Interpersonal dynamics & therapeutic relationship in patients with functional somatic syndromes: A metasynthesis of case studies, 2020, Krivzov et al

Andy

Andy

Retired committee member
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.
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Paywall, https://doi.apa.org/doiLanding?doi=10.1037/cou0000529
Sci hub, unable to access via at time of posting
 
patients were avoiding negative emotions in order to please and control the unreliable others
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Nope - quite happy to feel furious about this drivel of an abstract, which is as bad as any I have seen. Quite happy not to please these particular 'unreliable others'.

Attributing the dropout of patients from psychotherapy to
patients’ history of trauma, attachment disturbances, and mentalization deficits ....[and] maladaptive interpersonal patterns
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looks a lot like the authors are avoiding coming to terms with the negative emotions arising from realising that their therapy is a failure.

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.
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Hmm, sounds like an excuse to avoid the figures that accurately describe the failure of the therapists and instead just make stuff up.
 
Puts on rant hat

Here's the simple explanation: you're full of shit and have no idea what you're doing. That's it. You're all full of shit, we can see through it and dislike being blatantly lied to our faces while we are suffering life-destroying illness. Stop being full of shit, stop blatantly lying to people's faces, stop gaslighting people begging for help and you will never have to wonder why people call you out for being full of shit.

You're right that there is an interpersonal element here, but it's 100% on you, you are wholly and completely to blame here. Because you're completely full of shit and, spoiler alert, most people dislike that when it comes to their welfare. If you can't stop lying just go away, nothing of value will be lost.

Hat off
 
From the quote in post #1...

mentalization deficits

Can anyone tell me what "mentalization deficits" are?

doctor hopping

If I took my car to a garage for repair and the mechanic was a poor diagnostician of car troubles, which meant I had to go back over and over again and still ended up with a barely functioning car, I would be considered mad for wasting my money by not finding someone else to fix my car.

The medical profession has convinced itself that all doctors are extremely competent and excellent diagnosticians and if a patient doesn't get better then the patient is at fault, not the doctor. Since patients know this idea is utter b******s of course we try to find someone who is actually competent. (This probably explains the popularity of that TV series House MD.) But medical records can be used to "pass on" the incompetence to other doctors by recording the idea that the patient is mentally ill and has some kind of functional problem, so new doctors shouldn't waste time on the patient.

This idea that trying to find someone who can fix my body is somehow different to wanting to find someone who can fix my car has always baffled me. And also the idea that "doctor shopping - or hopping" - is somehow the sign of a diseased mind is just plain weird as far as I'm concerned.
 
Is it really maladaptive to avoid wasting your time with a moron who will not listen to you and always assumes that what you have to say is always wrong . closed minded people who are either mentally challenged or knowingly taking part in a huge fraud should not be surprised when patients walk away from them . is this the only field where such papers complaining of their failure blame the patients .
 
This paper is one of the most staggering examples of projection i think i have ever seen. It is almost spectacular in it's illustration of the dearth of self awareness & humility among many therapists.

Arnie Pye said:
The medical profession has convinced itself that all doctors are extremely competent and excellent diagnosticians and if a patient doesn't get better then the patient is at fault, not the doctor. Since patients know this idea is utter b******s of course we try to find someone who is actually competent. (This probably explains the popularity of that TV series House MD.) But medical records can be used to "pass on" the incompetence to other doctors by recording the idea that the patient is mentally ill and has some kind of functional problem, so new doctors shouldn't waste time on the patient.

This idea that trying to find someone who can fix my body is somehow different to wanting to find someone who can fix my car has always baffled me. And also the idea that "doctor shopping - or hopping" - is somehow the sign of a diseased mind is just plain weird as far as I'm concerned.
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Indeed.

edited - to make it clear it the paper i was talking about - not Arnie Pye's quote!
 
This is in the Journal of Counseling Psychology.

I noodled around and apparently it is a fairly high-impact journal, not some obscure dumpster. (see here, #27.)

In fact it is published by the American Psychological Association.

Evidently the APA has no scientific standards. Or maybe it will waive them as a "professional courtesy", as therapists' first-hand determinations are surely beyond question.

This may be the finest template for a spoof paper yet.
 
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.
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Jeebus, do these clowns ever look in a mirror?

All of the above could be fully explained by incompetence, dishonesty, and cowardice from the medical profession, and patients struggling to survive it all.

Don't you just love how the crowd that go on and on and on about the importance of social determinants of health are also utterly blind to their role in creating these problems? They still believe they are neutral observers, not active participants.

This paper is just straight propaganda. Purely political. There is no science in it. It is an excuse generation exercise, so they never have to face the truth about themselves.
 
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