Personal therapeutic approach in Gestalt therapists working with clients suffering from medically unexplained psychosomatic symptoms

Treatment specificity and adherence to treatment manuals represent essential components of the medical model in psychotherapy. The model assumes that psychotherapists who work with the same type of clients and who identify with the same theoretical approach work very similarly. This study illustrates the shortcomings of that assumption and explores how therapists’ individuality forms and shapes their unique approaches that resonate with their own personalities, inclinations, and worldviews. Semi-structured interviews with eight Gestalt therapists working with clients who experienced medically unexplained physical symptoms were analysed using the grounded theory method. Considerable differences were found among the therapists within four domains of the personal therapeutic approach, namely Case Conceptualization, Therapeutic Task, Therapist’s Position, and Alternative Strategy. However, regardless of the differences, all the therapists endeavoured, either implicitly or explicitly, to convey to the clients what they considered to be healthy functioning. There is considerable diversity in the way therapists work even when they subscribe to the same psychotherapeutic approach and work with the same type of clients. The exploration of psychotherapists’ usual strategies, as well as the alternative strategies they use when their usual strategies do not work, appears helpful for capturing their personal therapeutic approaches.

Prevalence of Alexithymia in Patients with Medically Unexplained Physical Symptoms: A Cross-sectional Study in Egypt

Background: There is a high incidence of alexithymia in people who report medically unexplained symptoms. There have been limited studies on the prevalence of alexithymia in patients with medically unexplained physical symptoms (MUPS) in various ethnic and cultural backgrounds. Objective: This study aimed to estimate the prevalence of alexithymia in patients with MUPS and examine their socio-demographic data. Methods: In this cross-sectional study, 196 patients with MUPS were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. Patients completed a structured interview; socio-demographic and medical history data were collected. Somatic symptom severity was assessed using the Arabic version of the Patient Health Questionnaire (PHQ-15). Alexithymia was assessed using the Arabic version of the Toronto Alexithymia Scale. Results: General fatigue was the most common complaint observed, followed by headache and dyspepsia. In addition, 73.5% of patients had a high Patient Health Questionnaire score, 17.9% had somatic symptoms of medium severity, while 8% and 0.5% had low and marginal somatic symptoms, respectively. Alexithymia was presented in 49.5%, 22.9% had no alexithymia, and 27.6% had borderline/intermediate alexithymia.A weak positive correlation (r<0.4) was found between somatic symptom severity and alexithymic psychopathology (r=0.277;p<0.05). Only the ‘difficulty identifying feelings’ dimension of alexithymic psychopathology was positively correlated with the severity of somatic symptoms (r=0.271;p<0.05). Conclusion: Alexithymia is associated with the development of MUPS.

Does alexithymia, independent of depressive and anxiety disorders, correlate with the severity of somatic manifestations among patients with medically unexplained physical symptoms?

Background: Medically unexplained physical symptoms (MUPS) are highly prevalent, frequently co-occurring with psychiatric symptoms such as depression, alexithymia, and anxiety. Objective: To evaluate the relation between depression, anxiety, and alexithymia and severity of somatic symptoms in patients with MUPS. Method: This is a cross-sectional study conducted on 196 patients suffering from MUPS. The patients were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. The Patient Health Questionnaire (PHQ-15), (PHQ-9), Generalized Anxiety Disorder (GAD-7), Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (SCID-I-CV), and Toronto Alexithymia Scale (TAS-20) were employed to assess somatic severity, depression, anxiety, major mental disorders, and alexithymia in the sample of patients. Results: The results of the study indicate that GAD-7 and PHQ-9 scores had a positive correlation with PHQ-15 ( p < 0.05) in multivariate regression. In contrast, TAS-20 was not independently correlated with PHQ-15. Adding TAS-20 to GAD-7 and PHQ-9 in the equation of the regression model enhances the predictive capacity of the model ( p < 001). Conclusion: The results of the study indicate that only anxiety and depressive symptoms, but not alexithymia, were associated independently with MUPS severity.

Patients’ Perspectives on the Usability of a Blended Approach to an Integrated Intervention for Patients With Medically Unexplained Physical Symptoms: Mixed Methods Study

Background Medically unexplained physical symptoms are physical symptoms, such as pain, fatigue, and dizziness, that persist for more than a few weeks and cannot be explained after adequate medical examination. Treatment for preventing the chronicity of symptoms is recommended. A promising approach is identifying patients who are at risk and subsequently offering a blended care intervention that focuses on promoting self-management while using eHealth as a supportive tool. When these interventions match with a patient’s expectations, their effectiveness grows. Objective This study aimed to obtain more insights into usability from the patient perspective to improve future interventions. Methods A mixed methods design (ie, the use of qualitative and quantitative data) was used. Through semistructured interviews, in-depth insights were gained into patients’ perspectives on usability. The analysis process was continuous and iterative. Data were synthesized and categorized into different themes. The System Usability Scale, which measures the usability of a system, was used to compare participants that found usability to be low, medium, or high. This study was approved by the Medical Ethical Committee Utrecht (approval number: 17-391/C). Results Saturation was reached after interviewing 13 participants. The following four themes emerged from the interviews: motivations and expectations prior to participating in the program, the applicability of e-coaching, the role of health care professionals, and the integrated design of the blended approach. Conclusions The successful implementation of integrated blended care interventions based on patients’ perspectives requires matching treatments to patients’ individual situations and motivations. Furthermore, personalizing the relative frequency of face-to-face appointments and e-coaching can improve usability.

ICD-10-Coding of Medically Unexplained Physical Symptoms and Somatoform Disorders—A Survey With German GPs

Background: General practitioners (GPs) are reluctant to use codes that correspond to somatization syndromes.Aim: To quantify GPs' views on coding of medically unexplained physical symptoms (MUPS), somatoform disorders, and associated factors.Design and Setting: Survey with German GPs.Methods: We developed six survey items [response options “does not apply at all (1)”—“does fully apply (6)”], invited a random sample of 12.004 GPs to participate in the self-administered cross-sectional survey and analysed data using descriptive statistics and logistic regression analyses.Results: Response rate was 15.2% with N = 1,731 valid responses (54.3% female). Participants considered themselves familiar with ICD-10 criteria for somatoform disorders (M = 4.52; SD =.036) and considered adequate coding as essential prerequisite for treatment (M = 5.02; SD = 1.21). All other item means were close to the scale mean: preference for symptom or functional codes (M = 3.40; SD = 1.21), consideration of the possibility of stigmatisation (M = 3.30; SD = 1.35) and other disadvantages (M = 3.28; SD = 1.30) and coding only if psychotherapy is intended (M = 3.39; SD = 1.46). Exposure, guideline knowledge, and experience were most strongly associated with GPs' self-reported coding behaviour.Conclusions: Subjective exposure, guideline knowledge, and experience as a GP, but no sociodemographic variable being associated with GPs' subjective coding behaviour could indicate that GPs offer a relatively homogeneous approach to coding and handling of MUPS and somatoform disorders. Strengthening guideline knowledge and implementation, and practise with simulated patients could increase the subjective competence to cope with the challenge that patients with MUPS and somatoform disorders present.