Hyper-réflexivité et perspective en première personne : un apport décisif de la psychopathologie phénoménologique contemporaine à la compréhension de la schizophrénie

Anomalous Experience of Self and World: Administration of the EASE and EAWE Scales to Four Subjects with Schizophrenia

The aim of this paper was to study anomalies of self- and world experience in schizophrenia from a phenomenological perspective through the use of the Examination of Anomalous Self-Experience (EASE) and Examination of Anomalous World Experience (EAWE) interviews. Four patients with diagnoses of schizophrenia were interviewed with both the EASE and the EAWE. A qualitative analysis of these interviews was carried out on all the data; quantitative scores were also assigned, based on the frequency and intensity of the items endorsed by the subjects. In the EASE, the subjects endorsed an average frequency of 45% of all items. In the EAWE, the subjects endorsed an average frequency of 26% of all items. Furthermore, the EAWE data indicated more heterogeneous profiles of experience than the EASE data. This heterogeneity is not surprising, given that the EAWE was designed to be a more broad-based or less targeted exploration of various changes likely to be associated with the schizophrenia spectrum (but also with certain other conditions). Our data suggest that although disturbances of world experience may always be present in schizophrenia, they may take numerous and varied forms. Because the experience of the world occurs across many different modalities, disturbances of this experience would be fundamentally less unitary, whereas the experience of the self presents a more coherent and unitary gestalt. These results show a certain overlapping between the scales while also indicating the potential value of a combined use of the two instruments. Finally, we discuss the relationship between experiential description and behavioral observation, and their potentially complementary value in exploring the first-person perspective, particularly in the case of experiences that occur at a more prereflective level.

Understanding Long-term Outcome from the Patients' Perspective: A Mixed Methods Naturalistic Study on Inpatient Psychotherapy

OBJECTIVE

The complex phenomenon of psychotherapy outcome requires further conceptual and methodological developments that facilitate clinically meaningful research findings. In this study, we rely on an idiosyncratic and process-oriented understanding of treatment effects in order to investigate long-term outcome. A conceptual model of long-term outcome is presented that comprises both a taxonomy of change and explanatory factors.

METHOD

A mixed methods naturalistic study was conducted in an inpatient psychotherapy setting. Long-term quantitative outcome data are complemented with a data-driven thematic analysis of interviews with 22 participants, five to six years after ending inpatient psychotherapy.

RESULTS

Long-term outcome findings show improved well-being for the majority of former patients and this until five to six years after treatment. From the patients' perspectives, long-term changes can be situated on different interrelated existential levels: reconnection to others and (the meaning of) life, a revelation, an altered self, life changes, and altered expectations and ideas about recovery and treatment. The complex interplay of the person, the therapy centre, the outside world and the evolution over time helped explain the experienced changes and individual differences.

CONCLUSION

The findings support the value of an idiosyncratic and process-oriented understanding of outcome and recovery as well as substantiate the importance of multiple methods and perspectives when studying the effects of psychotherapy.