{"id":169,"date":"2022-10-16T19:51:18","date_gmt":"2022-10-16T19:51:18","guid":{"rendered":"https:\/\/comvigil.evcc.be\/?page_id=169"},"modified":"2026-01-18T12:10:03","modified_gmt":"2026-01-18T12:10:03","slug":"relevante-publicaties","status":"publish","type":"page","link":"https:\/\/comvigil.be\/fr\/relevante-publicaties\/","title":{"rendered":"Articles pertinents"},"content":{"rendered":"
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Publications pertinentes<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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CONCERNANT L'IMPORTANCE DU SECRET PROFESSIONNEL<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Le secret professionnel garantit l'accessibilit\u00e9 aux soins de sant\u00e9 mentale. \u00a0<\/span><\/strong><\/h6>

“La relation entre le secret m\u00e9dical et la qualit\u00e9 de la pratique est extr\u00eamement forte. Un patient doit en effet pouvoir se confier \u00e0 un m\u00e9decin qu\u2019il a librement choisi. La qualit\u00e9 de la relation entre soignant et soign\u00e9 ne peut \u00eatre optimale que s\u2019il existe une confiance totale\u00a0 entre les deux parties, qui s\u2019engagent par un contrat tacite, l\u2019une \u00e0 tout dire, et l\u2019autre \u00e0 tout faire, pour r\u00e9pondre \u00e0 la demande de sant\u00e9. Dans cette relation, le secret de la confidence est imp\u00e9ratif, puisqu\u2019il para\u00eet \u00e9vident que cacher des ant\u00e9c\u00e9dents, ne pas se livrer lors de l\u2019anamn\u00e8se, oriente le praticien sur de fausses pistes diagnostiques, et fait courir le risque de <\/em>traitements inadapt\u00e9s ou dangereux. “<\/em><\/p>

“…notre soci\u00e9t\u00e9 d\u00e9mocratiquement avanc\u00e9e ne peut se payer le\u00a0luxe d\u2019abandonner le secret professionnel. Les exigences de protection de la vie priv\u00e9e\u00a0contre les intrusions ext\u00e9rieures, d\u2019o\u00f9 qu\u2019elles viennent et m\u00eame de l\u2019autorit\u00e9 publique,\u00a0doivent r\u00e9affirmer avec force l\u2019imp\u00e9rieuse n\u00e9cessit\u00e9 du secret professionnel. Ce n\u2019est que\u00a0lorsque le citoyen est assur\u00e9 de la pr\u00e9servation du caract\u00e8re sacr\u00e9 de son individualit\u00e9 qu\u2019il\u00a0peut trouver librement sa place dans le corps social, et contribuer, par sa vie, son activit\u00e9,\u00a0ses actes, et ses pens\u00e9es, \u00e0 la r\u00e9alisation du bien commun<\/em>.\u00a0“<\/p>

De Toeuf, J. Le secret professionnel du m\u00e9decin et qualit\u00e9 des soins.\u00a0\u00a0<\/strong><\/p>

any disclosure of confidential information should be a last resort and that psychologists must push back and limit the growing list of mandatory and permissible disclosures<\/em><\/p>

Donner, M.B., VandeCreek, L., Gonsiorek, J.C. & Fisher, C. Balancing confidentiality : protecting privacy and protecting the public<\/a><\/p>

La libert\u00e9 de parole est une condition pr\u00e9alable au traitement des probl\u00e8mes psychologiques.\u00a0<\/strong><\/h6>
In addition to the negative emotions often associated with secrets, concealment has been shown to play a role in the development of physical illness and to be related to negative psychological effects, including lower levels of well-being and life satisfaction (…)<\/div>
Baumann, E.C. & Hill, C.E. Client concealment and disclosure of secrets in outpatient psychotherapy<\/a>.<\/div>
\u00a0<\/div><\/div><\/div>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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SUR LES RISQUES DE LA NUM\u00c9RISATION DES DONN\u00c9ES INTIMES<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Le consentement du patient, pour stocker et partager des informations, est n\u00e9cessaire dans une relation de confiance.<\/strong><\/h6>

“Afin de garantir l\u2019accessibilit\u00e9 aux soins de la sant\u00e9 mentale et la possibilit\u00e9 pour le patient de nouer une relation de confiance, le passage du dossier-papier au dossier \u00e9lectronique, centralis\u00e9 et partag\u00e9 ne peut modifier les r\u00e8gles habituelles en mati\u00e8re de partage du secret professionnel.<\/em><\/p>

Une question reste en suspens. Comment convaincre les politiciens, les directions administratives et sans doute certains de nos coll\u00e8gues que, dans notre domaine, \u00ab\u00a0le respect du secret professionnel n\u2019est pas une entrave \u00e0 l\u2019optimisation des soins, que du contraire.\u00a0\u00bb\u00a0?<\/em><\/p>

Comment convaincre que m\u00eame si une continuit\u00e9 des soins impose le partage de certaines donn\u00e9es confidentielles pertinentes, le consentement \u00e9clair\u00e9 du patient est la premi\u00e8re des conditions cumul\u00e9es autorisant ce partage\u00a0?”<\/em><\/p>

Monnoye, G. :\u00a0Secret professionnel et\/ou continuit\u00e9 des soins par le dossier patient informatis\u00e9\u2026 et partag\u00e9, un conflit de valeurs<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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SUR LA M\u00c9DICALISATION INJUSTIFI\u00c9E DES PROBL\u00c8MES PSYCHOLOGIQUES<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Les preuves de l'existence d'une cause organique dans les troubles mentaux sont encore insuffisantes.\u00a0<\/strong><\/h6>

“Pies vertelde dat hij zich\u00a0enorm boos maakt over de theorie van een \u2018ontbrekend stofje in het brein\u2019\u00a0als verklaring voor psychische problemen. Zijn grootste ergernis betreft\u00a0de suggestie dat dit \u2018belachelijke idee\u2019 door wetenschappelijk geschoolde\u00a0deskundigen zou zijn verspreid.<\/em>
Die ergernis moet Pies dan regelmatig overkomen, want het gewraakte\u00a0idee komt in allerlei neurobiologische bewoordingen voor. Men heeft\u00a0het bijvoorbeeld ook over een \u2018chemische onbalans\u2019 in de hersenen, of\u00a0een tekort (soms teveel) aan neurotransmitters, dat \u2013 net zoals insulinetekort bij diabetes \u2013 met medicatie moet worden gecorrigeerd. Specifieker zegt men dat er een onbalans is in de dopamine-, serotonine- of\u00a0noradrenaline-huishouding van mensen met ongewenste eigenschappen,\u00a0emoties of gedrag. Soms volgt nog als aanvulling dat het ontbrekende\u00a0stofje in iemands hersenen verband houdt met\u00a0een ontbrekend stukje in zijn of haar dna”<\/em><\/p>

Dehue, T.\u00a0 :\u00a0Het \u2018ontbrekende\u00a0stofje in het brein\u2019<\/a><\/p>

“For three decades, people have been deluged with information suggesting that depression is caused by a \u201cchemical imbalance\u201d in the brain \u2013 namely an imbalance of a brain chemical called serotonin. However, our latest\u00a0research review<\/a>\u00a0shows that the evidence does not support it.”<\/em><\/p>

“Although viewing depression as a biological disorder may seem like it would reduce stigma, in fact,\u00a0research has shown the opposite<\/a>, and also that people who believe their own depression is due to a chemical imbalance are\u00a0more pessimistic<\/a>\u00a0about their chances of recovery.<\/em><\/p>

It is important that people know that the idea that depression results from a \u201cchemical imbalance\u201d 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”<\/em><\/p>

Moncrieff, J. & Horowitz, M. :\u00a0Analysis:\u00a0Depression is probably not caused by a chemical imbalance in the brain \u2013 new study<\/a><\/p>

“For some of us, madness-as-strategy has a liberating and empowering quality. It means that our delusions, our depression, our dissociative episodes, aren\u2019t the byproducts of a defective mind. Instead, they might be ingenious solutions to the problems life has thrown our way.<\/em><\/p>

The point here isn\u2019t to destroy madness-as-dysfunction or to deny its value entirely. Some mental disorders do stem from biological dysfunctions.\u00a0Lewy body<\/a>\u00a0dementia, for example, is caused by malformed proteins in the brain. Both perspectives can comfortably co-exist\u2014as long as they make space for the other.<\/em><\/p>

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<\/em>.”<\/p>

Garson, J<\/a>. :\u00a0Madness: A Philosophical Exploration\u00a0<\/a><\/p>

“<\/span>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\u00a0<\/em>Diagnostic and Statistical Manual of Mental Disorders-5 {DSM-5<\/em>), 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<\/em>.”<\/span><\/p>

Frances,\u00a0 A. :\u00a0Saving normal : an insider’s revolt against out-of-control psychiatric diagnosis, DSM-5, Big Pharma, and the medicalization of ordinary life<\/a><\/p>

L'hypoth\u00e8se selon laquelle la pr\u00e9vention pr\u00e9coce emp\u00eachera une psychopathologie ult\u00e9rieure n'a pas fait l'objet de recherches suffisantes et est pour le moins inad\u00e9quate en tant que mod\u00e8le explicatif des probl\u00e8mes psychologiques. Les soins de sant\u00e9 mentale ne devraient donc pas se fonder uniquement sur cette hypoth\u00e8se.\u00a0<\/strong><\/h6>

We agree that there is sound evidence for treatment effectiveness in the short-term and there is some evidence for longer-term effects of certain specific treatments, such as behavioral parent training in children with behavioral disorders, as acknowledged in our editorial. However, we strongly disagree that there is sound evidence for long-term effectiveness.<\/em><\/p>

Roest, A.M., de Vries, Y.A., Wienen, A.W. & de Jonge, P. Commentary : The evidence bas regarding the long-term effects of childhood mental disorder treatment needs to be strengthened – reply to Dekkers et al. (2023)\u00a0<\/a><\/p>

The paucity of long-term studies on the treatment of childhood mental disorders is a major gap in the scientific evidence and therefore an important direction for future research. In the absence of firm scientific evidence, the expected balance of benefits and harms in the short and long run for the individual child in his or her particular context should guide treatment decisions regarding ADHD, behavior, and anxiety or depressive disorders. In some cases, watchful waiting may be the best choice, especially if symptoms are mild.<\/em><\/p>

Roest, A.M., de Vries, Y.A., Wienen, A.W. & de Jonge, P. Editorial perspective : are treatments for childhood mental disorders helpful in the long run ? An overview of systematic reviews<\/a>.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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SUR L'IMPORTANCE D'UTILISER LES DIAGNOSTICS AVEC PARCIMONIE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Il vaut mieux ne pas commencer le traitement (imm\u00e9diatement) \u00e0 partir d'un diagnostic : le mod\u00e8le stepped care comme alternative<\/strong><\/h6>

First, it may reduce the number of children incorrectly diagnosed with a psychiatric disorder. Children who improve enough with a behavioral
intervention without a classifying label benefit from treatment without having to bear the negative consequences of a label. Second, children who do need a psychiatric diagnosis and psychiatric treatment are not missed. Better resource allocation may especially benefit children with severe problems in impoverished, under-resourced communities, in which underdiagnosis may be a problem. Third, since, in less severe cases, unnecessary and expensive diagnostic procedures are averted, time and money will be saved. Fourth, some research has suggested that many people choose not to pursue mental health services because they want to avoid a diagnostic label. The provision of specialized help without a confirmed diagnosis may lower the threshold for children and families to receive help that may benefit them. Fifth, since a confirmed psychiatric classification is not a component of the first three steps of the stepped diagnosis approach, children who are impaired but do not meet DSM criteria for ADHD are
not deprived of help for their problems. Finally, sixth, problems with inter-rater reliability regarding the assessment of impairment are minimized. Classic evere cases of ADHD are obvious and inter-rater reliability will be high. In severe cases, most practitioners will go to step 4 of the stepped diagnosis model immediately. Reliability problems emerge in mild and moderate cases, in the grey area between typical and severely impairing degrees of inattention, hyperactivity, and impulsivity. The difference between mild and moderate problems is less important in the model, since, in both instances, the practitioner will go to step 2.<\/p>

Batstra, Nieweg, Pijl, Van Tol & Hadders-Algra : Childhood ADHD : a stepped diagnosis approach<\/a><\/p>

Les personnes peuvent s'identifier \u00e0 un diagnostic en partant du principe qu'il n'y a plus de changement possible.\u00a0<\/strong><\/h6>

“One interesting (and, to a therapist, somewhat disconcerting) side-effect of the 1980 change\u00a0toward descriptive and categorical psychiatric diagnosis involves the ways people in Western\u00a0cultures have begun talking about themselves since the DSM-III paradigm shift. It used to be that\u00a0a socially avoidant woman would come for therapy saying something like, \u201cI\u2019m a painfully shy\u00a0person, and I need help learning how to deal better with people in social situations.\u201d Now a person\u00a0with that concern is likely to tell me that she \u201chas\u201d social phobia \u2013 as if an alien affliction has\u00a0invaded her otherwise problem-free subjective life. People talk about themselves in acronyms oddly\u00a0dissociated from their lived experience: \u201cmy OCD,\u201d \u201cmy eating disorder,\u201d \u201cmy bipolar.\u201d There is an\u00a0odd estrangement from one\u2019s sense of an agentic self, including one\u2019s own behavior, body, emotional and spiritual life, and felt suffering, and consequently one\u2019s possibilities for solving\u00a0a problem. There is a passive quality in many individuals currently seeking therapy, as if they feel\u00a0that the prototype for making an internal psychological change is to describe their symptoms to an\u00a0expert and wait to be told what medicine to take, what exercises to do, or what self-help manual to\u00a0read.”\u00a0<\/em><\/p>

“Since we know from clinical\u00a0experience and research on self-reflective function (e.g., Fonagy et al., 1991; Gabbard, 2005; Jurist &\u00a0Slade, 2008; M\u00fcller et al., 2006) that the development of a personal narrative about the connections\u00a0between one\u2019s unique life experiences and one\u2019s idiosyncratic psychology is a key element of mental\u00a0health \u2013 so evident in its absence from the shattered mental life of many survivors of trauma \u2013 it is\u00a0not hard to view our current psychiatric nomenclature as contributing to self-fragmentation rather\u00a0than providing a means to heal it.”\u00a0<\/em><\/p>

Nancy McWilliams :\u00a0<\/a><\/span>Diagnosis and Its Discontents: Reflections on Our Current Dilemma\u00a0<\/a><\/p>

“<\/span>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 be\u00efnvloeden. Taal doet iets. Taal brengt iets teweeg. Taal is performatief. Door iets wat opvalt aan een kind al te benoemen als \u2018prikkelgevoelig zijn\u2019, maken wij dat dit als een afwijking wordt gezien, als een stoornis die in de hersenen zit.<\/em><\/p>

Maar hier blijft het niet bij. Met onze taal be\u00efnvloeden 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 be\u00efnvloeden we ongemerkt wat de psychiater gaat zien en denken als we bijvoorbeeld over een jongere praten in de spreekkamer.<\/em><\/p>

Ze maken dat wij problemen van onze jongeren opvatten als hersenstoornissen, \u00edn hun hersenen. Willen we dit? En wanneer gaan wij onze eigen labeltaal opzijzetten en kijken waar ze daadwerkelijk tegenaan lopen?”<\/em><\/p>

David Con :\u00a0We plakken te snel een etiket op kinderen die zich iets anders gedragen<\/a>\u00a0<\/p>

Le diagnostic entra\u00eene une stigmatisation.<\/strong>\u00a0<\/h6>

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<\/em>.<\/span><\/p>

Yanos, P.T., DeLuca J.S., Roe D. & Lysaker P. :\u00a0The impact of illness identity on recovery from severe mental illness: A review of the evidence<\/a>\u00a0<\/p>

“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\u2019 experiences of feeling insecure and unsafe in the presence of patients with mental disorders [111<\/a>,\u00a0132<\/a>,\u00a0152<\/a>]. Following Link and Phelan\u2019s conceptualization of stigma, health professionals\u2019 experiences of lacking knowledge and competencies regarding mental disorders may initiate a stigmatization process in which they\u2014due to dominant cultural beliefs\u2014link undesirable characteristics and negative stereotypes to patients with mental disorders and engage in a separation of \u201cus\u201d from \u201cthem\u201d, leading the patients to experience status loss, discrimination and unequal outcomes and opportunities [12<\/a><\/em>]. 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<\/em>.”\u00a0<\/span><\/p>

Nielsen Soelvhoej, I, Oxholm Kusier A., Pedersen P.V. Nielsen M.B.D.\u00a0 Somatic health care professionals’ stigmatization of patients with mental disorder: a scoping review\u00a0<\/a><\/span><\/p>

Research\u00a0has shown that people with SMI often receive fewer physical\u00a0health screenings and interventions, compared to the general\u00a0population, even in developed countries\u00a0 Despite clear\u00a0directions and numerous recommendations over the last decade\u00a0to improve the quality of somatic health care for people with SMI, little to no progress has been made. Moreover, it even\u00a0seems that the mortality gap between people with SMI and the\u00a0general population is widening.<\/em><\/p>

Several patient and illness-, treatment-, healthcare\u00a0provider-, as well as healthcare system-related factors act\u00a0as barriers to the recognition and management of somatic\u00a0comorbidities in patients with SMI\u00a0 A US study showed\u00a0that lack of awareness of somatic problems, poverty, financial\u00a0barriers and stigma were primary barriers to oral health care for\u00a0adult community mental health outpatients with SMI<\/em><\/p>

Kohn, L., Christiaens, W., Detraux, J., De Lepeleire, J., De Hert, M., Gillain, B., Delaunoit, B., Savoye, I., Mistiaen, P., Jespers, V. :\u00a0<\/span>Barriers to Somatic Health Care for Persons With Severe Mental Illness in Belgium: A Qualitative Study of Patients’ and Healthcare Professionals’ Perspectives<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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SUR L'EFFICACIT\u00c9 DE, OU LES FACTEURS INFLUEN\u00c7ANT, LA PSYCHOTH\u00c9RAPIE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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La relation de confiance reste un facteur important dans la psychoth\u00e9rapie.<\/strong><\/p>

“This volume examines the common factors underlying effective psychotherapy and brings the psychotherapist and the client\u2013therapist relationship back into focus as key determinants of psychotherapy outcome.<\/em><\/p>

The second edition of\u00a0The Heart and Soul of Change\u00a0also 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 therapis<\/em>t.”<\/span><\/p>

Duncan, B.L., Miller, S., Wampold, B.E. & Hubble, M.A. : The heart and Soul of Change Delivering What Works in Therapy\u00a0<\/a> \u00a0<\/span><\/p>

Le traitement des probl\u00e8mes psychologiques offre une grande vari\u00e9t\u00e9 d'approches th\u00e9rapeutiques, chacune avec ses avantages et ses inconv\u00e9nients.\u00a0<\/strong><\/h6>

“What is \u201cevidence-based\u201d really supposed to mean? I noted\u00a0earlier that the term originated in medicine. Evidence-based\u00a0medicine (EBM) was supposed to represent the convergence or\u00a0intersection of 1) relevant scientific evidence, 2) patients\u2019 values\u00a0and preferences, and 3) the experience and clinical judgment of\u00a0the practitioner (Figure 2).\u00a0<\/em><\/p>

“What has happened to these ideas in the field of psychotherapy? \u201cRelevant scientific evidence\u201d no longer matters, because\u00a0proponents of so-called evidence-based therapies ignore\u00a0evidence for therapy that is not pre-scripted, manualised therapy. In 2010, I published an article in American Psychologist\u00a0titled, \u201cThe efficacy of psychodynamic psychotherapy\u201d\u00a0(Shedler, 2010). The article demonstrated that the benefits of\u00a0psychodynamic therapy are at least as large as those of so-called\u00a0<\/em>evidence-based therapy\u2014and moreover, the benefits of psychodynamic therapy last. Proponents of \u201cevidence-based\u201d therapy\u00a0typically disregard this evidence.<\/em><\/p>

\u201cPatients\u2019 values and preferences\u201d also do not matter, because\u00a0patients are not being informed and offered meaningful choices.\u00a0They may be offered only brief manualised treatment and told\u00a0it is the \u201cgold standard\u201d of care. \u201cClinical judgment\u201d also no longer matters, because clinicians are expected to follow manuals rather than exercise meaningful clinical judgment. They are\u00a0being asked to function as technicians, not clinicians.\u00a0One could argue that \u201cevidence-based\u201d, as the term is now\u00a0used with respect to psychotherapy, is a perversion of every\u00a0founding principle on which the concept of evidence-based\u00a0medicine rests.”<\/em><\/p>

Shedler, J. :<\/span>\u00a0<\/span>Where is the Evidence for “Evidence-Based Therapy ?<\/span>\u00a0<\/span><\/a><\/p>

“<\/span>Les r\u00e9sultats des \u00e9tudes men\u00e9es en ce domaine d\u00e9montrent que les psychoth\u00e9rapies sont efficaces aussi bien sur le court terme que le long terme. Leur efficacit\u00e9 est le plus souvent ind\u00e9pendante de l\u2019ob\u00e9dience th\u00e9orique du clinicien. En revanche, les facteurs communs comme l\u2019alliance th\u00e9rapeutique ou les particularit\u00e9s du th\u00e9rapeute sont des \u00e9l\u00e9ments pr\u00e9valents de m\u00eame que la dur\u00e9e et la fr\u00e9quence des psychoth\u00e9rapies. Concernant plus pr\u00e9cis\u00e9ment l\u2019\u00e9valuation des PPP, celles-ci sont d\u00e9montr\u00e9es empiriquement comme \u00e9tant efficaces pour la plupart des troubles psychiatriques. Plusieurs caract\u00e9ristiques des PPP sont en outre corr\u00e9l\u00e9es de mani\u00e8re significative avec l\u2019efficacit\u00e9 th\u00e9rapeutique<\/em>.”<\/span><\/p>

Rabeyron, T.\u00a0L’\u00e9valuation et l’efficacit\u00e9 des psychoth\u00e9rapies psychanalytiques et de la psychanalyse<\/a><\/p>

Long-term effects of psychotherapeutic interventions : A review of recent international research <\/span><\/a><\/p>

\u2018Psychotherapie verlicht wel ons lijden, maar kan ons er nooit van verlossen.\u2019 Dat stelt arts en systeemtherapeut Flip Jan van Oenen in\u00a0Het misverstand psychotherapie<\/em>. <\/span>Door zijn wetenschappelijk onderzoek naar de effectiviteit van psychotherapeutische behandelmethodes kwam hij tot een ontluisterende ontdekking: al vijftig jaar doet geen enkele nieuwe interventie het beter dan een vorige, nieuwe therapievormen die betere resultaten claimen houden bij herhaalde wetenschappelijke toetsing geen stand in vergelijking tot eerdere vormen. Er is, aldus Van Oenen, vooral meer inzicht in wat we\u00a0<\/span>niet<\/em>\u00a0weten: \u2018Er is niet meer inzicht in de werkingsmechanismen van psychotherapie, het maakt niet uit welk behandelmodel gevolgd wordt en er zijn geen betere behandelmethodes beschikbaar dan vroeger.\u2019 Volgens Van Oenen koesteren onderzoekers, therapeuten, ggz-instellingen, zorgverzekeraars, politici en cli\u00ebnten desalniettemin collectief een mythe van vooruitgang.<\/span><\/p>

Van Oenen, Het misverstand psychotherapie<\/a>. In Eos Wetenschap<\/a><\/p><\/div>

Un nombre suffisant de s\u00e9ances est important pour le succ\u00e8s de la psychoth\u00e9rapie.\u00a0<\/strong><\/h6>

In addition to severity at start of treatment and other predictors of outcome, a low frequency of initial treatment sessions might lead to a less favorable outcome and a more chronic course of the mental disorder. This association seems not to be limited to a specific diagnostic group, but was found in a large group of patients with common mental disorders (depression and anxiety disorders) and patients with a personality disorder. Despite organizational obstacles, more effort should be made to start treatment quickly by an effective frequency of session.<\/em><\/p>

Tiemens, B., Kloos, M., Spijker, J., Ingenhoven, T. Lower versus higher frequency of sessions in starting outpatient mental health care and the risk of a chronic course ; a naturalistic cohort study.<\/a>\u00a0<\/p>

(…) structurele en financi\u00eble inperkingen van de toegang tot psychologische zorg hebben vaak het tegenovergestelde effect van wat ze beogen: ze verlagen de effectiviteit en kosteneffectiviteit ervan.<\/em><\/p>

Luyten, P. Toegang tot en vergoeding van ambulante psychologische zorg : wat zegt wetenschappelijk onderzoek ?\u00a0<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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SUR LA RECHERCHE SCIENTIFIQUE EN PSYCHOLOGIE<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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La pratique fond\u00e9e sur des preuves est-elle possible et\/ou suffisante dans le domaine de la psychologie ?<\/strong><\/h6>

Randomized controlled trials (RCTs) are the foundation of current clinical treatment guidelines. (…) We provide the first quantification of the proportion of individuals with MDD in routine care who would be excluded from participating in an antidepressant maintenance treatment RCT. Under a narrow definition of serious somatic disease, more than one third of these individuals were deemed ineligible to participate in an RCT. When broadening the definition of serious somatic disease, over half of the individuals with MDD in both cohorts would have been ineligible for RCT participation. (…) Our results reinforce concerns about a lack of translatability of the results from clinical trials in psychiatry to real-world care settings and individuals. Our findings emphasize the need for broader inclusion criteria in future trials and for complementing RCT evidence with robust real-world data, to ensure that clinical treatment guidelines are both evidence-based and context-appropriate for the realities of everyday psychiatric care.<\/em><\/p>

Representation and outcomes of individuals with major depression\u00a0in routine care who are ineligible for randomized controlled trials: a nationwide register-based study<\/a><\/p>

“Indeed, if Bem was able to demonstrate the existence of precognition \u2013 and given that precognition cannot exist for a lot of psychologists (Reber and Alcock, 2020<\/a>) \u2013 did he show unwittingly that something was profoundly wrong in the way experiments are conducted in the field of psychology (Wiggins and Chrisopherson, 2019<\/a>)? Many relevant papers have been published since Bem\u2019s initial publication (Pashler and Harris, 2012<\/a>;\u00a0Savalei and Dunn, 2015<\/a>) about the replicability crisis, Bayesian statistics (Witte and Zenker, 2017<\/a>), and questionable research practices (QRPs;\u00a0Wagenmakers et al., 2011<\/a>;\u00a0Bierman et al., 2016<\/a><\/em>). 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 \u201caccident,\u201d 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<\/em>.”<\/p>

Rabeyron, T.\u00a0Why Most Research Findings About Psi Are False: The Replicability Crisis, the Psi Paradox and the Myth of Sisyphus<\/a><\/p>

The hypothesis upon which it is premised, that psychological attributes are quantitative, is accepted within the mainstream, and not only do psychometricians fail to acknowledge this, but they hardly recognize the existence of this hypothesis at all. It is suggested that certain social interests, identifiable within the history of modern psychology, have produced this situation because of the ideological and economic secondary gains derived from presenting psychology as a quantitative science. The question of whether modern item response models are exempt from this critique is considered, and it is concluded that they have not yet faced up to the challenges of seriously testing the relevant hypothesis or even bothered to recognize its existence.<\/em><\/p>

Michell, J. Is psychometrics pathological science ?<\/a>\u00a0<\/p>

En th\u00e9rapie, le clinicien fait un usage r\u00e9fl\u00e9chi des preuves scientifiques et de son exp\u00e9rience clinique pour faire face \u00e0 la complexit\u00e9 de la r\u00e9alit\u00e9 psychologique.<\/strong>\u00a0<\/p>

De kennis die op deze manier wordt gecre\u00eberd, gaat niet over wat altijd zal werken (universele kennis) of wat waarschijnlijk zal werken (statistische kennis), maar veeleer over het vermogen om de feitelijke en ethische complexiteit van concrete klinische situaties te begrijpen. Dit is niet enkel een methodologische uitdaging, maar ook een ethische uitdaging: het vereist de moed om de situatie te benaderen, de voorzichtigheid om dit zorgvuldig te doen, het geduld om zichzelf en de pati\u00ebnt de tijd te gunnen, de waarachtigheid om objectief te zijn, en de bescheidenheid om de grenzen van het eigen begrip te erkennen. In dit opzicht is professionele ontwikkeling door training, supervisie en persoonlijke therapie niet alleen\u00a0een traject waarbij kennis verworven wordt en vaardigheden getraind worden, maar evenzeer een ethisch project.<\/p>

Willemsen, J. Op \u00e9\u00e9n been kan men niet lopen : over het gebruik van wetenschappelijke evidentie in het klinische redeneren.<\/a>\u00a0<\/p>

“In the scientifc literature, clinical reasoning and clinical\u00a0judgement are sometimes portrayed as naive, intuitive, unscientifc. This paper demonstrates that it is underpinned by an\u00a0epistemological stance that can also be found in other casebased disciplines. On the basis of the diference between\u00a0thinking in cases and statistical thinking, it can be argued\u00a0that thinking in cases is more suitable to support clinicians\u00a0who have to deal with situations that are characterized by\u00a0<\/em>uniqueness, uncertainty and value-conficts. The reason for\u00a0this is that evidence within statistical thinking is evidence\u00a0about groups. It is unknown to what degree this evidence is\u00a0relevant to an individual. (…) The current approach to evidence-based practice in psychology is too much based on an emulation of the medical\u00a0<\/em>approach to evidence-based practice. In medicine, the traditional evidence-based approach has been criticized and some\u00a0have advocated alternative approaches (e.g. narrative-based\u00a0medicine, value-based medicine). Clinical psychology and\u00a0psychotherapy are fundamentally diferent from medicine\u00a0and should develop their own epistemological framework.\u00a0<\/em><\/p>

The role of empirical research in supporting this approach\u00a0to EBPP is still crucial.(…) But Overholser (2020) identifed the overreliance on\u00a0efcacy 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\u00a0<\/em>to a paraprofessional technician. In order to bridge the gap\u00a0between science and practice, efcacy studies need to be\u00a0complemented with patient-oriented studies that (1) address\u00a0questions that are relevant to clinicians rather than researchers, (2) embed data collection in naturalistic clinical settings\u00a0rather than in controlled experimental conditions, and (3)\u00a0involve populations and interventions that are part of routine\u00a0clinical practice (Castonguay et al., 2021).\u00a0For this mission, a multitude of methods can be used,\u00a0both qualitatively and quantitatively, both in groups and in\u00a0cases. In this context, systematic case studies are particularly interesting as a more systematic alternative to clinical\u00a0case studies.\u00a0\u00a0In\u00a0recent years, an online archive of published psychotherapy\u00a0case studies (www.singlecasearchive.com) has been created\u00a0to allow researchers, clinicians, and students to easily find\u00a0case studies that are relevant to their interests (Meganck et al., 2022).<\/em><\/p>

Furthermore, more research should be done on conceptual and refective skills in practitioners, as these constitute\u00a0the link between research and practice. How do clinicians\u00a0actually come to understand complex clinical situations and\u00a0how can they do so in a trustworthy way? Are the current\u00a0training and supervision practices in the feld of clinical\u00a0psychology and psychotherapy sufficient to support this\u00a0process? How can clinicians work with value-conflicts in\u00a0their work? (…) A good clinician should\u00a0not only be able to do his or her job, but he or she should\u00a0also 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,\u00a0social, and even political role of clinical psychologists and\u00a0 psychotherapists in society.<\/em>\u00a0“<\/p>

Willemsen, J.\u00a0The use of evidence in clinical reasoning<\/a><\/p>

(…) for valid data collection by means of self-report measures, the story of data collection must be taken into account. For this purpose, we have argued for the use of qualitative or mixed methods as vital for a valid data-collection via self-report measures. Often, quantitatively trained researchers think that broadening the scope of research to qualitative or mixed methods makes research messy or even less scientific (cf., Willig, 2008; Hesse-Biber, 2010). On the contrary, we have shown that ignoring meaning making processes in measurement is unscientific, as it relies merely on face validity, while mixing methods allows researchers to develop an evidence-base that rests on empirically validated evidence. Importantly, this approach goes beyond a purely pragmatic mix of methods and requires an epistemological integration and reflexivity too. In this context, we advocate to take a qualitative stance to psychometrics, that allows for a valid and ethical consideration of meaningful measurement.<\/em><\/p>

Truijens, F.L., De Smet, M.M., Vandevoorde, M., Desmet, M., Meganck, R. What is it like to be the object of research ? Of meaning making in self-report measurement and validity of data in psychological research.\u00a0<\/a><\/p>

Les mod\u00e8les de traitement constituent une bonne base mais doivent toujours \u00eatre adapt\u00e9s aux besoins de chaque patient.<\/strong>\u00a0<\/h6>

The current lack of empirical support for the assumed superiority of manuals as a universal principle for clinical practice urges researchers to rethink the function of their evidence. Instead of taking the evidence for using an effective treatment manual as a conclusion, it should be taken as a starting point to investigate which components of the therapy, and which steps in the therapy process make the manual work.<\/em><\/p>

Truijens, F., Z\u00fchlke-Van Hulzen, L., Vanheule, S. To manualize, or not to manualize : is that still the question ? A systematic review of empirical evidence for manual superiority in psychological treatment<\/a>.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"

Relevante publicaties OVER HET BELANG VAN HET BEROEPSGEHEIM Het beroepsgeheim waarborgt de toegankelijkheid van de geestelijke gezondheidszorg. \u00a0 “La relation entre le secret m\u00e9dical et la qualit\u00e9 de la pratique est extr\u00eamement forte. Un patient doit en effet pouvoir se confier \u00e0 un m\u00e9decin qu\u2019il a librement choisi. La qualit\u00e9 de la relation entre soignant […]<\/p>","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-169","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/pages\/169","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/comments?post=169"}],"version-history":[{"count":116,"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/pages\/169\/revisions"}],"predecessor-version":[{"id":488,"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/pages\/169\/revisions\/488"}],"wp:attachment":[{"href":"https:\/\/comvigil.be\/fr\/wp-json\/wp\/v2\/media?parent=169"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}