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Lien L, Malkomsen A. Eksistensiell krise i den biopsykososiale modellen. Tidsskr Nor Laegeforen 2024; 144:23-0839. [PMID: 38506016 DOI: 10.4045/tidsskr.23.0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. "It takes time to see the whole picture": patients' views on improvement in cognitive behavioral therapy and psychodynamic therapy after three years. Front Psychiatry 2024; 15:1342950. [PMID: 38559399 PMCID: PMC10978640 DOI: 10.3389/fpsyt.2024.1342950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction There is a lack of qualitative research that retrospectively explores how patients with major depressive disorder view their improvement in psychotherapy. Methods Fifteen patients who received short-term cognitive behavioral therapy and psychodynamic therapy were individually interviewed approximately three years after completing therapy. Results Some patients had altered their views on therapy, especially those who initially were uncertain of how helpful therapy had been. They said they did not realize the extent and importance of their improvement in therapy before some time had passed, which can be explained by the surprising cumulative effects of seemingly small changes. Discussion This should make retrospective qualitative research an important part of future psychotherapy research.
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Affiliation(s)
- Anders Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Toril Dammen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Theresa Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - André Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Julie Evensen
- Nydalen Outpatient Clinic, Oslo University Hospital, Oslo, Norway
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Malkomsen A, Solberg CT. The expectation gap in psychiatry must be reduced. Tidsskr Nor Laegeforen 2023; 143:23-0081. [PMID: 37097245 DOI: 10.4045/tidsskr.23.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
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Malkomsen A, Gardsjord ES. A. Malkomsen og E. S. Gardsjord svarer. Tidsskr Nor Laegeforen 2023; 143:22-0796. [PMID: 36655963 DOI: 10.4045/tidsskr.22.0796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Malkomsen A, Gardsjord ES. Farvel, men på gjensyn! Tidsskr Nor Laegeforen 2022; 142:22-0663. [PMID: 36345636 DOI: 10.4045/tidsskr.22.0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study. BMC Psychiatry 2022; 22:433. [PMID: 35761306 PMCID: PMC9235099 DOI: 10.1186/s12888-022-04083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD). METHODS Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach. RESULTS Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth. CONCLUSIONS These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts. TRIAL REGISTRATION Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.
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Affiliation(s)
- A Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424, Oslo, Norway.
| | - JI Røssberg
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway
| | - T Dammen
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway
| | - T Wilberg
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway
| | - A Løvgren
- grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Nydalen, P.O. box 4959, N-0424 Oslo, Norway
| | - R Ulberg
- grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Blindern, P.O. box 1171, 0318 Oslo, Norway ,grid.413684.c0000 0004 0512 8628Department of Psychiatry, Diakonhjemmet Hospital, Vinderen, Box 85, 0319 Oslo, Norway
| | - J Evensen
- Nydalen Outpatient Clinic, Nydalen, P.O. box 4959, N-0424 Oslo, Norway
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Malkomsen A, Solberg CT. A. Malkomsen og C.T. Solberg svarer. Tidsskr Nor Laegeforen 2022; 142:22-0174. [PMID: 35324118 DOI: 10.4045/tidsskr.22.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Malkomsen A, Solberg CT. Psychiatry's crisis of expectations. Tidsskr Nor Laegeforen 2022; 142:21-0895. [PMID: 35170927 DOI: 10.4045/tidsskr.21.0895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. Digging down or scratching the surface: how patients use metaphors to describe their experiences of psychotherapy. BMC Psychiatry 2021; 21:533. [PMID: 34706691 PMCID: PMC8555134 DOI: 10.1186/s12888-021-03551-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the present study, we wanted to explore which metaphors patients suffering from major depressive disorder (MDD) use to explain their experience of being in therapy and their improvement from depression. METHODS Patients with MDD (N = 22) received either psychodynamic therapy (PDT) or cognitive behavioral therapy (CBT). They were interviewed with semi-structured qualitative interviews after ending therapy. The transcripts were analyzed using a method based on metaphor-led discourse analysis. RESULTS Metaphors were organized into three different categories concerning the process of therapy, the therapeutic relationship and of improvement from depression. Most frequent were the metaphorical concepts of surface and depth, being open and closed, chemistry, tools, improvement as a journey from darkness to light and depression as a disease or opponent. CONCLUSIONS Patient metaphors concerning the therapeutic experience may provide clinicians and researchers valuable information about the process of therapy. Metaphors offer an opportunity for patients to communicate nuances about their therapeutic experience that are difficult to express in literal language. However, if not sufficiently explored and understood, metaphors may be misinterpreted and become a barrier for therapeutic change. TRIAL REGISTRATION Clinical Trial gov. Identifier: NCT03022071 . Date of registration: 16/01/2017.
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Affiliation(s)
- A Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway.
| | - J I Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - T Dammen
- Department of Behavioral Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
| | - A Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. box 4959, Nydalen, N-0424, Oslo, Norway
| | - R Ulberg
- University of Oslo, Institute of Clinical Medicine, P.O. box 1171, Blindern, 0318, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Box 85 Vinderen, 0319, Oslo, Norway
| | - J Evensen
- Nydalen Outpatient Clinic, P.O. box 4959 Nydalen, N-0424, Oslo, Norway
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Malkomsen A. What Richard Doll can teach us about smartphones. Tidsskr Nor Laegeforen 2021; 141:20-1017. [PMID: 33754664 DOI: 10.4045/tidsskr.20.1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Horgen Evensen J. The Synergistic Process of Improvement in Cognitive Behavioral Therapy for Major Depression. Int J Environ Res Public Health 2021; 18:2292. [PMID: 33652563 PMCID: PMC7956317 DOI: 10.3390/ijerph18052292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a substantial lack of qualitative research concerning individual cognitive behavioral therapy (CBT) for patients with major depressive disorder (MDD). In the present study, we wanted to explore how patients suffering from MDD experience improvement in CBT. METHOD Patients with MDD (N = 10) were interviewed at therapy termination with semi-structured qualitative interviews. The transcripts were analyzed using a thematic analysis approach. RESULTS We identified three elements that were relevant to the process of improvement for all patients: the therapeutic relationship, the therapeutic interventions and increased insight. There is a dynamic interrelationship and synergy between these elements that may explain why patients considered the same elements as helpful, but often in different ways and at different stages of therapy. CONCLUSIONS Highlighting the synergies and interrelationship between the elements that patients experience as helpful, may help therapists to learn from and utilize these experiences. This is a reminder of the importance of always being attentive to the individual processes of patients.
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Affiliation(s)
- Anders Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Toril Dammen
- Department of Behavioral Science in Medicine, Faculty of Medicine, University of Oslo, 0372 Oslo, Norway;
| | - Theresa Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - André Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway; (J.I.R.); (T.W.); (A.L.)
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Malkomsen A. Kunsten å tenke annerledes. Tidsskriftet 2020; 140:19-0729. [DOI: 10.4045/tidsskr.19.0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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