORTANCE D'UTILISER LES DIAGNOSTICS AVEC PARCIMONIE
"One interesting (and, to a therapist, somewhat disconcerting) side-effect of the 1980 change toward descriptive and categorical psychiatric diagnosis involves the ways people in Western cultures have begun talking about themselves since the DSM-III paradigm shift. It used to be that a socially avoidant woman would come for therapy saying something like, “I’m a painfully shy person, and I need help learning how to deal better with people in social situations.” Now a person with that concern is likely to tell me that she “has” social phobia – as if an alien affliction has invaded her otherwise problem-free subjective life. People talk about themselves in acronyms oddly dissociated from their lived experience: “my OCD,” “my eating disorder,” “my bipolar.” There is an odd estrangement from one’s sense of an agentic self, including one’s own behavior, body, emotional and spiritual life, and felt suffering, and consequently one’s possibilities for solving a problem. There is a passive quality in many individuals currently seeking therapy, as if they feel that the prototype for making an internal psychological change is to describe their symptoms to an expert and wait to be told what medicine to take, what exercises to do, or what self-help manual to read."
"Since we know from clinical experience and research on self-reflective function (e.g., Fonagy et al., 1991; Gabbard, 2005; Jurist & Slade, 2008; Müller et al., 2006) that the development of a personal narrative about the connections between one’s unique life experiences and one’s idiosyncratic psychology is a key element of mental health – so evident in its absence from the shattered mental life of many survivors of trauma – it is not hard to view our current psychiatric nomenclature as contributing to self-fragmentation rather than providing a means to heal it."
Nancy McWilliams : Diagnosis and Its Discontents: Reflections on Our Current Dilemma
"Waar draait het in deze voorbeelden om? Om onze taal. Om onze eigen woorden en ook onze stilzwijgende en vanzelfsprekende betekenissen, opvattingen, eisen en verwachtingen, waarmee we elkaar beïnvloeden. Taal doet iets. Taal brengt iets teweeg. Taal is performatief. Door iets wat opvalt aan een kind al te benoemen als ‘prikkelgevoelig zijn’, maken wij dat dit als een afwijking wordt gezien, als een stoornis die in de hersenen zit.
Maar hier blijft het niet bij. Met onze taal beïnvloeden wij niet alleen elkaar. Onze taal, onze woorden en betekenissen nemen we ook mee naar de spreekkamer van de psychiater en psycholoog. Met onze labels beïnvloeden we ongemerkt wat de psychiater gaat zien en denken als we bijvoorbeeld over een jongere praten in de spreekkamer.
Ze maken dat wij problemen van onze jongeren opvatten als hersenstoornissen, ín hun hersenen. Willen we dit? En wanneer gaan wij onze eigen labeltaal opzijzetten en kijken waar ze daadwerkelijk tegenaan lopen?"
David Con : We plakken te snel een etiket op kinderen die zich iets anders gedragen
The "Illness Identity" model proposed that self-stigma impacts hope and self-esteem and subsequently leads to a cascade of negative effects on outcomes related to recovery among people diagnosed with severe mental illnesses.
Yanos, P.T., DeLuca J.S., Roe D. & Lysaker P. : The impact of illness identity on recovery from severe mental illness: A review of the evidence
"Overall, our scoping review underlines the presence of stigmatizing attitudes and behaviors toward people with a mental disorder in the somatic health care system. The included studies show that stigma may be caused by several factors, e.g. lack of knowledge about mental disorders among health professionals, lack of time to care for more demanding or difficult patients and by health professionals’ experiences of feeling insecure and unsafe in the presence of patients with mental disorders [111, 132, 152]. Following Link and Phelan’s conceptualization of stigma, health professionals’ experiences of lacking knowledge and competencies regarding mental disorders may initiate a stigmatization process in which they—due to dominant cultural beliefs—link undesirable characteristics and negative stereotypes to patients with mental disorders and engage in a separation of “us” from “them”, leading the patients to experience status loss, discrimination and unequal outcomes and opportunities [12]. However, the identified intervention studies reveal that attitudes toward people with mental disorders among somatic health care professionals to a great extent reflect the attitudes of the general population."
Nielsen Soelvhoej, I, Oxholm Kusier A., Pedersen P.V. Nielsen M.B.D. : Somatic health care professionals’ stigmatization of patients with mental disorder: a scoping review
Research has shown that people with SMI often receive fewer physical health screenings and interventions, compared to the general population, even in developed countries Despite clear directions and numerous recommendations over the last decade to improve the quality of somatic health care for people with SMI, little to no progress has been made. Moreover, it even seems that the mortality gap between people with SMI and the general population is widening.
Several patient and illness-, treatment-, healthcare provider-, as well as healthcare system-related factors act as barriers to the recognition and management of somatic comorbidities in patients with SMI A US study showed that lack of awareness of somatic problems, poverty, financial barriers and stigma were primary barriers to oral health care for adult community mental health outpatients with SMI
Kohn, L., Christiaens, W., Detraux, J., De Lepeleire, J., De Hert, M., Gillain, B., Delaunoit, B., Savoye, I., Mistiaen, P., Jespers, V. : Barriers to Somatic Health Care for Persons With Severe Mental Illness in Belgium: A Qualitative Study of Patients' and Healthcare Professionals' Perspectives
OVER DE WERKZAAMHEID VAN OF DE WERKZAME FACTOREN IN EEN PSYCHOTHERAPIE
SUR L'EFFICACITÉ DE, OU LES FACTEURS INFLUENÇANT, LA PSYCHOTHÉRAPIE
"This volume examines the common factors underlying effective psychotherapy and brings the psychotherapist and the client–therapist relationship back into focus as key determinants of psychotherapy outcome.
The second edition of The Heart and Soul of Change also demonstrates the power of systematic client feedback to improve effectiveness and efficiency and legitimize psychotherapy services to third party payers. In this way, psychotherapy is implemented one person at a time, based on that unique individual's perceptions of the progress and fit of the therapy and therapist."
Duncan, B.L., Miller, S., Wampold, B.E. & Hubble, M.A. : The Heart and Soul of Change Delivering What Works in Therapy
"What is “evidence-based” really supposed to mean? I noted earlier that the term originated in medicine. Evidence-based medicine (EBM) was supposed to represent the convergence or intersection of 1) relevant scientific evidence, 2) patients’ values and preferences, and 3) the experience and clinical judgment of the practitioner (Figure 2).
"What has happened to these ideas in the field of psychotherapy? “Relevant scientific evidence” no longer matters, because proponents of so-called evidence-based therapies ignore evidence for therapy that is not pre-scripted, manualised therapy. In 2010, I published an article in American Psychologist titled, “The efficacy of psychodynamic psychotherapy” (Shedler, 2010). The article demonstrated that the benefits of psychodynamic therapy are at least as large as those of so-called
evidence-based therapy—and moreover, the benefits of psychodynamic therapy last. Proponents of “evidence-based” therapy typically disregard this evidence.
“Patients’ values and preferences” also do not matter, because patients are not being informed and offered meaningful choices. They may be offered only brief manualised treatment and told it is the “gold standard” of care. “Clinical judgment” also no longer matters, because clinicians are expected to follow manuals rather than exercise meaningful clinical judgment. They are being asked to function as technicians, not clinicians. One could argue that “evidence-based”, as the term is now used with respect to psychotherapy, is a perversion of every founding principle on which the concept of evidence-based medicine rests."
Shedler, J. : Where Is the Evidence for “Evidence-Based” Therapy?
"Les résultats des études menées en ce domaine démontrent que les psychothérapies sont efficaces aussi bien sur le court terme que le long terme. Leur efficacité est le plus souvent indépendante de l’obédience théorique du clinicien. En revanche, les facteurs communs comme l’alliance thérapeutique ou les particularités du thérapeute sont des éléments prévalents de même que la durée et la fréquence des psychothérapies. Concernant plus précisément l’évaluation des PPP, celles-ci sont démontrées empiriquement comme étant efficaces pour la plupart des troubles psychiatriques. Plusieurs caractéristiques des PPP sont en outre corrélées de manière significative avec l’efficacité thérapeutique."
Rabeyron, T. L'évaluation et l'efficacité des psychothérapies psychanalytiques et de la psychanalyse
Long-term effects of psychotherapeutic interventions : A review of recent international research.
OVER WETENSCHAPPELIJK ONDERZOEK IN DE PSYCHOLOGIE
SUR L'EFFICACITÉ DE, OU LES FACTEURS INFLUENÇANT, LA PSYCHOTHÉRAPIE
"Indeed, if Bem was able to demonstrate the existence of precognition – and given that precognition cannot exist for a lot of psychologists (Reber and Alcock, 2020) – did he show unwittingly that something was profoundly wrong in the way experiments are conducted in the field of psychology (Wiggins and Chrisopherson, 2019)? Many relevant papers have been published since Bem’s initial publication (Pashler and Harris, 2012; Savalei and Dunn, 2015) about the replicability crisis, Bayesian statistics (Witte and Zenker, 2017), and questionable research practices (QRPs; Wagenmakers et al., 2011; Bierman et al., 2016). In the present paper, we would like to suggest that this debate could be an opportunity to develop original thinking about psychology and replicability. In this regard, we will show that the Bem studies are not an isolated “accident,” but are actually inserted in a long tradition of research which tries to deal with complex epistemological problems concerning the nature of reality and human consciousness. Specifically, we will argue that the controversies about the existence of psi could be highly informative about psychology and consciousness studies."
Rabeyron, T. Why Most Research Findings About Psi Are False: The Replicability Crisis, the Psi Paradox and the Myth of Sisyphus
"In the scientifc literature, clinical reasoning and clinical judgement are sometimes portrayed as naive, intuitive, unscientifc. This paper demonstrates that it is underpinned by an epistemological stance that can also be found in other casebased disciplines. On the basis of the diference between thinking in cases and statistical thinking, it can be argued that thinking in cases is more suitable to support clinicians who have to deal with situations that are characterized by
uniqueness, uncertainty and value-conficts. The reason for this is that evidence within statistical thinking is evidence about groups. It is unknown to what degree this evidence is relevant to an individual. (...) The current approach to evidence-based practice in psychology is too much based on an emulation of the medical
approach to evidence-based practice. In medicine, the traditional evidence-based approach has been criticized and some have advocated alternative approaches (e.g. narrative-based medicine, value-based medicine). Clinical psychology and psychotherapy are fundamentally diferent from medicine and should develop their own epistemological framework.
The role of empirical research in supporting this approach to EBPP is still crucial.(...) But Overholser (2020) identifed the overreliance on efcacy studies as a negative evolution in the feld of psychotherapy, as it promulgates the application of standardized treatment protocols and reduces the role of the clinician
to a paraprofessional technician. In order to bridge the gap between science and practice, efcacy studies need to be complemented with patient-oriented studies that (1) address questions that are relevant to clinicians rather than researchers, (2) embed data collection in naturalistic clinical settings rather than in controlled experimental conditions, and (3) involve populations and interventions that are part of routine clinical practice (Castonguay et al., 2021). For this mission, a multitude of methods can be used, both qualitatively and quantitatively, both in groups and in cases. In this context, systematic case studies are particularly interesting as a more systematic alternative to clinical case studies. In recent years, an online archive of published psychotherapy case studies (www.singlecasearchive.com) has been created to allow researchers, clinicians, and students to easily find case studies that are relevant to their interests (Meganck et al., 2022).
Furthermore, more research should be done on conceptual and refective skills in practitioners, as these constitute the link between research and practice. How do clinicians actually come to understand complex clinical situations and how can they do so in a trustworthy way? Are the current training and supervision practices in the feld of clinical psychology and psychotherapy sufficient to support this process? How can clinicians work with value-conflicts in their work? (...) A good clinician should not only be able to do his or her job, but he or she should also be able to critically question and defne what the job actually is: what are we doing, who are we serving, and why are we doing this? This requires an awareness of the ethical, social, and even political role of clinical psychologists and psychotherapists in society. "
Willemsen, J. The use of evidence in clinical reasoning
Maak jouw eigen website met JouwWeb