semenvatting
Het omgaan met en de behandeling van hypochondere en somatiserende patiënten is niet eenvoudig. De therapeutische relatie moet bekwaam gehanteerd worden – aangezien deze patiënten liever bij een medicus zitten dan bij een psychotherapeut – en het onderzoek naar de effectiviteit van interventies is beperkt. Ook bij bekwame therapeuten draait de behandeling van deze patiënten makkelijk op een mislukking uit. Deze kan in verschillende fasen van het contact optreden. In dit artikel komen achtereenvolgens aan de orde: het behandelcontract, cognitieve gedragstherapie, exposure in vivo met responspreventie, en het gebruik van psychofarmaca. In de discussie wordt besproken welke factoren een rol gespeeld kunnen hebben bij mislukkingen en welke lessen hieruit getrokken kunnen worden.
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Abstract
The treatment of hypochondriacal and somatizing patients is not simple. The therapeutic relationship has to be handled with care – since these patients prefer to visit a medical doctor instead of a psychotherapist – and the research on the effectiveness of therapeutic interventions is limited. Even with a skilled therapist the treatment of these patients can end in a failure. These failures can happen in different phases of the therapy. The following is discussed successively: the treatment contract, cognitive behavioural therapy, exposure in vivo with response prevention, and the use of psychopharmaca. In the discussion the factors that can account for the failures and the lessons that can be distilled for future treatments are analyzed.
Sako Visser is verbonden aan de Vakgroep Huisartsgeneeskunde, Rijksuniversiteit Groningen, Antonius Deusinglaan 4, 9713 AW groningen; Theo K. Bouman is verbonden aan de Sectie Klinische Psychologie, Rijksuniversiteit Groningen, Oostersingel 59, 9713 EZ Groningen.
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Visser, S., Bouman, T.K. Tobben met hypochondere en somatiserende patiënten. DITH 14, 176–185 (1994). https://doi.org/10.1007/BF03060088
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DOI: https://doi.org/10.1007/BF03060088