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Medbestemmelse i psykoterapeutisk arbeid

Kruse, Siri Selvik
Master thesis
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URI
https://hdl.handle.net/1956/3485
Date
2009-04-15
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  • Faculty of Psychology [463]
Abstract
The patient's legal right to participate in clinical decision making is a professional challenge for psychotherapeutic work. Active patient participation in therapy is also seen as a precondition for successful outcome. The thesis discusses a key question: How to conduct therapy in consideration and promotion of patient participation? This is a clinical task requiring a patient perspective on therapy, and an autonomous administration of professional knowledge. It is argued that these conditions are accommodated in the Policy statement on evidence-based practice in psychology (EBPP), and that EBPP may be a useful conceptual model for the clinical decisions underlying patient participation. Evidence-based clinical decision making starts with the patient and asks what research evidence will be useful to help this particular patient. Clinical expertise is a core element. Case formulation, treatment plan, client-directed outcome-informed therapy, and individual plan are strategies recommended for evidence-based practice, because they are presumed to accommodate and adjust treatment to patients' needs. It is argued that the strategies have the potential to facilitate patient participation in clinical decision making. However, their desired effects depend on, amongst other conditions, the patient's subjective experience of actual participation, and the therapeutic relationship.
 
Pasientens lovfestede rett til medbestemmelse er en faglig utfordring for psykoterapeutisk arbeid. Aktiv pasientdeltakelse i terapi er også ansett som en forutsetning for vellykket utfall. Oppgaven drøfter ett nøkkelspørsmål: Hvordan ivareta og fremme medbestemmelse i psykoterapeutisk arbeid? Dette er en klinisk oppgave som krever et pasientperspektiv på behandling og en autonom forvaltning av faglig kunnskap. Det blir argumentert for at disse vilkårene rommes i Prinsipperklæring om evidensbasert psykologisk praksis (EBPP) og at EBPP kan være en nyttig forståelsesmodell for de kliniske beslutningene som ligger til grunn ved medbestemmelse. Evidensbasert klinisk beslutningstaking tar utgangspunkt i pasienten og spør hvilken forskningsevidens som er nyttig for å hjelpe akkurat denne pasienten. Klinisk ekspertise er en kjernekomponent. Kasusformulering, behandlingsplan, klient- og resultatstyrt praksis og individuell plan er anbefalte strategier for evidensbasert praksis, fordi de antas å tilpasse behandlingen til pasienters behov. Det blir argumentert for at strategiene har potensial for å ivareta medbestemmelse. Imidlertid vil deres ønskede virkning avhenge av flere forhold, blant annet pasientens subjektive opplevelse av reell deltakelse og den terapeutiske relasjonen.
 
Publisher
The University of Bergen
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