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Medically unexplained symptoms as a threat to patients' identity? A conversation analysis of patients' reactions to psychosomatic attributions.
Patient Educ Couns. 2010 May; 79(2):207-17.PE

Abstract

OBJECTIVE

Interactions between patients suffering from medically unexplained symptoms (MUS) and their physicians are usually perceived as difficult and unsatisfactory by both parties. In this qualitative study, patients' reactions to psychosomatic attributions were analyzed on a micro-level.

METHODS

144 consultations between consultation-and-liaison (CL) psychotherapists and inpatients with MUS, who were treated according to a modified reattribution model, were recorded. Linguists and psychologists evaluated these consultations by applying conversation and positioning analysis.

RESULTS

When introducing a psychosomatic attribution, therapists use discursive strategies to exert interactional pressure on the patient; while simultaneously using careful and implicit formulations. Three linguistic patterns could be found in which patients subtly refute, drop or undermine the psychosomatic attribution in their reply. Moreover, in this context patients position themselves as somatically ill or justify their own life situation.

CONCLUSION

The results suggest that patients interpret psychosomatic attributions and even subtle suggestions from the psychotherapists as face-threatening 'other-positionings'.

PRACTICE IMPLICATIONS

When implementing the reattribution model, it should be taken into account that interactional resistance might be a necessary step in the process of the patient's understanding. Nevertheless therapists should introduce reattribution in a patient-centered rather than persuasive way and they should openly address patients' fears of being stigmatized.

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Authors+Show Affiliations

Burbaum C
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany. christina.burbaum@uniklinik-freiburg.de
Stresing AM
No affiliation info available
Fritzsche K
No affiliation info available
Auer P
No affiliation info available
Wirsching M
No affiliation info available
Lucius-Hoene G
No affiliation info available

MeSH

Attitude to HealthGermanyHumansPhysician-Patient RelationsPsycholinguisticsPsychophysiologic DisordersPsychotherapyReferral and ConsultationSelf ConceptSomatoform Disorders

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19914023

Citation

Burbaum, Christina, et al. "Medically Unexplained Symptoms as a Threat to Patients' Identity? a Conversation Analysis of Patients' Reactions to Psychosomatic Attributions." Patient Education and Counseling, vol. 79, no. 2, 2010, pp. 207-17.
Burbaum C, Stresing AM, Fritzsche K, et al. Medically unexplained symptoms as a threat to patients' identity? A conversation analysis of patients' reactions to psychosomatic attributions. Patient Educ Couns. 2010;79(2):207-17.
Burbaum, C., Stresing, A. M., Fritzsche, K., Auer, P., Wirsching, M., & Lucius-Hoene, G. (2010). Medically unexplained symptoms as a threat to patients' identity? A conversation analysis of patients' reactions to psychosomatic attributions. Patient Education and Counseling, 79(2), 207-17. https://doi.org/10.1016/j.pec.2009.09.043
Burbaum C, et al. Medically Unexplained Symptoms as a Threat to Patients' Identity? a Conversation Analysis of Patients' Reactions to Psychosomatic Attributions. Patient Educ Couns. 2010;79(2):207-17. PubMed PMID: 19914023.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medically unexplained symptoms as a threat to patients' identity? A conversation analysis of patients' reactions to psychosomatic attributions. AU - Burbaum,Christina, AU - Stresing,Anne-Maria, AU - Fritzsche,Kurt, AU - Auer,Peter, AU - Wirsching,Michael, AU - Lucius-Hoene,Gabriele, Y1 - 2009/11/14/ PY - 2009/02/19/received PY - 2009/09/18/revised PY - 2009/09/18/accepted PY - 2009/11/17/entrez PY - 2009/11/17/pubmed PY - 2010/7/17/medline SP - 207 EP - 17 JF - Patient education and counseling JO - Patient Educ Couns VL - 79 IS - 2 N2 - OBJECTIVE: Interactions between patients suffering from medically unexplained symptoms (MUS) and their physicians are usually perceived as difficult and unsatisfactory by both parties. In this qualitative study, patients' reactions to psychosomatic attributions were analyzed on a micro-level. METHODS: 144 consultations between consultation-and-liaison (CL) psychotherapists and inpatients with MUS, who were treated according to a modified reattribution model, were recorded. Linguists and psychologists evaluated these consultations by applying conversation and positioning analysis. RESULTS: When introducing a psychosomatic attribution, therapists use discursive strategies to exert interactional pressure on the patient; while simultaneously using careful and implicit formulations. Three linguistic patterns could be found in which patients subtly refute, drop or undermine the psychosomatic attribution in their reply. Moreover, in this context patients position themselves as somatically ill or justify their own life situation. CONCLUSION: The results suggest that patients interpret psychosomatic attributions and even subtle suggestions from the psychotherapists as face-threatening 'other-positionings'. PRACTICE IMPLICATIONS: When implementing the reattribution model, it should be taken into account that interactional resistance might be a necessary step in the process of the patient's understanding. Nevertheless therapists should introduce reattribution in a patient-centered rather than persuasive way and they should openly address patients' fears of being stigmatized. SN - 1873-5134 UR - https://www.unboundmedicine.com/medline/citation/19914023/Medically_unexplained_symptoms_as_a_threat_to_patients'_identity_A_conversation_analysis_of_patients'_reactions_to_psychosomatic_attributions_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0738-3991(09)00459-5 DB - PRIME DP - Unbound Medicine ER -