983 resultados para therapeutic alliance
Resumo:
Motive-oriented therapeutic relationship (MOTR, also called complementary therapeutic relationship) was postulated to be a particularly helpful therapeutic ingredient in the early-phase treatment of patients with personality disorders, in particular borderline personality disorder (BPD). The present pilot study of randomized controlled trial using an add-on design aims to investigate the effects of MOTR in early-phase treatment (up to session 10), with BPD patients on therapeutic alliance, session impact, and outcome. In total, N = 25 patients participated in the study. BPD patients were randomly allocated to a manual-based investigation process in 10 sessions or to the same investigation process infused with MOTR. Adherence ratings were performed and yielded satisfactory results. The results suggested a specific effectiveness of MOTR on the interpersonal problem area, on the quality of the therapeutic alliance and the quality of the therapeutic relationship, as rated by the patient. These results may have important clinical implications for the early-phase treatment of patients presenting with BPD.
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Several patient-related variables have already been investigated as predictors of change in psychodynamic psychotherapy. Defensive functioning is one of them. However, few studies have investigated adaptational processes, encompassing defence mechanisms and coping, from an integrative or comparative viewpoint. This study includes 32 patients, mainly diagnosed with adjustment disorder and undergoing time-limited psychodynamic psychotherapy lasting up to 40 sessions, and will focus on early change in defence and coping. Observer-rater methodology was applied to the transcripts of two sessions of the first part of the psychotherapeutic process. It is assumed that the contextual-relational variable of therapeutic alliance intervenes as moderator on change in adaptational processes. Results corroborated the hypothesis, but only for coping, whereas for defences, overall functioning remained stable over the first 20 sessions of psychotherapy. These results are discussed within the framework of disentangling processes underlying adaptation, i.e., related to issues on trait and state aspects, as well as the role of the therapeutic alliance.
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Interpreting or addressing defenses is an important aspect of psychoanalytic technique. Previous research has shown that therapist addressing defenses (TADs) can produce a positive effect on alliance. The potential value of TADs during the process of alliance rupture and resolution has not yet been documented. We selected patients (n = 17) undertaking a short-term dynamic psychotherapy in which the therapeutic alliance, measured with the Helping Alliance Questionnaire and monitored after each session, showed a pattern of rupture and resolution. Two control sessions (5 and 15) were also selected. Presence of TADs was examined in each therapist interpretation. Compared with control sessions, rupture sessions were characterized by fewer TADs and especially fewer TADs addressing specifically intermediate-essentially neurotic-defenses. Resolution sessions were characterized by more TADs addressing specifically intermediate defenses. This confirms the link between therapist technique and alliance process in psychodynamic psychotherapy.
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The present study examined the relationship between depth of defense interpretations by therapists, and patient defensive functioning, on the therapeutic alliance in a sample of 36 patients undergoing short-term dynamic psychotherapy. Defense interpretation depth was defined as the degree to which therapist interpretations contained information regarding the motivation for patient defenses and historical origins of the defensive processes (Greensen, 1967). Mean depth of interpretation was compared between sessions that were identified beforehand as either high-alliance or low-alliance sessions using the Helping Alliance Questionnaire (HAq-II: Luborsky et al., 1996). Results indicated that defensive functioning was correlated to defense interpretation depth in low-alliance sessions. Moreover, mean depth of interpretation was also higher in low-alliance sessions, pointing to the possible "destabilizing" effects that these interpretations may have on both defensive functioning and the therapeutic alliance. These results are discussed within the context of previous studies of therapeutic technique in dynamic psychotherapy.
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Cette tude vise comprendre la place du sentiment dimpuissance de lintervenant dans ltablissement dune alliance thrapeutique. La perception des intervenants lgard du sentiment dimpuissance et les consquences possibles quils lui reconnaissent sont analyses. Par les moyens dvelopps par les intervenants pour contrer ce sentiment dimpuissance, des pistes de solutions sont proposes. Par une mthodologie qualitative, vingt-cinq entrevues semi-diriges ont t ralises dans le cadre de la recherche Lidentification des interventions qui permettent de btir une alliance thrapeutique avec les jeunes contrevenants : un enjeu de premire importance du professeur Louis-Georges Cournoyer de lcole de criminologie de lUniversit de Montral. Elles constituent les donnes principales de la prsente tude. Un groupe de discussion, ralis en milieu communautaire, a permis de les complter. Les ruptures dalliance thrapeutique constituent un contexte favorable au dveloppement du sentiment dimpuissance de lintervenant, conditionnellement au soutien de lquipe et la perception qu lintervenant de son rle et de son contrle. Le sentiment dimpuissance peut mener une remise en question positive. Toutefois, il peut aussi tre lorigine du dveloppement de limpuissance apprise, qui se traduit par les dficits cognitif, motivationnel et affectif. Parmi les autres consquences du sentiment dimpuissance, une lutte sexprime par lvitement, lexpression de la colre et le contrle, qui ne sont pas souhaitables en contexte dintervention. En misant sur le soutien de lquipe ainsi que sur la perception des intervenants lgard de leur rle et de leur contrle, il est possible de prvenir et de contrer le sentiment dimpuissance.
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The Working Alliance Inventory-Short Revised (WAI-SR) is a recently refined measure of the therapeutic alliance that assesses three key aspects of the therapeutic alliance: (a) agreement on the tasks of therapy, (b) agreement on the goals of therapy and (c) development of an affective bond. The WAI-SR demonstrated good psychometric properties in an initial validation in psychotherapy outpatients in the USA. The generalizability of these findings is limited because in some countries a substantial portion of individual psychotherapy is delivered in inpatient settings. This study investigated and compared the psychometric properties of the WAI-SR in German outpatients (N = 88) and inpatients (N = 243). In both samples reliability (alpha > 0.80) and convergent validity with the Helping Alliance Questionnaire were good (r > 0.64). Confirmatory factor analysis showed acceptable to good model fit for the proposed Bond-Task-Goal model in both samples. Multi-group analysis demonstrated that the same constructs were measured across settings. Alliance ratings of outpatients and inpatients differed regarding the overlap of alliance components and the magnitude of the alliance ratings: The differentiation of the alliance components was poorer in inpatients and they reported lower alliances. Unique aspects of the alliance in inpatient treatment are discussed and a need for further research on the alliance in inpatient settings is pointed out. Overall, the WAI-SR can be recommended for alliance assessment in both settings.
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Background: Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. Methods: A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. Results: The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F 1, 73 = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z 55 = 0.99, p < 0.04). Conclusions: These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.
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Psychotherapy research reveals consistent associations between therapeutic alliance and treatment outcomes in the youth and adult literatures. Despite these consistent findings, prospective associations are not sufficient to support the claim that the alliance is a change mechanism in psychotherapy. The current study examined the direction of effect of the alliance- outcome relationship, the contribution of early symptom change in treatment to the development of therapeutic alliance, and the potential for pretreatment interpersonal functioning characteristics to be third variables that account for the association between alliance and outcome. Participants were adolescents with depression and a history of interpersonal trauma that presented to a community mental health center for treatment. Findings demonstrated that a more positive therapeutic alliance predicted greater subsequent symptom improvement, even after removing symptom change occurring before the measurement of alliance. Results also suggested that early change only slightly contributed to alliance development. Finally, though pretreatment interpersonal functioning was related to the first session alliance, these pretreatment client characteristics were not related to later alliance or symptom change. Overall, results provided some support for therapeutic alliance as a mechanism of change in psychotherapy. Methodological and clinical issues are discussed.
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Young children often harbor misconceptions about psychotherapy and the role of psychologists. These misconceptions are ignited by rumors and misinformation that are provided to the child by a variety of sources and can compromise both the effectiveness of therapy and the therapeutic dyad. In this paper we explore how recent trends in patient engagement in child psychotherapy, cultural dynamics between patients and practitioners, and children's lack of knowledge surrounding mental health services can negatively impact therapy. Wednesday Afternoons with Dr. J. (WADJ) is a whimsical fictional therapeutic narrative created to inform children about aspects of the therapeutic process while providing adults with tangible structure surrounding how to talk to children about mental healthcare. The advantages of utilizing this narrative to prime children for therapy are discussed, as are methods for promoting the narrative to the greater community.
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Foster parents have the potential to effect lasting therapeutic change through their role with the children they temporarily foster. Therapists working with foster parents can understand, support, and inform foster parents in their role based on a commonality that exists between the roles of therapists and foster parents. Similarities at different stages of both the therapeutic and foster parenting relationships are addressed, as well as the use of these relationships in a therapeutic manner. Advantages (for foster parents, foster children, therapists, and the foster care system) of articulating the foster parenting relationship through the lens of the therapeutic relationship are also discussed. Future research into the experience of foster parents in their role will be essential in creating an effective and sustainable system of care for vulnerable children.
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Supervision of psychotherapists and counselors, especially in the early years of practice, is widely accepted as being important for professional development and to ensure optimal client outcomes. Although the process of clinical supervision has been extensively studied, less is known about the impact of supervision on psychotherapy practice and client symptom outcome. This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. The authors randomly assigned 127 clients with a diagnosis of major depression to 127 supervised or unsupervised therapists to receive eight sessions of problems-solving treatment. Supervised therapists were randomly assigned to either alliance skill- or alliance process-focused supervision and received eight supervision sessions. Before beginning treatment, therapists received one supervision session for brief training in the working alliance supervision approach and in specific characteristics of each case. Standard measures of therapeutic alliance and symptom change were used as dependent variables. The results showed a significant effect for both supervision conditions on working alliance from the first session of therapy, symptom reduction, and treatment retention and evaluation but no effect differences between supervision conditions. It was not possible to separate the effects of supervision from the single pretreatment session and is possible that allegiance effects might have inflated results. The scientific and clinical relevance of these findings is discussed.
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RESUMO - O consumo de tabaco foi responsvel por 100 milhes de mortes no sculo XX. Apesar dos grandes avanos alcanados no controlo deste problema a nvel mundial, sob os auspcios da OMS, no contexto da Conveno-Quadro para o Controlo do Tabaco da OMS, se no forem adoptadas medidas consistentes e efectivas de sade pblica, a morbi-mortalidade que lhe est associada continuar a aumentar durante o presente sculo. A promoo da cessao tabgica constitui a estratgia populacional que permitir obter ganhos em sade a mais curto prazo. Embora a larga maioria dos fumadores faa, ao longo da vida, vrias tentativas para parar de fumar sem apoio, apenas uma pequena minoria consegue manter-se abstinente a longo prazo. Os mdicos de Medicina Geral e Familiar so, de entre todos os profissionais de sade, os que podem intervir de modo mais consistente e efectivo neste mbito e que melhores resultados obtm na cessao tabgica dos pacientes fumadores, dado o vnculo teraputico e a interaco frequente e continuada que com eles estabelecem ao longo do seu ciclo de vida. O aconselhamento breve, tendo por base a adopo de um estilo de comunicao motivacional centrado no paciente, adaptado aos estdios de mudana comportamental, tem-se revelado efectivo no apoio mudana de comportamentos relacionados com a sade e resoluo da ambivalncia que caracteriza este processo. A reviso de literatura evidenciou o facto de os mdicos nem sempre intervirem nas reas preventivas e de promoo da sade, em particular na rea da cessao tabgica, com o investimento e a continuidade desejveis. Por outro lado, muitos pacientes fumadores referem nunca ter sido aconselhados pelo seu mdico a deixar de fumar.. No so conhecidos estudos de mbito nacional que permitam conhecer esta realidade, bem como os factores associados s melhores prticas de interveno ou as barreiras sentidas pelos mdicos de MGF actuao nesta rea. O presente trabalho teve como objectivos: (i) avaliar a hiptese de que os mdicos que disseram adoptar o mtodo clnico centrado no paciente teriam atitudes mais favorveis relativamente cessao tabgica e uma maior probabilidade de aconselhar os seus pacientes a parar de fumar; (ii) estudar a relao entre as atitudes, a percepo de auto-eficcia, a expectativa de efectividade e as prticas de aconselhamento sobre cessao tabgica, auto-referidas pelos mdicos; (iii) Identificar as variveis preditivas da adopo de intervenes breves de aconselhamento adaptadas ao estdio de mudana comportamental dos pacientes fumadores; (iv) identificar as barreiras e os incentivos adopo de boas prticas de aconselhamento nesta rea. A populao de estudo foi constituda pelo total de mdicos de medicina geral e familiar inscritos na Associao Portuguesa de Mdicos de Clnica Geral, residentes em Portugal. Para recolha de informao, foi utilizado um questionrio de resposta annima, de autopreenchimento, aplicado por via postal a 2942 mdicos, em duas sries de envio. O questionrio integrou perguntas fechadas, semifechadas, escalas de tipo Likert e escalas de tipo visual analgico. Para avaliao da adopo do mtodo clnico centrado no paciente, foi usada a Patient Practitioner Orientation Scale (PPOS). O tratamento estatstico dos dados foi efectuado com o Programa PASW Statistics (ex-SPSS), verso 18. Foram utilizados: o ndice de de Cronbach, diversos testes no paramtricos e a anlise de regresso logstica binria. Foi obtida uma taxa de resposta de 22,4%. Foram analisadas 639 respostas (67,4% de mulheres e 32,6% de homens). Referiram ser fumadores 23% dos homens e 14% das mulheres. Foi identificada uma grande carncia formativa em cessao tabgica, tendo apenas 4% dos mdicos afirmado no necessitar de formao nesta rea. Responderam necessitar de formao em entrevista motivacional 66%, em preveno da recada 59%, de treino numa consulta de apoio intensivo 55%, em interveno breve 54% e em teraputica farmacolgica 55%. Cerca de 92% dos respondentes consideraram que o aconselhamento para a cessao tabgica uma tarefa que faz parte das suas atribuies, mas apenas 76% concordaram totalmente com a realizao de uma abordagem oportunstica deste assunto em todos os contactos com os seus pacientes. Como prtica mais frequente, perante um paciente em preparao para parar, 85% dos mdicos disseram tomar a iniciativa de aconselhar, 79% avaliar a motivao, 67% avaliar o grau de dependncia, 60% marcar o dia D e 50% propor teraputica farmacolgica. Apenas 21% assumiram realizar com frequncia uma interveno breve com pacientes em preparao (5 s); 13% uma interveno motivacional com pacientes no motivados para mudar (5 Rs) e 20% uma interveno segundo os princpios da entrevista motivacional, relativamente a pacientes ambivalentes em relao mudana. A anlise multivariada de regresso logstica permitiu concluir que as variveis com maior influncia na deciso de aconselhar os pacientes sobre cessao tabgica foram a percepo de auto-eficcia, o nvel de atitudes negativas, a adopo habitual do Programa-tipo de cessao tabgica da DGS, a posse de formao especfica nesta rea e a no identificao de barreiras ao aconselhamento, em particular organizacionais ou ligadas ao processo de comunicao na consulta. Embora se tenha confirmado a existncia de associao entre a adopo do mtodo clnico centrado no paciente e as atitudes face cessao tabgica, no foi possvel confirmar plenamente a associao entre a adopo deste mtodo e as prticas autoreferidas de aconselhamento. Os mdicos que manifestaram um nvel baixo ou moderado de atitudes negativas, uma percepo elevada de auto-eficcia, que nunca fumaram, que referiram adoptar o Programa-tipo de cessao tabgica e que no identificaram barreiras organizacionais apresentaram uma maior probabilidade de realizar uma interveno breve (5 s) de aconselhamento de pacientes fumadores em preparao para parar de fumar. Nunca ter fumado apresentou-se associado a uma probabilidade de realizar uma interveno breve (5 s) com frequncia, superior verificada entre os mdicos que referiram ser fumadores (Odds-ratio ajustado = 2,6; IC a 95%: 1,1; 5,7). Os mdicos com o nvel de auto-eficcia no aconselhamento mais elevado apresentaram uma probabilidade superior encontrada entre os mdicos com o menor nvel de auto-eficcia de realizar com frequncia uma interveno breve de aconselhamento, integrando as cinco vertentes dos 5 s (Odds ratio ajustado = 2,6; IC a 95%: 1,3; 5,3); de realizar uma interveno motivacional breve com fumadores renitentes a parar de fumar (Odds ratio ajustado = 3,1; IC a 95%: 1,4; 6,5) ou de realizar com frequncia uma interveno motivacional com pacientes em estdio de ambivalncia (Odds ratio = 8,8; IC a 95%: 3,8; 19,9). A falta de tempo, a falta de formao especfica e a falta de equipa de apoio foram as barreiras ao aconselhamento mais citadas. Como factores facilitadores de um maior investimento nesta rea, cerca de 60% dos mdicos referiram a realizao de um estgio prtico de formao; 57% a possibilidade de dispor do apoio de outros profissionais; cerca de metade a melhoria da sua formao terica. Cerca de 25% dos mdicos investiria mais em cessao tabgica se dispusesse de um incentivo financeiro e 20% se os pacientes demonstrassem maior interesse em discutir o assunto ou existisse uma maior valorizao desta rea por parte dos colegas e dos rgos de gesto. As limitaes de representatividade da amostra, decorrentes da taxa de resposta obtida, impem reservas possibilidade de extrapolao destes resultados para a populao de estudo, sendo de admitir que os respondentes possam corresponder aos mdicos mais interessados por este tema e que optam por no fumar. Outra importante limitao advm do facto de no ter sido estudada a vertente relativa aos pacientes, no que se refere s suas atitudes, percepes e expectativas quanto actuao do mdico neste campo. Pesem embora estas limitaes, os resultados obtidos revelaram uma grande perda de oportunidades de preveno da doena e de promoo da sade. Parece ter ficado demonstrada a importante influncia que as atitudes, em especial as negativas, e as percepes, em particular a percepo de auto-eficcia, podem exercer sobre as prticas de aconselhamento auto-referidas. Todavia, ser necessrio aprofundar os resultados agora encontrados com estudos de natureza qualitativa, que permitam compreender melhor, por um lado, as percepes, expectativas e necessidades dos pacientes, por outro, as estratgias de comunicao que devero ser adoptadas pelo mdico, atendendo complexidade do problema e ao tempo disponvel na consulta, tendo em vista aumentar a literacia dos pacientes para uma melhor autogesto da sua sade. Parece ter ficado igualmente patente a grande carncia formativa neste domnio. A adopo do modelo biomdico como paradigma da formao mdica pr e ps-graduada, proposto, h precisamente cem anos, por Flexner, tem contribudo para a desvalorizao das componentes psicoemocionais e sociais dos fenmenos de sade e de doena, assim como para criar clivagens entre cuidados curativos e preventivos e entre medicina geral e familiar e sade pblica. Porm, o actual padro de sade/doena prprio das sociedades desenvolvidas, caracterizado por pandemias de doenas crnicas e incapacitantes, determinadas por factores de natureza sociocultural e comportamental, ir obrigar certamente reviso daquele paradigma e necessidade de se (re)adoptarem os grandes princpios Hipocrticos de compreenso dos processos de sade/doena e do papel da medicina.
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The aim of this exploratory study was to assess the impact of clinicians' defense mechanisms-defined as self-protective psychological mechanisms triggered by the affective load of the encounter with the patient-on adherence to a communication skills training (CST). The population consisted of oncology clinicians (N = 31) who participated in a CST. An interview with simulated cancer patients was recorded prior and 6months after CST. Defenses were measured before and after CST and correlated with a prototype of an ideally conducted interview based on the criteria of CST-teachers. Clinicians who used more adaptive defense mechanisms showed better adherence to communication skills after CST than clinicians with less adaptive defenses (F(1, 29) = 5.26, p = 0.03, d = 0.42). Improvement in communication skills after CST seems to depend on the initial levels of defenses of the clinician prior to CST. Implications for practice and training are discussed. Communication has been recognized as a central element of cancer care [1]. Ineffective communication may contribute to patients' confusion, uncertainty, and increased difficulty in asking questions, expressing feelings, and understanding information [2, 3], and may also contribute to clinicians' lack of job satisfaction and emotional burnout [4]. Therefore, communication skills trainings (CST) for oncology clinicians have been widely developed over the last decade. These trainings should increase the skills of clinicians to respond to the patient's needs, and enhance an adequate encounter with the patient with efficient exchange of information [5]. While CSTs show a great diversity with regard to their pedagogic approaches [6, 7], the main elements of CST consist of (1) role play between participants, (2) analysis of videotaped interviews with simulated patients, and (3) interactive case discussion provided by participants. As recently stated in a consensus paper [8], CSTs need to be taught in small groups (up to 10-12 participants) and have a minimal duration of at least 3days in order to be effective. Several systematic reviews evaluated the impact of CST on clinicians' communication skills [9-11]. Effectiveness of CST can be assessed by two main approaches: participant-based and patient-based outcomes. Measures can be self-reported, but, according to Gysels et al. [10], behavioral assessment of patient-physician interviews [12] is the most objective and reliable method for measuring change after training. Based on 22 studies on participants' outcomes, Merckaert et al. [9] reported an increase of communication skills and participants' satisfaction with training and changes in attitudes and beliefs. The evaluation of CST remains a challenging task and variables mediating skills improvement remain unidentified. We recently thus conducted a study evaluating the impact of CST on clinicians' defenses by comparing the evolution of defenses of clinicians participating in CST with defenses of a control group without training [13]. Defenses are unconscious psychological processes which protect from anxiety or distress. Therefore, they contribute to the individual's adaptation to stress [14]. Perry refers to the term "defensive functioning" to indicate the degree of adaptation linked to the use of a range of specific defenses by an individual, ranging from low defensive functioning when he or she tends to use generally less adaptive defenses (such as projection, denial, or acting out) to high defensive functioning when he or she tends to use generally more adaptive defenses (such as altruism, intellectualization, or introspection) [15, 16]. Although several authors have addressed the emotional difficulties of oncology clinicians when facing patients and their need to preserve themselves [7, 17, 18], no research has yet been conducted on the defenses of clinicians. For example, repeated use of less adaptive defenses, such as denial, may allow the clinician to avoid or reduce distress, but it also diminishes his ability to respond to the patient's emotions, to identify and to respond adequately to his needs, and to foster the therapeutic alliance. Results of the above-mentioned study [13] showed two groups of clinicians: one with a higher defensive functioning and one with a lower defensive functioning prior to CST. After the training, a difference in defensive functioning between clinicians who participated in CST and clinicians of the control group was only showed for clinicians with a higher defensive functioning. Some clinicians may therefore be more responsive to CST than others. To further address this issue, the present study aimed to evaluate the relationship between the level of adherence to an "ideally conducted interview", as defined by the teachers of the CST, and the level of the clinician' defensive functioning. We hypothesized that, after CST, clinicians with a higher defensive functioning show a greater adherence to the "ideally conducted interview" than clinicians with a lower defensive functioning.
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Though considered by some as a difficult if not impossible task or even as a challenge or a sacrilege, research on the efficacy of psychotherapy has grown steadily over the past decade. After a brief survey of the most substantial results over 40 years, the article proceeds to point out risks and misunderstandings that have arisen between researchers and clinicians. In order to illustrate this issue, two frequently used concepts in research are presented: meta-analysis and therapeutic alliance. (PsycINFO Database Record (c) 2007 APA, all rights reserved) (journal abstract)
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Introduction: Consultations with patients suffering from chronic pain without objective findings represent a challenge fo r family doctors (FDs). A mutual lack of understanding may arise, which threatens the doctor-patient relationship and may lead to dissatisfaction of both patient and doctor and to a breakdown of the therapeutic alliance. Objectives: This study aims to investigate FDs' potential protective practices to preserve the doctor-patient relationship during this type of consultation. Method: In the first step of this qualitative research, I carried out a range of 10 se- mi-structured interviews with FDs to explore their reported practices and repre- sentations during consultations with people suffering from chronic pain without objective findings. The interviews' transcripts were integrally analysed with computer-assisted thematic content analysis (QSR NVivo ) to highlight the main themes related to the topic in the participants' talk. Results: At this point of the research, two types of FDs' protective practices can be identified: first the use of complementary sources of knowledge in addition to the medical model to provide explanations to patients, second the collaboration with multidisciplinary teams or support gr oups that allow them to share profes- sional expertise and emotional experiences. Conclusion: The findings could be useful to develop ways to improve the follow- up of patients suffering from chronic pain without objective findings and conse- quently the FDs' work satisfaction.
