Doctoral dissertations

Hundred Years of Single Case Psychotherapy Research: A comprehensive review of psychotherapies with adult and child patients

PhD-Student: Anouchka Meliková

The aim of the present doctoral dissertation is to provide the first comprehensive review of psychotherapy single case research and to investigate the potential of single case studies to bridge the gap between psychotherapy research and practice. Firstly, the review study will give a broad overview of the number and the type of case studies that is published within the major therapeutic schools over the period of the last hundred years. Secondly, it will focus on the question as to what the influence is of time-period and of theoretical school on single case studies of psychotherapies with adult patients. This question will be addressed by means of qualitative techniques such as thematic analysis. Lastly, similar inquiry will be executed for single case studies on psychotherapy with children. 

In search of lost time: A dialogue between psychoanalysis and myth on the symbolic form and function

PhD-student: Carolin Baes

There is no true story about the past, as a character from P. Mercier’s “Perlmann’s Silence” explains. And yet, the past only exists by the grace of our capacity to tell stories. Stories we often tell willingly, but even more so reluctantly or unknowingly, through our dreams and symtoms. Over the past few years however, echoing an evolution in the teachings of the incontournable J. Lacan, more emphasis has been placed on the real of (inter) subjective functioning. But language or the symbolic in more general terms, still moves in mysterious ways. To further help elucidate the symbolic form as well as the role of the symbolic in (inter) subjective functioning, this dissertation will study the story in its most ultimate or fundamental form: the myth. From the outset psychoanalysis has been intimately connected with (Greek) mythology. Freud had his oedipuscomplex, of course, and Lacan repeatedly made use of mythological references to illustrate or even found some of his theoretical concepts. Moreover, psychoanalysis itself can be regarded as a (multi-form) myth that tries to capture the fundamentally elusive human experience. The dialogue between psychoanalysis and myth will be held at two levels. First on a more theoretical level: after a short introduction on the status of psychoanalysis and myth as symbolic models centered around and impossibility, I will explore what they can actually learn us about the symbolic form or the signifier. Secondly, the dialogue continues on a practical level, between psychoanalysis as practice and the practice of mythtelling. Guided by the works of Lévi-Strauss, who understands both analysis and myth as a search for lost time, this will lead us to examine the notions of forgetting and remembering, truth, and time. Running like a thread through this section, is the question about the possible mythical functioning of analysis and vice versa, the analytical functioning of the myth. At length, differences between both pratices will be discussed.


Interpersonal Dynamics and Therapeutic Relationship in Patients with Functional Somatic Syndromes

PhD-student: Juri Krivzov

Juri Krivzov

Juri Krivzov`s PhD project is concerned with interpersonal dynamics and therapeutic relationship in patients with functional somatic syndromes (medically unexplained disorders). Patients from this group often report a history of trauma, abuse, and parentification, and are often perceived as challenging in medical and psychotherapeutic settings. Maladaptive relational patterns may lead to mutual mistrust between the patient and the therapist, alliance ruptures, and stigmatization of the patients. By means of a metasynthesis (i.e. systematic secondary analysis) of case studies, we attempted to gain an in-depth understanding of psychotherapy process in these patients. Thereby, we could gain better insights into the links between these patients´ (early) traumatization, self-exploitive and controlling tendencies, as well as interpersonal emotional avoidance (alexithymia). These results should help therapists to predict relational impasses in psychotherapy and to find treatment focus more efficiently and quickly. Currently, we conduct a series of mixed-methods case studies of patients with functional somatic syndromes based on the data of the Ghent Psychotherapy Study. Thereby, we study the audio-recordings of psychotherapy sessions, patients´ self-report data, and supervision records.

A Conceptual Qualitative Study of Mania

 

PhD-student: Bart Rabaey

 

Although bipolar disorder is a common psychiatric diagnosis, there is a dearth of attention for the phenomenon of mania and for the diagnostic category of manic-depression or bipolar disorder within lacanian psychoanalysis. In this dissertation we undertake a conceptual study of mania in psychiatric and psychoanalytic literature and a qualitative investigation of the experience of mania in clinical practice. In phenomenological psychiatry the manic-depressive experience is conceptualized as an existential phenomenon related to the experience of time, space, the body and as a particular way of being-in-the-world. We aim to situate these divergent phenomenological analyses within a psychoanalytic structural framework that relates these phenomena to the notion of the subject as related to language, jouissance and the Other. We will investigate psychoanalytic conceptualizations of mania based on the writings of Freud and Lacan with the goal of constructing a lacanian understanding of mania. Our qualitative research will consist of an interview study of the experience of mania, focusing on the particular way this experience is disruptive to the experience of subjectivity and the particular narrative strategies people develop for recovering from this experience.

 

Promotor: Prof. Dr. Stijn Vanheule


The experience of negative symptoms in psychosis

 

PhD-student: Nienke Moernaut

 

Negative symptoms of psychosis, consisting of diminished emotional expression, avolition, alogia, anhedonia and asociality, are less well-known than their positive counterparts (hallucinations and delusions), but have nonetheless a tremendous impact on patients’ quality of life. Despite a growing research interest in these symptoms in the last years, little is known about the subjective experience of these symptoms. However, anecdotical evidence and the few existing studies show there is an important discrepancy between the traditional conceptualization of negative symptoms and how these are experienced by patients. This dissertation aims at setting light to this subjective dimension by the means of qualitative research methods. A review study of existing qualitative research concerning negative symptoms aims to settle what is already known and which elements should be further explored. An interview study with currently psychotic patients aims to shed light on how patients experience these symptoms and how they try to make sense of them. Finally, recovery of negative symptoms will be mapped with a cocreative study with two experts by experience. Whereas our research aims to start as much as possible from the experiences of patients themselves, we make use of Lacanian psychoanalysis and phenomenology as theoretical frameworks to guide our analyses.

 

Promotor: Prof. Dr. Stijn Vanheule


‘Under pressure? On the finality of time limited therapy and the effect of a time limit on the psychotherapeutic process.

 
PhD student
: Rosa De Geest

Over the past decades, the use of time limits (when the amount of sessions is set beforehand in therapy) has become widespread in the psychotherapy landscape, though very little is known about how the intervention influences the psychotherapeutic process. In our dissertation, we interviewed both therapists and patients on how they experienced the time limit in therapy. As a result of our study, we found that setting a time limit can interact with several important aspects of the psychotherapeutic setting, such as patients’ expectations and motivation in therapy, therapists’ focus, and the outcome and goals of psychotherapy. Especially for psychoanalytic psychotherapy, we observed that the time limit can stand in the way of free floating attention, free speech and free association. On the other hand, a time limit can provide opportunities in therapy by adding safety for some patients and by motivating them to continue therapy despite the emotional difficulties they encounter. As a suggestion for clinical practice, we propose to pay caution to the way time limits are implemented and a to carefully select which patients are suitable for a time limited therapy and which are not.

Promoter: Prof. Dr. Reitske Meganck


The symbolic polysemy of language. Psychosocial research and intervention through Emotional Textual Analysis (ETA).

 
PhD student
: Fiorella Bucci

This doctoral thesis finds its roots in my more than 10-year experience in intervention-research as a consultant for organisations of different kinds (local governments and public institutions, corporations, non-profit organisations) and in different fields (mental health and disability care, youth employment, university education, urban development), as well as in my clinical work as a psychologist and psychoanalyst. My research deals with the psychological method for text and discourse analysis called Emotional Textual Analysis (ETA). ETA allows the psychologist to systematically explore how the different components of an organisation (or social group) emotionally symbolise their shared reality (or aspects of it), and to identify crisis factors and development resources in local relations, thereby supporting targeted interventions. My research aim is to achieving an accurate positioning of ETA within the wider scenario of methods for textual/discourse analysis which are in use at the present time in the field of psychology, by clarifying its novelty in terms of theoretical-epistemological framework, operational procedure, scientific and professional relevance.
1) theoretical-epistemological framework: ETA rests on a specific theory of emotion as a form of knowledge linked to the unconscious, which participates in the psychological construction of reality, according to precise rules that have been explained by psychoanalytic theory (in particular, Matte Blanco's semiotic model of the mind). In this sense, it can be interestingly compared to other methods sharing this root in psychoanalytic theory (e.g. Lacanian Discourse Analysis);
2) operational procedure: ETA could be termed a mixed-method research methodology, as it consists of a qualitative analysis of the symbolic meaning of words, based on a quantitative analysis of the words' co-occurrences within a text. In this sense, it can be interestingly compared to other (software-supported) lexical analysis methods, focusing on the emotional component of the text (often from fully different theoretical perspectives);
3) scientific and professional relevance: ETA was developed at the end of the Nineties as a research tool for psychological intervention in and with organisations. It stems from a theory of psychological technique (Carli's theory of the Analysis of the Demand) which assumes both the psychotherapeutic intervention and the organisational consulting to be founded on the analysis of the symbolic components of the client's demand. Such a methodological centrality afforded to the demand needs to be rethought today, as an added value and a limitation.

Promoter: Prof. Dr. Stijn Vanheule

 

 


Countertransference in psychotherapeutic work with patients with anaclytic versus introjective personality structures. 

An empirical study.

 

PhD student: Vicky Hennissen

Summary: Psychotherapists frequently experience strong feelings and thoughts while working with patients. In psychoanalysis, this is referred to as countertransference. There has been a lot of debate on whether these thoughts and feelings originate from therapists’s internal conflicts or whether they need to be seen as a normal reaction to the patient’s personality and behavior. The past decade, empirical research increasingly focused on the relation between countertransference and (DSM-IV) personality disorders, demonstrating it’s diagnostic value in therapy. Although these studies yield interesting results, the possible contribution of therapist factors tends to be overlooked. The present study aims to explore the interaction between patient and therapist factors, allowing for a more complex view on the occurrence of countertransference in therapy.

Promoter: Prof. Dr. Reitske Meganck

 


The patient doth complain too much?  Creativity and passivity in the neurotic’s lament​. 

  

PhD student: Goedele Hermans

Summary: Psychoanalysis has always understood the neurotic complainer as taking up an active role in his or her own misery. Phenomenological and existential readings of the complaint also underline the activity that goes hand in hand with passive suffering. The widespread medicalization of psychological disturbances however seems to lead to a fully passive reading of the complaint. Starting from Freud's ‘Ihre Klagen sind Anklagen’ and the Lacanian ‘Qu’est-ce que une vérité, sinon une plainte?’ this research focuses on the concept of the complaint as it has been shaped by psychoanalytic practice and thought. This analysis hopes to contribute to a better understanding of the repetitive character and the joyous dimension of the complaint, a dimension for which the theoretical structure of present-day mental healthcare leaves but little room.​

Promoter: Prof. Dr. Mattias Desmet

  


Moral distress and intent to job leave in relation to team climate in medical intensive care units. 

 

 
PhD student
: Bo Van den Bulcke

Summary:  Fostering patients with serious critical illnesses and innovative complex techniques, intensive care units (ICU) make up complex and high cost work settings, with multifactorial ethical implications, and thus forming a source of moral distress (Reader et al., 2008). Perhaps the greatest challenge within the ICU environment is the ethical decision-making (EOL-DM) as a part of the daily tasks, which is highly burdensome for patients, families and clinicians, not in the least regarding end-of-life (EOL) care. Research in different clinical settings has shown that good interdisciplinary teamwork is beneficial for healthcare providers as it is positively related to job satisfaction and negatively related to burnout and staff turnover. The goal of this research project is to examine the relationship between moral distress, intent to job leave and team climate in medical intensive care units. This will be performed by combining quantitative and qualitative studies. 

Promoter: Prof. Dr. Stijn Vanheule

Co-Promoter: Prof. Dr. Dominique Benoit

 

 

Power and ethics in contemporary psychiatry: A conceptual and qualitative study based on the works of Foucault and Lacan. 

 

 
PhD student
: Evi Verbeke

Summary: Psychiatry as an institution came to life at the end of the 18th century. From the start, power and coercion have been a part of it. In this doctoral thesis we want to examine how psychiatric power operates in contemporary psychiatry and how coercion is experienced by patients. Power and coercion are studied within a Foucauldian and Lacanian framework. The genealogy of psychiatry by Foucault is used to understand power in psychiatry from a historical point of view. His theses on biopolitics, the power/knowledge dynamic and the way discourse grounds behavior are the most important concepts in this analysis. From a psychoanalytical point of view we start from Lacan’s discourse theory that gives a view on power as something that differs according to the social bond and is grounded in an impossibility of human relations. The research starts from the hypothesis that power exists within a social bond and is primarily exercised upon the points of impossibility of the Real as conceptualized by Lacan. The next step is to investigate which ethical consequences these theories on power and coercion have, by comparing different ethical viewpoints and assumptions in contemporary psychiatry. The doctoral project also contains a qualitative analysis. Patients, who were hospitalized in psychiatry, are interviewed about how they experienced power and coercion during their stay at psychiatry. The interviews will be analyzed according the IPA method. By this, the author includes patient perspective and examines how coercion is subjectively experienced. From both the conceptual and the qualitative study the author investigates the clinical consequences and the perspectives to orientate psychiatric practice in the 21st century. 

Promoter: Prof. Dr. Stijn Vanheule

Co-promoter: Dr. Jan De Vos