Resistance, early engagement and outcome in psychoanalytic psychotherapy of patients with psychosomatic disorders

Abstract

Background Difficulties engaging people with psychosomatic disorders in psychotherapy are widely recognised. Such patients are often reluctant to participate in psychotherapy and to consider the contribution of psychological factors to their somatic experience. However, less is known about effective ways to address what is commonly referred to as resistance to psychotherapy among this population. Objectives To study early engagement, client resistance and the impact of therapist response on outcome in treatment of psychosomatic disorders. Methodology Mixed methods were used in a naturalistic longitudinal study of 22 psychotherapeutic treatments of patients with psychosomatic disorders. Results Persistence with treatment was associated with better outcome. The extent to which therapists addressed patients’ in‐session distress was associated with persistence with treatment, even when distress was not resolved. Discussion Results do not allow attribution of causality but indicate that further research investigating therapist recognition of and response to client distress may be important in the development of more effective psychotherapeutic response to people with psychosomatic disorders.

Antibiotic stewardship: Improving patient-centered right care in urgent care using a shared decision aid and 5 Ds tool

“…There seemed to be a correlation with providers not documenting clinical decision making when they were not following protocol. Yasky et al (2015) demonstrated that clinical decision making in documentation promotes adherence to guidelines and safety. Steroids were given to 28% of patients with acute bronchitis and acute sinusitis over the 90-day period.…”

The Peer Supervision Group as Clinical Research Device: Analysis of a Group Experience

“…The aim of the main research was to explore resistance to treatment among this cohort and to identify therapeutic strategies likely to help manage resistance. Different aspects of this investigation and its main results are reported elsewhere (Yasky, King & O'Brien, , , ).…”

“…The ex post facto phase, which took place at the University of Queensland, involved a thorough analysis of the data (questionnaire results, transcripts of audio, written notes, and basic statistics of group work) generated in the course of the research. Aside from this study, the data yielded: (1) a description of observed client resistance (Yasky, King & O'Brien, ), (2) a report on the impact of client resistance over treatments (Yasky, King & O'Brien, ), and (3) a description of the method utilized to determine the outcome of treatments (Yasky, King & O'Brien, ).…”

“…In summary, the results of the other three specific studies were: descriptions for ‘thin‐skin’ and ‘thick‐skin’ patterns or states of resistance were proposed (); a rationale to utilize clinical judgment to complement outcome measures was presented (); and the quantitative results of the study were provided (), demonstrating strong correlations between length of treatment and outcome, and between effectively addressing client's episodes of distress in the session and the duration of treatment.…”