Samenvatting

When psychotherapy fails
H. Merckelbach, S. Houben, H. Otgaar, B. Dandachi & J. Roelofs

There is a deeply ingrained notion in some quarters of psychology and psychiatry that patients have to become worse before they become better. This no-pain-no-gain principle has a long tradition, but its empirical basis is, at best, weak. More importantly, the no-pain-no-gain doctrine obscures instances in which patients experience serious side e¤ ects during psychological treatment. In the current article, we discuss the literature about such side effects. Paying systematic attention to therapeutic failures and errors and disseminating information about them is an effective way of increasing expertise. Society increasingly demands evidence-based interventions from psychology and psychiatry. Studying adverse side effects fi ts well into this perspective as it may help to defi ne boundary conditions.

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Psychotherapie beoogt patiënten beter te maken, maar kan om diverse redenen in deze opzet falen. Therapeutisch falen is een belangrijk onderwerp, maar die erkenning was tot voor kort niet vanzelfsprekend, stellen Harald Merckelbach en collega’s. ‘Dat psychotherapeuten mislukkingen nogal eens over het hoofd zien, komt onder meer omdat ze geen classificatie systeem hebben voor ongewenste gebeurtenissen tijdens de behandeling.’ Zij bevelen een programma van zes punten aan. Filip Raes en Giovanni Timmermans geven een reactie.

Wanneer is iemand deskundig? Wat is een goede dokter, ingenieur, rechter, of – waar het hier om gaat – psychotherapeut1? Wetenschappers die zich met deze vragen bezighouden stellen zich vaak op het volgende standpunt: deskundigen herken je niet zozeer aan hun successen, maar aan de mate waarin ze regels en inzichten van hun vak volgen (Lerner & Tetlock, 1999; Giard & Merckelbach, 2009)1629. Deze nadruk op vakmatige regels en inzichten staat mislukkingen toe. Het is, bij wijze van voorbeeld, heel wel mogelijk dat een dokter zijn2 patiënt volgens de regels der kunst behandelt en de patiënt toch overlijdt. Zoiets duidt op de grenzen van het vak, niet op incompetentie van de arts. Om regels te leren volgen, is het nodig dat de deskundige zicht heeft op het resultaat van zijn handelen. Terugkoppeling wordt als essentieel beschouwd voor het opbouwen van expertise (Ericsson, 2009)12. Maar zulke feedback moet dan wel ongefilterd zijn. Selectieve feedback is funest. In jargon…

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