castele de nisip daniel david

COJ?ERTA/OEORGeMAlUR TEHNOREDACTARE/NICOLAETURCAN

REDACfOR/MlHAl GOTLU

CASTLES. OF SAND Sdence and ~seudos.deJlce

in_ psycliQpu~Uology. · ·

~ COPYRIGHTTR.ITONLC .'CLUJ/ Tui.IF~U.: +40.164.431.655

B UCURB~Tl/1'e1Jflnx.: .,_40.21.242,.54.09 · e:•nnll: ·[email protected]

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DeJcrleten CJI' R l}lblloLe-;;ii_Nu'l~nRle P 1toan6nlel DAYU>,DANI:EL . . . ·.. '<

"FIIstelede 11lsfp .. : ~Ubt.ii. f~psmtlo~Uiulii in p5Umpatologie I Daniel David;'::. Ducu~ti : Trilonic, 2003

ISUN 973~8497-1.1-J

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Daniel-David

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CASTELE'-DE NISI~ ~tiinta ~i psettdo~tlin~a

i11 psihopatologie

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Mndu: "A:f~ri .JI devi110!" (Ooelhe: .Se/Jge SellltrlldJI)

:, Dedicatle:J.Jtcfll(ell.~e,tkdicalii acdorcolcti ~i pro:fusioni:;fi Jlenrm care ~liinJa eme opl)rtu~itatea 4!= a 1e mira critiC ~i activ fn(i de spectncolul fumii·~i ck. a k: lmcuri\din plitll~:pmpriiJccoAllibnfli Ia a east specfilcol, ~:nro! au supra vio[uit inca tncerclirii-lnle continue d~ a lc snbotn .

. Dedication: I dndioatc tbis book to those ~:oUeoguell nnd prof~imtalslbr wllflll\ scienl:e ~presents·tbe opportunity lh crilically nnd' activ11ly wonder -in the facb of I!JC~ wm:ld Bpeclnclc and· to fblly enjBy your own contributions. to Ibis specrnclc. contributitfna that have still resiliently Sf•r

vived your peNisteni:.attempt to aqbotnge them.

. Mnlfutuiref Aparitia,acestei·JfJcilri ·afost_impulsio~nut dt! oameni cArora tin sate null!Umesclrimod deo!ebit;ParaMizlindll fd calebrli, Guy Montgome..y,~i"ilana,Bovbjerg tie Ja r,:lifo1mt Slnay;·S~I\oc:ll of Medicine, SUA, an-btl tr02.it din 'SOmnul tJO!filatic Qi m-au lnvl\1111 ceeu·ce inse6mnil flUnlll, certeflu'ea.vi pmi;lica-vtiiqfificli;'lltUnCi dud CfeM'lm t1l ~Jill RCtSI i1iem fi ell nu mlmlli p~te ~Jirimlani.mi~. ~~rHilis .. d.: la Alben Hills llrstfrure. SUA. a faar onruJ,Citfc·n141 iospinn fn1UOOdineft crilic;ii~i refleJtivd QSUpl"n Bllll I:CCD ec·fiU:~tl:afC't!""ainviirbl sltnll:f~f pierd niciodrtlif iucrederea fi sA tontinuu sl tollStfUiesc Criticlltdnci dnd muldl tumc f:Stc tll\pl)

lfiw mea ~i a dec&~ me:" AR.Ptl'UN.Bca lucrurlle·sli stea nll16\, dnr niciunde nu si:ri.e, t1 lncmrile N\J.'Iltl!llUIJ!sl\ sleanva prosb::um stnu,.deei:c:4}nlinull sll construitfti $i ~~ eritic~ tin,c insutl" .. ar sptme,ekS,~evcn ~~~n~ ile h1 SUNY ar Binghamton. SUA ¥i laving Kirsch. de--Jn.Conneaticul Utlivo:rsity, SUA. an filM Jlfieti;nf ljlmodel~tde,atlbldiQe crlliiA fi constru.clivli ~Stlpm domeniului tlinic, CIU'C ln.:.au infliienJ&tinceelfce lim &ut oict MtdlttnlCSI: lroftlorcolagi ti prititeni care au citit rextul fi care m-au njutat Siiil n~roximez itt aoaastl thrmii •. SuPl prea multi ca sA·i enmnlb' a.ici; ~oi ftlentinnn door oote.tlii tie In Catedm de Psibologie a UniveuiMtfi DabCfi:..:aiityai din .Cluj· Nntmc~r •. cnre anm.ticlind nllfptmntolluciarea ·in cndml-col~:ctivtilui ile atfttfrii lltl ft~ut sugisfii (ll!omonrarii ulile. j\tola unde este enzul ii vni ili~rttionl\ in mod SJ1cCin11~ incepu~·· ~llCllroi ,capitol pe tlcei pl1lf~ion i~l i,

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colegi ~i prhder1i, care au recenZHf mnlcfiu.lul ~i r.nr~ ~i-au ;tQl~. n.~;lfel conlributia lafonualui actualii. Nu in ultimul rfiud, n~ul\Unlesc.srudeJ;tilorde In Progrrunul de ~aster iu "CoJISilh;rel'sihologicli ~i rsihotempie, de Ia Uuh•ernilallea Babc~-Bolyui,. Cluj-NapuCII, penlnlsuge:tliile referjlohre In :;lruclurii Btestui ·votum lli [a iitabunnU'itiren OSlJeclulu.i slilislic. Pruadoxal, trebuie sa mul\utuesc lit ocelot "ptofesionil}ti" ca.remi-nu dat. oportu11ilnten all itlli exersezsimtul critic prin:;ofi:~mele,:~olemlliliilile bannle lli lruimnele pe cure le-ou )Jtudus lli pe cure le-ou ridicat In nivelul uuor opere vi d1scur.mri ·~liinliflce. ·

Ac:lmuwlc:tlgenumbi: The writing Qflbis hook was olirnulnled by peotJie whom l especially want to lllB!Jk. .Jllllllpb.,;'rJi~g u fnmous-saying, Guy Montgomery and PnnaBovbjerg, from Mount Siuni School of Medicine_·

· USA, nwakened me from the dogmatic sleep m•tllnughlme \vhatscicnee, research ond Jlnlclice meuut iliu time Uhougllt lknew lhi! all lou well and uothing culllld 1mrprise me. Albert EUis, from Albertfillislnslilute. USA, wns the mntrwlm. ins[liretl me lo-ba criti~>nl nnd re0e1'ive witU everjUting l did nm.Fwho taughlrne never to .lose fttith iu myself and to wnlinue to .m1ild crilir.nlly when mnuy were agni.ttl!t me e.nd my work. Stuen Lynn, from SUNY nt Bingbnmlou,USA,atKIIrviugKihJcll, from Cotmci:licul University, USA, had a major impac& on my work, being friemla nmlntodels of crilical ttud conslntctive ollltude in the clinicul dorunh1, Lo:~l but notlcast l woullo . . ' tlmuk my colleagues Jrom Bnbes•Bolyal University nnd lhe students en-rolled in the Master's Pltlgr.am in "Psycltolaglcal Counseling and Psyclmthetllpy~' Jmm Babe:t-Bo.Yni University, Ch[j..:Napocu forlheirsuggeslions

.. conce!'niug the slruclureoflhis vo'lume and I be i111proven1e1il o[lhe 11lylistic nstJecl. Pnmdox ically; ll\tusfulso llmnk tlrose "prores&itrnfils" who gave me . the opport\lnity to exercise my critical s!lllse 011 lheso}lbiarus, trite reatmrb und tmismsthey had pruduued uud raised lollmlevel of scir!nlificdisoourscs nnd self-declared works of ort.

Prcz;euf:tt"l!IHutforului; Daniel Oavid esle p~iholog, leulllr univ. dr.ln Coledra de .Psihologie n Universiliijii Bnbev-Dolyaidhi Cluj-NnpOQl. A oblinut !icen!o in psihologie-{in 1996) Ia Uuiversilnlea Bnbe.~-Bolyai~i ductomtul in psihulogie { 1999) Ia aceen~i Universil!'le. A fi~ul studii .postilniYernilnre

· (l999-2002} iu psihologieclinica Qi psiltopalologie Ia Moun I Sinai School of Medicine, New York, SUA, ~in JlafCUIS un progmm de fuonnre (1998-2001) in psih(llern}Jia t\lgllilivii ~i comporlnmrnlnla Ia Albert l!llis luslitute ~i Academy of Cognitive 'll1empy, SUA. Esle pre~edinldeAsocinliei Rumiiuede · Hipnn7.ii si P::iho1ern11ie Cngnitiv-Comporlnrnentnli'i.IJircdQr ol Centmlui

Rmn5n de Psiholempie Cognilivli lli Rt!lionai;.Emotivil \{i Comportamenlnlli. · ~i Hditoral revistei"Romsninn Joumnl of Cognitive and HehuYiorat f'.syho

lberapies''. Automleste memb1_11 in=SSillciJ1.Jii prufellionttle iJiten!nJiontde de· Jrrolili desfil~oarti activiliili didnclice., de ccrceJnre, ~i ptacticil pflibolerupeu~ ticii ii 11 publiclll pfina in prezent 4 ciiJii vi p.esfe 3U de urficofc,· din cnre majoritatea in revjste de presligiu diu strninillale.

Volume rt1evnnte: David, D. (1000). Pf"efucrarilillcoll§lieule cfe irrjoriuafle. Cclflftnlli

nar~cr l'·'iilrologicci in mas:r-mec/i.o, practica · cliJlica flju,-iJicii. Edillrm Oncin: Clnj-Nappc!L .

David !}i co lab. (1998-200U). J::silrotempit ~rtrlpllt1fet"t1J1ie crJglfifll ....

comportamentalii. Editulll Risopriot: CluJ-NdJlOJ:II. •

Aboul tbenulhor. Onuiel J)nvid isliceru:ct.{psychpl~gisf, )?h.JJ., nnd Assislnnl Professor al-Bnbcs-BblyoiiJ Univemity, 0eporlr11ent"uU1syclru1ogy, Cluj-Napoca. He ublllined his licenllc lnJJ&ycho1ogy {in ·J!J9G) nl ''BnbesBolyoi" \]uiversity, CllJi:-~arKJ(:onnd lhePlt.Q. {in 1999) ~t lheantnc University. Ha cmnpleled a postdoc1omlprogrum (l999-2U02) in clinit:al p.:ycliulogy and psychopnlhology.ntlvf,ouut Sinni Scbool of{IAeditlinc, t-Jcw York. .USA, and a !mining progrom {l998-2002fbi l;ognlti'l'eand bcbnvioml tbcrllpies at lbeAlbertEilis lnstilute RtJd A,clldemy otCogniliveJ~u:ntpy, USA. · He is Pre:lidenl of the Ron1nnian ABsociotlon vf ll}lpnosis and-Cognitive .Behavioral PsychothemlJY, Direclur of. Ill&! Rl)mn~tianCetJies:.fotCiJ~nilive nnd Ralionoi-Emotive oud Debavioml PsycboUtcrapy and:6tlitnr cpf'~llothonilui Journal ofCognilivc B.ntl-BeiiiJ,'Y;iorfll P~ycbodlentpieu~~. The uulbor i1:1

member in iutemnlioual prore!laioJtBiliiiSo~iali~us in lbe nreu pfiuf.erest: nud is invoh•ed in lenchiitg, research nnd',psyclu,tbJ!O\peufie;)J~ctlce nctivitie!!. He has nlrendy published 4 boo~ nml over 3.0 urticles, most of these in f!restigious inlemati,on!lljoumals ..

Rell'.vnnl hooks: David, D. (2000). Prelflcriiri incollflielllc de iTtfontra(ie:· Crmtqm

inm·e~ psi/Jologicii .f11 mass-media, prtictica··cllrilcif~l jllridlcf'i (UIICfltl~ciortS lnfornrafiou proces.rlirg). Etlihtm Dacin: Clu}-Nu}JfJCII.

David §i oolob. (1998;.2000}. P.dltof~mplefllriptmiiU·cq,;e cogllitil'comporlamenlalti (Cogni[ille-be,lmvioml p1ycli1Jtf1eropy a11d ltipuot!leraJ~lj. Edilum RiSOJlfinl: Clt.Y-Nnpocn.

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c ~ t iu · -, . • · · · 5 uvan c re.~lll Qr ········-···--···:··· .. ··· .. •:·-·n···············--··-········· .. ········•···· l . Pref.'\Cc ......... ~ ................... , ...................................................................... 27 Povest u 1 • V -·· · 1· "- · ·l · R · I 'I k' 2.9 . ea tvtare UI lliJIIarL 111 u.£qt a m umpe stl ts m ••. 7 ........ ,.-....... ,.

Comenlllrii despre§tiin{ii •. :." ....... , ....... : .......................... , ... ~ ... : ................ Jj

Pna:tea I. Fundnmeutcn.l~pr>lh~pnlolnglel en §llinjlL_ ....... ~ ....... ..;. .••... _. si ci ·rol 11 n fi ·r · · ' · · ·1 · • tpl_ u •... e .. mJtqtpreclzilrlc~nceptuo c .............. , ......... : ................. 51

l. r. Defiui(in Psibopntolo(:.ici ctt §liintll ............................................. 51 1.2. Slln~lst~ ~i_bonlll ......... v--···•···•·•···: ..... : ... , ............... , ....... : .. ; ....... 52 1.3. ~olltl11i a~ribu(iiiC: psiltgpp~ologului ·•'c'·······--·------·:···----·····--···':.'" 5ll 1.4, Orienliri t(l(}retic~ in psjlmpatolo_gie. ('\,$!!tn1ii introduc.ere .••.••.. 59

Cqpiloluf 2. S~ruphttn amui•s,!ndiu de l<!lZ •• ~.,.,., .. , ................................... &I '} 1 n· · · ti · · 1 · · ,. • ·· ··· · ·r.· • . I«R!'os c ~· evn uare ~mtcl\.. .... ~ ......... ., ...................... ,. ...... ,.,, .. 64 2.2. Con~pllJnliza~clinici. , ... ~.·····:, ................................................ 71 ;l.l.Pinnul d~trahi~ent'lj,descrierea inter\ientici .............. : ......... : ..... 76 2.11~ Concluzii vi ~tirea evnloliei pncientttlui •• : .. , ........ , .. , ......... , .... 78 2.5. Unexemplu dcstudiu dccnz. Cn:zui.Dnn!l ;., ...... , ........................ 79

l'artea:l. Psibopalologl~ P~lh~indot~1i_leit!unlJzl de ta2 ••• ~·:·--·· ......... 91

opifolul DiaJJ:Illoalicnl vi evntiutrcn cliniciln pacientul1.1i ~ .oparologic_•·:--~·· .... :.~ • .,. .... :: ..... .,.:.,.~--~·--··------···-................................. 91

)J. Scmnl!l}isinlptomc.Tubloul clinic ai . . . pacieritului Psibopiltnlogie ....... : ........... ~·~ .............. , ..• , ....................... 9t·

:t 1.1. ProblemcaJePaibopnlologjei cu modnliffitil~ de a fuCG din,.PQ&tt"c•"i cvol • · 1' • - ·f · ·. ... . ·v, ~l'!rlr p 1n1c~ ......... ::·--·-··:. ... : ............................... 92

J.l.l.l.liumiiml ~xngern( de mare dp categor-ii diagnostice lji tendinfl! df! pnrqlo~t~.'Y a vlet\i ~ntidieM. . Mnlla!S Malefi~ntnJ .. , ...... -......... , .......... ,., ............................. 92 3.l;f:2. Udli211r~ ltllui ioiii.:;I!JMmlor.~ihologic depil~ir · l}i problcmntlcsau Cm-ut en Hoi· ...................... ,.-... : .............. 100 JJJ ~3. Oingnostic nosologic descriptiv versus diagnostic nosologic eliopntoget~elic. 0 int.Tem'"ire ill proiecr ............ 105

. - •. . ·.--:·:.

--~---------~------------------~.:::t

,)C J(lh!JYi!ll(U! ?t hiri;tiH ... ;.u .. • ................. - •• ~-·· ....... ~·····- .... --~- .. ······"·· • ••

).1.2. L Numaml i'a>tlgenu tit: mare ul fonnelunll! tflllllllli:ll\ I nl • - ., M' I . .. . nn Sllll Lttlllrtnl\i muumm m ................................................. ..

3.1.22. Bre,e in ~lidilfltea §lilntificii atnltiiillenlclor. lO Ecce Mesmer .............. _ ........................ ! .................... , .......... i 3.1.2.3. Lobby ;i traditi~ 'impolrivn ~tiintei; .. C l - -d. • . 116 117.11 shmtt e s1ne , ................................................... : ........ .

3.1J. Probleme ale Psibopatologiei cnl}'IOdalitil\ile 1 de: a fac~ cero:c[Jlre ............... : ..................................................... l .. l

3 .1.3 .1. Caztil:nlttlir.aliei llntideprMivc $Jill . . . . ; ti" t . l i? Victotia mnrla:ting-:ulurtanpatmYil'~ mel............................. --

3.1 J.2. Cazul efe.ctului plncebo smr . Cum sl i1cizi ell mliinilc -enrate ............................................. 125 l.l.J.3.:Cn:nil psiholiJillpiilor:in psii\QIIOID&tioll. Victorip dorintei asupra dntelar ~i · · Re-zcrvare penlnt locul doi ; ... , ........ - ............... , ..................... 14<1 3.1.3.4. CaznUnlemcierli.ltJgiceinceroetorea ~liinli tid sau

·· .. Em tJC ciind nu s-n viizut. a2:i o vedbm Qi nu e" ................... IW 3.1.4. Problcme nle PsibopBiblogici cu modalilntj}e de o face cduct~pct §i funl)BrrJtrainhtg: ••• - ..................................... 110

3.1 A .l. Slmctum progrnmelor de fomare/lnlining in psibolsrapic snu HirotQil.iren ..;. ................. , ................ ; ....... 171 3.1.4:2. Provocnrea psihologiei puziti ve .............................. 111 ].1.4.3.Jlrovocnre1lpataprof.o!SiORiljlilor ............................ : ... n6

. . 3.i.4.4. Provacarcm terapiilorautoa:dminisrmrc .................... 179 . · ·~. :u .45. Contestareu cxperlent;:i eli nice ............................... ,.100

3:2. {stndcnl tnbloului clinical pacienl\ilui Paihopnlnlo~;ie · (pimtnt detnlii v~ Sora!I.On 'i Samson. 1999) ................................... lll-1 3.3. htorln pen:onnlli Qi soci"lij <.t p"cicntului Psibopalologie· ........... 1116

· 3A. Ste.tut:ul mentolalipocieunalui Psihopalologie .... ~ ............ ~ ........ ~ JG1 3~li.B.ezuhnte1e ~iagnosdr.uluiQi.eYnluiirii clinicc 'fl RIC P.IICi6111UlUi.f'sihOllntillogi.: .~ ....................... _. ............................... !!.1

~l@Conceptullli-z.·u-~ tauloului clinical pncicnlului . Jli:ibapatulogi~ .......... , ........................................................................... 191 .

· 11:1. Meoon\sme.le_ntio(ltltogr.metiuespecifice ................................... 191. · : -'1~2. Masani:nne ctiopntngenclice no$pecifice ~nu jJsibopnlologi<J .

psihopatelogilor .............. : ........... h ......... - ............ u. ........................ 2110 4.3, Fnctori de prmectie ~i reziilttntH. , ....... ,; .................................... 203

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•J.J. t Niv.clut ridic:alal capacilifilor intel~ualo :;. · : •. ulec )lSiftopatoiogitor ·-····-··~·~··•1••·····-•·N-·•········•··•:, .. , .. , ..... L.l04 11U.1.;Spiiii\il critical.psibopn.tGtogilo.r: ••• -; .• "••··;~~.;:0;.;;.';~ .. : .. ~~~ iU4 4J.3. P.reSiu~Jea.cwrelordeasiguriri;dtJiiniJ:IRfr:: ·.. ·. ~i Jlnmdigma·niedicinei:!ialidatii\tlii.l\lific •••••.•••. ,; ......... ,;;.. ...... ..,~w: 207 4.3.4. Globnlizarea vi inlerdisciplluarltrJI.eli§l.iiltJei ••••• ~ .............. ;. 214

Ca]JitobJl\5 l'mtanumtulpacielltuluiPsiliopalulogie.;.;,....,;;,.,.., .......... .,. 216 . •• to tntneltluLJ1eUtau pn:ible~ueleinmutlnlititlle de a face

· dingt1~sticft e'•alunrecliiuci,lneiiutarea&mntului:GnJal·:;_, ........ :.·ll6 5.2. Ttnlnn1enlul pe1~1nl probleJnele t~~lhlifiJild.tle~~· :. inlet v~jlie ~i lnllruneril; Sfftnla.Treillte ~~~::u..~.~~ ........ ~~·; .. .:: .. ~: ....... ~. 117 s.J~T~lttan~~J.lW. p~p~ebl~Ji,et:!~~1toaub1i'i:l~ ..•.. • • - ;,. de a f~ce Cercel!!re. Cele VBSe.POruncr ••• :.,~ .. ·~···~· ............... -:-.... ": .... _.,lt9 5.-i. 'trntamentulpcnttu.prnbtenrclailrl\ludllliifttrfede a'f~ · . ~ • ethn:.ntla vl funoaJ;e/lndning. Bl;iciull~Qe®ftt .. , ................ , ....... ""' .•. 22:2

1~,• ",{.,,vi>';;.:-\ ',• ,'',·.~~·~j" ~ ;"-~'~;,.;:•, ',"~1~(.~/··_..,.,,"'' '' ">'•,-

CllpiJ~lul6~ Jtsiltui(Jgiaclinic,iht Romll.l)iasn.\J fugadit~'(umuf~~t~J,el. · . Un pnJ-,\net fundJ\nle•1tat ~tiintific: ........ ~~ .. ; .. :~ ..... ~;.;.~::~.,.. ......... ~: .. ~; ...... :ZZ.'l

Capiltllul?,. Psihologiac;ttn~ vernwrtJsiltologi~ 1\Jllj~atii inJ~l1e dQmenii ~,.,_,, ""'" ' ' ' ' ' ·''' ' ,, . -''. ,, ',: ' .

sau Cent~iireasa ............. ! ..... :.~ ............. - .. - ........................................ 2•13 . . .

Cupitolul U.lteanm-ci linale :;au Un nou inc6pUt· .... ~ .................. :.--....... 2.S5

E11gllsla SuaOI!\nJ7 ••• .; ....... ~ ..... ~ ...... -. .......... - .......................... .-..... :l5tl

llllillug.•·fl,ll e/1\efca·e••ces• ................. ~,.. ... ~ ... -·-••""''""'"'"'''"""'''!'~"'-···l-i 1

li;ltC...'tC ••·•••'"-~····• .. ••·•-••••••• ... •••,••·.~~··.•.,••"••_..._ • ..:.__to;~!·;•···-~"'·~~~··•• 2.83 Ane:tn' I. tlata lratwueutelor p&ibotcmlJ~WtiQe validate vtiittlifi~ fi instJttt:lh~nide utili.~.~~o~ ···~··· .. ~·"""t"'"''":~r~·:--··.;...,,.,,, ..... ~7 .......... ; 2lU .Anexo~~Gy.Wponc.nte.,vnlic;fole!lliin(ific · diu teln\ia psihoterillJeuticii ............. :_: •••• ,.:~~~~-~····-····--····~·: ........... - .... 314 At1e:tn 3. S~tul de insttmoellle psiltologict;.penlru ~tb;!Jfen :rti evnhlilrea COJJijlor/elevilor in vetlereu. orietdlh:ii teo fare nprobate

11riu Hotarl\rell Ouvernului Romli11iei nr. 2 l 8 din 1 Martie, 2602 ···---·-~-JII'i

10

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.Ftueword )'~(a~ ... ····. • < . •.. . •

· The story of •he·Orent. WiUud of Oz: nnd the slol}' t.Jf Runtt!e151Hl'lk.in Comruent.o; aboutscic:nee .. ..,1,>····· · • •: •·

J~art 1. JJus,h:s:o[psycbopalliololfr us.adetlcu·' · Chopter 1. Jlcfinit.lons nt~d coJ1qt!pL~Il1 cloJ;ifi~~li~•l~. U. Deftnil!luw•ef'pfi.Y£hupatij'Ji~8}F!it sci~·?: •· : ... 1.2. HeahMutti'Utn~s.•·J;••,<''3~'!•· .. •·· •. · .. ·.;··; · '"~ t3~ TJni·psycl•opatltolo~Jlst•s ·~tel$. ... .. · .. ?! ••• , :_ ''"' t.4. 11teofetica:lonet1lntiunsill pqy~bt1tmt~o,IH~;, ,~]lri~f inlrotluc-

tioo .·· ·' • o.,_;,.··.c·"';''·'" .. ,,,, ' •·

Clt~pler 2:. Structure aftti:a~e study' 2. J. Diagnosis ana clinical ~\l~luo,ripll 2.2. Clinical COllteptuatilll\i9.:t · , , 2.3. Treatment plan and if:t~euli~Jt . 1::4'. Conclusions 8ltn fqllo\v7iip .,(r h •• ,.

25. Example of& c:Qe stUd}; The cn1;c of Dnbp. . '

Pa~t:i:ra~opu~\Jtogr'~t~~,t;:t.~~~~-~,~;eas~•·~~l' Clurpl~3. Dtnsl,tials opd cHJjt~l ~~Jt·~~~t:!9~·~·P~-~ts~fted Plly-

ch~pntltology . ·t ' < • . ' .~· •• " ,:·· : • ·~~ ,;, .. : .;•:,; ···

3; C 'SignS and syn1pioms. Clbtic:uf \lreBenlation of tliejJn\iEUtt l'sycbop pntbology ~ •

3.1.l •. Problcm~l5Y.C:bopathqlol\Y has. wiiJa. di.ll;~nl W&)'s-bf conduct-• ing diagnusii; and 'clinical evaJiioiion , ... . . , ...

3.1.1.1. TI•e·fnrge nul!l~r ~r tll~E~WIIU~~~f,tQfi,t;~·!nJl;!b~'l"''dency ttl see everyday life as,vlllli~togi~!7:~~~~~~~~7~~.t~~~,.,~, : .

3.1 ~ l ~2. llte. use of obsolete p6)'cltologt~~~~~~tP5~l'11til~tS; !l~ fhe I}~ en Cntt

f I

.•

3:1.1.3. Descriptive no.:ologicnl 1Ui!gnosili versus etiopalhugeuelic nosolo~ical diagn~is. Stuck in lbe original prQjocl ·

3.1.2... Problems Psycbopnlbhlogy bas wilh different ways of conducting imerventinn and lteatment

3.1.2. L 'l'he large number of trentmenl melbods or the Labyrinth of I be Minotaur r· . . .

_3. \ .2.1. Breilches in lhi! scientific validity of the treatment Ecce Mesmer

3.1.2.3. ·Lobby nnd trn4ition agai11&t scienc:c. The eliSe of self-~teem 3.1.3. Problems P!;ycbopnthp\ogy b11s will).dlfi'e{qnt ways ot conctuct-

lng ~enrch · 3.1.3.1 .. The case of antidepressive m~icarion or 111e victory of mnr-

l::eting on science • . ; . ·' 1 • 3.1.3.2.. Tlie cuse of 1\le jiiloce\Jo effect pf How ll;l klll and kt:i!p your

luiutls clenn· · 3.1.3.1. Tho c~c of Iisycboti;CCOJ.li~. in psychosom.llics. The- victory

of. ~ishfullhinkif!g on dntn nnd Appli"Prion.fer the l(CCOnd plaec 3.1.3.4. T~e co.sc. oC lo.gical fotmc\llli!ln. in:-~icqtifio research or ll :wns

when ilcQuldnol be seen~ rodny you,sec h yet is missing . 3.1.4. Problems P:.--ychopmbology has with different wnys of conduet

i ng. educ.triou find !mining 3.1.4.1. SlntCI\Irc or the lrpil}_illg prpgrams in psycholherni)Y or Tiu'i

Ordaining _ __,. • 3.1.4·.2. Tilo challenge of pQSitive. neycboiQgy 3.1.4.3. 'l,lll challenge or pnrnprofesaionnls 3.1 AA. TI1c challen~JH;~f~!~~l'-help_ t~tmeniA 3.1.4.5. Speaking ngainsc llle clinical experience

.. ...., ~ .. ' ... .

32. His{ory ~>f lh·e·cliniCllll P•~flrariqn of d..-:: pntient_Psychoptuhology · 3:3. Pe.-sonal·and .&ocinl history of lhe pntienl ~sychopalhology

·· 3.4. Menl.{l! &.!fl.lD.li Qt' tllf: ptltienl Pli}'chop~tlmlqgy • , 3.5. R~1ts of diagno&ia and cljnicnl evaluation qf the p11tie111 ~sy-

cbqpnlh!l1ogy ·~ . ·

Ciu1p1Cf:4• ~OI!CCplUuli~nrion 0~ cli~i~aJ pcosenU:tiop Of the pl!.lienl Psycl,opalliofogy .··. · · ·... ··... .. . ... · ... ·. · .·.·. · ·· · · / . · 4.1. Specif}'.!-etlop~lhogc~~bt-mer;)lpni~ms - ..

4.~. Non-specific eriopllilhogenelic mechllf!isms or &he psycbnpnlhol~ ogy of psychopalMiogists ··

4.3. Protective factorS nntl resiliepce ·

li

4.3.\. High Ulti!Uecl~nl 1\bi\ilies of psy~l10palho\ogint:s 4 3 'l Critical sense of psyc.hnpo.ltu:.loglsts • , , •.. · , ~i.3~3~.The pressure of Henllh lnsunmce Companu:s and fht p.u.uhgm

of lhe evidence-based medicine . . .rt'l.4. G!obalittllioo m1d · interilisciplmruy sc•et:c~

Chapter 5 Trentmenl of lhe pmient Psycbopnthology . ·J • • · . . . .:-...& 'n the WR11S fi[COilllU;l·

5.1. Trentmenl for the problems encountet~ I • 1

ing diag11osis and clinical evalUation. Tile scnrcb \'or l\l.e holy frnnld . 1 S.2. TI"eanneotfor lhe problems cn~u~ll~red in "the wnys 0 . COil nr.:-

ing intervention nnd rmatment.: Holy Tnmty . . . _ . 5.3. Trentinent for the. problems encoolltered m lhe wuys: of conduct-

ing research.11le six .::omninndments . . ·. . . • . . 5.4. Treatment for the problems encmmte~ m llli: WI\'JS of cOO<IIIcl-

ing edm:ation and tn\ining. Occl\m'c razor _

·.p1wf 3 Ronilinlnn renlitles, cmu:lusions nnd discu!i!llons ;Chtipl~r 6. Clinical Psychology in R.omonia or esc11pe from the 'f,wer

or Babel. A scientificnlly grounded pntnphlet .

. Chuprer 1. Clinical psychology versus psychology tt[!plied in other

domains or Cindo!rella

Chatlli:r R. Final rei\\arks or a new beginning

. E!nglbh ~IIIUll11\rY

Bibliogrnfie{References

Appendices • . . . • . . d" • • · . Appendix 1. List qr e'lidence-bosed psychotheruptes nnd &reclJOfill

fnnJSe . . . Al'pendix 2. Evir.le~ce-tased cOill}10nems In the psychother•lpeulll:

rapport . . . · · · . . _ · · -1 ·1-._. . Append ill. 3. Set of psychologicnlmslrumenl!l usetl ro~nppnn~m-g" :' tlrenlp'upi1s for vocational gni~ance npprov:'?d h:y ~.~m.nmnn Go~emm~m o~cisiou ilo. 21 il ol' March 1•. 2002 . · .

.13

,·

. ,. • 1\. """- ·- -....

CUVANT CATRE Cfi1:TQR

Sesponeciidiferen{at)intreuu geniu ~iunhnbeci1 e!;tedi primuhre limite. PsibopatJJlogia .::a ~tiil\tii, s-nprezeutntlanive1 social prm promovurea obseslva a tm~i itu11ghd de .l>ceuit-in termenii reu~iteblr, ram {J pre:re.nt(lre.~lad\~l pn~lii n.lhui tel or. gre~elilor ~i ner~tl~itelor ei~ Ace~ til htcrate.{ vqtum) va incercn sn of~re.incontrapon~ere.o al).ordare t:tlticaa psi,bopa\Ologi.ei. Lm::rnrea prezetltaUi.aici es~ nllfeh fii,ndatipicllpelltfu peisajul lite.qtturii ~tiit)\ifice romllu~ti. dat: J'llii regaS~f! ill.eli complel :, I ma exprimii cu clarita~·ca· om .~j .. ca profesionist! .M.id prer;is sp!Js: lucrarea de· fatii este uninanJfest ~tiintifi.::.cu elemenle de pam.flet pentru o MitliiJJaRatjon(l/i.;.'l.itlpsibopatOlogie~i trebuie trata.tii ca atare. lguorj]l'ea a cestui nspectpba.~duce ln pierdereu rnesajului 'tiintifie. olluc::riiril ~i 1.a anit~ozitiiti fn\ide en $i autorul

· el. · Sper ca acestlucru s.ii nu se. inUbnple Iii ca lucrare1l. · sii fie privltiica 0 premierii jnl.£resanU1l ~i uu modelde'uttnatillliteraturn l;tiintifica. romaneasca.

Urml\nd logica hegelianli, arttebui ca teza (ln1ag\t)-en de. scenlt a psihopatologiei) !;ii aui:lte:z.u (ttce$t velum} sit ducn la sioteza (promo.varea uueipsiltopatologii valid~e :ttiintific). Vom vedea in psihopatologie, prin prisma acestei logici hegeiiene. dacli Hegel a putut lntr -adeYar sll gtiudea.scli. gdndurile lui 0-zeu de dinaintea Crea~ei, gftndire care 1-a dtts la. panioglsmuJ exprimatprbtformuln: totce e real est.e rntlouulfli totcee-rntional este real. Angajamenttil meu~tiintlfic§i epistetriologiceste unur al Rol;ionalismului Cdtic dublat de uu sceptioistn.de genul celui promovat de~coala Sceptica a lui-Py.tdton din Elis. Stml insa

IS • F ~-·

--~--------·--·---~---------·-~---- -· _ ... _

~~~~sceptic mai atipic ~i mai conslructiv. Cred en tlirie ca eel mui lllll mod de a te ap'ropia de cea mai bnna . . . .

:::::::{':"'" ~te niil~~ea crlrlc~¥i reflruri~~;.:';! !,~~~: . . . .. ll~~c ust; l'jtnO:tlfice. Critica permanenta a acesco·ra

~~·;.:::,: !:!:.";'~ l~r _:mb semoul inn-ebiirli. sno>l cliilc ea;; P .. 1lcn.rc in ·a .· . una.I~{eleger-e a fenomenului studial Din

5 .-eel ml\l mulp oameqi d c ~ · inQeUi.tonre• Iii anume ac~eA de n-~i a;a:au;ad tlU ~les ~ cale pernl.aJ!ept p1.0dalillit{ d .. ·· • · · .. ···. . 0 u~e ~· cautfind. c:ontraexemlllele.'Nu~s·l.c nfm~o~fl~m~r.e a lor.· tgnoriind "'"P ~usptle'J.nmctele de \tbde . tJ~u ~n-a cauta-exemple pentm ln o scofumiznro a-1-enlid\ 'ire •.. re r uclln~acestdemersd~ce· conViilqi·pr.intJ;:.:oigrto~a~::.-o sttlectte a datelo~ enre ne pc care~ sl.lsJinerir~ Aceastao · .. i\e~~mplelo£ lnteza generalii f}tiinti defensivi ·~· nroeriint:tf~ne lt.fac~lpemulri oameni de

· mecanls&tmldeli · ·t. · . .' . e cnrern e de performan{li· . · . ens v prototJp C!laca vrei sli . .. • d . . .· . . • pcrfonnanl!esre sa-l~ ci\ri tt . . ;. • · .. scnpt e cntedila de rigiditare'':. o clisc:utfe .·. 't~~ ·~~~ ?llmmdu-le "stereotipuri ~i este !nterpretatiide ·as;l ~e ~e :to~re_la_~;oprlile l~r ?rod use en n~c pemonal. ceen ce reflec ~r~ .. ~s'.olmitl ca ag':e~n~ttnre snn cu.prodnsul acesi:\Jin. Acesli . m.tde~fi!iea~~ropnnlmlor .. E.u .. Cl~impactlimirar.limltii'dat~~~t:~~~~.du~ 1~ produse ~tiinpfice nutudine din perspectiv R . . . u ce ~1 ~l\1-e l•e-apmdus. 0

. includem sqgestiile· via~le attna~smul~i Crit!c ne penn ire sit de.vede~remitate dintr o·a a e c~ .ed_altJ coleg~ snll puncte noi rezultat d~pill}indliniirel~ ce~t?Cnu~n slintitoas~; produsul asrJel . .. Cmdo· ~tiin{if.ic .. v~i anau:·~:: .,a c~pt. _Prln ~rismaacestui

.. en 'it. iint~ tratfi ·.d· . . ·. . . . . re~ nctllala a pszhopatologiei n -ocn·pe.1m pnci t·

paihopntolog.. P. . . . . .·•·. . ·· .· en cat·e sa prezil}[li la

r~spunde la ~;..:;:::e~~i!~::!::i ~~~a::izoi~linice ... vo~ ·· . sunptamelepacientului''; (t}Su . . . ~ . and. ~emnele ~tt lulbudil'ilor psihh::e corecre ... ;r.mod~litaple de dJ1lgnostic al lltlburarilor·psilliceefic·,•· t~?e,. Clem~?; (2lS~nttrntamcntele . . . . . ,. . en e. ~1 asociatacesteLintrebihi, sunt .

16

-.................. ...v~-.<· •.• -

psihoputologii mai fedci\i ~i ntlll sanato!ii di1\ tnlllCl de vc~.-\ere psihic 'in compum\ie.en -restul populaV.ei?; (3) Shot ce~·cetarile dio psihopatolegie riguraase? ~i ( 4} Snnt pro gramele de. form are

· ale psihopatolQgilot bine orgaoizatr)?. iar apoi, pornind de lao arimdine criticl\. coostructlva, voi prezenta -m~da\lla~i de

~orectare. noolo uru\e esm·oazul. Motivm·ea temei. Deee nm ales sii serht aceasd\ lucrurc.·?

Douli. cntegol!ii de f.actori nu-detenninat.ncensH\ dedzie. Pdu1il cttt~gerie dB facrorise refedi ln:nspgcte 11rofesionale. Adevnrnl este di a>Jeam plnnificat sll tdmin _de scris prhnul volmn de "Psillologie cftnic5. :;i psihopatologie; F.unda.n1ente 11i parrea

·.general[" dintr~Ull trntat de patru yolume. intitulat .. Trarat de psillologiecl~niclt.psihopatologie'!lipsihoteravi~". Ce m-a fi\cut

. sl\. amlin lJt1blicar-ea ncest:ui velum fli sa public 'lnll.\i aoei\sta Incrare? Sa e1tplic succiot ceea ce s-n-'indi.mplat. A!lu cllm nm spus.mai sus, nngajamentul meu ~tiintific ~i epintemo\ogic es[e unul a\ RapeoaHsrnului Critic (Poflper. 1959; I 985). care m-a ·inv~tat cii pt:intr-o htltudine criticli coostructiva futii cle prot~riih! crea\ii ~tii~ntifice roa apro~ii cnl mni bine de fenomenullJe care vreuu sii-1 stndiez.. Sigur. nu am o atitudine popperiana ortodoxn

. ci 1mn 'inti'hita pri11 nsooierea conce.pmlui de ft\lsificabilitnte celui , de vel'if.ic_abilitate-opera{ionnliz.are· (Bridgeman. 1927; 1936; · ·. Cf\rnnp. 1937) l}i flexibilizatn pdn dezvoltl\rile postpozitivisre

(Lak.£ttos, 1970-; Perehnan. 1970; Quine, 1953) !ii prin cele di!Sctiind clemente de influen(a sociaU\ in !itiintii (Rulm, 1962;

: · Feyerabend, 1911). Modul1n·oare·toate acesrea se comb ina iu ·nngajamenl1ll n1en episterna logic ~i profesionnl va fi n!liefar pe

,, par12nrsul acestai lucdhi~ Yo c6ntradic1ie ell ncest nngnjnment epistemologic.ru}a cum am spos mai sus. arn observat ca n1ulri oamen\ de ~tiiO\H: au nles o cale 1n*eH\toare in !Hji promov;l cren(iile ~din~ifice. Iii- annme aceea l,ie ale apl\ra •. cnurnod permanent ·mo&nlitliti d·e aonfirmnre i\ lor,. ignorf\ntl

' contraexemplele. Acensta ti fa_c~ d€fensivi iar acesr. stil del'cnsi v

11

--!

··-· -r·-. i

;

\

.· · .... •.· .. ·. ··.·:•.-....... :

~~nereaza produse -~tiiufifice ~i stele - "profesioJ~§ti" _ de lan~tru~oc,,J~~~ .P.,£?,r1u~e. ~~n(ifi€e pentm_ o.tJiata iuterna~qnaHt ~i .. pr~f~I~R~~~y,~voca~e-~t anveL=gur_iiintematit)nala.Acesle stele de lact11aroc SU~t .adesea fie fom-te complexnte, crezand· cii UU

· (~Ot fi :omparab.ile cu colegii lor:diu strainatate, fie"d,hnpotriva l?ru:te unportm~~e, crezand di ~tiu tobJJ~,neayand cultulvalorii ~i linut!=!lor propntsau_.a.l respectului valorii celuilalt. Uuele stele expandate de.iannaroc publica ~de.'ie~ilucrnriin ca.re mereu 1i se pare di fac dlt~ orevoiuti~-!n dqmeuiu,.revotqfie p~ insa care . . n~t Q bfl~a ~ seamii-~imeni in afar,.., celorobliga{i prin po~tia lor s~ ~ fa.ca (ex. SlUdei-.p). M,-nau sa[Untt sii lTHtl.revalulii de iarruaroc ~.t_ ~n~1 e.~te do; ~tt,'yiid in: ~tiiuta Ull s.til. on;;&t, baz;at pe con~~711tiza~-en fu~utelor P£Pprii ca om ~iiJrofesionist, pe respectul

. valonlcelmtaltllt.peo atiludinecritica ~i conslruc;.tivaasUpru n ceea ce face111. Mi-a fustdat.sa vijd ncest stil;d~fensh',in nmlte ii_ll-er~cjluni cu :uul~i prof~ion~tl ro1uaoi1 stitc<U-e m~n·surprins VJ.pe care 1-a H1ceput•ru.-a-fostgreu sii-lnccept dupa ce am pelrecut aproape trei ani Jn SIJA 1a !Vfouut Siuni School of Medi~in~. ~~New York, Ioc und~ atitudinea.onesUi, critidi ~i constructt va este tuotorul principal al calirnjli; Prin propriul ex~utplu a.m Incercar ~a sclli1ub ce,ra In- atitudinea. aCf!Btor profesioni~ti. sa promov.<;z prin cotnpoJ:ta.\uenlulmeu uu stil ~ritic ~i construcli:v, da..- se.paredi, -~Inc saschiJub ceva,IUn rett~it doarsafmi fac HOidu~·~ ~! safuu in!if«;pi1I1e~ Unit coJegt Djll IJac~te unii nu sum: capnbili sainte.lel!ga.cao aiitudiue c~Uicii asup.ra cevapoatesae~pdmeun,seiml de-apte£ierefatade ace! Ce\•a; atiLudinea cdtidi poate Scoate tqt ceoo ce este Ulai bun din _lucrul critical a~a cum {llefujrea upui <;liaJ.n;tnt uu duee la distrugef~alui ci Ia.fnfiumusetarenJui:Pm:afrazfind o ntinnatie cefg!Jdinol nu critidiln valepi ci ceca ce apre.ciem, cn~deut di are poten~inl ~i iubim! Restul nu merill:i criticanoastrli. Dinpacate

. ;;~desea n_u s-a :inteles ace.stlueru. Amorsat~e am~sle aspecte. am hot.:frfr.t di e;l'te cazut sa fac altceva: sii ex.prim acest stil a1

18

Ratioi.thlismului CtiUc iutr-o lucnu:e. Nu an1iluzii di polschhubn ce~a seuuuficativ urimbi priti acenstii Iucrnn~. du.P.maca~ po~ sa ftu consistent cu mine :jlpotsii dau :un e"trll:lPlu• de atiludme edtica .'Ji construc_tivli asnpm p.ropriul~tldo.iu~itiuae c::rc_.e~~-~i practh::ii: Psihopatologia. A~ a ca run mc~put:ceastl,l c?lal~u: terap~:utica" care poate·priu mod~lare :}1 invatnre .YJcuna!lla s~ sdtimbe ceea ce discutsul ratiOnal t1u. a. ·pt,ttut .sch1mba. Examinand Hternlura . de ·speci~lita;te din c!outeUi_.U~ psihopalologiei, am ob::Pt'!at cfi ~is; e~m;~ d~ llUttlte~lucral1 scrisedinperspe¢tivuunmRat1onaUsmCr~lic. Cel~IUa.J_mttUe lttct:ru"i arn.l:ii osjttla\ie ,.rozli.'' a psihopatulogiei, pre7.C11U\nt\ ~~ar succesete arestd discipline. Este fo\}~te.bineca arat1u.ulucn.•nt: bune. in ncel.a!ii -tbnp. ~te ins a ~i plical eli nit :;e.!n-ezint? one.r;t ~l 1" nilele ftu1dameJttale ale acesllJi domehiu .. invatan:~a li.levol\ltm i:tr-un domeuiu sefacceJ mal biue pdnl.r~o c~mhin~\ie ndecva.ta iutre ex.emple ~i cootJ,uexeruple., cau~ite :flne.teu!iite. ~r~ent_area t'elll;ilelor ~i ignol'area lintilelarduce lao dezvoltare~d._e up delu-anl eyi defem;iv a dtlmeniului. Alladar, atu-1\utat:t\t _ca sumnte de.a fi ... li. "'.-til~ .. ·aflnte_in luc. ru este__ c IIZUl_ ·. · .. $11. s. ·_c··.· rnt u.lu_ crare r.h n ma za em'"' . . . . . . . • .. .. .. . ... . • .. perspecliva critidi asuprnacestu1 dom~niu; lucr~~ care.upm sa se coustitlti~ jn gludulpracti.tt d~ elnb.t:tnu:e ~.une1 ~uctl\rtllespr~ psi11opatologil! ~i psihoternpie. Am fost i~tcur~.nt J~l nceru;~t1 optiwn~ de-apadllile re.tatlv recenle apatru lucrllti trp:~~tan~e ll1 •

litera1uia de specinlitate1 Cllre abori:leazii 4e pe pou.tu cntlcc d.omeuiul psibopatol"!giei.· Astfel, Roby~1 rd-~awes~ pro~e.wr la Carnegie-Mellon· University, n public:U . lll .199b _luct n'7a intitulatii "House of cards;· Psychology ond.p~yc~l~tbc:lap~ ~?~t

-.- .. -_.-.;

th•• care este o abordnre critidi a proctich ;,:1 cetcet:.tru m on my . . . . · . . . . . -~ ·... . ··· ·· . B 1 · dom.eniul psi~topatologiel. in ac~e~~- tii.refti~· ~~~"Y.. eu~ ~r ~~ Mark Malik de la Duke Universtty -lil en11f?m~~Umvers•t?. nu

bl. ·t.Am~ooz o Jucrarefoarte_ biuc evalu_atadere~enzoru de pu tea -~ . . . . .. . . . . . h . ... ll . . . • l"+nt care face o a\mrdn_ re c_r i_.l_i.di __ n_D.:tM_. )Jngnosttc spec1a \Ul. e, _ . . .. . . . • .·.. . . ... ·· . .

and Statistical ManualofMeutaJ Dtsordel1)"~~~~~1'lul de Dntg- ·;"§~~~ .. :; .-~.:~·~~-.

. : . . .• :- ·7-~.

:>,'unor(int~ts:e- Ji mo~~vn~i. p~s~nale. ~le r~c~~r1.9~~l~--~ ~}1m ~e pcidt~faee*i~eest~nctil'lSi~l!J1n~ ~~t,.s.~i1ll.dt~c.rni}l~,!!1etft~Pl~)gle

: ~ito~Dcll i\~lo senp'~le lltnJ~~fi(pJilbleme? f\H)n~tlwnl~~r~~,~ind · c«:a:fu.aibttfill~lltodq1~g1e~}!trlli\VIU1Sarencunoa~~ji,e~ cure o av~nYtn n'C~sf~oll"\tmt. ntrll a spune cJi este J;i pe{fecrlt Ei

birie~~inv~ca·nliiitae,g~~iflie.~lElmett'idolagie ~tiintifjce penrm . a critit:a o 'luCI11re 1lau ,n~:d~-qienil~ {irirh ,este ipocri#e (mafel su)1t a~sea ctiticaife; P,c:'~~~ept"i~Brlri valor()ase!). !O .1urirare

: z ~ :: tintii 'trelltt~ricntic~t~:~!;t!~obl~tt§le'~llpl itpontnrc; ~e ·care le · ··, · ; ..• nref.t(ltde pro6lemcla•gencti1elfttc rnete~o1ogiei ijtijntl~ce. n ltfct

· ·»j\lugem•saicrlticum I~ltbl fiecilre l~cn\re. De llse~nea, n in•·••• clU.dc:~Uenefbtf.ttc'tJe•IDerod01Mgifi4ttintlfibliaifi ,1nei lucri'iri

.. · slt;:betll.entlnib."liiliftelen.tmfo11lfii:fliir1(ifice" ~st~1utli~lincorecr :•·l •· <{~tf~.:aoesea!Se0sitlvea.zti:i,Jtttfltti slabel). fn~e~~tlnil sa evil

.• ip:~zi.a:~lctiticmde'dtagu1m-iticii,. r&abotdarea pretenmrli nici · ·~~r8'p~ihopatel$'gi~i·~~vai actlpatdoal'iJe·eroril.el~i g'r~clile

,.t;l.p!oi:\a~ ate;ac~HIJ~·I!}oi'den~u~··t'itcib~usclfud lill)i~l~ inerente. oomeniulni. limite demt•minate det.tB'$1lfii '1imitele imetodei de ~tcetae Ia care ~ihta ai1\jnns·~dizj; ·In plus.· voi bvim Cl·itici

•·.···.· . ~n.;;ml~~~~~lnep:u.~el: §tihftific~fh·~thepatologie •. chnsider.l\nd, · .::·j·~a\§~cli~,~ ~f},t~'!t ma1sus. metndaftlin~fiea.ca;~ind cen rnni · ··!f~~~1l~~d~·~~·~)l~~M!~.dinOO.le.~~iste~te~flt~~'1'~~0llsidCTt•

ttl~}~ ~'!~la§t tltt.W'"tt~~~ pmfectli-.c:Pcmtru•erltltrl nsupra de·.tl'l~rs;olui, .. ~tiinlititJ:~PfOpl\ill-!7.is-. c~ implicpt~i··~ti pe\itru . p#ii~qp~~lP:tiC.Iimte,r~!!LOOflS\llttrr~a ilnot autqrci p,~tcum1tuhn ·(l~6,~~,'li,F~.)fet.1Jb,~~,(l97S).·f>eliarece·nQi n'iilifitm·}lenrru o psiho{Jat.ol~i,e,valic!adi.§tiintifie,.;i cdflctt nonst£1 vn:fi una

•.. ,:ll~~u~it'~fiiiJ(i.fic.:Psihc;)pato1ogia.:a:fostmer~\l obiecru1unor ; ·;' ~, ~1lord~~r c.irit:e ·.maf ~1t ll~u·•nmi' putill serio~~e. 0 scutta

::Jnv~l,lati~ emplri~p!i·fnret:netu:tili71lna ori~r:nol~r de ~nutnre. · =toiirJi.n~ cia 4;i · .. (!~V~nte ·chcic;·; ''psychopathology nnd

·.' ;: psin1dos&iencet~·~au (:p'{inte acciPerlnd nceea.~ir4!Datica, ru'iltlt ·;ca exjStli rnii de:fi~iere' p~ aeeasta ternii: lnvesrigllocl nn e~aniioo

21

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IeprezetltaLiv de l OO.de as.J:(el decone.>c.huu din caleva mii obtinute pi·iu motorul de. cilu~are ··ooo.CLE'". DJ\l aflat ca doar apw~,~~~at!;!,~!;;~.J!~~'!~IJ~lilj;.s~~e,.~a~p~"~~"~tiit(; " restl}lJ~i!i~~Etlt,~~i;).~.~fu.£1,~~te,;· p~~i'-"W~ll~1te• .S:att tottfple.t: u~edo~e:,.¥:~1,.~1~~~ ~tfrl.g~~;~a,t~Un4~tY.oium,,o[erlud o . ubordar~.frilic,~ (Uifel~~~~~.&if,.tJ.pc~i!GIJ;:YWeJJl~;eon.stJ;llc-.

. live pen~ru progresuliJl.dcmu:miq.Jlplll~. v9itla posibilimtea . , . : r. :·· ... . . " .. • ·. . . f.>· • • . . ..

celor~aJr:nu s.tilit de ~S9.@~ ~;~C.U·~~t tex~si:lti e:lprime · plHlc~et~\de v~derf~.r&Wn~~~ \~ii~:.in,~i~ta, al:catcied,itor suut: ftg~~ntl1PurJ.la1.o.f..~Wti~~r.B~aviQ~~ P~fcho~lerapie~/Rt;v~sta )i~~I!l. de Psibokehpii ©~gititive.,f Con~.eo~1fUtet~tale (IlttR;f/~~~p~pb,otbentpy:llll)• , . . . :

lVlollnlltnten 1\e.-~t).ot:dnr&.l\i9daliliat.ea•de • alloniaa:~ a . ·I ' . . . . . .. . .. ·. : 'r•;:-• h".

tel}\~ a~tei :lusr~i -va n 1Wl.ll1:11C01Ji~liltita.:·~ai Pf~~~ ~pys. . ''pacjeutt~r···~;u:e ya:fi qnaUut pepa.rcurstiKn008teUtilif~ va fi

tqqm,ai ps~Jiopatolegmii!IP fliOdalifi.\~i dt; :nb{j~~ ~~,~~~ta. toctJliti. iilliLJeb::u,ipipgia .u;tilii:atltinlp~pa~ltigie'c~~·~~~m

de-a fo,ce pu:QD ptl.~Zieat:Q.d~varat ;' 'tiU1anZt1 clniici'O,:~. #~ -. G~t\ cl\ ~itea.s~il nbord:u:e;iq.,~tiip!Iate con~tbuilr~; . 'i ••. .. ·

•. . .•-0 .~ni Q.!lnli, cao¥iep~ a:litllitelilr d,oJI1al~i~lill prio reliefaJ:el;\:.~lerpf!nte,_lor de nernu.:l.itate {'tiinti}' fii ancl'rnUl1j~te (p~et,tdo~ti~ltt~)din fl:atiiul a.ceswia; ...... ·. . ... . .. . . . •. • .

• 0 re,ceptat-ershnukat1ii a\lllmstY.Yl~a.¢Str.il~~ihi w ~pul de pr.oft;SiQtti~ti,~i,pampf9fa~oniv~.a~t P!ibbp!l{qlo~i. <tlW§i -uuli pC\nt!ls;)fe8iom~~'tit1tiblic:hlhlrgtiin~rliJniM~~Jl.~~~a 1ulo&ita aidl Astf(d;.v.silxepatplogji o utiliz~~tn·n~cti~.,.~ntl ittrpa.r~rofesioui~,lii :;ipublicullar.g ap.aiii.it deeil pin~clkti~i nuu.e sau.tuti.i .autrait-o ~t.. · · . . · ·

.Psill'1~atof0gia es,te';dennititaici.~t~·d1'Ip-euiU1f~~ijltta~.g!!~;r,~ !JGUpli ue\stutQuhU;qcll;lltifiJJ car~eJrif!~~azo~ ~V9,1~ut('~i setemlina tiolile·psibice. Malmultecat¢gorii depr9i~opi§.ti suntitripliti~leJn ac.es~.dom'rnil,l..ceimW:i11JpQrt<l\lti~~~l,lJar:.,~i ~ (t nditie .ftjJulilsiltologii,clipicte)ti ~i p:!_jhialiii-~~aclar,fell()Jll6l1ele

22.

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cnd\ul c~JpJiolu}ui respecri v. B ibliografia ~i anexele vor 1ncheia nc~asta lutrm'e.

-E\\· apr.eciez c.n fiind co.ntri\>utii originale ale ac~teHucdhi urni~toarelei - _

. '."f~t~~.fintTe put!ne!e abordari critice ale \)Sihopatologiei dm peasrutllltti!n\tudi romane~ti.

o Orilizea7,it o modalirare origin alii de \·eliefare a t)roble~nelor psihopatologiei. trntl\na Psihopatologia ca pe un pacient

. m ca~h~lunei an~li.ze ~;:lin ice de ca~ _ . ... . . ·• lncea!~lt sa· f~p~·clar 0 disti~otie intra "descrlere" .lji m~e.rpr.etare· .. 'OescrJenle se ba':lt;aw-pe date dinliteratura de

. specia\itute lar interpnstll'ile pe care le faoem aceston:hite- flidi a av~a _pret,enpa f<ii snnt singttrsle poail>ile;, ~ .·voT fi meaeu nrg\llllentare in cadr.ulunui diseurs teoretio .!!8ll:prnctic.

•ln CP!Jlparatic cu lu~rli{i stmilary pi'Czent{ltc 'in Uteratura de 'PFialitate intema(ionaUi(ptttine [a numl\r). Iucrarea de-fn{a

ndu.~~ cflteva ~~~l!:~cte . ooi. ca urrnare .a 1:1tjnnlirli laola1tl1 1o . c~pttolela noestei c~r.ti t\ unor inforrnnpi prezentate in articole dtsp~mte,_ ~rr_icol~ id~ntificat~,pijn analiia pwprie a bnze1or de dntemterotl(l?naleMEDlJNE ~i "?.SYCHINFO: · · p Evatua,pn efielenl-el prqgral'llelor de farmare in p!ilho-fernpte.; •

a A~pecte ~feriUHtre la psihapncologia psihopatoiogilor. l?~lgur.,Jucrnreaonr~liilimire,limitepeea~lementionez

tn co~tmq,nrc:··'llJteeas~a secpune ~e:cuvant ciitrecititar. pennu 1\ ofen aqest.pul.~portnmtaten de a ave a el tnsu~i o ntimdine ~ritica a.~npm P.IJ:~~z~nl'e1lucrari. ·f • : . ... .. ..J~ _anumire segnient~ ale teJtului lu{!nu·e~ cere mtllte prereo~tZJ~e COJ1Qt;p~uqle ii de specialitate de la oititor. astfel cit nu es~e ~n te:tt~or.1n p~us. Nte:lentm'ea SllCcintli fii punctuaUi a !t~o_r tdet, uneoti fiirii dotalii lj~ficiente l'efetitoare la_constn\ctele utJ)~~te •. p.~ate .c~~~ citltomlui difi~ultati in a in{elege lnlele nspecte care IWfC~itJ..p_uno~tinte cu carncter mni general. Ynct!rc

sa co~pet\sexz. aeesrelimitari ~and meren, acolo undee~re_ eraul: ttimiteri pentru nmi m\llte detalii lo.literamra d~ spe_:mhtflte_~~ folrisind uneorl un limbaj rnii :Col'ocvinl. Fo1osuea m anum1Le.·

. sectiuniale lucrl\rii a unut \imbRj et;llbcvial nu 1nseml"ma 1n~a nictdecum Tenun~reu ll.l rigoat-e•l~tiintifidi n cr~ntinu~ului ~

;.: • Uneori textnl vn iintroduce anumite cuvilife noi·cme se rcferii ln wncepte importantc din liter:iturn de specialitate dar cafe 11\\ fi.U 1nc1\ un corespondenr genet·a{ t\CCepmtin limht\ roroana. Desi voi evica s~ fac acest lucru, neola unde totU!li voi fi l1evoit sa i~rroduccuvinte noi. voi incercnsli le p1;e2inr elm· !li · patcis. Gu toate ncesten. cititorul s-n~rmtea nfln·'in· situntin sa nu ~nt~lef!gli seml)ificapt\ unor tenneni fii sn~fie nevoir !>il commlte litciraturii suplimcntnrli. ceea ce neeesidi timp ~i efort.

• CGl~.n1ai multe date pe baza caroril tmi fundrunenrez. lucrrarellsunc din conrexntl cercetarii americane !ji vest ~europe~tc 'i~don1e,~in, astful eli ele .s-lwputea sa nu se potd'lleasdi ll'lodului inJ~riL'l! npa,re psihopatologin 'in ~He c.ontexte specifice. Tinilnd tnsl1 cont ~e faptul di· t\spectele generale ale d.omenjului sunt aptoximnt~ tn principal de acf!ste doui1 contexte, cO'Otexte cu o fort~ ~tiio{ificl1 ~i ecouomid. deosebitli (vezi spr~ exemplu utilizaren pe scarii largl a DSM). credtotu$i ell generstlizt\t-el\ lor e&te celpupninfonnacivli fii pentru i!lte conle>:.re mui specifi~.:e. in; plus, voi prezentn 1ul capitol sepurnt 'jn care una din· .

·· c#mpo11enrelo psihopatologiei. p_sil1ologi.a clinic~ este discumtn

SJ?.ecific In conrcxt'fdmanesc. . •-·; '* Anumite inteTpretiid ale datelor pre.zenrare aid, deJii

atgumenmte. nr putea sa nu fie· singurele existent~. L11s ilsrfel cititomlui posihilitatea de. a face propriile iuterpret~ri.

In iocbeiece doTeSC siimentione7. ca. peOh"\.\ a fi congruent C~l fllOda{iUl(ea inediti\ de nbordare a remci. ~i ljmbl\illl Utillzflt

vafi in anumite segmenre mai dit'icile ale textului unul colocvhll si adesea la persoana intni s1ngnlnr. exprirnllnd i.n\erognti1k :;i indoielile pel'Silnnle n~a cum a par in fiuxul gfi11dirii, fl'lrilit face

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~ prelucrare formaHi a ]or. in conse~jnta. distincli~ .. dhtlre 0~.utext~~;~e~g.?~eririiu !li ''contexlulprezentliriiei'; est€i-;ni~d

putlllln_m~anta m aceasUi lucrare ~are adesea _ .. _., te- ·sct'1' .; ~ · _-t- · rb-'1' u~ _...., samr-un un aJ ( etnterfa~amtre unul ~tiinfific ~i unul del)tipul · ·· · S t '{ ~:~nzarea ~~untet. p~r c~ acest lucru nu·. va du.ce la o singulm:izare n dtscur.suh.Jt c1 dimpotriva Ia impJJcarea in text atat a

profesioni~tilordi t~ia parnprofesloui~tiLor ~ i·n p~~licului larg.

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.. -_P-REFACE ...

. lt is said that the dlireretlce bet:Wl!en a geniuiruWl'aniinbe

cHe is;tha~ lhe ftJmter haslhuitaitl6us. PsY.<!hopaU;.ology M sci~ ence made nn appeanmce a£ the gaclallevel by prontotiilg it.; . successes, ,.vltl\but honf!stly ll.nd cl~ndy displajlug i\slimito;. mls~es a.ndfailure8.This p~per offers .JJs ciounte~t!lgti tt ctlt1.~ col· approach to J?!iY~bop.aU1oiogy .. '11tufi,• it: is highly~\'tilusimJ and atypical for tlt~·eJtisting Ron1tti1iau sci:CnGfit!liU:rat~t·e. J n other words, ·tlu! presentpaper l.s ~ st!iett'tific'JlJ;anjfesto, COlltaining elemt!bts of pany_:~~let foi·ll Nlinbna ftatiohali~ 1n p~ycbopiJthoiogy. and mustbe c~rtsidered as suc!Ii. My sdenlilic a(ld epislemolQgical COllllttitmelitis'Critidtl RalibuaUsu1,' combined with·a Skepl:icisin lik:e·the eue'promoted. bytlit! ~kepli.cal School ofPyrrhon ofElis;- yet, I am a riiore·ntyiUcat aud:tonstructive skeptic. I strongly believe lhatthe bestwa}' lo approximate the optimal perspective on a certain phenomenon is by adopting R critical and ref1e:;dve a~tituue about your OWll scjelt,~ tific methods and rest.ilts;pennaneully criticizing, challenging and questioning U1em is the way toward lbe best uuderstatld~ng of the studied phenomenon. Unfortunately. most scieutists chose a deceitful path, Ibat ofprote.cting lherr resul.ls, perman~ntly looking for ways to confinn them, ignoringcounterex<mtpll!S- This makes them defensive and threatened by petfonnmce srum.lards~ jf one w~ts lo escape the performance standards.;· the prototypical defensive mechanism is caricaturi4iug by caUing them .. stereotypes aud rigidity", A critical discussionab9u~the.ir re~ sul~s-is interpreted by. th~e "'profe:Jsloimls" as~aggi·~ssiveness

27

or personal offense. whicll refle~ts the identification of their ego with il"s -results. These attitudes lend to scientific results of lhuited impact, lim irs set hy the producer's ego. An attitude fron) the p_erspective of Critical Jlationalism nllows m: to include vinble.suggestfons ·from cullttagtle~ a.n~t other points of view emerged from a-healthy self-criticism, maldng the results thus obtained go beyond f11e limiU. nf their producer.l will furtl1er nnnlyze th~ p~ent stlltfi:pfpsycllopatholPgy. throllgh this "Scient~fic-Cre4() ... trel}liPg\tl!~ a p_atient seeking the belp of a psycltopathologist. ':fhroughout tb"-pa~r..,.. "1he clinici}l nnaly~ sis•:- ~pan lll)lll~J:l~the:·signs am! sy.mpt.oms ot ~J_c patient", I wtU try. to.an$Wer t~c next,nuestion&: (1) fs .tbe diagnQsis .of

__ ment~l~isorde~ scif?UtificallY.Sopport~ and efficient'J;(2) Are rhe (re~tmentsfprmepral disqrders efficjp~t at~Jevidence=-basep'i. ll1ld lll~onnecti,;m totblSjCJll~tlon,arepsychopat!\Ologists hap}ller a~r,l mentallYJlealth~(JJ::I:hnn tile rest afthc population?: (3) Js the r~SC(l.rch iu psychopnlhology rigorO\)S? and (4) Are (he trai_Ili1lg. prOgJ:f'lmS for psychopatnhlagists ·well-organized and evid~9e~bt\sed? Theq, startiqg with a qo'!)structive criticism, I W1U preSC{\t W}lfffCVCf the Cl)SC suggestlo~ for conoection JlQQ impro:vemel~L ·

.,

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POVES'l'EAMARELUIVRknTOllDIN oz ~~A LlJI.R"QMPELSTIT.TSI\JN

Marele Vrlijitor din -91- a rem;it sa.i.nwt·e.sioneze pe toura lumea .. Vrl.ijitoarele din c~lelalte tinutnri se temeau de el ~i de fo,·{a h.ii tcribila. Onmenii .din tinutu1 srio lji din Onl-!lul clc Smnrald nnde; lo~uia vrl\jitorisl, iJ JiESj}el;:tflO en teamli. Nll eru.lncru pe cnreVriijironl din Oz sa nu poaUtsl'i n faclt Ern eel mal mnre :;i mai putemic vdl.jitorl Inrl\ insl'i ca. in rimp ce printr-o prctinsti prezentii nevnzmli r~r demonsria for{a r~ribilli 'i'nrr-o incapere in· care se nfl.a Llll,grup de. vizitn~od venit~.f!n il implore sa-i ajute, Toto. cfiinele unei felite numite Doro~hy, smu\ge perd.:a'-m c11re ncqperea tm col~ dintt-o 1ndipere. Acolo, mirati. vizirnrurii nu vihntun on~ulet. Tmbiitr8nit, mi_c-lii sperint:

•• ... E!u sunt morele Jil fngro:thon1! Oz", n.spuli omllk\ul t.:U o vu.:e tremualinda, &}lenind io(:li sli impresloneze. Vib:fl.nd insii cl\ 11 f0111 d~cup.:.

. til, a contlnu11l: "VIi rog, sii m1-mi fnceti i'iiu. P11c. orice spune~i voL."

Marele Vdijitor db1 Oz ern de faptun om nbif;nuiL TCJ::Hit vrajirQtiile lui erau iltl7.ii ~i ~:rn-curi. El era de fnpt un fosr arrist de eire care distra onmenii zbu.l'lind- cu llll balon. LEI o .asrfel de ,·et~rezenmtie. un vfinl putemic l~n dus fntr-o a!ll:i lome .. Oameni i din acea 1ume v~2andu-lzburtind in balmt, 1-au crezur vrajiror. L~i i..,a plilcut :rcest]ucru. 11~a ca ~i-a intri\l tn 1·ol. J-a pu~ pe loctliforii acelui iinut sa~i conslrlliasca mrpallll de unde-li ilnzi~na -en mid rr~curi ~i ~mecherii". Spre exemplu~ Om~ul de Smnmld pn era chiar ve .. de. O:tmenii n·vedeau a~n deoarece

29

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Vrlijitotul iu~a-e.ra de neitumit! ju,cen de-a treiazi, ~;~enals~r IJ:inlJ~. ~e J~pa~te~jt'u¥,~~>~~~~u,te,tiUJne~•·tei; ii·p~~~~r~~ ~~i~~~ frt.C~\l~Pqtlt!~P t:t~~.~~ . .;t;¥lb.utu:u.0Mt11~t~ilttlnH:are-. cnul:.fl:' ' ·. . . . . .. ' . .. • ,,

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" ... den.r prince l c.ume ft·otn you ••

noue cau guess, none can .dnin• · .. ..,.

that Rumpeletill:;kin is n•y name.~··

••. vui ve.ni .!lli iau ci:-i '' tm:u . tnliine .....

• ciici nilncni .Jt.u ponte ghici. nimenl 110 poRt~ fli

cli RunttJe:b;lills1d.n ml 11c spune..:•

Lq_aqzul~cestei Ve§Li inipiiriiteasa s-a~U(l]PJUtd~bucu.de. Cand vriljitorul a venit n treill zi i~upft.dltettsn 1-a :~pus.uumefe: · Rumpebtiltskin.ln ncelmometlt vdijitotulr$i-a pierdu;ttualii forht mitleficfi. §i influenpt asupra.reginel. Pe fapt~ era atiU. de fudo~ C<1 aceasta i-a descopo.rit nuntele im.·.it a iutratto pamant ..

Ca in1paratea,sa din pgyeste. fi psi!mpatologia aiaculJ1 .tnUllimedepmmb>iruy t!§.samle~a ujtat . .Ea a p1iORDS prO!ilOVafea iJniii demers in care serviciiJ'e oferile populatiei &5. fie fundamentale ~Liin{lflc; .a promis sit punli ·,tiintn inaintea iotereselor! Ignorate, acestepronusiunl se hatorciJ~lpoy·ivu ei •• Povestea fratilor Orimm m:atl insii. eli. uoeoli, num.lnd>dlul e"'pUcit, · problemele creoLe de ncesla se pot reml)!a. mut ·uw~ Aceasta voi tncerca sn fac ~i ett in cazul psibopfJ.lt}lo~Jei pe parcursullucrilii. .

A:;;adar! lucJn£e& va fi :;.i.nJilara:uuei c;i.Ulilorii inlumea 0~ pentru ·a-l iotillni pe MareleV:riijitor., a b:age perdeaua 'Ji n.numi raul. Voi incerca astfe1.sa elimlu iluzill.e. Cllfe exisUi in jurul

· psiftopato{ogi.ei ca ~tiinti. sa VUd ce Se O.SCWlde.-dupt{ perdea~ ·.din colo de imaginea de ~tiinta rigutoasa '§i putemidi pe care ~i-n construit-o Ia ~tivel ~mcial Sper d\ uumin" diul diu ;;~cest domeniu, acesla Sa i§i piardi illflUellta JUaleflca, Wlf.l CUJll ~i~a pierdut-o ~i Rumpelstiltsldn. Sperde as.eme1teu di, la fel cu fustul

31 ·~ ..

~ar~ Vrltj!tor-· ~iu Oz. psiiwpatolagia v~ fi mnitumita en tmngmen ~~ !eala. care va reielihfin analiza prezentei luci,". . . cnre este ma. plilcuta. in opioia mea, decat imaginea ei de s:e~~~

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COMENT A.Rll DESPRE STllNTA I I

0 ubordare criGdhmupni psihopntolcrgiei ca ~tiintn neces.ira clarifica1ea preulabilli n coristnlctulul de Jiliintfi. Flidl n imru detalintin llSpecte defilosofie a .$riint~i ~ide episten1ologie (pentn.l dera!Jivczi Greenwood,. t 989; 1'oulmin, l953), -voi prc2.j!nf.ll '111

. conlinoare aspectelc cele mai rel'evante f\;>Upra demcrsr.lui !itilntific. A~aUar., ce. 'insean"lnii o n'bordare ~tiint.ifidi tnrr-uo donieniu? tn primul rlind rrebuie spus c1i $liintaNU l'nlietmmii cunO•lStere adunntii tn sisremJ. cur/i aaesea se nfirm~ "in uncle Jucraride $pecialitme. Daci\ am concepe asti'el .!]tiint;1. ~~ l'i sinucidcre pentru noi. ca onmeni de !j;tiinta. intr~t> n*fel de per!qlecLiva,.nu ampnteaJatefarli et'iri'cilorcare at1rmn di un fenomennueste~tih)tific deonrece nu avem in·acest mo.menL curio§tirtte necesar.e predicpei Iii controlului lui .~i in coosecinfi'i, fenomenul_trehuie a};1ordat p1in strafegii a1temttrive !}tiintci. ~;Qinta este un proceso' tste o mbda1irate metoddlog1cll de aburdar~ a.nnul·fenomen 1;are duce In cunoasrere ru.1uoad\ 1n siJtenl. A~adar. chinl' dabl\ nu nvem initial cuno;tin tele oeecsmi: ui1ei nbo~ditd !}tiiJlt:Hiice asupra· unui :feriofllen. nceftSra nu insearrm~ ~a fenatnemilrespecov nu poare ft1ce ol-,iectul desmdiu oJ,~tiintei.Dacn. inptineipju. el pdate fi abon..lntprin mijloace specifice ;'itiinrr;i atunci este un f~nomen filiintific; o ~stfel de abordnrc }lOl\te avei\'foc ulterior. dnci1 fenomenul este i nreresnm.

tu ~liiotn. seJace () djstinctie c~rli mrre asump{ii. teor!i ~ii modele senck ·i Kenrre,199ll).

• Asru1lpfiilc. Asumptf e suntlde'i funclamenrale care sum acceptate ca fiind adevan1te de~i ele nu se pot resta direcr em,

33

.. . ;

: '

': :

~ .. !

! .

. ~ ·.: ~ ..

plric·:imiles~rea }t_?r eitefoarte dificilii, d~i p~s.il)lla in prJ!Icipiu • .Elei (e~. ,.~~.~!1JJ~tHfa decermlnisumlu~. a~\~l11pJi~ .. fcni~c;perU: " . psillictdut:_ifina!l ~a sistemd~prelttc11're·~.t~tuiili~~e1 etc.), (Qrm~a~a.preulabilul filortofic alod~ilrei mclQqede Gl!ttetare · ~m~\t·i fip~ J?n(J.~mer,. ;1'973)'~. ~al~a~~lor e.~~1~4e~~_pragtnaJiF·· D!lt:IJ,nsumptille · aa• consecmte PP71lt!Ye .(~X::. ~Juti Ia. generaren de leorii, modele 4i tehnolo~ii.e.Q#ietire):o.tuncisuut buuej~l.valoFqa~~; d~t!li nu'O:eteonsec~n~~.ItP~i~~-~ •. ~~~~e~ stmt fitt;lt~al[l{lf~·~i ;probnbil en intin.lp ~ntqhilll~a. itiintifi~a va r~R#JrJ~;-~e; · ···· . r~ ... . ~.': .· · : . ·· · .,.c. ·. :' ...

•·! l;eQ.riik. Teor.ill.e.Jitiii~[ifl~e s~q~tfa,~I~~d:iJ5l.det.iv-e din . a~unm~ii~.earepotft~~te-~IYP~p:rr~WJ.~.~e;aQ~tYalt:~aiealor de.,aq~v.aq. a~~d~i"t' ~e&~l'~ .fl)e~·d~,~#te~ 'R!!flle ~acli este ~tdev&fatitsa\i fntsit' ~is~~~~ #faf~,~~; ~!~.~lWt.ta~ceewce este •

.Jttt -~le1 sau.di·ceea ·ce nit, ~te; ~~~~·. cQns.tif.U:ie,u.,teede:"fr4sii; o : : ".. :,.··:. ,;._r.:·::t::·:~::-->,·'"-{;;;,;~(·,·.-" •''~.-' '•;- · .. - ·--_- '·'

.teode ~ste. ,ade"arata cl~iits~.l!l;!e;~~ ."~~e;g=a:®este+~j ca nu £Ste c~ea·ee uu es.t~fi~·¥atsrow~·~p"s.:o.Lt;aFie'~ate mfe\iaralli citld;c~ero~e'~U:£ti~~~-'£?~~~$:Qlkdatcle de•oas~[1r~e ti este fttlsii ,c6.od IlU C:~~Ul 0 ~SeJJ:l~R~a C:Oll;SpOUtf6fi~reoriile. suntsistelUe orglm1iatc:.d~ cons~e~j tiiud nsU"eclfd~te din

I ... ·-- ;: .. -':\. :;'~_Z,->t:'i,·'· .. - /-· - "· · ~ . _. _ '''< -.. ··,·.-,-··o,;-~/_;~ Pr(Jf1Ciu~i: Fu.nc.tiif.eupei_teqfii,.~t.tn.~;(l)'functiad¥8edp~~~ {se descr.ie\ un f~n~ltJ,~q); .(2) fl\l1e,tia ·~;c.p!ieat.fvti''(*'~~ll~~~, uu fenomepJ;'_(3),'~·~Y~~.~~!:t~l;·;{s~~faep~~i~ti~~~fij\~unui feitorn~n) 'l(4)f~~~~df;~!J~I:e.tmt~{seergatu~~tof!lhtatea iof-onnafillot.ttsllprn·it.nn!(eno~en,lrltF-&srmeru~~~erf@.

•.L1{oa,elet~~,~l?Ji~~~ .. QJil~iteerii..'ft~ofificel~~ll.~az bine ·cJelhuitu~~a~1ao·~~~~fie ~tJtg~ lllO:~fe~\:i.W,tifice. iu pmc11fn $tiintific~ ~ illtthllpm.~d-en moiieil.tJ. sa fie ~es- . coperit ptimut iar ~Eqf:,a s~d~volte rg:t~.urie pdu·gene~pirea •uodelul_. Ji l~ufuli tJ;J.~te ~~~~i sit:uatit Oncum. •..dl~fta rliinaue

~--t::· ···-:: \ ,- _· ~-- - .· _.,. - .-- -- ._.:;,,·,:,·-,:·-<'-.~~:;.',; aceea~i:1rpo~el~te.t~~ pattiru.[aral·t~Fi~ihdiferent ~are uiu cdc QOUa t;:OU~ponente:sedezvokit pru:tia. . . . I ·.. . .. . •

34

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(euinpte, 18~~o).:P~~~xoJL~t ipc~~o·~~1•118f~ estcf ijco~{a ... · . . . ··~· :.l,l~1.>:'~i\-)~ri,. )Jll0Jl&;Diliti'f'e•1

sisLentatizat --~~.a .de:tW.I)lbt~ 1~Ptt~<\J\J,:~mle tiel

:~Locke; B~dtel,ey. "tq. _:_.,. .• '~-~ -'~-~ ~lt"'·'•"'.;-4~ alii~s~;tilfu:tt!~0f tum5unt ... . . ..... · . •. ··• .· _· .. ·•·. , •.

. sisremall~t\t~i ~ de~~Q\t~t rm~tivisnrol sl•nholi~e: T~pnenulde pgzUiv llli ·· • .

. . ~ ul"'·ti·,,,.rui· pon __ .tiv inseanma ~adar.mteme&nt pe este opus spec ~ .. .,.. • .. . ·

35

' l

. f~l(.lte s.tiin{iflce, -pe date empirice. Termenul d~ .empiric ate in \ lunba romiina AcademiaRon:lllna,l9g6) o sen1otftcatiediferit.'i \ de eea folotitii in ~tiiMfi- 11 l1mba r_omana ~l se ref era a esea la

· rer__ce~~\ n~s~sre.rontice.. ha2nre pe experienta dfl viata. in timtl · ce m §titn(:llit filosofia ~tiin{ei t~rmctnul se referii adesca ln dnre ~erv,n{ie"sistematica en lese prin metode 1;guronse ~i care ad?Sea as~~rJi genem1itnte11 conclu-djlorformnlnte 1.,e bu7J\ lor, sensul ~tthnttfic·al tcrmenului de :empiric este eel pe· cure ilvoi .utiliza 'i'ti ncenstli lucuwe. -~adnr. suport empiric 1nseilmna in ~r.:eltstli lucra~ .. intem~in~ ~t:iintific. PozitivismoUogic apl1mtin

· JUL"Ll~ ~~eulut de la y1ena {aarereu_nea autori _precum Camap, Schl1q.k) fa~e partedm~-:un grop .de ~ol!>li reunite-sub numele de fi~.o.sofie.-an~litica (M"ar_ga,l9S8)~ ~~~te:~coli ntilizeaz3 anidizn. ·I (ad~~n 1o~co-matemstic:tt)pentt.~ « clarifica teoriiJe coustn.1ih~ de ~tun{.lt us!lpra :fenomeoid.or~are fac obieclllllor. Po1.itivismlll ~~~tc reprezintii cehirai clar Iii tigt1ros aaiimstatradi{ie, As a cum Sagmund ~reud prin sisremul ~rent de el- psillanaliza -·a avut

. _. ~olu~ dtHl mflucn~n dez.~oltar~le ulterio~i:e in psihoternpie { cnre n~esen s-~u ~&~olrarpr~qtr-o atjrudlne Pro sau Con{!"a· Sigmund F~ud), po:tilJ-VJSapullogrc ainfluen{Rt noiJe·qezvoltlhi infilosofia :;tuntei·<laL'e s,-au rnportnt permanent la el tn 1e1·meni de Pro snn ~onfJa. Pozitivi~mt~~ ~o~i-& .este, l)"\etnforic spus, lm Sigmnnd t fell~ ai filosofie1 ~tuntet. S~tetit- prezentat. pozitivismu..!JQIDc

. C'lmudcdi eli demersul !ltiintific presup_llne nnnatonliea secven{ll: . • Obs~area..unni fanomen: -~

. . • Pe_ haza.·datelor~~ obsefl'npe (ex!srent~sau prod use prin i mti':tvent•anmu}ui de ~~mpt) seelnbareaia reortile !ltiintifice bine I scm~~l!-ate le>g~~· ~ttuctura lor lagici'i tor~spuoz.ind stmcturli {

~:bt~~~· In p07.lttv:smul ~lasic se cons idem ciifi.mc~a explicmiva \ . eorot ~r nu sere~edi lao expl.icatie gene£ativa. c;acinu pntem

~unoa~~e ~a~ra. adevilrata a 1ucrurilor prin care ·acescea Jnflu~~t~mti'i. ~lte lucruri: Noi incepem eunoa~teren de fa

propoutnl~ de.obsenmlie care :ja sunt altceva declit realil&tea \

in si~e.(desigur, de upro~timea:zi\.r.el\lltnrea, d<\l" no ~un1 tC:'Iilt~le~ sunt ceJJJ!IWcfii d~e£ipt.ivealo..aceliteia). Dacli.t~ona exphc~u.'va bl;\-z~t! IJe date empiiike esre ~onwi ennsidernt~ a fi una ge~e.l'nlwi\, atuoci.vorbim despre doetl·inn l'enlismnlui (Greenwood. \ 91~9·, Puli1am. \ 9&11- •· . . · : HJementll\ l'uo.dame.ntnl al abor ~· ii oziri_vhtre _{:~ 1

:1\

filoso·fici Mali tire 'in.gt'incral) e5te c.Qnce u.itde ven-ficablh,ti~~Ce .. •1seumt~ acest1ueru'l n pdmu\.llflnt\!r.ht~orie (~ropoz1:ule mol~culnre.) este verificabiln dacit ea -ponte f1 ~edusa -~~~ (d~coml'\lSii to) prO[JOd(ii de obsen~ntiel!'rotocohm: (prO~l:::?J~II

. nron"lt\re). Propo?.i\'i,ile de observatie SUO[ ace1e p_ropozttl\ n\e c.ator va\ori da alftevl'u:.s~ s(abilesc:confmnr.'ind du-ecL e~untul prOpo:z.i\iei ctl datele perceptive-(ol:lseii!Vl\Ut directsilll cu uJtU~r~l\ upor tilboologii (ex.. microsoop)1; spre e.xemplu. pro~~:cl{Hl ''A.ceasdltnbUi nre culoare~\ .fll!ttgri\ .. es£e o p-rollO?.t~le d.:: observatjs:o. A ~duce e i:earia ht propontii.d~ observa\ie ~ns:ullll)ll n d~riva qin ea toate propozitiile de.abstiPii.l{ie din con.1hn1aren d\rora rezulmteoria. Oat! acoste prlilpozi\ii de observu~iesum adtwlirate lmulci tamia _a-ste ·adevnmrit; duclt pro!1oli~i~~e de observntie sunt false ntm'lci te~n·ia ecta.falsii. Uneort varrfacm·~a

. este posibiH\ .doar in principi\.\. ca atuoci d\nd -~'~mun~l cle -prog!)z.itii de observntie G!lte pr6n .wu\fo-•:peot~:u a·t1ll~nve.'>U£.lltt\ fiBcare l'll pnde sau dlnd nu av01n .lncn tehnologln·Jneee~ur~ imre&tigiicii,.propfi2.i(iilo.r de obSaJ:\lDli~.{ex. mulre pre(h.ct\1 nstrOllomice m.1 a.u -putut fi vet"ificate inninre de desnopenr~a relescopului). in aeost GR:Z.. concluzin ~tiil'lt\licli est~ una probilbl H\ dar care ponte i11 pdncipiu.sii se trnnsfonn& 'in leguare l)e ·m:I~nri\ ce.uulcgem date:re.feriroare-lb.:toarn }ilr~poo.i{ii \e cl(} obtterviltl~ h1 care se ruduce teoria stn.t .pe ma.s.\"trl\ dez.vcltari\()r ~hno\ogu:e care ex\ind sin\\Ufi\e prQptii (eK. re}eSGOpU1;01lSCl"OSI!0~1~~\elC.). Deasemenea. confe:n:m fil~sofiei anlllitice; t:onre -propoz1tnle care constituie lemia trcbuiesii respacte.silitaxn. logidi., strut:rum logidi i\ ae~s1orn nru·pximfind structurn t1\nnii tf~;\\e. Spn~ cxr:mpln.

J7

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. ...... ~' .. -:: ... ·.: .. ...... •.•;,

~···

PfOlfOZitia ··va~ti~l David. este lllUlla~ pdut. n.uu esl~ f~.lsl .ea est~jfiir~J~~!!,~;~~§arece ·nu tesp~cta siltt~~aJ{niicli .. (etiritrirm· ;:~_:: siJ_'_t.1'ei logicei Daniel David nu ~re prog~~~tiq:.~~.iiii,~1uiir

. .'pr~lJ. ~tplus fata de al~-rc~¥ ~~_tr~~lie,i~~!l~~~{~i~~~111uJ logtc$l .. uss~l• .196~} ~~ a ~ezy9lt~f pces~~l;J,,~it~Jj~lein. J953~].·pezJttvUJmuHogiccete.cat(Jf1Le~or.s~1fcU,J.efalru,itetu

. elnbej:areaune.i ~rli'Y~rifica&ilt: sit1fil?~ l;ttutl~U9ry-eri,&ablte= ·rus~4tt~r -o pm~eziJi.~~~mqltRf"~r_~·J~P:~P~~!~.~~btJic:.~!i·P.oatl fi red~set~ l1,!()POZl~l~p~·Q.~s,~~~~~' ~~~~ir;~~plu8 dacii?~nun mf ~enfic~u-~au~b:uc~l:Jl;~~ ~~f! ... ~~llllfhpg_al,l,ul.p•~~'acelu de a p1ne,ac~~t~~~~!J"u6~lntt--o'Pf9-PO~j\i~cl~~en\ata ae·•tipul: X e:>te~·~~Elf. A.pqJ1~c~st1l~Pf,OJ;l~~e!~me~·estt:f!(td\1sa la · ·prop(J?tlV:J-_cle ~~~eJ:;Y,,V~ .lili~ \9.~~;~"tl1fie ded~~i:lm (J )• * este u~.?:~f',~tJ.fC e&.t~ ~e:IJl\jJd~•;•{;:$<~~~~~t\1 ~c\rp.~~:fotcMud o,~tnlJ:!~~~~~cl), f;ll!:r;ll~ln~ iS. Veri fica ll'Pft1.Podfies~.trun 'cij~truct este. slt~l~~~W;t:tJ" a; ;Vr~u~lil;~.uu·,oo~ 'bmlFI~Ic (~entiil.'l~~de) rqpeR~:V~~ ~W~H>.rjt.~(peJitntceucepft~!'ttn~1fcrosc~p.t~t~le JJl · (fo~si!J.~f'":le,Jtev~~~c~.bile f:llin,llfOc~~l~~cli~·~!l~s\1~.~unt · fi\.ra ~eUf§.~<<se!;~!lieqfi:i~fJ~~et!~'"¥ttiv~S:(jf;~~~Qt1#inlli,

" elt;llt1i,nt'ti~tific;~~ ~tuftud deat~d'l'i,llJ~~i-~~m ~.9.~ lfpl-e . exemnl~. . " .. . . . . . . ....

· · (2) tpo!tl'imt-oye~afietn:l~~Ulu': .. (;~·it71{t.). fJ~~ti~ist pc~tra.~·\)Hnta. a fost·~~! extreni:~~~".~t;,,ltl lll!fJ!e ql~ifJline, tna1. ales\ in cele soe.i:o~~.nnat,te dt\J; ~i~~lrt ~~e ~··~~iqj, ltttele

•· ··.~ol~Sb,l.lc~~ (e~,-:s~~e~(!?g~!i_v~··;c:7~~~'(J.tl),~ic1~9ail~t;t.put~au fi V.tU]fl.:<al;ecdqpi1 cr1tt~~1.UJ.. PGZ1~VI~t ~®$~ 9"~te~i~ ~,lost sedos . £lex:ib~t de.~o&ir(na.?pCiatio~~~t~(~it~~~tlllr1927:

. 1936? ~arraaparut pen~.~r~~!1 ~~~-~~~_Q9;9{PQJI;Btestei dQctnue:,,~!l~~cteie~u:o•~l~nu;~~q~~a~~\V•Prnpazilii de o~ser':~~e CI tr~~~~ ~a .fie opera~~nali~e·pdn.pJopo4ifii de ~bse~v~ifrf.: ~f.J•·e 7~e(l,~~l:n5~ de n~: ~;~gu& Ia~·. !e£rne1uU de uperalimrali,~an: . u~a~~ t:a,propo~~~ijc;,~eabserva~e aco.pe_ra

tloar un ~peet din concept;uHn;vestigat.a~a CUltlpriti oiopsie

38

l

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1

luum (toar H p~te dM\tr:;o:;.tumpra,::urn.\iht~'.npoi_·~lt:t ~oJ:aqlpzje.de:;pJt;.i~tli{ffm~tU~ti1wit~tt}1irc~';t1:~te• .....• tnl~li~ismul ~f~~\~E~nside~prea sev~f'.iil\l~~h\~; ·intei t~P:i JiconstNct~ia~FS,.tui~t:f!lif::ittij_e,~i·~;!ill~~l·,~,,,, .. •~ottice · qeosebite, ~1r ~are ~u·p1Jt~~fhyerJfiCJites~t;t·~p~~J!~~an-~ale

· rigu~.-os(ex con"tuts;;.tul•de se.hema•·e<i~UitiYijt'. ... ::.: .· .•• (3} R~tionalisuaul tpdt~~Cptt}Bf'~l'~ ~· •.. ·· .... ,~,I.?~~}:i!ic~nt-cR

:disG~~eataadordU1-d~ntE}f81lltl~~~fMn i'e ~~~~ilitale • J~fnt~ifit;abilltate; o~pf0p~·f~.~~ ·~·· ~~~'tl ea~~ p.o1~fonnula:dhlersepre~l . Q~;s ~' • . ... • d,~"@~~tva\te

• {pP3tQcqlnre)•'ireate•pOt'fi ... JP? ~lf..c~lj. ~~~leled\n. ·. . .1':- · · ·· ~•;;.• ·• • "·:· • ·• lelliilltata·i'"•'n,.;..~t~J:iuqftild :c.meditt.marettS~t(~~'?.~~t~.~;:~.;+t ••;··•·•~ :•''. • . · .·

..•• ·i.·nnat0gia eu,c9~\titi~~~ais~a~.~~~Ci!·~'t'· ctm~t;~a~~tJ~,~seama : .. deeXistet\\tl'tih~UllitQ~~·~b~qypri:u.!f~~;~l,(~?~i~leren

tettsiunirb!~cnu\i~~1~·.~~;.\'~~~P·~~~~·~·eot•tr'e~ · (pritl · verificabrJihite) sau. viiii,lli~l~,J»~~j;;r~tli~·i!~~;Et;(~pmtleiftdiaare.).

· · • • • · · • · ·t. · · ""'" .•·t · · ·· · . . · .··. · ••• .... ;~a~e en AcensUi flenbilir:a~ ~lt} ~~~l.\7~~11~¥~~ .• · ..... . sGbim&ii ~mu;,lfl.C~t~ IQJt~gjiJ.~Pi~~~·fliiD\i.f:ti~~~~~(i~t mo·

~. ,, '. meut;rull~tfo~~ it~~~~~:~(m~~~ip.,Jdid~u~~~~ (dacn av~l\l __ tooriaJ('"~~.a!~W;BFGli~5ia'~• e~•J!I~ftUi~!jrt,entatii ·pe_~iQp~T.i\!i·~~·~##:~a~~~~~~Pf~!l ~:;~~'~f1t~!~ta <X est~ p~ob~,~~~"f~t). ~~· .t'@'O,NI!lZI\iile ;cie ~~~i\le suut adei"'1; i. ·n;~.tJ:~.~~v~o:~tl~~~-~f!!itU~ es.tc

, .· faf~l. &eli~~~~~~ o1J!f$~:!J,~je.sunt·~~~ • s). -~~~ · 'vaxi8lita'\t~iUC~~\lUitl,\\li.~ ~ie;~X).~re~~ni ~. . ~1(11

tie ()~~~·a~ era ml;~~S~~;IUleYifati\••9el~r~~ ... , •· e de obs~rVa~~(p'c.citQ~dc?~ft~~~6ll~f'·M~:Jtii:~~~~\!}!lui ~ oteoli~~tii~@~~-~~'r~fpb~t:'t\~~s~•tk}~~t·~~~~u lJrt~ tve.rificabili~*· cii. pr~~ ~~~~~\lf:ij~ftl~;:ln:luC;sl • in~~iiln,:Ja . Mtsinfex'empie care sa 'conffttne teoria 11\l(':Str~n~i"lfl!buie $i\ . Incerciitn sli gii.siru c~.ntrae'lt!emple~ Da'~;;~~Sim acesle , contrae~emple at.unci cu cerutuditt~-pute.tU:sliiiieiniihuant tcoti .. 'l.

. Daclipp gasim ace.sle coutrat;~eJ:uple alunci ~S~f:l?t~~~:g~:obabi\ ...... ::.: -:~:::::;..~.:~:-·. -~·~:-·:_ . ·····, .. ,..

39

sa fie.adevaraHi (na n~ropiem de adevun1l reoriei de~i prol)nbil ciiel nu va Li•atias niciodata}; Al'}adar, celmai bun lncrn pe ·care putemsiH f(lcean daci'i·tlorim sa COliStruim feorii ~tii(ltifi~e -est.e ·sa delliiYiilt1,predictii (r.iscante}cdin·acestea ~i sii vedem dacii ac!!slct pmdictri suntsan.nu suntconfirtnarc.de dmele din realihlre. in ilCeSt context, l:rebuie sa.discoram 0 .alta variaotii de mtionalisJn lli nnome raf.ionnlf.smril d(scurslv (Perelman, <1970; Toulmin, J 953}. Discursuhation.alismului-cdtic.resre unul reoreli.;:, p1·in care -se incearcn .stabi}irea valoriJor de adevnr (ex. fals sau

· nde~iirat)illeunei teoiib Par~JmatMrarltch penrnumumite disf?i[llineitiintifi~ett (ex. drept, mo-t:~HO: un dischrs prMti·c cares~ refurtt·Ia ceea ·oc 'e:;te jn~t snu inj11st,. folqsitar -san aefalositor este·mai ·hnporr-antdecfit nnutreoretic. Awndar. I?erelman insisra cii t.reb~a ia s~ aocepriim cnteriului ~thlphic (eipiimnt Wt;mij foe de

· · pmba) ~i :funcfia da~tQudard §tih1tjfictfurr-undiscurs pmcric (voi t·cv~ai·c~ ci1uificliti. asupl"a·atest~:~i nspect'Cfin_diliscuram procesut deiattemeiei~acuno~rln{olotin cnpitolu13).

·· {4) Emptri~rnlil pragmatic (Quine, 1953) fle.xibilizenzl:i ~i ll)ai unlltdemersurilc! · nnt.eri(ilare.. El repreiinta o comhi na {ie fiu;cinantnfntrepr~gmatism,s-i poZitivisrn, fiind·uria dintrecela

·mai flex.ibije.abordihi din filos~nn .nnalirieii.. I>c:oarece poaitiVi$nllll·n .fo&t .descris;1naJ sus, inninfe de a prezenra i.f.lei1e CIJipitisllJUlui prllgmnric sii:t1c~mcateva comenrani de~pre pragmlilis~l. f'l!ag1lraUsmuh-aformtnfnjt;~ntf Clubului Meta:fizirc d~ Ht•f!at)1bridge Mass~tclntsett!i 0 B7l) care teunea P''()fesol'i ca

· C. S. Peirct;;W, Jaq.ies ~i altij.)'-lullleje ·de pragmatism n fost mai in~fti folnsJl dc·Peime c.-nre )-a deli vat din distincp.a l.:anrianH din~"rariuneapra~ridi" care esr.a 1-ariuMa mor.ala, ~i ".fntiunea {Jt'I\Wttadcii'' Ct!re esto tnthme.a ntilitarti. Ideile.fun_liamtmtale ale pr,agmarisniului.sunf.(Mm-ga. 1988; Peirce. l93$. ·apud. Buchler, lSNO): . .

•Vin{a 11\Ste ~emeiul cunoa~terii.;. •. Cu~roa~terea -este activit-are;

-.. . ·~. . ' •. .·· ·=':"· ..

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~ .. . . d- ~ati csre conferil tie. reu~it;.\ ilC\iunii p~! ,_ .. Adcvarul unct JU uc. • .

ca~ o orie~n~nzii~ - -~ltin1~ i~tantll re:znlmrnl on or infe~~n~e . •Realitateaesteln . 1. · 't"tadeonmenide:Hunta; . . - I il comumlntl!! ne 11llt .. . • iporenceoperar~ L ~ • • - nuchi area mtiunii 1n-pmgmatlsm.

coiilunitarea.nelumrarn esLe_m .• : ailistiL~criei dinrre discur:ml . . Pragm,~u;i.smul reduce nnlpo~?. dl Avllluai"e aici nrin· reu:;il n . . r . a:mbe e a-un ... ·~ ~ tcq~:eti: IJi ce pmct1~.. · . irismul pp~gmatic nrara c~.

nctiuou pe care o orre?t~a~.:.~r:me an vnlori d~ ndevl\r pn~ .chiar dnca.nm ~cceu-m•dqea c~ e(ide&.a pozitivjst!l. el!i nu port~ r-ap·ortnre Ju dntele d& observatte . gm"t.Ic~<- ... d,.vamluneJ

. . d I . Aslfel maxtn1a pr.q .... u ... ... • stitbthte meta o ~gtc. . • . ".. e cnre 0 orienreaza- rrebtne teorii estecpnfentd~retl~ltnncp.um-._:J? ., tt'c nrau~a c~< ltltce Leorill . - . E . . mul prqgmn UL a serios valonzmi\. mptns · . t un 0 serie de iporeze aestatli ~i predictlilpdtrrivare di~ eda ~ m ... =rpte"ta-111 iporcza eli ura

In dnc.n onn1 "'"I "' -nuxillare. Spre exeal~p • ~ ·y iji fac~m predictiu d'i fcnomen X cauzeazri un a!txe~Q~?·mi nmnci fenomenql y· dacli producem f:Gf!OI_lJen~. • . e l:e'fntfimpln t::n predic{ia sa nu tr~buie sli aparij de tr~J on.:e~J?Oauget:eaza l"fttionniJS!TIU] critic, fi.e confirmat~. A<:e~~cn ~r u~.;ps~) 'l~s~ ;;e at~~\tionea2ii ca ~ste Jn. infirmaren teoni;t. Qume.(l 9 . 'I 'l'nie s'1111c ' . . fi devaradi dilr tpoteze e l.UJX.l h • •

posibj) Cl:l teonu ;;it 1e n • .•·'}j· e~n e~emplul t'le mni SUS esre · f~lse. Una din~ !potez~l: au~,~~:~~ · rezenta feoomenului X.

_di. metodn/sa~·cm~ Z mi\~?::a_ a~e fa~n anmci relaria a~teptulii Dadi nceasta tpotez.~nu_x.t 1 ace~~ Jucrn sn fnsemot! cu necdih1tc

.. ~~ noi ~~u va UJ.l~f~f· ~r~~=nd 'tn cons1cien1tt acesre n:pecrc, s: ca teo!ud{ est ~~-~S:Ji!ultll:lealulpal~}l~l'ifln ttl uexperune?rt~l~~ parecaestegceu ·- . ·. d ~re'on·t· nflnte in contr:JdJCticJ, ,. . 1" re ~K rrflno:e1ieinrre oua . ~"!J"l.\CHl en • l:i•! • v ~ - r Tfiatfl, poate·sa fie. salvmfi pnn oricnre·teor!e, m cuz ca esle m n '·t' .. · e Aceste idei at I fosr ·· · r elor sale ·mx.1 mr · 'r'nodifica~eu _tpo e~. , .. 9·-vo) C ruomllui Lnknros (1"970) un 18 · ltttre de·Lnkato!l'(l ' · a . : -~zvo . re·a:kiltuit din doull componente·maJore. s1srem teoreltc es . de .sigunm. r.a" :?i cnre : • Un nncleu pi'OtejaF de .. 'ce~mn 'han tine nspectefe centrale rile teo'riei;

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• Ui1 zp~;,.d~·prole.cfle formalli din ipolez;e auxili.;re. . . n.a.s~g~~~~fuile infinna predicpilc fii.cute p'e ba21aniicleului ..

tare, mf.trebllie:~a. negam ad0vfu:ul acestuinucleu ci~putew. · modifita ipolezele aux,iliare Jiiprill aceastn sii dobfitldiut\.Ui plus de cunoa!jlere; un astfel de program de cerceta{"e riinlli~1e un program de cercetare pmgres~v. Newton spre ex.e1pplu1 pornind de I a te.mia _elahorati\ de el.a inceu:.atsa. pret.ldi orbita lui Uranus. Predio~ia nu n .ftJst insa confinuatii. Farii a considcra ca leo ria sa este f~li. Newton a modi.ficat o ipotem aux.iliara ~i anume di t:irobabil existl1 o alti. plaueta itJca.neidettlificata n1

f , - - •

d\rei efect nu a fostluattn ealcul in predictille generate pe baza LeoHei ·s·ru.e ·~r de ~ceea predic~iilt; 'nu au fost coufinnate: iufradr'flir, h1cluderea acestei fpoteze; all)ljliru:e a dus ladescoperlrea plane lei Nepl::tut. ,P~ca ihsii modificl.ll"flaipolerelor imxiliare nu aduce uuplus de cttnom;tereci ajutii.doar ln salvarenuucleului tar~· al unei tt~orii; atunci l\cele progtame de cercetare suut r.egre.~ive ~i probabil influenta lor in cercetal:ea ~tUntifidl se va reduce. 0 alta couldbu(ie a eiupirismului prngruatic este ideeu di o teorie nu este leslnta iuflecare propozitie.n ei lua~ti iudiv idual, ci ea este testat~ · ca w1 tot. unitar. D~~i in cerceLfu:i specifice facem predic\ii. poruit1d. de la iununite corup~neute (pmpozitii) ale te6riei, c:le sunt itlflue-lltaLede tecn;ie ca wi tot. ~i iu · couseciu.tli, concluzin. ast1pra lor sc ras.frt\ngc;: adesea:rumprn iutregnlui sistem teoa:etic. · ·

A doun b·ad~.t~e asupt~aqtiiufei este uun ci't-s.:-dptl~ii. E~ ne araHi. nu cum ar trebui sa functioneze llliinta"ci CUll..\ ~dese.a .func~Oneaza COUCl~t iuviata tle z1 ~\1 zi, fiira Sa i~fproguna CU

necesitale ofer.irea de:standarde pcnt.ru ceea ~etnseantua ~tiintn. Dadi in prima tradipe s~.recuno~leai'n dife.dte ~de ( de1~inwnd de ~coala).un conslluclivism ep.i?temo~ogic ( cuno~fintele ooaslre 1m sui1t slamlarde absolute ci npro.Uutiiri. ~iq:mstruc\ii ale fenotnenu~ui) ~i de cele tnai multe od. se nega un constmq~i vism ontologie (darvezi pragmaUsmul), in aceaslii trnditiei descdptivl\

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adeseori un constructivism epistem.ologic poate sa fie 1nsotillji de WI COllStlUCtiVislll ontologie-S~n~aga eiistell\n'UUei roolita~i lndep~ndent~ de subiect, realitatea ilt~a.~l fi.ind c:onsttuita de acestR-,·.Spre e;tetnplu, .Goocl~ta.lt ( 1978) ~rata cup1~etnetsul unui studhi,poateJl astfel oontrol~pncat~,ebtine~dalele pe care le a~teptiint oonform teoJ:iei. Suportul eL,1plrie n.u e.~le obiectiv ~i imuabil..Ci este eli11su~l9 coustrocU~teoreticii:. Adesea

... vederi1 in datele de qbservaUe!' ceen ce ue sputJtttceria. Astfel, este clasic cazul orunenilQrdp. ~dlnta di.usecoltr.! xvu-xym. adep\ii teodei preforu1nrii, cru'e privittd-,ltt uucroscop celi.\lele· sexuale nmsculine au vtizut -conform teoriei preali'!.bile - ca aces len. coutin fiintetniniatnrir..Rtet Astfel;.ln celule seJtuale ale· n(luasruilor au -vl.U:~t caiitl1ninintudi, iu cele;.ulecftitillor au v6.7.ut c!llui 1n roiuiaturti. iar in cele rue oamenil.or, desigur; t\u vhul fon.t1e umaueminintudwtel (peutrudetnHi vez;i~rsch, ·I-999); in ncest coptext Goodman (1918-) vorb~te despre "[nbric:area faptelm;"" S-ar puleti replica autofl!l.ui cit d~ioalel~ empirice n ... u st.u.ll.imuabi. 'le. elesuntcelnuu rigums ... c.riter···'. u .. · .. P .. "'·. cn ... r.e. 1.··' tl.\'~tn ' . .

pana in nccst montent peutru ~tiin~~. deoar~ ele .pot Ii e:ut-minate critic prin rep1lcare ~i ncordul iute.fevaluatQri (ex. t.eoria prefor_maril a fost infirmatitot emplrlG). Desigltr, oatitucline cdtica reflexiva asupra llmitelor acest\Ji~r~ti'l\ ~111'pidc ~ste insa de dorlt. Voi prezenta douli orientat'i ill c::ndrulh«e5lei trnditii. d~criptive, care nu avutun impact mnltnnre in filosOfill. Gtjjn~ei.

(1) Cndrul par-ndigmntlc: ln 1962 Thomas Kuhn a pubticut corte..'\ numiUi c•structurareyoluUUot ~tli.nti(\ee" in C'a1"e

afinna diistoria unttldomertiu al ~tiintel parcur. g~de obicei !ja.<:e . ' . . . - ' . .. etnpe:. .

( 1) perioada preparndigmatidi; (J.) ~ti\nUi uurmaUi, ewpa ln c.at~·~\.1;. expluratii!'}i elaum:ata

paradigma·~tiintificii; (1) faza de cr.izli; · (4) apari\ia unei !lOi. paradigme.§Liinti~ce;

·····.(s)Tiizh:~e ~'~~~i~~.~ittttjtn i~r~ ~~~~u~Ni .u,oQa pmJ\di,gma; ~~~~·,<~> ~-~~t?!iri' 'ti~~,,a,,,,rli!Hr.~.}~'elp 'do~tli Pilradigme ·~i

re"rnmat-cet-en lll· ~a~a i:f~~fih1Pi,not~nitt!fi. 1.. . . . · . · .•

. . . A:cl!~tlf~est;ner~a·~tF\~~i ~~v~illti~i ~~Hn(iljce a exercirac · · o putimieti'abil£ti~'~sit~t-~·ruiii1en,tl,o~~.~e ~l"iiQ.ta. cat'le~lui 11\omtt~ll~ffiin'Icl~cttifiii~t~~11.na·~in ~~e filai pitate carti .de-fiJ9Sofia "tiin(ei,·tn'lb~ilJStiJct~espb'ciali'ra~t .. · · ·.. · . · · . · , .;s,Jr(~). :Ji!-~~iltktji~.:,PiiiiiafmaliiL A~eairii eta pit a-~.voltl(iei fiti!Ptifi~~~~erenta\lttWtl4l'fiiipn1furil1~t~n·s.Cte: · ·.· . •. ···

·r•~rd~te1e•,•cib(i~1t1t:e. .sunt'irrtifhiplatollr-f:. ·~learonrc fii ,~~1n~dicliale;•,·•· ,i ~ •• • . · .. ·.· ·.·.• · ·:

·:;· .~'i •;.:.:~;:;~ e:~etitamo>s~. ba'2'ea~H ~e obseiva{ie •· {ades.~a }riesis~ , ., l'i?rtll)flf?i~)~n~ipe31l:qterit1lenc;:~;:' •', . . . . .• , ..••••.. .

,;!; ::jYD.1>'~.ttJ~~~a~;AA;:ti}nlielor_ ~mllinl· simplnl riu cdoiplexul • . ~":~'' a~~.¥Jlf1Jl·~,~;~lml!i:dirn:tltlod lm~asot~bre~··tn peritPf!qtiva

))) ~~~~ta:f¥1\Qf!l'lll~1ui;,tn-ngat; : · · · . ...,~·;; ~'~~s,~:~9~~i~6lltlfr§~PU~~O:SL1riUn cqmpeti(i~ urrele·cu'altl}le,

,,,, .. ,.: 8~~~fVfi~~f!Q~i~twf\nd.Olposedl\'•ade~,~n'l~1 ci\ este mai .•. ~t.~~~dF.pljt:~~~P~W,iJ;·:~;~;~ ':

. ··t/ttl::'!tf'!l/,t;lliJifl~~;qiA'.:A;~east:Q•SC¢JirBcfi!Fi~.prin: . , :;;· . ,i;:-'"~~~Pe11;~!1,1m~~~~!~:ftiillti1l~.BBninificative; ·

,, "'' ';.t:~~~ . ,,,~:o'!i.,.,.;.,- <r:llll?.e117ll

.;·;;;~e~~~;~:=:- ~·p·i· .: .. ::'. ·~:ra gmn esre reprezeittntli de ~ump(ij fund~llientale onrd

1U~ pot fi testate in.~o~ ?i~~;D~p~ ~um llfian&Kt•hn (1 962),

•. i e~!~~·~er~~f~~lm!~!fl~~~t~~~~,i~ad~1raJnJr.-o paradigm!. 0 pn~thgm~.reprcz~n_tii o ~?l:cpe~ d.~ Rf?C~~'!IJii~J';icJ~IpJ;in care Cc~c,etittoru SUnt ID~!rmtt smpbcat ·.1'ce sa crea(Ja.'•, '•com sa

' realtzeze_sntdiite··, ~i ·'cnrtl s untrezu It~tele. pe care ar ft"ebui ~ille

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· ,ncre~te•·. in Ciu:h'lil.•;ileipatlldigme,tl~~i s~~l.?ltl~v~t;' 1:or:i · · ·si modelete:stare;empil'ic,ndesen cercefB[Ont ptefera sa rezah e

.• •. 11btemeJde'tip'!'lllta1e~'i t} problemi\ tl~ tip '\luzzl~'!' ~ste o :~hJellia{dapajeculcWEtcela~ nlime) ae,spre ~ar~ }jthll_, ~ ::oi :1tt! caset:t0rtfe1:azol Vil:ji inaihleS1~llql ell~Velll f~tne ptesel,e,~et;~~~lre

· ~lvaffiiiei; trl!boieitJ()qt sa combJnlhn atlecvnr .a.ce~te }ltcSC

·:dll'p~n.tn;model dihp'nrndigJnlL!'Rlbleln~~detiP.')iu~!e" es~e . ,···,cna~nti\e~1.pawctigma,~ultanal.es~ll,t~; nntlCtp?~.~~.~~!U{Ja

...... eijntareste·~"'Peetiv.a:par:adtgmfu.;Unanumltfenotl'1en~evlne o ··.· . :p~-ri~le~ d~ tip "Ptlnle·~" ~~nci ;~~nil:_ ( l)_ ~n n,~tm~t:·Jinare .d~ ~~tatori dintt-un domen;tusuntlmpllcn~ m FezolvnjR:n lm ljl

.,Ji,( :(£ ~PeStlt,(!Pe$Je~egj}ijatcidew}J:le obiectul prroejpt~l nl~J!rc~tarii. ·,·~-. )?n~H;!RY9,.ll~iiqtifi4;~'1lt~l~"pret:¢:a~,'ii · h~regrenzM lfSrce~t~ ~e · · · \:~li-;1~ a,le te~niil()f§'i IDQpe~1or ant.enonve 1;1 ale n_oo~rul~r ~111

.1Jerl()at)~l{lt~paraali~ati¢li iQ cadtul sisten~ulm sa~[ teo_ren~,·:utlli2.1lnr:l lenne.~. proprii.:De.;exempll:l.Jnps•holemp•F~tentpln

. :.·.l , • ~(}~i1l¥?r~"fl1tmr~~ a ~~~~rp:retat.tc:bnicilc psjbnn'nltti~iq,~efmel~~ · . '.<1 :~Qkitj fnv.J~iirll, bin~ :vaJ~':\f\tl :stii nti'klP". ,val idare.c11t:e ],, psen 10 ; ;~~~ · · 11'66~4B£~a lui ~t~nwn~Hlir~lJti. :A:sr~el (pent~• d!!!~t\l)i "~ :Qolhwu · ·;Ji :: .. ~~:Mh!e~~-t~-2:5p,~. tJdglf~;}:.~~~ ):. (l)~tr.aJ,l!!ferul e~te i nr~:pr~tur;:-~ ·'·~· ••. ; ~n,.~specf~J?ec~p~ ... al f~qflm,f?nuJu•. 4PiJ!CJ~_er,u1•:zn~~::;1J.:~I.'Y!'t5t ~~·

(2j''Tepresi~ e~teltp comp~rll1Jnentl~vlltn~ deo~rc.E~ ~a~~·.nt!h 1r · · .. ~ ·· · 11~gaihi pfill ieducerea ~mx.ietli,il;. (~j·intorore~n~ea esr~~uil~ chi~u·

d~~n~l¢5te,1ldt:vib·artt, deoa~ce,;_ofe!"~;pac.ieJ)tJllu~ a 1stone 'i;6~rert~ qe vi~{li~r~!l'relwica asocia~iil()f m~ere este folo.o;iroure

. cie.9arec~ pne:ientul interpreteaz!i aCC!'praren! de cnrre ·. p~i'hoter~eut n verbdlir.ililor. sale automar~ e~ .. ie~lnre., ~i in · ctifl. ~tl!. ~C.f\111~ ~op;:a~a. «r~-. a~rtj;t~.Yef"J?ahzfirt se;r~d~ce ere •

. , fnPh .... ·tt~etiipl~).11lfadiB;ma s.tii{l{ific~ po.a~e .rroexi~m~.cu nlre. ....... _ .. ,,, ~ atlorditfi/~iplie~fr·a)~).>mf~~dei pr~pa ra(\i-grni\ti.fe ·Sllll ztlo

JtW~ttJrnrilortt1ineffipa p&}J~Illdigmnticn. . .. ••- .. · ... i'<. I • , ..•

. 3r•, · (cJ:· BiiJpii:dc.&iZi. Pal•nlfjgmn ·~~in{Jfidi est~ ~'P?~ptnrn de cii.tre oa1henii d!! ~liintl ctiiar 1daca ea· rin t:X.lllicii tbnre dnrcle

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·-· ob{i IIUte·empiric. 0 perloada de Qriz.ii,pur\tine atunc.i ca;~:vec.bea P11•~[(~~"~~~~=t~~~~ntl\lii<GU qurueronsep~dicpi;~1hle ~j · · · ·t;~!~,,J;·~Ilg~:,~e teQyiilol)~irffl~'4:lfl~.a~~,~~pij.c~~~~~ ..

··;1··· {d)~Ap~17Jii!:B;r;UI~t!l.;;llf:JPi[l.IJ:lflit/im#eflifl!~~&.tJ!tl;eclJea · pn~~ig1.1:1~ nu. PQf:!;f€;. expli~.lli,IJ;tteroa~~ {e~~~~na:r¢i~v~ute

. pen~~ ~tiiu~l\ .. fi~· se ac~u~~ :Pr~icti~~~nate; apar~)J.lt~ouii. · Mt7tdlg111~t.A~~ e,ste~p~l!l.e#,i;uli~F,t;ti~.~~olWliei:~mimce. • • ! (~}~Rc<;l·vJufiavtiia(.ilir:ri~(t!tQ~Ear;.t.e:li~fltilpcin 4Jpiul cB:

! ..,.. se ttdan~te a~pecluteo.tlllf~btr;tldJtiue.vecJma,·,jt1Joua para.fl:igma; · · • • · · ~ : .. ; • · · J ""'··npat.·Iucrriri~tii•ltifieesccls~lu• s~irill•H npii:p~~lne·

• ;.... veciJUeidei~suntcoflsider~te fahte~ ''·' •. • .•• ~ • . . . f'.(f;]ReJI1ttJ~.~~a£wm~delfiinpriJal111dll·~u~rlintre ·.·.par;a.~···.··l:·.g ···.• ... ~.~.e·c .. ··a···.~.ti .. &•a. ~.~'e.··.* .. ·. ·~li.'·e·:·.ftn ... · .. d·· .. ·· .. ··~ .. ·o·t.· ... c .. ·ee···.l\.·.ee··· ··a. ;·.·.·.·e·x·p.!tli .. ca.fc·· .. :.:eat·· •.. · al.t.'i llm"~~tgllla QJ'' lTUU .. mt.dt decftt !!til~ 0 'parte~(!Jlft aspectele • pattttJ:ig~ei ~~~re S:pierdut VQl- fi reml'el'flMOI:e ~i integrate in

•... 1 ··t•t:· .... ·;,;;, .. · ...... . · .. ··.... . ..... i ' s~:stentu ~~eoreliecuparn ... rgtllei1~fe1ldlitig~": \ic':o•' ··.·

· jr~~ ;ltnJJnf~i~~ lnet\J.fl~J;· .. tJ'~~ ~adfu ep'is~tnql~gic c~ .. jnfll1~1!1~so:t¥e"ii mai.~~~~-~~·~~~~·~~~?!~~~llbend (l~?~} ~el'~~be~~~f!S~.Jle~~\l~Xi~ta o:Jn~~Ii(~tiirffii, ~i cit·

.. o~~~,ni.id7!tijnfM·:~~a ~ra~~~ I~ ~~rli,Jtii~JiP~d}!l~lotiv~ ~u~~;Ft~~j~•.cJ!!~~.~~~~~~\~~.~.~.~:¥S~~rw~~claz, e$~;Tb~e. l~·~.~~C:~.~f~~;f·tif~~~:Cfl' .. ~~;~f.•~~J~~H~e. este nee~?[ p~ntrlf ~ a.~,~~li,..~J~· dop~e~y.p!"l(Jr:· :~:Y-~f~~¢nd iss.i fonu':l~¢1 c~~~4Il;.ea,t~~deJ~f~~a··f)~J~fqqc;~tQneatit'' ~~~tr~ffi.d~!~~~~ ~·"ti~~F~.{ili~ef~~~~.~'~.'l~$~a ~l1(~~~;~:;tr1gii ,t;el19rta~~ Cf~~e{f!-tJ~~f I~?~fse~:;.:H:~W ~~1?:f~iqit~tilor. adtwliftil P:r~ yo~ :f~ .,vti!d~l\jJ~~~ul~i~' ~{UJL. ~ta,Ji«},ardete ~~!~tm~ fpA~~it~~~ .. ril. ~;e P?~~#~~a~#_~n1~I~i~S ~g~~~~IJ etic, legntalde,mntotl!!I~p~~~~o~.n~?~~~§~Nii lc:u~~;penuu · n-~i c~nsen'{t ~i eJ~.tinde dm1le11i,l,f fl~·,aptivita~ ... ln :Ykiunta t:Irt~pt~fa d~ TJ!Oinas.l~\lbll, mc;tdaJltijtile:de,i~l:l:u':m·$~re ale parad:i~W€11 nsupm ce~torilor ~~q(}~pliUlui par a fV•~Plicite.

46

: -·~

47

..... ---

1953). Considerlind 1~r&meiere .· - . ntlcleuhare nl validitlif" f' . fi a pnn snportul empiric ca fiind snbiecriv s·1 ·t·J.- ~"'· .. ta- .:tn·~·IJ un[t 1ce •• se reduce l'onder.ednctamlni . · • · ... ll».•· .r 1-mpunerea n · · · · · fen omen. Astfel. · . .. • nei pitr-Spectwe asupra unu i peripecti~n tearer:~~en~~l se _mnra ~snprasnporiului empiric. eel c .. llre.prop.un.e. ~-"'cJ·a~sun .d tdt 'MS.ratn re.petat!}i independenr de

""'"' • an mo . elul pdn. l"d -Acest·supar~-em · .· · . · va ' are mterevalllatori-OperntionalizaTc·:;;~::~\7-~"' :;J_'rimrr prin verificnb;Utat~: poppe .. rhlJJ.a $au a de--Lvo1tli !l~on. dl ttate.(in~.elea.sll in vm·iantfi l> • · · ··· • · ·. · · · '' · n or a use de ·dtferit · · r:agnlansmului(ra-tion~lisn'lulilisc . . · . . e vanante nle lJ.e¥i acest deme-rs ~0 ' . ·. ·· • un;av ~empan:smul prngmmic)] . nodeul- tate nl dem:mar·:. ba~ucye supqrtul em~iric est~ psihos .. oc··. h.lli .. n.Ie.·n .. r·ao .. ·n·•....,l.!.su udt ~tuopfic. desig.llr eli .factorii

.. · . . ·. . . . '" ·""' an mo e)e des . . . . . mult sm\ mai''Pritm acesrnucle . . cnpnve-oonmmmeilZfi mni

estetnsli aceln·de.a .. · ... ·. . . . . u. tara. R.ol~;~l omului de ~tiinlli d ' •.··. • mnKmliU pondcren stn d d e areduce poodel·ea fuct .... ·. . . •.. · .. . . ." ar. ulni empirre-~i

. modelele desc1iptive .. ·· ··· · 0 '10~' contamrnantt. prezentati tn

AJte abortlt'd normative· !flni pnstmoderniste·extrem~ 1- r~cen~e._cum suntdezvoltnrile 199l)~i cnrepe·liblnliun ,.asllpr~ !J,limteJ (De_rrida~ 1 976; Rorty

e2 excesJv• con r · · • sus tin ~i un ·"exre • •• s ructlV1Slll episremolo~c

.- SlV COOSI:nlC[iViS f . b"

snportului empiric.rolul dee ··r . d .· ~ onto ogtc, negfind o.ferit tncll. smndarde ulrem~::i~:l~· ec•stv pen~..!jtiint~.:nu au lntuatiaincarefiecare{ind· ·a : are sit ne I!Jllfe sa depli~im

. lui, en. m=vnllrc •li ·tmei ·im~~i~nu ~mp) are adevamllui ~i ~riintn t~rmehulde·~excesiv" I uruce.-in fenomen! Am tolosit rotnlil· a construo~"iet P:!.~~ru. nf_::tflitn~oa se.incearcii relati viznrea

. • '" .,.-.mtt ace An vari t 1 neoll~Zltiv.iste (po~irivls"nlul · . . 80 e e pozitivisre, 11GStpoz1tiviste(rationnl;....., l· •. l~dg!c, o~erallonalism) si .. ) ...,. ... u ora be Sl mcurstv· e • . 1 .

. mnttc presentate-aiai' d~ . · • mpmsmu ·pt-ag-e . . ,. c::;t se aceepdl un etsremologic -~i uneQri chiar 1 . :on_strnctivism

sugereazl:i cii exis~:c . I nul o~tologJC moderar se •.. • ua m~t~ standarde m· · 1 •

fjtnntifice comune nwjorit~ 1 •• _t~tme a e coustrUC(iei atn oamemlor. Accste· stnntlarde

41!

I

commie-- l.!::itedul en1pir\C - ne njlli"U sa evitfii.ll silm,~ii\ ·in C;\re

fiecare avemadevarnl nostm tii asiglli"a minima rut\l.)nn\ili\le -minin'ianlionnlia-in ·ctiscurS $l comUI'\\Gare.Alle ubOl'dli~i noi·mative postanodnrne motluate~i important!~ it1 fitosotia $fiintei

(d~i'nu nu penet.l'llf practica ~tiintHl.ci\ atf\t de purernic ca nbm"Liarilc desctise de-noi itici}precmn feoomenologh1 {llusser\. · 1947) flihennel\eutica filosofica (Gadamer. 1975). ~are. t\\1

recui1osc :;t\pOrlulrti empiiicr:olulrnaj-or in standardul ~r.ih1{ific, 1 · pa:;rr·eaz.ii (Otn~i criterii miniiue c-omune construcl)ei l;fiintitice.

Acdte Ol'ie:ntiid postmodeme n'loderate au incercnt sa ofcre ~liintd stanrl;nrde no..-mative. nlternntive celu1 etnpiric, Asrfel, fenjillcnQlogia {Hllsserl. i947) a aiffmtcli scopul ~tiht{ei nu e!lli!

cttnon$tereafaQru lui empiric ci itfenon1enul tli.l\ctul de co o:>ri in tli c:we ne pen~1lte nccesulla faptul e1_npiric~ prin acest tmgajamenr. fenpmenologill anuleazlidisiincpa dintte subiectul cuno~d\tor

. · 5iobiecllll ctinoscut.Jnroi\ionismul (Bergson, \934).!li 1\bon:tnrik: henne.nc\ltic~ (bilrhe~. 19~7~ insistl nl!,Pe faptutenil"lir~~.? situ pe fenm'nen. ci p~tdiirealinterpret.!lrea fupmlui eo1piric: la ui yel subiectiv. Sa exen1plifi_cam cele ~l?nse aicj~ 0 1tn~\lizi\ illungi mii de undli n culgrii ~9!?U este o abo!:~1l.\ce emlliricn/enotitntivii. 0 nonU-rli n.modului in cnr~ el{pttli.\entien• lnnivel r-ubiet:tiY culoa.-ea ROS,"Q :or.uin. o trliit:nflll rerp~t~rn noi, trnire/h)terprl!ti\fe. care nu sereducejn nivc;lll\;\\l~~imH (le.unda :- ~ste l'l ubo~·dare · jmui\ioni$t'a *i hepneneubd\ Ct1~ pu ge~-ati11 ~ti inti\ ll'letntlologii.l · cnlimtivll.?· A poi. pllntlnd-~n parnntezruobiecml. culonran R.O~lJ in, ,,cest cnz, pu~enHljGnge In fen omen, "!'di9a l•' uctul d~ con~lihl[ii (~X.. esenla. prpcll:;ohJj pllrcept(v}.cn~. ptin fnptul en c.xi:>ri\ ~i es.tJi: cnrscterizat prinintentiGmalitnte•(se rcfe.ri\ h\ obic:ct). c,;ri! prerechizit;a !fi fllndnmentu1 annli~oJ?.r;antit~[jve $i ~illililllVC ule colorii RO~U[nct}aljta e~te abordaren f~nomenologicn (Hu~e~l. 1947) !lin h~~l1Cllti!:ii filost'>-fice (Gqdamer, 1975')}. In 4nncluzie. d~m~rsul ~tiintific in cndrul pozitivismului. I1eopo'1.\tivisn1ului (pozitivisnml logic; operutionuli~m·} ~i

' '·

-·

postpaz.i~vistuului (tntiunalismul crilic fi discrusiv; empirlsm\!1 II pragtim4c) ru:e -~JJil~!~lil tare suportul ~~~~p_jtk. Suporf.\lletil:._ · · pitie poa~_rf91!tf1i.~~i?wutiversemetor.le·~eriercRbli~~SiU4lU1!-'·: · · experim~~tnfn~T~.tuffitii'elit1ic cetJtrolatimt ccl~ nt@;~~oasu: ' - t _ meto~e9iiiiei.•pey.ntit ~i ·genetali$rel!Jr~iUJibttelor~·-Desigor di"' ·· ~e:l\istit~iJ\tdte; Jnetode •perttru 8:'¥DU$ti!!:ll'PCt!,DOa~tii pe baz3''; prlliclpiq~~I!Ji;-~l11P;:iriG'.t;7~t'l~nl. de-ca~,t-~l:i~atta!-s~tet\latiei'f

. .aunliV~:tt~e,! s,iruat(i-pt'oblenta sau.ex_pelieutactinicii~~otgut:e 1~ ·· uoi. C\}~t~t.i_Jl(£,,- sff~ ~eq~p,~u~ t)c~te:~lllltl~~iltt~ S'~~t ~s~ _ coulextwd.¢,>el~:uu ppt~rr:'ge11e~~B;~#~~~~llasnrp;;·tn'_core ~:' cou,tiett~~~;:ace&~tu.-eru:m·;~~opl!ijna~tli~~~~sand'' furmtr:l~1ii1eorrcl.uziile·pe~bQZ&·•~91tat8tor:-QbViflt1ltel:n'a~te·-·-melode .~ek~ -sntd,in~ -lile'c~) facetil1'$t~1ntit ···tit inaatin1 in a«~.

- "=. ~~ \' , ,, • . : ,·~ .· .-- . , ;' '_/- • --·"-·---·c,-· _"!·~ ._': '•< --/~ -- _, .. ulili~iitltzY~tfel>fle;met~tJ~>~!~-r:sttllfiti'·dec:9zJ'~B:t1t ., it getlemli~~Y'l"el~ul~~le·ob~utitef~t.~~tte~~.Jl· ·· . ,.,:,.:~: Pentr~tgeJJernliza:tea-~ultatd:I!Jf•&vettl'n.evore des :rtce coJ.tb:qlatet }\lllflar~;Jn itetastii1luct'a',:ei -~91et'sl!iiii,~ijf . ·;~~If;. tleu1e~;c'S .• ill>~e.nteiat. ett\pidc~:rseudl'JI}lJlijrlt~ ;inseanli'ili'iitrna~' suppn.~;tluJ~~htpit'ic {~. dateleempiiicei•vali:taeazitcel~atliiliiite:':

· saucutt~~.W~~epre.zentate~a·JJiud~atle¥~'11tratt[qStinca~': les.tale ~lllf!l:l"jc} sau ullilizarea l11i' Ql:fnml·~ex-~ get1~riltliarea \;.:. concluzi.U9J:\Pe•b~a.unor··date·emph:ice. eltiaut:i·pnii{met~:>_ care tJu pen,tit.genentli:t.area) .. Cu>toatelii11itaelui'~'cutoatcit presi unilela ear.e este supus de·facta.it £outamitmn\i, aee&f't~itrrt£; .. ~lupiifG$.-~·~~~~i;tb~~~J!c·tn~evolli~;~e~tritteJ~~bt~~~ ;!i~1. · ~ Jtnbi.Ulit~t1~111l'!e,l:l:,ll,.t.tt;(itl,tl1ll,:.constit.umdl~Wffdmtclell\l'.tpte'.Ul-::. :;tiiutei ci}In~~·~a.il;l~l~~f.i;£UitiiZ;k:~~:Qledefi:Usin\Jl~dem_t\_:: (c;t. .. fenotlleP{Qlg~ja\ ~~]~le!llt':Uti£a,;.i&ui~i'lnismul) nwa•reu~jt :, : sii se iu1pulta ~,~Q:~l~ati~il ~-efliter~ul~mpitie-iu '~iiJJ~fdara .gene~11L abo~~J cqw.pt~ffl'~lato celo.r,emplrice,.cutn·~tll.et~ . dolog.ia ~ti~ti;v;~;J!Iell~ unpliattii fJ,l;psillolegie'V6Zi M:Hrtin Jif ·-.Sugan~ul11.2QRO),.iarpostmodemisntulsextr€m:t'(DtSrtida,•1916:}'··· ou a. adus inca u~inh~. competiti~rtdedit nl~te,'lettuti de sea.di inleresnnte. ·

50

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·~~~~~~W:,iJ~"" 1, 1. uimi•i"='~ .~sl"-~l'Qt.9t~~.-.~~f~~~§ui~t;l.ti7,._ ·

·A• . r .. , ... ·.,. ">·· ··-- :

l i l '

.S 1 .-.;·.

\

\ \

.. ':..

, "!.'""", "),· ", ,c" . :. . . ' • . . "i · ;" ~ii/ii '$}~.G- ~i~•ll!W~~s~mnhf,O; . ma,..,li) J,"~~; fo<\jle ,\< .-.in1i~~ m>llio~~\'il•P"' fi itl@!iliF!»~:~-~ln>";llm ~-~~ all• J>'l#~,.i!!fiu,:;i>!.p"llit'llllll•l!"•bli>C•;sim\'lrll_i'< p~@~*-'nd•p~;~fll ~·~~i"'\'""de~Aaiil~ien!ul (ox,l""'l•lic<ln de;~ulo:~re ~PWi\;m<>llificOfl1n~}~'~£:~"'~ - ~(!e.<tc~ ~~"'p~;pd~e~~1ftpare;1de .la sym ~:in1pret1na~·\llp~e1 n· ~ u k'ldt.l) s~nt-lice.l~anifestlilime h : lii curet\ oftl·in• ti~'tt.lrfind 1q;~ft\T4rl~··· ·.a~~ .. ·\~ll!~oltfai"~~i$l:sgn·J:1~p~rientinte d~ca:Gescn·" 1n:nlve~:~(b~V~iel~!!Wfi§~1lte~c·~l:iniql~n·dli)ut,tfit\ir~. idli_,..,\..,Wi~~··""'"""<l<ofdeli'JC1Joclc$eaUI• .j sii!J'tW'~\\~4;~~ IIP'Pl!•U>iP'!""'l•="'""""~ Oi~ (gr. ·Y~ · 'ti..,il:<\""""'"-~~plu;.OO.epP• nii_M~~ . . f!e,p~~-JI!"!'P.fliiaf!• )Aironf~' ,;...t s~:~R~til ~~i~!lnl~p,lll~t~minfl~uo"~~dtprnci]~pres.iv_j~~~k }~i <J!l'!'>d!l11'll' 1-!~l~ ~sa a•bli n enoloJ!I" \flolnplil. ri$1;~~~01 ~~"~ti~.aip"""i .,a.~m· •u•• ~u!•~!Pll'li!~~;,.pl]le1lf~ deSpr!!~tpe\1~

· ~ljl·~ ,.,\olil~""'...,..,in'ttl>Cl'ln""''"'l ~e-~drom ~· . eel d~ bq~tli~·~i }lolt1$ltl (1994), 'l'li&,tnmentcl~ e~~·e~vi"l.en~l\ · dlf:ect retl~1~ere~ .~¢'siorsniDnH7estl\ti ·flirli• a .scl\inlbaJcno'i.~le l:ii

·. •·•· • , :·•· ·.'· .·. .. . . . ... . , .. .. . . . . . ... · .. I •" " ~~~u;sn"te\~: oal:~. :\e .. atk,genotllt. strnnn~esc tr)atumenre

uiii'PtQ~Jl~· · · . . . . .. . . . .· .:·[ c • ,,,-.9l~ll<!!'B>l""'"'";.orolt1ai!Ol'tlfl'Dct1Jrif"tt'~'"~icl <~ll},l~iicVal~¥~1~gl'}, dlptmir;:rii fiiJnt~~iJ"ftplilttaslt6mdasifi'?"re'n~w~ag~tilf~(!t~\~~elibll,gi~i. . Dpp.l.!Wn""' JM.<>i¢ • elosiftol'Ji>~ ".•lSg<>iii'~~ ugenli .:~nd~g~·~j~ t.~ rAndul.;\DT& ':A'ge'nt1ieic!igoni•l'IO£ 'sli'Ji~ '!1zid • (ex. ;:mf!(!AJ'li\tt~:te,:Ulici, electrid;· ptlfi 6n~rgie'rt\dilinta•titc"J:i dt in1ici (<;1• ~·"'"-1' baoci ~·"'!'c). l>i<llois'>:l{e.l 1!Jili*;' .v~ .•<•iri, ?11~fil7i\i;;!lil1~1~\;di·f8r~t~t:m.'la~t8~o1~u\eorgani~~~f~')$tlis~ho: : so~iaU:{e~.;-str~l.ll~ l!.~tl da:matamul\nl\tos) .:~gcnlu;enl\ogel11

. a;eJt.•f1lctori genelici) pot n oonsidern{i primari. ptpdr{d\nc\ di•' +verse tipmi dennomalii eTedit.'lre; in ult~~11!i instanttl d~unt\n;;fl·

53

_ _,

..,•.

.. :

' .

. · ... ··-- . :-...... : .. .

55

:":,

.Tnlr~'1!~n~~t~ .. ~ol~~~;~icaleputal£e~eti~el~tihP;~t~genetiea)., · ··· smn Uri dO>~~~·~ :lmt~llft"""·ll rue~~f~~~ '!<>l!il• deooreco:

~Je ~~~zli.~llislllle~J,;etip~gi~ ~i~rol<l'lnlrt~ (rele . . Piir<iJi~Wotil!!>l'!io~oi ~n.~i)reJe,sill1!)tomarire ·

· '''' ?n sti,li~. ~iu~\za1tr;,litle'a~~a ~to1hl1or~~ de-n ·exi~ta piinii ciind ....... , ·•·

1~1~ ~!?~fbi~lJ~9~li~istmrett.tn1~rrmtaif.~re~~~~PilffJ&I!nerice Silll

[iilnii'c1tnd. ~~-~ul c:Unic &e-atneli"l9t'e~~cl\urmlu-~. a .evolutiei

'ri~tu.ili~a~Jj()~Hf :.) ,,, . . .... · .. · . ···•. ·.·· ..• · .. ·· ·.·.·· Jn'Jjllz~~Jtll:~s~utia-re;mnisus. ~'clas~can;6I,.l'91 em·istic ;Oft.~~~~;~JI ~,a~iji ~David. :200j,~>J\c~~,Sr~~i:,1llkifJF~trA: consitle~l··~i·Jnillt,n•(!!titew:iul •··•eti~i;'itt"Q~ifi~~·c~l~l:n.itoi._;~fi·ne:lltli·~larftJtQ.lh-a·ra.inenteJo,· •.'' L~ilt.o~aii~e Q{:l!'l~~fl1.ot·bt~-!fie'1icate penoodj.Veii;e cnr~gori i ~e

lf; :;;~iJUJ~u~Jii.jz:F:V.,;~ .. ~~',' ::;,., ;;t, cyt;.• ,. . i:<c<dl;~.··•···· ...... • .. , .;, '? .1 ·~liltlui-Jiii~·:t:ilfe oa11~un. tJl].)Joit eUn~:fonnat ftffi· selnne ~i

.,,,;, .+.J0):c;·•.· •. ·. . . . ......... •··)·.:··· •J)~!(. . •. ,,... . . .· •.. · .• ·• :; ...•..•••••••

. ·<n~~!Jl1Ptfil,.tlfetl~t~a~,~~ii~B~#;~·flcaiczirnpUc1i'(h~~(Dinanr .;,,;.,1~~Jm.-~~~Ja!Qgfce~.n'itfmente :.;~~~ ,,, ~IJI(id~ii!l\lltdoar ;~~~lit>eifi \in' vj'~' . . e;;;;.;;,t,blmoluf~;TJibi,.ilrilc

cnr~ au un 'l~hl~u ·~It•J.c,c~~~t!tigll~,deJ;,semtie ~i .· siJ11ptome .. •... ilP~~hoiogi~~f.iltNtt•n't'ii~9nis!l:l~.~~tQgenetiOO;tomati~~cgsirll

i·:f '<· .... ·• . · .. .. ··• •· , ., ,. •vt ... ,,~~. •• ; • ·••··· ., . . . . . ·.· •> .. ,.,. ... .. ··J·l' UJ..·•PJiM~lr.liln~~~!n· ~t~~1el1~~m~dica;li roh.d'• iliagtto~~cului . ''"~Oleo~ ~!l~filisiho!<>gii~tit Jlj, atend ·.··· , ':f~:~ •• ~~;r~~(n.~,.~.,..,.,...,~nt»:- oil

~.~lnpriililit~~J\l,9Ji~~~Plllbolag!li(fn:.&asrn · ·,"fl!\~.l!Jllaml<Dlii~J~i!•~!o~;~-&i'!!Pl!llllllfie :snttji&riiaf ,1,~~ ~O--e~Jl!¥t.m~c~oolab!on _,.~~~~~.::=.~cr. · ~~,~R~.,..~., rn•ii>lst ... • · · ·; ~~<po\md)bg;Jo.Wil£dll(u.S~;np..,IJUllicc;,a<ijuv~l:elor

'•>!(?)•;•)!; ...... ' ! •• ·'· •.• ,.,.,,,.,.,,,:iil~!;.: ...... ,. ·: ... ~: :mecllf:a~~~~!Jltlnmfite lfdc '«l1lrot'tfi1j}o't.l HiiP* i111plieit~s-ernne ~i ·o: i••u .. ,.; . · .. • <· ..•• ,, "'•; .··• •'.· .... !. • ·

, .. s~mproll'~':S"lin'Uti~e>~hftt rt1~ea~islne1o. ~tiopatogc;rietice sunr • ..... ,. ·.:.!! . ··. ··.. .• '· •. .;,. ! • • • ! . • •

56

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1\dbui~t:t:: 1 ·."''. :I~ . sdihatr:l.ti)f;•:n.~

. [v~l)4f.Jt;if/ p~ntt~ , .a~t'~P*Yt-r 199-'fiJ

.. . . . . .J,•· .

..•

.. '

combinat. Adesea este o p.wvocare pent.fu psiholog a face p'silwterapjg_~~ ~c~tii. cntegorie ~e boluavi, deo.are~ ~ce~lia, nvaucl sirilptcin1ntologic-somaticli. nu intel~g gJar ~i.t:lt! flCceplci tt~or rolul factorilor psihologici in genemre:a d.; nce:;tlucnl aram .. lipsa tll1:~i .. s!-ll~ur1 psihologice ~i prezeota uLtui model"bi~~~~u.:. · col oitodox ~i puternic nu doar la nivelulsim{ului coJnuu ci ~i la uiveluJ. uuui segmentlarg de profesioru~ti din domcni\Jl sanatli(ii.

1.3. Rvlul ~i atdbufiile psibuvntologului ~

. Psihopatologul are mai mulle nltibu\ii (penb.-u detalii verl. David, 2003}:

(1) Diagnostic psilzologic ri tWaiUBJ'e clinicli. (2) lnterven(ie ~i tra.tomeJJt. Dadi psiltopntologul este

psiholog, fonua de lratnm.ent ulil.iz;aU\ include consHierea psihologidi. ~i int-er-veutia psilio~ernpeuLidi .. Ea ·s.e referli la ~ontroltil factQ,rilor p~ibologici impiica~i 1n boat~ ~i in optitiuzrirea subiec(:iloru~nani s~inato~t))ad psib.opntologul este psihirt!J.U. atunci tratamentul esletn prindputmedJcamentos, d~i mulfi psihi~td au qi ·co-mpetenta .in psiluJLerapje. .

(J) Cercetme. Sg,r!!fera la .invesligarea roluluifadorilor psihologicj lli. fizici impliC~\i lit sanatatf? ~iboata.

(4) Edu(;JJ{ie'-{i fonmu:elcrainiJ1g. Psiholog'!ll olinichin este ucellicentiatln·p~ihologJe .. ca.re.s~a speciaHzat *i l\lcread in domeui.ul clinic (ex. Spitale, lal:Ioraloare de SRnatate rojntala, orgmu;-;atii ~oa1guvemamenta.le). Psibiatml este licenpat in tnediciun ~i a parcurs 011 progrnlll de rezidentiat iu. psibiatrie. Arubii profesiollifiti pot pg_rcurgeoption~ programe defo~mare

. in psihulerapie care le:oferfi. compctentade praclicant ~i fonnator/ supervizor (pot cduca~i forma nlti pmfcsioni~ti) ln psihole.rapie.

53

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i

1.4. OJ:ientar-i tem:eli~ io. p.sih~patologie. 0 scut<tli inttodut:ete '

Exi:stli doua utnri clasti de orie.O:tad teoretice in psihopatologie ~i anlu.ue, una pslholog.ica ~i UJta \.liotjtedicuJn (pentiu cletalii vez;i SaUlSOll ~i SatlJSOU, l99.9).:l~dmn-orletttnr~ confe.ra p~hologi6i clinite ~i psJbotempiei rolul th:ilicipal in diagnoslicul=?i l.J.lltamenl.ul t'l!budiriloql~ihieste defioi~.ca fiinrt~tiin a cal'estudiazli factorii pslbologi~i in~Hnboala ~i'ittt~;ptindzareasutti.e¢\i ot tun:a..t1is ·. nto_!t: Dupii cum rezu!Ui lli din defi.nj~ie, ui1 accef)tptJ.te•ldc se pune recent :in. psihologia cl_ini\!ii ~i ~supxn pr.ofilaxlei ~oHlor ~i optiHtizfui iperfunnahtelor subleetiior ut~iiu1is3l•lito~i. Jn~cea.'itii diL:ectie psitl~l'."9giaclinica cun\rlbu!eln .furlli.~lunprt!':bnologli · psiholo~ice de cont((:Jl·nlsttesollli~ nl ttrtdrtJblceluri ulimc:.ulnre dez;adaptna-ve. de autoconb'Oleitlotionalet:C .• preveuitld imtfel tmbolu~virea.·=1i optimiZfuia· perfm·mnntele S'-1bitc~lot'!umani l.liinii.tt;Jl;i. Cele ddl.di· aspecte in care sunl-inlplicf!tifactori · psihologici,.curativ ~i d~ optimimf1Yprof!laxi~~.de.f111esc dit;ectiile 1najore d~ dezvoltare nlepsi.boh.Jgiel clinic\:<(J;{SJ,pla,u<'il eulaU., 1997). Profl.hmia (preven\in) f?oa.te .fi pdnuu:a~ secuitllt\~il sau tertiara(Kaplao ~i-colab., l-997). Plnv-etffittp.dil;Jad-:s'e referii In

:lntervenVa·care previne-insta1~ren bolii. Ba se adresenx.ti populnpei sanrltoase dar cu V\tlUentbilltal¢ Ja baalalji sc·iealizeazt~ adesea prin interventilla 11ivel d~ ~n.ip_ Cse.l~tiolit\t, comuni\ar etc.). PJ•cvcntiA secllntltll-K'se ref era ..ln b)ler:v.e•ttia =care are loc imediat dupil apari~in. bolli' t}i C.ru·e n,te en: scop prevenirea complicatiildr $i evolu{iei bolii. (ex.. t~duc~readaculuide su~u iu·lulburarea depl:CSivatnajota). ~nfia.fpliririise ruee,:tn caz.ul

bomorctouice ~i UriTiafC=?Lereducema c«;n11.pli~iltiHoriuouse de complica\iile bolii (ex. crt!§terea cn}ita\Il 'Vie.yi .. peft;Oanelor depresi:ve en tentative cle su!dtY_. Psi!Joterap.ia. ~te itilervenlia psihologica care vlzeaza -n1odificaten facto~il~r ys_il.mlogici

. . •, . ~ . '.~-~--?~:;:'";::--:!.:.~·~:: . ~ .. · .

59

imQlicat.i ip b0ala ~i·tle~volrareai{)I?limharea-personnlli. Cele r~~~ste 200 de !icoli depsillon~rapie snnt grupat.e tn trei traditii mujore c-t·l~1·g;n ~i Garfield. 1994). Elevor fi de&crise succinl in l't•k .. c ~trmeazi\ (pentn~ deral!i \'ezi D9-v'id, 2003; Sarason ~i ,"\,ll"LISOO. 19.99). .. : , > . • • . -

TDJ .JlJ,ordp1feflt1iiutrn_ic-psihtrm•lili~;i)pelln-u. yeralii vezi. Dav~2003). Gao pafn~hgtn1i.ce a fost~l~l)otara pomiod in apecial.c.lela ebsew9tii ~i intuitii eli nice, psihanaliza a abordnt prepdnc1erentiml*lcl:\llJnoon~liel')p,ll'Ji·MPP~Jl~tulb,,rliri1orpsituce fiip.sihosomatic~. Asumptiile fundnmenlal~;_a1e acestei perspecriv~tsunr: ··

1 ·. P.sil:\icu}·uman ~rc o-structurli {ljvelarn fiin:d nlcatuitdin L h-elcQmpQnenrs (n)ld-tlls~u lne(Ul~tientU carp funet1onenza

dupH .i:n;incipitJl;pllle&jifil.cart} contjne:instinjfteJe-namsrre sexnule Iii ~gre~ivept·e~~l!Jllli q,naul~i!l1edeiuforqltttii refulnie, asQ~_inte

· nc~~ror in:;tincte; (b)$go-t'l_ (Eu .. ul) sau can~rientul .care fu~ct)ona~z~ t19-Dli .prineipiull.1U\Utiitii. prindpiu en,~ dett~rmi~i\ refulnrei\ u1.mcon1ftit\t1t .t\ il~faT\llali!lor anxipg~~le cu tocardlrurli sexual~csau..ngres~vij.. Fl.l.n~pon!lrOD;~~o--ului ~lite constrfiosn *i de_<\ ~"e!4 ~roJ10nentllp)SupnJ~"n-{tl ca~e.cl)ntine normele :;i pr•ni3\Ptdet-u~~:ale ii:;ocF\leJn~Fioriza.,t~t de flee~ dintre noi,'in pr.irrtulri.\nd B\\·UQ'lltlrf;fl.•educ..~ticidin fa ~iii lle.

-(-2) Coq~nu\til refula.i ~Uit-ului finc~n~rienru1t1i) tinde ~a seexpfi!l1ep1enar.la ttht~lul Ego-ulni (Qon~tiem).

(3) DptJ§fjC}~pzaren .la niv_elul Bgo-uloi~ a n~stuj eontinut. ,re_fulnt geuerefi~illl'iirUt;· em(}\~onnltf'J!~miv,e (ex.nnxietate). oqnta. _generate . .problemele emo~i9~1lle, ijgo-ti1 .!lp~)Q{l:ili. }a meca'lusnl~ 'f.\8.: ~pa~qre · pen_tru a. qltwa coQ~tientianaei.l ·lor (ex. I-eprru;i~).-lt1tregul detne.-s _este.sinrerizft,t sub fonna nqa-nqmi{illui "triungl1i ~l.{!?~f!icrut~t~'~i(.vez!fig. l), element imparram din stnu;tLlfJ\ tQ.lbura.lilorpsihi9e Iii psihosornati(:lf. Ac6sta are trd c~mpon~nre: 4 reprezi11tlt cm~flictul-psgpriu-:zis • incon~tient. A reprezinta anxie::rareq gengmt.i de cpn~tientizaren conflicrului.

liO

f

I

I \ I I

I i 1

I

iar D ·re.pn!zinrii mecanisme1e defensive la care s.uhicW.ll

irpetefiia in scopulredttcerii anxieratiL .

A D ~·· · ... 7

v X

Figura L Triung!1iul c~onflic!:ului.

(4)Sim.ptomilt npare datodtii unufconfUct acfLiill, care sc: reduce def-nptla un confllctbat.nl din11rin1a copiU\rie. .

(5)ElimitHuet1 slill o.ntel'ior-aTea s1'mptonlMologiei sc face prin eliminare&/re:rohiar~a conflictului ·ac[unl. renli'l.f!ti\ pri~1 re2otvarea eonnicttilul~n?.'i\l cu njutoml. ne.vrozei dewnnsfer {conflictuUerapeudc)':Ac:eSt'demers es'l:e s1ntetiza£'fn.fJgnra 2._ •. unde Treprezinrl1 r(ilatin rernpeudca in care se manifestli nevroza de rnmsfer <~rentlt intenponat de tel·apeut). A e~re Cildrul d\ 11 vinta pad~ncululin care·semanifc:S.tM conffict.ul pr~zei)t, 1iu· C repo::z,inti1 prp.)lt\ copiliirie tmile se n1anifcsta conflict\~1 ba2a\: triut~ghilwile niici din cndrul tdunghiulni mni·e repn'!'l.ii1ra

him)ghiul conflictu1'uidescrls rnai sus. ' •

61

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' :. -

Figura 2. T~;.i.unghiul terapeutic

(2) Ahordanicuurwn.ist-fP.:W(~nfialis1ii (peuttu detnlii.vezi · David, 2003). Abordare{l Ul'llnRiat ... e;tistentiali5UI. porne§te de ln premisa ·ca palo.logia psih.icn ll~ _psilloson!aticlS. a.cpru:e. caur.01ru-e a faptului Gii expeci.eu~le. ne_gatiYe rle -viata b.locbeaza'~Ioqele''/ factori i pozitive/pozitJ,viGare sl:au la bnza!Jersonrllitatii uoastre. DJHIIe ace:51l factori fac parte n~v~ia 9,e.aulorealizare, apreciere, securilnt~. afiliece.. seusetc, ~colidifeqtc:fdin ace~stu.nbord~.tre. audat tloudereJnai mare unora din nc~tifactQri (ex.. nevoia de se.ns-lugotenipie; uevoin.d~.autorealizare~let<.tpla centtata pe: clleut etc.). Pentn1 a debloca aceste forte pozipve ~i impli.cit penfi-u a runelio.J;a patologin esle nevoie de asig_urarea miu.i context psiJwternpetHic caracterizat Rrin etnpntie, acceptare. nec~:m~litiul1ata.l2.i congruentn. . .

(3) A.burdo.rea cognitiv~cuntportcumi~ltalii (pell.tru detaiil vezi David,2003). Abortlarea cognitiv-conlporlamentalacon,sidel·a pwblemele psihologice ca f~ndrli:;pm1sud ~ezadaptative iuvatale, sus\inute de cugui~li <lisfunctionale. Pent\:u R \rata e{.icicul J-lfobletnele psibologice, este ne.ce.'iar sa modific~n.l comportanwnlele J?i cogni\Hle dezadaptativepdu telmici specillce de interveupecognitiv-cumpmtamentaUi..

62

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1

lndifemnt de· tipul ~colii d~ psiholcrapie, cmnp.mienlel.e l interve~i.eipsihoterapeutit.e suntaproxituati:v acele.nj~ r f diagnostic ~i e:valuare cliuicii; ·

.. couceptualkare clinic.ii; • . . • iuLerven~~psiholernpeulidi; • toate acti:yita~ile.aute.rioure se desflcyoara i.It cndruJ uuei

rela#rii de Up ternpeutic; ... p.reven4en redii:leriJor~ iJtU!.gistmt-ea1i unnarirea evolu~ici

pacienlului. -. 1-Tonle, aceste cumponente suntdescdseJ11 'lucriiri cJnsice·

de vsihoteraple ~i psiholugietc\h1icii \B.etgin :,\ Garfielt:l, l994) . ~i aeyndnr nu suntdetalin,te ni(lt. Unele dlntt~.ele Vl)r fi de.ta,liale pe parcursul ace8Leflucr3ri llLunci efuld .suntimplicatc innnalirele .flicute. , ·

A doua orlenf.sre teoretidi in psihopalolog~ este abordaJ-oo . \

biomedicala (penllu detalii vezl Kap. an fit colab., 1997; Sa dock ~i col.ab., 2002.). Psihiald£1. iu g.enernl ~i mai ales psH1intrhl biologidi in particular. suut pt:Gftl@tpurale plinclpnle nle ace."ite,i abordari. biomedicale, · d~i p~il~tria · qre.stdU.tse Iegaturi ~i cu ps.ihologia ~i psihoterapial Psjhiatrial .din punct de vedete etHnologic, se define te ca ~tiitttn vittd ani/a.m~liodidi

1 urlicilor ps nee tpsyche-su.flet; iatreiR.-viu ecarcJ. Abordarea bionledicaHi.consldera. di tabl(Jul clinic in.psihopatologie presllpuoe mec(lnisme ctiopntogc;p.eti,ce pr~omill.at soft1nt1ce; jo cons«refota. trnuuueJ.itele psihiatrice bazatepe ii'lodclul biomedicnlincludlJ.lltanlentul ntedicamenlos, terarie pril'rcle(;trol}oc $i alte proceduri meilicale. 0 tendiiit5.'itllpu.i:tanta i~ psihiutrin biologica contemporana este aceea ·conform. c~reia unele tulbudiri psihice (ex. u11ele tulbu.ran ufective) au. uu su}?strnl genetic,transnliS ereditar. .

.·lit ullimii ani' nsis_trun la ileivolturen lll Peneraliz~eu unQr lem.linfe integratiVe ill dome1llul p~ihopatolugiei, in cadml mode.lului stres-vulnerabilitate (pentru dctalli vezi r<:;aplau ~i

63 :T".

•; .....

c~li\b .• Ul9V; $adeck ~l:colab .• 2~~2; Sm1tson ~iS1~nlso~~ l999 J. ·· Confurcni"lc:estlli ;Pi~t1~l. f.a~to"Ei~~psihol{lgici ~i cei. biolo:[~ici au acela~i statllLontolop.k:ca:ifi fuetOli' efi~ldgi i~ 'pai_olilgie. Ei nctronen:dt inten:Iepenllcnt in de€:li\n~area· ntlloillt.W clinic ~i in consecintn tratamelltele tt&bui~' t~··ne c~nlplexi~~; incluzfind . pr,qt;~du(i,me~icme · ~i ·t:lsiflolag}ce_ ;1mlbal.e.procedoli AV.~nd aeeln~i stntut. ontologie~ ne,i progresisre~:~eeato reqdirit~ i·;l·t~~

. ·~9fi~et!Jl~i!P~n~~ d~0c1frt1dadi: n\lmai 'elir~' })sih&tbgidi ~i · medicalli ~;i 4speetelc teol:"ericc ale disciplinei. prat!tica'cu~enrl\ 11~expd · d~!!ll~lt ~~d~n~'ma~.es,~01Jtcru,.:pllQmQvi\nd•lln modi!l

';··;~il1il).. ... '··'· ~ija~~l~1~ .. ii.t. 12en~b~- .:Sit.~~ia ··esre.·simiJarat. •en

·. ,:=.tii!~~,.ll~fQ~':~~-;;.:~~g~ . , •. ,D•lr ~~d~iteei*n~ 1,iL'i\t.\'impnl'{rt p\iterea ~l'n 11·u1d. egul .• Zeus a

rltmns stftpiin !·~ ' .'

•· ~'.'~C~!i~8it1Li ···s~gcTBJ~A·~Nuk~;~~nm· ml:,.~Az

i''' ; ~"""-~ : . .:':~'':.\~:· ,,.::_~.~~-: :-"·.-.->'·- -- .- - _-

···;· •••: ~-l~,~!.a~g~Qst~J~· •. ~l ev~lnarepin~cil ·.

·I>b>~~9~~;~l;(~:·~~a~~~~l;o~-oa~c~tal~ d~·~di~ri~~~~de }1~~;~J'}-j1~!~;, ~N3~i~:;9"1~q;~!lter~) ef>tl!·'' din· • pitnc[ · d~ \t~dera •·•~·~IT'r}e~~?·.,f?,&,f!.t!~~ll~~·~~~~n:~aa~~e: Psihodi!fgrlosrictll•~:tc?fem

.. l~.C,LIIle~r~fCI.l rJl.pa;ps\~PllJgi¢i·ni>$J~jeetnJui•umill\l~i\,.18sea

. J~}~·:{~fe~il~t~ .. ·· }i d~~fFr~~ np~~lt~(i •• :esiho~ingnusrict\)itJ]hic ... ~~F~~~~~~l?: .;7 ~ ./,~PfQ~Jor;;~sih9l9gi~i cu reJ,~;vantn ~~n~

.. ~~!ol~~e~Jrac~.~J~e:.um;ie~vot;;p,rezenta.doBrmot:Jelutprotottp ~-,_~_-----~"'.· < :~( l/-."·:;,, )~'(. /"''' ,_.;;_•, .· -. . - ' '. -. _' . -"':"- -

. ··,·.it' ps~~odiq~osti~nlLlf r;:linie -psi4Q(jiagnQ!!tic't:lini~ rio~otll~c .·._ Cgr~ no~~~: :rail: li.cidli\l,~:~~·se ief~~;ittai,meatruat:eir!einsificnrea · , ~11ilil\1e1orp~~i~J)~ij\~' tnrr7o i\nu~nitl categatie det81lbnt"i\fe

~" . ,~-' J t ' :-;. -->·· -,''.' 1 -- -- ·'• ·, i. --. ' - . .., - - ' . '""""'

•.- .. :.

·----------------....... ~~.

psif11c·a. (penti'U dumlii vczi Kaplnn §i colc.tb .• 1997; Sj~dock $i

col~6.: 2002). M~ntlonam-ihsi faptulcii in fm1clie de Oflenrareu teoretid din psihe:patalogie existfl·. ~r alte mo!dele_ de psihodiagnostic clinlc~ 'Spreexemplur, tn-esfhodiagnosri¢ul clinic fm)clion;tl nu sc urml\t~retncndra'ten problemelor pnoientuhl~

. rntr-u categorie nosolot.rica,. ci ithmtificm·ea ·tJnor fndon . psibologic:i. cognitivi-eoJrtpottiUnenta.l:i' (ex. srimull; frttariri po~tive etc.) cave sli explioe;problemele 13aaientului (p13t~l'ru tlemlii veziDavid, 2003; Satuson fti Sarason. 1999). ·Mt."'dll) in

. cal'C sc s-enli7.e.~?:li <(l~~i}to)ili~~nost~Clil·:~~i,gl~ nosologic face (Jtdectultmor ltrc~iiti.dereferin(i: (l) OslVf.:..f:v (APsyl\.. l 994); ICD-10 (0MS.l99~);S~ (~h"U~t\'JrBdCli~ic~lJA,r~rylew for

bBsMtJIJtenlhii'C1iWi~ SifticttrTift'p~tfli J:\~Mi Spi~\~ ~rfoluh .• ; ; ., 1996~:~ Sugl}e!fntl 'Cititiil!i.tli'lt' sJI' 5C!Jn~~t&lill~~~e l'ucJlri· . ~nl m

e~ii'; in' .. uo ,'cd t1rmJin'i' . eSOEienr·cUl'Ar JSuccihfs~Yentele . ··· iaftnte~'l"rea · nm pst 1 i~gJ1listiC,:i:11Ij~clj1o~o1il. gic: p . ··.. . ···. < .. · ..... . . • ......... :: ~' < ' • ... •• • < . . . <

:, .. 'it' •FPttrt'inf6£Viritc ·.· .... '~~teStareapst~Q .·. gls~;;e.~~!i3~a:z .. intt\ttftttel\'fo~ble~elilrphilieiltulur .. inn'-o'.annmitli(~~f~korie

•; n&Y;eJ<Jg1cl\'lfaiete1T~ili]jescrise mai,e-s),: ·. . ... · .. •· .··•·· . :/ .··. . , • · )· .. ' .. Pri•i eyallil~rg;(!Jifiica (fazK ~J· s:e partitiiltiriz~nzn. detali!az'&•'r~shiteti~eaiit'da:ter~·.cules~ tn· fnz~le 1. t~i * pet~r,:,.l n

· trint~1e~fi(t\~hind'd1naiiiiea·fi~iirl)f in~i vid~ d·ino~ld d~ c;:nregori~ .niSsnlogicit rn···carea:~fpst incad~~te;'til·0Hteinel~·~ld,.De a~eJll~Jneit1~ a•ici :se descoriipnrie afagn~sricn'l }ti'ti~9l!lgfc. in

· p~obleme •. co~Cl;ett\ de viatli penitr~fiecara Rtie~¥~·r: .1\.~a(hl:r ~t{n~ blte·iitmal:Wjmupu'ne~!8lfft1ai(Cimincilihllsc~t.nelo,·

.. ~{si:tilptoljlelti1!)~slnrextti (~tabllirea•~ateg(}rtel \\os~T~gtcc l > an\a•U%ii>(d~suompunerea•diiignbsdriulUi•l'rtJSologictl~ prd!)l.eme

... c~ncrotc:d~vinfa)o~Li:,:.Hi ;; .' .. ' .· . ..·• 'l:;,•c.(·.: •• ; ..• ~Il; Faza llntervinl i'n€epe.cu O:ffis~upe despresill~~{ij care i) · p~tr J!le pncient intr~o••pozi{ie confortabflii, de itl'~t•(.tuere ~i !tgnrantn. Aceasra·dtice la ·detanxi~tllalui• ~i hr.;~~~libiliratea de a intFa mai n~01~in comimicare cu cliniciannl, De aseme.nen.

65

in ac~stli faza se inregistreaza num.ttle-~i prenunieie p~cienLuluit . ,Yfu·~~(t~ ~~~~?~:. ~1apo~alitatea ~i-~omicilil!li u~e.Jlill~~tede~~~pncJel!lf::sa~;~~H~Etillaton -ln~ cazul ~.t.nm: tulbur~p.~guav~, Sf.J.U a. COll,HX e:npiiaza ~i motivlll trinutedl. Spre e~~\plu3ii CJlljUl

... uttllf~ 1 .~~Ua.fizici. am iu~eput intervlul c:u discutii'~re prruuU~~ua~. proiecfule·p.e J;ll.t~J,f; ~~-~bu~~~~lA\'S:t;rl\ill~atc prilntteeDat::iilerapetitui do:ve~~ ~l~q~tinte lllido~;netiiW. de itite~1·~t.'pacienthl;':J,l.qc~nsia~~l:l~'f t'~llbibui :ta dezvol~area poxili~l'i~mai rapi;dqJ•:-~!,tj,eJ ~~Pt;u~ce. Nu insean:U~ti. ca treb~':~~~t'' e?cicl~·-'b.~~~!~¥nat:l?orcli o ev~iafuaUi preg.~.~g,n~enoadt -:-f!JC?atu~:m~~~tn cu cu~evoru d1s®llls-ar}pl,i~~a-.. sn fl~ ~U:llTB~Ulnl a,~~~~;:);~~ raportlrelatie C~lllCi eficie~J~~-:'Apoi, tJ.rep!at1• se. v~reazll ,ff~re. obit;ctul ten1piei, "1~~!!~~~\~~~ ~1if#l4~~~b_t~t~~tf~~~,~~~cteristici~eri~~ la p~~~t:!:~~~Jt~;. pac1~11t ¥'Bun, bat aC;J:tm~'lfne intonrcem pU.liu.l~

··pi0tikrile1ei1o~l:l~~lfiiai;:aims&~:-· ~ ·· •us u ,ce, ·· .. · {su arlt a .. i _ .. 'ft~t' ftebcmfi~ _ .· puL Deci,ce pro~leme. (neca~ti)'~uni:,~ ·ce _te,:~up,li,:l.;t.· ;,;J.ieazii)~!':,·,i!~;~putinuare, intervi4l trebuiesii,vl~ ··

!rl~<;fiere~.t?lruilasimp4llll3tpl~~~; •. ___ .---'-·. ; 1 _, :;,,;: ~~~~~tul • ~t~!~I'-~M ~~~~a; ~~tl~. dlnd a\t' tl)tepu~~; de

cful~; ~u .ob;;:ervat aceste modiflclfrj'l; iu~ittte de Criiciun 1T' (ilit c!J;'t~l•lt:it~ pa~iet,1t~J a~ c1~~'!!tii.$i i'1 !'--:~~ ~~.a~i(lti, ~~utul, esteaju~at cu anrorse~ Craciuri;'i~~tlelJ1a~terle"?tc;l~ •· _· ·

· • a).te 'bolj .~otl:l£!-~C:~ ~ilu p~~~~.Jn\ernan··anmttoare; · .• cpndi\il social~;;eononti.ciiititif.'~muatii familiale,silun\ii

su-esaul~ .. ·,,.,. ·

} . ~a\ s~.~i tu~ ac~s~fK'!F';:. 5~7~~11.'?: diag~o.stic uesrlogi~ • Jpotettcl ~t; Ide91J,ij~~J!· ~ntnl)..l!;,.fO.~fl Ipotetici declan.'§aton,

tleLenuHmti\i, favodU!Jti.·predlspomnli Ji de meutinere nsimpt~r . mnt.olo. ~iei.

E;c\e~n lu Tnmurar:;~ de, ~~ll~·.cu. dispozitie del!Ju~si::va ( c.qle~c.Jpe: n()sologica), f'actori d~la-ll:p:ll2li (momt(!a n~mn~i),

' "· _/: i) \ ,, ',':, . ' ~ ~.

66

I

\ I.

factori predispo.x.anti (persona.Utate · depeude11Ui},. fnctorl fav.od~antL (pl""Oblcmlele fiq,anQ-ia,r~)! ~~t::!f,)Q; ~~ .• ~l~lllb~~~ 'c_'rinat ·ue::ec::tii16ni!~~-·.rtn~teH'fi)t>~iiti~ia·~~1I'"·' ~~·:~:. . '" .; ·· v~za·u.ttirm\~d.oualdutcivitituiurnJsiio.ilive!dim:e. ·dete,UataA.~'lJllJl.~~,ent\dl'i-!Ji-oot~Y.ler;Jpslbiee~,,lt~estigatea prin interViU trebuie Sa fie dublata de o.;~-1-"M~tiga:~~o)!)jeeti.va prin teste--psibolo~ ncoio~unde ncest:l~c1Jlt .•. · · · ~~i!~~Un exel\lplu schematizat d~.~~,g~ care ttebpi". ln cursut itttervilitui ~ites~~J:>s~h'!l~Jilce ~~ · · · __ .. :l!l~ pes,· est-e prezentatltl "~~ 2(p~ptlttf{U _ -·IJ.t · i~sqw; ·. Spitz.er l$i colab:.,J~~~~t;,.~~~q i.faze, dlagllos~c.u1 nosologic p~l:~Jmiu~se~G~'1'\0z _ .. , • • . I ·

. Fn7..8 m. in f~'\att;et~~~~~l~~!dltJi\rli clluice, Becpo~Le tt-eee ta 0 inve~t!~ii~ i~~~ 't!~i~ ~lzeazli su~rin~rea stru~;tmii ~i,dina.Jilicifinflli:. (!ientului. l.care 9feri 1Dro · · :~,nteletf:outiJ~(core

p d'reli~a ··

1 cme catege;~;ia; neJ~et~gt _ .. 'fl~'P1l~¢u nn~ . . u pacientuluipe fQ;\il Aiciseate.i!t~ ··· ~aluarea psibol~idi detalinta a stiini'w~t~ .u :1~:¥~~J0 . _ 'i a Inodul~Jiin c~tc se ndapteazijl~BiiDJ;l@~;~~~~~~~'?~~'-i.E!i.~,~!P;?~~glLefo.: ~;unptolnati,~. a si\t.uatiel·s~li~ · iate'·a'~~ietttu.~.ui. o din~ljcii~i~~~~~!~*·; · · ,.R:~,;,., ;,~,II~!\i:~t~~er-pen>t>,J]~!~pllbCJ:IJ~~~.m~f,,.~. ,~;:,., . rnrs _ . e,afun9,tulor :;;i.i~~~m·i~eu,~,,f1:1)1~~~elQJ7~er~ns,vel3i de ~OJ~i1..1g pr~um §i g c9nfllc(~l{)r. ~!;W1:1311li~~1or;,a}¥:';~~~tp.\ll~::~ .. ~~pll ~~sine, a iQtel1gi:!0~ei, a· Q,~ifitltti}ol:';; 18: :~~!ilt~D\el, a· uetemltnafl\ilor

, .~~i@.;§i:_situ~t~iJ.orc~reQ~"·~Yii\a.;~jp~blemelorde ecqlugie · s-ocial,a.,:;j familiaUi. a cunt£-(;)llu:lui 'ii autocontro'~uluj compo~,~~nlultti ~i emotiiloretc.

. · :t.a sfat~itul diaguostid\rll ~i evaluiitH. cliuice nvem .nUit o CQt~gQ~UQSO}Ogicade diagnostic Cat ~i J_latticularizm.~n BC'e."Jtein pri!i ~{lfPri'Q.derea (1) diuamicii indi viduale a tnl~ur~U~l~~!lll

,'., .. . . ,' . .... ·· .. ' -~-:.:~ ': .;, . . .

61

_____ ..... -.- i -~~--·-=·--..z_...:_.,~~-

'p'ati~ntt~hit ~f,,ll·{~),P;~Qilttll:ui1•1.cnre c,~te~ori~ .9~t?PlMiS~ "se ,,~xp~-i01a ~I.j?~9~J~IJi~ .C(\n~ret~: pe :via tliJ~e ... I'Itrtl fiecar'c:q1aciimt .·,~·<··~- ,.,,' ' ~·· '·'' "' ··''" ·,.,,,. '"' '·, ' )•- ,, - {• -- ' ';' ,,, ' ,, '"' '

·• · ··r~;~ • 'I&Jiielut~llnn1m1~l:sdlel.1lntb: did·nvesdgllj.e a&i'llOllti:\meutulul ·· 'iJ'A4fnnt¥u•()rp$Otkt! · · · · ·

68

·:- .·. ·. ;_

~edlotfaJ. •. •·R;~y.c:s;y: .•

W;AJ~·i· (Proba41l tl\Cilttotht)

. I

I 69

gem::ra simptoq_~~t()logia. Spre. exemplu, dadi modifl~aril~· · benigne-ate 'fitih:tihii cai:diac ca urmare. a unui efurt fizi~ sunt adeseailit~r[:mitate ca.senme nle unui imineutstop cardiac sau ·ale uuei boll severe, treptatunii diotre uoi putem dezvol~'ailic de panlca satl nevrezii ~ardiadi. C~racteristicile esentfale ale unei concep_tq~d cliltice eficiente 3utit:

~ ~a h.e acceptaffi de pacient; • sa ne ajute SU CQUCeplualizam teoretic problemel"'

padentului. lrnnsfonnliud incomprebcnsibilul iu compreb.eqsibil .. .

(a tat pentru pacient cat ~i pentru psihopl\tolog). Acestlucru J!Sle

similur cu principiu1 lui Itumpe!stiltskin, descris de nQi in introducerea acestui volum. Aiadar-, dadl reu~im s~ nuiuj_m simploniatoiogia pnch.mtulu.i, sa 0 iitcadrlim leoretic, ea de~ine nmi comprehensibila ~l illi pierde·o .Pa~te din 'Tor{ a maleficli";

a~ sa sugereze exis~nt:a unor t~hnici_de interveti\ie eflciente in reducerea simptor.hatologlei. · ' ·

·_ Deci. a!la cum se observii, com:eplualizarea climcanu este important sa fie adevarata pentru a1i utiUi. Pacitimtul are nevole de o conceptualizru-e cru~.sa-i explice shnptomele lli sa-i sugei-ere o scheLt15~ de tratameut, nu de un adeYar ~tiin\iOc; in ac~le condi\ii. ctmceptualizmea clinicl!. esle un mit. in mitologie, nt~tul esle definit ca o. naratiuue ttadiponala emRilati'l. de o societpte

. prinuti"a imagi~1fuldu-~i explicarea concrcHi a feno.menelot ~j evenimeulelor enigmalice cu e.nracter fie spatial, fielemporal. car.e s-at\ intamplatln existenta psiho-fizjca a umului.in natura runbianlll ~i in un.iversut vizibil on nevnzpt; aceste evenhnerite stmt in legatudl cu destiu~I.condiP..ei cosmice umane, dar omul le atdbuie obar~ii supranalurale dalftnd din vremea creatiei prin10rdiale ~i, ca atare,le considera sacte \'i relevate strfuuo~Hor arhetipali ai omenirii, de fiinte.supranalur.al~rn clipele de gra\ie ale inceputurilor (Kern bach, 1978). Adaptaud aceastii defini~ie in psihopnto'logie, mitut cliuiclternpeulic este o conceptuali:c;ru:e 'din.icadespre care uu ~tim dacli este adevaralli sau nu. Caud:

70

\

( e,'{. se face o lista cu pf()blome concrete de vi at~). in functie de. pacient ~i de obiecLivele.letapeutuluL(cftt! in[onuaUe considerii l:erapeutulL-eJevanta pe:ntru tmlnntent)~ ~tapa de diag.; nostic ~i evaluaoo clinicii S,~ poate intiltde iutre J-2 ~edin\s. · l- ·· St1maridlnd, eta~a de diBgnoslic 1i evalu~re cUnid\ 11resupun~ urudiloiiL-eleomnpooe.ulepriuci~e: - ' -

- · •Identificarea· senmeloc :Ji simptomelot; • Istoricul tulbuti\rli; f. • ~toria pe1-sonala, sociaUl:Ji medicaUi il4;:t12itilui; .·statutuimental; · . .- Formulnrea diag•ulsticului uo.sologi.;. (DSM) :ti

concluzi'upr evaluarii clii1ice.

. 2.2. Cenceptuallzarea. clinlcli .

~~unlizntea (explicnrea, iuterpretarea) fiicutii tnb~oului clinic al pacientului este fu.ndrunw1tala lu reducertn sitnptomatol~ei (pentrti detalli vczi Fronk. .1973). Pe lfinga Q

ronceptualizare genera Hi, fec:ali~aUi pe cnlegE>.cia nosologici in -~are se incndtea"Lli. tnbloul clinle ».\ pneienf\luui,;pe parcursuJ trntamenltl.lube fac conceptualiziirispeelli~peutt~ piObltnnele de viata.specifice pritt care se exvrhnii diagnostlcuhl.osologic. Dl!!ii conc~pt:Ualizarile generate fii, specifice se.lae in fune\ie !le angajamen.tul teoretic:'al psihopatologttl\li (peJ1tm delalii vczj David, 2003; Sarason. ~i Snrason; 1·9.!'19), s~ pat evidentia nmunite trlisaturi cbmune ale acestora dincolo d:e acest ruJ.gnjmnent .

Astfel, o lipsa a une) cenceptualizari .cli11i<te sau o conceptualizare clinic a ina0.ecvati4 uegati va, poate.~mpliflca 33l\

genera sirnptomatologia. Spre exemplu, da~~ modificarile benigne ale ritmului cardiac ca unnare .a umti efort fizic sunl adeseainterpretnte ca semne ale unui irinuentStop cardiac sau ale unei.boH severe, treplat unii dintre noi putem dezv.olhl ut~~c

' .. :

71

. . d~ p~!lf~i s~~ 1\~W:;(ezi\ cardiac~ Oarnc~tlsllcile ·esentiale ale ~ :~: 'tln~i ;Ct1IICJ1Pill!l~i!aa£i\e:li~tice ~frciente surii: ' .. ·· ... · .. · · ·. . .... ,!\ '· • ~.~~:fl~·~¢~~fitatiideitJif~1enf; •. ·... . .... . .

. · .ll•¥n:: .•. ~-. s~ :mh'aj~(e~sa ~lln~~l)~ali~iin-l.~~fl~t9~1 ftroblemele• ;, ••. :P~Pt~!lt~l~~. ~~·~'-!'~~~ in~ll1pre~~nsibHiil~1it;~~~l111ensibil

. · ... (?tntpen~ .. ~ci~cAt~·pcdtrupsthqpatalog). A~El~cm estc s1milnr cu ·princi~iul ll),l RumpelSoltsldn, descris de noi fn i~troduccrea acestt~i vo1um.l .A:~ildlli,; cH\~ii' 1-uu~rn. sa numi.m Slmpto~~~wa.;g~io)\:ll)lt~1 Sit 0 mcnddhnteOr~tic. en: devine mu~ 'Cti'ii\prebensibtla ~j~i pierde 0. paife din .. 'IOrfa .;,ali:l'icli''·

"s~ su·o:&-- erl ~~ ... t •. . ~·t l •· ··•A · •• ··• .... • :. · · • • 1 , }.:.> y\ 1. .,,r;, , , ~~o;;csoi"« ~ .• s~,a?~()F. Mlll"Sl ue-tnt,6r-yenfl~ eficterare ·· ···ln redl~rea.stmpto·marologU!I.; ,; •·•· ·•.;·.· ·· ·

• peci. ru;a cum se observli, conceptualizarea cli11icii nu este· nopo11ant~~:f}~ att,eYitT;;lta )?r;q~cfr,!l:ff:t•lili\'Pacientul are nevoic de o coneepllia1futtecal:eslt-ie'xplice simptomele :;i sii-i sngerete '0 ·s~~ll ··~~ ,:tf~tn'!~l~~',J"IU;::~~LUI) .,s~!!~E. it~ii'fl(ii.fic;in aceste

·· : ;· ,,qOI)~~~.'l!a'.~~~ti~~}~~~lj~1~' ~ft;.·9"fl~itl,ffiimitOlogie.' milld . •· . . ·. e.st'Q:defm·r4l 'L:tt o n.a~(li;1ntH1:ndip onalli enll!na:l!l• de· o saeietnte .. : .~ •.. p~tivl n\la~nfi.~?u;~~e~pticaroa 'C~nc,re~~a~enoJmmelal! ~1 ;f} .. ~·;,!i.~'?Y;!.mente]~J:E~m~~~t;~··~~.c~t~~ter ij~spatj~;jti&tem}lornl. ~¥'~.1 ~·, .'t. , in'tftifitll~~'f:'tn;~~t~~ ~~~~l~f~ei<lli~ll"!ulu·i~'fn;fialura · ·:·,y,, .... · ~1),.. .. ···. . ~~n~~!¥~p~t<Vjiil5il,c).,·i-lu~~,z~t;::~~s~el~v~niitfente • i c,~;;·.~ll"'~~n'itgl.'llli\~it~[ifnf . J~i~i9.o~lnt~n:m·an~; datdmul ,~ , ..• 1~ .. ~1JP'l1~iex,.o?ti'~if!$ri!~ ., 1 • •.••.• l~~~~~~nd~.~~c;YtrftmHa· ·~matjei. . . •. I~~t~~"t~b~!flif.Ul~~~~~e·~nsidtfli~!lf~ f1it~V~~s'tmt1UYi;ilOT , arll~etpah ru-..~mctl1ff1. de::fiutrlf s_tlprnnaturaletn;elit~lede grn1ie . ale l~ce.put\rur'llor:~K~rntiaclt; 191&). Adapt!lnd aceasrii definitie

in .P~Jllopat~l~i~,-~,i~~~~~i~ic,~~~Tap~~t,i.c~rers.coQoeplUatizare ~l·J(»,~~i!tlil'!~ •ettl'~ 11~l -~t,idt-dac]t. ·c;~~:it{iJ~'l~taUhsatP ntl.

pal,J~~,t)ll~,tt~31iriatett~lini'Bii se dpve&:t~te a.fiade~ll.nni'::- t!e ~ 0b~,aa~1t~9rii.~Vcl\ti~nte·~fiillpfic-:-· ~ffl~~rpo#9~iltii~l~~r;n

~ .. ;,;:Cll~l~~·•;~f;l~Dd~te..~q~Ult~de explh:a(le pJi~j~fvf-ernpe~l~icl\. · · B~~~. n.t~J~'iW~m_.s!l i\1 fac:em pe p·acient sii .acc~pJe,c.a -~i

+····· ·•1t~i1eeptll~'lli~iiri'Clinice ~d~vllllll·~~in;\l~5 •. nu esto·;~ ~n,g~£\ic .

Jhit¢ril\CDnSti:ili UUI\ilt:cli~iC C~~esa'in(,;leplil}~aB~~i"fl\llC\iR de · .;ttinuepn1nliwe'c1iHitlr(~~; v#~fup~tul~pli~ati~~JcJig~onse. 'f1~ihilnalitic~ ~t~;!: .~~!:_ fe~~trn~ .rr c.~~~. ce crede4,I0>1~c~~,:~ SiJ.n1und'fireud~ t\uatl~~~~!\11:~~ eltbt!~;a~a Fe.bo]f1a'1ul ps1h1c ~~

· c~n eli bolnnvul considerlin ft adevarJtn~lUl).·• • 1 · . . J A~eastli ~za ... co'O~~~[Oali~nre,a. elinicit nu Lrfbuie si\ tie . adevlit&~a pe~tn\ ~t fi'~~1:,l\;~~~~.~t1~~taRi~·~.de!i~.~\l!,d~ }nt~lell · ~)~e i\eceptat pei1tt1H1n~J P~t1Cief1I ~ Ge,lt~t~t~r,t.«;~~e.Qr~alJtar~ oiiratt pritilitnnenorms*61-t~~PiiTjnl~nt~l.(~~~i de,r.,Jii ~e2i

.. Frank••t91a; ~rscl1f:1?90)~l~xistl[ )l1ai 11l~'I~~d~Pt)6 de·

~ptfc;~f\Wtl;i~riiipsi~?t~~PQ,~f•.ti!{~~f?~~etc~!~W~iR{!uli~~e. c\inal;"S1iP"7I!Slh:malitHre,'\imnnisf.:eXJ:Sten\IJ\l~J•P~lfi:'?~~Ppl12atld

·.• .~ri~n$Uai·.prinl!ipaclc. in'psihopatcilo~:~y~i·~~~~id· 2.003 . ,,,~.P~~i£H:,d~lnliU~ ··Pn·•iipl~regra~v' ~e':~c~~e~~.t\X~!~~~~;~\.f:l\~nicl\

···.· ''' · geilmli. prezentatn.succint'i~conth1tl~!~'(~~~~·J1ff~lii ve1J ... , ,. .· pavid .... ~QQQt;~l\:\tid ~i colali~ 2otlO). ~iisi~~~~.f~.}:ubi~cml

· ~antrebui~.mnU'inda 4 niveiuridifefi~1rirH.trd!Ji1nen ciil1ne ., •• ,., ...... · ·.· ' . . . ·. . . ................... •:'·.i•.;);.;t,l".l .••

.•... :.~c~~r:~~.;flJllqHdPTPlf"'~~cxcplica tnlburanle~s•lt~~fr·~!l1llllttce , ·~1p~llu~~Uqt~ti~e~ipr¢e~m Jii ata(-et\ desttJ.1~t~te. · ·.·. !:~: ·:.( ,i; ,. • .. ·

.. ,.~:.~:: · ....• ;./~J.-ffi~~tft!l~iqlpgieseTefetiicla tlfitt~·~~~~~~~·;il.~·~t~~,e . ' • ·.·IO:c. jt} .• qr.m\m~m~·~·,n~~tnl' mm•.aspett -fitt~1V.~.rc~•. a11n{o~n1c .. ( :+:!~M"oil'ificlil.'iie iizicer inouse. de sist~ffit1~ii1 "'ltl\!'Nti'S vegetf,t1"

·>• .. •.;<'<•··· '·"""· x.····· . · .. ·· . . . . .... ·· ....... , .... ,.,i'•;.j•·'······ .•... . •. .· , ~~g~~~~~~J!H9H~1tl\tell:$Eihfii:noa~~·em~tiop~li1/~~~piec~ive.· : t ···•· r .. ·:c ..••..• (2) Nit~i;luJ~91[JPaif,ifll1tiLJilif~e ~eterat·la'c~i~p~.tn .PSll\0-r

,~;~~~::=;~~·~~7~ i'-~'f11lW{~rB·~nnresu\l.Co~1ttl3hvnill'lntar.;: .. ;~'; .. s·sc'iiD"·'· .•...•.•.•. · .. t

••. ; .. ;y,, ) .. rJ)ft{re1ill,;,~ll:.,~:s,r-refern:lnprocesibiie.~~for~,a(io•q,lri •· :-'.~i 1~. ~9.~\~nui~ll.~~~~tpt$\;.li~istli dot\ a · ti11~pf·t]e .l!ropek~ri

·•'':t';itif6rttlaf{o~l\~~: co11stientel si -inconstieateki?rocesl\dle 1 'i~'inf8~i~t1Liri.'ll~;~g~~~tWt.rser~fuil\'la'e~prlmarettlingvist\c~(lll

-retmeaii'st"Jec(fici.snil iitrermeni-gen.erali (pltteft{a vs. absen[l~ ·.··- ,:, '·>···: >e> ,';, '. 10 ' ' 1 i

~. ~· 73

~.• •• • ••io • ~•• • ..,Jot¥• a • • a• • •.. ·~ •'

.;

. l

. f ~

- '· - .· .. · .. : .... o. · .. ··.·.·- •. :. ~.:,, .... ;.·~!:'§~:i;.:'c·.~·.··,··

sunmlului sau coupuutului,iuformajiooal)] a continutului mental

~i a pr?ceslit:~or informationale. Procesarile inriJrmatiouale JUC()?~liy.r~J~ se refeta.la faplul eii uu }JUtem exprima,J,Jngvistic eontt~~-~J.t!:pl~tal qi procesfuila info.rm::rf.iona!e •. Prelucrarlle infoituatioiJ ale detennina calitatea trliitilortioliSiie eJJtotibnale/subiective in condi(llle tmei Bctiviiri fi,riologicereduae si.lu medii. Dadi ac,tivarea fizlologidi estefoarte· mare, atunci iudiferent de lipulcognjtiilor, trrurileemotionale.suntndeseaneg~tive.

(4) lVii'Ciulsubiectiv se refera la ceea ce simte ~ublectul uman.El este ope.lfl\ionalizat prin descdexile pe care subiectul le face propriel atii.ri psibice ~i emotiCn\ole: poiitiva; negativ~ .sau n?tttdl. A~adur; acesta ~I.e opera~ionalizaL prin etichetele verba~e ale 8liirii euto(idnnle·(ex; "mn silnt auxios/deuuul.igitl n.1~innl'~ etc.).. · ·

Compone.ntele. principale ·al¢· conceptuali~ii cliniee i11te· grutive ~i Utodullo.rda Otgpni~ara suutptetentnte~Jfigura 3.

. A!in CU!ll_apl~ ¥gura 3, od~tfi .~nerati\ J>.i'in mecanisme etiop~togen~tice · specifice ·· [agenrl . f;\~i~logici (tiechtn~atorl, fnvorizanti. detem~lnanfi~ pn~clispozanV. de menpn¢(e) ~i tnodifidiri patogenetiee (teac{:ii ale organisnni.lui 111 agentii

hlfDlJ!t-aiaro:tsunplolr~at.,logtnl tle clilte J.uu:itud

I Shnptul~alologH! l-~~ #

l'rrsctUt~lue eit\lp.atugeJUiii.cti ~.Peclficc ·

.lle•efiilo ))lodf~ul .oclat

Fig,ura 3. Mecarus_me itnl,)licate U.1. conr;eptualizarea dn~ica

74

.f

I

-. ·. 0:: ._ •. ·.·:'· :.-.-•. •.

etiolog,\ci)), simptomatolGg[a este m.eu\inuta ql;amplillcaHi prin intervent]a unor faclol'i uespocjfici, extren~-de cofDpl~i ~i greu de ~ontrolal: Pentru detalli privindmecbnisn~ele.etiopatQg~netice

·· specifice implicate in div~rsetulburilri·pa1bice pot~ censultnle Jucdirile de spccial..itate (Sarason ~i Sarasou,. 1999).it~ceenoo pri v~te mecanismele eli.opat(Jgenetice uespecillce (i1Jtex:p~;etaren s1mptoroatologiej de catre pacieut ~ireat:tiil~ ntediului ~ocial), e\e pot men\ine sau ainplifica siiupLomntqlogia udntif,g~oerall\ prtu me.cm:usme etiopnt?.gene.ti~specilice, A~tfel1 dad\ sul:.lieclul 1~i- iutcJp£eteaz#: siuwtoii-&ttologia liltr .. un mod n~gativ ~j dezastrt.t9~ (v.ez.i fig. ;,l), nct:".Q5ta duce prin..in~rmediul sttesulu.l ~i tUL"tieta~i generate de aceastii iJllelpretnre la RtU{JJificurea· simptomatolog~ei.. Spre eJte.uiplu, d~diuu padeo~ i~j inLerpreteazii situptomeleca.fiind ·incontrolablle, de_uerezolvnl, ca expresil ale.unei. boli a.Scunse §i inc.l!rabil~. c.~ de·neinteles, .en sf5.r~illu lui ca pecsorulll~O~-~ii.(~sle~leQ~O~·deci 'l sJfu~itul carierei, famlliei etc., aceasta gener~clQlres ~f.a,mti~tl1te prin meca.trlsntul discrepru1tei c.oguitive.(~.; ..... tlll_·t!oresc sl\ flu considerat. nebun. dar nile. ell sun(•; ···yreau sa .inteleg. ce se 'iutampla ilnt nu poi:'' elc.). Stresui ~i anx.iem.te~astfel ge11erate pot mnplifica siroptOinatologia care >in tmele cnzuri, dacitnu nr n Jost prelucrata de subiect in. J)tod eJtl:tgei-at negativ, nu ar fi (ost prea inteosii snu reul.atcatii., -dispiir.Dt1d pda~ Cl:!_tteceren timpull1i (ex,: modificiiri in ritniul ~ard.iac ca unnare a UJ1~lefor\ ~ de.osebH: ln cursuLzilei). Un\alrJ.oilea factor etiopnto~enetlc ne&pecific ex trent' de im~ort~nt, care. itt~l~u~nt~aza

. simptomatologia prin ptecanisrnuldJucrepanteJ deacn~ mat su~. este.reprez.entat d~ reac(iile mediu,ui-s?daJla.sitn,pt~m~l?logte s11u La perfotnlan\ele schute ale pacientulm, detenruuar.e de

· 1,rez.en\a ta\:lloutui clinic~ Spre exemplu, ca. unnare a uuor simptome {ex .. nmnezie.le.<jin, nnxietu~e etc.} grupul cle prieteni. ~i cunoscu\j tncepe sa ev.ite pacientul, nu il mai ~trenenl.a in activitii\i c.oim.me etc.lu conseCinlii. prin' mecauismul

75

diSC1'4pan{tti eo~n.ilive (ex:.: ''vreau,s~ fiu.cu ei dar nu pot. nu mi nccep"ra"' ""yn:;all .sii reu~esc in ceea ce fac dar nu fac fatii s~roi~ilor•• ~tc.). stre~>u l~ anxietat~a ·asti(;l genemte·an1plifi~a SlmJ?f0fll_Q£qlogia. ~cala~Unct'Ll se fntfimpH).tn cazulln care . perfon~anfele ser,;!duo ca. L1rmare a simprmnelor. Spre~xemph};. i"~ Cll7.Ul,onorsimptonu~ nevroticr:;~_cnpacirurea deconrentrare. ~ pacieotulniseJ+;dlice d1:asnc. Yn con§ecinta. p~rfom1an{ele.t;ale (ex.:.~~ se~iciu) .se~nc.:an1treni\ndcdtir.i Jii otiserva1ii dh1 pa:rtea ~9rl.,l.~ (f1lt. ~~!l~'ltutea ~efuloi):.Ace:jte.nai conflicte nrqulifich de!a'Pt~tt·~ll9t~~lumpt.oPlatoJogta,dejl:l existentli. putf\nd ndauga cluarelell}O\lte noi.., · . . . 2}~· Planl)lde tr~tamcnt S,t descder-ea ·intet;rentiei - .

· ·.. . •. _yra_ta.?len~ul. ~tili~<U_I'Jste str[tns Je_gat de' coq~ptnal izarea chn1c,n ~I VJZet\:zi\.w.o~t.ficf&rea el.e:mentelm·pnt.ogeneti(:e snu de sanog~n_e:di.,_'~f~bule_ facucK o disrincfie Clara .in~re· tehnici

· temp~uucc !I nmf\lun te1:npeutice (~~nlru detalii va.i David, 2~0). Frank.·1973):VorbU'J1.de tehmCl rernpeutice atunci cAnd pr?c~J':lt'ile _de. irlf~~C:~ti~ ~u:nt · ~n:nns legate de mecani~n~ele ettopat~~?.netit:iS. Apec1f1ce .!il nespecifice cuprinse 'fn concept\la~JZ~ren,chmcii al tu}bm:lir-ii pncienmlui; uceasrl\ functie sc_iU.~lire.!i~eD~~c~cJin~·.c~nt:eptualizareaclinicn.este!liexplicatl«? chn1cl\. _yorbnn t)e ntmtl terapentic .nmnci clind tehnicile de intr:nenpe stmtstl"lins''Jegate de tm mit te~a~~lJtic siurVizeaz.l\ mecanism'?. de tip plucebo (pliei'entul cfede ca trntamenhll esre fiP~ifin'f.len'b~ ttifbnrarea de ~are sufera. d~i tratamentur nu es~ legl}t d~ ~l!lburaYeQ.:'Pncielltl\'tffl).'tn c-azul1mui rratament

\.~ pslh~tor~peult_C;Lfdesen se regasesc urrniit41tlre.le cornponenre: . · ; ·: Ljs~adeprobl~e-. diagnooticulni:Jsologic esre pnrticUla

nzntm I>~hlerp~ (}e•v.sn{n. Altfel3.Spus. ne interesifazamodul in cm.re'tmfilgoriileno~ologicese manifes£a in probleme de v1atli llenl:{u fiec;.ue pacient, ~riuf fiind faptul.cli a~ela~i dingnostic nosologic se paart mnnifasrn diferit la pacir:mti di·rc.riti.

76

I

I

l \ ~

I t l

~ ' f •

• d.cop.tlrile. Scopmile. stah\\ite tt'ebuie sa_fie._cl~re *ipre-cise, eve.nrual orgnnizate perermen scurt, mednf ~' lung ..... ..

a PJ1wul de lril/MlJ~IJf,#~llrile Htilizllte. Ele sunr: stran~ legate tie ooneepma]jzatea c1 inicn. ~~··sunt ~l10prii_ f~ecfiret moda.liH\t\ terppeuliCI!', ile~i ~desea nsistam in- pracncn lann

eckcristnmet.odolagic. - · .. Qbstnco!e sconlate. E1e n'Gbui~&c.clnrificate de la'inceput

~~ planul de tratament trebui~ astfel cobceput 1Wclit si:i lUI fie afectnt de no¢13te JllbsmcmJe, · · . • RezrJ}tiJteob{illl.l(C. Se tnregistl·ell'loii tezultatele· obr;inute $i se urmare~te e:voltltia pacientnluiiaitimpulrernpi~i. . . .. .

. Yn caz.ul unui trflU\Illent n1edicamenros pentru tnlburftn p&illic;e._ see~e,n~I~.sunr ns~ana~oar.tt{I{ap1Rn ~i colah., !997: Saclopk :Si Qolah,. 2,00"?). · exceptfind"J:-se uneori &tabilirea une1 ·listed¢ p~llleme cleoarcc~ n-atamentul.roedical\1eotases[e focaliu'\tR;e. categpr\anasll)logi-cit. Trel:mie m(!ntionatinsa·l'•~ptnl di nilesea tratilmennllmedit:alllentos l:Ste insoti.• de terapie suporctva unde:·se disiilMli n~~cte \)Siholt>giae ~i prC!bleme. .:~pacific~· nsociato trntamenrului medicnn1entas. Pentru multe. rulburi.\ri lmtmrienml psihelogic ~i.JI!;nlm&dict\l'I.Umtcs se. com bini\. Aceustii combiniltle rrehnieinsii fticudi pebazn tmor studii cares~ ate~ae ciicibntn combifmtiai deam<ece adesea,nceastli combinu{ie nu duoeha un rrntamnnt mai eficient-ci,donr la an rrntament mni costihi.tor. St~re. eltemplu. 1indiile nrotn cii o combina~ie. '' lratil!rienrulni.psihologic l}i mediean"lenros este indicatli pentru tulhp'diri. ps1hotice dM nu est4\ n1totrlenunn indicnra pe111ru rulbUI'i:\ri de i\llX.ietnce (ex.. ulili2'J\rea:nmtioliticelor poate inrerl'em cu 1ipadtin activarii fi:zio\ogice intense necel:lftl•l\ in rehniciteconipormmentale de.expunere) snu exisdiinca semnedeinrreb~\11! asupra dicielltei acestei combinatiiin cazul tlllburiirii depres~ve mnj'l1re (Antonuccio ~i _colab .• 1995; Kaplan ~i colab .• \994\

l®j~ .

71

..

2.4. C~mcluzii ~i 11J.·iuarirea e'\•olufiel ~:otcientului ' . ::.._~.:...-

-~:

. · AC.~~st~:~~ectlt1ne a aJmlizei de t~z include ton~I~ziile · asuprn cawlul ·~i evolutiei ac::estuia;Jn filllpul tratatne[ltului ~i prez~ntnrea planului d_e ur~uir~re_a ~volu~ei pa~ieutullii;dupa mch~Ierea lra~entu~u1, .1~ difenle peno~dede timp dupa lerapie~ penllu .a .pc:evem recadedle (penttu d~talii vezi David 2003· S<!raso~ ~iSarasou, 15!199). · • · .'.

· _11 cadml acestei etape un element important esleinre~tra-rea ~~ e-vnluarearezultutelorobtinute. int-egistuu:en !;i evatuarea rezultalelot tn aceao;ta etap~ se fac priil doufi modalitliti:

~~> Sl,Jbiectiv (declara(:iile pacientului); 8 . ~blectiv (iutegistrnrea d~telor comportmuentale sau

fre~ventei silnptotnelor pe parcursut ternplei utilidud un iustrumentar psibo1ogic riguros). . ·

Evaluaiea rezu~tal-elorinter.ven{iei esle in1portanUi ditu11ai nmlte motive:.

-in primui rand, ea.ofer&turlfeedback pozitiv ternpeutului 11i pacien~uluire~t::ritor lainterven{ia ternpeuticii (este en e.ficace'Z; putem intrerupe tcatmneuw17 daca nu·est~ eficace, ce trebuie sc:_b~J~l~Jat? e~c). _. . .

.. -.in ru; doil~a .rfutd •. evaluarea este uecesard. activilii~lor ndmuustrntive ~:hn cadrul in care tBrapeulul i~i desfli~oara actlvitatea (ex. statistica_interventiilor, a reu~itelor ~i er;c~;:urllor intr-a nnumitapedoadiitle timp in cad1ul unui spital).

- In W. treilea rfind, datele cul~e pot fncc obiectul unor nnalize ~liintifice ~?i E!. pllbli~::nril. Pentru. detalii vezi expetiltlenlul cu uu singur subiect (Catania 11i Brigham, 19?8; David, 1999).

2.5. Un exemlllu de slmliu,dc c:tz...Cazul Dana

2.5.1. I-storiclcl cazulu.i Daoa.ore 28 de ani, este medic, are un copil, locuj~te ·c.u

sotul sa~ ~;in ulLiro'ii treiani a lucrnt c.a rezident intr-o sec\ie de ntedicinii inlema. . · A. Acuzele priJlcipa.Ie

Dana a ptimit trnf.amentul psiholo6io lleotru atacuri de panicli ~i anxietate genet:allZJf.ta ptezeti\.<'ll iu ~est$tu.diu ~e caz In perloada dintre sfllnlitul anulul 1999!il i.nceputul onul\.112000 (J 8 ~ediLite). Cu doua lw1i inninte de incepereu trl/.tamentului, . nceasta avusese deja trei a.t.acud de punica ~i se lemea de probabllitatea de a mni fa<Ze un ·alLul. De' itsemen~n. aeenstn mentiona: .. De prin 1991, ut-am sirnpt afP.tatl ·11i extreln i.le anxioasa ln legatura cu vinta mea (ex. "viiJoarea men profesie de medic"), relapile ioterpersobnle (6X.; .. cu !i!Olegil ~icu sotul") ~i ccle mai irnport.ante activititi ale meJ.e (ex~ "rezultn~le ~eol:u:e, doctoratul") dtt~Si. sJncer vurbind. sunt mult mal ingrijornta de receutele atncud de panidi".

B. lsloricul.tulbnrib-Iiprezen.te iul991. Dana s-a mutatiutr-un nlt ora$, departe de pi\rlntii

ei suprnprotectivi, peutru a stqdia medlcinala o uoivet-sitate de prestigiu. De alunci a inc~put.sa se simUi tleajutoratK =1r sii. a.iba

. atacurl de unxi~tale !li "ingrijorw:e in legtu.w:ii cu orlee .. (si.mptome. t;luotio.nale). Aceste tdlirl e~ot~bl~ale se asocia':' ~d~ea =~~ tensiune musculnta, senz."lt\e.de slab~chme, \'?b05_eaUl.B.t tulburau de somn (simp tome fiziologice). intrucat simten aa ti_:este greu si:icontrole7.e aceste manifestliri [iz.iologi.ce, ea ain~eput si\ wile activitntile care. presuptmeau efort fizic- (si.mptonle comporl~mentale). De muite mi se gandea. di toate aceste shuptome vor a rata di valoarea.sa ca persoana .~ompetentii este sd\zuHi (si mptome coguilive ); in conseci ntn, .se sim\ea deseori neajulorata ~i a vea o stima de·siue sdiznm.lntlli tnedicu h~t~ ~h~

79 :.

' ::

. : ~~· ....

flU!i'-aU pen.uis Sa JOCUiasca iUfr-UI\ cfun.in Sludenle~ ~i i-au im,,liriaL u.u· apmtameut·peatru a puten sa 1nvete in.Jlui,~Le . .In

. titupulpli9:tH~~! .. an defacu~tate ~in~e~t.~~:~~~Q~U;~p~temiC · • .. sinlptQfiT~bffB.ti?Q81itri'geneiB.liza~~iinet~.s4ll.P.t~we.~j~~resie :!~b,~~ini':~~ ~e':1i~tnt~·!fing~~.n,;~~t#~~!rit.·.~-~~~P:~~.,~.a se . ~~l~~.~.t~z~ ,desence (inslt·tt~ ~t~e m:et~i?~:(~~~~.se~~r~tii. d6 P.~~~!l~et?··~~~e.st_e un~l dnt~·~~otiy~~~ l'Fll9J1f,C~~~~~~pms

: ttfl:Pp.~~ttil. dt~~uqstic rde'aU)Ct~~t! ?e .~~~~;~~p~ ,ltt.~~l ;de-:n .. E'~h>#~~ ?~~1d7 ~a~W.~~{1993~'!.~~!·~~~~ ':l~zG'~W~l~~~.J;l~:tnedic .·g~n~l}s.~·§t.Ja ttapsihmbru.~.1""3.U P.~~!"!~~9,~1\\,fl.\~,li!t;~Olln). BHRA\t <;~~~~·~.lL~ni,< ~ana: ~·:~~~l!~K~~;g~~~1~,,~,j~'!ece ~,UHij~q~t~!~ ,Q~v,rU~~gllate. ~7!I~f:,~al;a :f.,~~~~~~l!:r1~~-CJ~a . p'~~~~£!:~~1~ ~b,ar:~J:'!_ftcondtttile:l!~ .. ~~~p;~~~~~t,o;giel, a

b I ' "t :c ··"-t ' ... ~2"!ft~i*t ..... 100"7 """"' ~ d --~--.. ~il.Xl.·.s;l;l.§~qces~,ac:Ujltn ea'~:.-v,r . ~ .. ~~~-~?V~:,E . .-.~~~m -l1l~c!i~\:•~ziA~~tt;ln.;spe~.if:IU~~!;?i, .. ~~· ,, ,.,.~ ,,~i~f!l~tfft::~tatorul

· au.! ~'! \~fl~~~l' peno~da f~a'C:U~~~~~t.~ .. ~ J1~ .. ~Yffi~pJ~iitt sot~ pe ca~c;.iJr'4~¢t:te qa pe'Un~argp,tl~Tttililt~h ~~~:tc_)ttUultur, cu

.·I 5. f!~'-~ \r:rn~hin: "~!it:d~cat'·ett:·cer~tif s-au ptiicuLfi;~p,~ls-au · casiito~tit in -1998. Iu pre~~nt~ ~-I9~~!~t~ H~;B~:t~~l:are ea a absol:vJl.fa~.J;Jitaten, Dupl ~.-ll!r d~;t; ,1~~~., fl~ J'YI§W: i§.uUor. l)?t ittl\~9:~ P~ua f~ii!~c,:peis~~~~~~- -;:-•·.~:.~fflt?f4hmedict¥.t. Pe ·p~~:cuJ:sl!.l.~pllt:u · 'de:-af• tlo.tl1a ·a.n_ .o~ ·~tr~1f~9~, .. 0~11£~k ~sta e'4_Jeri.e.~aziLtlriJUtd:atac·e~e.~~~~-iy.;~~~lilm~~;{lnO~ca,t;o ill

'-~ 9,?9 •• ~uptke:a,~usesed~Jili~l'e~ ~~J;:flct;~tp~,ul\l~;~,p_ar:~J,~elcu .in~~/;~~Uii\:psil1otetapetttlca; ~t:UL.J(tt~:-9'~~bU\IiJ:tlJ,:atalJ1ent, rne~i,::~n1t~tl~S>~~~)p~~rlli,~el1l~icqJ.;Ps).!li~~U• .·

~ i J;J'!'r '· I~ton.c medfedl. ·~ _ ·;: ., •.. _ : _ ... i: "r:· .. ; . ,O;a,rl~.uu·avea:~ciun fel de·pto,W.~Jl!e ~f]i~~,,~,sl ii

iuf1tt1311_l~fmt~tiQuarea:·psibica;prt)I.U~Jl\~!r:R~.lM:e:~U{en:tel$8u p,to~,~ ~~ Ja,ll:;c\tnel4t. ''· • • · ·· • ·· ~ ... . · · \ ~~ \l:.·$f«.~sd.tre,,IIJ.l . .·· .. , . . .

\ ~qci~uta·elia bine'orientatii to_~!PP-~patbt~. £4.ojd!spo~(ie anxi(Jnsa,,\ · · · · ·

.. ~. . . . : .

83

~Ufr~rt-dirrpart~a SO{Ullli e! ~i de:faptol caSe simtMeoplc$ilfi de ~nrcmlle as~mare ~fa(!ton declan~atari). Dana se n~reptase la surortemotlonal dtll pnrteusotnluisau:; in schimb ea simtea ca ~n~ii ~nsatorie a avutfiimai mnlra obliga{ii decfitinainre,-.~s£f~l mcatacesreill\O st'a~itprin f\ o coi?I~~i. Aces[ moment coincide en decl.an:;.llren primului:atac ds.panidt

IJ.. .. . ~l•altuiJ·.eil cogJJifiilol' fl eomporlamenlelnr ar:tuale .~ SJlllT_Popro!Jle.IJ]lJticii dpic.iiipentru Dum~ a fost ~ea ·JegaU1

del1l'lmnl san ata~;: ~e·pani~iL In tim.p ce isi pn~gliteit exainenul !e ~~to~atin ~:U?e.nt fil. i-RVllti un:gtind n~1tcimat de genul~ ."N u

Ol.ICU!il s~ ma pre-g~He.ac.cum trebuier !o 1.mnotoara.le zile . d~O~l\l'eCC. 'lll\- mli. ajutli ~imeni Cll-~t.elelnlte· sarcin·i .fii llll pOl sit Qb~m mm mult~ml' pcntrua-:I"Ili p.regati ex.ameimr'. bin punct L~~-v~d~re -~~l~{l~nat. "S"-.a simtit foart:eanxioasa~ s-a opdt din c•r•t.!i•. S-ll_ndtcat dln foroliu. A"pt>i a simtit c.1. nu inailpnare respira ilt~ durert p~ecordia1e,palpit.'l(:ii ~i tremor incontrolabll. tn ncei moment·· <l·avnt.u·n n1r··· " ··d· • · · ~.,..• · • . . • gJlfl ~amomatlinterpretare catasrrofala: ~nn~ bolnilV~ ~~ ~-m;p!ltea &a anum arac de Ltorod.l"~ Simptomele f~:~enonre s-a~ m~srficttt .. {panicii: despre pnnica - emorie S71

t.:un.darli). inP lu~ea/~nmern i s-:"a pnm~ c1udf\ti\ l$1- fiea.HL -Et10t~9nnl, _n ~}t~enentutt sentimente de·teama ~i dis~onfort Jl lferm~. A le~at dan ctunedi ~in1ncercatsii ajungli Ia hlliepentlu ~ He spill~ pe. ~U1 cu ~pa rece. 0 a_ d{)ua s.itt~ll{ie tipiclfse referli

.. n~.el ce-.al dotl&antl,lp·dapnnidi. tn timp ce: :Oana fl1cea cutJ:i{enie !n apnrtament a observal eli an: Pf\lp.itn{ii. Gl\odul sl'tu"i\utomat/ nue.-pret~ren Cftta~.~rofalii a fost; .. Nttdio nou! VoinlUri !ii nimeni ~lll yn ~n.l {lVell gtljacltt- flnlmeu·~ . .fl! rninufele tlnllatoflre ac.-.. te·l·-1 iH\ decJa · t · · ·. . . . ... · . ·. · . ·.· · • . ..... 11

. . . • . ·U!la un.no11 atao de filnnicn. cu pnlpitntii dureri P.~cco~·d!ale.~i n-en:mr. A.inaercat sfi njunga l!1Lulfot9lit;(1n cnz c!\ l~~Jlla) f;Jla telefo~·rp:ntrn a--~ rel~fona sottllu·i sfiu (dnr nu l-a _mn~ sunnt.). 0 n lt-eJa 5Jflll1{ie_a apamt·itt tlmp..c~!;i~i pregaten lnc•af~~,pe~lun.conc.T~s~tU,1.1tific.dernedicina intema. Atunci s-a gfindlt: • Nu am suficient til~1p pentrit a face o lucrare buna.

Nimerii nu mi\ ajnta ca sa 1\Jll mai mnlt timp". A shn\itd\ i\re

pnlpirat}i.t?1, .apron:pe.imtldiat. ba venit on gand o ~nreq:ret:_\rc eatnsrrofnH1: '~Vai.de rnine. suntcundov&at bolnava. V m \e!!ma ~i voi didea''. lfi,onreva minutn;·a experien\iat_U~ al trft.i)ea ~tWC de pa\1ica.1osiide data aceas[a tean1ade n. nu-~tpterde contt o\u~ 4itle h nu 'ionebno1un fosr mai, p~tramic~, A io!iit din c_tnne:a ~\ a mei:s in lillfl'agetie p~ntro·a: fi mai .apronpe de td~~o.n $1 s-1\ a~;ezntintT-IInfotolin. inceDCand sii se relax.eze,. 'tn G~~(~l\ asigUditiloTtepetnle.,da_ted;medicnlgeneralist, cl\-nu este ou111c 'inneregulifcn snnlitl\tea sn.Danaa continuat sa~un~ t\rt1Cm?le sale de panlcil ~1 sti'i.r~ledp·nnxictate pe senn1a unetholl somat1ce

- ~ediagnosticate. Asnel inclU. Qe~i!G:tt d~vedit: a·fi d~schisn hl ideea t:1rml\r-it. un\ii-tt-tmmaent psihotcPapeutk, nu n ·foll~.'.tlfel Lie . recepdvhln Q CQJu:eptu~lh,niepsihologicli a.problem~lor su1<~.

· C. . ·· Evalriarea loirgilr~t{inalli aDogrfi(iih>r fleolll]JOrlrt·

mentelor . · · · ' Dana:acres¢t1tJnrr:-ll)familieon pi\rinti extrcmde [n:otec[ivi.

Sart·h1neiera sa·i~'vetcbine.in~mp cepal"int~i li nsig1:m1t1 t'c,ate cele necesare. Madar. avea snficientttmpla.dispozi~e p~ntru n-!!i or.gmtiiii ttctiviftt~le f!Co1n~.1n oonsecintn.Dana 'era o eleva· foarre'b\lnii.J ~n•l~~el'ii4Jlt.B1B·ei de :vlatll. s-a\.1 dc:z.vohnl .

·• n-e{credint~riRli PJ'im/1 cnulintJI-cenli'fllii(scbema cogn1tiv iil . , --·~ lu compl!t!sttli:.".a.fae~ttotubla standard~ mal.te'", Aoeostl.\

ctedin\li este: ftecv~nt evalnat:a: ''TrebUie'Sli •fi!lc toltll ht stunclarde 'jnalie, nltfel:;untinbapnbiUi, derestnbiUi 'i ~ltlbN'. Cen·da-:-ll dtJW_} widinf)l>t::ent-rnliiSi:!Tefel~ la rcspons(lbilitate lji control; ''Dad\ ceUal\i nu mn .ajutn~ .auu~ci nt\ mn pot cancentra s.i nu por sl:i detin controlul ~\ sllreuJif!S¢ tn sitt.ta\i'll~:huportante din viata men ... AMi\StR cognipe est~:l.ncontlntlnre. ~J/f\hliltli! ·~Jl~t'SO(U1Cle apropinte niie trebriitl"Sli mlli1jute s~.contr61ftg;situatia, l)entru ca slims pot COI'lCerttra Iii sa:imi at.ing flhlfiotivele i mp.ortnnte. Dncil nn ma ajnta, este gronznic l!i nu pdtS\'\porta aqtl cevn". Ceil den {J-eia cJ-edin[:'f centmJ;ise rcfera la d:mfort ~i control ~i pare a l'i

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implica~a tn apari\ia-emotiilor se£undare (adica. panicli d~pre paoi.di)~ ··o~ca suntueajutorntii ~i nu miipat control a, atu.i1ci ~L eu ~l ce~alti ~01~ avea ~e ~fe~;~~~.J\treat;l3:. 9{)gt;~itie ~%~pq_i . e~·.~t~{ll,~~§~~kt::-£~b];U;~~.-til~UI~:fi~J4.Lrm~, pt~e~~~~~~~11ie · ::tu~sup .I~ .... :l ::,,~~ _ .. __ .. .• · · ~·· .:::~~-~::.t ·'

.·1J •. 1· .. :fMl{~-~i!Pf~i~~.e~~JJ~tfi~~. t(U"i-4lf!:pa~ietztJtJ,J{ · .

._'--P~·~~-~t: -~- P~[S{)Bll.~J~~b"k~l!lifrc~.q~~~~~~.~~i~~tia . ll:lbe.-ste·n~~dJCJJn\ 5il este foar.tediseiplitu!L{L Ea d~t;~e~t.p_ua ce est~ JP~l ~till pe•~t:J:u.: ~- ~i f~.ij~~t:JJ~-~-GO:l\S~ilil~llici un . efor~ 11}}.~~-ef?F~~ J~~~f~!~~n~ ~.QijtP:!,e~~t blem,k.tE!lWaaltrait cy ~~!~t~·fr~~e!"~~li9P. ~np~P;P~·~p~;~i~ltt~i:~ti

'?am,.: mecitt,m:.stuele de coptnJJ. uttltznlt;r•ap- ;fo:st:·<~Vlt:itfea · p[9b~~u~F,~f··~~l~area ~r;u~l!li :fq.k_-fi.i.stqdinl.intens(f ·:

.E~~j :ri ;~CJ?qt~,~~~t;r~~:,,;, ...... : . .. ,p~~J~ ·-~~e5~!1Jlf,W;;ntlti,~tale'getJella~tli?tie()~liCtf~lf~e

ei.~e\1tJ;wg,({~orl;J1_~~,.~t~)a~t 11iB£Ut-'"o·~~fiJf~£~o g~~~~~ •• 1~~-~g~."'d~. :situ~~H (la~t~rl •d.ecliftl~:!torif~·}i~1td · at.~Jet~u~a~are: Pm~abil c~~lta~i,n~'u?~'~~~~¥}'let\1p~ -: :f~~~or!iAA\YP':Z:~·\11 ~-~€ex-,.un (l~ne~""' Bl~~c~l,C:f!~·~~nt~Jt:; .re~. ndica~e de~t 1tllte~u):.au precipttat·~x;;ennea;;genelitJ{ilttli.li depres.iasljbcli~tica,•~ctiv~-~teei_ -.. . -~e; ·.i mult,· hlp~~~~i.latea8isteil'l\l~~~'~os'v~~· tfii .~~!~~ -~illet!~i~}~~pEinletill!·rel"tii!e• < \> ·.··••• _ ' · ··· ·

ale,perso~~t.li~il·deiJ~l'ld~~t~•a.efj;~ij!Jf ... ·. -~1!1 Ja si~•P~CJ!~~ologia.UJJ~~i;tQ~~i dq1re$ivlt~~, · UJ~dqr;J~r, ~n~nsociet:ti-"a~el(Ui~oiiGf:$:.~~!~ ..... J?.~.!l~\"1 .~ '"·· .• ·.·a,,.·u_•

(factorp~filisp~z~tt)•cu ClJtn:esiuitt~~~~~~~~~~ .. ''· ••. _ :ri.e:\ii de diJt>a>cas;tone:lit~~rl) fru~t,J:ru"ca dlltlt~-~~~Ptii~ ... . ~iS;·~e · stts\ill~~~~!Ji\t\-~n~~asotu~~~,~~o~~~~~¥~ti)~,~~'t 1;$iPt~~ nt~C;:;\U'~e.~elp~t.llCa; Acestea·nU rc;,st·sfi.lltutat~ ~~ •rtf;l"\:lfe~l;i,le ~nt~~.(ale\~rl~~te:de·;}L}$Ula:•·i~tcil"pretc~i.~'cli~~-tl~•c -4~v~p.t)~ m:;talaretttnnucntl~pre panrca:: ·· · ·

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per:.weffi"f~ t~ap.l~J.cqg·nittV6 · · · . A~. . lJst.tL 1fe.j1Fgbl~n.es. · . . •... _ . . . ·.. •. • _ ...•.. 11

-•~'~ .~t.~F~il~~.P~·~~.Iileililaitd.; ~!21) s~atlnt~'!~!~~!~gt~-· .. jo~aW:itl'eg~p..~q qri~.~~~t~·n~t*·~u.eyniW;!t~!fi.~~~esJe ·· · · .·. :;ubiURi~);.{~~~Plii.C,~~W\"'li§ ayJ8td~3J.!poQipe ~~~esta

l-~r.\1~~pf~g.~~~<4)sti,fflii.cl~siue.~ilsel1bdtatesc~}~te'~~~~illi\i scicin.le .~e~cita.:e. . ... r; i

. ',)£ :• $t,~./}Ml'JteJ!afleutic• . .. .. •·· ..••... ··_·.·· .,Jl) ,lM;lu~~~t.aQ~mtlhl~~-paui~:fmt!~SiY ~ .

,,:::;::=;-~~~r,~;t de ·$Utnularea asertJ.l(f,ltll~U lfl '~?~~~,;~l~l , ~~.tfl{ ·. . .·.· · ......• _ .

..• prbbi~l'l1~peutw. a ~J]h~~~~tfi~~~~,~~,~.f~\q!~·~'et~~t~ten d~,re~otvare · a_ ptobleni~~R~···~'!R,if~~~~ •.• ~~·.'1!:);~~l~u~iit~?rea .abUita\ilcrsocialeeu.tm,p~~~~:W~"~~~~W~~~dt:~pen;ol\1,\~t~le :depe~del111i. . .. ·.·... .. .. , _· ..• , • .·· ·, or -~ • • .... ··•. • •·:•.:

W·iC~ _ . PlruJ.ificar4!~ t~C'!l''~~ • r;· ~·· , , __ . ..z , •;· ·.· ·.·· .. -· ., . Plattw'ge tmtall)~uty~~.tH.iiJ;itD~t~~"'~du~n·~(lfilor

• de~~uid~ \~~~.~~~ .• gz#~~~~~,~~~~j~~Ji~i"l'~~~i~~~~~~~ret\ ·aim¢ •· ~~:~ei~lgl\~1;\§f,~i~e*~~·~l~l.llia~~";!~ea.

.. :~,~~ • r~\18~a •. ·. uti~le£~~~lf~-~li~~~~.J;l)~.f~l~Jbl~trodvs·'fl1 !'~~!""In -?e~reverlii"~-a,~,~~Jilor. ,.;'·, . · ,; · . _ ... · · ·./ .. •:· • · • • ·• ~enti'tJ,~a,<;~~·~,P~ti!··~•·!fqlt}sitn•t•lltJe~i;\e }~~~~~IJ,ent ' ca~cttit\r~e: '<if telu}ici de res~~~~ti\f!W(~~'t!'95) J?~~tru ~~~~e,~,~rp~~i:l~~~f11~li~nftdei~~~~f~!?;~l~~~o: mat~? ~~.:(:l),l~L,t,p~~~ely~~~,O."~}fl~lfJ;~e~D~,ol·~.r'TI~~\let ~(Ost,l93ll'P~P~~ a ex}1lj.CJ1 tiT!llli1Jlle)~lflr£!Jll~la~Ul!l:!~~ele_ ·u~,ii~c;(\e·pani~~-Oe,asell1Sllea>l1nhlrle_pu~lflnieN~u1l~Hi.Iost \ttili~n~~ o' tdmi.~~4~'-dis~re ~aten\ltii;am.t:ihieoitditt"'tllc (a

87

,,'~fita rel~tia dint.L·~ ~L1gnirie ~i ~tnotie}cfit ~i tetapemic (manageme11tul rnpid nt sitnlll!mm•elor): 'Apoi~ paclletul de

.. }'~~went\t;~lll)l amcul de p\nic~a'fostattnpfarpenUl1'aroti:rnte .· .~~)"l~r~l~t~§i depJ'esie :mbe\hlica~ ~H!anst1lnd1n: ~ilr~~~~ici de

ft!JilJ;~tt:rjtr~e • ~ogniliviL(Beckjtl976~ Clark; }99~) !l,en~ru ~C;t,0dif"W!Jr~fkgl\n6u:ri1onuit~il1atrifii:a ci"Cdil\ t~lor cl!~rhtle'!! i {2) teht1ici de relax are (Ost. J 987) pfentnt:-rl!ild¢eiba ah'tivlrii

. fiz.iologicc crooice. Ne.:.am c~:Litmtt.d~28S~~nen ~i pe modificareil · •.• (l~d.i{~d~t!ii~lp.d~al;JstFaet~Eure)t~ogni\iilUr~evat\sntiv~aso.ciate

· •.<;~~~teJ~~~ilttn!~:~~t,~·~\~tebsertivirntea~ia~it~jbi\~tnti .•.. il~i~ifi.im~:Jro~~~~~~~t~lo~it~~!'lif!~ul ~ntm•«setrl1ilrateNit1in

!'ili~E"lir lS~f~~~ ...• ·~·· .. ~t~r"~· ~~~~H~filor s.9~1~1i ·de l'etolva<re n :Pl7bl:»fent~toi t: .; . ,.·.··.·. ¥o1~~~t.c~ls~9nuJ':de a ~ aji;Jta sihrleyi,iil:mni

•:•t~iif:datia~ttri~fili~i\~~tt#mJl1 ~~p~lld~otiL Pa~h~tulde·tebnici •• r~·~f~st apU~~t: dtlp~ .ct~nt.ti\-n~t:az~.: ~ ~·.. . . .. . • . , •· : .•

.. ·~···;~·~J·1• .\I~ R~tm:liritltd~de p)ml~i.pilhi~nta:afost jn~arar~pJe]lnica de distnigere n ntenriei {ex-..sa ~~ie detaliattonre Q.biectele din eamedJ ... Ac~att~ .. ttJlmicita~ 11ote~: (n);.sli.~ombata

.. . .~py.v,ial~&.a·n~i'Cli'niV·a~ c9iiirol asup~~·~a~i~t~tii .. ~,nle;•(b) '!~~lii,.'Q:te•idll~;m,.~·~~me~t·li:'silh~qfu~tpr:. A~i!il. i~ptru

,.sitt~~.riil~rtta pnrrea~da!fettlgiil'ilci~Uir'anto~t~~r)n.4!ftciJ~~;.i~c) ,$~.~o·~~"~ui~·o•ne~n .. f;I'J1{r~·fleli'~n\:t.al\i~'~e.t~t.i.i.ccig~;rtiv at .~~~i~!~,ll!~~f~{li;clc·c~g)'ltn~ai'Q~~~~ttii~e··rt;~i&r~r~.I~i.~c~put,

·,',··~;·tlnA\:i.~1,,p~zeanlt:r«liRfta1cJ\~~~ti&i~ft~(p;~~~~ia.·~.f~Cium\ . ~'Po\~!!~• ·~~ifie8t~1l"'inf:erfjtet.iini catit~'ffOfale a' se.rii~~IHor . corpornle C}(perientinte de P~na lll timp\ll,otim~nlord~pauicli. : ... · .. ~trJ!nJc2!~~~,~01ttmli .. ai;;:tespit1l~·.nrost1tfe.·agemen~J~losita, · .. t~tru~•r:c:tl,J:Jc¢b~nrcntilalin ,,· ·. · .. :•' / / •· · ·•

·,_~i~l~t~tt=~i"t~VJ~~~ - :~~~~:~lat.~·.=t.ellnie:hde;,;rces:fln-ctur.ate eo:~~.1tfv~.-)i--!'e;f)nlci · .•.• ~.~fft~~p)t~~~~;'!~~e~.·{le ~aseme;nea; n~~atn' :f&ca.~~z~~; lli pe

~ ~f.l.c;l~fie~re~ ~Pffll'i~iilqtrevru uatlve priifihtelVenpc la liiferite

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2.£.,1:--Riizzi.ltate,. concluzii yi u.rmiirirea ev~lufiel

pas:.i~ntuJni . ·. . . ... · ... · .. · ·' < . , : . ..~ ·.I··.~ .•.•.... f'rn~enLuJDanei s-:~ ~~.~ p.~~fl!Ct,U-:JUhi:~B '~iii'e~l.a ·~~~~Jwii{~~tpijillchei~ tercipie~~ tm,~z;:~.!\~m~gi~fir.aculi ~.~ clll\9~SA;;Sau ;~in1ptoole de ~~~~t~;~~HJl'fJi~~~.i;lJt~Ltf,", au

.. •11e~is,~at tf1tele,simptome~an&el~t~~g~~~'~tmii:~~ttm ~\,.,~~t,~lm;J~1~1~p~~t: ~ri~~~~~lY!~l~~·P,~~tnij~~~~~ de a!:l~.l~t;~ gem~Ealit.a~ As¢L"~Y~t£\~l;l;~.P~IW! ~~' ab)Jitatfle; sale

· s~c~af~\s~EJ,Q.'intbuniita~t :Jef~~~y;,/f!~t~ ~a:vuftliil;itpact ~c;J-dti;v:\~l,lpta 1-elaSfiio~ ~s;t~:C,f~~lf!s~y.~~ §\ltUi :;1 pa~iili~~ ~i a Il~~~~!,~~ii··Lr~a~I?f' se~J1i~.4~;l't!fA~~~t~'ff1~~~~~~te. Toa,~e ac~~te·repr:tlta~ a'tl·fu~~ Q;R~WA\\altzate·uJ:lt""'~rt.'aestgn exp~fh~en<~l:~uun sltiJtnr~~til~t:,~•.u~'etUJ.i;~le~&!Jia{,i '·'1' o,. lr, it':,c~~ 1(~1tp~(jn-te!~r,{P~~~;~~~Li ""~~j<!atam~!i'B l9;7,;J,;lQaNI~;l9!?SJ)~ ' · ; ''"'

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,·, ·~·,,",,>,; v •. ' '·~:,"'·<;'·,·;·,.·;;''~;5·};/-->';,'<-},.·''''<b' ,, •, '.

. . se~rinelefil~Iwp~~i;~~~~~t\;~l6tuattit~ .. ~~it~l~gia ;"capacienfvor,l:) an~~ait;.i~:t'4lle>een,t~~~~~~) , .• ~9:~1~t in .

.. •ctfreel~se' JI11Jriif~li in.c~~;,~ltcntegorlil~t·i~p~ · .. eJ~~'~tijlor •pliil1op<tto~9&utif~Q$~,~~pitalul·~~=.~~)·.~~···'; .. ·· ~ ~.~ie,:V;~l,\~n: clinicl(;(2}:id~~oope.~i tmrmneu~ (3)t~.rce.tare fundatneotala!}l aplic-t:lta ~i ( 4) educatie ::iforumll~/lrauHng. ,.,:./':.- ..... .

: . . . . ::. . . ~ ~ ~

9\ ...

3.1.1. PPobleme alePsihvptltologiei Ut motltllilnfile fle a face diagnostic # eval-uare clinica.

Semnele l}i simpromele care m·ara llrezentaunor probleme 'in ceea ce prive~te diag11osticul ~i evalumrea clinic~ ill psihopntQlngie.$untprez~ntnte!it11:-on~inull~~ D.ac!cdi~glto~cicnl lli evnloar~a:Giinit!i~I\ Fsib()p~fQk\gje ·s.4ri~aot-~ctc ljt tdic1ente nmnd ne a~repdim. ca (l) numnn1l categoriilor de diagnostic sa reflecte iiMele ~tiin[ificec exist.enre; (2). sa fie renJh:\re CLl m1 jn.slrumenrar p.sihologic ~igLh:Qs ~1 (~) .sliJie bazn.te pemodele}e &f:le ma_i dgnroase tl\ (\~\ll~ohl (ex~ ~lod~lutetiopatogeneL_ic). Sii urmlh-imtn conlinuaredacl\ acest9IW(dlcliisunt ~on~nnat~ . . . ·• .. 3.J.l.1.,NtmJ{Jrni.n~~agtJr(lt d~.ma~e de oategin·il tliqcn.o~litp ~ih{? ds pcrtillog·t.ars: a t'is ii cotidisne.-

nllpus ll!lale.fkarum . ·: .. . . . · . · __,~--,l:taptu\cK s?iisti [In fl\ln-ui.rmare de ~at~gm:ii nosologjce

psthinttic~ lltl este o'.pra~leroa in si11e; Dimpptriva, un num5r 11\are de ~ategoriinusnlogice identificate ~i cn;ate pfin1.\.i\CUI;n nr purea aratfi rohuste.~ei\ cercet~rilor din acesl dorneniu l}i

miittwitntea acestnin. Oneil acest mimlit mare de categorii nosologice nu are insn o justificnre ~tiintifidi ci lUlil socioectmomica. atunci. ncesclu~n~ dt;~iqe o.ptl.lbl~n:'ii pentl-q ~tjin{it • S1I vedem cum stau 1ucntri~e ... De: la apatitJa primei edifii a DSM-I ,(APsyA. 1'952l.~i J?'fin.~ 'ln edi{i~i n pnn-a DSM-IV (APsyA.l994) nnmaml categoriilor diagnostice psihiatrice n

· crescnt en 300% (Ht\utS, -2002}~ tlnii anlori (Houts, 2002.) au nriitat eihlceasti1 cte~l'$reae'ste nltiific'\'lliil l}i l'lBQb~ml·irti, ~1 d\ ea nus~ t>a~euil peda:le '}liintlfice ci pe condifii socio-econotnice ~i politico. Ap\\ri\toril D~M (Wa~fie1d) 1998; 1999;l999n) 11e

Splln p~ dr ~~tli parte, cllnceastli cr~tere nu este una neabi~nui t~ 'penttu ~tijop.IJllediGaUi~i di ea gstejm:tifieata t1e dezvoltarilo ~tiintifice din ae~asta pel"loada. Allfef spus, eerct>rlirlle din 11sil}opatologie at\ dtls.la descaperh-ca unar-noi h:ilburari psihiee, dl.tfll\ cnm~i cercetarile medinale au dos Ia descoperiren m1or

92

noi boli somatice. In Ot\:lUl. bolilor somntice, numarnl .:1~ Crlt:el:{f~i ~ dh).gnostice -a crescnr_pri n:. ( l} idc:nti~G~re:l. t1 nor _l~ l~_urn_n i1ei(lentiftcat~ prin metQclel.e de diagflQSllc,precedente; ~~ ~~) pn_~ ace~sul lJUC\entilnrhl serv\ciile Inedir:ttle- (Wnkefiel_d. 1 '9?.9). ~P• ~ e~:e~w\n. nm•lfiJ.ftl {I~ cntegotii 4~i1gnos_ritte ~1u b.ohlo~- Sl~~cr: 1:1 h~ circulator a crimcut cn.200%r·tar cel.al srstemulUJ ,thgeshv .t

·.·· ·· . ·. ·. · . · . . . 91}0) 1. y·'"'O-HY{J990) cr.escnt cu i23% de· Jai~D-:·8{1 q _· a L: .. · .. ·. . . (W!lkcfield. l999)~ Daca aa11astl1 nnalogie elire co•:ecd:· ~l~n~~ ~rt{ltiimcil fnct(llilcare till clus htcre:jlentll numnn)lmd?.c.ategOlll

· · diagpostice.pcntrubolile solllatice sii fie"Ili_spun~nt.on 7• ptm.ln• cr~terea otU11limlui dr; cttl~gQI1ii dingnosttcil p:nhmtnce. L.\ o n1l~lid. al:entfi, 1nsil0 naeasHi anal&gie- .esre. er~nala.• ~fe~te~~~ nnrilan1lui rl.;: €R}egorii dingnostiec in ICD ~stc-1 n pnnclp!tl. (hu a. a 11~ exclnsi v) £"ezu1ratulreeodarii unor cntegnri1 pree>d&tente nu nttaparat deseo1"Jedrii mv1r holi (Hours •. :oo.~~- Cr~:;f~re!' nutniirului de cntegorii in DSM-lV este msa m' pnnc1pal l'f:ZUlratulad~ugirii lll,OI' C{llegorii noi (Houts, 2002')-_De wr•: dfi- Iun gul tim . nlni. din DSM s-au sflos ··i s- u ndau- · uran rn func~ie de presiu nile ~i sc 1imblirile ~inl:. Spr!!: ~>ternpln, ~n p1·imele editii ale DSM homosexualitatea ern o carc~on~ noso1ogicii iiwlusii: 'in lista tu\burhriloqlsit:ice. Sub 'pr~~Htm~;\

. schimbl!\rilors.i mijclil"ilorsociale aceasta afosr scoasli dm 0~~~1 frr'@ ramanand nsocin~ _en ntlbtidirile psihit?e numal ll1 ml1sura fn ·care este\ ego-disbnniqfj({pacienml o pef'c.ep: _t:_'.'~0 surerintii)(Houts. 2002). S.imilnr, mt~sturhat~n n fi1cutc:f1t1emu1 mediciria &i psihiatJie.cr~ ''baala"'sau.on ·factor impo~tm'lf io t.liverse pmbleme tnedica}e §i .psibioe (~tengers t;i Viw l'·leck,

· 2001 ); .'in sahimb. astazi iUt esre-oon8ideradi un emnpot'tament sexual :;;nntltos i'n mi1sora 'in ca-renu se mardfesrn ego-tlismnic.

_ .Probabil ell psihopatologia~.aroueaza scuze multor oumeni C<lre tul fostconsidcrn{i de .. a tungulrhnpulul boh1;Wi psihitt den~,re.ce. erhu homosexnali .. IHHl se masf~lrhtlu! 0 1\naHza concrern a n)oduluUn ca1:e lulbudhilc de somn an njons 1·n DSJ\•1 •Wat:\ !\~

93

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. . ' . ' . '~

- ..

asemeuea di ap~~itia imornol categorlinosologicein D~1vlnu este into.!~~~~~)~~ ~~~ll;(ltul cerceliU:ji fltiinP.tice. inainted!H)SfY.r~ · ·· UI-R, t?lbij~alil~ d6-sonmt~u aufast~ous1de.mtetulburliri p:dhice. Ele. ntt fGst coi1ceptual.izate en tulbul·iirfpsibiGe incepfihd. ell DSM-lll:"R ~i au.fos.telaborate ca alBre In DSM~Iv. Dadiaceasta [email protected] attrebuisliidentiflduu rezuJ [ate impolian.te il,e ceccetiirii ~tiiutifice asupm tulburarUor de 30lDll din acea pedoadii (rezultate.crociale-cutting"'"edgl'! re .. search) care sa arate c:H. a~e:~tea SU11t tuib.uriid psihice dellili mp. de .40 de ~ul u~ ~JJ.fos~ cobcepute nstfe!. 0 armliztl aliteraturii de speciatitale atata eli aceste ·~rezultate cruciale'' cnre uu res~nuifi~t tulburlirileAf!.sol\ln ca tulbudiripsiliice nu au exist,at {l:lolJts. 2002). Probabil di introduce-fen lor in DSM s-a flic~•t prin vot, pardort,adicli prin'•consensutspeci.ali~tilor" ...•.. ·· ·.

!n p~us,numarul extremde.m<l1-e de cntegodino5ologice psihlalric~ ducela·o teudinta.cle pntologizare a yjet~ c0ti~iene (Beutler QiMalik, 20QZ; Groth.-Marnnt,~20.00,).lntr-ndevar. o succlnta exnmina.re a DSM ~IV (APA. l99.it) va relief a cat~g.or-ii nosologice precum: · ·

- Rroblem;U relatioQala cu parb:meml~ -Problema profesionalli .(ex. Jnsat1sfact.la la lo<;ulde

munca); · · · ·

- Pn;llilentii ~coladi; . -,.Noncornplianta 1;,:t tt:atainent; • -Neglijarea copilului; -Problema relap.~mala iutre frati; · ·.-Problema reluti_ollalaparinte-copil. · E~aminaud a.ceste oat.egorii . nosologic e. se .pat:e cii viatt! ·

normala, tara pntologi~.'inseatmlaconditia pdma,radinroi. Ea nu mai. poatefi gasiUHn lumcniu.::are \l:~lll.c Viata pare sa~o mare boaUi .sihidt! EKe.lllplel~ prezentate tum S\JSrelleclii prtlJlcme de viata, a esea care f;in de domellittl socio~nmral, dur iali1 di eJe sunt considerate actun tulhurari psihice. Dcfapt, daca

94

retinem acest exemplu ~i adaugammo~upg care se. define~;Le · tlillburareapsibic~ - -tl !odificad ·psilnce ~il~mu ~Ottlport;:tm~tuli:l.l.e ·

. ~Qciate cu o stare .de dislres ~fsau disabilitate sau ~ate cresc. rjs~ulsere di~tres §ldisabilitate{vezi DS,M-IV~APA, 19:94)-, observru.n di.estefoarle gteu 'Sa s; evire incadrat-ea.uhor pt0bleme care exista lli mod·{recven.Hu viati\, inJP..u~categoricno3'oiogidi psillia!-fidi. indefinitialullmtarli psihice dl{:ivatenneni sunt a{ti.t de WJ.lblgui: ~rtclit.utilizar~a Jrr deviue .P"eJ:iculoasa ~ifi~care ne pt.ltem treZl ca am pulea p{ltriviun ilingnos.tic psibiatric. sn nt1.afu;atn ac~ti tenueni.

· • Modificare psihicii qi coanporttmaeutalii.· Cfit de JUO·

dificata tre.buie sa fie nwi:litica.rea peul.r\.T. a ielli diu sfera uot·.mnlitatii;t Cilnpldiscut.linldespt~moclil;leiid laniveJ biolt1gic lucrurile sunt mai cl~. Aici se [email protected] in care Un pru:run~tJ:U. ppate.Hii varieze, dar sa dinttiliU lOtlt!ii in . lbnitele honn;tlitii\ll (~~i ~iaid pot.in t\Parliunele excetl\il). in ceea ce pdv~te aspectele p~.ibologice !fi comport~unenlale, luc;rurile.sunt ins5,Joartecomp1icate, UnJ!rim·td~'lu cure a fost propus pentru a.delimitauonunlutde~tnomml-(pntologic) i1

fostcelsta&Uc(Delay :;lPicbot.l~Sfi;l971)~ Cbl}fonn:acestui crfieriu, nonnEirins~mnn.eeeac;.e.aproJtitnea-zti t~ediapop~latiel (~eeaoe fac eel malmul\i.oameni).D~i Wletite.iiu util,-ncesUt uu este satisfiidirorde unu.lsiugur. Probabil ciiel Jlllll.tfunctiotm eficient nici macar in.domeniul biologi.c~ Carla, spre exemplu, este o p£YLel1t~ trecveum 1& major!latea popma\iei, ft1rij'Caace;lsta sa o. facit stare d~ uonnalitatetApljcat id domeulul psiho- -coll1porbunental, acest · critenu are probleme se~ionse. Spre e:r.e.tllplu. pt:obabil ¢a tu Bvul Medi.u, -un sill degandire i1on.nnl !li non-patologic em acela.-care cousideraca pamt\.h.t1.ll~ste plat. iar un stil de gandire patologic. deJ.irai.ll, era acela care sust i nen di pam{lntul esle rotund.L Ald:uilea criteriY ·ptop!JS peHlru a deLiuuta uommlitalea de.anonna1itute este · edtedul culturalideal (Dealy ~i Pichol. t955; 197l). ConftJtm acestui criteriu, ~ ...

. -· c ··'· 95

nonnnleste ceeace sea~reapUi afi nonnal iutr-osnciemre. idealt•t pe care gmpul.social'i1 stabile~re uentr.u star6n de· sani\tnre. ~adilr, ceea ce .este considentt uom1al fntr.cuncontextsocio-

· ... cultural, poate sa fie eonsidernr. patologicin alt contextsocio-

cultnra1. AI b--eilca c•·itca·it• este eel fmtcfionol(~lay ?i Piehor. 1955; 197l).Elar~~a;t:a noEnlalulinseamna capncitatea dtla-li nringe scopuiile i-mportante in v:fat~Lfilrii"'a. inter.fer.a ct runctiqnnliratea celuilnlt. Asdj~i. normalitarea este ddinitiffn pstlmpn~Iogie. inh--un ~ndm delimitnfaprotlimariv de cele trei crite~i ?Jenti?nate~. cu nn a~cent n1ai pntet1Jic· pe cri£eriul

{ { funcponal. .6-f;ia:dar,. dupl\ ntapfi ,ani . dlb'- cercetare, no.ooalitatea

·t~~:l~~~:::~!:i1;:~=~:~~:l~f~~:!~:~~~f~~:~;!:!i~~~~~~l~ 1- ~is:tt~ ~1-disablfitnte, !? tiropee torm~nul de disnbiiitate ~~ ma~ cl~r ~efini~ ~incapa~i tqre"func{ionalK),. stras-ul'i distres~11 s~tn~defintte mattmprects. Stres:.tlleste o pre~re_nta corratanHi ~~ vulfn;no.nstd: Bl este unu14in filctodiinrportanti-pentntviatii ~lmen{me&"et\ ~· (S~lye. 1976)Wistres:Ejfin sc.himbeste definit caun str~care~reconsecln e .. ·· ibolo ioe§ibiologicenegarjy_e CS.elye, 19~li)._Dar unda ·e~te ·litnira intre stres. qi distt·e:;? 1?1ferentu d~e at:J'eS.:jJ dJstres c.ste cantitntivli san caliri}Uv!?

--pml~epntologm r;m pmnte Taspund€Snc8 r.iguros ln acesre j"ntrob1iii (Ellas.l994; LAznt:os •. l99l).ftrplus. Etdcsen distinctia dintre ~fr-es-ul ~~~~!! (eus~rcs};i distres se faee a· posteriori •. ndica

.. Lluplt npan{inef(!cteiorlor,Dacli efectelele.suntnegarive ntnnci str~-111 t:Ste i!ll~trpret,at a a distr~imt·~acii efec!Cele stint'(JOzirive stre~-u1 est~. lJttf!rpretat Pa.Ellstm!!-.· ~adar, acea.sradistincfie·

' ~~1st~ v~. dtstt::- llUJl~tnc~ vnloare predictivli sau,explicativa ~• doartJ.rta cl!lstftf;nt~l"Je<,-n posreriori:;.. .

... ~}p~c sp1;e dish:e~ "i dis~bilitf.\te. Acest element ttl

d;f!~~ttn~e~te·rlnttl.co~adev:tratporicnlos pe1ltm patolagizama VIO{It cotn'IJ.en~. Ce inseamif dsc? R.ise IltsBtunna pmbabiJiraren de a apib·en tevu:negntiv. Prin definifia tulburl'irii psihice mni

®

sus rrtentionilte • .risc'i.l} presupune predic.tie.nsupm £lparitiei slttrii . £le distrcs~i disatilitate ~i sugereaw di noi~ p.silloparologi i, putem · face ncel)sta predicti~~ Slltrebarca lle care Ltebuie sit(} tJUnem

1nsa es.te unualoaren~ esteunl\"atament hazar pe ncest okiY!I!nt •tlisc{spredistres eyi/sau disabiHtate•, justifioar in.cnzu~·ip.cnre l~ilci~nwl ma are 'inca int rablonfclinic mas\\fcst? Dafe;)&,~tiintifice pe cdre1e .avem tn ace::;tnJornenl: ne ru:atii di N"'Ll. nu este justifi_!!al (O~wes, 1996)., Predicpil~ ,\)e ~are le pt}tenLface privi..'!.d

·, de:?,voltarea llOOt viitoare QTPbleme psihicesunt ex.trem. de i 111-

precise Yn acest moment.Chiar cunoaclind factorii etiQlogici de -risc;(ex.. favod:z.ap(l •. p;;;cllspoznntirderenninan\i;declan~atOJ;i)

~i eventualele cnracfedstici,@le ·Il!~dililui pl!CientuhJi. prohnbilitarea de .a faceo pr~diptitJ:, aot1rat~ nsug:r~ dezvolfarii uno~· ·tulbudl.ripsibice ~ste e~tteii\ de mica (Dawes •. 1996). Pro~abil cil de7.VI)ltih:ile S~tiintifice vlitonl'6 ne 'f'Of oferi (~tmine~elJtm aJace predict]i mai precise. darnu esre cazul sa crede~"l Ca pntenJface acum acest luc:m. l)aci'i cineva .S~lS{ine conlrariul, prob_abll di a~cunde foarte 9ine llarele emrJirlc~ pe baza cliront 1-'ii bnze.aaii icJeen! Pentru a prg!.mJental1l muichw ~ceusta concluzie •. sa. n~focali~lim.pt; tulbvrliT~,psihic:e presnpuse a avva o componentll genetiga ,pm~rniclL Astfel, chiar pr~upunfmd cl.\ prin consiliere;~eneticii Sa .es£imenza Ca cil\eVa nre'unrisc pentn.1 a dezvol{a •llchi~Q.[l'!i:nic de 7~%. tutt1~i nn

· put~m fi.siguri cl1 U.\lludi:vid .::u· acestris.c va uvfia:sc}\izofrenie pepnrcurslll vis:{ii. tn sj;himb. esteposibilcu u11 it1divid clann

risi.7 calculat de 2j% d~a dezyf.)ltll sch\.zofi·eoie~ al\ nibl\ sch~2ofrenie pe parcon;ul vie~i.i. 10A:Jadnr,; pt:t;dictme noil3l.g!

. .$~sti~ennS:.'l eX rima Cll neoesitate Jan;velul jndividului. fn co~. i(iilefncare ~tinl eli TtJr)si~qpllt'?lag.ie.~rliUlmf}niJd 11U ~sre n~li11inistra( unui "paci~TI£ ~tatistic" .·.P1.nml! fl8Cientanulf\t • slat\

· nc~ste trat~mente au l,li .a m~l ·.me de e:fuGte SttCU 1dan}(Kapl;;;; ~i ~pi<}h .• l ,, ; .. a oc ~ ~i coh)h.,2002). este evidenta problema etiQa in jtlS~1ficaren ad•ninistJ:li.riiunor trannheme pe baza unui

. . .

97

. "•.··-·.-· ..... "" ... .,.,.......

' .~

..... )

._e

'. ~·-. ~

,.,. (· -. ''

ris~ calcula~ de a dezvolta o tullmrare psihidL Pe aceea~llinie a ?rgumenijidi:ideii t:;ii in psihopatologi~predictille nQ~Jre sunt.,

· uu~~~i~~.}~~~,~c9estmoment., un altaspect c~ trebtfi~'alstut~t e~te'pr~i1~c,\fit;f?~·h;azuun~ ~uaUzeiclin.iced~taUat.e?lls~pun; ~de.'!,e~ cap~e~IC\·!aiacuta an unna uneuunhze climc.e (ex .. Q!:in mt_:H•tul chni_9· esle:mai precis a decijt o Qredictie statistic a J:!e bazl\ includerH pacientului1n auu.witedase 9i c-.ategQ[ilinu.{ma . examit1fuii CU anutuite teste psihologjcesa.Uill1.l}]113 \UlOftlflafize 2emografice- diagnostic stati~tic.: {pentrudetalil vezi Ffa~. 1996). Ll1 primi!vedete acea.s1'i1iio~a este Ull;t reiouabWi., Printr-W"l diagnostic iudhr1dualizat cu ajU{oml iftterviuluiclinic. pulel"!l ana infonua\ll.relevante.:;;l detaliate penttu pacient. neaccesibile prin alte metode .• info:auatii care ne pot ajuta a poi in predictiile pe care lefacem comp.ortameutu.luiucestui padent.

@jire exemjillb o testarepsihologicli nepoale sp11lle.di padentul no~tru are un coeficient de inteUgenta 1lle9iu.pdn r:apoitare la etaloll. La 0 analiza clini .. a. ac . te . . .• . I oate

dobaudi st::muifica~ii noi: ( 1) pncienluleste uu1i inte ellt, dnr este e.x.trem de anxios la testare; (2) .pncienlirl afost u1aiirJleligent, dar ca unnare a un~?i trawne cerebrate s-a delerioratcpguJtiv sau (3) pacientu.l a fost mai putin inteligent. dar C:a unnarl! a unor programede il1Jbogiitirecognitivn aevoluat u~o~ etc.Tbate nc~te dnt.e cutese prin a_nalize clinice n~\,lc un bagaj intpO[tant de infonl1Btii fat11 de di!lgnosticulstatisti~· infomllllii cu~npatellt ne pot· ajuta in predictiile pe care le )'OUI face,des,pre . performatttele a cestui pacjent Pare evident, dar a~ a sa fie7 Ce ne spun cerceUidle7> 0 metaaualiza sumarizaud rezultntele n peste 45 de studii (Sawyer~ 1966) a arlitat clnt ~i iadi dr~pt de apel di aceasUi ipoteza este falsiL Un diagnostic clinic pnrlicu!Einzat paclentulni"-nu estetnai eijcl~ntdectlt pu 9lagnostic sta;tistic 'in prediotiile p~ care le J_:mlem. -fnce asupra comportamet1telor pncientului. Ac.easti:i concluzie a JQst cmJfimtat.liin mai rnulte metaanalizepublicatede-alungulanUor.

98

sururuizand rezultatele -nre.ci de stu~ii (ex~ Dawes ~l eolab., 1989; Meehl,1954). De ce.se dovede§tepi:eijietia slutislicli eel pu i u h\ fel de e.ficientii ca redic ia clitti,:;~ in ciuda.ru:te taril;r . coutrru:efYuadin e.xplicatU estecau1etodelestatistice uutihtsl el Conuepute indit sa poaUi evidenp.a I.Jl}.ttern-urile e:.tisteliteintr-p colecpe d~ date ili,ncolod~ ••z;gomotulliisennialuldish1rsionat" nle aces tor d~Dn'Yes, 1996). Onnteuil, pe de·altnpaltt:, fie ei ~~ cliul~i~ni prof~si?ni~ti. pti,nX~s~~ a~tc~ra ~or~e~ni~vli a~ dificultatilil a oombmamfo,piapt calitauv difentesaumdtcaton rar. asociap in viata de .zi cu zi (ex. fre~'Y'ei'li-a inotului· 15i • perfonru.mteleJUanagei:ialeo 11tiut Uindf'apb.il dtadest;tatnl:,l:e ac~ti indicatori exism o corelatie' pcttitiva, · setfiuificativa stl\tiatic) -(Aud~.rnon, 1990). iu consecittf.i. adeseautil.itlilll sintetne de decizie descriptive nu normative in p~~~c\.iil~ pe ~areleJacem. Ast{e.lde sisteme de decizie .descdJ?tiVe ne:dir;~orsi.ouenzii preidicVUe. Spre ex.emplu. doua din c::ele <mal C.Utlo.scute ·

distorniuuisunt introduse· de .accesibilitateatti .ir!p.lJ.'2'eilfntivi{Jlt:ea inf ormatiilor (pentru detalii vezi, lll:aJluel11an ~i Tverskji .1972; Tversky ~i Kabneman,l973). As~ aqtW~aincent prediel,ii.pe bnza ioformatiei nccesibile la un ru1unut mom~t. i-goortbid hJoouaUn care nu este accesibiHi inconte b.ti at dar care nr fi os. t h.npo.·. ltllitta..··. tn P .. .redie~.·.e. Pe de t11Ui parto1 .Q~ca'cevn-este . . . ' ' " --, ~-

foru:te. reprezeu.tativ plllnttuo categori~ nceo~mnu tQseaumltcli. -acel ceva. esle §ifoarte probabiL DaciL spre.~etnplu, se iuezii'ii.it

.... uroJatoiueledouaafmnatil~ · .

f•.. - 0 .:l)·e· .m. · eieJunmtoare;a fiioutcanc~r.la pliimaru. (m~op .. ~ .. runn pul.monar)

. - 0 femeie a fiicat cancer ln pllitnihd. · ' Majori.tatea. subiectuor afmna di primul e.venilllent estetuai

probabil dedit eel de-a doileadeoarece siutagma "o femeie futnato!lre"esle mal rep~ezentatbti\ penll:ttc.ancet'Ull~ plamftni dedit siotagma .. ofemeie". Desj.gut~ o anali'llilogidillmt!l. e-videu( di a d_oua shun tie este maipro~mbiHi.

99

--------·

- J.~.~~" '· .iir!ft~{i!~tzlillit~1iidrlnn~rtl~(.~kt11olQgtc itej,~fil · '8;~tt/!~5'~~~~~,~derl:~vi ...•. ; · " ,, ..... · ..• ; ~. r+:i·~·· .

···~· ...... Ad~i~~~taYiU~f!a•ui~li.dilig'1~sric nosologte P~ll~~+'f!Jc ~~il!~~~~!l?li·~Me 'de JttUtn1atol: rez~it-Jt~ cliu testa~ l\silu~lo~dt ~~~~tnl1lc··a~attilt'0i1t~l¢le ps~t,~}p~e~ au HJ{I~i~~m,te.4ir~?Cl ~\,\1Ba\t~lii~cn-~a~reS'i~1o~ m6&ih~Ie (Nfey~~~i~pJa~:d~W 1: p~~·dl~~·tiivczi~lf!Y~rh.·~~~~:~~lilh, ~001). Bin.~~~~m~in ~i~l~~.·fa,tt~~JJt!:·~i~ e~tti?'tl'~~ilisM.l~rit~l"'l)si~ol!>~o. ti'89r9s. '·~~~~t(.l~i~t4q~t;f<se·Q~i~t,.~ta~t~ drl,~$~~~. ff;~~~·;f!'~?"

111r11··· ·. it.i!H·~!i~~~~,til!:c (I~~eh>~.uAstret:;'EI~nf~!<J.~r~~l~b. . '·. ;·· ... s:9t~~~~'fft.lJJ~~t.criti:dit•$i. ex_tensiva:~···~S'iefor

ti~~itti~··••·; ~~~l~~~i~~:j:;~':~~:s::=::.:~~~tl • 'fii11i~pd ;d~ r~~~~)ps;bal~giclisi~'da:Bi~ninl

;t .. ~lif11iJ:;(: . ~.l}~e~!AA\~k($tetneatrimJJ~hH:e}e ;· •· ·m1tFn~· . g~qg!~~~J1.,p'*al~~~ljnipii:.(Jcllriro~feldilJi 1~··:··~a1f16"~~ • ·· · ·· · ~~~~-e;~i illsr~~~nrnrDP$in~I!gic

• • f : .• n~l$e •.. ·., .· .... · .. · .. ·.·· ~~ ac~crn~1il~i\:;I~~Jgpp~are8conilor .·. ''···~~!\i'i;ifr~il$~ii\l · ~~e>tpfi!S·ie a:df.rioJtitt'ii;e¢tcetllfi1ar

. ':::z~~t.·~·· • :: teot:~trc; "S'tiiiittfif'dizlftJ•'".!if ~tnion;atg; :a~N;,QC .!~st 2R~iJ10Jijgic

(Anasrasl. .1958.;. '4ess~cJ,:_ • J~S,.Q). ~J#e ~~~J:lltt, dl!$i .studiile, : .. ·, .. dt{~~l.Qmeimp1wtifaupertathtr1i~jadan1eniulclln;c.:a4'l.t.~uh. · ~ · aspeeiteorericcftt fil aplic~Uv '(ri\t":i€:J; ~UOO; ~c;l~~r~:~~i ;TnlVing,

• 1994) •. mr aycm inc1ic't~ t~~t i:l~''ii1etilll}!ie iQ)p{i~i~.fl1 ciuda ·· ~*i»te~'el11ll)~nn:lit~fl)ilS,e·:~utti~(~X.~ltril1}e;.{~~~ .. de'·.;tnel\1orie ; : h\lJllaii tM91~~~·i1~rl$'Yi!~ ~f.~t~e~~~J\o tn.gien, .t~)~~'"'P::.m~ni~1rli . . .. as.~iinlffttb•~tltl~~if!'il:ak'mfilisifiirli :4f!''l1ieilliamenre,:sia-.,. t~~~~-itu:as~a,~~~~stti~'Zffi.·,~fi;~a/.~eti~lri't'.~i' i~i~~~.a· · sistemlllui mentfn nl1,histii1nt~ti~rpQihofpgfc adesea depa~it !}i

.,JIOQ.

-:. ·.; ···.· · .. •.··· ~- ·.:-~--

! J

~ .... J!

·~·

I ..

.. j

~ -~ ... _ __.,.,. ........ ··~·.

· ~ue~~.n.i.~J~~~l_(Jfcdef;:ns~ ve ~u con=?tie~tizeaza ~cesi)il?{~,~~~(3) u~dt~.~~'+ .. ~J,~~~!eaza (d~1 diverse motive care uu tiu dl;pafologiq . c1 de u1Lerese ec~n~nu~ spre exe~plu). A}getsvus,Jn groput~ .

•. eel or_:-~· ~par ~a probleme psduee in unl}a unei'astfel de , ,~v~ll~at? · psJ1mlogtc~ a~e~1 de fapt eel pu~u doua categorH de · l:ldlV~z;l:.(l)~~ll~tO~l p~dll~ ~l(2}cU osanatnte psiltica iluzorje,. ~:1~trn ~CeJ?h~ dm U~lllRO Ullerventie tJSihoterapeutidi.-nr putea·

. ' mlfla1sa amplifice stre~ml \li psihopatologia, caut1nare a abnrdudi ~necaJ~i~m~lor def~nsive cme au asigurat p sli.niitate ps"ihica Iluz;~JJte. Stgur. Ia ceea. ce am spus lulli. sus,. s-a( p1;1tea .aduce d~ua conlraargume~te sulide. Pr.(mulconfi"111ll~umentat fi acela en aceste scale de JiUtQev.aluare nufost:;erlos vali®,te. A5trel pe b:U:a 8corurllor otitinute la aceste scale (p~f!di(!tori}se poat~ pr~ZI~: un specl:tu la:g·~e !ndicalori psiho~com,pertameutali ( cntet~J) .. E~ ou spun msa ca aceste scale nu s.un~ valide .. Spun doar (veu ll~ ShedJer~ic?Ja.b., }~93) cavaliditalealo~p~djctiva cr~t-e. atuuc1 ca~1~ scorurlle mdica :psihopalologie ~J.fll~e .ninb.igua a~u 1cJ. dind sco1.urite lor indica si:tnatate psihidl ~t'.:ltistic, :acea:;Ui SJ tun(:.t(;! VU atC.OU8 coeficlen!Ji d~'Va)jdi~te [1fedjcti va. dar HU Va

elliui1J.a seii:mificaP.alorl Cu alte cuvin.te, v~;~lldHatea p~edktiva: n ncestor seal~ ar J?Utea ariit.a bil~e. ~ilr validitat~.cotu:;eptt1a.Ui .este problemnhclil. In plu~, mecanJSt1Jele defensive care rute:J:"eaz.ii si::orudlela aCestescnlepotnllera=lj sconuil~Ja.~t·iLeriu fieel subiec.tiv sau compurtamental, lntr-adeyat, cerceUidl~ ati aditat di atuuclc!lld sunt l!tiliZI.lte critetii cm-e·sunt mu\ greu, ixlfluental.e de:· mecibusme defensive lucrurile se schi.\llba;. st:ddatii. c~ apfu:eau ca fiiud sanato~ipsibicla scru.ele de nutoeValuare av.E!au ~m1~ mare pro(Jabilitatea s~iaiba tulbudiriemotio•IaJe ~i psibice J.n tnupttlluptelorl (pentru detalii ve:d Shedler ~.i co lab~, 1993). AI dm1~a cr;mll-aa.rgwneutar .fi acela disc::aielede autoevaluare utilizale pentru B. evalua saniitatea psihica ·au jndlcatQri de ~uiuciuna cu ajUtorul dirora puleni ideL1tillca indiyizii c~lfe ne mduc i'u eroare. Dirl pacate cele mai multe sc.;He utilizale pentru a evalut~ sanii.tatea psihidi nu au scale de ulinciuua, ~i cJiiar in

102

.... ' ..

cazulcdor cate au. llllilim dac:;atu~canlsmcledefensive uu au· alterat Iii s~prulla acest~ sCale;ln plm;,t;<;t\leledenliucimJasunt bunp1~ pr.hlc~pal it!.a d~t~ta.iu~lviz;li {;nre suiuilenziinuaUlt pe, ceicareu!ilizeazii mecnnistne defenslvel A~estelimite ale teslt:lor psihologice pun sub selUnul intrcbudl concluz.iile .umltor cercetmi diu psibologie C_ru:e =:IC IJa~azii.Jle Utiliznrea t\llOT scale de autoevaluat:e.Spre exemplu~ psillologia pozitiV'a a ~ditat cu s~nata~ea psih~di. defin~e de .. capacitalea. iudi~izilor d!! n distorsrona reali.tatea m favhm:ea·1or{ftlylor,.1993) 'Jntitntl ce un sill realist lllll"e sa fie BS,J.X;ia.t cu pr;oblen¢.psihice{eX.. t'-tlbururi depresive). Trebuie.ins9.sii.tneution8tneainc~uldepi:esleince.st' lucru este vruabil doi\r penuo o fbnna deiutensitate.U!iUnr.iL ln cazul m1ei depresii,de.itttensitate medic ~nu severastilul tle· gftmlire nu mai este realistci distorsjouotsprelaturn uegativaseexngerewza Bspectele uega.ti.ve...Rnpqrtulcpgrdtii.poziti-ve versus cognitii Jtegative in, ca:z;ul nonua.litii\Uidepresici ~~oare/ r~speetiv depresielniedil-severe este de :i la1/ Hal/ respecliv

· lla 2. Prill prisma eelor discQtate 1li,ciapeste rezultate pot tusn sii fie··interpretate ~7l altfel. Studiile .de psihologje pozilivn utilizenza adesea scale. de nutoevaluare.. A~adat. f!.._tup~i de illdiviziuormali COllpUe nt§,tindivi~ JJOrtnati cat~ilndivb;i CU 0

sl\natate psibicailuzorie,. a~tia.diu Uflllii.justificilrt~l'eZUltatele cnre ru:ntli. di cei cu sijuiitate psihlcli ~"aluata .cu ~cnlele de nutoevaluare· distOrsloll~ le~litatea mai Jnultdeciit cei cu pslliopat~Jogie (ex. tu1~urare ~.e.Ptesiv~ m~Ybdide iat~ns.ilate ttljmu.-ii). In ~este comli~i, rolul ilJ.l~<lf: pu~tive en' fnclOri protectori alsanatli\il psihice arputea saf.i~ sbll.f?le ru:tefl!cte ere~ ale prin utilizare net-eflexivil- auU\lLinSt)]JJ))el1~r psihtdogic. Prubabil di studiile viitoare vor cla.riUca cat ~te iluzie din nfn·n1atia di i.luziile. pozitive :mnt factori protectoti. peutru sanatateapsih.id\ ~i cfit este~-ealiJate (pentru detalii~i informatii suplimentate \1ezi Ackerman ~1 DeRuheis,.l991; Sltedle.r lli. colab .• 19~3 ~i sec~iu_u.Ue 3.1:2,.3.; 3.1.4,~. ~i 5.4. din nce~'il volmn).

lQ3

__ .. _,.... '"'I

O.a dowJ·s.itwlfieinteresandi (pel'itru deram vezi WaJ:!;qn eyi P.~nnebake1i,1989} este aceeain care s-ainvesrigat relatia dintre distres .,-eya1uatcu sca:'le d~ autoevalunre- ql siU}ptori1atologia somatidL.Scal~\e de auroevalliare a sanatatii psil)ice, respectiv n I"everSl.\ltii-ei. srarcade distre.s;indiferentce aspecrevalueaza, co.releazi\ ~tii.tdepu~en1ic intre ele tnditincarcii un singur factor in. nnalize1e factariale.· Altfel spus, siinl\tatea psihica, respf!ctiv rpversuLei. staren de distres, sunt considerate construct~ multidhnensionllle. Cer~~taril~ au arittat cl\. s£alelc J!p antaev-altUlce.n cdi.stres;.llltli coreieatii .uremic qi senmificati v cu -scalele de autoe"aluare a·simptomatolo lei ~o atice (Watson Jilliennebala-.r, l9B9). e e e& cercetarile. au 1lrlitatcli scalele dc·l{utoevnluare a sim tomntn1ogieisoma · · c('; coreleazli.

ermc ,~1 semnificativ en indkat()rii obic:ctivi lJ..! ~ strnptomatologiei somatice (Watson ~i Pennebaker. 1989).

-coroborlirlCl a~~te doualfuii de certcdid. uuii autori s,-an gdibit · sltle considere ca dovezi ~;lle modeluJui ,llsillOS!Jm!lLic-facrnrii psibologi~i au roletiopa!ogenetic to t!l~~urarile somatice. Diu plicate ioslllucn•rile :mntn1ai complicate. Cercetarile lllterioare

. na,t at~ tar. 'i!J~r-Lln mad .Sl.lprimatot, en retapa directli c:linh:e di~tres ~ evaluar.prinscnle (.Ie nntoevalnare-f}findica,torii obi~cUvi ru tnlbud\rilor somntice nu esre sistemntica (penlm d¢talii .vezi \V~l!lon.:Ji Pemui}l?lWf• 198Sl.) • .Alrfe1 sp_t~s. de9iA (clistres-ui evalllatpriusca]edemltoevaluaf!!).co:relfi1li.cttB(siptmt1a£Qlogia sof!lnticaeval.'tatii.pri.ns~ale de ~utoevaltlnre} §i B cQrela~a en C(sill\ptomarologia ~onl~tiblifvalutlll prii:rindicnlori obiectiyi). nceasta 0;~ 1nsc~mlt en ~i A co.relea:zli·yu C. Varinta comuni\ dintre AqiB nn ses~trrra.pune cu varianta con)tma dintre B ~i C de~i 'B ~i: C · &e presnpune .cl\. tnl\soar! acela~i lucrn! Aceasta pnne sub sentnnl intrehli.rli .tante concluziile .. mollclnhli . psil~OSQl)lntic ·.pazate pe rezultatele '?btinute. prin uti \i·larea pte.pond~renUfa sc.nlelor de autoovaluare.Probabildi din nou, pre.zent.n ·nnui grup cu sana tate psihicll iluzorie fn cadrul

104

indivizHor considel"ati slinato~i psihic este nn fa~~or d~ · 1 1 •0 traintuitive descnse mal

distorsiune cure generaza re2.n tat~ e c n . . ~ . . . r S\lS PJ-ezenta acestt\1" ind\vit.i CU sanatate SlhlCU. I}UZ.OflC ~Oi1 e re.d~lce semnific.ativ corelatiile inverse el{isn:nt~ inrre sannra:.~ -~~]~ ·~~ ... l"tii ~ ~ Cl\ scale de nutoevaluare §t·snnptomntolog._l•' ~ . · · ·.- ~r }u"ru estc .. ,- evr.l. atli lrin incticaton obteCllV1, aces t. _,. somauca ·' if • 1 -resent a1 sus imu de stndiile care nu ariitat c" un Ul ve (.; :--~nismtlor de~ve de ti negare (care generea~~ o s~~~~~a~~

pst iclfilnwrie) dtlcc a. t'ln activ_are fiuo o tc crescu . • tulbnrari somat {Pennebaker fil Susman, 1938). .

l . 3.1.1.3 Diagnostic. nas?logic. dese:riptl:"' ver.su~ ~·:;nas~ tic nosologic etlopatngenebc.. 0 tncre~erur~ ~n p-.:. o~~ . .

tqointe de K:raepelin. diagoosticu1 tulburl\nlor psdu~e ~ fo~t 'In haos.lsaac Ray i-n cmninuatpe ~quiron !l~ Pine11n d~stl~Ctl~ diotre nebllnie [includnd mauia ii demenna prn~~~£, (a~t~z~ schizofrenie)l !ji·· deficienta m~nral~ @ncluz~nd ldlote~?la _lil inlbecilitata.a) .• s-n neg;lt·'itlsa eonsmnt in aceast~ :pen?~da validitatea unor clasific~ri mai sp~cifi~ ale (1.l}l:l~ra~J lot· psll~•ce (I~i11l~trom~ 2002)~ Krnepeiin·(lB96) atnoerc.a.q;~ fl~h-~e ntd~lul rh.ei.li~al desctis it~ sec{iunea1..2. ~i tulburl\n.lor pst\nce., nnmte de a continua, treb11,ie i}T.siL.sa elim,ttli~ in· acesr co~~e.'ltl, o

.·, ·• ·.,, t'. •. ~ir .. a care.·· eXJ.·stll i.n lirerat.tWI. psi}ll:\p~.to. ,,o. g1e1 (ex. concep1te gre., .· . .. .. . .· · .···· .· . . · · • · 1 . d. . r cu\ Sa~:t\stm ~i ~nrason, l 999)" }Aodelul-tne~tc~ ~~ loagnos .' eiiop~rogenetic nu insean).nl\ un ~ec;luc~olu&m luomedlc.l'll; lGac[lelin n ir),\eles prin mo!iel {nedtcnl, unmodel 'in. cnr? boa 1 :~ nreariumitetntmifestih:i(tabloulclinic).ca~rze,(~ti~logte)!lt_:n'!actu

nrogenerice (veii Sef?t\~mea:1.2. a aces~etlucr~rl l: m~camsn~ele ~tiopatogentic.e nefiind doar biomedlCale. Cl !il p~th?SOCIOl~ {Killlsrromj 1002); tn consecinfii., primele propu~er~. at~ !ul I .... ·.' ... · -1·. · ... "l·l·f·o~·.r .. d .. e n. face o clasifioare a.tu1bnd\nlor. P. s.1h.'ce u-n~pcm.. " .... · · ·.· . . " a·' ·· -(nosologjcli) ba2.atll peffi£iliatoge~l de a evt tn ~ln .. Hignos tic ;rzosologic descri}ltiv, bazal donr pe ~erLlne_ ~' ~t~pt~m: {Kililstrom, 2002). I{r-.iepelin s.i-n oat seama en tlm pncate ms.a,

185

. . ~ . _ _,j

.: ...

·-·

cuuo~tin~ele limitate din acea perioada despre etiopatoge.uez& tulburllrilor psil1~G6 nu ii permit rut sistem de clasillcare ai.~torn bazat ,P~:~!f:cjpj(9$~n~za. A~adar, incerdind din u~u sa ~Ji{~,~~ .. diagnostic nos{)logic descriptiv,a ao\.\a propuu(.'!re a lui~l.l fost . penln.t u Ll sistem de clasificare bamt pe evolli\ia ~i progn~sticu£

\ (gr. prognosis-a llli dinainte . pro-ioainle; gigno:Jkein-n W) Lull.mdlril (Kihlstrom, 2002 .. Kraepelin conllider~:t cif cee~ c~ fact>; ca·psihozele inaniaco-depresive sa fie sim.ilare intre ele ~i dife1·ite,de schizofreuie nu. se rei era atfit de molt la simptOJ,ue ~1 sem11e cat la evolut.(e: p~i{IOZele rmtllittfU:-dep.resive tind sa se nmeli~reze pe cfind schizcfn~nia tinde~a se agraveze (Kih1stmrn.

. 2002J· Ace~s~a a dou.a propunere at-e iosa o problema mnjoiii. Un d1agnosttc corect poal~ fi fiicut dmu: a posteriori, dupa apru]\in ~i eyolu\1~ bolii ~i a~~dar, elnu _ajutii foarte mult in procesu.l de tt:atament. Deoarece ICI·aepelin(Kraevelin lJi Diefendorf. 1907) ~1-a baza~ acthdtatea ~tiintifi~ p~ asumptia eli tulbtu·acl similare s~ e~ prin~H ~rin shuptoUte ~i se1n.t1e sinubu:e ~i a.u o etiopat0ge1)ie sJ.mlladi, ~~ deoarec~ uu putea cunoa:'jte clar in acea vreme nspectele de etiopatogeneza o. ttd.bw::arilor psihlce, n acceptut provlz.oriu uu diagnosticdescrlp~iv .. focaliiat omnai pe seiuue !li simptotue. Paradoxai .. iutentia tui .Kraepc::lin de a evitn un diagnostic descriptiv a dJ.Is tocrnai acolol Problema ~te ca piina in ~ilele n.oasn·e diagnqsticul nosologic psibialdc a rantas llnul descri.ptiv. uiUi.nd angajamentul etiopatogenetic ante.dor (K.ihlsu:pm, 2002). Acest diagnostic descriptiv, de clasillcare a · semnelor~i sllllptonaelorin diverse categoriinosologice, es.te tuml prqulemnlic. Clasillcareasenmelor ~i sin1ptomelor se poate face dupa c;tiverseciiterli (in priueipiu o iufmi~tel)~i nu putioe au fost cazurile in care. s-.au construit categorH OJ'i s-au ,s~os calegorii liosologice din gh.idurile de clasificru·e. n li.tlburariliJr

psiliice pe baza unor criterii instituite sub presitiue .sociala (Borges, t995; IGhlstrom, 2002); cazurlle masturbiiri.f lli homosexuaHtlitii mentionate autedur suntilusl.rall ye in acestsens

W6

(Borges, 1995). ~e ade:vllre.linsii,.cii iu ullimele edi\ii a~l (ex. DSM~IV L. APsy A. 19~ incearcli.gi\sirea un~ cri~i yaJldate ~tlin\illc de clasificare a semn~lor ~is.iroptotn~~. DJ_!! plicate seiguorliinca dlagnosti,cul ~ti~patogen_etic.ln cott!leci.nta,

~ cunoa~terea uoastra rlimftne ln ni~~l:ilescdpilv.. adesc:a ;fiit:'li a. ~unge la.nivel e:xplicativ. A~adar, ~~ ttntamenlele a(\tnuuslrate !li elaborate pe baza unui diagnostic descriptiv au uml. pu~n~ 11anse :sa atace mec~misme etiopatogenef:ice re.\evanle •. fimd ade.sea simptomatice._ f. ·

@ Problerne ala. Psilr.oJJUiologlci c~ m.odaiUiifile ..

de intenren(ie §i tratmneut. · . . · Problemele fsillopalologiei relbtltoare la modU11n can~ se face trntamentul tulbnrru:ilor psihic~ sun.t dese.tisc in cele ce urmeazl\. Diid.i tra.tm.netitele tplburl\rilor .J:1~'~.i4ice sunt eficiente lSi valide ~tiintific attUiclne llliteptfun en: (l) n\lmfu:ullor sa fie constdlns de sup01tul elnP.iric; {2.) .sa exlsle J.a:e empiric: ca~e sa SUS\illU eficienta lor :ji (3)pi01U()Vatea ~Of~Q fie iacntii [lflll

suportl.'ll empiric de care s~ bucudi. Sa urm~nm m?dul it\ c~e nces~tli suut coufm.nate de.starefl e. Jt.. J:stentli.. U.l.domen. 10.

. ~ Nmuirul exo:gerat de mare al [ormetor ile u·alnment SDU Lnbidubd l\'Jiuott\Urtllui . . . . . · · Pnralel cu. cre:,terea numiirului de categoriluos?la~ice psibiatrice asisi.UtU ~i la 0 CJ:elil:erC R ll~tlti.~~Ui fotme!or d~ trala1ueut (l3ergin ~i Onrfield. 1994). Dm tulU. 60 p~uti manu '90 nun.tfuul de trntameute psibote.rapeutlce a crescul cui@:"O%) (Miller ~icolnb.,l991). Numul in psiboterapiea~e~t f1e$te_20~ de· ~coli de psiho~eiapie :Ji peste 400 de tehtuct. ~Be~gt~ -~~

· Garfield, 1994). Acest lucru este fonrte bun, ant ftlen~\I sa sptmem. Cu dl.t oumar:•l de trntatne~te ~sp~n~bile esle m~l.n~·e cu a.lil.t ~ansa de ameliorare a sufenntei pmluce esle matmm e. t A~a sa (ie7 Din p~cate ct~terea UUl\.1~-ului de tra~men.l~ B. •• in mnlel ~teren ar ic.inHi a nu.marulm de: ca\egorn !.-.--~- 107 ~'. ·,~,

';' .• 1.

n.· o .. ~.~ ...... u. L. o ...•.. · .1·: c. e psihmhice, 0 ind ~adatea ins~i arhficia~D··· e .. ·· t.l .. nde,

1

'"\ •.. " ~tim ucest lucru? Hat sa presupunem di aceasta c~lere nn este mtificioila ci~xpresie a celcettirilor ~tihl~fioe care an dus la forme noi !li diciente de·rratament. Dnca acestlncru esLe adevarnt:

o Prevalen{ll (mimarul de tullll.trari 11sihice ex1stente la un n10me!lt dnl:) tulburarilor p.sihice trebuie sa· se reducn odt1tii cu i'omulpreafratamenrelot eficiente; ·

• Trebute~"Q. nsistlhn ln clarificarea unor modele etiopatogenetice pent11.1 foarte nmlte tull:;mrari psihicc_

Dilj. pacate n,umli.rui maro de tram mente nu aduii ln sdlderea preval~n[ei pl'tncipale1or .tnlbltrari ·. psihice sau la clnrificnren semnificativii a unor mecanisme etiopatog~netice (Lilienfeld si col_ab .• 2003).1\1ai m.nlt._preva~or tulbndiri p.!!_bice !!:_~. deti e resiv)a crescnt tn ulilinelei decenii (USDHHS, 1999). . igur; ~e po~tecorimntrgtunerl_ID(modi .tcfind o ipotezii "'1xiliilri1!)

.·. Cfi ·Qt\n{fi C~ dC7.VOltarea SOCietatii S-aU dezvoltat Si . iversifjCI\[ i - i!Ctodt.'Ca"te detertniaiHulbnrlirHepsihiee {ex. srres~ul). Aceasla E;i~nacl tlet}i·tratamenrele sunt eficiente ·avemrontsi mt~Ue

tlllbnrari pslhice deoarece ~vern mai inJiitl far;tori eti~lo&ici.] Aeest Brgument esteintere~ant. dlir-la o examinare logica atentit no ~E:te s~ficlentde. utero ia, D~cn el esre.·adl!:v~mt. ne~am llJirep~a cam prm1nl rQn ncideJ1 trdbilrarilor psihice {nuiJl~rul de tulburltri sibice 1\{)l:careaua .. ~utirttr.,o arittrtlitn~o.lldii) sa creascli,JlU Beapa~tpr.ewalenta"ior(pv~tlpnn nd cli cei suferinzi sunt-tratap ef.icient}. Or. noi ani ad\tat cit prevnlenta u~or hllbur~rilorpsihice afos£ ~i esLe 'in cre.~tere. irtaercan9 sa f;alviim rorn~i ipote:za en rrntamentele ·lunlh'ii!'iciente contin\mndcu o . ··. - . ' ' ' ' ', ' ; ' ' ' ' '- - --__ .-.'

ton1~ula ile t!pDuhanes-Quine (Gl·eenwood. 1989) 1\m puroa modd.'i':n o nmt ipt1rcrli au)(.iliadl Qi um pi .rea spune c! tratume~ ;ttunt eij,ciente dat_cei strferiozi de tulDurlb·i psiltice nu au ·aoces

}a ele: ll' _n§adl}r. preval~urlirilot psihice este maa;. Cei • sufer.m7.l·qu mJac~e$laace$te trnramente eficiente·deoarece:

108

.. ·· •,.

~ sonr f~arte scun.llle.tntr-ndevlh. costur"ile trnt~tnenrd~w m\tom~atUor ps\hice suuturia~e.irrSUAam~~lc~lcl~umdu-se m ·nr de 100 de miliaTae·deUSD {USDiffiS, 199~~· . _ ~ J ~ nu sunt Sllfici'ent ddbiue disern:innte. Stud u k ar?r: _c~ ~/ 3 din cei diagnm>£icabHi cu o mlburnre psH~idi mt canra ~~ nu prhn~sc nici\Hllllltutnenr (USDHHS, 1999).

.TinlimHnsa cbl1l ca: _ · · . . . , • .:_ mlburlirile psihice .suurp~intre cauzele p1i1~~ipale pe~~tru.

morra1italeill {lltile dezvoltnte, eJtistiind ~adar.un mte~escr:_,~t.tt tn n le rrnta {bx., conform-e&ti}l."llirilor OMS .• tulbnranle gs1~u~e

·. snntcauza numnruldl!ii pentru.morbiditate Jli mortalitat~: m l;nn1e

de7.-.ioltnte~USDffilS, l999}4ic~ · ... · .· . . ~· . ;·~ dntele empirice arad\ ell tmtnmentele penrru. rulburanle

psiltjce stmt ·. nrltJseo~rnptontatic~i · didto~a ~~~storn e~ri! departede a·fi I\llll{umitoare [(e){.irt cazul toll?urarudep_rest~e ma}ore~ iutuma rrarame{ltullli ~11edicament'os doar aproxu~1nt1v 4S·3iO%dintte pnCientU!J1 an1elioreaia simptomntologia mr ~~l !nfi.imp~rea ,acestufa, tauloul'clinic va r~apare~ ln5_0-'t._O% dJ 11

cei. cnresi-au arnelim:ut·sin1ptomatologia'(Antanuccio $1 e?lnh:• 1995; D~kersbach ~i colab .• 2~eo;1)~Rubeis ~i.eolaq .• 20? l) l. ~otbza confonn dlrcia avem n·atttm~~ce foane ~fic1enre rtar•·ele Illl:'a·nn 'l. ei . erin?.ieste · u n rol:lab1l s fie

~de~litati\.Consider mai degralllftvezlfli Daw~.l99(l),.'fn baza date 1m; pe·ctln~ le-am nnaJ~zi•;, c:iimai pro'brlbila est~;"; concluz~ ·

. con:fotm cli!eia aven1 tpttunlenre fonr~ . !ea).nml~~7.lnUv e. JCJeore en e· rctent mnltum1tonre penttt1 anumll"e conc.htu {ex.

·1 ~de anJC.iet:ue .~i·malpu~in eficiente. penn·u al:tecondi ·ii (e~:. tulburlrl bipolal'e ~i gretl _ncc·esi · Promov.a~en ah~udlid-lot mai ·b1Iie vah ·ate ~tiinti"fic .{ex.. cognlttVcot\lportamentnle·~ biornedicale) este c~1e~ f?8T~ ne -~~~~~ scoate din a.cestlabirint form~t din sme de tratm11ente aruftcwle care

erlitacesc sicnreml ne i:tnc nidiieri. ,. . .

109

c1~ lh~~e .in v.nliditnle."l :;tiiu!Jlid.i a tratame.tJl!!lur. Ecce lVfesnu!t:.,; . - · •·: · ·· ·

~e!~-g~~'4bode tebuielqe jnterveutie p$iboteia~~~tidi (Ber~m 91 _Oar~~ld, 19.9~) au ~ost ad~sea-inte1neiate pe exper~en~a ~l8tudiide caz ~~ rar.eon au fosU11vestigatei.uatudii ~xpen!nent~Ie sall.~tudli cl.iuice. controlale. Putinele studii ex_p~nme!.Hale ~au cJiuice coutrolate asupra eficieutei PSlh?te,r?,PJ~lm·,eXlsteute. totu~i. au fostsum.:'lrizate.inluetaauaUze canLHatwe(ex. Latni:H;!rt, 2003; Lambort ~i Ogles 2003· Wa~upold~icolab.,1991) . . u ar.U~ clipsihute!1lp{ue 8m1~ ~ntru uns_peetru 1arg.de wJturhip~ce, acolounde sun!_eficleute au,efecte petermon lung sip. revirrrecaderil· ·· · · -: b. .. . ..··.. .. ..· . . .... · ... ··. . .,. ..... ·.· ..•.... emru we.··· .. ··• ~li:Ufia• •. _siliotro ___ asi. ___ ._·?.~ e.Iedintreil~ele,fomre d~otetalJ~~ nu su.nt s.e~Ct\tive;(d~iexista(lu ll,10L' a\Tt!fitaj al psthot,urapulor cogmtiv-comporta~hentale fata. fie celel~lte fon~ede p~;jJl?terapii). Mlllte pin aceste Sll!fJii aufosti.os~cciticaLe subaspec~ttlngorii l1letodo1ogice;·~acllrezultalele ~i cou.ci4~me LUetaaua.l:iz.elor bazate pe ele. ~uot discutitbile. in li!OUSe~¥inta A~oci~ti~PsU~p~o~ilo:.:~ericatti (APAJ:;;iSodetateapent~-~ Psdtolog1e CI1n~c~ ~tlint{fidt(Soci~l)r • for Science for Clinical Ps.ye!!l?logy;_,SSC!') di~l cadrulDivh:ieLde P~Jbologi~ CJinica (D1 VJU.aJ2J.au i!lcep.ut U11 pmg,riitm de stabilire a cdteriHor pe care o :>ll'(l~egie de. ~ntervenUe. paiboterapeutidi trehuie sa le respecle pen tru a deveni validat~ ~l:iintlfic {peutru detalii;eti APA la h(-g.J.;.Ywww:C{):za.mg ~i AI1Qa l). Ctiteriile mintme sWJilile d~ APA peg.ttu C§ un tnttamentpsil~~e ':~idat§UiQ.tific suut firuictisem coh@uare. · · · ·. · -.· ·. · ~

. , • Trebz:-ie ~a existe un manualcaresiihrcrie cfarsfJ-ategi_a ~SJgur,uu estevor~a de,algoritn1izarea interven\ie.i

clunce. lntervenpa psihoterapeuticii trebuie particularizat1i pac:ie~Lului cu care lucram. Este vorb~ despn~ u~te strategii eun:;ttce care apoi Jn functie de condiiille pacientului ~i de {exapeut, suntindividual.izatepenttu fiecare.caz. Prezen~a acestor

110

strnlegii euristice repr~iinta ~fiitl\a, ~llJ;!Um:ficularizart!alorin cazul

fleclirui pacientl~eamnli:;tiiata:ntcuHfcuattlt · Iii 'JraLanJenlJ!!. gm inv-e,Vigat_ fn cacln~l Stuclii/or C/ifiiCJ?.

controlatc (randomized clinjcaJ aials; Ret). Phcien}ii- sunt distribuiU raudomimt in. eel p~1p.n doua gmpuri .. ··u.n gmp de · co11trol (ex. nu prlmqtetratameut; este ttlacds pe o llstli 9e . a~teptare; primelj~ Ull tratameut clooicdeja validu,l)Jii Wl grup experimental can~ prim~tetratatnentu~!nvestlgat. A~tt cummn mai afi!Lll:~t. smlt con!itlen~ de faptul cii_ exista metode dj{eriltt p.enlru avansarea cunoa::;teh.i. Studiul "de caz, observati~. sistemati~ analiia unei situalfi problema_ ~nt1 ~xp~ri¢ntapUuica p.otducela noi cruJo~tinte, spre e~emplu. Ace$te cvnri~ti.ntesu1tt · insacontexluale, ele nu_p.ot:ti gen~ralizc'1le. iitJ.ttiisuptiucat·e se· con~tieutii...eatii acestlucru~l se exvrimiif;lceastii id~~ ~uci cnud .

· fomtuli1m..£wlclllzlile pe baza. rezuitnlelor obti.nule cu aces~ metode (ex .• studiu de_c.u; ....• ~acem tii. __ lL_.fn_tll~sura i ·. are· uliizaiu ilstfel de metode (ex. #;iludiu de citz)darill C(,H~ ge.neraliz.'Un rezultnte. h · . . · d .· este se~lclOllliiii\n.

· teJor a"en1•1evoiede att\~liiclinice conlrolalel GeuernUznrea uUliziirilUllPl'.leluilci.de.p~,illolet~pie care nunu fast testal:e in slttdll cliniqe c;ontrolnte e3tepedculoasa. Dat:a Ott sunt e.ficienle {presupun8nd di J;lU .reduc d.w· f)ici _nu ~llplifidi5h.uptomatolqgia4ejaeltislenUU)el,educlacoitur-t.!/1

\ laprobleme etice.Dnr uneori trnlamentelepsibt;J.t;ernpeulice nu } consecinte n~alive-il!lificftnd shnntnltlatol~ pfttdi.la JO"'o/; . dintre padentipot sa:..~i amplltice shnpl91tUJlolof;ia cnurmare n

efecteior s.ecundare nle p~il~o.terapiel (J~~tbett.!Ji·()gl~,200]). Sa exami.nanrcum ig11ornrea celorp~euta.t~ tu ~~easta scctiune a Iucrarii poate avea: ronsecinte negative serioaS;en~upra saiJat..=t\ii padeu plor.lmediat dupa atacul teror;ist diu u; sepletnbd~200 l t

segmentelargi de populn(ie ~i profesipniqti diu SUA au prim it servicii 'psilloterapeutice de . asistt;mtii penlm situatiil.e crilice slresanle (critical incident slres.s debriefing -CISD), Unele

Ill

segmente de poptila[ie :mifo~; ~\liar oh!ignte sa urmeze astfel de tratarnent~(ei .. p!lmpierii.polili~fii !linu)ncittniiimplicati.direct In acliunilt'Hle salv~re etc.)! P$ ce !HI utiHzar. pe scadUnrga aces~ tip tie seDI'icil ~chiar s.c;:dogat!n caznl unor subie~{i care

_ Ilu dore~u · nsisl~npi >psih"ologicii1 Sn expficnm ceeh. ee s-a · .,.. inrimplat ,!personal~ am:parLicipat hquocesut de elaborate a unoc

mafcriale ~ S"ervi.bii pslhologi(!C penttncei afecta{i de evenilllenllll din 11 septcmbde1,00 1 "pnn Ac&l_demy of Cogniu ve Therapy, SUA, nslfel ell. am i\'\!Ut acces lln:doar la datele expetiment~le ~are le stis(in~ai:l Cl ~ilaprocesulde implementare !ii promovare prncticll ~ lor)~ lit 'bnxaunQr il'na,ihe eli nice "Efi studii de c~:ZJH1 obset~at eli t~~~o siruntie tranmati2nutli avem eel pup·n'ttci cntegorii ae rea~(ii psihdlo.git»:(l) Fc:acfii de st~ AC~It SfiU Sh~ posr~n~mntic; (2)reactU :emopona1e negariveiintense·dar c~re nuJndeplinesc criteriilepenlni t:r';'!ategotie uo5ologid1 psihintritl\ (ex. stiirHntense;,£1e strea. tehmli~ tristete. uemu1tnmire etc.) ~i (3) Jips~ 1mor reric{ii eJ~otionale negative intense. In mo(tnormal, pent.m ~ublectii cnre experi~n\iazli prima caregoriede reuc~i psilto]~gice se bf~rn -astst~l}tade specialit:ite hazatli .. pe.studii cliuiceconlrolare" B:-.a observl.lL'Insa tnpracricaclinica ca unii subiecti car.e nn reactii .entotionale negative intense tarn n se incadra intr--a categori.e nosologi"ca vor dezvolta ulterior prob1eme·de stress posttraumatic. P~ncru a evitaaceastasitnape .s~a·pte~upus, pebliza Pn\?ticiiclillice, di ntitizarea· CISD in ncest ~az pof!te:pl'eVeni·acest 1ucm. 'Scurt spus (penn·u dJ!talii

. \lezi Kagee, 2"002), ~· s~ referli la temple suportiva,ventilare cmo[iotJa1h. incut:ajareadi1cntitd1 everiime~tu1!)i tinumatizani !ii expdmltrii emo(ionale··etc. f~tr-adevitr~. a~alizele d.e .. c:az nn~deare "ntl ~tgirate·ficien~'! CISD!:Iara ins a ciistud'iile eli nice control~te efectuate receiit, nrnl:a ca crsp poate ·amplifica sirntltomatologiain lac san reduea ~~ su pt:evinli ap11ri\ia stresnlui pot~tln\tlrp~tic (pen~ detalii veri KrtfSee. 20oi). AI tfel s pus, t'lacihm s-ar utiliza CISD, renctiile psihologice negative intense

· ~ · · de \a sine de , .. 1 ""Orill '> pre7enrata Inai S\1S) s-nr cMmnua . • . . \..:neg - _ •• 1 ·, ,· -eactii ndnptatrve

. oo:entiind de fapr un reac{ll pato ogJce ct I . . .; repr . . . .. . te· ele ne l\j'uti\ sa prclucram ale nrgmusnmlUiln l:ntnatn suesnn • _ _ d . f . t'-1 traumatizame asimiliindu-le 1n ~ttu~tul 1\ noasrr~ ~ m OTmntu e ·- . . . d' . d <m ·e acestea ~~ sa CllllOStinte. tncun'tjfifld snbleC\11 sa lSCU[~ e~t·1 • • "I) le cot~trolezt~ in C<izul unor subiecti (ex.. in ca~wl celm rept"CSI\'1 •.• :

· • .. : .1'n£.ense SO nO[ ac:cennla Sl ac~tB renotii emntionale nJ!gau.ve · ~:· - ~ trrinsfeuna tn psihapatologie! Iat~ cmn•utilizarea pe ~cara J?l'g• .• nerefteXiVli, a UD01' pTOJ}edUri care Utl a~. fost l'ncl\ mvesttga~: ri.guros (ex. snb aspectul generaliz~ru lor) po~~e du~e. , consecinte negative severe. Probabll ell studulc ~hnt~e. contralate var arata daca1}i in ce condipi CISD ~sre ~ficle1:'t <1_~ 1

. · ba2i\te ml\i mnltpe ana t2d 1-1e. reiall:ntele pe care le avem acum, . . . . cn.z ~i studii eUnice necontrolntc. nu just~fica utlllznrea lm pe

. sciulHal-ga. . . . . . . . . · . •. . > • ?i ~ • • b' n ~ { •PttrfOniwri{F,I.!Jll.lJ?ului cxper:i.tptmrM ue~u!f s·Je If11!1 'J;, v

. dxlitprufbrmilil(a ce!uld¢. control (sau c~!a -ct~.anc~Juro. d~L9 ~niptd dei ·wn. rTiolprJm'qtt;. Qn. a.-a· tam. tm(.clnSlc.") .. in evnl um .::_a "' ' • ·· · · ' • · ·· .. · ··. · t1 8 ... ianl11 calcul ntat rezllltatelor nnm pl·ogram d~ }ntervenl.e. '"1 .•. · . : .. "< .•

ciiteriile shitisticc cat !li ce1e. eli nice (eco~~~lc~t.Rd~Vlll~~~ si:atistiea :·hsi gudi · generaliz.area' rezultatului , m . P.oplllatte, ."11

"~levantit,'ecologica nsig\lrii implement~rea lm tn praeuca · c~\rentli. Spre exemplu, dac.itse apliel\ ~;grocedurll. de re lax<~r~

... ·· c~rc reduce· tensiuneaattetinlli sisrolicli a~la 200 l_nJ 80,.acen:;ta djferentitponre siiJie semri"ificat~va statist~~ ~e!li no a~e }"e~e~nntl\ i-:'t inidi (pncientu1·est~•totllipertllnsiv). 0 1nterven(le efic1 en fa

· (/a reduce ten1>hmd1 arterii\la sistoliciid,e 1~ 200 ~nl~O. c_ee~ ~~ 1nseamnii semnificatie stt\tialicli ~~ ecologi?~ ~~ac~e~ tu 1 s~ m~~11_e fhlimftelenollnalltli\iipenrm valoarea·r.ens1unn artenlll~SJ~roltce}. · '. • Aceste criterii ·minhne pentru en un~ ~rntame~H ilsihoter~peutic sa fi~:validat eytiin\iflc n'u fast in~a lm~ogiit~te ~eoellt de cl\tre A~ A. adaogftntlu~se elem~ru~ nm. • . ·. . :' .. c Clindcrm 'utd~ .. ·.··. ·. 1 ·. UJ?Ull~ Jipsn trnllll~1Cllflii~T :~ml Jjs{Jl de nt:tiJptare. este 'necisnr l/11 lJ] treilt;l1 grupJ grupul

113

• ,• ... - ~- . ······.•:-."."'i:.";!!Y'·-- .... ·

····· . · .. ·.·~·-.... ·. ··-~~-..·.-...:..::- ..•. ·.

pla~cbo. G:upu~~placeb? prim~te un lr:lfaiii~Ilt care se p1-e_zjntli _ _ , pnc1 :nt~~ ~1. c~JHn.d eJicJeu: p~ulru condi~ia.lili; d:ar t<I~-~-[apt · :.•. flU l' I:;:e~a, tg~7:~W~S!llele ~tit>patogenetiee presu!Jiise afi iiiJpli- . c~te IH .sufcnn1·a · pacientultti. Ca exemple. de tr~hiJftgute psih?lugjce placebo autiuti.m discutiile libere, clisGutiLcu i~ti:te specd:1ce (ex. despt~ nuu-ipe), temple suportiva ~tc .• iar ca ex~~uplede tratamente.tnttdichl~placebo amiutim a{lminisrnirea 1 ·

tmei:cttp~ule care d6§t este prezentatii paclentului .ca.r11edka,.. JuentJJ.u ~ou~ne ~ciou svb~t:anta ac~\(a f'rezenta ~mpului pla-cebo ne permne sa fesfli.PJ sunllltau pUQQ<tr eficienta inLervc1j{iei ci ~.;: t_e~~·ir· p~-~~~u~a aJqstifica iuteli•ev tia ·~pectiv.U. lnllpsn g.upwm placebo pute.tn spu~e <;loru- ca trat(llncntut este eftcient dnr nu· cuuo~tent cauzele aceslei e.ficie11~e. Adesea taridse pwpuneu11 trat~~ui: no~ (snu unsi$tetu oeucle tera.xt~e), at~\a

. . npar:. Cil ~m pacb.et continflnd tehnic.i de interventie ~1 teoria "l [a~?c1~ta lo1·. ~~adar, penit;u a fi co~sidernt pe depUn vqfu!yt ( ~~~~frfic, tlO {J~ognu~de. l~lterventie~lreb~e ~a~aibaaUJtteb~ci ." efu:aente··~tennl vali.de .• care.salejUslifice. Dadi fncem

disjuncp~ !ntre cele dotiif compo"nente, putein sa lijtingem la si tuatii ciudate, in. care c~Ilnicile de mesme.ris.o1 pn;~haoil nrfi cousideral~ !lli.intifice, Sii.Jtrgumeutfunpdn aualogie eele afmuate nici,·d~Cl(iind succiut evo1u~ia mesmerismulu.i (penirudetalii . veziG.auld~ 1992J~~~erafostunJ1Iedicvienezcareaelalmrnt o. Leo~Le confom\ c~l'e<Ia planetelelihte1eJe 1te influeutea~a prin

. .iu~enmxli.J.\ ttuul fluid uumiltnagnelism i!.ltitlll.1J.: Mngn~ti:u;nul mumal ~te preze1~t in.{iec~~ din noi ~i in mediu1 iuconjuditot. .Dadi ex.isGi un. e..'{ces sau dudwcilde ~guel:iSm in \lrganistuul uman atunfi~ap~re bo~a: Cmus~ face tratamentu11 CI.Jnlm a6ea periond.a s7at1 descoperit magnetii {obiecte interesat]te.care se . influet~tau-se all~~eau :>au;serespiugeau ~ recipi:Oc., care atlilgenu $i inf~uentau alte _corpuri}, Me.sm~-esupus.c~ nuJglle(H A,U

-PJlli?fLetutea de amtluen ta n:mgnetisumi animal, 1 n co~lsecinf.i, e1 a inceput,sa u foloseasdi in tratameutMaineUi era p~i p~

II<!

. .. .. . ·-:~ . . . • .

zonele boln.a:ve sau acoto undeapareadutfll"ea petll.ru a reduce · dezedlililmll de mag1~ptism anitiJalpt;~upus a d~letmiilaboala Mai t.1rziu,Me8m~r a sustinut en elpreui~~abllitati spedale.esle mai ·sensibll.la ·tuu,gnttl!,~~ul t\l)bna1 - pdn: cate .. ponte modifica direct deficitul care cnuzea,znbpa1a, .flrii'amai it.til i-z.a cu necesltate magneti.·.A.~Qdnr. atltlg&nd b.cilnavii~u ob~gheta sau fiicand pase ,lnagneticede-ailulgul zonelo.rbolnave.MesJ)ter elimina de1echilibrul nmgneti~mulul.an.imal ~i· r~ducea .sau dimina '~stfel sim.plQW.ntologia.: Utillt.lucliaceste procwtui se afllllln di Mesmer n au1~ltor~Lsau. vius:lecat sufe~ntu n peste 20000 de j)acieuti . (Gauld~> 1992). l'rObabil dt dadi.. aeesle strategiiru: Ufost (X)lll.Parate cu un grup de control(rtirl\ tml~ent smilistadea1jleptare)iutr-w-st;udh.Idimcconttulltt,ute51U~isluuJ a.r fi fast cousiderat~tlin\iflc;:pe baia criterlilut tnitlltne. Mesm~r insl\ a ce.rllt ca ~i. teorla l ul >su .fie nreuuoscul.ij ca flind ~tii~\ificQ. . Ludovic al XVI a .oumit () >coiJ.l.i,sie regnllic~udusa de Benjamin Franklin· (ambasadorul ~pA,i~l Frnutain acea pedoa~)() 'li compusadinpej:sohalitatile acelei yrer.ni (~K.Baiiy. GuH.oline, Lavoa:~ieretc.). ·Penl'IU ~.(~tuteoda.Iui Mesmet,un gr~p d~ pllcienti afos~ rilf?smeti'l;{lt 4e ciitte ~esm~ tasu.,iia.r u~ n!tgrup afost indus \n eroare: li s .. n spus ~a suutmesJnenzati, dar de fapt JlU nu fost Cv tout: ocefle.a ma~if~~rile ~i n•~:ti9!'ilre~ suferin(ei au fost apronruau.v tdenitce m cele doun grug:Llrl, inflflllflrtdu-seaslfelt~da.Ni Mrstner. C~nwluzUl~ cotnis~ei au

'nrntat eli mllguetismul a.nimnl. nu produce uimlc.·Vind~cru·ea este data de sugeslibllitpt~~ · ~iimaginatia bolmtVilot, c~f1 c.e astiiii ain. numt efcctltl placebo:. :frltl prisma n:ce~l\li exe1nJ?lut

· poate di intelegem mai t:l?t httpox-tall\i unui gtttp .placebo i~1 5t,udiiled~;: eficien\a a diversel.ot" fonne.d~ tratameut Probabtl. ci\ eficientn n:mltor fonne de trnt~lUeilt~~ ~attumitcle ~tam.eule al:temati ve (ex. bioe~tergle), poate fi ex.plicaUtprin efectul pln-

[ .. ce·b· o• .. · . ..-.in. ·a··.ces .. tc ... o· .. l.tte·. x.t ·.·.···lr· .. ·~.b.· ·~·.i.e·. _me~.~.tiu. na. t.·.c~.Rri··.·n.· .. p~j. s. ma§_ti~u!e~: nu ex1stii h1ltamente §titntifice §1 allernatwe (ex. de ruetbcum a~f.cidoar tratamenle v alidaOO. :ztliupflc sau nev<tlidate

······'" .-.;,· . .. ::::--·-;· us

.·· ~ - - -

vr···,· , r

'''•''~1i~0i:t's·'"'''''~fiH·\!i'~~1lit~ili~i;:l~~j;~~H!l,l1,:.Sii,an~l1~~~t~;:ilsrfel .; ! de'cazl·· ...... ·'· . ·••· ·~··~ ······: ::·;;~~ ~~iil~l~t,:I?"Pnlr~.~~~~le·1JjR~tt:ea\di '··~~ :£l~pi(J~lei.V~t~t~· ~~~~~~~otog1qe,S,ta·~0~m~4e.sift'5·~~~zut'a :,:.:l('{le1~~fii'HEfatt1·!~t .. a»!~·.J996)•tlMli~ai.ostimacr4sc~ra.fnta ····de~l~rrilil.fi,ai.~~~·s,~',l·n'itl~1,.lct~J?~;~~<l.Si1llti··binei.~·+t¥1Jrr~i ~i · lc~~W~rt.alt}elir~Iepi-o~sq,~i~lp ~()f fj,J1lai1F!~ .• ~roase.~1Jteo\~i~ nil ... :,:;;=~~::~:~~···· ,,,,,,, ·f~~;l~~;~:::~:~:~~=~:l~: \;~~~%[f[li;~~te1 ll~tl''" lh n . , . , ~·;~:ih19~~~qint~!lllllOi

~res~, .,~"""::~~iE .~ .... s~a'{itilti~,~~·parte!~i~~~ .. si~;p!g~i~irde

k. '" . ··•~ .. 0~1~~!·~~~~iu~fi;~~n~~iril!~~r~1fM::,~1~ J!~t1~,IJ>~W:es, ,.~~~@i~~11a.pa~~~·~tiiuta.nu~st~'r~(1.)f!1PPr~l~f~U~,in#~ ,jn~~" ··,:r~Afe':'~'~rilti;ilsf!il ~·~~!;~J~Mi ~~i~i~} "' .rJ,$i. a crt£!\ ... ' · ... ~~~e,\l.lrs~~qle'ea·&llri~·in•a~e~i\~l~ri .·· ~i .. · IJ\ ~l •. Al .. ~;~;~1 ~f~x~!:i~4~:in;cdn~n)j'are~~~Si,s~~u;,., .. ,.> .· · .:E~~1~!h~ ,,f\l ,L1!iD~J,,ptiJJl\Una.in•c1aJrieni~~JfiJnt~i .. , .. · .·.UJpf\ce· 'K ·".~$!l~~Jzi,iate~iJ~i'~P~!t ·Fti!t~''·''.·. 'I;?~~Htl. R lu'Jp;?til, .. n•witW;'l?r.tt~teritodn' .•...••..• i~f~~b~tiil)fit'Jcii

yt;;u;:~~~~~~:~~iJ.ltt~~" ··• .:. , .•..• ,tJltm~ll,~~ruJ,~~hn :V%lscontellb!1 dht sr-nti\l di\lifo~:nin. ~'.(:it·.~,~il)r~JJ~fl»J\{lt,dt::pov~nie(ienU'hl1~~\f .. t~f!!~, ·~~:.~~~~~,"~:~~~~t~,n~~"rifj(ilte~fii!l~ific)·~inr~;a·tt,ta· I ...• , .• , •• J~Iar~ , 3ti,i~~9~ ~d,~f:P:~~~~~~:cl~~oJ'l~fi)·~nrepr&Zerir~tl'&i?liade·.•

. ·si~eJ~~~l[n~~#jt.f#p4 ... ~~t~~nfl·u:sanata(ear!iiiiS~ajl~iilicit tta f>i=hp~~tt}it;fui~ fm , . .. f ~ful.sJII.@1n;~~IUifon1i}{~;~:.*c~e~t u11.:,

. gftrfj de'ltt~hf '(Tasli,Frirce) pentnl n e~~i~~·supotttL1h1tiH1tifi.c O)JCbHsttUCtllltt)' Stii{l~ d~ Bine~i a poi a pTOlll'?Vil acest,~nSil:l.tC{.

. I

111

·-

Guv.ematoruLstatulul California George Deulunejian a_oferit un buget .acestui grup de lucm in 1936. Rezultatele attfost publicale intr~~ ~~f:~~-e inlitulata. •'T'llcsociaLimportanr;eP:t~eif~· · · esteen~".·J:f;iJ.t~j:f~'-§1 colab., 1 989) iri l9&9~;_,CoucllhHle fundame11~~r~-~ieacesteilut;rari sw1t: · . ·· · ·

,. 0 Sllu1~ d~ sine crescuta duce la ( c;.mzeaza) cm;se~inte psihO'-COJ1lpOttall1ei~title po:citive; · .

., 0 s,tima de sine scil4~1Ui duce la{cauzeaza) cottseciute psjhoLcumportamenta1~ negative;· ·

• Progrn.mele de CJ:elllere a.sfunei de sine trebuieiu.cur~ate Ja nivet individual, falnilial, de grup. ~omunitar 'ji. social. : _

0 anal.iz.ti. atenta adalel01: pe-baza cliror~s-au elhllocataceste conduz.ii aratltinsa o cu totulni.uisituatie.(pentrudetali.i.vezi ~i Dawes, 199~):

•. Cele ~ai multe &LudU.·exauunate ~i u~clu~e in.lucr£lrea ll.l.enth:umt[(Meca ~i colab.J 1989} eratt studil corelation.alei nu exp~dui.eiit~e. ·A~adru\ a concludzioua eli. stima de ~ine tiste cau~a pen4:ti tfiverse "specte psiho-comporlament.."lle nraUi ldmufulipo,lt?Zei:'li dorintei asu.pn1 f-enomenuluil

II' 0 11~ parte diu~orela\ille semnillcalive diutre stima-:l:le · shte ~i diver~i ~udicatori.psiho-comportameutali·BU{Jvaloare

sca-z;ut:a. a marimii efectul~i. Spre exemplu. corelafialtte-die dintre stinut de sine ~i pe1fom1~ta ·academic« este de p. J 7r Intr .:!Jll limbaj mat simplu, ac~!lSJll ara.ta cli stimadesh~~.e~plic~ ddar 3% din· perfonnauta ~cotarli. Allfel spus, aceastainseamnii di perfonnart\a ~c_plat:a est~ detemunnla de alfi (actori Care SUUt Ult,tltmaiimportall\]. (acop~ 97% d1n perfonnant;a ~co4~r8) dedit r.Um~ de sh1e _ · ·

.a. in plus, . o s~4na de sine prea mare. duce . adesf;}a la comportame11te agresiv~. anti~sociale~Temiile c:lasice { f;}X.. Beck; 7..000}, flirt\ a sugera cu uecesitate o rel.atie cauzala, aratli c .. a

·, ' ' ' ' ':'

iluiraclodi §ipersoatlele ~gresi veau o stilna r;ciizuta f.nta de pro',. pria perso<nl~i.. Cercetaril~recente au nunn\at. Iusa aceast~

\

concluzie (DiGiuseppe ~i Tafrale, .2003 ). PelSilgi\. ceic~ s~mii de sine scazuta, exisUi un grup de J?erso~e care au ~l sttma _de s~1efmirte crescuta, a.st;fol cll.udceiilcongn\enta ~tredot:in\ele lor ~i ceea ce se intlimp~a qttce lfl reac.Vi ~tn?iiodale_ i;ote~tse ~i compm:tamental¢negattve. Mpraln este ca $luna 4e sme trebUie sa fie rincleva la nivelmedil1, o stiui5 de sine prea scazuta sau preacrestml~ putrlnd ducela pro~leme pslhologicei :· .

·,. Stima de sinese c,{Jnstltuie priu procese ttationll~ . ( dezndaptative) de preluc.qx;e .t,l· jnlunnn\ieJ.._(peq.lm uec.alil vez.i

-Ellis,·t994). Astfei •. ndeseasliiim de sine sti ~azea1;1i.pe faptul cii noi facenleYatuii.d.globale asupra prQtlrieipersoaill}pomim\ de la coto.portntne~tele t~oa~t.re \intl\. 0\ud. cQmportamente\esJ,tnt perfornuu1,te atuuci m~ evaluliJa:f pozltiv fti experien\l.em triliri nfective pozitive,iarcfuul !;omportnnlentele·sul1t.llepc:tfort\\ttute ue eyalutUu (legD,tiv ~iexper!en\ie.ln trniri ufec~y.edmfpnc;tkmnt: negaUye:(ex. de tip 'depre5lV). ~ceste evnluan sunt 111v~tate ~l l.ncurnjote social. Ble constitule noimaiutr-o soci~tateinot.le•:nti bazatii pe autonomic, iudepe[ldent~ ltlivalopzmea, e)tcesivil_a proprie~perso<Llle~ Iuciudaacestui l~cru, eval~Uirlle ~9bale care_ stau la baza constroctului de stim~ de. sine nu su~tjustificate logic ~i ~liin\ific. Ele co1espund unei etorilogipe uun.Litil "sultu~ in nrgutuentare" (vezi pentru detalli sec\i~~~h 3.1.3.4 ~·a:esle~ lucdiri). Astfel, pomind de la c,at~vn comportameul~ltn.t.fi, uot face111 o e:-~illuaie.globulii a prop.rie~ per~oaue·, ftU·a Ct.' legl\lura sitfie sufi~ienmlogic. Spre exein}_)lu, dncii. nu runluu.t un exnmeu (~i am inca eli\evn perfornum\e scazu.te) 8lU teudin\11 sl\ spu_n cit sunt n~~perf~nnnnt ~p.r-o.st) :ji _p?n u~are, .um~uri_intr-o astfel de siLuatte:vm eJtpeneup.a tr1lin llfective dls.f~UC\lOll.Rle negative (ex~ dep.resie). •Din llllnct de vedere Jogjc, eticl~~ta de neperfonnant sugerea1.il di ~icompmtamenlele 'tn~le vnloare vor fi neperfonnanle, ~enU11 ca unin_d.iYld neperf!'mumtare ~i va avea comportameute neperfonnante. Pe de alta pat~te, ceicetii.rile aram ca acesle etichete ~i trasalurile de per~9~l~tate . . .~.?~~·~:·::~ "·~:.--; .:.;•·:: ....

~~;.: _.:. ·.

119

acopera dour U}lTOXin1aliv 30Wo-din vnri<\nta C()mpurtamentului no.stru (Mischei.1968). A~adar. ncest prpcesde ~valuate glnha\a este unnl ita\ional dic.i el permite ·cnn(l:adict\1: rin ind1vid neperfonn_ant.poateavcn*ieomportamente perfonnailte!.Deeyl irrttioual, acestpro~este util atuncicfind nvem cornportnmenle petfnrmimte oiici ne face sane simpm hine :}i va1m-o!ii. T[ebl\ie insa sa COOfitiefltizam Ca i\tund cfind COf!tpOctame:ntele SllUt ne.pet·fpnnantet()t el ne aihncain suferin{~ emotsonalli(e:x..de rip dep-msiv). Avem nllll vnl'inntfiq P~~ o vnrinntl1 mtio~alii. Varianta m(ionalii este. de" a tnlocui'concepruf de stima de sin~ Cll celd ,.. e tarenecondi i~nnt1t careesle logic eorecr ~i mni P'·.agmntic.{BUis. 199 ; Roger:s. 1961). A.!iaclar. in variant:. rl)tiona11i. noi .ev~lu.i\m·comporfann::ntete noastrenu per.sonna.

. PerSI!IiU)a nt)nstdt" est~ nccepftl.ti\ necondifionat · intllfere\tt de p~rfor~an{i\.:~licies.te prea co\'nplexa itncontinuirschimbare penfrtl a fi evnluat 0. ill, pomind doar de \a Une~antion..de cotJlptirtnmente ·c;oncr~te Jl sitthl{ii c~ncrete. Spl"e. ex.emp n, antnoi cSind am un efiec voi ::;pune eli am nvutun cinnportament Mpeiforma~t nn cii sllnt neperforrnamcn.persaan~ .. Aceasrn filozofi& se tegru;e~te llHnm.ile 1-e,ligii ale lun,ii; spte ex~mplu 1n Cte:ttiniSll'lea este fo1ule hine reflectatade formula "pedepsim plicntul dtll' il ierdi"lll pc }lociitos 1 ... Acest mod de evaluare este onul logic, Jar darele empirio~ (Chamberlain Iii Haaga, 200 l;

· David flicolab~) 2002) amla eli ·in1plementarealui fn via(a de zi ·en zi<este un fac'r6r protecliv fatli £Je evenimentele stresante. SiguT, a ~e."\liz!l ace~stl1. imple.mentare esre grcu, caci en este onntrl-\intuitivlt. Ctlrcetlb:ile suge:ibazlf{Ohnm'(}ednin ~i Hnagn,

·. 2001) ct\ arunci ci\nd SU\)_t ltwaf,a\i:aceasta •'fjt~sot'ie · d~ villtli VfllidatltemlJiric••. ceirnai nmlti.ol\meni () asfmileazii rnnl u~or

. J\Slfel: cf\nd an pe.rfot·mante -pozitlve,s!} ~¥~1uel\1l. pQ:z.itiv {in ·. tennenii :itimei oo alne) i£11! cnnd au perfonnante·ncgativei~i

· · eWtluea~comportamepu•l &r!t-a~.!fl evnlua persoana (in tennenii

ncteptihii necondi\ioniUe) accasta ducilndla emotii negative

120

-_ . . .· . . .. , ' . ~ disfllnctional~ {ex. depr~sit). E:\e: .c. fu·i'.evoualetcX.. to. s. te\e.J llU . • 'l. ro·.rJ·i'•>{ .. ;; do n1rionit·l .. tl:Hc

· ~. · , ~ 1 , gl\!U o ca e ap 1: u '' . · •

mpdahrat~ pragmatt"'~ ( e a ·aza mistil de gandir~iralianr1 \ ~ 1ntr-o so. c1eta···te ca .. repro. moye ~ :0. . 19n.::·} .,..:, .. en ce. twarl\ . . · ~ · · asa( · awc:s. ·· ::;;~u ,.._._..

.· A~adnr.1aoana,Izangur~ ..• de .cine esteasoeiatl\ cu '

. · .. ··t· d ...... · ·~1irare. eslc en stimt\. . "'· . $\_ndll e e Spet:h : .. · . tale Ac~:tastansodefel10flt~. '

• ·riP .I ~te n~tho-comportnm~n . . . an·u· nuLeasy-- ~"":> ...•••• .o a }:luna Joafie .... mare.

\>( • d ln una foa,;te mtca pn.n • . : . ·.. . ..... s•1 vaneze e • .·· . . ... . . rein Uteramrn de specinhJntc, nu

· Uo1,~ndn-cne -pe date.1e e~stc:-~d . •. . .. e&teJn general nn factor pnten\ afirmnJnsi\ cl\ sumn. ·!~~~= sihr.rcompor.Lan1enrnle :;i cauzalfundainentai pentru nsp . .. p · . · · 1 de ilezvolurre

. sa{li1tnt~a ps~l~ica, fii ~.cons7Clfltl\.·J?r:~::~:pob1l~'\. Acolo ale stimei. de sme·trebme SUS{lfiUte.t~~gl\. aoeate pl'Ogrnme· cle unde s;au impl5mt.ntnt ~e s~r. a a consi.derll .s~tiosidi:tte.le aezwlltare a sumel de $\'"le,,..,.r . .. . . ' .. ·. . .·.·, sfihttifice, eitelocul node po\!tiCJ\ 'in alhm\li C\l S~ mtul COfl1Ull ,~U

· :acis,~ti1n\nllrin lobnyl

3.1.3. ProblBm.i: nle PsiJwptJtologieicu ~rtulalitn(llc iJe a fiti~'d CBJ'Cetare f'

. . il . attit o latudi de ceci::et01"e fundamentu :l :slllopnto ogla aTe . ~ Ccrcetnrea aplicatii ulilizeaza

. cnt ~! lma de ccrcetare npl~cata: arolo- ie tum alre cliscipline . ce,·celm;-ea foudamenmUi dtn:pslhop . ~- . d 'ld''"''e·" de 1•'~ : . · )ropne pontlll • ...... "

colarern.le. (lar, are !' an~poi~~:~eoill. -En cretl d, din pacate, .. PT~blemeco~~.;relet mt~=deinflexibl}a ~j obmzli la rez.ultutcle:

'Psthooatologta es f\ eli. ~ . . :\"•'· ·eotl\ \·\ ~ . d P·i{lti)"'t\tologia pare oarb•' ~~ ma.lJt;r . '

cer~etanlor. A esen :.; J.-" fi ..,0 di!seod dorin\n'in f<"lt~' -ntfi.mpHi fn cercemre. pun 1•

ficeea ce se: . DRcli ae,:cetavetl in dmne.t-iiul PsihoptllO lpg~~i G:-:t:e ·: enom~nu m. . ~ . ye:tl\1tnrele cet·cetan\ s, Ee '(_rigtlrOa~ attnlCI ne "'"~ep~n.,p. H\ ::ndofensivli (aid vo\ anull'z.t\ promovezetntr-oman~er o~es ~ -n\icnbilimte ll

,_ "d . lor)· (2) sl\ emste o oarecare .... L_ .. ca?.u1 ant1 epres1vg · • - ' · \ . \ ~ :bo )· (3) Cl\

rezultatelor (aici voi aurtliza cazul efecm ut p nt.:e : f • • •

rezulttHele: sa nu se generaUzeze. dincolo de date\e extstc:nte ~t

l2l

::; < ;,;.. '

. .r.·.:·-· . ··:·· .... ·-~·-: . -.- ·. . .. _ . _ .. -.:. _ -~-~_f!St·". -_-_: -~:--; ... -. 3rtnu ex.ist~§~d~de:duble tn evalth1rea rezulmtrlorpeicelam (aicijvoi'~fiali~n~~~~li{~silio,te~p~~r-.ip"Jl~~p~gmpif~:ii,f~l~·cac, cr. ill. e.· ·.ti·f1···'

1. ·.e ... • .. ~~1 .. }l··.· .. ·.g· '.t···.c·····i·.·i··· .·. ·~ .•.• i .... : .. ··!.·~ ... ·-.:~·,··.i··· de· ... ·· ..•.•. ~ •. · .. '.,·.· .. ·.·.: .. :_a .. :.·i. SE; .. ·•.·.•.·•.•·· ... iv1; •. ·•.· ..... ~.·.ill .. '.·.·. :., .. ·'.'·.·•... 1

p •.• ·.• .. ·> ,.,..,_.· '.'· .. · .. J ... ·'······· .• ·· ·.·_ ...•.• :c·····•.~u ... ~~ .. 'p.; ;_'iu . cerc~ta~~mn;;9,QUJ.enih~!i1i~iwrah_Wii'U. ®-ui,~e,se-re~(~~~~:~~-~~f:el1t~iJer~i)~m~~~ tht~rs~ttt~ut .... ~~i[~iit~ J\l -P:tiii~pt\ttJ~bgiet~:si4Vetlei1rt~uaiserti~~-·a~este'titi{lti~W.iu

d~at.~:'=·~:;~~~~;~~ .. madt~l:i~~~~t~ mtf.Jfj~~!!a1~ihf~i o_,~*-~~~~,P.~~~Q~cl .. ··. 'i'.eoil~b•~1~~0~):;L ,,,,,;,,·,~~(-~' r1'''''. £•;··~>•' ';:····' '.y·>h · ,, ••. ···:':·

lD J.~~~8st~secfJuu.~·voiEidf4cuii,'' ·.~v~tttl~tun,en~ iu:f's1hopate\J:ogie'nltc~o·~: .. . ,,,,,, ~~~l~fulli~. .;. ~~~~~~mk~~~

1 ~.ercejt~;r~~~~l~~tfil~,!~·~Jl~~R~~,. ~-~,~~~~h~;,~~~l •. «!!.~I?u . J num._~~-~"·~llrtW,J?:; ~~~ ~t~~-~~~'~tJ!,"i,eliclenpt·.

~ tue~ut~~h~~\lW.;-~;g~·,pl~~P. c~~~1~~~" ~bi~il~.r t un~~~~·,~~~~~~!J,,~\{j~!I-P~ltl~~Pf!fPUf8G6l'flltrf.iU~ ~· Ltret em~:fVSJJ,f~~~rT?2~g;(l)\~~~tJ:tl~:acJtt~ni~il 1 E · -un~r ;sn~f+~.~.~~ .. ~~~~~Ji·':·P13M~,11 .. ~. ,~~'1i#~~g~ t}f~JZ<tele1Lui1im; l orgau ·· i',~1~W.~t,~l.~~c~~tm;~~9!ll'~•·•i$eazlb'nl.llgrt1~ 1' res[ra.,_. ":' .j§~;tl;i~H~~J.•I~fi~eJ~~ul~J\~~~~,se p.n=iupt].n~dio: ~. : .tratao~.~~il~~~~~~tti\~gnqti~ .~t~l)l~~tafe,fe;ittitnelor'. ~. ~~uli :. r~~·f,;~~r~,"~EH~J.tt~~~ftt, .lfct~n~.ntedicamea~ijf ~tee" ; l!JV~4~!~t:l~~~'~w,;a~Jfle~p~n,~~easmurtii~Zitrei, 1 Ioturfde ilabieiiti..Ob. Iotde paci~\i~~~ b:artini~ttij:chi$i~·.

:;a~ (~~~~~1:1?:e~igp)_ ~~i!ID,trnJBmetl~·,tlllf•;Jlt•Iet,tie·Vost~n~h···· Jll111l~t~,!;l~t,.W~~u:tff~ti:qe;:,!;!p pla@&Q1ti·.se;sprlne''t:a•·pr:f~.¢·: medicape dar in scllimb priu,esc capsule care nu oontin niCi: o

. I . - . . . • ...•• · ., • substa!lta artiva. Un al b:eilea gmp prilll~te ti'atfu11enl.\tt'~3re se. dore~L~ fl:.fi,~wve,stigal•Ca~sa [email protected];al\1~ttt!fr~~f'ie sa.riet1tatepcietttpcincomparat~e·c'='tetetaliedoult.i.1ii1W~i0.:: SUA, ?t-gmli4a.tia care ex~mine.1za aceste studii ~i care bQtara~tc··

' .

122

daca un tratamenteste s~» I!U nP.llVl:m.~iiJ-~tJttU1utiiz~eJe:seadr .... ·~~~~~~,te~i$9~.~.~-~~.l4~~~~~tL~~i:~~~l!~il!~~~.~s: . :

.·· ... pruia:~l?~~·r~~q~p~~~~lfl~~~~!l.~~~:m~:c~~m~cute;·qt'wtU. · tttiJ,i?;nten1,~4~~~~!~~j!~i'!.~ti~~pf:f4v;~ .. ~ ''tlr, ·

: "'''•:f ·· :• FluaX.etioa.~.ro2;ac)· ·. ·•·. ;;J.'.<r}< _; i1, ~~i)· .~. f~21iffl:'l \,~c , , . I ,

:.~a~~ :o, ..... , ,q~qp~li(~~~~a}•

••. :·st~~i~~.~ti~n.£l\rQu~:,.I 1.1 'lJiA>all\Jitt~<:leeiua,cJl~ a anr0t'a UtUizai:ea QCestOf Wllidepresive au fost l.v\.•'"'U'L Ul

cate e~e~tul>pJ~~ebd · · · ·· · · · ulilit.'ili~He sttidlile c. 'linj·c~J~illlml.~~,q·u·• _1· d~Illenilil fmmacmogiei

; (pentru,~~[aliivezi l999iAstfel: ·-.~~_t:t(::~_Y' ' .. ,- ... ~ .. ;· ---·~::..;;.~~.

123

-(

. o Adest;{r'S-ll_lltiliz!lt 110 pl:lc~bppasii' ~i nuwwl uctit'. Madicatia are 0 nml~ime de efi:cte biologicc nespecifice (eK. cre~letell temperat!lfii) ·Gn.rt~Itl[~fesC 'fncrederea pacientului ca

este tratat cu ·medica tie ac~va. in grqpul placebo pusiv · aceste efecte lips esc fii subiectul poarerealiZil ca se,at'111tl grupulplacebo .. care nu pdme~te un·tratamentreaL A'?es~ lucru afectea-za negativ efecml placebO' care se bnzea7Ji lo~m~i pe faptul-ci\ pacienlql crede cu U\rie ca prime§t~·.m1 cratapu:ut activ {renl). Utilizaren· unoT gtupud pln(.l;ebo i)Ctive (ex. se utili:z.eRzl'i o substantii care nu ace efe:c~ specifice nsupratulbt\rarii tratate dnr are efectc nespccit1ce-crc;.§~l:\ tempernturi~} ar fj de dod[ ~l Rr .duoc:; }a 9 mni COr~cta ev.nluare a efec~\ui Specific al medieapei., · ·

o 1n cdc mni mulJc:. stud.ii. paci{UJ{ilo.r 1i S·EJ spus cifc .. :dstli 50% jal1Sif~lifi~1n.gwpulcu tmtamcnLacds1o11:50%_Fims1istf{ic i'u gFtpu.lp.[accbo. Aceastii. informa{ie iej:}ucf! sen1nificativ efecrnl placeb() care se hazeazJl, pTill natQra· lui. pe faptnl eli pacientul. c~cid~ cu tarie.{spre)OO%) eli prime/ite tmtrnuuncnt activ .l.!lJliactic~ clia)'icji_..i'ncqnditiileJncare se administreazn medicatie placehp,p~cien~lesre convms cii. ·. rim~e llctiv.ii.. n aceste.con i{ii. c1inicianul nu n .s tme tll\cientultii ¢ '•poateJtt au. me ica te.. ont& i i dau.\m tt llan1ent plncebei ... A~a ar. studiile eUnice cm1tr.oli:)r7. sobevnlueazli _impa'?tul efectul1\i placebo-, Ufia cum se manifesra el in·pract:Jca clinidL

EcoulacestoJi.rezultnte extrem de lnleresanre afost redos il).·gn1pnr de psiblatn,. ~i?ro.exed1plll. Asocja~iilepn~fesionale jn\portmJ.te Jill 8.llluato :atitudine .. ~ficialll]a ncf!sl:erezultate~~e.

'•asemenea. pompaui!J~ fall'!1fi~llti£m continua sa . prQmoveza medica lin nnt}d~presi~a-fnrli a menpona insa explicitrolulfundamentalal fnctorilorpsillologici- efectul placebo- Q~reacoperii cea n_1ai ma~ parre din efide!lfa ace~tei medica(H. Esri! ciu(!aL cum aceasrn "schizofreni~ .. in don1enin duce la focAJizarea

. resurs~lor: de timp, hnni ~i energie pe investigarea nnei

124

•'')tn ... ·P· .. · on .. enh~ .. cu e .. recte ~nid.:in tirnp c.~ .. co.mpon~".'.t. e .. w,_tlm~ .. c. :i. d_u~ ..... · . · ·· ~ f t l niedican~t

\ conttibulin ct:a mal uwr•orU\Ota la e ec e e <' . . :. .. · . · ·. · .· .·· ..• • ·... · .. ·.· · ·· . · ·h 1· ·. · -~1 . e'te. 1gnmara ~·

nnl:ideptesive \; con1Eonenta ps1 Q og!=l- 5 .· ... · · . . _ . ·.·· .·.· ..... · ... ~ Altfel sons 'in laesa incerdin1 !ia maXliJlilhian1 §.' nepromovam. . ·. ' • . .. · . . .·... . .•...... h r . e -r ·ati·<\

. salttilh.l\ro eftClel1tefecml tnm Ollentel lace ~ (lll' ~~ ql.. :.' nnti~Jell"eSiva-eare aco ra80% dif.ll" z.ult~te~ .lD IUPllobse::;l~ .. ·~.··· "~ ri.s.· ~·I:)Tomova.m c. oml{Onenra hio1agic··. nati vii care acopera mcer~.;<~l · . • _ - . • . · · · :t. nde~"'n

--20% din re~u1rate.Tipic penrru indu.stna tarmacemu::u. . :'"''. 'VIihzlirilt.~ g.;ahn de. a .pnne tn.vanzarfilll'.nou protlns medicmi'leriros de~i inca 011 avam suficien~e date de.~pr~.l\\~d~tt in ~are ttcesta ftmc\ionea2n- s~mt:pl.ls.einamte d:ltelo~ !ltuntrfk_e

·. · ·· •· .·1 ·.,· .. r· -mai. nt.e. si .. g1. '. r. a. · .. n .. tei.·.H. nc.ien. tilor. Pn .. t. en·t· da .. nnm.enla. ~e Ill nneo1'1 c l .. . . . . . . • 1.' . . . . • . .· J .... . . . c· j" exemple care sli i~tpnfil'llle c~]e nfi~m.at&. ·}utii~_dl£::-o·,, aZll

antide~1,cJordescris-maLsus nrata vtctona van7a1tl~t ~~l~P:"' diitelor ~£iintit1ce. iar exemJ?lel~ pe. en rtf_ le vcn .1~1-e1._t? 1 ~r~\ 1 ~1 cOntinuare~raLii victorin vfutzl\dlQr asllptta;Stgurant~t pacteu!JlOl.

· Spre exempm.RezuliJJ-un nfost un medi~nmentu~lizat i~'l ~~ab~r cat'8 n fosr produs de Wnrner-Lnmbert Cmnp~ny 1.ac:~u~ Pfi:r.er~: In tmnl2000..tnst\ FDAa cerutretrngerea lut de pe:Pt+\\a (delll

·;· · 'i'n~inte a foslapr.o~~at deditre F.OA) deoi\rece s-a· qb~er~m ca.acest n1edicament. arc~ o multine de efecte Sa??un£lm~ st:vcrt:_(ex. nfecteazilficatul)~ Ut\ alt exen1p1u ast,eT'Cilot~o}-tJl (protlns de.BoehriT\gerJngelbeintCompany),·un btonhodilatntor.~nre .. :l -iosn.ttilizatpentrll a h·ata astmul hToOI1$ic. Dinpi\car~ el gen~m . en efe,!te-secundare tplburari cardiovasculnr,e ¥i dupac.5 a fo~r uti1izfitil'l ~tnmedt o"tmnl\_perioodadeJirttp a fost J'~lr~ de pe piata.ExempleleJ'o£continual . .·. . •. · ... · · .. ·.· .... ·~ . · 3.1.3.2. Cazul efectulni plneebn· smi Cnf{l·.sii ucizi en :ntMltile enrale (pentrn detalii ve-ziDu~itl ~i Iv1on1gomery,

2001.)-. IntroduGere,

In aceasrii sectin,ne voi arlita; prinl)naliza rnodului 1n care efectul placebo estetmtut 1n domeniul inedical. cun1 cet·cetnrcl~

125

]

.. -..

din acest. !,kii~~jiiMl~il genernl~ ~1 deci ~i cea din psillopat~ltigie . in special,,esle ·rustorsioitatii de fa.Gto.ri extemif}tijntei. E,fet;tul placebo este. gr:eu <J.e defiuit intr._o maniera satisfliclitoat~ in cercetarea: clinh::u,. placelm §e re(era la tratameulele of~rifc · . ..,_ .- .. __ ,_,,,._-·--.. - --_ .... _. __ ... ;.'._·;··-. ---.- __ .-_. ~

· grupurilorde COlllmt tratatnen~ &inJ.il~e cucele.ale gcupuri;!ur experhnen.ll\le, insii film comp~nentcle acti~e .~i spedfice ~

" acer,lora. Efectele tratamentulut pl\lc~boJeJmm~c. eiecte placebo. in~el>and cu anull950, instltutfil~.J.~cale au in~epqtsii recLmot\sc.ii. di Ln1tan1en~le cu plnce~.o au e(ecte pul~rl}ice. S·~ presupus a.~unci dt tratmueotele cu plnc~bd auutJmare.gradde e:ficacit(\te fli':lidi. in.lratarea·~i.nruellora.re~ -ttnui ~IJectl\\ larg de • · tullmriiri. e:f('}ctele placebo Jiind prez.eu~ein·nproape35% di.lt ca7-nrile clilliee (Beech.er, 1:955). Utilitar.ea actualii o. lrntamenlulul ptacebo 'ill. cercetarilc de.f~.~nuneologice(ca :ji grup de· t:onlrol). porn~te d~ la asufl]ptia di ace.sta pPuLe ameli ora

. setim.i fi~ativ simptomelem.ultur boli fi"Lice.sllululburliri psihic~ ··. fj ind _in acelo~i ti mp unfenomell biue.dtJcwneutatpd.Ji cetcetatite a Hit diu domenit:ll mediCal i;!at ~idin eel psih:Qlogic ( vezi.Kir5cb, I990). , r

. Ill ciuda aces tor concluzii apare.ntra~uste. dinlilerJllUra'de speci.nlitate;,rece1lt.HrohjaJ.t:;li9n lii Goetzsche(20() J} ~~publig.t intr-o ·re•list~med~calaprestlgioll5aJill studio de metna~ati~in care a'7incorpo1~t Lea.te sLudi.Ua clitiiceconttel~tte asupra .. efeciliJ.ul place.bo versus. ~rup de cpnb-olefectuate.piln1Hu1998~ lutiet;~re sluiliu ei:i!iU.CoiUpru:atp~rformanta gtupuluiptaeebo en eel\ a · unui g111p de .controt(mi primea: ttatmuentsau empco·tistli 9-e a!iteptare)Juand 1o calcul o singt1ravatiabiUi dependenta (ce:t m.aiilr~port:antli.penttustt'tl=liusail,dacli.uU.sepreciuaeest;lucru,

I ·. . •. · .. ·· ..•. · • • . ••· c.en pe care a.ulotii met~analizeiau aonsiderat-o cea mal important~ peutru pacien\i). Conctu~ia studiului .. lor. esle surprimJ\toarn: ex,is~~ dovezi cares.a nleste efeclel.t<cliQ.i£e

--.pute_mlce al~ t(atamentuluicu placebo ~iprinurn1are, nllM!~Ui .__!1itnic cru:e sujustifice uliliz;area acestuia pe 0 scad\ larga in

126

practica sau cercetarea cliitic,2-:· Aptorii aceslei mclaaualize. t:antitatlve sugereilza ca efecte,le putell\ice f,\le t.rawmenlelor .cu placebo obtiuute Ul s~':'diile· artterio.a.re' pot Jj, si1pp~~ rirte[ncle sau se pot da~ora unor.g~eiUu deniersulmetodtilog!:j Daqii acenstli. meta:-analizil re.alizat~ de Hrobjmts~Oil ~~ Goetz,<::cbe, co rezultatele ei pro~o~atoare 11iuan~cum nen.~teptate;ar fifu~t publicata ltJtr-~ revisUhnedicnUi mai puliltpn~stigioalla,nb a.rn p•inut probnbll. atentia cuve1Sitl\ tUn pruiealntilii.~tiluti.UGtk [)ar .flind publit:aUiintr-ttnndiJ.i dOO"~l/iai,prestigion~ere"YismJl'ledieal~

· -"NewBnglandJoutn.al o{M~dicio<J'' -{NEJM). revisUicnle ure un ·ractor.tle itnpl\Cl injurUl valorli. de 30 (eeaitiai.tnnre valoare intre revi~tele medicale)1 ~ceustli !te.fCelru·e meJ1La p analiza n1ult.rnai d~l®:nta ilr conte::ttlil.atndizei ~tfir•~ei·lij pseudo!itiintei in domeniul psihop~lologlet A~itd.ar, peuttt' ·'-' inielege. mni .bine Iaclorii restionsatlUi .·. pe11ttu. te~ultaie~e COiltradictorii ob\iftilte•p§na l\C\lln de'sttit)l.ileasupra et:e¢lt.dttf placebo. an1 fenli1:ato ailaliW: psihosocialhun~tlUnllla u l\ttt\.t~r cer~etiir:ilor eUnice iucluse 1u metaanaliz~ .reali~i1tn .lle Hrobjartsson~i Goetzsche. Am·fostiuteresati '~adi'', ••cuu1" $l ''in ce 11.1as:udi" factorii psihosm::ialL (ex. pt%a~a ~ro~ioimla a c~IY:!etatocilor) au nvut o contdbutiela ob\inerea re~ult.!felor studiilor asupra efectuluiplacebu. Ace~tl\idl:e·nu estelo.sli Utla uo\larsi.uicilipsitB. de=$upor:tlo&c.Douii aborc:l~d ~lilll\ific~ vln in spdjhJ.ul aeestuideme~ ~Ji a ::1cesteiidei. ·

· Prima. nboitiare este legilla d~. cercetarlle privifid .. e.fectpl experimentatoffil.ur•. ·tn 1'961-. Rqsentbal ofe.roa. doYez.i 1~1 sprijiuul ideii con.(orm cateia· (l) inesajele .iutpU(;ite ttJe experimentatorului pot ·influen\a perfurmau~a subiectitot" l.n sarcina experimenta\a ~i (2) re7..u1tatele cercetaril pnlfi p~U\ial prezise euoosdl.udu-se catacteristicile exp!;!titneMat&ru{ui. Studiite lui Rosenthal au pus iu evjden\a fa~lhl c'a ot:ieniarea e;tperimenl.alomlui, pd11 expectan\e sim scopu~J..:catre rezultalele cercetiirli, poate influenta ~i determina par~ial aceste ~e~oltu.le .

127

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Acest uefe~l nl exlle~i,tllFntntot:nlut pnte afi }t~~sp~ct ~omun

~nr~~.;ei~~~~~~~~~e,~~~~j~~~t;i~e.:el~!pttt;ep~~ll~~E4~· Jl\B\1~\u·.c~p~mnt~Iqr·c;xpel;tl\1!?~fntt:)fl)l~!' ~"flra.re~lt~teJ~, obt1utite·{~~sen:~t;.l9~7;I!~94};p~ve,i.i~1ilf:~ll£l~ijld 1f~st: efeel· sllinttadrure ~~> erircetllri ~~n tlon'l~iul meili~il\et,• .ai .. p&il~l~i~r:cl~m~;~ ~fulli! ·~e1r~li.~~!'~~.~b~~~n,~s.au.~ •.... · ceJ;cetm!il~CJtpeti~~1·~8Srtpt~ coth-eol"ta•nf!lltnluJu~ll' Gvcrd•:> p~tpulJe~,R~Ct1tliJil;i~6~l.}994 ·::t~:~T!ti~~!nt~,~.e,pu.Unn'P~ n'~~tlltea~eet'l\.~l~l~·e~t:im ~r:til.~i·~~.·~ibl,;\ln ~lllP~~~·.·J Pl\~~~·~~~~r"·~,l,~~te!?r,~ · .t~ri~~~~,~ ·· ~a~~ll·~·· · p~£9M~~ce~~Ltl.Qua.lm"Otl1c;n ...•. .. . . . ., ·.. tnrpc:~p · .... ·rr~mt ··· ~;r,n~~~-"~ oi'YSontic~Jare'~eiex.pe0ia-fi}~ ·.·.·. •\1. •• ,1~~9!

· · ·· ·· · l~i16l~·4f•~ll::zex.pee£afl.{cle pa~e~plCrt-'s~,~~fa~to.d '-~~c41lffit~rnci!n-.tujlcu~:plaect1)fi ~11¥·1l\ltlne\~·.

~ tie ~e~Jl~f!ea~ivli~tn,qbfinetea~"a:es~nl:.'~fe~t~ ~. , t1n{ ~~~~''?1l~ind,~n[l~iiplU1:abt&:c~n~ahJafi1;·.

~t\}l•lQ~~·.4~~J~stimuli<'Sall·· am~~~sitnati~n~l~···''· : · .. • ¥ •••• · .:)~~·~)~ 'dn:.1lrm~j ~fectutiplfl~alo~a!~: t\t'r· ,c· Vb ·:;l)'l;"~{t:.~tul~~p~rbneotate.rtlt\1i·~;it1compiffiiti6.~ i;

:a~;:,~m§:J' Potl~ivitr~$'ct~il~usi: • ·~~~r,hifl~Jl96J.;;,l~P~):t.;,arie$t~.haz·

. ''"t,cc:ru~ ~J.l':~~J~!'~ !•r~q~ti*ft,:~lltlu~.,t~~d~· <i"· U''· ~ ::.. . • ~~j .o•pregJttreli ~r!l 'ntn!nibfeslal}nlli a.cercela~l'iJru}lli;!t;iil_. ) >

cip4l;t'l' .,~. '':ct'r% :·:;·· : •·.: "' ,0; . ,: ·;,, • :co»ie~thl:ffzfc·'J~. ~nt·~ .. e~J:cet.iitor;ll.l

ex~~l:;~~(~'~prO~toritoqiasia* renfUllF (t~'eeilJefa~~ P~.~tim ~i tie l"ela[ia lni ~u ~~e~tia., ·

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Ull efect plac.Y,~in.sLudHle efoctuate de cercetiilorii ftil:a p~~gatit¥ .. medicala:.fo\J·ivitteoriei emisc de Roseulbal {1967). pfudi~1fa .genenllapdvii'ul it:Upactul pregatirii profesiomtl~ ( ce~ratori cu

· .sau .flira p~egiitire t11edicaHi) asupra rezultatelor stttdiilbr care investigbeaz~ efl:!ctu1 placebo ar fi putut fi iutfiunatafita prin lunrea in conside~JJ..re a uuui factor adi~ionai. Aceslasereferi Ia ~filierea acadetllli~a (tnedicalii vs. uoit..,tnedicala), care este legata

·de cviJlextuJ fizic .in care. se desfli~oa1a cercetarea. Cu 1.oat~ Q.Cestea, 1m al'n putt.itinclude aeest .factvr in acest stucUu din mmatoarele motive: ( 1) nu a fast. ill' mod clar .specificat in articolele nnalizate ~if sau (2) chia:r dac5 acest aspect a Cost specificat, a fos~ nml~ pren gene-rallJenrru a putea deduce corecl nlllie.t:ea acadernidi Sl'lecificii (context medi~al versus c~.qtext non-Iuedical) ·a cercetiitorilor priucipali (ex. cercetator lu \Jnivei'sitatea din t..oudra). · . .

A' doua abordare itiitJfilica cru:e su~tine ideea itJfhte~tei fuctorilor psihosociali (ex. pteglitirea profesipnaUi). a;supra obtiuerH efectului placebo decivlldiu. filozofia 11tiintjei, Astfel, unul dilJ fnct.orii care ru- put.ea infbienta rezultntele cetv;:eUirilor pqvind efectul pla.cebo·esl.e cont~xtulsocialiu care .este .realizaill ccrcetarea. Dt,tpacum ~nua Kuhn (1962), orice. eel"celm:e este renlizaw intr-o p~ni:digm1i. A=i~a cutn anrmai 5pu,s. o paradigma reprezinUi o colec\ie de proceduri )fi jdeipdn care cercet~toril Sllllt instntiti hnplicit !"ce Sii creada", uCUlUSarenJb~et.e.stud.iile., ~i ;"car~ suut J·ezultatele pe cnt:e at lrebui ~a 1e acc.epte". Cercelatodi tncenrca se rez:olve donr probleme de tip ''.puzzle". 0 problema de ~p "p~zzleu este congruentli cu paradigma. :;i soJu\ia ei inthe~te .respectiva parndigma Efectul placebo t:."ile u astfel de. problen:1a peut:ru cercetiitorii .fiid\ pregatire medicala intrucal cerceliirile asupra. acestuifeuomen intiiresr. ~i e;'{littd in aceln~i timp paradigmalqr delucm {ex. pentnt psil10logi). Dadi e[ectul placebo ar constitui o p[oblema de tip "puzzle" pe~tlru cercet5tori i cu pregatire medicala, ue-am a~lepta ca diferen\ele

130

~. ·.• : .

dintre ace:}tia ~i cei fiira pregatire medicnUi iu sl\ldiile asupra efectului placebo·safie ruultntenuate. ~a cumairi mniafinuat p~ pnrcursul a~es~i lucdu:l, 1111 nnumit feuome_n tlP''ille o · probleina.de tip .. l,uzzle" aluuci cfind: (1) uu numH.r mnr~ de· cercetiitori dintr-un dotneuiu sunt itnpllca\i in rezolvarea lui ~i · (2) acesta nu e5tet\eglijat~i devb1e obiectul principal ai.cen::e,tru:ii. A~adar, cu ~at ~st.e .mai mare nutntirul de med1c.i care investigheazii eieetul placebotutr~un ilot'tteniu Slle~ific, cu ntllt c~te probnbllirnrna.dea gll~l efecte pro-placebo in studiite r~spective lli cu atilt difereut~l~ i.q rezultatele ob\lnute diillre c::ei cu ~i ffu:a preglitire medica1a vi,Jr fi ~11ni reduse. Iiesigur, s·nr· putea S\1\IUe ca st\ldtile BllaliZate aiel ~i i~lC}US~ in tnctaau~lizn tul Hrobjartsson ~i Goetzsche a.u f~s~ ~laborkte ln Bljll f~lmc9t sa evite distorsiunile aduse de •·erectuk experitneutatomlui"

· (Rosenthal. 1967) ~i de pm~di gmn in care s-uu reali~t (~uhu, · 1962). Spre exemplu. Hrobjarl.sson ~i Goe&zsclie· au ex.clus

· am.m1itestl1ilii dMnpersuana co,r:eevalun rezultD.tele ~linin care grup e5le pacienl:ul. De asemen~a, 79% din studiilo incluse il1 metaannliza .nu mentioneaia ca_a[tioctiv· explicU evnluarea . efectului placebo. AceastafnseUlllldi. cii in act:Ste studii. efectuJ

·placebo nu este chlnr·o probleUia d~ tip ·''tJuzz!e••. In pt~ts, s-nr poten spune eli '"ef~ctul experithentntol:tthil'' .uu.e5te chim· o erOate sistematicli itJ cerceliid. Cu. tonte cli Rosenthal (1967; 1994) araUl. cit acest efect e3le .puteruic, illti autoti nrnUl d\ distorsiuue;t prmlusu de- "e(eclul eKperiinentaroruh•~" ~le aproape neglijabilli _(Barber. 1~69.~. J~~ssen~ •. l9'13). ~01\91UeC aceste contra-argiunente d.rcpt wtreblih emp1rle'!e. RvscnU1.al a nrtltar faptul ca· 'ex.isla mni multe m~dalit~\i ?rin catc aperimentatorul-poate iufluenta raspunsunlesubJ.OC\tlor. Uode c.Untre acestea nu se supun controlului experimental. (vezj Rose£tt11al,1967~ 1994). Spreex.emplu.. cereerntorul princitlal ponte lntnsnlit~ expectnn\ele sale asisten\Uor Sal de cercet.nre, iar ac~f:ia pot }a rfin.dultor iufluen\a inCOU:?UCllt ( ex..lJri?}nodul

--. . ~- - ..

... · ~'!... :: .. .•

de inter~ctiune s6"iai!' · · d ~ . . . · subiec ito' P- . ~; . a, pnn~no uldecomunicare) raspunsurile , ... 1 tt •·· . r .. _?tUtmlare. daca .. efectul ex:perim6ntarorult.li" e~"la ~· ~ • ~u-emltn"tle~tudlilor careinv6Stlgbeni;ll•ll!ctulp~aceo, :~«tnCl acestlucnt ar trebui sa lranspad\ ih investigatia noastw. A~adac ar trebui -a oh . .·.. ··. . . . ·.. . . . rl1spnn!lUTi plac~bo - . .~ . . ~~em patr7rn-m:i cliferite de

'CO.Ih.·p • am .. ~ ... •. · .. ·1.· .. · ...... l~ cazu .·. stu.dailor e.feetuare &..me .. dici in ·.. . .P"""en~ ~.reahz.ntedoces;cetl\tori·fti ;Ji ... a •...•

DacU in scbimb ac~st ~~~feet 1 . . . • .; preg ure medical I\. tent. 1\tu\\ci h\1. va fi us 1 .··. n ~~JCpCnm~~mtoruloi .. este ineJlisprofesicinate a.. . .. • & ·. 1\ ?' l~el\(a ftlC.t UD efect a( p'regatirii in studiile ~r fte:ed .. ~ fOl;"';llm n.s.u.pra r~zu1tatelor expe~i1tleutale

!IZ_ n e~.eorul p1uccbo. · ~~ad~r. un p-rim.nbiectiv nl.sturliullli de tatii oeste J d

a reaUza o analiza psilros6cia1~ li . a~ a c tn ll)etaan..ali2~ h)i ]:1 bj am ~un{ttll acerccrarilor incltise asumptia eli mzunaU: -s:r:~Qn -1I Go~~C]Je. Pnrnim de la

- profesiorfal'l( . ... n l or vor fl. afBCtate de pregntite!l' 11 a ·cereetatprulni prin · 1 ( . ' preglltlrc'lnedienlii) M · ctpn cu Jil r~pectiv- fl\di

pro-placebo 1(l sm~x~~t,. ne a~t.ep~m eaproportia de efecte Sir"fie mtli mans tl.,.,..At rea. lz.~r~ de eel fiitlt.nregiitire mfihcal1f'

.-.a proportta de e~eote 1 , studiile ac:;e}erru;i ~rcetlitorl ln . .,. .. contra-I?. aceh~ ne ntteptilnl ca :pro . • .; cazul atydulor rea\iwte de medici ~ mai micH. sau. s:::~~::~:are obpn e~ect~ pro-placebo sn celor cm·e ab"'n eti t _. mod sel)lntficativ de proi)irtln

,. ee e contra.:Elacebri Fa d predic~ia conform dt . . __;_ cem e asemellea profesioila.le. vor fi ~ul::~~l!~~re~te~e datorate pregatiTil >rob lema de tip ... p.;zz]e" ac e et::ilJl placebp deyine 0

medio_aut robi"'"'""' d ~~ ~eptru:i Ct:rcer!torU en pr~gittire .,.,.,.... e !>' ozz eJ' -n· d d - .

. Dl1ml{ul mare de ers . . un efinlta atcJ prin ~-....:c:.:·~~o:.l... ..· P _o~ne z~pJzcau; in -studiuJ.efectu~a-

. . .•·.··.· S.cl~fi~·sfndiilor A .. ·. · 4 llz · · . . · . · l.·Trob. d·.IP'.· rsso~ Qi. doty ··l . mana. 81 tQi\te a~udijle folosittuJe

•. ·. · ~ · •. ~. · 'LJ . SC lC·(2001}'iU ID"'ta · }j · · y. nnaltza or-iginaUi ei au.inctus 114 .. · ..• E. ana za lol'. m mota-5. categoT.ii:Jl) Psihiniri.e· ('l) N-li~dn. P.e cnro le:augru{lnt ln

.· .. · ·· · · · · • - e)llOlQgle! (3) Gtnecologie ~i

132

-- ··:---~-~-:-.-·

Opstofi:idi; Nl Medicini\inre.nl\; (5) Chi•wgie ~\1\ne:>tt:t\ologi<. Aln.exdus 11n stndm. seffil1f\tCU un ps~qdonrm (l3Fecho. U2.92 Iuset1~.Arc §iGrepa, il9B9) d&oarec~cercetl\toriavean pregatit·i diferit.!!(atat n.ledici cat ~i ·cercetl\tmi fi\d\-prcgatiremedicalli) ~i nu an\ pututafla cine este autmul principal al studiuh1L A1n mai

. excltfs doua srodii (Bertedetti f1i CC.Iab~. 1995;-fJ.allshish ~\cu\ab., t9Rll) nl~ Qlicor :nuteri{l) au pubUeat un 1\lt StL\di~l (iL~clus.in . anal!~ deJa pi), (2)stttdin can>; ave-a acelaQitell.1.a !li (3}'tn cure · nutQ~~i all obtinut 1\c~leru}i a:e~ultat~.nAm -exdus aoes~e studii pen~i}1a ~"'il)lposillilitrttea c·a datelesi\ fie inVluentate de t1n au tor ear~J~Clny-tllllil> ~.111ai rnult(\e·o cercetnrepe aceea~irellla,'. cu ace\~~i Tezu1t.nte.ln totat·run·inclus I-ll stud~i dintre sntdiik

cn~iau pattici\)atlameta. .. annlizanriginal1\: . . . '{Se\ectia daiclor. Au fosr• ex.trase -darele pri vitoare lt\

pregltirecel:'::etiitl;)miuillrincipal (pdmul,autor al stodh~lul). Am · folq~jtresutih drl?ei~temet. iadtibnt_tlfll citre acesteinfonnnti i n~. ~~'lluto~fi e1ttras~ din atticolulintl~i tti roetannnli.Z1tsaL~ de ·

.. pel,dternet,I\n);cimtactatdirect ntuori'f. ; · .. ·· . ', ·• .• . •.. . . • - . ' • . • ' .· .....•. ·. • .· .. . . < . . . . . . . . ; ~il\t~~.4~f\\fll'· J\_rQ _fticut o anr1lizli ~loball\{toate cele

.. 111 stucJliinC1l1se/fn aler.aanalizli) :;i c§t~ b. aonli21\ pentm fiecl\l:e · · cat~gode1nedicala speciJi~~.= ( 1) PsU1iatr}e~ (1) Neuro1ogie; (3) · Giljecologi.e;";i·Otistetri~n; (4) Medicinl'iJlterol\; (5) Chinwg\e

Qtknesteziologie. ln.ftecni'~ analizt· an~folt)sit do\ in.dicntod. Pr:trnul indi~lllJ·sereferl\ ~a te~q~t~1r:f~:<:tUi~l i placeb(l {plac:t;~o trend ana\y~ll\). ComP.atftnd grupul p\a.c~bo cu. celd. e contro. ttn

.. . ...... · .. ··. . ,. ·.··· ··.·· ·.··. . .. c~iulsnadiUor ct~ va\iabile depende~te dihoton1ice, un.risctellltiV m~i ~nic del indi~l\ un i!frict. pozitiv al trl\tamentultti pfru::ebo. DacariscolrRl_ativ.este mai mare snu-egal cu l, acea:;tn.t!$r~ o d~vada impottiva ~x.,tst~ntelefectului placebo: ?enrliu stlldiile crip~ au utilizatvariabile den~udente continue, Hr~bjartss6n ~i Gotyscl1e nu cnlcQl~qlifet-enta standard d~ nwdii intre gp1pn~ p\acebo *'eel de contrpl. 0 valoart} ·de --1 semojfrcttun.efeci

· p\acebOllutemic. 0 vnloure de 0 san+ 1 el?tg o dovada 1rnpotrivn

113

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~xistentei efectului placebo. Amt in cazttl analizei s,p~e_F,iJj.ce,_ pentni.J1~Saf¥$~tegmie medicala, clit~i In cazulan~liti!fglobaie~ ..

. am calcuiatpe#liu cereetlitorii rara pregatiremedicala,~i pentru medici propor~iat:fe studii p£9-placebo !Jl cot1tra.:ptad~bo~ Ccl de a/ doilea. inrfiaatwl" se raferii 1a implicru:ea .in dotueuiu -

. illll'JliGare in sludiefea.efeclutui placeba, pe bazanumliptluide articole incluse !n .ptetnimaliza 1ui H.robj~J.rlsson ~i Goelui.t:he. Am luatin calcul propor(iile de cemeliitod pro ~i contra-;placebo in fiecare coudit.le medlcaUi spedfl.;::a separatpentru cerceUitoriilild\ pt"R~atiremedicnlB., J;CS.,pectiv pentru 11Jedici in cazulaualh;ei globale, runluatin,calchl proportia de cercctatod Jndi. pr.egatire ntedi<;ani ~i ¢edici en tin indicatOr preliniinar ~I contributiei generale.fu domeniu. ·

Rezultnte Catege.rla stu4iilor efectua~ .<le medici include 42 .de

cercetad ale cnrot: cerceUi.tor prlnclpal este unmetlic fJi .5 cei:ceUUi ale cawr cercetlitor P.Iincipal este (.) asfull::ui.ii medicalii. Ca~gona sludiilor eiectuate de cell(etaturi fua pregal:i~ mecUcal.ii~clude 62 de ~ercetari ale caror au tor priucipahire tiuut de tJQCtOr ( e-:t. lll psihologie, ed!JCilfie) ~i 2 cett:;etiiri rue caror ll.lltor pri~cipal este absolvent de program de Master.

':!.<Analiza geuerl\la . . TelJ(:/iiJ{.a erectufuiplaccbo. Rezultatele • no~stre. aratli di·

73% d(ntre cercet!itorij.ilirli pregatire medii::aUi nu gasit o tendinta pl.n:i li va pentru efectqlplacebo, in tin"lp ce doar 27% au giisit.o lendiuf.i negatjvii. {IK0.01). in caiul cnf:egoriei medlc.i doar57% ~ntre medici nu g8,sit.o tendintii pozitl.va pentru efeclul:placebo, ill limp ce 43% diutre ei nu gasit u tendinta negilllva (p>O.lO).

· CoiJtJibu{ff:! generala fn domeniu. CerceU1rile asupra e(ectului placebo incluse ill studiul nostJ-u :;>i in met~annliza realiznta de Hrobjartsson =1i Gotysche (2001) au fost realizate de calr~ cercetator.i fiir~ pregtitim medicalii in .ptopoJiiede 5B% ~ide ditremedici itJ. proportie de 42% (p>O.lO).

l34 \ \

Psibiatrie{~3,de sludii) . . - ·· • · 1biidinta e.I-cc.tului placebo. Re-z;ul~tele noas~oo nra~ c~

7l%. dintte cercetiitorii flim pregatire medicala au gis1t..U leildm\a pozitiva pentru ef~otu.1 placebo, in timp ce ~~nt=:29_~ a\1 g~sit ?· teudinta negativa (p<O.(J:l). Ul cnzul culegnn~l meilic1 don1 439to diutre"medici au gasit ot~ndintn pozitiva pentru ~fectulpla~ cebo, :m ·utnp ce. 57%· dintre ei nu gil.sit o tendintii·i~ega~v~i. (p>O.lO). .· .

Imp/ica.rea Jil JolllMf-t.t. Imptioate.n cttrc6tatorilor .£adi. pregiitit-e medicaiii in cercel,area efec~lul plat:~IJ~ in psib.iatr~e e:~t-e_de 32tH% (dintre toti ce.rcetntotilftrli preglinre med1cttln) inr iinpiic:rrea medit!ilor estu de t4.89% (~l_intre tO\i merlicii).

Medidnil:. intend& f.l8 de studii) . • . · . TeJuJi1JfH e:fl!ctalui placebo. Revsltntele no.nstr~ nrnl~ ci\

67% dj nlie cet"Cetii.torii flirli pregatb.u·ntooicmlt-a!J ~lt'O" teodmti\ poutivii pentrJJ efeatul plo.ce~o. in limP, ce do":f ~~%~~.gas ito tendin\8-.negativa (p<O.Ol). In :c~z;11" ~aLegope1 medJci, 64-?V dintre ei au giisit 0 tenilinta poutivn peutru efeatul placebo, 111

timp ce 37% au gasit o \eudiula I1egatlvlt.(p:>U.10). . Jmplicarea. fn domaJJiu •. Im;Ucm-ea. -eerc~l=itotilor farii

_ pregatire medicaUi in ce~tareu. e~ectului ~las~bo ~n_ ll~e~lid_u_n iuterni.i este de 37,5% (dintre . top. oercetU:tonl .fiirlt p~;egauu: medicalli} iar i~pli6u:ea uiedicilor este·de'~~;78~ (diot~:e lo\L u1edicii). · . . • · · · '

. Cltirurgie ~i Altesleziotogie {33 de studii) . ~ TendiJI(B. ef~ui placebo. Rez;ull.atele ll<Jnslt:e nrnl~ en

7 l% di11tre c&cetiitoriifilra.preglitire.m-ed.icaUi.auglisir:o Lru.llh~\1{ pozilivii pentro efectul placebo. in limp c~ dua~ ~9% n~ ?as1t u le!Jdinta negativa (p<O.OOl). iu cnzul ca~gone1 m~dic1, 69% oinlre "tnedici au gi\sit 0 tendin\a.poz.itiva pen~ efeslt:tl placebo, in timp.ce 31% au gasit o Lendinta negati:va_(p<~.OOI). ~ · Implicaren fJJ! ~ome.niv. lmpUenre~ c~~~e.ta~(lr~~.~r ~~-~

. pregalir~nnedicaUl. in cercetatea efectul.ut placeb~,m~cmr~rgre

f35

.. •

=li al\estezioiQgie este de 15% (llinll~ l'?ti cetcell'itorii fara pregatlri$ 1U1(:dicaUi) iar implicllrC;a medicilor este- de- 36,17% (dintre to~i mttd\cii).

Nen.-&logie (6 studii) i

TPlldiJJtaeiectuluipltwebo. Rezultat~le noqstre a rata ca 2 · -~ dir~Lrtl.c:ercet.:~torii tam pr~gadr~ rnedic_nla au g~sit P tendintfi , ! poz.itivi;i penta.l efectulll!acebo. in timp ce.nici uqul nu a glisit o tendinta negativli. tn CI\Z.Ul categodei medic\, 2 diptre ffiGdici: 1m gl(~if 9 t.enclintJ·.pol?itivllJ?entru efectul placebo. in ti~p ~ 2 nu

l}ltsit.'o tendill(anegativ~.. ~·.·· . . .. ···.• ..... ·. ·•· .. ·• I.raplicarpll .in dD.manin. TmplicaiFet\ cercetatQrilQr :fftrli

pret;litire medicnlit'iJ.l-eere.ern.:ea-efectului plac~bo fp neurologie esrede 3.12.'% (dhtll"e • top .·cercetlitt>rii flirl:t·pregltire medicalli) im: impl\c1\reamediciloreste c}a 8.51% (dinttetoti medicii). · • GineonJqgJe ~iOl)stohicli (6 studiil · . . ·

'lf;mdia{a fJit;t:ltrluipf.nc~bo. Rezultntfll~uonstrearnUi ci'i 1 ce~-ceui~er flira pregalire medical! ll giisjt o rendintii po'-Zitiva

· p~nnu.e~octuJ,J.lla~lJ.o, Jn timp ce nil;i un cernetnt0rfiirli pregalire medicnlKnU.a-gKsit-a· t(!ndintfi n~gativa. tn oauit Ciltfe.gorlei meiliei, 2dlntra medici su'l'gMsito t()ndintit.pozltiva pentrn,4f-cctul placebo. in Lintp ce. 3 :ltl g;ll~Uat~ndintl\ negativli.

ImpfJ;:huCa m. dD/l'le:nju. In1-elica1ea cercctl\torilor flirli pre-glitire· medicn1l t~ cc;rcetfjr~ <;·fec(ulul placebo.fu;gh1ecologie ~i ol.>stetricii e&te de 1.5% (dintre toti cercetlitorii flidi ptegatire rnedicaUi} ia1: hnplicaren medicilor este de 10.63% (llintre to{i ·medisii) .

. Con.;lnzil~l ~ise1ltii .·.·•· :• • l11 ce~a ce. privefl(e tlscnl relativ fii rnfirimen efectelnr,

eetcetirea nons~ii a evidentiflt ca·m;mltrul cercetlttorilo'r rnr-l\ · preglitit«·n.mdicaUfQare llll i.'1\&it ltn' ef~(~t pozit i v alinterventi~i ·.· · de ~l? placeb.o este ae.mpificariv; mal n1are clccat numlhnl cercotlitorlll:Jr.flirfi pmgatlre n1editru1\ care nl\ a\1 gfui~t ncest efe.ct. Efec.tulplacebn pentm cercettitorii flira preg~tire n1edica\a e&te

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·. .:: }4#;f'achu episremo!ogit;. mai SOCial~~ Illai ej:fr.~trlfst este. pmpus deFe~erabend {1975), A;; a. G,~Ul)U~~iuni.spus •. F~y~~abuend sus!u~e d.nu exista o Jogicain ~tiinta. ~tea omneuii deqhmtacreeaza~l at!~ratateorii~liin~{icediu tnoti~esubiective ~i.chiar ira\io11ah~. ~1 fac_ oike este. necesa.r peutru a ~wansa.

·Evident e.U n u apar p robleme in ·inte.gtarea n~iulta£elor.ob jJnur.e ~ de.noi in acest cachu.epistemologict.Cercetatorl fl~ilpregallre m~dicata par afi dispu~Jsiifacii oric~peht:m a.ex.tind~ domehiul lor de :ercetare, iprm~dicii o~ce.cons~rvlLnbordar~a propusa · de 'ei. In ac('-st cadm. se poate ridi~S. q l'ro1Jlema.de.ordin etic, legatit de n:JetQdele peciye oamenii de~ti.iufa.Ie.utilizei!Z<li peutru a-Ill extinde domenitil dt'e. a&t_ivitate. In paracligma pr~pusa de Ku~m. modaliUitile deiufluentare tnu a fi iiuplicil~~ iarefec:t11 t-1or. poate. fi medint de exp.ectante!e hupJicite a.le :!{P..edm~ntatoruhti. P.erspectivaluiFeyt\\abend l\U maii~pune ms~ aceastli constrtlngere. Pe altfttl,·J.ll()dalitiitilepqstulale·de acensta diu· unna. perspectivii :SUnt. coHgruente Cl'; utiliza(ea · p~ittnii suciale (ex. p.~iuu.ea.s[Jonsorului,. afi)ieren) ~i.auuot· metode nuti .·. Pll{:iq •·orto.doxe'' (e;~~; .. ueiueludt;:rea. rlt s tu!!H n aumui tc:n:. rezult~~e ·l}a~e. · 1111 sustin .ipoteze_le, ·dist~rslu~Ii in

· .. modaliUifile de pte~entare:~i in,terpretart: alf) dlllelQr). fu conte]ltul · '1--CCS.tui ~adru·epistt:~olo.gic me.n.tip.nfun feuorue~ul.de ·~oEt}.~~

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.·nlilt .metm.mnllz~le . cnlitalive ciit · ~L. ~ele ... canlitativ~. ·nra,ta di - vadabilitatea. re7.:ultatelor stu<liUor .eUnice ei~te u:ro~iata- c;u . pre;f~nteJ~ qi .e~perti~a echipelot d~c~ce;l~ue penl{U un aDUillit

• tip. de t.J:atament (pentru· o anaJjza dnta.J.iatn vez.i c;ba(ubless ~i Holl<?n. 1993). Autodi (Chmnble.':is ~i floJion, 1998)prefera sa creacl.a d\ acesle d.iferente sun l date dei11~apacitntea echipei de ~ercetate de .<l huplemeuta.uutratatu~ntconcw·entcelo1 pecare

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142

ei U prefera ~i nu tie e[orluri rauvoiloare de a iuflueu'a tez.ull:atel~. in orice caz' a.ce5le anqiJ]aliiparafiinn\iJ.nportanLe_c:lecl\L cted.eul. Posibilitatea unei conduite UtWti;il~pfice ll1Jillinta a lnceput sa preocupe tot JJl&igmlt comuni!ale(\ ~tilntifi~ :Ji~~· ca at.a~-e., examinuta foarte serios .. Spre extmplq nscul !fl coudtulK u~tiintifica in ~liin~a ?u fo::;t ~is~ulate de Scha~;hntau{l993) tn infloenta revista .. Science ... Mai tecent, "'New England1ounwJ ofMedicine" a publicattmeditqrial d.¢spreSJl(}IiBorizare.dreptmi de qutor ~iresponsabiJ,itate. fn nl!estedltorial sediscutti diierite no nne ~are. sii incerce sa fprotejeze. cercela~en· tnedicala de distorsiuni in cercelare~i c!e div~e lnterp.:re(ex. aspoDs~ntlui), care au devenit prea mad pentru n tllolernte sub etichet."\ !l\Ult mlli inofensiva de "efec~l-expc,titnentatnru.lui"; J3tlitorJalul a fost semnat de 13 f;{)itori ai celor mni influent.ejumale luedi~te intemationnle (Davidoff 11l cu[ab.,.2001),·care'~i-n~ expritnnl iogrijornrea cu priv.ire.la cen::ctli.dJeluedicrde '.i·Ia cercetarilc psihologice complementare.ln. coutextul n~estei • paradigme epistemologice a.r·fi. fost interesanln. investigorea efecl~lui pe cnre il are spon_sodznrea de calre eontpP,niile [nn~laceulice a cercet.=trilor asltpm efectului placebo -- cu un posibil cazdc presitUltl sod;llii: Recent, unii medici -~· farmnci'ltl (espans~hi li nuluat ntiludine fa\11. de presiunile cotnpnniUorfarmaceuUce nu door in manifeste .teoretjc~ de geuul celui nteulkmnt tuai :sus (Davidoff ~l colnb., 2001), ~i !$i b.t acUvit~ti prnctic~. AsfJel, uuii dintre ei au aldituit gmpul numit ·'No Free Lunch'.· (/JJJJJ,:/1 !J'WW.notiey;Jg,I.wh.aal umliirind·sa reduca inf1ueutacot?pnnii1Qr farmaceu.fice ~upranctivi~pi lor litBSUptacercet~rii Ill J'rB~liciJ in domeniulu1edicnL Din picnt.e. informatiile refer}toare ht spm.morizarile -;e.rcetllril de ditre cpmpanii\e Iatnmcculice nu sunt 'intodeauna ·lransparew:e in s~udiUe pnbli.cale~ Spctiim ca, um1findu~se nonnele p.ropuse de .editorinlul mai sus mnin.tit (Davidoff :sicolab ..• 2001), acesttip d~ ,informatJe sa devinanccesibil in lucdirile pubUcate. puUind.astfeljudccaintr-un <:On

text mailarg rezultatele ob~inute1n diverse sludii . .... -.. ;-...:

143

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In al doilea :tan d. pare -ciudat d\ pan a ~i asrazi unii pl'ofesioni~ti Llin t'tomtniul sanatnrii nu in{eleg en efecrul pla

.ctb(j se realizea~a printr-un mecani&m biologic plamjbU ~i nu egte dour un efect psihologic -pur asupra unoi factori fi2.ici (Kirsch; 1~90). Nu mai vorhimde dificuWitileunorprofesioni~ti deaintf!legeciim:·iceinterventje sihotera euticaarecons. in e 1-Jioo)timioa 'tn creler. altf~I.ruw ·c1r · tera ie este cbiiniotempiei··(Fut·marl::.~ colnb~. 2002; K.ixscb, I9!?0)~FactorH psih()logici can:i sc . considerli_ c~ afectoa!Zll· difcrite nspecto biologice ,il.! fl\tOtQ~ttl!\8 t:tn:substmtbiologic- flU Sll~[ de Sine statlitod .. 11i acest .substrat bioldgic voate media inipactullor

· rumpradifetitelo£ aspet:le biDlpgj~e{{GJisch. 1990). () expliAare · dhr punct de vedi!Te ·hiologlc;(ex. 11eorona1, bio-cl1imic} a

meeanistneloc·efectului place)5o-arfi __ pvea coll1p1~ fji .df!taliatit }Jel,ltm crt" artrebuidescl'is, de ex.etrtplll; comportamentulunui nnmar fo'J.rte:mare de e&l\tle-neurol1nle. Din nceastfi cat1za nvem

· 11evoiede un nivel de at'rollzti. mai abstract iar ·pent:J:u. aceasra 11ivelulpsihologio est~ c~l potrlvit (Aridersi;m, 19!)0)~Di~ltcnt!:• inloc snin el .. dMicderile biologi:ce !ji cele psiholo. ice suut doJ,U1 Um.bnie dif-eLitcf"elosite pentn.l nceea§trea Itare,(a~~~i realitate ~stc...descriali ·ln · nlvcle difedte. folosincln-se limbaje dif~rire .. · · iacl :1 • • "ta 'lebielogicli l .. ihQl-ogi~l.ca fiind dinnire. D .. ·. ' ehiitlt c . ·. 1 .11 ex.1 i\

nlcilm l\1r:ea11~mp.s1.m a· c : rl\-unsubstnitbioJo "c(I<lrsch. J!)l ' . tcbrer i:colab .. 2002 i, __ rini,rmare 2 ___ tnfeno _en l,sihqlosic.nrt: atlitconiteclnlc psiho1oglce cfttt;lbiologice~. ·. en .• ·n o~sl!l.·vtrmodulin cni~~ce&te idej ~unt~ereze.nt.atem grup~rile

. de r~~~tici~i. i'ntt-!Un $lUdiu recent _:rea1izat pe. 60 de medici (vtlrst~111edi~ ·34)-~i160' de psillologi ·(vftrsta medie.31) Ml pus· U11Jllitoare\edouii mtrebitri:.(-1)-P.rincc:mcclltJismes~rea/iZ(;llZif. 1'/cotfJ.}J-'hlf:ebQ?. rl:ispunsnrila posibiTe erau: (a) pnr psil10logice;

. (b)pt'u··~iologice; (c) in ncela~i thnp biologice ~i ps.ihologice; {d) nici mml :din rnspnnsurile anterionre nu este corect; (e) nn

. lrl&

- - -~- ~ .. ": . __ . ~· -

. . I bon "n.,.inntdc de ra:wnns '1i trfl ~~ J 1 p ace . :' .. ,..,. stin~ {2) Ln ces?-.refer.· e.c I ~·t logive· (b) donr ln ldocte ;i.l' fo&t: (a) ilmw la efecte ~~~~~ice ci\t ~1\a efec:te bio~og1ce~ biolo'giue; (c) atat \aefec[e·pus. 10 ""en"onre,nu este corect; (e) nu

~- . 5ID1. ellth "" 'd a -Cd) nid unul-tUn ~aspll~ ~ 65(}1i rrnn:e medici consl er ca ~tiu.!j.te1.nltntele !l~' l.uatm: ~a . o i-nsiho1ogie ~1 donr 35o/~ • , . :u- :e un meuan1sm P' l.' • clir s1 efectul place o nt . le snnt atllt psihologtce . dintre ei au spos·cl\ mccant:~a intrebare. doar 5'3% d\utre bio~egice; p¢-ntn\ c~a. de~as· 41% au-ales vnrlnnta (a).ln c_aw.u\ rnedicitm nlcsvmianta (c) "1 " •· .c0 stsbniltui:·SS% dmtr~

. 'h ~ . attern-ut gul:llt a J; • •

gropului deps1 a ~gtp. . 45%v·aciartta (e) 'In cnzul pnme~ ·•cost\ a no nJ:es vnrumta (a) !Jl b ·n3% dintre -psihoiogl ... . d douatntre iU'e, a . • intro\llhi; pentl!ll cea e-a. ", a .. l:anta (a) Din non. trebule

V :\ ~i 1'1% au rues v .. ' . d o au ales. ~punsu xBJ '1 eZU}tate ar pntea avea om: · sl p.nemcont de faptUl ell aces;~: reglitir:en. ·profesion~U\ ~

val~dit~te ·co~tex.~'l~l~ Ieg~t Rorn~nia. tn ciuda shnilantatn Psihologilor ~~ roedunlor dm .,;. ' .l.l A""'V6S. c efe.otul placebo.

-1•· •• ~:.i pBlnCdJg r.. . moduloi in cn1-e. me1;1I~tl 'i d ... 11 de di.ferirli (chiar·~t in

. o dau ~ste esLt ~ :r jnterpretarea pe cn~e·t- . ll1) Adeseamediciitin~sall ~ru a

. ·: .·:·-··· . .- : ...

litfiratu:rn ~tiinpfiellnlemt\~t~na. . ....., lat si. exclns"'in i:lifentele _-s-. rei:re;bulesiHiecen"o • . . ) ·

oa pe-un.ln1c:aaotca ·nidi a ·nonor medicamente ~~ studii medieale (~ .. test~ ~li e biti1ogice mni n1ult san rna~ care nn este-roedtatde·n1el<3nl8rn: ,..._ .,.~.,c,lfl 2001). :Pede nlta

(l:s· b"attsson §1 \Jou .... '' • · pnpn cnnoscllle _ .,ro ~ . t!l\ un fenomen psiholflgtc narte.psihologii:'tind s~-l pl'i¥ea: . caps~einte biologice ci\t ~~ ""· t are· are ·atut-eon .. t . ' ren\ lji impoTtan c. • . ca na~rn sl! ·fle seno~

. n are ·este nevmc d'i'. ·~ psibolog!ce;·J.lnn ur l .· • 1990).t\.tltfeldeconceptii llen.e investlgat~ldezvoltnt~fr~ch~inecnaoscu.t Iii displtndit nu pot despre un fenm:nen re :ahv . . .

' 1 lb' nsiho-somal. . .· ~ prGnlOVa mode.tl \O-r rOll1CllJei- 'Din pel'SpeCtiVu.

0 stratsgte tle·rczoi>Ya-re'R P d 1 lbio-medical.tiebuie .~ . te« menetl!8. roo e u l

Psihologi'Ca, pentnlapu "~=· • • ti.unctele s1abe n e d ft ·v puRctele tnn ~~ 1:' 1 l evaluate non- e. nsl l l . sihosomaticmodern (mode n

vsibologiei in cadllll mode u u~ P· .

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bio-psiho-social). fiieflua ref~rin; Ia ceea ce in nmd trt~~itional numjm. s~in5.tat~J1zic~ ri"boa~somaHca. Prin Ufmare, i~l:ceJe ce ... unne~.~~i~)'.l?t ~'i{filii~ rol ttl ~i · statutul·.i nteryenjillor · c~giJtti~comportrutteutai,e iu m~cjuapsihoagm.aticlfmiilfel'nit N:Uivoi centra_ast.Ipraintervenfiilorcogtutiv-cotnp.artamenlniette¢ml!te:,, (1) reflecta<intpac(ul psibQlogieicu b.aze empiriefdlitiinJ.ifice nsupm cerc~tarilorpsibologice; {2.J,sunt investigate p.rin design-uri e~peritnenf:ale· rigw:onse ~i :Jtudii dinice contt'olate .eare implicafolo~irea unqrlotiu:idecoo~t~lplncebo:ji (3)~desea. :mnUnvestigate.luaudu-s~.ill n:alGul atAt ~peetele ler: teotetice dit ~i efff-lele lor prnotice .. PrincipaleJe aspecte ale intervei11Ji1or cogn.iti v+c:;:umportamentale sunt: (..I.) factori.i cogniti viu&emazii im paclul mediul til asupra · aspel!telor .··uoustre sttbi~(:tive/ emolionale, cogr1itlve, comportnmemale; (2) · aceiJti factod · cogultivl poLO idenqficatifpiagnos?cat[ §i apoi.(3) lllodi•ficati pdn·iu[e.(ven(iicognitiV-comportamenlale.lntreb~rilespeciDce carora iocerofun sUe gii.Sinrnn rlispuns in ~«;ea,slii anBnz.:t ~ticli . a impnetuloi iJlterventiilor cogoitiv-~omp.oitrutieutalt: ill meqiciuapsibosolllatidbunt:{l) in1Iu~ll{eazafncl.cJdf..psjfi~!Pp;it;:1. de~voitru:ea ~i evolutia .~olilor: organi~ .. 'Ji. ale Jiltor ce~.difii medkale?; {2) • interventiile·• psUJOlogice afectaadt factlilrii/ mecanismele psHIOlogice iJ.Ilplicale in ~e~yotmr~a ~iev(!lutia · . bo1 ilm· orgnnice ~I ale fl.ltgr condi ~ii ntecucate? §i (3) intervegtijle psHt~logice imbunata~G evolu~f} clinicain boille qrgan'i~ %i nlte·.condifii med1Cale~&tisptiuzilndlsacestelntrebari, am put~ · ~omparn mal biue \'allditateumooeJ ul11i. blo7medical aaresll~\in~ . di f£tclolii psiltologici sunt.iil prineipril artefacte saH ~IUJt niai putiu imp'ortanU pentru ./i~hii'll:atea ~~ boal~ fh~ic[i, cu cen a mod~lului psiliosomatic ntoderq car~ sus{ine cadit~ pu11ct de vcdere etiopatogenetic, fac'torii psibologici au ncela~i sl.atut ontologie bu Tactorii fuici ~i oa.inb~rvel1Jiile psihqlogice:(ex. psiholerapia ?l consilierea} au aceia~i stutut ontologie cu Lmtame-Itlt:;le Juedkalep&ntnr diferite buH orgatJice.

150 f

\ •

0 trecere in rcvis.ta a dateJo•· . . . . . . @Jnfluent~'lia fncforii.psi~~!oglc!.J,lezvoltpr~ :jf. evulu{ta .

bolilor orgaoi~ ~!ale nlton;-oudi.puJte(l.tc?l!'? :' . ·. . . .. ' . x· .• : . ··.· .. ee:n"u•htinrofesiotilij.t l ar.· f;:Qllles.tn. lnfl. · .. u ... enfa'{ac.(O. ~1lor

ll urop . ,r< t . I;' . . . . . . . . . • . . . . • •.•• f1 .. e con llln)· . . 1· l ...• • . ea stilul de Vif!ta (ex. dletli, exe~ctru •.... ·. ztc , ·. ~"7 o.

~::1 :s:arllorde com_pprtmnem (ex. ConJ~liauP,I !n,.tra~!11~ht) l t1 t' bolii' organice mulri sunt md~tq.tm PftV.tn{a asupra evo u~e r • t" • • 1 • . b r·

influen\ei directe a factQri\or psibolo~.~c~ hs_up~ eyo t~e~ o u or aui<::e (e~. Relmanl1io A•~f.l, 2002.). Pnnu~ueutn_d~recl5. inrelegem un. ~feet uemediat ~ factor~or p~dto!ogact (~x .. d . . optimism) asupra meCi:lJusmelor biologn:e §llllt lUI efect

epre.sae, . . • diOdiri ale iufluen~at de alti .factori psil,ologlct precmn mo ,, compliantelsau ;Ulu1ui de via\li(ex. sclllrub~rlin co~p~rtantent). D . ur factorii pslhologici nu sunt de sme stltaton cl au._ un su~::at biologic. P£iu urma:re, chia.i: \!l\~f~t,?~ediat al.f~ctonlo.r

'h l . ' care nu se r~Iedi la sclumban m complmnta Ia p8l 0 ogtcl tiluldevt'"'ll&rtrebtd tolUifi'.inteles cnfHnd renllzat tmtrunent snu s ··~ , . · .. · )!

rin aeeste n'lecanisme biologice plauzt?de. 0 tr;c~e m re:lsla p ll .·· de specialitate a relevnt fnplul «:~exist~ nu.tlleroase n dt~~atui J! .... ~ 'ntlpnctUlne.u\ediat al InclorilOrpsi\itiloglci a,SU}Jra stu 11 cnre <UU<q o't': " • U tl • t Oo

de ll" •. i evolutiei lmlii organice. 1\Suel, a,..a uratntca :ac oru -~hvol ~~ J nfeet...n"'a hipertensiunen (J'I:Juas Qi colab:, ~997)y

ps1 o og1c1 ~ _ - · • t·o ~000) llfV/SIDA (Mayne ~i colab.; H196; Lesennau ft. co ~ .• , Qi cancemL.(Everson ~i colab., '19.96; Watson~-~ colali .•. 1?99).:· D Ilea studli prospective Bllur. dovezt care sustm ca

e as~~ne .1l• ; 0 g1· ci influente~n c.re~terea ri~cului bolii faclom p31 01- ·t ... ~ l\t: • "li t:OIUllafieue ~i 11 mmial\tll\ll din urice ~zlitl\ pop\t l:.\t~ 8• 1~· l~ru.

. 1 b 1·993· Shekelle $i colab., 1983ht ca eXitS a un (And a Ill co a ·• ' ·tic tltti cfect puternic al facto.rllor psiho~ogi~~ _asupra pr~gnos . t ·••

·e ltil"'r cu boli camuBriene stnbdlzate •(flrasftre-Snnth ~l IJUCJ. I , u . , . .

col~·.·. 993; Willlrun~i't!olab., l992). . · .: · .. · ·'. (2 .·· tervenVUe psllmlogice afect~azlif1'1C.ton~~!~u~smele

psiuologice hnplicate iit dezvoltare~·~l e"olu\ia bolilor mgaulce

~j ale altorcondi\ii medicale'l . . ....

151 :. ..

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Un numnr.m<lre.de ~rcetfiri sumatiiatein ·meta:malize ea~itnti~~ 'ij cunutativ~. nn nrntat i~ lilod clar ci\ ini~~en iilc P~lholo "ce(el( si\ietenr i cori.silieni otafr'*"'d' ·· -.~ · · -T 1 · • · .· . .......u. en .~,acton

~~~ 10 ogict7~1n-7lln1~orrnn1cnt'la cognitii §i emntii ~are s~ tlt=m~nstrase antert?~ ca . at' fi rela[ionuti en diferite. condipi med1~e (eJ(. 4Yflnn 1JL W ~ds,l993; Friedman s;i co lab 198 ' , , , •· Dtn )"1i~Pl:li1$~ile. hu::e~~ rlou~ intrebM) analizate ptl~ii llCU~ ~lm fi renratr.;~EI~ndu-~e p!!:un rntionament siJogistic (figura 1):

~~.(factc5ri psfhologici} _ _:_ (afecteazli) p_ (~ond:itie orgt101c8.) · • · • · · · ·

· . . S O~n!ervettfie pili)lOlpgicn) ~ {afecteaza) M (fncrori pstho1oglci) • • ·. ·_··.·. · .

.sltcon'*•z1onamtH;. . ... . · -~· £inte_tvepriepsiho]ogi~a) -~ (afecteaza) P (eonditie t)rgamca} . .

.... ~ . ·~ . -~-· . ·.•.-.· .. · .. v~.·.-.- · .. ·- .

(et. .. John~ton .~i colnh .• ··1993; Montgomery. Drwid ~i.:CJlf,k•_ 2002). De'eX:elllpltl, illlF'Q metaanaliza realizatii de noi {~l~ntcgomecy, Pavid$i cola b .• 2002} '3.ul'Qescopmir: oa fli:'\Chmtueare nnna11 a [t operati (1624 de pacien~l) ~i primeau rnnan)enr comporta~uental pulangacel}nediealstandard fiU·llVlllfC7.Ultatc · mai bnne dec at 89% din pacion{ii din gmpnl de control .~are , primeuu ~oar ~ngrljire medinaH\ smadard. Aces«: 1-e:zultnte se ' refedat.litla intlicatori subil!tctivi (ex.. ematli negi\tlyH,dnrere) · cfit 'ilft )ndicatori. o~iect,tvi ~otiiGa\ie analgezlcii, indicntori fizlologi.~i (ex •. cntecolamine. presinne arteriall\) .}}i timP, .u': : trptaunenr>(ex. durat.a spitalizarii. d.urata jnt~rvenpe1 chilurgicdale)]. · .

· Efectl!ll'$ interventiilorpsihologice asuprn bolilor m·ganice ~i nsuprl:' diferitelor conditii fizic~ medicnle nu snnt_dc.nr Qemnifi~~tive: .. din pnnct d!}. :yedere .statisticcompara.IIV cu gr:upurll~, (1~ -~()ll ~ol·(tr{lta~llt -mediQ~l standard. tratalnen~' metlicntstan~f\rd ·p1u~ PT()CS~~J:i plaq6bo) ci efectql· ~[e .!Jt: S!!lll.ll~fiC.at:iv .c.li_R-i,c (i!0010¢c} (pentmdgtalii:a Se vedea Johnl)tOI~ :ji cola~)~l9~3;.I.,lll}g .. lfi•.co~ab .• 2000i Mo~tgoril~ry, D~vid ~l colab .• 2.002Jt Mai multd~i\t .. atllt. •acqstilt;<'efecte:sunt.utLle suh aspecrec~oomic.De ~x,emp1Q, Lang Iii" co~ab. (2002) nu·,aditat cii, ~ostul n~ocit\t.cu J:eclarea stanllard.Sn .lin1plll dife~itelor procedu'riradil)IJ?giee e11w de.§3B USD/pacient, compal'ativ Ctl

300US'p pen~ sedaren in~otitade inr&rvtintii.comportamenwl~ ndjuvaii~: B!i~tlnr,. utili.znn~ainter\lcntiilorpsih(l1tigice a dus.'a eeoncmlisirea a~'338.1JSD.}lentt'Ll fieenra,cnz. •.•.....• . . . .. ,

C~ndu~U ba:tatep~on:qalba litern.turii llesnedaiUnle. . . cQI·oborlln.d riispunsm:i)cla c.ale !rei tntreblhi s-ar puren spune l:a nveln. sufici~nra pro~e .enre sl\ sus{inli .asu~Jp(iile model~.lui psihoson1atic Jitod~m:. iutBrMenti ile}!sihol.og~e inflnen{eazaJadorii psil)olqg!i:i oan; la randnlloi, in~za

l Jlir ... rilor or nnic6 §i ~1le difer-ilelor

Jj)

i --·

'"''" ...

Totu~?i.-.:U~'aro di.utr.e acesle conolut..ii nu· fost t;;.ttk~te. · Priucipn,ie)~·•11f:9bleme ale acestor stQdli {Jo· ba~a- caiilt~'8~~u~ elaborat concluziile sunt (pentru detalii vezi.Relmait ~iA~1gell, 2002): - ' . . '::·' .

· @ Vtt.qaeJ1e'w-(11imdari!. Multe. din studille meu~i~nntemai sus nu au c~ntrolnt clar variabllele conftmdate ~i. prin Ul]nnrc, e.ste posibil ca ,rela~i~ apa.rentii dintre uniifactori psibologid :Ji unele aspecte flaica·sii eiisw doar Qiu .cauza unei'li treiavadabile fizice confuuda.te care ~ec;:teaza atilt.fautonit psihologic cfit ~i raspunsuHizi.c. · · · • • · ,

~-valoiUr:Sr:lizutifflmlfdmiiekctului. Uneledintresludli aurelevato mfuime a efectul;ui scli;;utlllli, a1?adar, rezoultatele·lor sunt ll!jOt 'de distorniont~-t de &featele v.nriabilelor confun'dnte, cunoscule sauneounoscu.t:e.; ,

~Se.fec(ia uateloJ~ Aceasta se referala combiuilfiile iutr-un nu!uar mare de r.ezttltate ptlua cil.nd,ln final, unuldintte ele este senmificativ statistic (ex.. 3 rez.ulWte poz.iUve.din25 de

· masudi.tori): !11 aaest caz, rezullatele arputea;fi determinate de · ~ans' ~i nu doar de o-vadabila G:Ontmlata; este mai degraba ~m artefact dedit ~~ fenwfneu real~ Mtllle diu stud.llle descris~ mai sm; au aceasta prohleiua.. '

~CQnfundrutiil. Clli:IZei cu efeclul in multe din studiile auuqlili!' ante1·ior ca~~a poate fi cu gt:eu separat:ii.de efect De exen~plu. iu sludiultw Watson- :'ii colab., (1999) ill h)·c sa Cr)I~~~U:ioufu.n Ca .u:~uto~·ea ~ du_s la C~terea 0Scu{Ui .de recJdiva sau tnoarte.m c.azYtpactenp.lor cu cancer Ia san (neop.l~stn m~mm.r), s-ar puten spilne cii. ue9plasmul manuu: iiltr.:o faz.a~ avaqaata cauze~ii.sentimente de neajuto£are. \

"0];1i1fCipr:et_liri distoJ~iOJJaie.. De cele tnai mulle ori ele se refera Ia ~ltagerarea aemulftca.tiei eUnice a unui rezultat: De exemplu, ~asirea unei legaturi int:re u.nii factod psibologid r;j un indicator biologic (ex. anticorpii-penlnl vimsufbep~?.s sim-. plex) uu spune nhruc des11re efectul acelor f;Jctorfpsiho.logici

' '

154

{

~ -:·: ·.

asupra bolii organic€: A~adar, adesea apare o ~oufuzic Jttll-e impactul unui factor psiholo.gic asn,tlra u~mi efeot .fiziolagic ~i

. impactulunuifaclorpslhoto~ic asupra bolilto sjne. _ · Tinand contde acesle ctitici, ·o concJuzie nmi ec1Jilibrala·

ar fi nceea dieste foarte prohabilcainterv~utiile psihelogice .sii -inlluentez.elaclorii psibologici. care •. ](l.r!ndullor, pol iufluen(a evoluUa ~i rognos.ticul boll or or aniae..l ale difedtelor conditH me lcnle, dar sunt ne~;:es,an< 1Ilai. multe stu· ·• care sa arate ca acest tit-adel no este S<B bil *~ cit .or tre ·. · 1 tleDJeutat in toate mediile me c. e. otu~i) eriticile aduse niodeluh:.i

--+--p~lhosonlaiic modem ar.pu~n fila fel.debjue alili:lse ~i slUdUlo&

\ t

b8Z(lte p~ ,modehtl:bio-medic:al. Sa argunienUim nccst luctu prln analizeledemaiJos:J •· r-! ·. •

(l) Vadt~bilc coJJfuJJdate. :Fuarte put~ne ~lntre sludiile medicate controle~zii poteuti,alele vadabHe ·psihologice

. confundate care deja s-adetnotmtrat eM 'at fi legate de dife.tilele er~cte biologice (~x.. optitilism/pesimism, sl:il db viatli. religio:z.i tate, mecarilsme de CQ{Jing). . .

(2) Valoarea scazutif ain8Jillliiaroowlui. Uuele stuuii din a.c~t domeniu au ·relevat o n1ariine a efeclului ~chUUi ~i. D!fndar. rez;ultatele lor sunt u~r.dedistoxsionat.de efect~le-variabiletor confunt,iare, t:unoscute salt necttntJS4lt~tt:e. De exem'plu, ,[u~a cmn run mai. ruxiititit.antl!fiur, recent Kirnch §i·cobi.b. (2002) ou antl.lizat datele de e.ficacitale ale eel or ~ns9 antidept-e~iye eel' mai fr.er.vent

. prescrise, aprohate ae Food mid Dtug AdlllilusfraUon, .SUA. iulre 1987 ~·1999 [llnoKetina (Prozac), pll{oxetina (Ji'ntd.l). sert.mlina (Zolof), veolafaxiu~ (£ffe7lor). uefm.oddlln·(Set"l.Qne) =1i citalopram (Celexn)]. in baza .datelor prezentate, ncesle medicam~nte au fost aprobate en tr~tlatueille eficiente ~i sigure pentru depresie in SUA. Kir!ichfll colali au descoperJt di 80.'fo . diu dispunsulla aaeste medicai;neute ~ra duplicat in grupuriie. placebo ~i diferenta mediei diiltre uivelul dep1:esiei ill. g.nlpul care pri.mea authlepresive ~i rrivelul depresi~i iu grupul tiire

155

prirnea h:ataritenLpla~elJo era de 2 puncte pe Scala de Der•tosie Hamiltoncnl7itemi (SQd.Gpunctehi 21 deitemi (62depuncre). Clli¥ dacil acest efeot este ~enii\ificativ statistic, eftictnl ~au eli nic {ec:ologi~) este nesemnificntiv{~ p\.lnGTe) (Kirsch 1i GQlal) .• 2002). Totu~i, chiat: dasa efcctul clinic :al m~dicatiei 11ntid~presive cmpparativ en eel al condi[iilor placebo &$te ambiguu ~i schut aan~ch ~i c;:oijtb_. 2001.) ... .tpedica~ia mu:ideptesiva elj(e ptezentatli ca ~incl cclllUli eficien~ fJ.:iUan1e.11tpentrli depresie de majorllittea practiqienilor, minfmi~ndu-~e rolu1 'h1lt.a~f!ntalor psihologice nltornntive (Kaplan Iii cotab., 1997; Sadoclc ~i co}ab., 2002).

(3) $e:lac(:ia d~tu:.Jpr. In. n1olte dfntl'e studiile 'Pfiihofarmnco}Qgice. .. numlirul vnriabileler (l~p~age11te se t~propic de.l5 (pentn) exe.rnple• vezi stndiile luCinse. in -tlleraanali:za Jni Hrobjnrtsson 41 ~ot:.zsche. 2001). ·

"(4) COJJfimdtJmn CliJ~f;ll ekr;mf. fn znajoritntea studiilor bazate ~e model~le psihiatJI!~ibiologice, est~ dificil 88 se sepnre cauza ~~ efootnt Iu aeost Up d~ stndil,Jnlf!!e sa concluzionl!rn ca o modificaa·e biochimicli (ex.: un nivelscnzuc .al .semtonlnei) ~;enore~za nn anun1it.si~prom ·,psiho.logjc (ex. dispozi{ia depre.stva) o aitJl concluzie. plauzihiUi ~te aceea cii atiit ·simpto11_1u1 pslhaJ.ogic cat ~i modificm·ea-bioohimicii 9unt geno.-nte ~e: un mecanism.psij\,f;){ogic {ex..t.ll.ecanisnu~legnte ds.sh~). Pnrtne stnd:U..:au.un C!esign-.care lf!i permitii ~leger(;a inh·e ce)e douav.adnnto. Al;adar, ide.ea !!On'fonn cltteia o1ice concon,irenta a tmui efect 8iQ1ogic lli.l\ tmnia,psiholllgic refleeta. de obicei, 'o

.relatip cnL\zaUi, plirnul determiolindLJ-l.pe celdyafqoi lea (~hm lovers), ~~re.rlllldxul nnei trndit1i veabi, reducrioniste. ~i 11u a u net teon 1 bauttt·pe dijte. · .

(.5) InttU:p.rct/frilo distar&/QDJite. De exenwlu, bnzAndu-ne P: st~rdiilc,ma{ sus amintite (vez.i, de asemenen, Kirsch,_l990; Ktrsch ~i cola b •• 2002} ~t~ t:lat eit: =o) SEJT1nificntia clinic a a rne~i~a{le~ antidcpresive ca tm agent farmacologi~ specjfic ~i actr~ este exngemtil. Este cindat ca. in cinda tuturor probelor.

156 157

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.•. ,.,,,:ftatm~~a~'~tmEieP'~it {v~~i5lt~,~~Jil~l\U: ~~~~~~,~~~~.:rezuita~~~~eci't~·~•'; ''.:~r ., .... (1~;0~-t~G~

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c~l!~~·t!.,~~i;~1:~iulall,li~t3;~3l,pe ba,bu.fr':jil [e'l~tei:tJu·'gf'tl,pllti de co~t.Vr~1 tiitaluent ~i a obse.t:V~t di tralarea tufurg,pa~i~n\ilttr

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. 0 Or)~ratorolmodaJ; :&;lede preS~I)JUS d\ , . (i doi1ditii de exceptare a operalon~lui mod~: .Oadi nu cumva ambii pannfi sunt striiini · · · · · ·· · H-·

. : ·[)acatet:a de intemeialderiva cuoeces1tate. dinmijloacele de itJtellleiere . atunc;i vorbim des pre demonstratie/AceasUi .modalitat~ db iutemeierf:. necesita. insa un sisteni.tco..-etic !formnliznlln1atematizat a~ a ca nu;eori vom regasi acen:;ta

·J.llod<lliWte de intemeie:re in !ltiinfel.e.sQcio~ntmme ~tiU n1edicafi:!. DB.c5Jeza de iutemeiat derivacu probabililatedio mijloacelede .lnten~¢iere atunci vm:bimdespre nr~~lenblre ... ·. · .... ·. .·

'· ·. . ~n. tiin a edsta. do~a ti urifJt} clistr~uri ~/ .. teoLr;tJc ~~ problematizenz.li pmt~tia dea?evlir a ~iuitUor;. --S.e urtilarqle realiz;area unuistf\ndmd al par~Idigmel go~itiviste

~i ueo oritivistetn care valori . .• le a<JeV3r a.le unei ~qt"ii "illnt . fnt.portanle . (prh1 lnten1eiere 1o forma dei1Jomm:~ 1e1 ~~ nr&umentarii . 1fiiscv~u1·' cticse roblematizeazlt 'relf!J:ttia ~ejus~ete.n asertitulilol:' cu .rivire lo.vnlod. o~ue. ceea~~ tre uie Jllcut .etc. Acesta este un l_.n·ose~ priu .c,al"~ .se do\]~n ~te ~rupului la teia_unuivorbitorin cadtu1npeic0inuttilli\i ra(u;maJ.e de Qo.meni (prin'iutemeie$lnJounaargultl.entiii1f}, cnt-p au. un litilbaj comun ~i intre au;e e~tista rela\iide recun¢a."?tere. in disd.ustd . ractic . e unnar . te ades~at:in etea . rimdard pragiuatic. it1 carecormecintetevr~etice£lle unel ~rfi d;nt~r.loare .a~esteia;~~~l ~leas._a ~a ~liint~ ~t~oilirifc ,. i ~lli;fde nUugere a eersuad~ru -Joaca a,de.sea uuroltmptJrtantm tl;tscursul practic. ~i in argu l11Clltare in generaL Discursurlle te vret[ce qi cele pragmatice suntfundamentrue in psihop<rtofQgiti ~1. ln consecinti1.. CUOOaJllerea erorilorcare afecleaza aC,eSlediSt;UfSUfl esLe f{}~.rte importantii. Erorile care apariu Pmcesuldelnte.meiere se clasifi.dlin trei categorii. corespuuzfin~ celor~i~ompol~Je ale proc:esulul de t11tem~re descrise m1terior. in ~lece Uf!.lieal..li vqiprezent:a ·cele mai frecvente erori{pentru delntii veziM11Xgll,

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1993),)arapoi vulnriita-cum a~estea se manifesliiinlitera.tura

psiho~logiei. . . . . . ' • . ft · . •• • .· •

· (ill..J!roriln teza de intemer.at ( concluz.r.e) il1Ut~lapa nceslel~ cu mijloacel~ deintemejere . , ·

·Imprecizin lczi!i. Acenstii etonre .ap!U'e atunc1 cllmlteza

cotttfueuo.Lenuenimpr:ecis · . . . . . . .• . · _·.. ... · lgJ:lQrnrea_tsr.ei. in l~mbaJlogic, ~QCSte et:on s~ nume.<;e

igtlo~o,;:~:~~:~:::.:~~~:~~~~ ~~~::f::;lt.itl.fap~ul ca seiuvoc~ autoritatea cuivn pentru n inlelneia '? t~zit .E,a ure mol multe fomte: ... , . . . . .· . . . . . . . . . . ·, · . · oAutoiitatencut~llbzatuare: •·spechtlistuLa spus astfel

o Autoritatea dogmatici.i: .. nt~n s-a stabili~·

:.

0 Autoritatea prot>t plass.tl1: "a invoet~ :ceea _c~.~ spus J3il1sleln intr'-un·dOlneniU ntrii l~r;litud.t e,~ 1i~1cn . .• . · • 0 Autoritatea venefnbiU\: .. ~tle 1naii)\Ldlfiinclca eiJ~C mal

in vti.rsta sau mni exp~rinJ.entae! 1 •··. .. . .. A_rgwnencumad IJpmiJiem.]$te 9 e~()~~~sen.lau?tonre

cuargumentum ad verectUidiarn in care se mvoca cal•ti\~tle sau defect~;:le cuiva pentru alntemeia o t~t.k ::]1 eJl n.re rnm multe

tonne: ·, · ... :. ·_ · . . ·• ·. ·. . .· . oAbuz.ivi;i: argutnellle7j valonrea tez.elUil~.l -vmbltm Illtn

experieutcle s1'1ledeviatii . ·.. .·• . ··. ..• .. 0 Citcumstantiala: se sugcroaz_n dl.oponeutul nre '·"! htleres persortalio a suspue o·lbza ~ls.stfel stib.ndne'Z.l

., t~zarespectiva .. · . . ,. ., .. ·· ··.• ·.u • . . 1 · ~ oTo quoque: a inl~l1}~ia o t~z.~ m:nlfuJCl c~ fl1_fponet~tu. 1, a sll!!tiout-o i:iinuva sau a ~-~spulge q tez~ anl,lfiud ca. Iii 1: opon~ntul a respins,.o c~n].vn. .. .. · _ · .. " • Argvme1llU1 ad ig1JO~WllJlJn1. Aceas~a,ero~~ ~pare ~aud :de ia ca argument ill favoareanneiJero ltnpo~IbJlita_te.a ~e a dovooi ~ontradictoda eb."'esl:e a~n ditltl ::= E_oate t.1ove!=h ct~ --esten~a".

l63

n ;t.iJArgtlbieniJJJn alljJdjlli!fun: 1\:cid~'ta ~tp ~fO,~~~~ in,~~re se accept a 0 teza deoarece ., . ai muJti oarri~)li. c.'.' .. sa•'!: . '

1vz,~f!'~JWirtiliiNJit~ . . ltitr fl~f~laf',<, ~ ~~re utilizeaza crinsec.intele pozitivesnu f!hgative &le·?hei t~'{ien'fiu

•.. nsi.l~fine,.adeidinus:atrifrilsitbteatu;~sleia: .·•.·· ' ·.··. ·····.'·, ..... , . ... Arcum~tum ad h4cultmi.E8tt~rdaiea cnre'pt1!sl!lpiiJ1e

)' •u~~9P~~fqq~i'(~«e.ll~jhbfoglce. eauia~p~~vaitn~u?e' sau a.r.:mp~f:1$&G, .. ~.;Y';!1)~1,£tJ::~~.h;,: .;,:·r •. r.'~·······'· .··:''''" ,f •·.t.'·•pi '•i~·· \,·,,.~..a~~~UJ~..,tli ,,,~~~~~:.o·~:::--··alo

.. ~gj/aa.tio.r.~~st~.~a.~.to~rM,care constll

:~1&\:~;~::::: . ~ . J'ctiUoan:Juctpii!~~li~s~' · · '' 'iif~M~~~~lit9 t;al>tul en

;~~~,.,~,,~,~:~~:~:r;r-,.~~;,, ,,) ,,;.J,.~(~ijp,,aJ~ c:ontra~:>a.,.ln,.facest· caz. fn ;ac~~I pro~ ~e · ,.. fntcllleierc. se opereazli cu Brgumt;nte. contradi~rii;'Wdesi:a ,,,,t,·,~c.~~~~,iPHSlilJ!I!V~~jfat~~ff·,a~adi~ntfllor~te'lmfseatli de !lll ':··1i1iibaj amb~~:ilU sau.t-Bnr:1lp~~3~eu de identif1cat datoritl\

/tEX!i-1., • .1111~t':~:~t(~~':j;~~.J~,,_.~~~K. ··• •.. -... · .. ·:.·.· ... d···. r.· .. ep~nQ·~ .. i_esQn{hi. · .. ~ .. ~ ...... ·~ .•. l· ... ,a. -.. re ..... ·d·o ... u.· ... ·.ll··· .. ··.·.fu····· ~.~ •..• • .. ··-.· ... ·~ .• =.·}~~ .• l.:·o···.····.·.·.·--re. ·.•· .. g •. u. ~:.generalii ... s .. e. : : ~I?hBn u~~ .•. ~~~,:m~~~o~~~~~!js~~~l.tr(:~t~:ti{ele care f?c .~;'}1\' ·~U£,~~.. •!~;;~~t,~'l~.(~rpa1t?~·du~~-!l~mtl.p-tentulu1); w,. (~) . ICil''lt eazc PR'J.1: . Ja t~ngr.lunet, .. t;~gtdJ generate

(emarea·converali aac¢1· )~l. .. i,iJ'~·.. • .. ·.. ' · · ··

' '''' ·:;~~~<i'4i~;~:;iiitnbtl.ii(aJ1.i'8r~ , . pr~~tat~'flll~~ce~oll~i,nfl"e 1imrln1Wefit~iteili Jst~Htegari1r~

(le~sen{iiiUt-m) lJDft logic:{ SiJU L1e Oecesitate.

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~ • ArgupJeiJ!IJIJJ ad ve.nxm1diam. in· gene.r~l. psj.b~llaliza s~a Imp~~ ~_a,t~-~!a personalitatii ~i autoii tatiUui Sigmun_d;fr¢ud t~u dat_onta supt)rtului ~ti1ufllic .. Putem argmneilr:.'{di_'a~a:~ta.u · lu~rurd~ urmari.nd Aaexa l, uude obsel'vam ctt. tiier'~slazi P~~ha.nalJ.za lllt figu,r«;:aza prln fonuelede psihoterapie ~ali date l}lilll~~cl. I?-e al~el. S!gmu11d.5reud~·· avutgrij~sa i~ipas((eze nuLontfilea ~}((:OI.l"l.U{l~~findu~1 ~cetca.renveaparetidifente. d~ eel~ ale lUI( ex. vezt C!U.ulluilung ~c.). _ .. ···-··· . . . ·•·· · ~ <~rgumen_tum ad ·horpir1em. · ·Mi.tl~i · terap~u tl .. C()~llitiv-

~ompor.tanum.tali. au uu angaj~ment t~ot~tico-r11eJodologl~ nu J n{UllctJe ~e rez;uitatt::le ~t:iiniifice .ci in functie de personltlitatea u nor .a~.ton. A~tfel.uui.i practidatti evitit:fofosit~u11pr sl.r~tegii c?g~1'-~Yc9?rup.or~a~entale tin0 datmitafaptuluidi uu np~j~ unelf! tJ;asatun .. ~~ p:rsonhlitate ale prhtcipa.lilo.r p~otnQtori ai a~~torsrrutegu ~llllil [ex .. AlbertEilis (arogant;.directiv)_sau Am:o.o :aeck(noudirectiv)] (DiMattia 1jil.Cga. l990;Ellis.:ZQOl; Heery. 2001 ). · · · · ·.

._Ermik~ · ... ·· tulinb~ltl~fl.-ii st,mtlara · fmme rijspnudi~e iu cercetarea·dinpsihopat!Jlo~i~. Psihanajiz:a a fost <tdesea CI .· 'cata CQ opetea~ Cll argmnenJ~ QOUt(adJctoriiput~.titl e~plica ~rice ~op~er, !959): Ac~11sta e:i~ eroar~1lde tip-.peU..: fJo;de c?n~r.De ns~mene:', ~rfi.Jn_rJ.amentalis~ . !a Jreiruse f · .. e ~nttu~ denva o a,nunutli le~li w este o · re:teuta

_frecventi\ inp~illop~tologie .. s~ ru;g~;t~enk)\rq .acesqu.cru, ·l'.stf~l d.iu ca~za Jipsei ~uui adeviiratpm~<deJ-ec.enr.je 11ia prezeutei sunullane a unnl mare numar. de ilbOnlad leorelice aflate in competitte in cadnd psibopalqhJgiei. e:Jte (recvent Cc"~.ZUt it1 can~. pentru a argun~ellta yaloarea unei. orieuta~i. cele1olte odentitd sunt prezentate intr-q ruaniera distorsio••~f;a. ctu'e apoi trebuic coreclalalnaftelucdlti. A adar uneoriinl.ocsa. re uicevtt

r-:-no . evollltia~~J?st~ ln t1. corecla. eJ."G.rile nef\>r ate ale alton.t! Cat.u I nbordarii evohrtiouiste iu _· siho · nlol ·. ie-1 aratadi ·sib() a 6Jo 1~

Iltl este ferilii.cleerori infu.l]damentul1ntetueierii. ~a4analiz:ant

166

l I \ ! t l

I I

.· .. "•

sucdnt. iu psibopatologie ex.istli o kudinVi.impoxtanta tjlin p\ina dez;voltate ~are cooj;eptm~liieazafuuctiile psihice 'I. ilSOdal ~ce.stora, \uUnn:arile psihice, prin prl:mmpsibologiei ~ibiologi~i eyolutioniste .(Buss ~j col~b •• 1998, .Gimld,. 199_1). ~r.o~esul

[,evol~tioli!i}e referala schhnblkiJD structura. orgauica a unui organism, sclumbari care nuloc in ·l111lJ!: Dill piica~, acensil abordare d~i. promitatoare ~iihteresantli este unahts~ticient de dgutVasa din cau~ faptului cii. in psihopatologie~eseunu. sunt . ulilizate corect constructebi)ps~IOlogiei ~ibiqlogi11:i evoturiooisl~ @.uss !ii colnb.,l998)~ A~?acum arata Buss ~i C\lllab. (l928) .trebui6 depa~it~. etapa- in· cnre atu(1Gi_ cllnd s.~ dlscuta despre aborda~ea evalll\].onistlt af\UlC\iil~rS~l) htl\)urlitllor pslJ•ice. ele snnt trtttale,dOtlf~rln pristna e~ucelJtubJ}d~ad~ptarel Psill(~logiu ~i biologia evolu\ionista. au _detaliat~i clarUlca.t concevtuJ. de

. adaptare, clari.ficiiri carf1Incli. uu. a~t p~tietrat lncEi dill pllcule · . psihopatologia de it•siJlJ:~tie eyqlutiou}Stt\• A.,!Jf~, in'J.lSlltolol{iu

i biologia evolu ·on.ism se face o dis tine · eclarliltJtiY.i~ ~ ~ arele conce te impottaute{vezi m.ai · s . ea tlidistinc,ie tr~buiud sn fie preluntii: e psibepat.:,l<;J __ 1 ... _ .... ···. adtse do

urous:a unc 1 · Ulh!tdt ·1.or sibice pHn prism.u evoluponisnluluL . .. . . · . . . . . . .· •. \ ·. .. · ~dapt~UonJ. Adaptareaes~ocanwt:E:dstidi

im1ascuta eare a. npfuut~ ormore n sel.ectiei:natur~:·njul.iinf-t. directsnu"luclh-ect·~producc~;ea1ut.i~lPUl,apUl·iti~j S~f;~ Allf~J spus, est.e posibUca o cm:acteristicl\. sa fie adaptnre dacaa ajuhtt direcl sau indirectrepro~ucerea!J.l· trecnt. ·cl.tipr.aincliJtt.pre~ent nu mai are aceasta tuac\\e. De~l adapbJ.rea ~le pd~1cipa\ul prod us nl evolutie:i, ex,istil=ii nlte_prmluse Sf!Cllllda~ nl~ n~esl.eirl. Diu~re proouseie.secumlare ale e:vol.u\i:ei cele·111~ilmporlanle sUt-itarlefact~le!ji zgomotu~l"tefuc~!Jt npiirut deoarece prit~ inta.n1plare el a fost a~ociat cu o adaptare. A~lfel, culonrt:,u alba a PQ!:elor sp~:e. exemplu.nu este rezultatulltnui.~lroces. de evululic d este Ull nrtefact al faplului di oase:le col} \itt· calcht care Je

167

·~-----·---.· -~ -

l .•

qsigura. re.z.ist~'mta (adapt~1·ea 0. calcil\ care 1\re cnlnate .a1ba. Mai 'Laproape de noi. uuii ·a11t01i au sugerat d\ unele fitnctiil6 psihla'e 1 p!l!Sl~p~se a ~ te2~1tntnl unui v.roces d~ evolupe prin sele.ctie · .na~1 ala (ex..l~bDJnO nn sunt adaptari ci sunt :1rtefacte ale unui

• crcJe~mare ai bine organizilt (vezi Buss !li colah_, 199& penn-u detalia). Zgomotul san efeetele int.litnpliitonr.e tlu snnt legme d~ adaprare; 7le pot fi. prod use de mutn(:i! care nn illfluen{eaza

/

reproducerea. : · · . ~~J,lfl.\l!e (EXaptn_tion)JE.xnptar~se refedila fa}~tul ca.

selec.tta · nl\\1.!1-aUi a ac,~aonat dln nou asupi-n unei ndaptari antenoare. t\.!;tfe~. m·ez.en&a J.lenelor la plislirl.este. eo11siderarli 0

· 8~ilptate Cl\YC: l\ ~JUta.t la termOD;~jtlM'e, ~j. astfella SUpravietuir-e ~l' i\CCf\6~ mduect a a,jutat ln rqnodm•ei·el) Ct\nd acensti\ ndaptl\1'8 .a 'il}OCB.Ut Sa fie Ulilizata pentrn :zbor, atunci · vorbint l}e~pre p~eunt~nelm· ca o exa:ptar~. Bxuptarea are functia de! a aJutadtl-eetsa,;stndhieclTC r.oi:l~erea.tn prezent.

. Spandrel {Sp~~drel).·:rennetlll e spandrel tn limba ~gl~zlt e.sreunulut1lizat fn arllitecturlt ~i se refeii"Ja.spatliJe· goa!e c~~e rii~i\&l :n stmctura linei cllidirl. Aceste spatii pot fi n~m ntthzate m dlvetse scopud (ex.."ca loc de odilmli 'ntnr·

. ~tvene ani~al~sa?'oameni fl1rlt Iocuin~) de!}f nu so viznu.r:runci

. cnn~l s-a ~on~l.nut cUidtrear ac~ste functii. ·s.pandrelol este· re&"!t!tul unuL prOCC$-de sclec{le·naturallt ca·re a action at . i'mm ;xtefiict. Blare rnncpa a· · · d' . . as~m:~ . . . . e n aJnta 1rect sau mduect

o cerea.tn· rezent. . · · . 7--Artefaclt~l. Artefaetulau influenten:zn tlire.ct sau inditecfL

.. · t ep.roduaet'ea ·Fl esre mztilratul i\nui pPoces de evolupe care a·. • - .nctton~t a~upl'a mecn11ismului cat"e il pm~u~. · --

. El bme. c~rce~ti~ite de psil1opatologie ar arlita nltfel, mu1t . rna~ compl~~ /il•tn.ctl nguroase. tlt1ca ipoteza di rulburlirile psihice-•

.. pol fi exp~_Jcate dm perspec.tivl'evolutionisra ar hl." Atn calctll roa te '""-·1· ·~ · • .. p.ostulltaple dn$cdse mai sus nu doa... d 'd· ... Su t.f · .. 1 . · · . · ' . • cea e a aptate! ..

I

\

n :n.nctn _e pSlh~loipce. ~~ asociataces!Dm. tnlbndiri1e psihicell' . -~ __...~ -rr-+..- ... ~~ ~~J .. - .• :>(.: Ill' ~ ~UY"t::; -iWf.JI"'"'l.a

rn¥}~ ~&lJ., ~ ~ fr!- ~~n. .

m•u b\,;~e in\ele~e ca ndaptari. exnpt'ari, spandrel-mi sau sil\"1\'lle

ai1ef;\etc. '? : · j~ plus. mvr .tiwd.!lmC. . t~ incura'at e f~. tl~l_ca adese · · ''' · retica ate ro riilc revi~te ~tnn 1rtce ~i prapi:ia eon{unilar~ §tiin~ D~n pacnt~ dincolec~ivele'd~ ... :ednc.tir. ale. tmor rpviste de ncest gen llpsesc eclupele ,d"' spl!cii{li~ti cu orientat:i .diferl ro. A par astfel ~viste •• de ~usa•· cln": gnnereazli efecn1\ de ~·oroupt11in~· (vezl pentnl detain Breh~ li'

· Knssip~ 1989) Iii care.geoe1~a21\ conceptii gre~ite f}i per~pecnve \im.\tfite tn domeniu. Penttu testarea aceswi idei fil!i exnminnl

· catev~ colectivede redac\itJ ale revistelo-r: din domeniul' ternpiei cogoiov-carnvortmnentale (lnternationaHollrunl of Cognit~~e Psyc\lot11Ctnpy -revista ,A.socia{iei lnternationale de Psil1oterapte Cog~itivl~Jouma\ofRJ.\tionnl-El']\OtlVC and Cogniti~e;-Beha.~~ 'ior 11terapy -revista !nstiturului Albert Ellis de Ps\l10terap1e Ra\ional..oEmotivll ·§1 ComportamentaUi}. Rezu\rat~\~ au -confirmnt ideilii prizentnte lflll:i sus. Spre ex.emplu •. cotecuvele de redacfle. Stint compose doar din poofesi:oui~d CU • .orientare comitiv-conrpoitamentall! Similat!; in nproape tonte lucrari1e Clt\s,cc de: psihdternpie scrise de profesiOJ!h)ti fl\dt odenra1·e cogJ]itiv-cornpnrt.amentalli. pantnJ a se evideu~ia cof!.tribL\tin

· t\mdamentuU\ ti psih"anaU2i la studiul incm}~tie.ntului~ teil\llia cognitiv-comportan:\t!t\taUi este preicntatli eronat ca focal Wind use ntlfl1qi pe cognipi con~tiente ( e~. Kaplan !li coi~b., 1994). Se igno,lii-t\stfelde~voltaqleilin ultimii 1.5 ani care. pron1:ov~~zl1 \mjuconljtient cog11ttiv !Ji tehnicl specifice cogua.nscpmport:amentale de mcidificnre 11. cngnltiilorincrin$tiente (Do':"'d qi Chonn::l1aine. 1996; Eysenek·!li Keanne, 1990). ln, aceste ca1..mi ma indoiesc d. tn·echipa de tecenzoii a aces tor lucr'ilri a

; J, • ' ' • ' ,'', ,' j

· fos(:i11vitat vreon ternpeut~ngnitiv-compnrtamental. ·. . \ . l:}n sftirs,i.t. erori~e·in procede~de 1n!~e\~~are_$e. refe;rfl.

.la toate eronle logtce care pot.sa apara m dwerse fqmlf? d~ rntionament, sunt iar~l1i o pre~nta constanta tn psihopatolog_ie. .

I

HiiJ

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t. .....

i ~·

i.

lJ.O

. Sa vedem cum SWJt ace~>t~ pr~dictii s.us(inute de refllitatea diu

j ~~i .. ~.~-1.·····8'.·.· ·lht .... ·., .. ~(u:··· .. ~·~"~;1\i~!i~ti~:~ .. ~ ''l'ii~terapi~~au.tnrt:ort!lllt<' h •·· · q. ·· · • ·

. : ¥el'iliru:ea'~sii&J ·X"tonf~mr·u~t1f'~ri~t1ti~·.~· :tJP&ilio~p:iei!pri~D .·• :~ 7·'d~lii bttp11~\Y~eiti:c;Jfj'f

(l}.O . .····· . I·· •

>d~ ut:lt~~f'i( . ·. ···.·.. ·. r · ..... · ... · C:,.,a uui~m~~a;§eat-r. de

'-~···· ...... · ...•.• •Iii. ...... · .. · •... , . • , .·• .lf'1.f!J~,re D~~f:7~. [-q,-Jn~f~P,r:.JJilfit:/.•~t(iJ ~sili'fl~pic.

:~~~~t ·····mo

,J~1,~\\ip;·~·~1:t~~~lu(;::Si~l\l~Vt\~,:;·~~: t:iNi~t*Yil!il,l~rs~ut in af,te~Qlg~'~za~~~~~ .•.....

ns~~~;·

t .rpsi~ttit~•.[He~s~•riftiow·lwa.pi\i · ,{;P;;,wn <!i'\~tli··sc&elna]~~~~'ei .

. forma speci~cli.~ ~·~~ti~·~ lcOli t}epsiJiot~fllpi~i~ . ,

:1:~--~,~ ,,~ Tdffii~• d~ trittal11ent (p.este 20~•de, =J~pXi.fll]Jes~e.:~JtlQ.ll[~,,tfdmicJ:j

' . • ' • ., ' •• >/';.1 \· • •• ' : ~· ~.,, . ~ '"> . . . ' ' ' . ,.. ' -',

l71 :~- ·~"'!

·····"······--······ . ., ... ...i

B~r~in~j GArfield2

peiffi~:rc£ficitiita •1\'t i%8tor u-nranilen1Itt

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I

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· tl111ofii negntive cu B,ctivnre tt tore ( e:t;

: -furiqlii~!I,-~i~,&j ; ·· ... ·.···.-... -• .. :..:.--··-· ... -

,.·

Emof ii negative . cu ac!ti vare 1nedie : (ex. trisl, i.ttgrijo- 1'-----,.........--__._~__.,_

rot}

Emotii uegntivet:.u at:tivare u•icli{ e.x. depresiv, letarg~c;)

· ... ··

E1notii pozilivecit uctiVii~inare (ex. ext~(l!t} ·.: -, ..

.. ' :-·:· -.

~lto!lipozitive cl.l acfivare u"Jedie (e.~. rericft. rllutrmuit}.

Emotti (Jozitive cu acrivure micli(~. cahu, Hrti~tlil;)

figt,tra 5. RelaJiile d~ntre emotiile pozitive ~~ ceJe Mgulive (pJ:elucrntdupiiRusseU ~i CanoU, 1999). . .

~~discorul i_n p~s.tiest~te IUitl S<!Hzilitdepatscorulin ptetest{~i m ColJ.Ipar?tte cu un. grup de control);·dn. dar aceste rez.ultate · ar-ala.~oru: cu_s_-a\1rtr~us emoli;ile negal:ive, Ce s-ait~f!lllplat~u en1otiile po~1tty~'1 A A us tt:atame11t:ul~i la ere~~~-\ frecventei aceslora7 Astfel4r; i,litrebii(ll}u fpst luate seriosin discupe obi a lnultimu per~pada.deo:ttcce psihop~totog~i lt\J e~ pregiltifllu cadrul pr:ogrruHelorde l.ra.b~ingsilcousidet:e serlos aspectele de op.ti.n~~re.lii_dezvo!tarepersoaaUtapaclen\llorl()r.Es~adeviirat dt pdn definitie, inte.rven~ia U.t paihopatologie-vi~aia otnt ~e!Itut.tulburltrilocpsilllce~t$idezvolt.aren§i.ohlit~a . pacientd?r. Este.lotl~felde adev--limt ins~ di i.IJdise ignora J~SJ.?ectul d_e dezvolt~-e ~r optirn.izare care. a fdst preluat ca uu dez1derat important de ciitre psihologia pozJtiva. Uniiai.ttbti ( v~ pe~HJ:t.I det~lii Pierce-~i Lynu,193l }au argurnenl,.atdi focaliUU"ea pe aspectul cmectiv este o consecintanatutaHfa complexului p~ t:al'e psihopatologia it are fat~i de medicini. Dome-niuf lulbudirUor psihice a fast malgreu cuantllicabil decfit cefal

f74

-: . . .... ~ .. ~ ..... :

tulburtkitor somati.~e. nstfelca psihopatologieii s-a refuzahnull . tilnlrStatutuldc ~tiiu@ ln compara\ie cu l~tul meclicinii.. Pelltru a ca~tiga.ncesb<ltatut, psihopatologi~ a copiat modeluJ.mediclnej

-in abordarea proplemelur psilucel}i de compmtamel~t, ceea cc a ·duslafoca1izw:eae~cf!Siv~pepalologie~Alti nutOrl(vezipenLru detnlii.Pierce ~iLynn, 199 i},·de.7irecunosp n.Cc£1.SUl foc~lizm:e ve asll~::Ftul ~orectlv, spun ca nu este nicidecmu vorbac<le.c;prc un c01nple~ ci despre odecrzle pra~t~nnficiJ., P&i,hQ{ill.tologia s-a dezvoltat acolo unf1e era cerutii. Oamenli;Jae npeLhl psihoh.lg. satlla psil}.iatru atune~ c~d S?fetii §.i (}Alld·l\U)le~ole de ajutor. 1Rconsecin~a, psihopatol{)gi.a s-aorientat pragmatic. uu defeitsiv.

_1. _' i11a~enslli dir~tie, ~(J.restll~~ue;d1~inei dealtfel~•tJiZ ~n;i~: de Juterventte v:al\date §li~utific -~· cm-ele :v < , · fern u tulhuran _epsiliice 11" IQ.~ f . .- --~.-· e naUt.{veziAn~~a 1).

ricutn;Jn l erenl de n\ot.ive, su.nt evidente in psihopatt)logie

·]_· jg~:i·~ftipsa,e~~,~~tor rlr:acle~'"fl~aspectel1elo~ ~1ec __ · m unl3II ll' ;oca~tZP[eR,eXC~Ii vapeaspec liLf! ~- _ ~c ve (Seligmmu;i Csiks~enntilmlyiJ f,OOO)~ "l~oate ~~sten aunt ltlt

. · JeUex allni!nina-ului pe cure pslbopa:tologul U llri£ne&l~, tl'a~- · _!gg_ focnlizaf pe p~tolo~Ie (cotectarea probl~tn~i) 11u ui ll£o no.nualit~te(ex. dez-volb:trea as _ eci:eler. orltive).~pte e~~rnplu. m multe Programe ely_ preg:,itirehlp$1bintrie din Rol.llauin. umuiirul preJorde pSiJlO~Qgie este [oarte .mic (adesea U!.l CUf$ tle till

se111estr.usau de ~n). Our n~Sa cum. inaill:te de astudia fiziopato.logia. se ~tudill-z;i\ fiz.iologia. !}i tnnlnte de a stud in anatomopatoiogil} ~e studiad1 anatoouia, .Elf lrebulca. mainte ue a studia. -sedQS psiliiatria sa se stmUez~ serios psihelogi.a. in medicina studiulup.nnalitli\fi precede studlul_lln()nl,lalilfi\H! ln psihopal9logiei11sa ades~aacest lucru nueste b.im: l~li.efnt,auul\i psihlalrra\ill;ud cllno!ltlute ntiuimedespte fU1tr::tionarea rmrnmJa ~lpsihicu}t.d utuan, Cum nut putea __ argumeutance~tJtlcm? E.'-aminandlucrad de psihiatrie, observfunca mCJ<JuHn cnte sunl t:onc~ptua.lizate fe.uomeuele psihologice su_nt J_~ nivelulunei

I . :.·•·

psih~~o_gii cle simi comun sao la nivelul de inceput. al psiholngid ca ~fitntiL Pentrn a piistra un discurs ctitic 1a dorneniu nu la perso~na, .voi evita sa_ exem1_3lific.cu.luctil.Iri care potrivesc ~e~cneren demai sns dar voi folosi o logica negativa. Astfel. voi spune di in cele mai nmlte lucrari de psihiatrie romnne.~ti (Sfire deoseb_ire de cale intemationale. ex. Kaplan ~i colah .• 19g7; Sadock ~i colab .• 2002) nu regasim teoriiJe consactate ale emopilor atun~icfutd se vorbe!fte tlespnMlfect (Smith !li Laz.'liliS, l993),nureglisim tem-iilemoderne i\le pc;:rcep1iei.(Marr, 1982) c1Jnd sc ~o~~~te despreil~H~au Juducina{ii, nu regasimtcoriile modem~ asupra memoriei ·cllnd se vof'be.lilte de$pre memo1tje

(Scl1acter ~i Tulving. 1994), nu regiishn. ideentln~li inconsLien£ cogaitlv .(Scbacter J~i Tolving, 1994) atun,ci cliud se abon:ien-z.a fe~omen~Ie. ipc?n,lJtiea:lte (se rllml\ne la a~a~i tradifie depiisirlt 11

psJitnn4l,'~et). ~' ~xemp:el~ pot CP.rttinua. DacjJ en ~esc. ~i dacli extsta cllrtJ de p.!uhJatcie scrisc de autori romliini cam incor~oreaztt aceste curul~tinre d~pre nom1alitntea. psil1ica, attincJ Ul\tascunse.4?tfgrtjlU .

,1.,.4.3 PrQ"VOC..'Il"~a pnt;aprofesioni.!ltilOJ· . .. • c.nn1 am Viizut nnlorior .. programele de training in

J'll'}.lotcnrpsf? ~u~t .complexe Jii orgau.iinte de-a lungnJ unei pei·Joade lun~ de l:llllp. Efortul flnanciar. inreJecrml} ~I de timp · este remarcabtlpentm n puten obfirie o cemperentit inlr-o formn· St\tl alt~:de psih~~erapi~. Dacli &Ctiste resurse ar fi nlocate altm! ~Olnen~~· fJl:o?abll Ca 8-ar putea Obtine douft licente in donil; dorpenu d~f:t•tc. A~ada~. estc de ruJI"eptatcl\acest prognnn complex ~e trarfl!ng sl{ duel J_a profesionjl}~.!lhilidi~ ~ performnn[e

. ~npen nrc celor care nn au parcurs aceste programe de train.Jng. Ce ne sp~lO~nsii datele ~tunt.ifice Rezultate arntli eli dlfi lfa ~nn~ profemo~,l~ti ~ · : . esJOniiti (onm.eni :fiirli. o pregllt!re m psallpp!ltoJogt:J sftu.f:!mtte profesioni§ti cu pl'egatire..m'li..lunga 9f ce.1 ot~ o pregatlre ma1 scurfli (ex. niveJ n0~1 l\tfnster)m ceeace riyesl~.eficien & tratamentului rulbtuMrilor

116 177

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... ··· ·• .... ·

cu a~ei pacieJJt:i c.i au urmat un protocol clini~creat de· ft • - • . ..,. .

· pt~.eswm~tl. . . . . ·. • : ·,l-:'~..- . . ··(!J)i!:;~/:,iceJ:. inaintc ~r;i fn ti111pU!/lpficiililpJ6tiJ&~illlui

··.·· cl~?Jic/paroprofesioaiftii fl" fost·supe{~izllfi ~df! pm{esif!ni~ri. pentru. a f1 :;lgurl di protocolul cliulc se

. adrniuistreazacorect . . .. • . . lata a~adar; di 0 .ttoncluzie uo~~defe(l~ ca

= p~~mfesionit~tii sup~rviz;JJi ~i c~ordoua~i ~ep~afE!SiQt~t • obtt~e rezultnte ef'lctenle .:m• pslllopu.Lol_gg~e.J,it..,con~nJu,. progr~Illille detraining al psihopatolO~JilOrar lrebui Sa iucluda

. 'qstfd de module fu. Care p!.Tifesioru,~ti.i Sa invefe CUm slr ' ,£.QOrdou~ ,siifoxmeze ~B.(Jt()fesioni§ti. •§e pare di

psihopnl~logi,a.l~IJ a itwatatdiu .. is~orie~. Ali.Wdineadef~dsiva nu a dus la :mccesr;:;.lm!!.diat dup! celde:-a.doilea.razboltuondial psi~i~lrii au iitcercat s~:.j l1loc;l~ez;~ p~ psilJ~lcjgi in a c:lobfuJdi comp.etentairi psihote.rapie.f.aUi .. ~.,ac~JUxllmbelec;iftego.rli de profesioni~li .au ~ceea~i c~mp~~~ntain, psihutenrpiede~i·.ponte

. d\ "··politiditn.ainon-d~ensi va.atmibiatrilorat:fi putut.ducela pastrarea COJl[foluliJi. ei putand spperviza !3ifonuapsihologi crlre ar .fi .r.racl:ic.atpsHtoterapiu ~uperxitatill!I a<ieea$i :;t~tudiJw del~silliatrilau·in~ercatsahlochezepsiliOlogliiutete§Jlti ~dobfindi cQmm~tente·tn a~ministrareade me~kalie

.. psili()tropapdn. t.miningauplimenlar InJ?sihofannacol6~e. full( <;:a ac1,1m JE\ ni:velul.Armal-eiSlJA. psibdlogil au o ast£el de co111P~~7n.tii iar recent, aceastacompel~n~Ka fost tecunosi;:utli in.

· cfiteva. zone :;i .stale .arnerican~.(ex .• Ourun-~i··~e\\' .M~xicn). Predictia. Jllea este. Ql aeeas.ta compelen~ii se y~ ge.U~r&Uza in viitor§i:in alte truidup!f modelul i'n c~re psihologH nu dobaudit cpmpeten,nJ.n-psUIOterapie. Ce trebuiesaJn.vat~m diutoate nceslea7 DaGa psihologli :ji psitriattiin.uatluptao ~titudi.rienon..: defensivafaUide studiile care arataefidetl.\B parap~nfesioQi~tilor 3-arputr:a sa Hibasurprire. Pe masura cenceste stud~i yordeyeni Lot 111..ai cunoscute; s~ar pu_lea ca unele esse de asigm_ad de s~al.'lte

178 i

\

su prefere sa pHiteascaparaprofesi~ni~Li.ca,t-e ~unlmaiieftini :}i in consecinta, ace.itia sir i~l organi~e.~e PraP~i.ile prograrne de

· fonn~e !li training. 0 atiltt?Ule !lon~d~f.euSiv" ftr'fi ~~amiuurea critiC\\ a a~estor studii ~id.amtltnrea dea1pi ~W!illl bltte coiltt.:OID.Le

. de cap:e Asocia\iile profesionale•rep~~ut:IJ.ti.ye t:lle psibologilor §i psihiattilor. Daca rezulta~ele niett\fonat~ 1\tOi se .(loufinlla psihopatologii ar trebui s~ i!li asuwe l"Ol\1.\ oe St~pervb:.or ·si fonnator·pentcu practica patnprofesion.i~lilor, practicli

.• recuno:;cuta aces~om penlf_U anlttuit~ ~o~dipi identificate lb bnw sludiilorxiguros condtis~ Allfl;!lo inviltftnd dl.{l islorie, {l.redictia

. noastdieste. ciidisputacu paraprofe1;ioni~lil. c€;ltJ.utih peutnt ruimn:ite seNjcii de psilJo\erapie, va Cl p~etdttta. .··.... . . . ·

@.4J) rr~vocnren tel'llpiilu,: ·m.~to~dlJlinlstra~t!· . · .. · Costurile. programelor de tratru.nenl peutrll.tu.lbudintc psiillce sunt url<lli"· Auunl Jo SUA sc pllcltul(:Sc peste 100 de miliarde de USJJ .pcJtb1l·$iinatatea psihicEi{USDlUIS. J999). -ln cons~cllll~· ca nlte · atlva la ttatai[lent~l • • e. de. profesi?ni$li a';l-api111l · .. r ·. ••.. tele de Ler .. ie. ~~ttoa(,lmiuistmm in ca.repacjemtul.i§l .aaministtreazitte.rapia ~iOJ!Uf. ~a a .

te;;plUe ~utoadruiuisttate pot slifia aplicat~ de clitt~pa.bientt~\ insu~i. cuo interventie minima diu- pnrl.e!l te,rnpeuiului ~i. tn consecilt\ii, ru:e coslvli..reduse" Ce ara\ltstu(:\iile: c1e speolitUI.ale cu refedrsla e:H<;letl\U nG:estor _progr~m~·l.Gf!rceUitile de metaanallza cnulltativn. sumndztiud peste 40 d,e studii arutu m.

_}iferei!\a ~in~ pa~hote~~pie- :,l;te.rn,pln hu~?ndnJ.il1istralii ~.s~ mi.niml ~1 ue e · 1 .·· ·. • .·· .. ··. · Sc~ · co lab., 199U).

· ceste conclUt.iiall fostapoicohfiJlllBtelllll\.l.lll~t{jnse alle S l l l

{pentru detiJ,l~ vezi Christensen ~l.ln¢{J~~(]~n, J?94)_.Ju c\ll~l! acestor~ultal:e clare, r . r. · .. le delralliUig Jtl·psillofenl le

- coJttJJma r;a ignam · impnrtauta: JlfU&edurUor .· .. ·e. terupie ;- . . . ' ' ·" • · .. r~~ - \.. c"eutdebittC UPft:Sioni~l\i. ln-!1ii~eslQ.m in. prnctic:llot cJ.inica (Dawes, 199

,--~--.-·

. . 3.1.4.5. Cont~ta\·e~ exflllricntei cli~lic~ . Pentmmnlri profi .. - - -·.·· . · ·

mnn .. ·.~cl(. at .• ... · .. ·.•.· ·~._·.·d·. esm.-.·~.l.~Jti,e~pe.;n··.·~nraclini.c:iesteAs-.·.111 din . . lltlCt can nn Slm[ bme ~ - ~ - . " . . 'll1ndamenhita·stiintin N . . • . . 1 ~egnhtl lnlr-o dtscu~ie

_. u ..•.• • • c .. 0 1cetm<lltureriamauzitdenenumarate 01'!ctt mraven1 inoa, · ·· • · ~ - . ' ,.u .. ·. . - - .•. •~ · .... oexpenentn cltmc5~ cl1-sunrem lehnicisli si t:!linaon;;ccmra ar trebui s- .. · 1 a · - . . ... · . · · nusa varbilll t;isa avent pre~~cn~~mye ~elmaa .. experi~enta{i,

. eli nu ~thn dttpll c.llt lim ~ . pe pa~n I Trecaud pesrefaptul s. tu.den·. t. .......... b xd· ·.• ·. p ~ncepe expen.en{a-cHnicil (cllnd eram

• ~_.... lll\o teptate mi s . . . . . . ctmic1Ldirr "l i\com d ·.'· .... · .·· .• 0 repJ;"o~a cauu anl. exp'erientli tot n1i ;~rf!p:o~ea:zl d::;!laT d~ Practic~ ~l~erceta~e clinh;:li de iU'l.l .. ·.·.c.'111 nu· ·Jim· "'.X • J. CD e.·gtCU pntc .. tiC.· a fil Cereetarede 30 "' ... pel!renfulor•)·•·l· • M dl!fensi•i ce ~.· · · ·'lr . • • ~. lat..~"v ... edeJn.t·n .. li. ·-u•l.mod. no. n:..

,. lll.!IOI\ml111 OX:pertOI'lfi\ }' • M ... " este ca? · · , ·o nucn ~lear_ de jmportl_\ntli

m-primulrind experie { I' . 2i • . . - ani deprnetic·:c 'TI..,.,. .. ~ • ~ a c. mtc nu- msearnnl! doar mulri

n. 1 --~ea UJ11pU]m:fl\r}i - ·1 . . Jlll este e:NpeTien"{lt cr . ~ . . - runmJ area de cunOijhn(e 1''Th-lP'OL.UI 0 . tm~~ ct clonr SJ¥PLA TRECERE A

• lreoere efie1cnU\ a timp 1 · . unor cuno,ctjpte C" .. "" J'nfl It u ut·pi•esnptme asimiJan~n

Y ,, ...... uenteaz~:~ pozitiv ti · M • • -nJe psil1Dpllto1ooilo.. A . ' · _ ac Vltntt1e Jmportanre

• - c • · censm mseamn- -l( ps~hopnrologii mi experi.en11t ctlniclt m a c~ ne a~t~ptltm en decl\t cei .cu experien{it. eli . .. . .. ~re sa: fie m.a1 eficienti nude rezolvat. Paf'-.ldo I ~len ~~c_a i'n .d.IVersesarcinitJe cnre le l- · xn !il conl:raitllmtiv lu ~ ·1 )eja ~tim, din ftl'lR1i2ele rezen _ · . • ~;;~n e flU .stnu a~a.

parapt·of-esionillt"a ~~- pro·~ . -.rn~e.~nrenor. cl.difemnfele dJnlre - 7 '"t tCSlGlll'itl ~~-eel d • trnjning oo1uplcx ii ex e .. · ~ - . e mtre _profesioni~ti eu - mni SCUJi~fi experieniap ~~en.talnare ~~ ~r?fesioni:;ti cu training .

. eficien{a tl.'atan'lenteio~~~:;~i~:rcwm!mef? ceca Ge in:iv~te .. fufboJ•Jfrt psfhice. fn ac ll • •. te de-ace§hfl pentru diverse pre athre.i rof,..... 4 ll last secpune a Iucdl .. i~ M!ita en . .....mrln . .. cUn. • : · -~ cor-ecl"itndillet\ closificli ·1 1- ~ __... .... , •• ~ • - .. n ~emelor ienrl . ~ d" . Ciltt!gor-u ·nosol"'~tt"ce . • 1 . .l or m 1fente . ... n1ct t>rec zm-u ~· .. 1 .·. ~ .compoitamenre pe baz;\~ . ~utoar o

• - L a~estor cla~.aflclln~-.

lflO

·: ... 1-

re:z.ultrttelecercetfujiornsupraaGestei U:Ine. (Dil\'>.'es., 199.6~ G,u\1. 1989;:199B}ml ~ratat ca e~pericmta. clinicli n~l f~nbtmaro{e~te

• __ petfor~mmtn~lini~]- Com de se inUimpUt acestlucru'? Oare.* ~u este evidenrdi toti 1nvatam din ex;perienta'i Nu inse11mnn en dadi nvem mai multi\ experic:nta atun{!i avenrn1ai: multe cuno::tinte ~i In coosecin{a. sun rem mni eficieQ\i ca profes~oni!lti? Orient cle ,plan:z.ihil! ni se pareaceasta ipoteza. eu nu ·esle confitnlatl\ d~ oatele ~tiin\ifi~{Dawe~.1996; Garl>~198!)). Cumam:p(lleae,.-;plica acestlucru 1 lp primulrftnd tril buie ~li.facem o distinc~h~tlltr~inviitareaun()~dep)inderi motori i (untie practicn este fnudamentaUi),ii.i'nvti(a:rca·tnlor .cuno~tinfe de~la~ative ~i

. proccllumle (eJC. con-.. sa c111Sifidbn p~cienpi.cum sl1 fac~m predi~tu.cUJ:l1:safacem diverse~ntecyel~ti~~tc.). in ceea ~e J?dv~te cbsificare[[, rroieli. 'lori.lt diverse cawgo1-ii noS(ll!l ice ·· ••. -

c ..• tctii~~tiicute{:.~~maeestei··c~l .. cnn •.. cercettltile.~ep~i~o_l()~-ie ..£Ogq.ltlvii i\Ui nwcatf-attnmfunda:mentah lmphcan 10 bun a

eaf:znrea acestOl"activitli i ·. ·• entn1-deralii vozi Ande'7oq, 1990): .. ~'1tt:garh1~/rclmiD Q/ardi::/irllte. Adesea acest li1cru. nu

. eJd~fJitn psihopatologi~ unde avem numerClase cate;gorii car~ . ll}l ~pnt clar> definlre. Ca exemplu ,ill1strativ este DSM care

pennite_int:ndrarea .. uoorpacien(i cu.·un·tal;Jl.:>ul.clinic.:re1ativ heterogen in nceea§i. ca.mgorie dlil:gnosticli;·. acestlU~tu. se 'int~mPlii !ieqare~tt at}esea paci-enlii trebuie 81\tnd~plineascit u n J}~fl}llr Iirnit·at de. Cl'iteriide diagnostic dintr-o Hsdi tnai lu•rgii,

. _astf~lcit. pacienti dif:n{i pot potrivi (:.l'iterli difetite di,n lista ·geij~rnlli~i rotllfiiintrlituaceeafti cntegorle diugnostldt · •

-.~cgu]jlc CIU"e 'dc:/irJ~-c cate!Jariilt:-trebuic pre.zcn'tnm . ·Jh.tiiJ;lle .cl{J'JI/iu;a alasiffa.aa:a $EILJ./rebllic ilt!acopiYftc qe $l1biect J?rip!_t7~~a(?k, ~~est l~cru owse reglis~~[e 1~1 practiea· btinica a p!!Ulopaml9giei.Presl1PU.nfind c~ psihopatologul f«cen mcadmre gre~il!al)'foble~lelorpncicmrului inrr-o categorie nosoJ~gidi, el nupri~~ fee£]bnckin,1ediat, dici dae~ ar existn nprlori,un nstfe1 defeedback:'atunci nu nrmai fi fost cazul sa fie fiicut dindnostknl.

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,a~.~<lstoriea\l~ta'tilcnllt!i;:cuil~/t: '' If: '~~'111fcieuttiltlt:~!(¥ti&ia~logi'ejc'1~· •

• } ;:!~'. ·(pen:ttil .cie~DliiJt'~i~ata~uti'·it' S'ii1tsiln:,1:9~9) _f!:t~~J ,tf-J'· · .~-1:!:f; 5~ !HJcf.:,:< 5-i:? ~

... ,,~,i~;J:l.·"~~i!}t.:nali~:ltifost~~;f~a~qt1ntl'dWl_lSiboter'cipie . . · ... ,,.~\JJ:-pn~!"!iA;ci 1\,~~Q~•r,t~l'Jil~~ d~pit'~tnd0lilltirel~psiboparolO'giei •

. ... pltruntf\pd in cultm:l. o· innre· p~e-din fun~ament:l~' ei'se

~ •.. ~-- .·.· • < < ;~~~7~~

.. ,i~g(eJ1!t!~~ti~1jl.i.~$lk0par~:toJ}ic~u.ITHatlnd .:. • .· ·~~ ~C!i)ll~~~e~tli18em:ne)~l}lsimptomele: .•

~'*'~1lt~~~~~i~(~) intewentle ''iJttnttqlient; ··" ·· · ,;~Piltf~,!~f9~rl'e¥i~'j 'iti;,·.·?'•'¥:'iJf ,vd:',~H .i~ .

~~!·~~P:)jniti~lQ:~P.ifeel~e,aliloilcmrlizboi : ,gtJ~'Q~l.inU.tpliiiil•c:a~goriilerfleS,alogice . ·

~' .• :i.i~·~~~\t,l:qi~~,~~,};p ~mlin~~~v~~; de.-~ ~·.u~~~i~i~~~<.m~u~l~: !ilMnlild;·a~~MDe\·· jP,~9 ...... · :Ji.i~~~g,if~:t· p~>ptote~iti:ni,ti · .

. . ~en 5 · ~patltti{:~ll~e,a{lu$laJncorpoFtlrert

184

.·

.. :·· : .. ·.···.--·.

psJllilJr~aJ]tzn clilsic,a. Din pacate. nici psihilterapia ..... 1!; ... ,.~ CQtnpiilTl1!UT!l~ntal! n11 a putut eficieritiza acest sislem ile train

185

:I

·I ... ~·~·

_j

l

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. preluaud aspectele sale fundamentale d~i uu t;rau verificate · "tiiu(ific ( ve~i stmctura progrnJ:uelor de training in psiliqterapie . .... . .. . .. . . . . . . . ··~····· .

co gnitiv-c.coiilppr.tan:tentaiala hup:!Jw.w.w -~1bat~o~11), :n~ul1&"'· · · , , . utitl tnodelulbiomedicill.este tnai b~ti~ on~W.Uzt1l:ji ma~'tealist 'deoarece elf~~ parte dh1progrruttelc,de fqmmtedirt do.tiih"'iiliil·-· •. acnd~ruic ( d~i a.1a cum atnmcil t-ional>nnt(!rior~stefoculizat pe ·.aspeclul·de patologi.e, ignodind.neju~Ufi?atno.fma).itaten), mai fle::~.i.~ile ~i lll1U permisl ve,.la noHe.q.ezvoltati ~u domeni~. ·

3~:l. Istoda pcr;soru•li(tji socin~a a .padentulul.J?siltopat.olQ.gie

1 · .. Aparitin~onllaUia sihopatologiei~avutloc.sptes(a ltul secolul:XIX-inG~putul~ecoltllui., x, Desii?;ttr, prf!~dl~ile ale, constltuirH.fpql!:dea psil:wpatt1I0gi.el au exisUit cu mult tin~p in' urma(pelttn.tdetalli yeti JlJ~laceanu-Stohlici •.. l981). . . , As tiel, ·~ul!.roistonhfi Anticbltatc idenlificfuncloua cur:~ute Cllfe releva rolu). facturilor. psibologiciinpatolQ¢~· Primtd curent este tJjlul d.e i6cginle tnagicii iRcareJbolile eraq com:;~vute sa ftiud ex_presiafaptului cli bolnavul ~taposedat.I~ .un spirit. Dacii spiritll.l era.rau (c~kmai udes~aln cazul in careholnavl)l ave;~ cornp9t"la\-p.~nt~·a1ltisocinl~ sattautl)puoitive) t'fl:nul.etllUlOOllS~ in eijnl.inilrea a cestui spirit prin anumite ritua,luri r~J.i:gloa3~ (~ exorc~z;area) sau anumite.rnijlonce·fi:zice.ouf\Uldnmentreligin~ (treJ_>ana.tii). Dacli spitltul era bt1IJ(comportal1le»tW .~Q~JlDVUlut nu era periculQS so.cialsau penlnJ.pt(lprl~pe~oa1)a), bi,Jllla era consider.ata sacrliiar bo l.navul enr co•l.Siderat t1l1.Jlll1·t;t,liJ.trli.Jute religiQase(ex:. profet). Al doUeaeutent c6oc.€!J!e<l boala.menta.lil cafiind determinntiide cauze naturale. Spre exempJu, HipocNit definea epilepsia nu en o boaHi sacra cica o .boaUi. detenn.b]atclt d.e tulburari ale ~reierului. In aceasra p.erioada modelnt SUlJrm~aturala.fostdoti1ilmnl · : 1

186

' . . . . - ~ . . . .. ·- . ·.' .... -~'""''"'-""'-·: ........, __ ~:; .. --~;,.o.."'""'.,.., .......

~ PeL!a~dal!w.J/uill1edJ.~u ldeca.Autichitiitii.ca bmu.a psihid\ este .d. eletm .. ma. ta d~ posest.Wl.ea ·.tut.ui.··.sp•.iritr.·a ..... ·U. ·.· .··.·.·d .. ··. . .. · • dom1 · Ui. B ·1··· •• ·· · ·· ··. · · ·· · · ··· · ·. ... . a evamt · ... · . nau . : . o n~v u psihicierndeclarati vdiji~tu:i, noseda~i'd~

~. Rl'p.Ie~c .. Ja.r.trata.t .. n .• e.ntel.econ. sta··.ui·u·.·izolarea .. a ............. • .. n·t· ..... ~J·n·lo ·, •. (1 . • - • . . . . . . . . . . . . -..~L"" .u cun . ll11P;opru .·· egati .. m !an tun), exorcism ~iuu~ori.chia( ~xecu(ja d~ca;a~sL? era I?' mteresul:_bis()ricii,1vlod~lu1 :mprauuLuraJ a pr~u~t ~1? duuens.mne mo.rala, cares~Jgecacliuueori.iu1bl.lrarHe psih.i~e ~1A de comp~rt~;nt ~u11t l11;t~u~onat produse de cei sufe. n.nz· .~ .•. u. 1(!-.. '-.'.n .. m· . od .. 5IttJ ...... •iax:c .. u c.ompor.:k-un.. en.·. ·tu··. • · .. ·. • · · .. • ... ·.h ... I. d . . jJ . · . . .. . . .· . ·. ·· · ·... . .· . . ··.. . . J crumuq - e-;mnt. n Epo~a.ll~.(11, ca ll[Jnar-eaa sllbiJifrol.ului bi4ericii n soc. Jetate,modeJu] antic co. nform. .. cru: ... :t. d .. a b.o .. al.·a·.· p··.·· 'I •.. . .. . · .fi ~ · · .· · ·· ·· ·. ·. · · · ·. · · . · . ·... . . st uca esle un euomennaturaluu:epesti.diwinadontina.ut. Acun···, . d" o ·· ro.r· .. · . . · . . ·. . .. . . .. .... · .>. np;u- lver.:;e

. ... ,.I ten .· . t !:;3ft~, .Jncearca. sa _expfic~ CUill 8p~t:e boala .. p:;ihicll, .. ~cllndl) .. ~e ilP;eUa Ja?t~ p~llt?soclall §ide 111ediu (ex. P1Jiltippe

'J!Inf!lJ. :fac~2tJ, orgarJtct{Oues.toger, ;«:raep~!itt)..~au psjJ1ologici (~~m:r, Charcot. J~Iet, Ft~~~).·Ej]()Ca. co11ren~po;"UIJ.i({sec. ~~~Xr~~esle cadr:u~ 111 care .PSihovatologiaad~ve.nit 0 ~tiinta cfe.,~ll_e.stii.lii£oare~u J.mpact major la nivelsocia13i cu o.rieutliri ~~retic7 dt~e~e pontre care cele.mai ll1JpOrtnntesllJ.ltorie.JJtarea ~~oiuedtcala ~t cea psihosociaHL Ae«;:sle~ ,tiltd iu ultiJtti · ·.· ·. ·• ·· " r0 .ru1 ··. · b . d . ·· • . · . . · . . .. • .· . 1 .auJ sa ~- · ·. eze .o. a o~ are mterncponista IJ.n~Ui pe mode1ul;stj"{'.s-v.: ..... J:,d.Jlerab. ilit.a.te Incluzau. d Ii ... a.cLorj. j elioJatrj~f d~ ..... c'l1·.·~.·.1• d· .... ·· ·· .. · ... ·.·.··.· ·· .. ·. • • J 1·1 · · · ·- ·· ···· · ·· · ... ·. · · ·.· . t> ~· • ., e nut Ht Cfp.tto u .' f~tortmcndru\clhoxafo.CtotitpsiltologiuuaceJa~i ssntut ontologie ca ~i tei fizici. . . . . . ·. . .. . ..

.3.4. Statutul mentalal pacicntului Pslbq~utologie . ~· ·.··· .·.·. . . ...

J•· ~xaminan~a·geuenua tt statullil~i.tneotnl se refetii Ia e~~runarea mod~lui in care PsihopaloJogia con~tieutiz.en7; ~tJ?ble~uele m:nttonatedeuoi pe parctu·sul ac€stei Iucrari. -~fieasy~ exanunaro treh eJ1icuta ra" . u lz~hulla u. :-loarele . IULI.-eban:

JlJ7

ell eate nevoic.dc~·1 i·~ ir~lr¥e11ltili. funcJionarea sistcm11Jui. . .··. . ! .. ..

, ~·/,-.;~~~R:~~: _:~:-~:-~i-t--4·:;-Ji-3[~~~~:%; :i':~~~,-t•j):_·: %;+-:- _ - _ _ ~- _ _ -, • --~-.

t~tcl~dtagn~ticnl~l ~i. ~v~l~~~~li~~ .diJJic~ . .. :;~JI!~tVt~~tulbiPsil•·optdol~gi~ ,,.~,;tj~.;· :;,ji

·:~7~~~;l.:~er#~¥;.~~t; pli~pirrc!li~i11 ... ·· '···· , ... ·j,sr de:~ofinranduifcf'cu· liierntt!f#l,.~l~

.. spe~1~1.ita1te.~r' ~ifpsil;op~talo~c al Psibopatotogielh~te cei prezentat maijos •.

.. Cte~tetii DUmamJui de :;. [lt:l;J.iiJ(I~II; o Dificulliiti 1n n oferl ttatarnenre.bine vn ftiinti fie; .. ." ... _.:.- .....

v.• 189

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· p -.-;bleme econou1ic~ · · ·. · · · · .· .. 2~ins\1Ii~ientil,p~ntrU. "~ .acopei.~

. . . . . ~versitu:teas~I.'Vjcillor oferite deps1bopa.tolegl,

1 · 1 te de medlulsod.al: ··• · · • .. • Prob eme egn ·· . . ·. · . .• . 1 -- SUA olung,a - o ~ninare.Sp~~e~~tnpu,J~l. . •. _.· ..... .

. _ d". -'.· e_.·_·u·:n. •ltulburarile P_.fl_lhi_ .. ce_.nu. ___ ir_n __ r_ost Perm a a.u · -~ t · · • -·· · . · ·· · • · ~- ea . • '·d· ·at"' la nmitate. cu <::elesmnancelll ce

consl! el . .,.. .. · 1:" · • · • d tal Abia. l'ecent ce.priVe~te :Xt~:~~~~:r4~~~it~a Asociatiilo; • ~~:::~~s:-11: rec;unbscut a<?eastlip~itnte;

-.omblem~~ucat!gm.d¥r ·······._.· . · .. · .... · _.;n1··.( ti ~ · ~ · ·c"~ · _ u··lltirta_· dec_ v_ a_·_Hi_c ___ ·_ e_ r_ ,_· ntel_ o_r_ soo ___ t. e_ · __ · .. ve . -. · o · urnc . ··. ~- ··· · · ·· ···· ·· ·. . .. · •. ··. > · tlimeleue

comentarlil~l~On~tre.refertlonre~.apt()~_-.···-···

training). r b .... l~ ""'unc\ionarli. Ar...a5 r.: ~ l evaluan~a g;lo ... u u .._ . •

Axa 5. Sexe~.era a _:...t·· · l:obalii a nivelulul gene-. .. ~ tiu a face o evru:uare g . r •

este uttlit.ata pen . t1.llJ '· (' djceJ.e(iA:f'>.Evalu~ tretlUJe l·nl de.funct}onare npaaen Ul: socinle evitlludu-sed.ifictillii\i sa fie focaU'£9.~ pe nspec:teld~ ~~ l~c:~icaie s~u )imitiiri ol(ntlediulul

d v unor con t\1-t llle\• "' 0 . 100· u . care se ato~enz.n • Scorul este cuprios mtte -.~~ " ' ~-. (ex. condlp.a econ?mtc:)~u atll.tfunc(ionnrea estemru bm~.a. ~ ciltsco.ftll ~te l~n:uir 'ho atologi.apUl'esanibau~ mdi~~ unnare a e'Vn.luarn tacute~ pst p ~:. .. ~n•una si\nptonte !ll sem\te

. ti" 55 A.ceast.'l. ms"-= . ~. . ~ GAF de aps:o11-una:_ .. ·· . "'=""'cul.tat\ moderate 1n ce!'!~ · · ~ · · · detatii precutl:\ ~1 UJ.U! "' · • • de ioteos1tn.te mo • · · \' a\a ce privel)te fuoc~ia socia\.alp ~Cllpa ton • .

190

CAl11TOLU~~ 4 CONCIWTIJALlZ~llEA TI\DLOUL'(J:( CLlNlC

ALPACmNTULUJ PstliOl'ATQLOGm

l Con~epL"ttalizaren cliuic3{1tlc~~a sereliefeze mecanismele etiopntogenetice speci.fice ~i · ~f!specifice .. E:ate expUdt tnbloul clinic a1 PsHtopal:rllogiei. Pentru .n siu.~plific~teX:lul, in cele-ce umteaziivoi pt-ezeslt~·opOf-f<epLUallzatf! cliniclgenet~!f-pentru intregul tabloulclinicJuat!Jll.lnsamblu ~i pr~~ntnt 1n capitolul 3 .Conceptualiziirile sv~ifice nq fostpmzentaLe PriUctliscutiJJe pti.vindcauzele ~i evotutiil,e pt~blerue.lor~peelfice pr~~n~tte in c.apitolul3; el~vor fi d~t~a~e nichnnnal peuu;u diagnosticul ~it'lvaluarea cHuicij,.

4.1 •. Me~istnele· ctiopntugeuetice spe~ifi.Ce

Mecmrlsmele etio a to enetice specifi $C refedi ·ta Ul<U ult~ cntego.rii cle factori ... Alia CUlil am .•• t.nai Ptt;":teutat.· pe

.Pl!rcursulacesteilucdin, factotli-cl~cbut1fatori se retc:rata.acei £cictori .care in mod dii~tproduc suupt01ll8(()10gia. ~:ai suntfa¢lori Hecesnri .dedan!liirii tabloului clinic, .~ar ades~~ 11\lz;i.mt ::l ~-ilb.ci~n.\i. De. asemeuea, .mai •lrebuie sit <li(ereuth~trl f'l,ctorii o~lanl}alorl·de~i detcnnitlrutti· fctctoriide~rn,l.Untolj nu~acele0$i ~.~rnc\erisud.~~ei declrutQatorHlar eisunt ~p~c.l~ati de un. tnbloul ~liuic (ex. bac.iltill(ocb peutn.:t tuberculoza~ in thup ce ·factodideclrull,latorinusuatspeciiicJ~gi:!UdetU].labJoul diuic

ex. stresul poate gener~ tulburari d~preslve ~a\1 amdonse). Fnctor.i.i predispouuiti st1ntaceifaclQri~are au ~tl1 c~w~crer general, apartin pacientului, au fostpre.zentiil~ainte de itistala.rea

U. t~b __ -_·_l 0_\.lh~i c. ·li .. m ___ ·_c ~.i-.e.· are. _· .... pr·· .. in··. i __ n __ te .. r.a.·c .• _till'. ?._-_ .. e·_·._·_.· .• __ ·._c:._._u __ ·. __ ··._f· .. a. ct. _o_-_r~i dec· ..• _-l· a·. ,_-_~-__ .... !!:.a ~OJ~-i r st fnvonzanp, due _Ja ~a?lmtl cliluc. J.n caztll P-'stl~~·g~t~logt~l:. nslalareatabloulul clune a fost declan~atns~ .n~~d~~azbume

1 a.r ,actQiii ~nvorh.aup a.u fost retfrezenta\i ~po~1l\)1litu~

JYI

•.

fo.:nrilor politicede a gasi solntii rapidela iucapaciratea sisten1ului medical{factari predispozanti)de a fucefata noilor siCUfi{ii aduse de ra~b<laie: Astfel. prezenta razboaielor a dua II'). aparitia unui

numnr mare de. pacienti suferind de.nevroza de rnzboi sau alte tulbnran psihice asociate rhboiului. Deoa(ece in ace•l perioada tmta1nenn11 pemttu ~lllb(n;arile psibice e1·a. fliq,ut do a£ de •. cau·e medlcil pl!!ihiattii, ace!jtia s-au vaziJtcople~iri.denumih.-ul J\\nre de bolnti\/i. iq pllts. un alt element pr~ispozantpentru in.stalare;l tabloulni cllnic alPsihop"atolo~iei {>axe sii:fie continua rea nnor trn!lipi depli~ite in prnetieii. in cerf:ZI:are fii i'n prpgromelc de fonnare. La nivel guvernolnental.s-nu clututsQlu~~ laaceastit

• prob~eJ(I.ll: Opropunere imediiuU a fost ca psi11~loglisn \)rmeze nn training snplimep.tarpentnt a prelua 0 parterliii competentele psihiatrilor._Ac~asta propnnere ufostacceprata nipid, argtimentul plincipal fiind .. nccla ca psihologii au 0 preglltire ri~lronsi1 in mf.todoJogiile de cercetnre ~tiinpfica -"'"" rrregiitire care.lipsea metlic~ilor -fliplin urmare ei ar putea sli acopere deticltnl de speeill~i~ti t?-domenhl.lfi. in plus. sitdea.o llOLlii f.qtii prncLicU 'in psih()te-.:apie,. pdn promovai·ea unor · tratameote Vt1Hdate ii sustin\ltC ~tiiiit1fic (Dawes, 1996).'74ceast8 decizie u dusla o de:zvoltare.extrll()i"ilil)arlt a psilioi~giei §i la diversificarea serviciilor oferite de psibologi, dezvolture·neuntidpatii 'ti c~re oaTecum i:a surp'rl11s ne[lregliti:t} pe llCe~tia.Spre·exemplu,dadf prinoJp!tJn :funcfie .~ psihQlogulJ,Ji clinician em tliagnostieul ?1inic, . intlt ca acumfun~{iil~]u·i er.m extiose .f!ltmgfindtHe hrpnritate cu psibiatdi. A.rnbete· gmpur1 dc~r.n•ofesioni~ti. psihoJogi ·~i psihiatri. au ca Iii competente:

;. Diagnostic ~i evaluare clioica;

•loterven~e ~i tnitament; .. Cercetare; •l3dncatie Qlti·ainingial domet•iu .• ln Ump ee psihiatrii ~i-an pastrat compett?nta. de

ndministrare I! m~dicatlei (COfllpetenta carein~a 'in unele stnte

192

arru:ri(;a!)e este d~ja recrumscuHi ~r psihologilor) psihologii ~iau pasttllt competen~a··d~'D.· utlliza instmttuenr.nrul ~i resb1rea psillCJlogidL Aceasti d'e2.volta_re extraordinar-~-a psihopatologiei ca unmtrc. I.Hlll&i nevoi•sociale de servicH despecia Htnre a dfis Yasaune~tila~uncren serviei ilotuferite iflalnte date lor ¥ti inti fice. Acest b.1cru s;-n ~xprbnn.t in modulmni l'lDtin perforn'lant' cia a face diagnostic, fratame~t ~i eercetare ~Hnlipsi~ preocup11ri1cir pslhopatologicicle a-~i·vnlida~tiintlfic prngrame le.de .fom1are. i

S~nrizfincJ (v~zi ~lPawes.,·.·1996), rfut.b~iele ·er!n1

consecmrel~ lo.:negattv~ prlvind cre§tera:tb!umatulu ide bolnavii cru·e ne~e~itau tralll1llcnte ;peqtl')l·. hJ]bnrfu:l.· psihice • (fa"Jt;;ri i dool~ .~ro·.d)au.'e:~sit Ul) ·S;isldm: n1elllienl"oornp]ar nepregiitiTCa

~ .. e ro to . . odelede . • . . tare IlL progran1~: . de fumune(fn(}tori gredi~pQ~n. i · ... · • erwe iunea acestor a~ tori: : gc~t:,rat ~.de~v9~r~w J:!ruSeli.§i ~replat~rmco og2ei1 ~n §tunt'!i. ~u av~lat.lJ§}~clar $thesunlqdoSo/1S~1lo aceJmra

_!vt.:rns,Acea.stf1.d4!ZVQitare-1lf(lstftlvott.izatn(factorifavodz.nn{l)

;.~~1t;i:;::;:;~:~:~.~::~~!~~i~~D3~~;=~: d~f~q~ ap rolpl dgasusuoe Slmptomatologia;aGest trol. ~ar.e. !l u~nl l~-J ·.roriLilecla .sa.ori ·. ·· v:odzaa1ti;.sau:

pr ... ~ts .. oz.~~~-om11au.. .· .. ·· •·· ....... tabloulc)inipc1ar i.4e:l!l{c .. :ap ori _cat.e -~" a?;Irut dneii g~~e:pt~~.,~ablt§ll.ll~ll clinjc. :Qintre. actorii de_meopner~.celmni \pmortantj •. pe.lrtrntfi~l Pstho n lo. · · . intil)l (v~zi pentru fletqlii Bet}Ller ~i M•1lik.! 2002; Dawes. 1996): • !

•Ineqinumti siste.111 fnv~chjc dar bin~ organiz·1t- ' • Sisrem inflex.ibil ~i ID-eoi m schimbare· f •

4 Unnumiir pr{tp mnr~ de pmfe_siQoisti 1~ domeniu ceea ce sfimu1c,~za atinj~in~ ps~w!q~ti,izitifice;' · • · · 1

"fnctori socio--econon"\jcj; I * ~.obby polHic. -

--_-s_~ exemplifica··{n rolul fac~orilor d~ menrinere a sunptomelor ~i sernneJor_legnte de modu I cum. se faee

193 ! •

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dhtgnosticul §t gyaluEU"~a cliuidi in psi,hopalo1ogie _(pentnfUetalli

\ vezi B!:!gtt~·~illiiMallJtj .1002)_ Numar~l m~de dh1;iul7s.tice t\OSoloSiGe:~fli.lit;u~tificare §t!JEtificli, a foste_?:.pl~catastf~l.: .· · ' :, '' _, .',-_ ·.• ·-·_ ',' ' ' ' ' . ' ' ' - ' ' ' '.· ......,_,

: o r;:aie,gqJ.ia JJ05r:llogic.ii;u-e WI raJ ale;Jti peatru discoJifQltll/pxvfesiai)i~cufui. Gonfrunt(!t c 1. contppr .uente ie~ile din 5fur.a nonualidi.fii, profesionistul i~i ~a,ti~{<!Ge uevoia · de Pfedlc(i~ §i conr.tcil pri~l. utiliznrea lUll){ ¢nl.egot;ilp()sOlogice. 11. pl~•s •. • incadrarea. problemeler pacienl~lui intr:o · categoric nosologicl\. ~Qget-eaza o schema ·de t"!~oment dattd coel-en\K acUvlUitlpro{es.lonistuhtj. Adesen. c~.~S~~.deasig~idesunatnte plii.tescttatatnentele daciele core~pund.dblgpo(lliculllistabilit, aslfelcti_ptof~i91U.1tli ~pqt UlCUEajdp sl utlliz;~z;e llces.te.ca~egorii no~ologice. Cu dl.t avemmai.n1lllte GUI1!gori1Itosologice «;\l alt\l futtC?J~ :tj roTtliS~i~nlpsillopatologu1uisunt 111ai biuc servltc.

o Utilinres. ·· tzQ.teg(}}riilor. ngs,oJogice ·oferrKc ..ideJJCitllte proi-esio1J:Jil.. J)iagnos ti!cul · acopera peste 50% <:Iintotal~t-alea: ac.tivita{lloi:des.fil~u.ratede. psihopatologi (Humphreys, 1996), .

· fiind m1a din· atribu\.iile pfotOtip ale-aces tel pJ:Qf~ii, aliiLIJri de cea de tratamentt Pqnb:u a-~i · pastm ideulitu.tea profesi?nal~ ad~ea interesm devagseazli Of.ltele ~tii.l!\.ifi~ I..ilienfeld ~i colab. (2003), tiu .adtta:t cum anutuite categorii ~iagnosUcepsihialrice { e;i. ADHD,·tuJ.bunuea. de personali.mre multipla tU!bttl"o/e de itleittltatedisocialiva) del1i illca n~Jatifica.le "ljfam\itiguedinpunct de vedere ~tiiu\ific, sunt~:lcomovatepepht\a ca certe :si inp1u.s. se adtnit1istreaca1ttdtamentt:! pe baza lor. .

oSii exnnlinfitn doar cazul AD.HD (Atlentiott-Oeficitl I~yperactivity .. Disorder;.Tulbtmtcea de deficit nte.ntional ~i hiperactivitate}. ·. Siinpt~mele acestei ·rulbtirMrf su.nt defi.drul·nterip6ilat(ex. Ueflcltin concentr,area ate_n~iei) ~i/sau hlperacli vilate"'-irnpul.sivilate. Tn\tumentul piiucipaleste eel medicaru.entos. cu Ritalin, spte exeroplu. De ce este cont.roversat a.cest djagttosti~'/ Unii ~ulori ~(irlnft di acest diagnostic esle Uhlll polilic care ne, pjllta

sa {aceru fa\a cOtJiilor nenscu1!~torj. Diaguostica{i psUJiatric ~i pu~j sub Ine<;licatie. ace~ti ~opii" deviu mai coutrolabifi, ·ceea ce este in inleresul pfuintilor ~i al ·. educatotilormt a tat al c::opiijor.-1,\utpdiilii ba~eaza asl.fel de ufimla,ti.i pe lip.sa uttor me~~UlisJ.ue etio1mlogeue1 ice clw:e{biok-.gice.saupsihulogit;e)~u.J,rU.aceastii rulbufare. Altf-elspus; pel;mza uttor c.:)"iteril sod ale se instituie un diagnostic ntedicaL p~fu;indnc~stgeJlde crllici leorefice (care se pQtrivesc 1\lai multo.r eu:tegorii uosologice· psHliatrir;e ..,. Itiud vorba d~ ~opii ci1rora Ii se admini:»treFt2:ii psibotrvpe cu£fect!Hiecundare ~i ell potential ri8C pentrude~Oltar~ .lorpsib!Jbiologjcii, eJc SUnt ntai indircaleemo\iolial"incozul.A.DHD) voi men\ionadouu (;'ril.icib.ine validate ~ti.ioti.fic. ·

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• Studiile recent.e ara\.'t cl exism o tendinta de . · ndmin~strare e~cesiva de ntedicatie penlru

ADHD. Un,s.tudiu .recent at lui LeFever (1999) · . a aratat di procenb.tl tc:a.tamenlului uti lim~ penlm · AOliDa uepa~itdetrei Ofi prevalenta estbnat!i a aces.tei tulburati; acest lucru ue ruttiitt~te de criticii ~.aCinna ca-acest trotament este utilizat penLrucpnfcirtul educatorilor ,i.afpfuintilor. nu

· Jlelltru oopU. . • Exista o foculizttre ex.Gesiva :ti nejusLificnUi 11e tratamentul ntedicatueutos in cuz.ul ADHD. igo.orti.ndii-seinlervon~.ile psihoterapeuli~. E:;te ade~iirnt cq:. studiulJiUJJic randomiznt '"NI1-JM. CollaborativeMultisite.M~~nl.odulTreabueut

Study of Cbildten Wilb.Attentiun:-Defficlh Hypetictivily Disorder" (lVl,-A) (MTI\.cpoperative group, 1999;_ l999a.) l~ o itite.r;preJr,lre cantitati.va sugereaza cii rel.mni. efici~~~f~lf'lllent este eel medica.meutos {a.u fostc.oihp~tfite·p~ln.t

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(l1~~!~J;;ii~,~~~~l,~~DR~)~{lat''~ni~;'?ifs~a,!~~nfat:u1\~p'(je'}'~',' s,~t;;rmmi:~P.syd\l~lagism·~~l'l~tittt'l1sibolti'giil\eilel1den\i ~l.e 1''~ nl~onlJ\~;;':'.H:i:~:;;;; .. .,. <;,,:::,. ;,;t:,+;):~

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di lm;~t!t:!Je,sunt cop1plet d.ifedte :;i anaJogia nu se·jttstifidL FaclfJrii;~§9P~~ogeneticiimplit~{i in tulburaHle psi.fii~-ii1clud o das~~}~~?PE~'a~~}ii d~ fac~url psibolOJ!iici.poL~upal.~ont!~hibULlh tin~p ~e {Jtiten1 con tro1a tn~i greu facforii- gel\~lici ~i bi\)l~gici, ~actq~ii psil1o!~gi preEtinJ; ruotlulin ~~-gftndim,ue.e~l)1portant elc. Stlllt pCJtent1al eonlr~IabiU. Este ci\ldat sa 8J?UipacieutiJ!~j: ~an- yt:i nj~ta sa i~i~~olve problemete ei.n.otioullle l~vatiludu"-1 ~tln.:t ~~ i~i COil;f:n?lez.e Gqtuportatt'~ntcl~ 'i co~.Jiile, dst· tu, en psibopatolq~. conlitmisa sqferi eU1ofkmoll Este ciudats~promi\i (l]toraFa iiveUu va.t{l siill.lefilQr~ntai•bin~~ siiiacore~tdecizii, s.a • .l!il coJit,rolez~ emotiile~_. sli.inve\e {l~ni·orepede, (}ar.tu nu llltmure;I ~au tuve~i'mrubine·caEll\il •. nuiei deciziimr.U b.IJI.lelli nu ~~li'mni stab it ~UIO\i~mal. Este ciudnt sa spuidi poti 5a-i iiJve{i pe .ttl~~i CU1l:\ Sa, iqi tdiiasca Cfi.(:i'entvi~fa .,iCtlUl Sa fie;:; fedci\i ' ~find lu nu ~ti cnpabil s!i obt.U ac;csteJucnu-H fn plu3 . cuut se

' . . . . .·. · .. · . '• .. ·.· .. ·. . . . . . ·' t:V~pHdi aceasta sitl.)ape dincqlo de- .fnptul ca prafesj~ de psiqQpatol~g. esle cuu.n grndlid,ic~tde. ~olicilare §is~ (Guy. 1981):;i in c1udafflptulul cit 70%.dintre psihop;_tlologl pa~urg Ull modul d~ ·te~apie petsonnlii en pbtt~a Jraiuiug~tdui Lor in · p~ihqt~ra1>ie (Guy. 1987)7 Ejtistlt.do\Ja expllca{ii po;U)Ue:

•Psihopatologii-;>tiu cum ar t,rebuiaU.~e cQnJ,potte~ll\ru .a n ferici\i "iipenln! a evitf!b.Jlburlidlb •· . sib1ce ~\tcoJ:ll}]~~~tu} iti' cw a ~itua\:i ilpr stresanJe,. d.ar acesle cuuo~tinte rlinliiii-;b,.ui've!-.

-d-eclar,nuv r;r.o.u s-.e roceduralizeaza .. · llU ~e .ex. .rimaJn · ~-D .. ·· .. Ji.mliiu· .e.rftip;umta'lPeutnr ase

expri.IJl.a in erfoilllktl a cuno · e .e .. (le;c a nti-..·e trebuie prgc:e uraUznte pdn.pra~ticri asvpr:nt!ropriei. persomi:c:;,-~n ce d uce,Ja t;On te1tb..1nlizaren lor si Ia utiljr.nreJJ.lor aU:lon\a~n .itt div~esituati.isl:resante (Auderitm, 1990)-Pin pacnte, pdnlrniniug-t.d .·lor !ji prln aa.tivitnten. profesiona\ii, psihoplltologii prm:eduralizeaza cuno~tin~le lor dedarative in primul·rfutd ~Ull.lpra,pacien\ilor.1lu asupra pro[lriei persoane-

102

I

•·Omo~llll\ele psibep~tologilor suntiluz.ij carefunc\ioueaz.tt petltrtt pacien\l pri.n efectl(l pla,cebo. in cons~~iuta, ele pot ameliora sufer.inta uuui paci.ent dar lUI a ceJuj c~e ~tie di i!}i administreaza un.tiutamellt placebol . ·-

~din acestedouaexplicatii.estetttaiptobabil~'/.J?.rima explicatie, pare sa ai_b~ 0 pbtuzibititale nuu lllare,potd:vindleoriile asupr~ distiuctiei diutce experU. l$i R\lVlCi! se poi¢ di tn· psilJOpntologie di.mfin~Jll,Ui!ile "'-v,e.-;t\ic ll(lv.ici" pqrl~nd baht~ cu. J.narca de ''atJare•tti e:llpbr\i,". Tolu~i, dac.ii 11e BJJliUL-im dl,. cunq~till~~~~ doba~dite prin prnctlca cll\1i(;i\ nu. ne fa~ mai buill inp~c:lictiile; :jill~tiunelJtel~.pe carel~ndt:Qinis;l;l:Wb, n.tu11cf~j tt · dou·l! explicaUe. ponte. acuperi o par,Le . dht adevnF; cerceUU-Ue viito.are vo~: trat~~a pwl,Jnl:tlllntte .. ace.qteexpljcatii p1'0puse a ici. Sigur~ d,isc\lt{b.td aceste e~plicatiiam ex:clus posilJilib.d:en, en Psihopatnlogii suntmaSl1cbi:Jti -de~i i.l inva(ii pe alpi;Sn fie. fe.rici(.i lor le place sa ~uferet

. 1\_.doml. categoric qe mecanisme eti~patog~neli~e uespeciflcesereferalareactiilemediuluisocia.t.Se parecaitt ceeai~e priv~te ~aztil psiboputologiei .eJdstlio oficlaJi-,o.re iustilu\ionanl a tablgului clinic. ij&nc{iile mediului sociJJ.l ~d11 ~ileasupraPsibopntolo.ldeicnsistem (ex.Sza.9Z,·tf16.7),prln ~lu~a peJltru. tcataute.l'JLeeficicnte· gi di1Jgrwst(cer dt;urouse, me · ---- ensiune asuprn PsjlJpp,atQlogiei, cnl'e'ponlc

-~·· 4.3. Fnclori de pl'otee\ie fji rerlsleli\n

ln ciuda tabJoului'cJinic prezentat exista e serie d~.faclllri de protec~stenta care Hn.utenz.ndez~~taQlou!vi clinic ~i care constituie pt-erecbi'citel.e pentt'U.\ltltrataruenteficleul.

21D ·:-'"

·• ·4~$J: ,lfn~'eltll rillltrti til.ctttnicitiitiliJ•· intelettJ~ale · ... · ale ;p$lllepat6IriftifuY. ~· ... ,. ::•• .. ?•. ·• : '"'' •·••• .. • • .'. . .-. ·' • , ·.·.· ..•.••• ; •.

-- ~ ·'ledes. ~ii- . •.• ·~cJ.u'ac1~r.J9~~}pua~a[ar cl\pro1 .. . 1~t~ibfi: .... :~r.. ••to ·~rsil!Jtdintr~el~x~~. ,

· fill s~e~tir .... · .... r(~!: .. f~S'{s •..•.. · ........ · ~~;·tgfa~~~r~'t,~~f:Li ... · cxanulltaOOrr);'fli·• G:AR.'(gmde.·;pCliqt nV>etii:,Se$r~~~~JC. Pi?~lfl'···

~m1¥$t-~ . int~ll&~ta~li~rtif~~~¥1\ilor RiWittesr doihe.~ia •(~~ltrYn\i'.'~U:; Wi~ooQsin ·Jt~nd4lefsea} este.C~i'mni'rl\lnrtti"cbliitfAriitie'2

·:·~~~~;;~ 20~?-)~.~i:gutti:t~a~'llcesre~st11diitre1lt1ie•v~uta'cttli1\~rreta·•ior•· (ex. marimea-~i repreunr~tivltnteli ~antiqanelbt;f61d~ite1 ~i.

·J

.< •··.•.;;•· .•.. ?f,, .Jt!f:£t'~:;;~~~llt~ . tttf: ~ ~a1ri,le.ripnilbmkpii(tcritic·fnd01nenin~ urmlfrind nn • fd~ol poppcrinn, fli ftnume ca Cfetl mni bunli calc de 8 te apropia

de adeviireste critica pcrmal}entli pe care o faci propriilor constructii. este o·p(erechizi.tli sanatoasa a domeniului. A~a cum

2M

:·.·-·:.

. -~

n.ite. Varhmtele alterualive_ BSM-ului sunt (J) o tlasi.ficare calegetictUi desmiptivu p~ baza d~-pmtotii1nu-pe baza ~~~-sdterii; {2) 0 c!l!~j;~s~:e etiopatogenetica a l\l]bu.t:arilol'p~ihic~~n~ ~una dt~script-{ynf:,t3) oclasificare·ditn~llsio_naUi a~tulb~tiirilQr.psiliice. .·· n~t uu~ _P~tt:&oriaHi ~1 (4' un diagnostic focalizat pe shifptom. Sa le nnaU'z;amsuccintin continuru:e~ ·t · ·

.:1

1

· • jJ}id.giiastic ca.CegOJial ~baia." unoraifelii ~~us ptoco@ (p,en~ude~'llii vezi.,I.iUeiJfeld ~i Matilu1.1985; 'Y~len~i.~htl,l., 2Q02)_. .Diaglxosticul DSM-este until Cil;tegprinf, ca~~#?~J"iile {lind in5tltuite pe bazn tin~r c·ri ierii · c!lare. U!l"CU dev!11_e ntembm al ca(egoriei pfirl'Compdr~tie cu crlterlila care d~fiuesc r!ategoria. CercG!1idle diu. J?Sillologia cogi1itiva atntil iltsa ca. noi ·rw:eod clas~c.8Julucntdlep~ bata_u~orctite~ (Roscb; 19'13). Sist~u1ul co~tutrv.· uman claslficit.}uCI}l.J:il&::. gr~p?nd.erent pe b(tzii de

. )§n;>tC>tjp:Termer.iul deprototl.p·aredouaiutelesud.l)uul.diu tHe · . . se.J:efer~ In l1n i!xeniplar~p,iot t)e:~~b.lt :s~ 1'e~Iaun e;temp1ftr ~ ideal. ~ .. ·. ·.• ~~~tll,Oltl~l\l?~~tcatlt iAsumeaz~ca~nteristi~~malumHm

. mbn N categof!%!. A~adar. ~tuuc1 dud elasifidim Uil-oblect intr-O f;Ule~crie,nu il. (;OlUJ?llrlilll~CU ,carac~eristi~~enfinle lllE! categoriri ~~pe¢tive, ci C\1 \lll ~Jlemplru: prototip .. P~utru a efittioutiz.adasill~apsilliJ~IJic8..~i 9ofaceeco~cg,c;a, lJ-a sugerut utl(i~a~(;ltt pr~tottpv.Iui:pent):u DSM . .Ptopuner.i.cptlctetc.peutru l\ll ~iagr}gstic .nosplb~Vc p~jhiatri~ p~.IJazitdeprotOtip. s-au-l1tcut (pe\ltJ;U detE,\lii $i. e;emple vezi "'f"es;ten 11i c~lab., 200~) •. ele urmntld a .li investigs.~e ~ub. a5pecl\,Jl validitii\H.lor iu_studii villoare.

\ ~.f;lagJJosiic-n.o~c)logicetiopatQgenetie.( a fostdi!Jcutatde noi}llllerjor, pe p~u~"SUJ.acestellucmri,6.1.1.3.; veziKi:liliiJ:rorn, 20~):& p~ntJ:t.' detalii). •· '

1: • I)iagJJoatic dimensional. Confunn. acestui Jtiodel

clasifi~adle .. tt,tlb!ldidlpr psihicear trebui f.iicute pe tii~te dimensiutii care saexp~:inte trec;erea trept.aHidela nortn:.tli~tt~ !a patplo.gie,la till p:rag delerminatotatistic. s--a uu~erclttp.nlpuherea

i . 106

unor .astfel de dime1uiittui( vezi pentm detalii Joiner ~i Schmidt., 2002) dar cum lista lor uu a fostdar cmweriitu indi.nu !:Hl

generaUzat&c~st~isl:t!J1ldeclasiEic~fe:., _·.. • [Jiagnostip carcgarjal· YeJ."Stls disgJ.lasiia.foeaJJzat pe sii1Jpcom(penlril detalirve~iP~rsot1S,.19a6). Diagnostlc;ullJSM cste um.il categodal. Uu diagnostic psi11ologi.c altertlatbi"s-ar focaliza p~ fqnct,iil6 .. psihologice afectat£.in divers'? tulburnrl psihic~. fun~\iic;}fenpatirxtnai t'IJttlt~ categ9riiJ}osologice~ Spre

~~:l~;~~~~=~;~~~~:r~~~!~"t:::~:I!r:!~~:~~-c~:::.::~ abor(\oiC? ar put~.a duce .la cln.d.fi~~-ren m~anjs.mhlor: cure ge-11ereazli aceslesimptome.speci.~r;e, PP1l~chule~inc~r.cetare n unor pacieuti· cu · .. shnptomeumogeue;-yol ~v.eoi cu · delalii asupram::estei orieutl\ri tu sectiunen deh:atatnent.

Cure!Jtulpenirv·utiJjPi8J_-ea ll"llt8JJ1enll)Jor6tr~fin.IJ.le ;;fiin(ific. Asoci11\ia Psibologilor Autericaui pr~ Divirl<.}.P· .~ pt;qpus o IU!!todologie prlo care sa fie promovnte b.l;ltflU11l:l1t~le.sustijutle =ililn\ific (peutro delalil vezinnexu J li.i <lis~a\HlediJt3.2,.).

4.3.3. Presiunea cqselot de asiyu,,-ari ~ $iJ.r',iJJate •

~g~m medicinl!F val.idatif ftii:tJfifM:· . _ : ·. ·· .······· ·. ·· · Ca urm~? a bugetelor retluse, cascle de nsi~l\tnrl de

snnatale a"oinceptllsa pJ:OJllOVJ:~e 0 politicli UttdlpdllC8fl:! S~Ul\ sl.ls\inute fi.n~cif\f donr.acele servicildesi\ri.Mate (l~e suut-vnlid~t~ :Jtiintific .. J\ce!;te t::ollstrttnge.ri au luat prin :;urpriridete siste.mul de siiiJijtateobi!ibuil:;~fi~sustinut-ftn~~!nr {itin sit~J?lU faptdiscopulsau-.etteunu1 t,tmanis~ -arilelionu;eu.sufe~i~l\t'ti lll promovarea ~~atlitii. Aceitstapolitica a c~sel~ d,~ nsig~-~1\ri_ t~c saniit~te. a dus la apari\1a .unor tni!Jcnri dept:umovat~ a '$fjmlel111 dmn,~niqlpsilJQpatologiel prin aparitia mediciJ1ei validatil ~tlin\ific (evidence .. based mediciuei EBiv1) ~i psihoter1\piei.v~H({~ile :;tlin\ific (evidence--based psychothern_py EBP). EBM (~ackctl ~i t:olab., l996)nu esle 0 \dec noull Qriginile ei nloso~t;:e pol n

\ I

~~

t i ......., _,

..

:J

l ... ,

: --· _ ..

!

-··

-,.,., ..

' " ' . . ' ~· '• . ' ' • ' '' ; ·!

. s:au efectuaunai routrell1amowam~· "·'"'r'""*'••i 209

_ .. ·-.. --..

-· -··

- ? identiGcat mai mull-e tumori belli ne. Autodi slt~diului au surrerat ~ '. -~ - ' b

:a a~~- ~n .. s.~_recomandaaceasHitelmi~ih_pacie.oUi tre!@e

£'~~·=reitq,~« .• n~•est.rJcrnv~ •• _asociat :cr-~toaH) :lara £~aei1:~sta-sti ~(:!ada -m,ort.aljtalta PWl~i-cer desntl. _, _-: ~,. . .· .. ·.· ... · .. ·.. .·. ..· .. ·· ....... · .. · ~

· · i La i1hreluf sim\itlUi comun t;i chiru: de catre unii.medi~i se iucufajenza rep~osui:l~ pat in cazul dure.di aellledg sputf; R~j;ulv tecel~f.. uu~tuc{jui .Glimc coutrolat (.lviahni:vaatll~ colab~ .. ·1995) ~ co~~&r~t ra?'e.nfll.cu astf~ld~ a~ecfluuedi~l:ribtJi!,i.,raqf.J~miUlt m t1-e1 ~upurr (l) ~Pirl~ care $nb~a ftl rep~ps lil pat}~(2) grupu} ~llCl,lnya~ safa~a-~~~area ?bl~llult~Lpeparcursul zil~l=ij (3) gl}1_pulyilre~cea ~~~E(!Itti speetfk:ede rootiilimreaspQteJuj, Rezultntele pubbcate m New ltlngl-ar-tt:l Journal-ofMedicine· au :_u-rtta~ ~a ~~l~u~~i ~u11e rezui~te~~au;ubtilluUt1 c~tiJ gn:•prllui mcunynt_s~.faca.UlJ~careac:Jb.t~ntutll_p~pa~ursul iileHJt::Cbiul, sfatr?ed~cal ~ii.lo tuipia ¢1e siuJt.Pomum ••dat;a te doore·spa(ele aLuuc~o_oclJhn~n:~t~~j rlimft.i o vrerneillrepaos-J.a pnr•, iata di:s-a · dovedu;ce~ putm m acest caz, un nut!· · : , .

. J?aca)uam lit cal cui ~r estJJ.narile · recente(1999Ji-Jire Insututult1fdeMediein~i"a11\eadei~IieiNafiouaiede~t,jj11fe.din · · SUA (N~ti~1al Ac:deuw of Soiences"lustitJ.Ite o~fllle<ficil~e). ~nrenram .ca rutualHI SUA mor panala- 98apo tle ()aQJ.enidiu ca uz:'l e:?J:il?r 1~1edicale, re<¥iL~n c~ meill.cinn 1'oljdaqt ~tii11~fflc estemca un 9ez.tderatnu.tJ.realil<l.te.IJltr.:;a(lev§t. ~ti.rnmilefiicute Ju auU: •7ol?; '8(~d= ditre US Congress O~ce ofTecbllology Ass~s-•.nentarata ca doar aproXinmtiv 1 tJ---20% din procedurile m~rcale ~u.nt validate llillnlffic .. Acetista. inseanma ca nu :Jtlin daca 89% ?m lratrunentele pe.care le prlrueautlnaceianl erau sunt sa~ nu ~tiinlifice, ~taipr¢cjs 5pus~ dacii ernueficiente snu u~t: Dcura Iua!-u ~'~ calcul!.i validarea motlelelorteoretice .pe baza . cmo:a_s: adt~lllll~tre~za_tratameutele ca-un ~;;;riteriu pentru 0

me(hCHla valtdata ~llin\llic, atunci prebabiJ di proceJltul de

.. ·-· ·~

10-20% esle si_ ma.i mid Stau astazi lucrurile altfel? Se pafecit. · Iucruiile s-nu lnllmnatli\it. darnu fmirt~ mult. Estbnarile recegte

arnti\'un procent u~or peste ZOo/~ de procedud Y~lldale §lil.lJ\ifi!? '(ifr;totalitatea procedurilor me9jcale-fo1osife~ Sigu~». dig~'lle protente sunHHferil~ in func~e c:le domeniul.tnedical specific .. Tahelul3ieda astfel de eslimllri peltlnt uneJe cfltegoriimedicale. Clns.illciirileimi in cnlcul valldarea paah~~:tnluid~iuterventu .(nu uenparat ~ja teo.riilotiJ ~j se tef~fli la. u~~toarele f;{lt~gQril ale v~Udam =;wn\ifice:.(l) Tntl~leiltel~ sunt v~i~pte ~.Uinlific .... _ ex.istii stutliic:Huice control(\\e care ar~li cli pmcedudle te:;pec~ tive sunt.mai eficiente decat tratamente anlel'ioar:~ gnJ.p pla~ cet~o sao de control; (2) Tr~tamenle cvasi'1tiin\ifl9e-lt\l exj.sH\ stuilii cllnlce coutrolate, dw: praclica cliuicii (ex. .. annlb:.ade"caz)"

· ~i constnsul profesiooi~tilor sugerea~ cllac~te f.rma.ult~J.d,e l'a.l" sa fie eficlenle ~i (3) TralRIDP.Dte pseudo~Jtiintifi~c .- Ull ~Ulll sus~inule de studii clinice controlate, procticn clitlicli suu consensut profesioiu:Jtilor:Jifsau uueuri acestea chi~lrlc-nttiln'_PiidaL

Amintitidu-'ne limilele aceslor studii, Jimite c~detiva diu in.s~i limite]e n1etodei §liin\ifice (ex. ~ant.lonrifei(~ difictiltltUe de genenuiza.re a re:z;ultatelor),-ribuilue impresit;rnant fapHtl ca uu numilr ex.tremde mic de lratamente mectical.e surn l.lioe )Inti ... dl\le lllllll\tfic. in cnzul psihjntriei, mai apronpe; d~ demc;:r8ul ncistru, auallzfind tabelpl3 cerceUtrilo uraUica.:J~.fii.di•l"P:tt(lcLul de- vedere R1 validadi ~tiin~ificp stit •nai bioe -en alte dQt1le:Uii medicale (ex. chiru1-g!.~) procentul de tmlluncmte vulidate !itUll\ific esLetotul?ise04Ut lufiudin t:alcul:

o stundardele.domeniului; 0 discursulin domeuiu.:..plufesioni:itii argumententil

$i prez.i.a1ta iulucrari de specialitnte di Lratumentele oferit~suut validate ~iliiutific;

o credin(ele pacientiloqi in general rcytepl!i.rile omuJui de sirn\ comtW de la medicina.

--·:::::-··.-:=._; 2U

.... ~

Tonte dilte1e prezenmte anteri C . reznllatele din anii "]0--'BO . _ _or _m ta~eltJl 3) confirma A. n·'lt. ~ d d. . - ~· ar.tta ca .progresul 6S£e infi01

" zan aceste ate s· d~ A • . • .t ~ augand faptnl ca adesearearia care

TiabeluiJ.l"rocentnltipnrfl 1 . . medlcnlfi (!lin SUA "f r.-.. . ) or f e trataJUente niUizate in lu-a~::ticn

• v a!dll"opa •

OotllBlrlpl-fi T:nttatnen~e Trntmnan1a Tm1.nmeufe lrtu~_lllla:peba:zo ~duta

cnroras'-au fliintifu: A'!JSiftlll¢1- P:VBlldo~tUu-

fon~"lulaL ac::esta fke 1-ifim

_ pnicaut.e -Psibiakle · . 53% IQ%. fl\JllUU6(S 9i: cola b. . 37% -(1299) . ·.

. Mlldicln& gooer&ID. 38% 4% ·SI.lUQpV acola. f'l

I .5~&

colr.D.c.lOOtr\ .· ModicinUrt9ma 1-l m·ditl.-Job.onu~ Ji·

500:,o 34% 12%

coJi!b. Cli)()(J)* 'CJiliuigl~ gwrtat& f:J% Lee pl-col6b.£2olim

. ·64% X!'J.t . Cqntn da k~tam6n! eat_ cancendai.(SUA)

249(. 21% JS%

BjUibe~Jc ti . ~ole~).~~ ?99) . Chhurgi11_'VUCllllit! 14% 11% How·..., gi col~. . j%

(l~~ · .. . . Detlllfl_l'ologic

Iomcc .fi cula.b 38% 31% 23%

• ..(_15198)' • ..

ChimrEie pedifd:tica Kcnny~i coiflh.

11% f 66% 23%

(1991) Aneslo~ia l'oillrlr:ii pi cnlab~

32%. 64.7% 3.3%

(llil99) . . *. - .•

;1% l~pectly 7% reprezinlM dificul ~f d · · h·ntamentelorYncntegntiilestabilire. ffi.l. e dnstficnre n

212

a fllndnmei\tatinre~.-.-ventia ml.a fostiuvestigarn scparat5ntdeget11 astfelcii declara-patui Dr. Robert Cnliff, DirectoT" la Duk~ U ni~ versity Clinical R~searehlnstitute1urevistaTitv1E 1a datn de 12 OcronlbriliJ 1998 ~i .anunu~~ eli doar aprox.imi\tiv 15% di':l servicille ofe.ritr. de medici snnt validate ~tiintific, este en.1nsa~ bine vatidarll. ~rlin{ific.

Desiguf, d~i focali'LIDtea absesiva tr-Gbuie-sa fie p~ validm-ea fitiinpficli a. tJ:atamentelor utruzate;tn:;buie-s.n fim .1-eali~ti: pacien{ii

. au nevoie de !\.iutor; ei. nu pat rustepta:un· studiu clinic controlat penttU. a primi un tra.trunent caie sli le-amelioreze RLlferi~l1!L P.e de nl~a parte,; ea profesiomqti,nu putem si le oferlni oricel

:~•dil<, ""':"reo<• trebnie»rmotUn alegeron _!!l)ta•nentulul_ _entrll un _!ll:;lent :anume .de_.dltvR no profe~

. £l'omoveaza l!tiinta in Il!ili.opatGlogie es~: · . .· .. • · • Trntnntente validate ~tiinp:fic atilt snb nspectnl eficiet1~ei

) ·cat .!;i sub-nspec:tu 1 validitatii tooriei; dnci1 ele nu existli.

. _·_.· atunci se utili2earta~ . • Trataln_ente validate ~tiintific sub llspect:nl eficientei;

.t duc.li ele, nu exista, atunci se-u £ili:zeaza:

'··'

-~

• Triltamente consid~r-ate ei:iciente prin coilse~sul s~ialiljtiim; dncl elc nu e;JC.istn • .att.))iCi se utilizeuzii: • Tratamente cBra·tle~i nu au fast investigate .!jtiintific deriva diutr-() teorie testaftl .!ii validarlr~ele tl•ebuie sii aiba ncordul gmpului p1·ofesional ile apartenen\li. sit fta potential utile ~j nepericul0all&. Dnci\ acestea nu existii, anmci se "Qtil'iz.eaza· interventii derivate adhoc' din pr.eglitire!\ profesionnlli (tooreticJi. 'li p~nctidi) '~i pe cm:e acordu1 celorialti colegi lejustifica in cazul cl~t cn:fiind

~potential utile ~i nepericuloase. I

213

_j

. . _J.

. t , __ ,

..

I· I

. .. . •••/•

.Loa diudul ei psibiatria Lrebui.; su!.§i reconsidere po-z:i.ti~ serlo:~.lnlc~ socii!taleluodernam~·~·dldca scus socictntU ..... preot'"I.Ji.;w«latliJfit~·~t!jn\~di~t!rl•~~~~·-!~~~~t-~iJ

ECGI~~· Uil R~Qf,.~i~in~!JU l~l~,ap~~·II .... · . l"J~·~~~jJJiatri!l~~U;,' tnwtapJti»elpsibi!ltrtipr. f.le~cu. 8$•~4~pm·~pr~,fesit>JJti'Jti · · in servl~ ~~~anitate ~lfi sliull~~ Jltenfl.illl)•~~P~'lil\lgi{It-,4!~1 inclu~1psn1' · ' ... ;,tinmltierreterL.! us~~~~ii$~~ilib.r~tU~tt uu rol tot . al!Jittifittnt11tiif~ste, ·~·~lllit~·~hO:'urmnre a nparitiei coselord~il$igu.:~l;~s~~taie.::.~ie;indome~tiu 11u ·:~lt\l ·~~~·\lo~(npanaJulf:llt.~:icil6tr•·· f::~:"#rl~llii:;~,p~ill)e uniww~i.tafe sp~Ct? i:~~!p,t.~ga~ ~~teli;fil•itlo~~liWil· s1il1illii\ii.Acesteschil~il\i·•!~~irt'~1~~~L. . · ~~ si\QiiW~§i•m~i~JliQ'~orG(jntt;ib~~~tUJieativ~ ~iJ~•pfttelqgiei;.,mn~:Mtfet;~~·~'litlll{! · ·e · nu~}!~"·'P"'tea i1}ttor;a .·lllh;infi:~~p~~i~~~,eet,~~t;oo~ l\e~,~ljlJj~·tlsU~f3t .. i~~~lQ~d~eQI~"':~uiCicu§~·;,•'

~~~;~;~~;~:=:==~ti=:t::~~93il~~jv''Sa~,~ j~!ij~J~~ij~l'J~i~~ilotll·~,~~~i" llOtltic ~i't~Oc iar Sttti pre}liUUel\f cei: .. ' ,. u·~ .. .'tems .. .:.~ •. 'tl ~· l .·.·· Ll@ t,.;.' i'p~ .. ,.,. ,~~~1:11!; pa !'\)~g a ·.·

v~aJ~·~~·~JP~ij . . . ; ... · .·· ......... ·. ! ~~;W~~{i\j' gt~~~~,!l).~~~i·~~!:i ... liit~t~,»,cpliB~fl~~~~;;mill~llle",! d~~~~~~~9~ifl~'ltti' •. d.,~tJl~l~*'JJ.t~·~i$lt:llf~de .. '(~e~,

<- ,,: ' " .. , • - • i • '- - _,,

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Modalitli{il~ de at'lle}iorart5 a probleme1or se1i1nalnte tn cail11 Psihopatolsgiei.~orfi rezerit11e in c01ninuare U1111ii~~ categoriile lorinlpOrti\n · _: ) Ungnos~c ;i evnb1~re _clinica~ .. -. interventie Jii trata.llli!n ((3) ercetare !i~ucap.e ~l·tr."ltamanL Urmoiizli·ca d-.mpui sli arnr.c eftcient~ lor 'in aa~ulin c~re vor-fi implemoma~c-coract qi mo~ul in care vu evolna'P.sihoparologill.

5.1. Tratamentnl.pena·u _pr.oblemole modt•litatilor den face diagnbstie. !Ji.e-\'aluare elinidi. ,

in:.diutarea sffiutului GFanl

Problemele djngnosticului (ll el•nlnnrH clinice.menponato 'in tablqul clinical Psibopntologiei potfi n.me ·orate sau vindecate utilizlln urmlitoarele a · · .. ·de trata t · ·

"' .Pezyllitiin#l unui .diagnostic tbcaliznt pe mcca.oisnJ(} @opatb.ilBntU./P{:)(pentru d;etalii vezi l{ihlsrrotn. 2002) .. · ·

'. Modaljt:aten de diagnostic al bolilorsomatice este strftns legatii-. de.. h:lentificnrea ntecanismelor etiop&toge-necice i1nplica.te in

rabloul clin\c. Diagnosticul nllburiirilckpsihiee este in,~~ un di· '•,•'~ ' .. ~·

..agnostic foealizat P': .sintprome ~.i semne. elementelepr~ale fiirld identific:area. lar npoi clasi'ticarea lor entru a genera di~ versecaregorii noso o ce.

• ~ 'tiJ;(lUlll!JI.li diagn~sci¢p.sillologlc_pcnl.Iu to,lburJi.dfi) ·psibice (perftru detalil ve:ti Persons. 19B7). Diagnosticul Cfltegotial poate duce adesea Ia situ atii nedodte: A~tfel. categoriile nosologice se pot :referi la p:acfenft c~ un triblou clinic par(i!ll diferlt; aceasfa deoarece ndesea pentru a potrivi o anumWi categorie nosologicli.. pacientii l.rebuie ·sll prezinre un -numlit de shnptpme dintr-o ljsjl1 mni 1tmgU. Acel numllrpoate include fnsli t;imLltome diferite din lista dat~. Alia cum nm mai afirmat. on diagnostic psibo1ogi.cs-arfocaliza pe acele func{ii psiJlologice nfcctate. care apart~ mai multe categorii nesolog(c~. Spre

216

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co.mun, intcgr~tiv, .Bclectismul temeticpce:mpune ulilizaiea.wlor . leurii {t1ferite ~~,!!pra aceluiafli fen omen ceea ce adesea d~~la con tradic~~-Jife[opriul disGum• ~i ilt consec.iillii!rsbt,lie ,~yliat; · .. llU.a\~l.J.lUlf!llfOfOsi .• ·~i· ... teor[i,~jnaqliG-pSih<lt~alltice f;i. UliiBtJisteJt~\ellVnlisle ~l cogtutiv-coU1pottarneiJ.hue.~i bi~~tledicl]l~~~upl-a ncfl~liayi J:enomeu deoarece adt::Seaace~t(:!a.s.unt coup11dictOJ;:i(;

· vo;m f()losi doar acea.teo,t:iecare esL~uslinuUide dai.ele ~tiiJttiJice ~i care poate ashuila J?roccd.uri .cUn. tradiUi~ifer~te. (I teorle ~tiintilidt reinterptele~zq ·11i inregreaza asp(:!c.tele. v-ruide ole leorUlot ~1lerioare in cad,rutsjstemultt( sau ~oreUc~ uLlliz.and Lenl1eULIJr(lpdi •. Afla~m am m~i:.$fUS~ iu psihotel"llple, ternpia comport~rri(!Jltal~ a rei!~terpretat rel;wicile ana]jti~.ein tenuenii'

. teqrleiiiiVa\iiti~ca;rt}Ups~a$1\ abor4tue£lluiSigpu~ud Preud .. De. e:teJ~lpl•(.(l) trlJllSfe[U ..• ~te \tlte . retat(;,Q\lH:~~pecUpt;pific fd f~!lJillleuulul. cf.e gen~t"aliznre n ruv.~ttWi; (2:) rep~J.a ~ ·e··• uu cqmp?.rtament iJ.ll!i,a deo~~ ~le tntaat p.t:iu: red~~ n~Il~retama ~Leulilfl.chtal: dacllnueste.ad~Ylitat ; tip>arec;eo~entuJ.. · . istQrlecoeret\fade~h\\a:Ji(4)teuuca ns,a~rli.bt~1!L~olositoarepentmob~it~fleln~ . ili~?!i$Jlt~derum~g:_p.~-· ~.~-~v~JllaUz8L:i!orsaleca ieJ:tate.4Uit!firetlnt~iaU1 c~st~ ideise ~educe etc. (Udolf~l98l)- •. . .·.··• . . ·•

.. Testarca eficiep(!iproc:edlldif.~ a ceqiiei:;c!Jimbani A~ a cu111 am' de3cris anterior, un trntnrtlent;;Liilltific trebuie Qa fie tes~ataU\tsubaspe.c~ul eficientei proredurii cat 111 suhaspe'ctul corectit'-'dinll teorieicru:e stli la bazti.eroeec1u.rU. 0 dL~ocie~ i111re ncest.e d~ua con1pone~1le poate tluce la. sinratii in care de!li lra~uJ1etttuJfunc?.on.ea.pt,,c~u7_Jtn~s~i efidepte.estealtadf!cat cea care ne este oferita de teotia pe baZ(! d\rei~ s-a elnui?tat tmtameutul. sau poate due~ la silun\in inc~ dql~orla r'~re co recta, .~n.Ua.uielltl.l L est~de~ efi~~ta.\e inclolelnicii..S,igui~ atunci din~ var~bim c1eJes'-?rea l~oriei .tl\l:intel~gem · o ,~esta~ in s~us dasic,.pdlitivistsau neopozitivist ldeile etUJJkismului pragroar.ic

213

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. @ca nu se pot testa t~~-te J>rOJJoz.Hille tmui sislem te~relic d doar opnrte diuele ia.rapoiteotja estevali{{ata sauJnfir.utaUi ca iutreg;~a test;p-ea· iimtez~h.lr spec:ill~~~ pres~p~ne prex:.en(a in1plicita a unorlpote~ au.'tiliare (el{.~~un testmasoaiii·ceea .

· te vrem 5i\ 1nvestigfun) ~1 in cC)ns~cht(a. Jipsa t)upprtului enlpiric. poate sa iJ.u;eUJf:!O "prqbletne ill ipoteZie-l~ ituJtUiJU~ UU tu cele specifice, suni. deja o parte integlJ1Ulii a testm;ii· tiuei. Leorii.

i!:.-::::t~~;:::r~.=;=~ · pe care·dorinlsa-l ating~mtini\nd.conl.de-fap~uJ di adesea cercetru'ense(fes!fu;oarii iu cad.ruiu~lol' l'llt:>dele.d;escclptlve d~ · tip paradigntatic (vezi pe1\tntdetalil.Kuhu, 1962) $i socioinstitutional (yezi p~::ultu detalli Peyet'Bhem.l, 1975) ..

5 •. 3, 'fratamentu.l pentrn J.n:nbletu.~le 1\lOdtll~h:]f:Uur . lle a face.cercetare.. c~le qa'le, P~l}ti I

Nu.ru:e sens si1faE~maklsugeytU.d,etal~te,.~efeW6itre la 1nodul com trebuie sti fie eercetareaJu .. <Jol:t,l~n\ul(:.llnic.;~inici I ca ~i in alte domenii nle ~~inter. cercetnren trebt:Ue sa resper.le

, metodologla ~tlln~cli. Voi ·•llen\i~mtt iii ac:estconteJ~.t. dQar raspectele tipi~ pentru cerc.et<,trea. clitaidt Astfel~ rr~buie sa

men · on:~ntclnr dHnflu .··· . · · u ·. iifttndattlentnle in . rac:tioa inicli se fac;e pr.in 11enetn'lre~ uno~ fll:tre succes~!Aceslefill.re nu au QU rol t~ret;Jv!penttt.l·~tiln\ii ci ~utulprotectiv

l?en · · ·· ·· · . Secve.ll\a~te ttrmatoru-ea: ·· .· ·· . . · ···· • "' Cercet~a TuJ.!damentala descoperiturJ princ~ o

regii[aritst~ 0 roudi\ie importantjiesie caacestprmdph.i Ha fie relevant. t!lll:tU domeuiul clinic~ J\Ueyca acestc priilt3fpu sf! . de5coperli prin • analiza su\JtecuWfmnmd si\uD.to~i as\fe\di ele pot sa UU potriveasdi [UllC\i,onan~a 5Ubiecti11JI Utnatti CUUL\'en;e · fonne de psllmpatolog~e~ Sp,re exel,1.ph.J •. pr~ncipiul disonii~l

2rognitiveafostbinesusp.uutex,petimental~es~t~!::r~,~?~7);el r :z·_ -~-"-~·-,., ... '.._~·:_ . - . --··-.:-:.~-:·" .·;, .

~ 219

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n e sp nne · c a- ·d l1 ca a pare -:o::-. ...:d~· i7s~o~n:.:a::n.:.!t~a~. ;c=o~g~n:.:i [::i:..:".::~:....· ;_;IJ:::l t~r,:e comp?rhwnentuhlostrh~i cre-diHfele noustre 1n rlm l c~dintele ·Se 1-educ la nhLelu comportamentului". Acest principiu pare sli nil fl.lnctioneze la .fal de bine 1n ~subiectilor suferluzi ue depresie ~unjorii (li\e(;k.~i calab.~ J 979), As£fel, ace!lti pacienti se pot im lica pel'f~nni\nt in ~v~e activuiiti(ca lUI\lare a sa~cmilor r~r:Apeuti~e)dar contmun s ·. &uapu . c . sunt~ incapab.i\i de a fn~e oeV!\:Chiar ll~mci·c&nd ill studU ni se spune c.a s-ainVe.s.tigatarudetarea san ·d~1n-esia, o nnnlizli atentli re.levli a(}esea prol;tlenre aubclini~ (e'JI;~ scott\l·mar.e an~ or stlbiecti normnU ... Ja o .scala i:te .tuix.ietnte) :nt1 clinic a (ex.. pacien~i dlagnosricati en diverse rtllbudlrl de nn:x:ietate). ·

'1. C • Odafiigiisitll11 p.riaGipiu cti~lcYJW(Iiclinicl ~trcbuic ·~~o.r;a~atD:tJ:-D proccdtJrXdointeiVcnf!cclitiie:!-Dn~e

po~te fa!e ncest ltlOJ:l) atunei deseoperilCi\ nre valoare teoretid\ dar !111 aril.unimp_a~asupra prncticii.clinice.

, .... • P.rDCIJdum 1rtJbuic t~tatl.IIJ ~ttidii dciJiicif.llltlf(Miiency). frt nrimn fn:Za SUn~ CX.fltlfli ~estoc ·Pl'O!;el(uri S~lbiec(i sanKto!li, . pellt~ &se nnnari.!l10dul fq;£~~~etionaazif.$ubii!Cti umani ln acesre procMice. Oacit ··li~Cste proeeduri se :doveEI~c

' n~nedcn1onse(ex. nu geaerottzit probleme noi,subieefllocsMn{it~i t;:liroca lP-.BU fostadmiulstro.te~ nt~nci cle var fi aplicnt~pllcientilor pentru.car~~ll fost ~la.borate. $e vizeaza cqlJlparatii cu grupnri de control §i placebQ.. ad~seatnn·-un meoiu . controiat, de l~borator. -aac:l1 procc4unl Si!i'dovede~tc eficlentlt statistid\ ~i clinicn (ecol~.liic-o marimemitre aot;fc:crului) atunei se trece Jn

. m"Jliatorul :filtm. . .· . . .. ·. . . .... ·.· . · . .· .· .. · ... · .. ·· .. ··• • .. ·~ . .llroi:edll.rilc iWdtU!IiJ.SllJlfo Sllpuse UIJQ( ,fiodiit(iJ. cfiaiitll{lf ~{affe~llvellets)inf¥!1aliCIJ cure[ltli. ~1~ snntstl.tditue

· cum fiinctmneaza .efectiv rn pmctica realli. (CJC. in clinic& X). Uneori e$~ posi}?il en o pm.cedurll d.o:·inc~rvenp~ gtfxirii efiRenti1 tust~tdit de labprator silnu functioneze in practica want (peritru de.talii pdvind dif-erenta clirirre.efficncy ~i eff€ctiveness vezi

221>

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·· NMhart· 4i colah .• 20Q_Ol;.1nstudi~ ile lilbmatrJt adesea ye iltilizeaza tl popillage-self:(4ionara. (ex .. dbarpaci~nti cn.~u.lbm~re depr&Siva n\njo~iiHn ti1Dp cc.in practic~ reaUi ndesea t~~b~nn·ea ~Iya majatii este ~c~n?paniara ~i d~ nUe tu~b~~r11n• (;x. anu1niteiLllbnrliri_d~personalltate) .· A•'.easr.a.comorb1dlrote.po.tte face ¢a o J,lroceduraeficientn m liiliorator slt nu mai func{ioneze

~li\pracilca re&llL · ..... ·.. .··•··.· .•• · ...•. · .. ·· .. · ......... · . , . . . . . < .. · ••.•. ·.· .. ·· •.. ,

·~.. 7 • PftjcetlLJdl~. CJJre.llot•cd~~ t'1 tilldentlf ~o!ogicli f'mt sup~sF'analiz. i c .·.• ... ·.·....... or. cost-e-'ffcc~cpffsJ- nacTl h11p emenratealor intr~oclinioll duce 1~ rea~ce~$=<1Snl,li1t,>~ ~an

e .. · .·. tivita cosfilt"ilo ""'nm ortcu b~n~ Jfl . . a9ni~ an11l · '1 . ~ua:~afiirnplen1entiltlt' Dadi uu~eint. n1p a

- a!ia.,',~tuncitnci~da eticlen ei•clinice se;-, ... untala~ Sisr~mul ·. ed,~a. i-lk ~bl!jnnit'Sit ~e trarar preferential; prin sh'npJul'filpt c~ sc.optlril~ snle BllOt'l'Unaniste~ Din· patare in sa. chiar ~liind 0~ on.ce .. padent arb¢;nefi~ja de' 0 interventie psih(llogicl\ n\\

· fus~hn1.ntt (:,nt~w~uTile treb~tio•lllt. sted!ii;m~ Sis~n1ul s~ulirar 'este Uti· Sistem, ciire~urselimltate. ·••·· Dacli re\lu~e1-e ·arfi· .. nelimlrare

···• atu~ci am ptite~s! qf~rirnfiec}5nJ1 pacient-c~lemaibune ~i'mni noi i~mamerlte {jncluzflllB asl'!tten tn psiholo-gi eli penfi\l fiecare boJ~~v), .. f)j]l pl\cnte'i'J\ .Ptactie~ lncrurile n~:t·pot. s~·.sten '.nJia, res'1..sele flinil'lirnir11te. ,A'~dnr-se v01·ln.1plementa D\l mni 1\Cele prooeduri (}are-sunl:·aft-Gien~e din punct de ved.~re.~tiintific ;~i al

costiln1or. . . ' .... •·· .... ··.. . . .... .. . ..••. . • .· .· i .• • .• .... . . , • .· .. . ...•

, .) o Un uJtini filt(l.m:ste eeJ·al lm lc;JD~atlfriiprdtocof,ufui ~. ·com fl. hili 'Jti. · -lUim ...• u · .·. :c .. · .. . · "laltJl . ·n~ori anub1itef!itO"t:eduri m1110t fi hnpleHlentate din cml2.a spn{iului,

• perilonalului etc. .. . · .. ·. . . .. . . . ···•.•. . . . . . . ..... ·. · ... ·.· .. ·. i • • i ·· Accstefiltre ades~ acluc-un ~nrecal.(! decalaj intr0 ~btinerea u~zulmtelo~ cercerarii·funda!Jlentn]c ~l nplicittin lar .. Aee.st 1Ltcrn

.esteinsanptu·obi~nuitill~tiinta. Nntoare rezultntale cercetlirii f~n·i:}amentale din g~nenca'-s'-ail conatituit d~ja in ap\jcatii ale . ingineriigenetice, du.pa cum nu:toare cercetiirile lli rratnm~•'rele e~perimentalc din psihafarmacologie sunt exprimaLe i'n

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trata~ue~ne medicate aplicate pe sccu·a latga; ele ti6b~it! testate privin~ ,~,!g}JtJUita §i eficieuta tor.De asemenea. Jal~dQhteniul psifmphto{ugirti Ull toate trntumeutele eXpednl~JJ~·(e . s.1mt hnplementa.te lit practica. Pentt:U sigurautapnci\~ritii9~. ele ·· trebuiesi.Sa l:reaclipriu fUtrele.m~utlonate D;lai.~us, ~labia apoi · "orfi implem.entate pe scartll .. 'lrga Jn practkn clinicli,

5~.:1. Tnlln,anentul peul;s;u pt:obleutcl~ UJoda)itiililox: de a face etlu«;:afie ~~ foxniart:/lr~ning.

J :Uriciullui_Uc~

Corectarea proble~uelor legate de ed~ca\.ia ~(fommrea psihopalulogilor ar trebui sa urmere unuiitoarele nspecte:

. 1• Utifiz n e cit 'ini viJlidace $tiin{lfic.. '· Ac~ ~rograme trebule sLudiate :in tJ.nsamblu fotoslnd stra gtn i evalunrit globale a progranwlui de troining sau speclfic, foJosind ' Glnttegia descompunerli pro&rrimului. de lroiuing.· Su-ategiu

descom(Jll(lt?rll prog7;f.llllU1ui de trainit1~ a.duc-e-u~i plus in comparape C1J stt1!-l:e~;tia globaUl d~onr-~. pennite imuadrea

• efici~u tel unei C<Jtnponent.e a progt.1l.JUutui cleformm.e: Ungrup 1 de vii Lor psihqlempeu~i eate pregiitit CQJ}fomlprogrrunu).uidnsic, ' unui alt gmp i se.- aplidi p.ro~ul~i~IIli!JUS o.'rummitli 'COlllJ?OUenUi. D.iferen\ele rezulb,tteltleficl,el'l$a~iuici\ -vor ex prima.

1 ponderen componentpi ~eclit~iJ].PJYJ!llU11f.!l de 'flaining. Ace~te progr:ame tteb~~ iJ.npUll!le. irt fn.~a. plistdiuo 9 po~i_ti.~ ecbilio~ validaJa §tiintifi~U1fre ll~sitatSJIDui \raining. fle:tibil (permifnud §tprograme~'o/'atl:tofo~ilnvataren p1-jn

1 expenen~iuda opozitieitnca e21.istente iu do1neni!-l fat! de ... ·.~ ,· .;~~:i\i1}f.zan~-~.nnmr-sb:ueturi~~nii •. · . ' • Avmovan:a ii1 PfVl!lllll~elc; de tipiuiag a tra.c~r : validate ~liin(it[c. Trata!Jtentele validate *liinVfic, cum ~uut cele •cogniliv-cmnpurtrunentrue •. trebuiepromo\'ale,r~ta~ ad\tund !d\ele se genetali~a.Uipescadi larglt.R€'-CC''t,inMaroaUri\altie, 'doar programele de terapie cognitiv:..comportamentaHinu fnst

22"l

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re.cunoscuro. ~i in cru.tSeciuta platite de· casele~ asigurari ~ ~te ca terapiR at\ju}'iU~tii,nted.icaJiei ·petltru tratmnebtul · .~ · ·· · · ·c • .Ut Ius. ill .SUA. pr()gvamele ·de

rez;iden{iat in psih.iat~~~ 1li tograttlele:de psJI:tO Ogle-r;· intca acreditale , [email protected] UbJ1gattJ{lU SR ·t, U a tn QUrt'lCU n

1--rl ... ~.!!._· ..... ~mm~ psiliQ.ter~pi~ co?uiti~crn~yurl#IDe»!al@·in··· .. ·.·.· .. P. ·a. c.· a~. e .• .· promovarea. unor as.tfelde lllteb'V~Util::lll'pt·o~l~le de traitdng .se }OVe!fle adesea df!,Ie7.iS~el} .l' ... ·. ·.·.· . 1.·. cl .. "e. f:i .. a ·.Vi iJ:igoareu

[, *·ti·'~Mc!~>naibuul~Megie-~o7ti·~·gp·· · .. '1

rigiditate, iar pe <;ei care o promovenza-; tehniciGU fl:i tipicari. ·. Aaron Beck :siterapia cognitivi\ au.f ustndesea ~terWlt1 astfd

df! aoel profesjoni11ti ~aie. j~i inve~tau. ~ropria r•m5 de psihoterapie 'i care nu sc: de;o.sebeaurJi.·~ veehli\.cu ().eJtpetjeJJ\:11 boga,li de v.iata''. Chiar atunei cllndace;t!,Frofesioni~ti ~qfnscri nu In training-uri d,e lel'llpie.e.pgnitiv-comportatl'Jf:J.ltQJU. atitudiuaa lor ern exttem de defemdva, Ei aqteptE\U tblla st.tpervi~on, sli le confmue experlen~a. ~i · ceea. ce . .taceau. dejil. .tn praelidi. -dar e~perienta ~if?ll\GtiSll ptPnste.nu pc,lfi ~lt~acoitfim tate I; in plus. prin interfereuta proactiya ele li impledlcl1ll·f:ll?.~ce.1ti :Jpecial.i!lti Sa asimileze iuWmiB~iile RQi<P.in. progt.'Blll\1119-ca.re S-'f\\llnseth;, D. analiza empilica fiicutii d~ avtur:pro8J:nm~1Qrde trnining de

· la lnstitutul Alb~rt .Eltis (autoru1 este supervizot' in ierapie · c:ogni.liv-cvmportmnaqliaUi l" JJ~&titutuJ Alb(l(t Ellis dht New York}, a aratat ca c~i car.or~ li se refuz.a cerli:fie.area in psihotempia cognitiv.-coro,portumeu.taUt tlbl c;nuz;a dfnu au

· · parcnrs efil:!ient progtwnul d~ lraining(cgi1t~tprpfesiuul!$li care (1) prnctla\up5iliol:enlple t\e tl,l.al multi·wu, Iat'~-a ftvea arn'egatit-e spec)ficii intr-o ®Unutaf O.L'lUa de<psiho~en.tpie{eJ."a\1 ee.lectici n; (2) aveau oaracteristici uru·cisisbhil)trionice l'ji () stirua de sine e."lagetat de crescuta ~i (3) adesea erau. 1nai 1u y{{rsta; Do

_ asemenea, ace5\ie p6rsuane au problemejn a. face ter~pie personal a, ei considerfind.acesta sub d~t·unitat~n-Jor\ Mural a este

· ta traiuing-ul in psihoterapie ar fi bine s{i pro~oveze tetapii

2:.!.3

. I validate :::tiintific·~i elmeriti\:ineeptlt cu oameni tineri saucu ·\ profesim1iJ1ti C4f« a~ dejao formate in~ltaformiide psihoterapie, fonnare.carcli face s~Hie mai pntindefensivi ~i foarte rucepti vi Ia rolnl de sruo~nL

• .:L11area .. ;tb ·considt!ra.m·a stl1diilor i:Me HIJJIR elfcienta psrapraf~onittilpr .fi/e;mp.jilt!H' autoadm:fuit.•/Pata Profosioni~tii ar .trebui pr~aUtiji ea,•it'n-:111ator-i fil snpel'Vizori pentru aa;sle g.;npttri fii fonne de psilioteropi~ Rolullar s:.arimbog~(i dtidi pe Hinga forma:re •ckrnol-=speciali~ti.in cadrulprogramclor de tralnin.g ar .dB&indi:oompetente .. i[l fonnarea.'~i -Bupe£Vb:area ptiraprofesi~ni.jjtHor=§i i~i~pervizarea. apl!d\rii• terapiei l\Ul"OftdMifliStrSJ.te. fn pl~ls •. profesiOl1ilftii 31" ti:ebUi SR includ~ Ill acavlllU~alor. P1lTft)?-rof~ili)ni~ti:dup~·mOdtdnlfncare ll1~diClll a inclu:ri~.activiratea lubal>ilitentole.ol>lfwlcul-facc dlagno.sticiql-si elab()renzli •schrtma-d~ t(atamertt. Ap19it unele,tFntam~nte (m~l comrJlexe) ~unt flicutede· medic In timp· ce :.lcqle suntflJcure de clitre. n$f.ste;J'ite. ~~~ \ften sli viid ~i tn 'psihop~tologie (l?i psihoteraJ.>ie lllai:.al~ lopera~op. (parnptofedo-nrfiti) cnre ilplica divC'rs~ teh~icidup.li•ce•Qil speci~lista.fihmt,diagnosticul-~1 a

, elf!boratrsdi~ma .ms .1r1ltmnen:L Ailull'lite.feiUtici:nu trehuie apliqate de: c~tte-profG~ioni=iti ci .put fi-·aplicate tJe clirre pnraprof~~oni~ti sub :mpc:nviznre. . _ . • ••• Luaitfa .fn -toriaidfJNirCHJ. ndJJm~ o:onccptualizliri din £lom"niu,._mp4Fticularcclcntll:rscda-pSi!Jologin pOzltlrdi. Tml}~lie insitfiicuta odistinctie cliU'5 intre'a9pectele validate ~ti inti fie ale psih~lugieipo~ ~Vy'IJ i eJiagerali·lp Cafft ll~ tndeJ?llrfea?li de·valori confum'n~ precum roalimuil, !JC:ceptarea . necondi{ipnar5, tncro(J~~o b~arll pe o-evalunre COl~dl, etc. lfi carene apropie de ideen cij sanae a tea. psihiolt dcpinde de. alte valori precum autotm;elarea . Iii autoilu2.iomu:ea {vezi peJltru tlerelli Dnwes, 1990). o:pend~lttr~ perinauenta in.~e r~alisl\1 ~i iltiziipozi~v~ tuinit'ne genereazii.l!111! opti~nisin renlist; care esre . calea Spre slhllitaten noastra psihicii.(Dawe.r:;,}996;.£chedler ~i colnb., 1993;

224

Seligffia~!li Csikszenmiha!y\.20~0): ~l:re1. il~fi~l~:.l?ozjLi~e . gene.tea:z:li ceea ce nm nuoul an tenor S£l}latare psJinca Iluz.one .

. iScl1edlti si cola g., W93). . .·... . . . .·. . .. . · ... · .· . . .. · _ • & t.f~etifriih nsnpra cficien(ci psibotmaplt::l c:Jcc{lla(c ~~e •• fl<Jrr:msJi s~oJubl.iX'K ilufost stmlmiZfita $1 Jt_[f;.Zentate ~.Ctll!· .- ·· .· .· .·· • , ... ·. ·· . 8· .· .1··,1·1··.L·· ... m·· ·" .. ~.·r t i!·£·a .. o.·.::J .. ":?\.· ... In. s::e. rcand.- s.a .. estnueze :Jnlr-o •:s.LtC.rB:J:C . ·· ·... Ll..... ,.. .-' J· . . . . . . _.

contdbtitia di,verse:lo1· con<poncnte ale t~nHt.mentultn psihoter~peuric asopra eficientei IICesteia. rezulmtelc nrar..11 urmatoaiea sima~e{vezi fig\lfa 6): !

225

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lmportuule ale rela\ieilerapeutioe. Rezultatele a cestui: program de cen;et~r~:~.,_untpreteutate ittAnelUI 2. . .. ·.· ... ·":t.~ •

· o Td:.uicile de interven~ie psihol:erapc:mtica aco.tiedi 15%. · · oEfectulpl.acebo ac(Jp.era l5%i in tu::estecci.llclitii efectul

placebo se refgli la speranta _$;. expegtanta deins~uat{f~.ire~i Ia spt>Uul\ad\ tratamenbJlunnatvaduceJa atbelioraren tt~filoului clinic. .

· o Factorii petsoJ.tali ai pacientului acopera40%.Elel\lentcle factorilor personali pot fi impartite in trei categoiH. Prhna cntegorie include . factori. psfhologici lli de_ educatie · Precunt iateligenta. A doua categode include factuii econoritieliar. a \reia uategorie se referalnsuportul social pe~i:lare pacientul. .

·in duda acestot date, dih pacate, prog[fltnelede b'ahiing se focaUzeazlt obsesiY pe con~ponen~de telu.1ica fiiJ?toced~di. A.ceste1-ezultate arotlica prognunele de u'clining t:re\>uir ~giJ,ridi te

1 cou1plet difecit •. componentele lor apr(I'Ximfu1!1 pqnde~ea pre~enta\.a mai stts .. RestrUcturorea lortrebuie.(iicutli peprincipiul ··ariciulU iJui Occam" I care ue spune ca LTebuie sll Pilsniint doar . acc:le componente simple ale .training-~llui care}ustifica petfonnanta. elhnioand e~cesulde ~ning_car¢;nu,1ldUfe un plus de···pet'formauJ*· Sigur~aceste_ c~z~l.tat~ Jttl.trebuie interpretatelD.tr-o·maniera.exagerallh·ArP,qteilsiifieU,nii_autori

. ·care sa sugereze ·ca· prdgl:amele.ile.troiliing~.ar putea .• ignora con~poneutadelebnlcii ~l pla~ebo,~hiisei~~ p~'celelalte

·· doua colllponentecare acopertt 70% ditte.Jlciert~tnttBJ:I\entull\i. j JtacestCO!lleXt deiriJn Sa lUCllpOBR~\Caiudiferentde pondetea lor, ·. Loute C~l11ponehlele sunt neCetiare, ele polent.a~dU-56 lji constr&ngandu-se recipr~m.Jmaginap.,:vl{ o interventie psihoJ:ernpeutlcii.in carenu ~eutiliwaza tehnJcl deJ~~erventie (ex.' de di.aguostic :p evaluare clinicii. de concepti.taUta.re. de

, ll'atnmeltf) ~lin care nu se dezvolta spenu*' de insaniilo~ire ( e](. efectul placebo); in aceste conditii.nu se poate dezvqlta nici o

. relntie terapettlica adecvata ~i wei fac.torulpersonal nupoale fi 1- ,... • . ~ • • .... < -

1 utitizateficient.

:· .

Pmtea a ~1-eia a 1ucrJtii parti~t1lar~eaz~"o componer~Ui importanta a psillo}Jatologl~i JJi atmnle.psihelogJncliu.idt. -Voi disquta aici sitt.t~tia pslbologiei clinice iu Romllnhi (cnpit.olul6:l ···~Ltolul acesleinln dotne~hil~lJsibologieJ.aplicnte (c.~pitdl~l 7). Cnpilplul 8 de RentUliei Fuude vn suuM.u:i'.tn ~i.iJtcbeia demersul acesteiltu;:rfui~ · · ·. . . .. ·

Moti Vl1l care a stat la l7oza • aces lei: u. Lreia puf~in lucrlirii, parte scdsii iutr-ulllimbnj pro&rnmalic qi cu un ton a~~ea critic 11i acid, estf!• conslruirea tUleielite lltiin~ifice .. roJ~.~l\ell_tiiu psihopaLologie in sp~cia{!llin psiholCilgie.tu.\gt!~e~": Separe ca ntiludi:mm neutrii a cercetliturilur !li practiciFliilor romtini de vnloare'indomeniu uu atlit<UtalLcevadt;cittsat.JeiU~tlly,prostltu\ht _~;i trn:Ucul'' psil1opato~oaiei r't>tnl\n~ti !li ~pari~~ unor 31.';1_9tdo?ti productitod de solemnitii\i ~anale. semJdoc.t• p.e c~m 1~ gi\sm~ tnsa in pfi.rghi:i de pur:.ere fii decide. Eu c.t':d~ii o a~~\U<;\!ue· ~-~~ ci:itica cnre ·· si1 plltnnoveze. 1ro:loa.rea _Ill sH. ~tac.e ·e"-phclt uo1niato~rea este siugura modalitnte. de _11\rezi orgoliul · profesionifjUlor adev.llrn\iditt dou'leniu 3i de. atc:~£~bi.Uo scnra u valorilor tn care elita ~i nu pros tin &it fie· in -varf. ·

22'1

. . A!}a~lar. sp~r ca•cltitorii silrilFeoililtlf!rih1a lsml!~~~\ft(C:ci,,~~nu::s~simti •lctap. ptoiee~dtJ-se rn 11~,~~l~iy~f~r~;z,~i~ti\tfl'f;aict.•M'8i :muf~.,;~entru 'fi~iltiita

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':.·f:l)enfl\V'' i "iii~ujift'll ''': • ~,, : · · : •· , .· , "" ,, · · ~t~'-'Fl"r~? ~' lt::'t!ki?;!:t':·. ~-91 ,,~l~J~ClOJ-Napoo:adedltre ~ :;:·9J~P.&~~li[~ ;11}~~\i Wi,lt~{lll1Wttn€h<>Jstorin

g ~''"''~~\;Jln~~~bllclumatil~ymultt'W*Vtrerite . . ~ . Wl~!~~,~~~\l'~m~tqis~;S~talisbnmmt

. '''""Jdeolagiei a ua .. uvoi iutra aicl tn detaliile acestci isoorii : "'cnres~\n~pr~n~ate pe larg it\ alte lucrfui ale mele (DaVid, 2P81;

2?0la; "Qav1d ~l colab .• ~002; David ~i Miclis)~ 2002). V.ol PI ezenta f~1 c:ontiJ!uare do~.sratnt;ulnctual al psibpl~giei l;linice: ro~ne~ts! 111 Cftd~l cercetlldi f!sibolqgice inte111arionale, reh6ffuld aspecte~·pmbJemari~~ ale aces~i discipline. Aceasta prezcntnre est: o sumnrizare n unul articolpubJicor 1·ecenl in

Z'28

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~~tro,pefut~~JG!lologist(Qit:V~~~~~~~~:·~O.~l. n~tldar. p&n~~~; · .d!fl'f}lii:~i :infonna\ii snpliq]entare ~g c~tno~a1 sl\ ~ml&Ulm peel

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,.~~~~t~~ta~l!lebllii•vezi~1!1n~l~~~~ilt~!t\ii "~$4il.1~~tlthilOJ=i~:l)iplame.(IJF."fl:•.,;.J}tn~t,t;t;jo4

~ti~~ljj;;.rar.geneml;peritratil.ll'-lt~e:'fl!~frs~t; ·· ·' · ;Dt$flii~#~N~hnnell'le·autot~rha~oiil~Je;ilf~$ei

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~' isjf . ··.· ~~~letit»ll~e}f:ale·~n rlolllcnm S1Ult~'7'~~li!J~i1~a~ ·J ~mt1W~~~~~~i!aJ:~P~)~~~t:£~\il;li~;:'~'~0fiiJ1~n''c~~i*~~~l' .

ca Ull:~Utt,)l' paate 'scrie4 volume ~ingpr ~i Sit -~i aiij}ljo:fi~tlll~~~~j, la. ute.nnura ~tiin[ificii! Adesea aceste volume suntjdOa~ sumati2Jiri ale nlror lucdiri f.irli sa adudi 11imic nou rlin pund d~

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dlitel¢f ... .. :~ •'1\tttelumniitipo~~~~ .,·:~~~~~~~t-l~r,,,.,"i

•;1\ifr'el~rl.i,udtd~~ijtj• .. "~'v~~;~.~~~lf!,~t.eo ttu

_::·t··--~~;~~!;~~~~~~~~rf~K~~~i~l\m~~;.i~';~;ers~l ., 'fiiP i1J(l'e , -v-· .. ·_. BSte ciUS:ie.ii ititfilQ.flallht ~}tfiuia« • Plntre ·

:~·~=t£;&!fi§ dentara ce,reet~ pr~pr~~::;i~li~ .t:',~~;l~~~~,t9p,tiu-zisa n -~~~~il!m:q7~t~fi~~~~~~t~lliti,~:1:·el'fi .. ,; . _ .-C

· -·· ::•·• • ···r·:!JiJ~P-_~p;.pu1Jl~q~l·luc.t;~ti.(~.~Elf~hdtJ~Jiitll ettl~~~~er{\le '$tlig.~fii;¢.$innpolflnlle illciut:laJ.trior~mi met.udo,l:egiceftugmne. ,,., • ' ' •• " j·' < ... ~ "' .,. • . '

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.. ·-·-· .... ,.-... -..... , ...... -. ...... , ·-· ·'· ..•.... -· .. _ .... ' -·.:." ..

Nuvorbescaici de erolHn prelncrareastatistidimartmnticii (de . se poate datpra·progranm~ul stlttistic sauuaoretori de tiplhire) ci de erori ·. metodologice '1iu1damentnle~ · Amimesc Gil· exemplu, utilizar~a eronntli a testitl ui statistie (e.t~ utilizm-ea unui test stat mric el~borat· peritrn-e~antioim;e;·indepenilcinte. in cnzul unor ~anlio~nedependente) s:tuutillzarea cu obstillnfi~asenmificnliei stal"biil:ice tadesfta• Qtilizaren'e,ste ~i ea gte-9idil; vezipintrudemlii Cohen,. 19.94). fliFli ·a lua ·fu consiiJ~mte ~i miinniea · efectu1ui ~i c~lllP:ll"Rpile l"l~nhative, (vezi pehtru metodologia adecv;.,;a Ke?dall1fi"col!'h ... 2000): Un a]t cnz ripic e.sre utilizaren fntr-u 11 mod c~mplet -neprofesiopist a cpnstmctelor de "mediere~·· ~ "~odeJ_·~··; £la,i Bl.\)."on §ii~eruiyau nr~tat din ·1986 cum 8e

· daf~~t•ilZii a~ts~n~vte la.niyel~tio.Jii 1n analiza smtistidi. ~u~~~ mnl'lln~hl9fi lC: t1tfli~nzlfcasinf:!nlmeprqdtlclind aslfel erori collCf!J.)ttlft le .IUJPOrrante, . ~poi sunt 'ftecvente erorile .· m · cazul com'J>aratlllo~ tnultiple.ll\stfel~ dncll BVf!m trel comp8r8pi¢~l testul "~·· pra~ullitnHJi de seirinifi(lati'?. stn1fsilblt n~ mdi este n.os ci

.• P~05:3~~.qls~nf:rt;Idetalil referitoa~e lamodurtn cam se aplica . a~east.\ ft>rectre -Bonferroni.- veii David ~i co lab., sub tipar). Oare dite. c~ncluzH .suspnute·pe" .nstfel de aualize sunt de fitpt v~r1J.e goale flhii supm·t ~riinfific?l In vern, neluareaJn calcul a puteni ~hl!istice.(ex.. numfiru~ mini~de;subiecfi in et~nntioanele ~onstmtte pe.ntnt ~ Pl)tea. detecta e:feciul existent) a dus la mlerpretarea unQr re;~ullatc seml1ifi~htivo cafiindnesemnlficntive. On~cilte ~on.cl';'Zii lnteresante au ·t;nurlt astfel'?! Prezint .rnaijos

· . (v.~ tabelal4) pentru diver~ design~url He' cercetare nnmtlntl nllntlT\'desutl,ft;n{i neuesati penub alestn ipoteza.Las cercetiitorii sa seproie£:!~ 'Ur acesteinformarii ~ish-~i autoevnlueze Jucrarile incarenu tu..J ~b(iriutrezriltate se'rnnificativel · ·

_. ···~in ptinct de-vedere t~reti~eatelnf"ric~nrort~ntru acest d_omenm eli se perpetueazlt fn prac£.icl1 nn dualism ~arreiiim ort()dox.. Qolegii~medici nfinnn adesea ca daca.exism leziune

· btpchintica atuncieste elat di mr avem. ce sif f~cem cu 0

~·. '

CJoi.fieiQntul ac-. lrill.-ib.- i

-u~ llid~~ J.') ...• •. ·. . . . . ·. . : l,.EGI~A: C~lt;Jrci va!ori !-fispu8llln linie tn~CCftl"ro c:elulA II t~b<'!lnl~ti

··.·.cor~punilcal~~.tr~id!mcnai~J1ia!~ ll'.~ri~lil::fcctlllu~ ll'i~ept?t(de ~~~~~n~n (a drt'.i]p~) (dtlpllColtcn. ·19?2): (l) m~nme ft cdi:etu!m mtcil L0-.. 7o)~ <;~ miirill1ea efci!tqltlin'll!die (:20~.50); 1T1ilqme~ 1\ efectuhu mnre f'"·7"0pent~ll

· sau">;BOin eelelullt: condilii). ··· .. ·•. · .· .· . . . ·. . . . . ·. ·. . .. . . . . .. .. ! 11 .. 2 vnrinbile flrt:llictor. b-'Jvllriabil¢ predictor; c4varinhile predu;tor, I . . . . . . I

. . . . .·. i. · int~e-ntie.psihological Se~·uitliatat de Ufiqr~a imerventu• psihdlogicli~(!Onse~in{ebiochimice (Furmnrkfil c~la~:. 20~)2: KirsPll, 1990). Uniicolegiips1hologi •. se '.'imhntn" de pU\cfre

· C!\l)d:oesco~ril ca al')Unlitef(:nOmenf p~ihologice au c~·o;spon..: dentbioctiirnicrunti ·ahitre ei au aJUli!i sJ!i.,.~i fttcli. un nllu! de

··prnfaslonist chestionnnu menm subs~mtul· biochi•·n,ic· a~ .. nnor . fenomen~ psihologice• Probabil. ca prin .. aceastli- atlNdm~. aLl

certirudinea en ceea-ce:stueliazli ex.istli (1n sens fi2ic)l_. dar ¢Ste

pi\eat ciimai au nevoie·if~·'il}\!ea.st~ certirud~ne Cfilltl<P_~iho1~gia en o-:nintn s~a j11stificnt de zeeide nni:j\ce~ttQ. SUll_[ uceta.pe care eu tim~mesc cei n"i"ai buoi psi110ldgi dintre medici ~i cei mai putin psih()logi dintre psihologi! Prin prisma acesrui dualism

237

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feroce, am vfu.utrenasdind.in Romfiuia cercetari cme au murit iu .alte tar~odatit cu evotuUaJ~ un model bio~psiho-sociai. piecum cele .lil.~~!1f~t!.~ratlidi fen~n~uele b.ipnotl.ce suuL a~o~npiolale de 1Jl(~d.tfip~n; ~erebrale etc_ Ac~te ~erc:etfiri c~;i.viieaza · substratul biological unorfenomene ps.iltologice;sullt de liT~UraJat. daca ele. UrmarC{iC Sa descop~re. pat~e£0-Ufi ne~roblolog!Cf!·~~biochi.n~cespecif.icepenlntas~tepslltologice s p~cifice; in aceasHidi~ectie. eie .pot contrihuila(}ezvoltarea m•or uoi tehnologiiin psillop~tolC?giel.Da.<;nt~sa.o.ceslecercet5ri arata uu!lmi;. (cu~ a~~ea s~ illtfu.npl~J :di .atiUI"J.tite T~nomeue psi~o~ogice ( e'll:. fenoJnen~ . ~lppoLic~ .ef~~uJ.. pla~bo. slari eJ~10\touale •. _tull:J.ur;;id cerebt·~le. et~.J au .. _ 0 corespondenta ne~JOcerebi.<tJ.a SUI,l bi()(;himicli alupcieleSl)Jl{; SOlemnj:tiitibann le

·.!.·. ~~'eale ae .seutidocti·~~~a.~laju~:B$m;ti sale~nlJobul·pre-i .. frontnldeapr?~.P~On~eJenomenpsil~ologic<ex .. deladurere Ia

· :: ep1~tie r;.i g~dir~I) .• P<B.i ~~u~tintd~ ze~ide ani catJ:Jihit!w ~te : ftltJctie a ctei er~ui 7 De ce v:a.:ruirati~i·va bucnratt afi,tnci drag.t 1 cole&i ci4td ''d~c0perit_i''cafenoJueu~lepsihologicesp.l!cifice · : p~ (!l.\fe !e studiuti a\t corespondent neuro~erebrru'll)q;t~ttu ati \ c~zttlcaaceste -feuomene pe care 1eexperienfi~nlcU l(ltiiexista :ln ae~:?l fij.dl. .a Rvea pretenti~ envoi c!ari.ftcaa.i(;j relafiadiutre ipsibic .• lii biologic •. (ea•nu._este daJ"i~c~tiinici··-~·-.lltenttprn de 11Slle~iWf~i.tt¢1)votprezentait~conUnunre.~ucflnt.(peJ.ltJ:~detn.Ui 1vez~Iti.rscb,.l990), l'l~oduliucare·t(~buievazul.3.aceast~rela\ie pe.baza d11telor pe care lenve10 ln. ncest n~oment F,igura 7 . prezeJJtallimai jos ~rata di.dis~sul psihologi.c ~icelinedical ~unt~ulesea.d~crieliqiferilellleaeel~irea1i~\i/tetio~~ue..Altfel ~pus,.~a cum Muhammad Ali lli ~assius pl.uy su~.ttpume tiiferi~e penLru nee~i persoana ~llimbajul!lSjJu;logic ~J:~l bioJ;nedi~al sunt dC$cd~i diferite ale 1_1celuia~iJenqm~L1. pupa cum estea\Jsurdsltspunem_diMuh~nmadA.li este.cau~al\JiC<tSsius

~laysuu. Cassjus. Clay cauzeaz~ pe Muhau.wdl\.li.nu are sens sa ue; puuem mereu problema da~a biolo&ictll ~a~lzeaza

233

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F2

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Fii!lllll1. Rebt\ia di1llre psibic(l!}~ibiologic (B)in ouzul n douii.feriomeue (F: F ,· ~i:F1)prezenblta iu douillJ,Odlll~Ui\i· grsficc ~~~ . .

. psihologicul sauinv~rs,fact(Jrli p;;JI~olggid Cl\Uztnzii ~nodifidiri bltdP.gice. in figUFcJ.7 ~.P 1,~e po,ate tefe:d.~prc:e:t~itlPl~tlll sc~l~~e1e coguitive negative.D~t;Jgureleuu~-usUi!n~e~. P1oba~!l.ca l?~ le Gorespunde 0 anun:uta realitate neurPtl!O~Ogl~a(B .>. 1pl'l!(":l.t~ tta.s--ar putea referi taun deficit de.$~rotoutntt. Scltema cQgn~t~ya

· negativiteste cautil"pettll:U o ~rilr~,d~m:e.aiva {~2):}\ces~Hdiu·l: desigur, i.i cot($pundeo reaJ.itat~ ~'~ur?bi()l~&,-pli ~2) (t~oteti~. 0 amplitttdine sdzutl\ a pot~:;npnlull:lJ.. posl81naplJe excttu\orJ. Afladr.tr, teoriapsihologid\ ad~p1-esiel!1i ~a~l;Ji~logicijno ~~n~ in opo'litie sau altennnive.Ele sunl descrieudifelJte nl7 ~celum*• feuomen;'in Qcest cOllleKt, ~is~ursutc•~auzal" (febuie UlCU~i~llll in cadrul·acelulru;i limbaj . .1\.fitnt.a\ia: _sclw:mde cogmtJvc

239

cauzeazii ldiirea depr~i a 0 ·medical urmfind ipo~ v 'ur yurea.corespnnde inlimbaj bio-. de sem;onina d.eter::~oastra a~ten~oli., sfiro1.apei eli: deficitul

pos_tsinaptic excitntor. D~:c~~t~~t::me l:-~\Sa a potentialu\ni scheme ~ngn"t'

0 rotonma nu ne face sa avem

~: 1 tve negative ci ea este d . :;chemelor COgnitive n . I . O escnere btologica 11 .rc egatave Asadar dac"' ·.enome:n avem ntilt teorii 'l J • • • . • a nsupra Ull\li cnre este teor·la P"" c pst 10 ~g~ce dit !ii reorii biomedicule

· ... are o prefera ? D ·· d • exempl~;~. 'am pntea sli facem o m: epm e de situope. Spre deficintlui de scris-citit· A nnahzii neurocerehmlt\ asociatli psihologi~li n aceswi deftcl;~ute; Ynsli sa face_~ l}i o annlhli. mai util~ in acest caz? Art .li· nn: mtre cele doua abordari este sll claborez progn\me d ~ zt a pst1l?logjcl1 'i'n.at;estcazJnli. ajutli

• . 1 • e tn elvenftB penll'\1 d l cttitu tu. Nn ayn au-zit incli de " . •• ezvo tarea ~cris-mtl. invete cum sa s~riu' t 1 . pa:itsle Cftrc odatli tnghi{ite sl1 rermenl oi~lo,Pci ~ten.:ai ~'~~;;;nbn 'in alte siruatii. o nnnlizii; in Spre e:x.empln. p.rezen ttt halu ~ t. ~tna in termeni psihologici. psi~ologic daro teorie din cm~tulor _P?at~ ~ :-xplicatii !li maa utili\ deoaiece ea ~110pec~ ps1hia:tne1 btologice este

s-a ex:pnmatin trata ~· care pot reduce inte . mente me<llcamentoase Rezumfind renlitat .. ""esT~.St~atea. ~i fTecventa ha)ucinariiJor • ..- ,e complexa - 1 . . t •

· 'les:cderea noas-trl!i. fiicutl!i. a~e -~• mu ~~m~chu·li. A,!ladnr. !li mnlriniveladi. Linib;ijul sihdlo&~et ~ealtt!ip trebuie sll fie descried iliferire ale aceli I p .. 11 gtc "l:t eel b\ologic par sn fie vczi Kirsc;b: \990). ~ad~::; e~men ~enU:! deta1ii $i implica{.ii neurobiologrc ill llno (! raga colega eat-e snldiati .. subsltattil B}'ltinemflacum dt'tpa"'r t=tnomene p&ih?1ogice. tl·ebnie sl mai

• l1 n a Vl"Crrje. ·en. Q.,.; • '-' · are corespondent-·.. . • ,,.ce ..:enomen psiholooi.-.lenrocerebral si dec- d " t>"-cert:et~rile voa~tre ca an u • I, act, nu ariita(i in

-nu mni voroes:c de~~-a o.fieasr.n co:r~~spondenta este una specifica • 0 vJ l'l carea'te1a•iei cau-l</ " decilt £roisme si h.ic ·n . _ r ;uuc,eot- nn produce{i

9 • r n necesare promO\imi p ofi . -: Jn rnrlfllll ex.istlitndi b' d r esJOnale?

A~ a Cllffl am mai mbnr .t Ine ezvoltat.cnltul munciiln gnlp. ,tona pe parcursul lucrlirii, ~tiin~a modemli

240

I.

peno..mmirll~ i<l\i<'lisc\plinarll. 'i dP.<:<:\l\P~- In ~riin\ll. rounC• lngrup ne ·~gndl c~ P"'dUSUl ~wnutd4pli~e:!"' li!1lill>le eel hi care l-a ereat. Sp:""' uemplll. gruput de psiholngi de \n . Universita"'•lll\btJi-ll"lyal.~in Clnj a (ost recent illlpliCot intrnn piplect ~e.~are i\nvorgurll tare ~it,nllrtntre nl(l:le ~~ elnboi-a~ea unor~t~ ~ii~.str.mnentare psihologice.lmi am1n-

. · tc-Se clar cl\ ntunci ci\nd !1-a ell\h~rat U\\l~l din te~re, uo test 'de · ·Pff[llt~itnte deeizitiri~ll\, prime1~ -propunel-fin~ividu()le nle utuli

. !"ll"'iml constitlli~ d"."' ~· c.nd<» dt ~~;,_ Mnnc•ll) ~iPl\ n · dlls l~ unprodns cpte nti rlJ.ai sea~linti"c\1 prill\a sch i'l\ .dar- Cfire este,prohabil.mtul.dintl!e ceie•· m~t -bpne testa tle cnpncitm:e ~®iiion~Uie\abOtttte:Dl tarli\ Dacl\;nn arfifost'in final ~flt(ib~ltia · ¥<"iP...,• ~~~prob~\lci!varl;,tl> lino.m • •.~~~.;• re$< ot .· f:i fo~tl;lepat¥t.: d~-c~a ctt:ne-am prepo!l ca standnfd ile calirace.

.. .l·· . . • . . . . < . . . .. • . • . .. . <• • • ~ . Din•{liic~te aW.tu~l\ fjiOJCemplele care-infhJ{\al'. tezl\ cl Il1\mca 'in f!.lJ)V'.c;srerlpipii~ilun cer~tnrea-romftneasd\.ln~it~tJiinr.lln mlt\~lnl1nr,.:e~itli\i1e pilrticulare sit suspn un .curs de .fl1·1·Lie

psi~?l9gie<$.nidi •. an1 avur;pUicerea sn_coordoneadt~vn·ln~rari .. deli¥n\~-~\es~ilert\llor·d~acolo .. •Proaspatintors·.ditfS"lJA· !ii c~npnut\~l.d 11aivpn\9lict}·de acolo aiel. in Ronll\1tia,;m1linlplicut

mnl'; llll)l\i stu~Onti to. a~i p<oi<>ot' de """'"'"~ J\.~~~ar. tuig~jllll1!!!~tul'tc.>;oreJ:.i~? .. nlJucii\l;tot•era a&elfi!ii·. (chil\t C\l uncle

·. seg\_nen~~ Cc:illlUnl'tde teXt) dar ipotezele, obiectivele,llietoQa ~i a~ti~ar~i J'@lltat4lr;qlWJ1Cluziite~·nu fast comp1et. alte\elu t1ecnre sttld,eut. ttl1ll~1J}~d f\Specte·clifedtR nie a~lninl}i fenomen. Ei~ine, deitr ln.:!rlidleJ~P(!ctiV~ lW:fi.·p.untt fi publitnteJn revist~ de pre~tigiudi~; sh·ain~~at«. ~tudentii erau pe cale sl\ fieexmn[riclllati p~lnoti;t\l d1lllct:eL\zltla aocen~i temli :Ji atlliJcrliri dediJ'lon'le idciltieel.D~pK efortn,i!&-·mele ~· • wn11inge •comisi~ d< profesioni~n·· ca h1edirild sl)nt. diferlte ·dat aborden-z..l\ acel~\ feU'omen. amob,in~t Gastudentiisn nofie exmatricnla(i ~i p s-<l. dafposihilitntea sli-~i sost1nn:exa'menul "!mill vii tor! Atund. mia pan1t d\u pennu impUcaxea mila in alte nniverliitati romfi~e~ti.

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~i mi-::ruureditnenaionat ••revC!JlU\iil~" 'li stilu[ de a face ~tiiuta dJJp~~.a,zll~~Qf(.t.j,l~q~~~;\~J;i.lfq~t§,W.~~c::bq~l

r M d' ' · · ~ SUA A .. ·.· 1· · · · . . - . . '•!!. ·. •· I .<!~ ... > ~:,lCizi]~~;~U .. ,. :• : •t:~'l.t;O ~,a,~, ~·lll,;f~\~~1,~~~

· asp~et stitistic nu ~J!r~.oiez tuctiidle;m~ . , ,ht~~

· '::~i~~:~~r:e~~~~;;;t.rtr$~~~~~~·,~,~~~t~j~f.te:;au' .·· ·.···· . , .~lS,_,Q l .. ~ ...• ,_, <• ~ 't .~,,~,.;q•. , .. ~~ ::.t~RU,\f:!~.t~l 'I~.Jlll1 ,;iuce,!J:at s&l~llhie-$&Jiln!ilAt-e;;.~(~,lJUl~~l\aee~Lli ·····pl'tibli:sual·luer,ld~~ti·fi·,iai·~J~1pll!Jdtttel' liiele!.din perlondaromanticiiexp~e nJipsei!Y'iiUi.Jitdd~~~ii!~hsWlos · de .a !ace Qtiii~~ iu ~ameniul meu de inteJ;eBfL\rcdu"ile scrise

·• ·dupii;, l,Qij(J!•SU.UL. eel~ C8f0 JnJi·def"meSei'f care''e~·prim.ii. Ull

ra\ionnlism critic ent~nst in tot ceea ce Ja~~·eu Hl'aUi resil!'~'~·~lat~~~J.:Jf~;.~; ~;~~~,~~hP~.~~<;., ... - ···~at;' ca~e s~ . ,dofC#.~l!llla reyotu""lta~~; dej~~7f~;4~jl ···" poate n ·\eotl:sid~tli ca: a.tar~:;,p~~ eft@ 11 -~ 'j l"ecet1z.U .· intenta\i(Jilale §i mn(~~,.pr~bit pu . '~'? ., e (chini· ~i tit r:eiuniaf!). Safili'cfal-itn~i~~U!!• .busta eSLenumala&=a ' · attlUnn ·

. i. :·t.•]! . ''

on~li :;isin~;;ea care, ... .. s co.lri .. ·. . . ..• ,. psiliologieltn Romitun p,_-in pUf:ilicatiiin ta .·,. . ..• .. . insli lfi-ou ditnensiuuat ,corect luc~rile 11i nu·tut Pretins eli ;,t\l~~Bl(f.Jibu\\i .••t:evelutie,nare"iJil.·d~~a.lC!llJJ:ttlttlii~!§tjilltifl~li~iiJjuSJleDBci ~fregu3jie'l~abli~~i-~li'~~~~t~taf~ ~lli()J : ···e! ···. c~,Ji'·~cest ~\lOil~~nt~n~aUit ~Ji8]9~lu(;1tt~,Qi' . . . . nvalonn:a

· '' ~~· .u'eniQltJ~.-.tti.,tit~i~~u:I,•l P~~r .. ~~l~Ig :~JJr;\.~p,:j~~plogia cliuicli romlneascii esteghidaUiinclidupatt,~;e~ba ~t-e;sbiga

• ' ---:;]· ::· ~ ~- • _: 't '

243

;····~"''"''"~' :·::.:':.:... •.• "" ·"·.~··"-"~.:;;:.,. .... '"'-'>"t;,;.";.:_• -"'-"=""'·· .. ....c· ''""''•·;;:_," '"-"' -~···~"'-'- ...... ·=---~-------=-..:....-:~·""'-· ., .. ,,

eel mai rare nu n valorii srji'i1lifice. Probnbil ca'va rrebui sil ~ ' ' ' - . '

a~teptiimun thnp'pfina dind l11tmrile se vor m;eza. SLalele i:le ii\rmmnc au tel\llinta sa-~iaduca lfingliele ~isa lllTlllllWeW (m\mai pan a laim nivelinsala care nu · se sin1t AJl1tmintnti !) iobagi ~~ mu~pronstenumi~e oamentde ~tiiru,a ~i eX!)erti. nu piOfe:.~oni~ti care 't\n .. sunt impvesionat.i de srriilucirea din iannaroc. Cnm &pun~a nn htlTIPI~i~ten :d~-al1.1\·eu.~b:ehllie·a li al}tepili~"l en n noul\ gener1':{ie1•spe~mai madosllt; mni i~riricii fii -rnai at;itoretlexivli. sa njunglffn pftrgbiife de purere ~i sa scllimbe ceva, aducand

normalit.aten ~ dt1menit1. : ·.· .. · . . . _ ... · Revenind la investig~titl nonsh1i-earctfc altfel va:confirma

cele afinuntc t'il'a'i sus .... tez\il£flteTe ob.tinute pli~·annli:ia ba:zelor der;laten&entionnteanterioi•stmtprezcnt.atctn tnbcle5 ~16{pentru dett\lii pi·lvllld aceste reznltn'te ~i ·metod.ologia lor de oh\lnere vezi David ~-i colab •• 2GO:!).

Tnhclul S. Vhiliilitnt~B inh:rna!i~nnla n psil•olngld dfnice l'nnt!ine.~ti . · .

IiQJ!NpA . , ·1 • . . . VJ)..:vizihilitarea di•#ia. s .. a cnlcuhu prin n~tmi1rul !lc artieole puhhc~te de c:lltl'\:1 l\lCJ!1brii ClllCtlreJor de·psihofogie. (fn ftm~tle in2()01) pllnll l1\ .zoo l .Cinclnslv}~ .. llrti~<OI<; HisponibUc pt:-. bllze1e. de date men(ionnfe

VR--'fliibiUtnlea xnp0\1arl1 :1a Teslitael~ catedrelor. Ea »~a cal~ulnt __ tmplh"Jfnd VD Ia Rl}{Bi\l}ll mcmbritor fieclrei caledre de psiho1ogie {in · ftmc(ie ih.nlllll200l} · , • ·

..

-'·: .. ·· .. ·.···•. •· v . . · ~. . .. ~-· , d'rnicl··rom~-\ocascl\ e'::ltc : R .. ez.t.lltate1e .i\t. n·.·.tl\·. ca -ps.~1. 1 .. ' 0 .. logta. .· ~.~ •11 \1nfi. nd c ... ·ont. i.k ,,. ·'·· · . - · · al lucrurcmarcau · . ·. .. .

vi?.ib. i.lii.p¢ pla. I·:I. ·. wterna. t.IOll•. •.. . .. ·t;~.'t?-travel:ZSat\0 perW<ldi\ . .. .-- 'heilogta le-aavn u.... . . . --1 itltetdict}~le'{leca,te ps~ .· .. ·. ·.·• h . ~nelyai, prin publicillu e

·•s·t .. a U· mversttatea B. a e~ · . cOffitlUl .. ' • .· · ,

\ . LECJENQA . : . . . " • .. - llotl1l dt: ottlcol~ 11ublil

,~impnCIUl direcl cttnn~tfie81lt ~nn ~~~;r;e clhre me~'lbti\ cu\elh"~-ea1e ill ~v\ste,_c!Matc1AlP8"?a 16 ~001 l~ri\ .. · .. · ' •. ·· . . .: . ~·· ··. '. 1,

I . de ""iholoJl;o Ci'' 1\lnc.tte tn llnul 2 1 . ,._• \ de nrririule publican~ ar .-- . d. • anfific:at prln .numw" . . . .. . ..,.__

U)ld-impnelul . tTeJ,:• cu ... • f' biil catedn:lpr (le l'sinoiQJl,t~ llu • pllnll· tn 1001 (lltclu!i\") do .dttclS. 'y ~~m u un·fac.IOr de \Jrtpnct nlil.i ntnrc ~il fnnctie~n2®l}inrevlstecotnle . ~tc. . > · ... · .•• .· ...• 1

. l,~ ... · ·.·..••... .. ·. •..• .•. . - ··.. .. · ..•..... ·· .. ·.. e re!lnrse~ E.1 s'-a cntculat 'ill'\pi\1"\l!id _· .. • · .. ·· .-lR'-ialpactulJ&pOrtQt la nt~mnn:i d sibologie (.in func{ieii\'Bn~l2001) ID ... ,. a·,-,"1.1.· llllirultll·c .. mbri. lo. rlja·. ~~tc.IOT·. ep ~·· 1 .. d.·- ·res·. u.;.e El. s-,a c.. alC\Ih\t · ·· • ·· ·- · tlfl numant ·. ... "" - · · ··. · ··.· ·

lRM~impiiC\lt\ mnr,r rt\P,OriD - . . [ted ... \or de psihologle {il' • funC\\U - - . . d ,.D,.II la lnlmi\rnlmembolar en re . . .· .· - • . ! lftlpltr\IU l 1Y• • - · !

fu~) . . !

' . . rest:rllns ele colegi. este cea c:tre, a nutamlui ~1 ale unm •grill? x • .b:li .. ate date.le ararfind d\

. . -~eativ la aeeastn VlZl I u • • contribmt-semnl'' . . · bine dezvoltati\ ihn psihoiogin eli nidi oe la- C\ll~ ~~ c~=ceste ana1i_2.e 1-evisfa tftrli Menponez cl\ la da~ cnn am - t.rnip·e C:reie.r . . ·: .. d ·sn·· te Comlitive din Romama. Co., l\SOCJfttlei e . m, o· ,

245

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Compvmummr, riu. eraJnc;lvsa iu P~YCHOJNFO. Gnrpul.de la GluJ are Lendinta sa publiceJ:ezultatele-~tiinlifice in aceastii ~evjs~ n~a ~afaptul ca psibologiaclirtica delu ~luJnre,~nru mru-e V;i2;i~llitf!l~~interua~onaHifiira ca ea sa fie detennin~ti{d~- · publicatiil~ nute~ilor de la Cluj in revista proprie este un:lucru de ap~E!ciat. Din,. pacate. aceasti,i vizibilitale este redosit dadi. (acell1 co.mparatil cu alt~~psibologii preGux'l.rcea aineri.cari"ii sau · c,hi~ JitllaQdeza (peptru detalii vezl Dav!d ~i cola b .• Z002). ·~entru a c~te yizibllitateapsiho!ogj¢i eUnice rinnlt~1'1Li- este nec~ar~pubUcarea luJ;rarilor in rev~te vi-db He ~i hilluellie tliJl -Ji~eralttrA .~t.iiutH1t1a inte:matiunala .• 'Pn)habH .cit o mfti plara c~ndi\ioilare a Protnoxlltii ncadeniice pe-bam neestui. cri~riu ar d'clt;e;ln o mai ll"llU'e· vizibilitate ~ psif19lrigiei CJinice ro~u&n.e~li P$ scenainternatlomda. . .· . ·... . . >. .· ·.· ·.•· .. ·· .•. ···.·. ·

··A~1aliza factorului.de impat:t M psilullogi.~icllll,i<:eron~~~l~ti arat~i-o, lmng~ue similadi. Fact(:uul de irpp;~c~ .a. Jostlll}'Uizat cL~atl!iU.dlnd numarufde.articole3aulucrad publlc:l,llein ftliviste cotatt:lS!, ~,>i auurne.deditrelnsti~tul pe!llru1nfmmare ~tih;tifidi (I •1stitut.efor Scientifk: lnfomlation~ISIJ.x:te,vi3tele cota.l~·ISI cohstitui~ elita mvistelor~tiin~fice. Sp~ e~e~11plu; Jv1EDEINE

· include .Peste 4 ooo de reviste,- llU-I'S"YCJ-UNFOinj\fx:de qoo~ Cu. toate acestea, ce~cetltilf! re(!f!L~a~ aril.ta~ ca doar 150 do re~isle'acoperiijumatate diu toatf:cltllrile indoJUeQiu~Iun,kfert ·· din ceeaeste·publicatf.Ooxfield, J990; J?96). ~up~us, 2()QOde rev~sle ~coeedi 35%. ~11 toate publi~le ~195% din toate a1t!~o!elt: citate. fiiecare-revista cotatllSI.·.J;tee, .• 9t'lc~lat .. uu faptor de impact, care ~UUn.Uuenta nt:eleli)!Yis!elndotJieqil,l. ilnr~ desprien~ simpla, fe.ctqru.l de imp~ptnl. unei rhviste * se calculeuza imp:irtinlllnull.lar de ci~i {in,tlt:QJii~orU doi anide Ia · publicarea articolelort:itate) pe.£~Je-auprintifin altere-ifiSte toal~ artlcolele publi~ateinrevistaXintr-uuan.Jh numfu"tjl de· artit;ole publicate in revista X pe Parl;ursula~l~~ al). Cen:et,arile au ar. al~tca factorul de impact fi}revisteiesteun bllllprediclor

I .. •· . .. • ....... - . . . :

246

............ ._~~·.•.•r-·.··

··· a1 cit~h·Hor viitqa.re; ale articolelor publicat~ in ace.asUi revislit D~i UnivemitateaBabell-:Bolyai. prinlUeEiirile.autarului. ure celmaimareimpactdiutafii·inpsiliiJ~ogiaclinicahtterua\ionala,·

· psibqlogia clinicli rqmaneaspa ma. est~ ~n jucator hnp?rtant in · ~tiinta internationalii (pe~~t.ru detalii veiiillavid $i colab .• ~002). A~odar. chin.: d.{lcapsi!tologia clinidiromftneascaesle vizihiUi. -P~IJS~le ei nusunt, indi, _cotupetitive Q.i. in oonpecinHi. nn jucam un rot semuificuliv p.e st;ena §tii.nfificaJntemf1tionnfiL ~robabil-

. c:;_ o.s~te~e ~licien~a pen\~~ 11: cre::;te u11pactul psp~ologiei eUnice I()J11BJ1e~ti .pe scenn mter:uatlt:tnaUi.ar fl: · . , .

~ Condi(ionarea promov;,idlor acnd~mice ~e publicatli in rev isle cotate de cli.tr~ISI;

• Alocarea p~ferentiala de J:csJ;tll!e finnnciare ~i granlmi de cerceJ:are celO{ care dej~ ~i-au dc.wedit'competentn prin contribu\li 11tiiutificede valoare iulerna\ionalii(ex. pl.tblicatii in revlste lSl).. Meotionez ~ci un COl: ve AAre ¢utlconsidel" ilusu-ntlv. Un.grantdecen;etare care aJOstcousiclerat excelent ~.'flteslote df (he art" de ditre recenwLii lnternn\lqnaU ~j ctu:e n pdmit fblaJJ\f,lre in~ematiot}ala pentru cirlci a,(li -~ fo:lt lrimis (jnlr-o varianta:adaptnUi pentru R9J,Jl.fi.llif\),.p~ntru nverifica f}i modul_ de alocare a .grnnturilorin \iUii~ la Consiliul Nif\i~nal nl Cel"Ce,tfu ii Stiin~ifice din iuvii\lhl:tfultul Superior (Cl':'fCSIS). A~est gn1.nt a fost evruQnt cu 8~.33.d,e. punc~.dintOO pos~t,ile.11i l(Jcolizal undevain a tloua tteitne ti~n- totalitnt,ea aplic~~fihjt; l'fu mai m~nVon~z.detalint fa.ptul eli aeea.stlldecizie s--a ll1nt ~Jh'n n ~·i :;c .romunica ~melttariUe recen:wrllor(mltcar inTe-LQtnntl)pebn~n eiiroQI. s~a fiieut nceqs'ta. clasifiearf!. practici\ norJualti lu .orice irultituti~ se.doasii car~ oferti foriduri pent.rq cerc~lai:e. :m binc, apeasta juseainna Jie .· ca cdlerillc~ CNCSlS suut ex.Lrem de rJguroi}5C iar receuwt:ii f;lceslora su~t lideri de ~e.tcetare ~n psiholqgic clinidi~i psil~{}patologi~ la.niv.ellnt~laPoa~nl(usll~! ei a\1 Jdentifi8ltptobleme alegranlu11il neiden~cate.de expet1U it)ternati_onali) fte ci alocarearesun;clor de fiiumtnm se face dupa

1<17

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re~ul.l~ ~e1 ~P~~iJ~~ Iogieini~nci i-iJ~dustrip.lc~orgal~i:al\ioi}tiie sul\t adesea iJ~~~.l~?.".~te §i ~valuat~ Pl'idprism~·a~LVJ staudaid~ Sp.re .. ~.xe1nplu; ·ru1-alt~6nd cornpara~v ¥.(llidilf}~a ut1or,instJ:gmebte _ -psihologlceutiU:tat~in domenittl aJJJinfit~Ff~5eiectiE{d~per:. sonal(eK. testul: de ~bllitliticogni tive, i~lervipli~~lructu!~t etc.}

~,i frecventa lordeutilizare inpractidi, Judge(19~J7.)qbs~rva di .In pnlcticilutili.~ren acestorj11strurJ1ente ~pri ~~~gbi(Jatii de acUunide validnre:C:Peficie1ltuJ de comlatiei~tb;e VBlidi~atea lor ~i frec~enta lor dt? ~tilii;are (!~te ~e :- OJ(1'7, ceeu ce in~ennmit u~·matorullu~nt: cucat .l1Ll instt.1lt11~ntpsUtolQgic~tentaiputin vf.W.d. _c~t __ al~.t .f!l __ este mat d~--u~;?:.at. in prncuca psillglogiei n,tu,nicii ... i.ttd\1 s~ial~;.otgtm~'Zll,\~{)Ual~l Chi at•- ntqnci t;ft!Jtl, exista Cfl"Celiiri rlguroase cu implicapi practice, npar p-robleme in p::;ihol:()&ia lll~tu:li-inauslriaUl-'otgoni.zntjntt.nlli_ priviud dise~nimu·enlor (Judge,l997). Este, vorba d6 r.re~erea de Ja dpmelli.l]l~tiinpft~, dJolaborator,ilil'i"actica.Adeseit fin.i'tele decoJt:;u~t.alltu, tltt ~unt ghidat:e de rezullatele cercetlifii:~l.iii1\ifice, ci spmtttumagedlot ceen ~ea~tia.dorese ~iiauilih inptus, ele s~n; ,~fl~·;~o .. ·founat6 dit.LJ,teprofeSioui~tl·in _psiliol(Jgie,oferind sci,ni<:if d~a:;i~t~htltpsihologica ciupa un·eurs de c~teyd:luni! ~\~ desic ( veuClutrcb~ 1;991 peulnl detnl~}c~zulclisculat in -"faUS~reeqournai, in 1~97, care a aram~cli·'o frrma iJ11p6rtaota d,~. t;QnsllJ tall\~ psihalogicii-diniSl.JA aspus e~act a eel~~ luctu la: Z4. de coropanU n1ari, diagnosticfutd acelea;d prollh~me ~i S\lgerthuLaceJe~i stfategji de"modj.fic~b;ellf1 phtS, Jn~een ce

. prive:;te pr~gt'al).lele de ·u·ainlng ~ferite de dif~~ite.fh:t~ de ccin~tiltimta~·rareoifele suut validate :;tiiutific~ 111iji ;ties ·atunci di.)Jl{ ele suntofedte de profesio~~U:flira o-pt·egaJirep~_illologid\ _ (1 ~dge,l997;Pj tadtr, 2000): S~ pare C<~adesen tuulfi. angruati ai unor firme deconsultanta n\l Sut\l:interes~\1 in a consjdern r4uJ Uttele oferi~ de ~visl.~le :jt~npfiC(! de sp~j£llilate, ofelind 1nai deghtba servidi care se vaod ~i nu cat"{:.~unt valjda.te~[jintific (Church, 1997; Pltariu, 2000). A!ia cum sugereaza uut?tii de

2.50

in1pactiti doriieniu (ex. Church, l997;Guioll. 2000; ,Judge, 1997; Klimos.ki, 1997; Latha~n. 1997) suntn~cesare!' ·

(1) spotiren numfuu.luh:le ore tle.IJ·ainiJlg ln·cer~etare in ~druJ prograxuelor de fonnare itt psiholagia Jfi\mcii-in"us\i"iala-· organizatiouaUi;

.• (~lo ma.i buna diseminare a rdulta.t~l<Jr .exlstenle ln · cercetarea fun~arimntala ~i. aplicatii dbl.piihQlogia muo.ciib)dustrlala-o~ganiza\ionalli;f.. ·

(3) promovarea i.tt.aceste s~:~tv.icii n profesimtiQtilor .ct.• f'?nnare in domeniul psiltolo~ic. ei p.uUtnd aduce. ltll pi u.s de rigoare ~i prncticii vnliduti \ltHn\ific lll domeuiu. _ .•. _ . . .· ·

Un_obslacol in"!(JQrt~n-t pecare··stud!ifc lJtiiUtlfice in pslllolo~ia_an\,ncii .. hld\~~-Jall"'9tgt\Lli't.a\ionali ttebui~.sl\-1 trendi 3C. rr;fer~ la ctiterille de eUc~eiJtii folosite. Acles~-i, qcensu\

· efici~u\i\ este evnluatii prin u~illtalea uxp1irn~tll lu b~nt (l..uw. _1995).-~acum·in psihologia.cUr~icthte in~reseaza redu~ereu simptomelor . pacientu1ui, in. psibologla nnn~cii-iudustl'ialliorgoniz;atlqnnUi adese(l nelnterese~2Sa ditect redueeren plerderilor ~.l c~~lerea veniturilor en unnare.ttiuterventiilor psibologke.l\c~tcr.iterh.t e8tetnsa=vnul.:kt~m deprag.malic ceea ce J.te pQ~tleJndepiirla un~oride angajw:nefi.lttl ~liintHic. Sa nigutneJ)tatnacestlucru~ ·

•lnteiventiile de psihologia lm.lnfH7lu.dustdaU\organiza{ionalii uu :vizeazli dir~ct cr~.terea -venituri\or ci e'e -yizenza modificarea mmr .factor I" p~ilJo-sociali(eJJ'• Sfl.tisfactia in muucli, a~tocontrolul emotiih:n·!uegnU-ve), modifica}'e cll{e apoi poate induce cr~terea ve.niltlrUo.r. Ei bine, ~l)nf1contde ocest lucru, \lll program de interven'i~ care duce ~tfello c[t:t:lereu venitnrilOCJlU ppate fi asunmt automat cafii11d -::auzfi a acelej cr~~ri- Altfelsp~s. dacliA(pr~gran;tulde ittt~Jventie) cauzet1zn 13_(i~blcJnatiitirea comunieariiintte atigaja\i),iar.H cauzeaza C (cl~le.rea veniturilor fmnei) ~m putem fi siguri di A cauz.eaza

2.5!

C~ este p~s!hil ca intre A ~i C siifi interveniL alti factori (e~. .fluehlat.iile pietei) GAreau dusJtt aparitia luiC.

· .. Chiar 1Ji. -~·- conditiHe !n care programul de interventie ·este ea.uzil~llistaUi a_modifidhilor in veniruri (cauza proximalii fiind factorii psibologici modifiCD{i de programtihkinlclVentie), acensr~ nn fn~~n·ll\nlt.nnromnl eii teorin ~~ madelulteoretic care ao gPP~.I"i\t acestpt"~grtnn d_e inteaventie aunt.corecte. tn principiu. pc.nmtn:eas~ ~ficient! p_ot fi n~gajato o. ~nfini£ate•de explicatii

. pruJ~ole~'ce -~- de,~lode~~teQr~tlce• A~adar. daclt robd6lulteoretic nn este vnlidat scpa1:at fatlide ef'ieiental\li pragmnticn se proclnc m~medsme.indusrrial~-organiza(ionale!

·; ~Tt•.vreau.-sa exager~z sugeriiqil ca 1ri prociica psihologiei ~nul~c~l:utdnstdole-:owgttnizatiotra1~ nusu~t pf()gl'ame. de trn hlmgJv.aliQ8.~1! ~nu eli nu se Incearcli _ promovarea unoraspecre vahi!at~ fjluntific (f?etltnrastfelde pl'Ogutll)e veziBriner. 2000)~ ~fi~1 doar, nlhturi de ~lti autorJ (ox. Briner. 2000;·Chureh. 1997; JudlJe, ,1997}, ca acest nngnjament nu esto inca. dominant in donteniu~ fn plu:t,cred eM psihalogiei .muncii;industriule~ or.g~uizutionale tl va fi mult nuti gren ca p$ibologiei eUnice sa realize~ un model de pn1ctica vatidaUi ·~ciinpfic;din cauza fa_ptulnt clj.d~meniul incaret~desfli~oarli ocli~i~ten -industrullleconon1!C - e.ste gJlidat de principiuFprofltUlui nu de principiul v~liditiipi·ftiinpfice. De~i adesea aceste dbu~c1·ite,-ii por sl1 m.eargl}mprcuna~ tot la .fol de bine · ele por d. nu se · intalneascit . · •

~i~i i~ ceea ~-~-- p~·ive$re Pfibi!!loQia eduo.s(ii:Mlnlli-~calnr~ . hl~nmlr~~tsta•, __ rmu bn)e. :Prin.~piul ful)darucnral in domcniul .educa!I~J. __ m ~e_eJl c~ priv~~teinstituiren \mei _curricule .ednl!~ti011ale e~te atlttSea recun~terea ei de clttre·divf!.tStifomri stntalc {ex. ¥inisterul E4ucntiei).,Rnreori stabiUrel1 unei cnrticule ~u~~t~9n~le sefna~.!le t::.a~a unor studji .care sa arine-ciflcien{a '1 ele1 C\~rrmule,·efictenta·tUprim&tltin VQlumtd;de cuno~tinte Lledafi\Hve san procednt-.ale asimil.ate san in lll'[i indicato~-i

·-·· rekvhnti. Peotru i\ arguruentil ~ele.Sl1USe aici, men tione~ca abi a recen~ Cons.iliitl Ct!rc~tlitiiNJ\ponale (t-lnrionalReseru·ch «1on)leil)'i11 :S-rJA ~iAI];e~tin.deFormar~ &llrof€8orilor{Teacherrrainmg Agency) mlvb~a.Br't~ni~. qrganiZil\iile celamniimpor~anle car~ se ocur)a cu fomlim~a.profesodlorpentrn inviitiimfintul pte?l)iv~sita~~;· ~~ afirm~t oil. est{} -Hflilf!Sara pcomovaron! · unei e:duCllpi 'Valid~fe ~Jiin{;i.Jle (eyi~enGe~b.nsedccj~tc~tion; EaE~ dnpa ~ nwdelul_med\cinei 'ialioarc~~inpfie(BBM)(WillinskY.2001 ). Di.; ttou_ nmintescd\ o psihol()gle e{lp~l}~ona1a-$CO~~a y,alid~ttti ~tiintific-tl-ehuiesliinvestigl1c~ntdtefit:jen.t~_pr(lw'ftmult1ip~ptls, cfit ~~;vnliditatea re()rieisau amQ(Jelul~i r~oretic cun~l-~1ge~era1, -

.. tJltfe! vom produce mes-me'risme ednca~Julle.:~cola!'"e nprpbate

de Guveml _ _ __ .•. -.... _. ... . _ _ _ ___ . __ . __ . ... • -i ... _ . __ . _:; Yn.poncluzle •. d~i·t'a~urileaplicnte ale.psihol()gi7ipu au

.. fosr,biA).odatijJ1.tpte de.ce~tare. ele 8\I\lnele Piublenle,.~enrru a(!eslea. cereetarenfundatml1taHtdinpsiti~!Ggiea fqst meren o snni~ de cn~o~_tin{e" Yn plus.-pen:etnre~ aplicptli ~ni~i~t~d_i~pct in .n~te dp1flenii ~i-a adus prortriul apon-lallagnjul,tforcttico-

. a11licnn v. Din plicate insli ncestnucleu satilHes a fostcon.ralttinat · . de sf~mdardele domaninlui.tn-care llC"estuaiscipline f~(!{io~e~z~. · Psi~ioJogia clinic~. umnatjnd mpdelul medicinei.~-a fgchlizal pe.efi~ienta pr~gram~orde -interventie at:eastad~clind ~1neori laigfiOf~ren ;v~tU£11\rii mt}d~l~lorteore,oee.· _lVIi>J~n!ea m~dicinei validat~ s;tiintific (evil.leoe.e:b~sedmediciue; EBM}es~e rrisli uu suport s~r~~s p~n~t·ilezvoltarea acestui nucleu ri~rbs in psi,1olotHa cljnic~.,"ViiroruJ,Ii'areroai·putindal·.penh~•celelalre

· d~liirni~B.le psU\olpgiei ~plic~tte.Ps!bologianmncii-indt~st'~iulam:g~uizatil)hala_aft:~st•~e p~;re contamjnarli_·-r:lestand.ardttl ••yti1deriiproclu~wui~j profi('-ceea cea dl}S nu doar htignorarea t1rlor.mo~~l~ ... tt!Qf~tfce.yi ~iJa p~omovaren'nneoria 1unor. prdceduri cnr~llUauvapditata ~tiintifjca. Din pacatedo~eniu t industrialleconofi)1c nu par,e pib~i s.cl1imbe shmdardu l :Qi sa promoveze o prncticli· industrialn validara §tiin{ific" A~at1ar. o

253

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m~cnre pen tnt ·a psihologie a muncji-induslliata-organiz.ationaUt. vulidati\ 17tiin~ific ( eVidetice-based-Y'()t\ifln.dustl~nl/Qrgtltl~Uon psycb.olggy~}~fJ:WlOPJ_ trebule sit vil1~~hiat'~~·la~H!~#1t!niu al psibolqgi~i~ -?sU10 logia clinicl\ poate s~ fie l~tf ~lpdelpeJ:(fit! o astretde'iM~\:lare. d~i trebwereounqscut yapr~durn-~riiUHlor clioicec"Pn-tt~late. {RGl) trebuie sall~modifi~ntlpentni a .pu~ea n aplicaflitlmn,eniU1ui industrial~org~lizatlbll~l(e~. ~te ~nai greu in acestdomeniu s.a cbnstruim e~anlioaue ~chivaleHt~ peutru studiu). Siniilar, psibolbgi&.eaue~~i~.JttaJ,a-~coladt a Jost · cotitaminaUi.de standardl11.'deqiz.~ei prin:v9f'.~teaclevlitatcii adesea ea aincetMt'sn.p.t'otnov~z.e l11Q~ele.deintervenpebaute

, pe teoriif~ndatneil~u.e·~tiintiticptinsercetarea din psihologie I (Willinsky, 2{)021 ). darr~ori 11 te&!atempiric(l) va(jditntea i. nce.'ltl)l" ~Odf!le .teor~c~ apli~at~ tliiecl coJ~textului ~dtrcational ··.sau(2Jt;~~ieuJa.pteooedUJ;Uorde.inLervett\ie/¢wn1su.lael.abol'ate 'pe1Jaza·aces~o.r J~odele. ·Din fadcilte, in:educafie au ap5rtt~ voci (WilUnslcy, 2001) ca,reprQmovearJi o eduentie validatli~tiiu\ific (evid~nce-based edltcation; EBJ.!) dttpliJuodelulmedicineivali~ dnl.f?. ~tiio\ifie (EBIVJ). in consecitlta. psihologia educational;ii.. . ~co{m·a. va putea: beneficia de enetgia acestui n?u valdin ~om~ul-e:c.tuca~i.ei.~-trebuieiusli gij fie aMchi~~aceslei,lnl~cB.ri ~i gnl& a se nfln pe vaL. altfel va :ft inecat!\. :Sumarizftud, exista ~a11:;e mru-i en _prdu~nd modelul psihologiei olinice, 58. asistlim, ju vHtorul aproplat, la un 1mtdel generaliz;at de p~·acticli psiholqgidi vlllidati\ ~tlJntifit:: (evidenee-bnsed. psycbologlcal J;rnctke; EBPP). Aceasta esle pn;wocarea care stli}n fntu g~nera\iei actuale de cercetatori :'li pr-nclicieoi din psibologie ~i care da acestei genera~ii posibilltalea sa redefiueascl.\ prof~ia de psiholog :;;i modul in care se va.fa.ce psjh.ologie. Ti1llpuJ va al·ala t;at de- blne am utilizat aceasta ~ansiL Sigur; exis~1 po:;;ibllilatea r.a argmmmtlim di, pentru anumite disci.plioe a plicate ale psihologiei, modeluluneipractici validate l}tiiupfic nupoatefunctioua di11 cauzu parliculadliililor dome.uiului. D~i

254

ou cred ace.stlucru (ma baz.ez c{md fac acen~La .nfirn1a\ie pe . ltlOde\ele- deja· ex.istente de practica validati'i. ~tiin\i ri~:~ln loate domeniile psibologie1;d~iele nusunt intotO.enuna dowinante) . pute111 acc~ptadtexisutun.demel'salt~mati-v •.. tn.aces.tcaz~nsU. pentru a nu fi ipoqriti, .trebuie sa nu mai-ptelindt:lq .c.i\ practi~~n · nonstJ.·a este :validata .~tlinf.ific. En este nl.Jfel •. con~ormii cu . detne,rsul altematlv. oricnrear fi el.

f.

. CAPll'OL\Jl.. 8 RElviARO FINALFlSAUUN~OUiNCEPliT

. Am njuns !li la capatul acestei analize edUce a psiho~ patologiei en ~tiinta. Ce at!l rem1it si\ Wfiit pe JlO£CUT$ul acestei lucrari7 . .. . • _ . .· . . . . ,

, (l)Ca psihopatologii atlprobleme cu si~(emul Jorde d_mg-noslic ~ide evaluare tlini.d1; mai nnJlt. am ~tatat\;t\ p~-ofe."Jiun~tji mai e.l{perimentap nu stlllt ~'" performw.tO ~cc6.lpr~f~ionh:Ui mai pu~in ex.perimettta\l in a face. ppedJctii asttprn comportamentelorst.ibiet;tilg.rum~rl; . . _ · . . _ .

(2} ca. intetventiUe ~i trawmentele utillzate mpsdmpalo[ogte sunt de o ~ficientll indoie~nica l}i elt .adesea .perf.ortunuta pi:u:Bp1-ofesioni~tUor este identi~ c;u ceo. a pl"'!~iolli!ililor; tn jJI\Is, psihopatologii uti sunt mai feLiciti a au mni saniitoi;i dJll. pu11i::Ldc vedei-e·mentnl decllt restul populaU.eli ·

· (3) Ca -cercelarea flkuHi:de p~l~oRatologi e.o;te adese-a distorsiouata. condusa de iuterese socio-ecunomice :?i ,_mem·i chiar de fraud a; - . . . . - .

(4)Camo!lalilaten de thdnlng~ifprt~a.retudome&~lll efJ~ una dep~itM, defensiva ~i ca ~xperienta cJJIJldi Ill~ ducc Ul mod obligatoriu l~ exJ?erUza lii_performa.t:t\a. ·

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- · . ·• · Here we are at the end of our critical analysis of psychopathology a~ scienc~, at;tal.Ysis bt!sedonour. e;o;.te"usiv~ revieW of nv?ilabl? da~a ~nd oru{iri d~sum!uariz.edittp,nwious books ottUus top1c (Beul:ler8l;_Malik,2oo~~~Ja\Ye&i 1.9~(); ~iijenfeld et.at~ 2003; Pnm&Rpss, Ji?9S)~ "\tVboXnretlle.gpints we man• aged to mal<:e tbroughoutthis paper7 · · ·'

( 1 J P~?ycbopaUu7log!s~ encounter PJ:o~lelns with their di· ~g11osis _u,nq clit~ical"eyj]_lyalion. S,Ylit~u; l~o~ver .. we have showu thatprofessionals are not better t~~~,P~Qft!~:d~nals at 1~mking predlction~ llb~!Jt·b\lJnan subj~ctSbeha"lJot, bnsed ou the cJinicallillalYs~ they perfonu; ·• .··. · · · ,

.(2) Tbe ~trqetilS a11cl flte ioterveut,iriqs tis~~ in psycbopatJjology ~ oft~n of questi().ll.fl:ble eJf.u.U~mcy 311dfrequehtly .the pt.:r(Ofl1)anceofparav.I;qf~siou~is identiCilltcitbat of pro· f~sionals;Jn 11ddition. psyr,:bop{ttholggis.br are uot.hs.ppier or mentnl1Y bellllhie[" thau the rest oftbepopulatiou; ·;

(3) TI1e re~eareh performed by psychop.ntlto~9gists ls of. ten distorted, driven by.socio ... ecormmical.iiiletesis and, some· limes, even a fraud;

. (4) The methods of trainii1g i·n this area at'e_ obsolete, de~ f~n.sive,_wbile.cUnical e~q;u~riencedo~·nolnece.'is~ily lead to performance ~nd expertise.

Despite U1e5~ limitations~ that must he consi~eced reflectively and constructively and uot by ignorantly denying psychopathology as science which. fosters wilhdrn\.val and a de~ ~:rensive attiludefrom ps)rchopathology. 1hereisa •'beallby'' nnd rtgorous core represented by lhe coguiHve.:.behavioraland the

. 253

,:

biomedicalaJ_Jproacbes reliJ.IilcdundertlJeevldence;-bascd mcui~cine (EBM) paradignt• ortnore gene~lly the evidence~ based

. pr~~tice (EBP). Witho!lt h~ing perfect (tlley toQ'ba:v_e been cdti-. ciz~cl i~tiilsbookl), lhese 'new p~adi~~~~S•""-E)3M. and EB p - · promote 11 ntore open aud_lc~s tlef~nsive ~pptu3.cli,. e~pt~ted

. <IS:

(1) Evidence .. based iJiago9sis nnd.clluicru eV:al\\atinn using rigorously -valldate.d psy.Jhological.instrumeni:S <ntd 1abora-. tory tests; . . . • '

(2).Evldence-,ba;;C:dinterventlons; alfttiou~bprC,moUng.experifuentalresults incongruelitwilhsystetn ~yths_and ellpecht-· tioJlB proves. still difficult (see the ense of psychophanuacology (ield); · ·

{3) .Basic antl applied resea._-¢b condt.tcled dg~nvW!Iy. -jn , ·accottlan~withthe ~datnentnlprindpl.e$ ~fsc1entifit: researclt f methodology adapted to the clinical S~lting;

(4) FLexible trainlng programs, scjen\ificalty validated aud adapted to the requireJnents tJf a couthtuou.c;lychauging profes-

. sional domain. . , · TI1e evolution of psychopatllOlogy as science r.ests on the . de\•elopment of tll.iti rlgoro\ls lln:oretlcal and metbodologic;al cote and the coumge to promote it. For eiaruple,lwouid be pleased

) to &ee Sig_mund Freud listed in tbe historical references sectlo!t . ofthe current books on psycltopalltology, itiStead ofthe curreut ·trends aection. Honestly aud scientifically speaking, without emotional biaseS, in the era of evid~uce-basetl litedicine mul

.;evidence-based pl-nctice, Sigmund F-reud's place is iu \be hls- . tory chnpte£5 or, at IJie most. nuder the probably efficacious

1npproa~hes section.lt is a tnisforlunate habit of the pm;~l9 be.ginlhe theoretical approaches section in altnqst eyery boo}~ of _

'" · ·Jisychopalbology witb Sigmundlitaurs psy~lioiliaiysis,,iu tl1e lack of data (see Appendix 1-the list of evig~ncc-based psyF-hotberapies) to support the scientific basis pf most ofl.hisa~•-

. ~

proucll {see also the f;fiSe Of Other dynamic-p~ychOi!Oalytical and humtu1istic-existentialapflmacJles ). On,()e. othttrl1aqd ,. if I nlll. mislaldng aud.thetimasupporting the yalic}ityo~ Sigmund Fren£1.•slheo_riesdo e~st:,tl}llY are extremely well hidden and guarded by·th~ii proponents. This does not mean thatmnny of Sigmund Freud•s thc.s('!S (oro~ otherdynamic-psychoaoalytical and hnmanistic-existentialapproaches).couldnotbe confirmed 8~lentifi~ally. bttl: we·nn.sthave fl1e CCJurageto say thnt Until now most of thern have not been confirmed (they wer(} djscontirn1ed or wejtl~L lack sb.tdies about them) and that psy- · choau:nl.yal~ proved to be just al}.htter~ting_.story. If tlterlgorou~ c(lrc cop~q.nted by~ cognitive-:b~l1a"'ioraland the biomedical approaches reunited under evidence-based ntedicine.is suffo~nted:by>tbe pset)doscientifi~ practices described. in this boo~ and t~l&:: •• lack of C?'uage to dispose o~ pastha.bits, psychopathology wdl probably end np an inpatient of history.

I. • ~

.,

.. 260

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f;er~ky •• A~ Qi Kahn~man, D. (1,973).Av.lilnbi1ity<·A hcut rlslit. f~rj~dging fre..11iency and probabllity. CqgnitivePs..rcJwli

OCIJ'• ,5: '207 .. 232.. .. . .. . . . . . ... · . . . ( "' · Udolf. R. {19&!}. llilnc!book of h.rpnosis f& pr9fe.ssWJli-

aJg. 'Jan Nosuaud: New Yolk. . . . . ....... . . . . . .·. . . .. ~·· .... i USDJ-lHS ( 1999). !lifQ"J/sl heillt/l.'A.Ti!Jl~·r o~ lh~sr~getJ~

.b~tmd·~Xt;.cplil~esummazy.Rockville.MD; O.S.Depn~tn1e~t of Health a.mll:luman servic~s~.S\ll!lstance Abuse 11nd t\llenl:l!-l Health-Services Hf?~ltll. Nati"o"[lal InstitutFoiMontitl Healtll. j

Wak.efie!c\. J.St. {l998)_:('heD~M~s tlleory.;neqtralnos'1-lalgy1s'sci.soliti~flll}{ ~~grc:ssive: R~~P~~se t()·FolleUe an~ Hm 1ts . (199ti). ~ownni~fCansu/tingand ClinJcnl Psyahplogy. ~. 84~-·852. .: ·. ..•... . .·. . ..... ·· .· ..... / • . . . I

. • •.. _; ,;Wakefieh:IJ 1~9~ (1999rgh1I():,;ophy ofsqwnc~ an!i 11~~ pr?-~res~iJeness or"the DSNI:"s tlieQcy_..m~~ltml no!iology:·Respons: to Follette and Houts. Parll. BchovJarResenrchandTlli!£.'1J)J •

I

37. 963-999.. . . . ·· ...... · . ·. . .. . .'. · ... ! Waktl~.eld. J.C.(l9~9a). E:volt)tionary vei"sus. prq~otYL1e

~nalyses of rhe concept of disorder. Journal ot'.4bJ10rJl1111 p~,, ... chdlokf~ .3.374-399. .· .. ·.. . . · . ·. . . . ·:

Wampald, B.E .. ~· CQlab. q~97} . .A.111era_ana~y:ns _·af or.~-come t;tudies comparing b~na .flde psychorhe:rnp1es: .. B.~1}PWcally, ~·.Allml1St have pri1:es:·- Psychalogical.Bullctin, 3, 2lY~-215 :_ . . . . . . . . . ( \ i

·. Wn£so~, D.!fiClark.l..~A.. (1997) .. Th~ ~ne1wo~ern~nL a~d mism¢asurementofmood:. ~ecnrrentand.cmerg~n.t~ssue,s. lot~--.naJo{Pm-sonsBtyA$stl9s.oltmt. 116.261-~96. · · · _.· ........ ·•.·. ·. : . i

·:: Wa:mon,D, ~~Pennebaker, J. (1989). Health co~npln~nts, stressi and dis[(ess: Exploring the cenrrnlTolc of negnt1v~ 1)l'fec-

tiviw~·Psyehologicn1Review • .96. 465-49,0. . .. ···.·· . ... .. , .. ·.. >Watson, D. ~i 'feUegen;·A.(1985).Towi\rdn~on~~~stla\ srrucn\reof mbod. P.~choloJ!icnl Bulletin, 2. 2"19:.~135.. I

281

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. Watsou. M. =si colab. (1999). Influence of psy~l_19~~gical resrioris~~~if survi~aJ iri breru:t c~mcer: a poimlalj~~['{jfised co-hod st-u{,ly:-.GriJcet, 354, 1331-1336. ·· ... --~;; ,: .. :.

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• Williams, RB. ~i oolab. (1'992)". P~o~uostit importance of sod.al and economic tesollrces amohgtnedic::aUy tteat~d patieuw wiLJt angiographically documl?nled t:oJ:Qnary artery disease . fA1VA. 267. 520-524.

·Williams, R. B. lli Schneicleimau, N~ (2002j. Resolved: Psyfbosocial interventions cau im~tove clinical outcomes iu

i org*nic disease (Pro). PsychOSO!D. ft{ecf.7 04,.5:)2-531. ' Willinsky, 1. (2.00 J). Bxte~tdiilg tlle·pr(}&pecw Qf e'lidence

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5c!Jach 7 Science COIJ.Ii'OIJC$-tlJe conlmvessi~J iJJkblot ~t Wiley: New York. •

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ANEXE .

ANEXA 1. Lis'rA 'I'ltA:t:AMENTEL(m

PS~O'rERA.PEUTlCBEly ALIDATE~~'IDN'flFl€ ~I lNS1'ROCfiUNl DE UTILlZARJJ: A LOR.

Copyright-ul penttu aces_le jr,rom1a\ii (~Ude pe bnz.n ~ote1or disrronibile 11Anll in 20tll) opar(incs Asocia(iei Paihologllor Amerj_c::pni -AP A - (fmpY/.www.lfPa.OJ]l).lnformatiUe APA n\i fo11titrtbogll\ite cu clnriridlri :::d e:xplicntil ale. auian•lui. Mulltrlll.esc domnlfonre( p~IJr(l(og Bluncu Mocsvei penlru ~utorul dat Ia pregiiLi~ uceeteianexe. I

Terapiile inditate peutru fiecare tulbur~i:e prezentaUi mai jos au fost evaluate, din punctul d~ vedere n1 eflcieo(ei lor, cou.fonu unor stimditrde 11tiiutifice rigtlro21se. Pacientii · iitclusl tn aceste·studii, care au fost ltBtatlcu tehniciletnetlUonate tn aeet\SU:\ aitexii {1) au avutre~ultau:i mai bttne dedit pac~enVJcare·uu au . ·I primi t nic:i un fel de tel'apie, sau _(2) au~a:vtit remltnte eel pu{in la fel de bune en-pacientfi tratati ~u «l altli~ronrii de torapie cares- "'t

h doveditdeja eficientii. 'thrnpUle lunb: tu discutie fli-nu tfoyedit eflcienta in mai multe studii (eel putiJl dona pentru a fi uuu:uteterapii validate ~tiinptic- :,i eel pu!ln unul pentru it fi.fluntite - · Lerapii probabil eficilmte-), t:eali4u.te de iuai mrnte echipe de cercet:Uori din centre de cercetare dife.tite. in plbs, acesle iuterventii tenipeutice sum descrise delaliat 'in uumtiale de tratanient. care pot .fi folosite de alti lerapeuU inlr-.!_JIJ mod simi- ·

'- lru=, pentru pacie.nti preieuta:nd acel<i11Hip dep~f?.leiite. · · · · Majoritalea ternpi_ilor luate in discutie, ~~- .!p~i: evaltlate

·· folosiml un anunut tip de studiu ~liintific -·:3(i1iliUe cliuice

283

· controlate (randomized clinical trial; R.Cl). Accsfea suhtfolosite in mocl curenttn miUorit-atea rnvestiga{iilorpentru a ·detem1ina cnre re~-apii sunt eficiente pennu o anumiti £ulburnre. Intr:..un sl'udiu slinic contralat. pacienfii afectati de o anumitii tulbufllt-e

{ex.. depresie majori\}$1.11il d~$ti-ibuiti randomizatinrr-una dinrre grnpele afcrcflte terapiilor ~.hate. sub investiga{ie {a. tempie ·tnterpCl"S~~~ tf?rnm~~~~lifq:¥lh.~l\~~Ul~~-~~je antidepresivn) ~i In tntplil~~·T!antrol.'(~x:!J]\l ~~ .. ~a · •.. t..primesc un ~~~~~~Mtt~UtliUa!ili.P~lW-1d161ut¥b:Btlt. • . WI!Hlo). Modul de nfe.g~\;~a ~i~t}~~l!lii;!~litll)\i:·~~1~fllttmfailtt$'el mni inatr grad posibU (a~ ~i~mplii;·rratnnlentele s~mt de;ac~epf}i d~mrii, oferite. !!f te ti:, v• !Ji·.~~~perie~tfio e't'd1)!tpe~tru" a se .. ·ClJ ~· .. · ·. . . ;~l~kcl\~fJE~ixp~~ndi canstii

e." .#~~~~~-~:: ... ml'" E'laltl~ eficienfeiijceg[i,i'toi-rhecle't~~pie~~a fli.::t~;·dupli

criterli $1liif\tifice strict de~ina.~·~te:al).ll)~ttn f!~nsiderat·e ~;''~, .. ,;~,~ateJ1i'~~tecil'Yl;Y'rt'''nu,:~&~~'~!n.~tP~~:ria~~i~~~~~Mliiteril~ · ~~':ti~!lti~mt~~.opiiHite'•wr~rn~~~r~~r; }~~&.m"lill~,~~lf\ !5it•dii

!l~~~!lfF.Q~!f.letiau,dt-iff:C:'s.~~~e.~~~n'' :t~'f#~~'~i, ...• , ·· ~~ui,t:on:.~~lz;'~~"~:r:sDntd~'oU\tfb.ut~!fn'liindiile ate1it 'Cli t11t~ .~fera .;f~~~!:( .... . ~~lifO~nfir·il~&pre~fiei~ft.\;p'S~.i&i i~i, ,,;,, · • ... ~ ·\I~. ..t~iA~'~&J!tl\l~:f~~te'i;urr~~clt~ae:~· ...... ~~!?~~ vor

~~"~Jl~ntirei».~lf~ tf\'tii:jq~~ '~~ '~jlili\s Mest i\tc<u ~e .. ,, ,,.$!, . .A~:~~pt~ll\~'· ~'~JI~ea~tf'#~ati fost~gy~#i~F~".i~~fludii

, ,., : s~l~~~~1pttrMtlpifnier~tf mtmjiiJrillfl~n(i!ri~~~'{~)ii;eutin , .• ;(:OO~i!\qJ ~~~,~1~~ s-a1:'fil''ttb\re~t,in~t.ici~li(e·I~ii. (lti,oxitiai<e:

ddc=~~~~~~·(.: .. ::fi~ . ":'!.' •. :!~Hi~ ~~Ji1J~uifostfriell in~~'!lt~tt!:$~nr}jii~~,~~X~~~~~Ei~n1e

·, .. , .•. t,o,~llf~r.lq,.a~teqJndi~lfest~ recilm~~darcapn~e~~f~isbUGlle '· ··' 6i'ti~£~of~~~p~u1~llnd.\a~t~t;rttfun-,entecate'~~~t1Adti{;e(}it ·

· ~Rifltl~lli~~a fa ~a~-atf ut.otS'kldiidontrofate~ o~fil\,,nici mjicar

284

~ ;~ii.W,.$,~~~~~#i~ll.,._,.~~.~ l{l ·· pacu~ntu~ .A~i\iiar, dac~;~n~lll~ltlt.£e;::h·A~~n~ r.~e,•dllM~ld;re

~J~~.~~~ · · · · .. · ;f~J()sjrea,qngt•alt~~~arclrri ia~. , .• ... ,ta )l~t. ;;tJqs~ fn~iitev~ltil.ftJ~m~~':I·-tm

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·tiJn ltJ~ . '·· ·i,pa~t~t:[anQn'i~'bSre~~~~;(;.~lf.~;r;; .·.···.··.·· · · c~a$•.mb ·· · ···''l'tel1cie rei

''sa he ~.r·eJ~.h.h

· ·. atunci se lltilizef\ZI interven ... 2ti~fl''. ltt~'chr;

':::~~r!tl=:~~~f: ,:1,.,:, !,C\}n!i~~fn~un·,stl1dft:r~··l1tl~~rautenz~ ci1 aces{l\ vq..fi'Jl;t>~i. He ·' ;eficiefit perttm oticnro dintr~ iPel'.soanelo. chl~'se'r'p·r~~#tit Ita

.fl.Sihoternpie~.Pentru ~ ~ stabili duca acest\Jcm esre san niMnlu~il tn cr.znlopei UJlumire,persoane. este recomantlat en rer~pcn~ul ·}n. colabor!lte eu ·•· P.aci7mul: (1) ·sa. i-7i stal-,Ueasc~ (ll)~ei,U)•e .terapeuti~clar~i (~·Sa . .stal:lflensca dil1ttinre cum V()r ievaU.a ptogttselt ·flicure in ating~ea.scoBuulor; ·(3) sa monirht·ize~e a~ntprogresele im·~gj~trate ~i (4) sli fadi modi Iicari rnl p.hml•l l}e trammthtc.find,qpnstata Cantl Sff inregistreaza pro!ve:.;ele sconrare. ·. · ; \

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1~ Agol'ajobia fl tulburarea tle ttlac tlc p;Lnicij Atamuile de panica· se caracrer!zeazi prin dec.lan~area

bmsdi a unor episoade detonma intensa.1nsopta de mai mulle simprome· fiziologice en: pnlpitatii. · tahicardie, tremuditnri, tcanspira{U; senzafie de sufocare, durefi. de piept, great a ~i dured nbdominale_. t:~zatie de ame[eilla lli l~in,.dificultati respiratorii. frisonne sau puseuri de clildur~: fn cutsul \lnUi atac de panidi, por apare frecvent renma£)e moartc .!iilsau pienJerea conrroluluL De reguUi. in primelc empc nl~-lnstal~rii tu1B\lrl1rii aracurile de panicii !iC d~lanfieazii_spo.ntjlil. Ulterior.-acesten pot fi insotite de evititrea agorafohlcil Persoanele cu .atac de panicii se tom nneod slt meargl·tn locuri unde le-ilrfi.grou sau m~inos sliobfinli ujntot· sau de unde arfi dificil sll se reintoarcli acasli. in cazul in care or· avea_tlfi atac de pnniciL Evirarcn daro~-atit faicii fa(il de posibilc ntncuri de paqioa se nume~te agomfobie. Situntiile f-recvent evitate inclod: m2}gazinele aglomerate, staU1lla rfind, cpndnsnl maljiQ.ii. folosirea lifcului, restaurantt!:le, Wsericile san d~J:1ilrtnrea de casa. .

Tcrapiile dovedh:e clar n fi eficientc in trntarea agqrafobiei inc)ud: (1) terapia co~itiv-comportaJ!lentalii vi (2} terapin .comport~mental!l prin ~hnica expunerii. De asemen~a. el(,ista lJ!lel~ date care arati.cii troining-'nl de comup1care inpuplu poate cre~teeficieuta expunerli in trat&Jlll!lli:Ul agonrfobiei. Temp in cen mai e.fici~ntli in ~o:tarea atncului de panicii s-a dovedit a 11 terapift

. cognitiV-CQmp~rta~eqtaU[ ,E.xisUi fji date care sugereazii c!i rcla~a1·ea -aplicatii ar putea fi nJiUi tn tratamemul atacnlui de

· pantca. .

~raramcmtulAlbany pemm c{)ntrolul panicii in mlburarea .. de n.t~~ de,panicil .. fii agorafobic (Tnravsky. J: ~~Barlow. D.H .• , The Clini<:~l PqychQlogi~t. 48. ·s-6. 1995). s~'intemeia:d. pe

persp_!!Ctiv~ cognitiv-comportamcntaU\ fli folose~re merode de educar~ a pacientului referitor la specificui arec{iunii sale, tehnici de restrucmr!lrc-cognitivij pentrn corectarea credintelor

288

· .. . .

disfunc:tionale. telinici ·de respiratie penLru a controlil hipervb~tilatia in ~azul at~culll~. de pan~~a. explln~rea . interoce(lliva pentru e\in1innrea reactulorco~dltt?nale 1~gat~~e • senznlille nsem~nlitonre panicii. ex.pungrea m Vlvola Sltu_atul~ · nn.i:.iog~ne peim·u a sHibi asocierile e'xisrente intre pamdi_ ~1 : comporl:amentele cvi_tntive. De asemenea, ~n_cazul ngomfob1~~

. tehnicn eX.pl.ttierii se utilizes~ ciind e$£e pos1b11,1n cuplu. dutonm ,

•·ezultatdor superioare obtinute asrfel. . . . . : Ointte srudiile. empirioe asupra eficientei acestm tmfll!-llCllt:

enu~erlbn: • i -nndow ~icolab .• BehaviorThernpy.20: 261-282, 19&9;,. • Craske ~i co1ab:, Behavior Therapy, 22: 289-'304, J 991 ; • lQosko lli-colnb .• Journal ofConsulting and Clinical Psy-

, chology, 58: 77-84, 1990. . · 2. Tulb11rtirea tla an:ri~tate ganeralizatli

: Dtlpl1 cum sngereaza ~i ·denumirea·sa. tulburnreu. de anxietnte generalizalii se caractelizearl\ prln p.rezenta anx~et~l'.i~ cronice insotite de mni mu 1 tc manifesdiri fizice ale nrausal-ulu~ fiziologic ca: tremuraturi. nelini17re ~i tensioriare. obo5eaH\~ difieultl1ti de concenttave, iritabilirnte,. tensiune musculnrar

· · tulburari de.somn. tn plus. persoana se ingrijoreazlt excesiv dr; lncruri.te negative can~ is-,arput~ intmnpla !}i tntiimpinil dificul£fit~ 'in a-!li conuolft aceste griji. · i

Terapi{\cen mai efici.e~ta in tratarea anx.ietrltii gen~mlizur!! s-a dovedii n fi. terapia cognitiv-,compmtarnentaUi. De asemenea. ex.istii_ unele date care ~rat5:ca relaxarea aplicnUi ar putea fi utila .ln rrniamenmt.anx.ietatii generaliznte ..

3. T(llfmraren. Qbsesi.P-compulsiJ•n · · .Obsesiile reprezihtli gl\ndm·i repetitive inrruzive .. A.cest~ . gllndud se pot referi la: ranjrea cuiva drag fttlii inrentin de tl:l riini~ contaminarea en germeni sau mt1rdiirie fJi teama de n n_u

. fnce o gre§ea}ii groaznica. Cornpulsiile sunr impulsurj exrre1n _ de P\ttemice de a repeta la nesfarllit un am11~1it comporrnment

. . . . . I 289

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sau actlune, ~i sunt legate deseori de prezenta Ut]ei obsesii. Exen',[>lt'}~.compul5li rep.[ez:h,ttii::>pal~~earepetat~.~l~lainHor, v~rificatea sobelor sau a u~ilpr ~i p~$tt<it~ ·c~ifedt.e~or tucruri de~i a9~stea. ~u.au nlcio valoare ~~filimentaJ.ii s~u~:nuu1etara.', Pecldru1'eie'cfri.ulburare obsesiv-complllsi vaprezintn' fi~ ~bscsii,• · fie compulsli,Tie ambele. . . . . . . • .··.. . .. _ ... _.· ..•.. ·. , .· ·

E"Jtpunerea ~ipreven~iarit'iptfusu1qi wnstiluie. o<:~~n~inatie de tehniei ~ompm;tament~e dov~ditli ca ~iuclellclenta in· · (T~tatJ.Ielltul· tulburaritor (Jhsc:siv~9()mpulsive. J:)e ase!neoea, existii 1.m ele d(Jvezi care aratli. ca terap!a cugnitivii~. I?l1tea fi un tt~tament util1Q tulburarlle gb~iv-comJ>ulsive.in pJ~s, o suWi de date .sugerea.za di utilizarea ~1.0ui progr~1Jn specific d~ preve~1ire a recaQ.erilqr ar Pt1~a ~\leepr(Jbabi:liLa.tear~padtiej

·· probl~tuelor dupici lnclJ.eier~ntr.ata.tne.nluJIJi. 4 •. Tulb·~t.rarea de ~tres posttr«lLrr£1!lj.c Persotiuele, c:arc. s.-atl cqufrunta.t c~ ,()_.situati~ ~rauumtidi,

fi~:din ppswe:i .d~ victim a, :ijediq postu~ii demad.oJ:, attuneori diJl~;ultl1Jiln a~~i rev~nl dup~t.ra.wua.A.c~ti~ :t:~trruesc uneori eveo~J,D.elllul Bl:lb forxui~cp§tnar\1rl ~B.U ''fla&b,\Jac\r,-urf:\ Se sinttaJlxlO~ilSaU qeptimnti, $~inl.t.incapabill sareacVOJleze·emotioual . ~a.usontnemult9inill deviatalor. Dacaaceslesimptmncsetneu\in ~n~lo de o· at,umita perii!Jac]a· co.nsideta.tanor•uala penlru · rendJip~ade dupa tramulit persoru.ta at.putea~ufeddetuibunue~ de strea postrawna.tie:·(posttraumatic stressdisotder + PTSD).

· EJtistil. unele dove?J carearaUi ~a terapiacoiriportnmentaUi prit,t ex.puuere est:e eficienta iu tratamenlul stresu1riipostttimU1t:l..tic dezvultatiuurnta.evenituenle1or ex.tt"ertte apat"'.de in vin\a cotidiana sau pe:campul dglupro .. E::tista. de asemeoea, uuele date care sugereaza ca reprocesan~a ~i de.'iensibilil;area prin mJ~carloctllare mpre.rint~ u metoda util.a(ffiracateoriH acestein sa fie v.ruidata ~tiiu~.fic!) in trata~nentulsuesului po~~traumatic clezvoltat in. unnn eveuimentelor e.:ttreme aparute in -via\a

colidinoa (cum ar fi violul).

290

··,: .• ··----- ... - .....

Terapia compottamenlala prin expunere repre~i.tila o ,~ategorie de. tehnlci care iuclud~: deseJ.1si~ilizat:ea pr\lgfesiva

. Onvlvo !JBU :inhungjnar), fl<mding-uliiuviV(J ~niuiu intagjnar), ·. ler1lpia imploziva, de.Seasibilizar~:tprlnnul~~1Jlrol, m.odeh.trea ·

prutidpaliVa:ji alte tebnici.asendulalu~ .. SC{)pW: u~liziltii nceslor tehni~i penttu tlntamentulst.resului posttraunll1tices{e de a accesa emotiile asociate evenimentul~i .tr~llmatic. 11i de i. sustine

·. p.tocesacea eJtJ.ollonol~ vaz~t.'t de unii t;~ fllild. elententul cbeje. in tratareaace3tei tulb~diri:. ·oe.t:~g\lla, l:oamJonnel~de temple prin ex.punere (in vivo sau ill imagitutr)"folosite tntt:tttatnentt' \ PTSD presupun confruntat-en. inu·-o an\).mita mtisurH., eu stinmli · ~SQcia\i .evenimentuiui_Lrl)uii'latlc, proctdJJ~ e~ ppate sa fie a((Qmpitniatli sau h~l de incerca.reu de a 11.1en.tine.1.1 J;t.nre t\e t~laxare. · Dintre studiile ·elJlpirice asupra ef!cienJei. act:Stui \l:al<llU~nt enutneramt . . ·

~ stu.diiefec~uate'pe v~te!Qlli de thboj: •·Bt:.udewyns{P.A. ~iHyer,L...lleh~vior '11J.erapy, 11,

63-87,1990; . .· ·. ·... . . . . . . •Cooper,N.A. ~i Clulll• G./\ .• BebaviorTllernpy.20,lH.-

39J, 1989~ •K.eane.T.M.~Fairbank, J.A .• caddell,J.M. :JlZimtqerlng •

R.T .• Behaviqr Therapy .• 20, 245-260, 1989. -:. ~t.udii e[ectunte pe femeicare au trecut prin e~perientn

violului: - Poa, JJ.B.; Rothman, B.O., Riggs, D.S. ~I Murdoch.

R.l.\., Journal ofCoutJSeling ami Clin~cnl Psychology. 59, 715-.723.1991. .. ~· nlte studii

· · • Keane, T.M. ~i Ka.loupek. D .G., 11te CliuicalPsycholo-gist, 49,7-8,1996. . . .

. -. ::: . .. ,~ Jlneori, abor(\fuile clinice ale PTSDsuplin1~ii~aia tei11pii:t · p.dn expunere cu diferite proced\.n"i cugui~ve cafe -vh.em.n sentim~ntele de vin.ova.~.e •. distorsi~nile .cogl~itive~ credintc1e iratlonal~ sau valorile disfunc\ionale ale padeululuL Ace.')li

'l9l

' J

ndjuvantfcogqitivi au atat snstinere leoretica •. cat ~~ valonre intuitivli. in~a sarcillA de aledo·vedieficientaempiridi rlimfine · un obier:tiv prin&ipalnlstudiil()1~ vii£Oare. ·

5. · P.okiile specifics · . . . J?obiile s:pecif\cc se ref~rl\ ·til ex.perieo(ierea unei frici ·in

tense p iraponale ]a conractl;ll cu un anumit locro sau sittlafie. cum lli- fi~ iniUtimile. ·fu~ronile • .conclllcerea>ma~inii. vederea &1\l"lgelui. diferlte ua~imale sau )ns~cte. sau .. patiile inchise.be~i mtdte p~rsoanese confn.Jntil~u ilstfelde te111eri, nu lf; vom numi fobiideciitdaci.acesten.interf~azliputemic cu vjata individulni.

· pcQduc&.nd £lis~ 4ilsao disabilimte. ·. · Cel mai eftcient tratament pe1"ltro fobtile speci'fice s-n

dovedlt ~.fi t:erapia conlport.amenti:lliifolo.sindexpl.merea sau dobitqdireil cornpetentei· In plus. existi1 unele date care aratll d $i desensibilizarea sj~ltematicti, o fomiib asemtinlitoare de h.1\tamenr, ar n cficientll in rezolvnreafobiilorspecifice.

Tratamentul de do1Jiindii·e a competenteieste. o'abonJare terapeutica baznta pe performantii. "derivo.ta ilin teo ria social-

. co~itivii; Di11 puncLul de vedere.al acestef leorii;disal)ilitarea · 4i distresul apin1tc in fobli se datorea2li :faptului .eli indivhi.i Qinupie~ot S!!ntimentul de ·a\llo~ficacirnre sau inc'rederea eli pot sn f~cli fatli cu bine situatieisan obiecntlui fobic:~ f'-stldar. aceastl\ fom1l\ de terapiepune accentUl-pe interactiunea £1lntre terapeut $i.pnc_ient.'in .car~ prinmtapeleazala diverse telmici pentn\. a-~i njuta p~cientul sa &e implic~ ~i sa :rezolve cu succe~ diferile $arcini, dobilndindsentirnentul efici-en{ei liicompetentci. Dintre studiile elllpirlce RSl1J?f!'-.efi¢i~~teince~tuitrarament enumeram:

• · Bandnra. A~. Blancbaril. E.ll. ~i Ritter. D., Journal of Pers~:mality and S.ociat Psychology,l3,173--'l991 1969i

•· Ban~~Jnl, A., Je~y. R.W •. Ili Wligllt, C.L., rournal of .Abno.rmnl Psychology. 83,.56-64. 1974;

• Ost. L .• Salkovslds. P.M. ~ilfellstmm. ·K .• Behavior Therapy;22. 407 .. 422.1991; .·· .. · .. •. · . . ..• ··.. . . .

• Williams. S.L •• Doo~eman;G. Eii Kleineld, E., Journal . ~fConsulting and Ctinicl\1 P~ycbology, 52, 505-518, 1984~

292

\

··:"'--:---~--.---·-

.. --Willirtms, s.L.is,i· Zane. · G .•.. Beha~ior Resea1'Gh ··.mitl Ther~~Y? 211 '>37-2~-.5, 19119. . · . .· . .. . .· ~

6.F.obiile.socitl1e ~i(ln;l;ietatea dtut vorbl m.publt,c Ilersoanele afectate .de fobie.godala •. S~\nt e.xtrem d'e

an')(_iQQ.Se insitnatii carermpb(:a interno\lllnea cualrepers?anf· l?enri:unnii, pce)lStii ~~~m~i est~1inuradi1av()rbitu1 m.-pllbllc s~u nlte sit»n\ii s~cifice· V~l}trn ~l~~.oti~e ~toa\1~ rn 7nr7 n: puc~n iriietn6\iont\ c~ nlte pe111oa(le .~onshtlll'? un. n-.ou~. i:le tea~~a extrernli. P~t-sotmele cldo'biersocjal~ depun un ef~rt substa~(lrl petttrl.t aeyitasituatWe soci~_le~ . _ . · .. . . , !_

ExisUi •dove~ ~a~e arati\ ci\ In prez~nt CXlS[~ mn~. n:u tl,~e. trilt!lmente eficiente R~nt:n.t fobia socialif. pl"intre cnr~ ~era!~'~ cbmportamentallit1tin expun~re fiidesel~s~bilizlu-ea progn~sa yn

. ~i 1ernpia cognitiv-compOJ:t~mentalli de ~P· . ·. . ····.. . . . . . . I ~ Terapin·prin·expunerellt tra~amentnl.fobiel s~c~a15 ~~.e~fa

· deJaasumptiacaanJ(.ietatea legt1tlideexpu1lereala sttua{ns~~t~l~ · . vadesct:e!ite o datli cuint~lft.iroasistematicli ~i repe~nl~ ctlS!lm~.ltl a1nenintatin~i~A~e!iti stimuli varian de ln o scurt~ dasc~;~~~~ c~~ o •perso~n'ti:l.leC.unormu~a~pfinllaodiscritiefoTl1\ala Tnpttbl•:: iYn ca21.llfobie.i. sociatt. tempia :prin expunereeste iogreu~1.litn ~e <\nQii> aspecte;. (l) <vari~\)ilita~a sittl~tiil~~ fohiC.~ ~i . (~) inpredic~biUtatea p incontrnl~bllitnteasltuatulor soe1ale, c~1 e tngreur.teazaexpnnereainvivo. . . .· .· ... ·· · .. · •. I · 'Dintresu.tdiile empiiicensllp'raeficientei ncestui wuamynt e_numeti1~n: <· _ -• . : _ _ _ _ ., __ _ .· \

. · :· "J\lsJ:rom, J.E .• Norlnnd,CL .• Per~son. G., Hi:lrding.M. · t;:iLjungqvjst.Cc, ACHtPsycltiatrica Sca~tdinavica,70, 97,..1l 0,

19S4; . . .. · . . . < >. ·.··· . . . •••· .... •. !.

· .. · ·. •E.mm~:;lkanlp,P,M.G~. Men;cn,'P:P.A. .• Vissia.E.~i.'-~1\\\ .. den)lt;:lm.M .• HebavlourR.eSeRrch ;.md111ernpy •. 23,365-3f9, .1985; .. ·· .. · . . . . · .. ·· . ·.· .. . ! · ,1• Feske, U. ~i Chnmbless,. bL .• Behavior Therapy. f6,

695-:-?20. 1995;

293

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" Hope, D .A.., Tl.te C:linica!Psycltologist, 49; 8-l 0, I 996~ • .,ytazlo, z .. Sclrroeder-Hartwig. IS. .• ~-Iatid~ r:, Kaiser,

G -l?i Muncliau, N ;. Behaviour. Re::;egrcll aud Tber\tpy, 28, l81-19~,l9~Q~.. ··. . . .}.'fl~:,~, . <· · · ~,.~~-t~l:ripia cogniliv-comporf.IJ~nentall\ de gritp ib,piica pe.de

o parte iden~Ca.rea g§nduritor negative, disputarea ncestora !?i inlocuirea lo_fcu raspunsm:i rationale altemative, :;;i pe de alta . parte stabilireade scoputi comportamentale concre~:e pentru clieut; iu situa\ia de. expunere.

Dintre. studi.ile e1npirice asupra eficientei acestui tralamenl euumeriim;

• Heimberg, R,G.,.Dodge,. C.S., Hope, D.A., Kennedy, C.R., Zollo, ~- ~i Becl<er, .R..B .. , Cognitive The.:apy aud Research, 14, 1-23, 1990;

• H.eitnberg, R~G.,Jusler, H.R., Brown, E.J., H9lle, C.H., . Makri, G.S •• Leung. A.W., Sclmeider, F.R., Oitow, A. l?i Liebowitz, M.lt .• Cognititve-.behaviotal venm~ pharuuiculogit:;nl treatment ofsocial-phobia:. Posttreatment and follow-up effects. Posler prezentat la Annual Meeting .of th.e As~ociation for AdvancementofBehavior1berapy,SanDiego;c.aliforuia.· noiembrie 1994; ·

.. Juster. H.R. ~i Heiulberg, R~G .• Tht; Clinical Psycholo~ gist. 47, 18-20, 1994.

· 7. EJ•eni.m.en.tele. stresw1:t4 Uneori. persoattele irttfimpina.dificultiiti atuttci .caud se ·

confruutn cu stresori ca iminenta unei procedui.i 1nedicale htvuzive sau a unui ex..ruueu importanL Deregum.a~a devin. Lensionnti cu mai multe z.ile inaintea respecl:ivului ~venimenr, iaL· unii al• probleme de somn. Oricine s.imte o aarecare tensiune in estfelde situatii, insa unii sunt afecta\Hil n~a mn:.;irra incfilnu Isimai pot continua viata in mod normaL

.-.. . .. , ' ... ,_:__,~....:.-'

1911

: . -·· ···---· -·· ----

Traiuingul pentru itJ,oculf\x:ea stresului (stre.ss in~oculatiott training- SIT) s-a dovedit a fi eel ma.i e.ijcient tmtameutpentru expl.tnerea la diferi.\islJ:esorL _ .···· . .

SlTesle utilizatca fji b:atam.eut meiliha a jute indivizii r.~ faca fa\fi ell bine efectelor expwu~rii J.a stresori. pteC\tm !}i cu metoda preventh•a pentru a "'jnocula'" pcrsoanele in ~fSleptnrea · even.imentelor stresante. Ace:;t tralam.et1t cuprinde trci faze superpozabile: ( {) lam d~ cpriceptulllizare, ~)foza de fonnare :;i exe.rsare de deprlmled ~i (~)fnza deimplet11entnre ~i umdirire. Pe parcurstd pdmei .faze. scopurlle .principale·.vizate sunl educareapacientululdespreimpnctul coguitrei.as~tnn nivel'ulul · stresu],ui. foltllarea abiluatifde n percepedife.reittiat.e:;tresorii ~i de a segmenta s~,orii complec11i In tinte pentru coplng-ul pe term en scurt. mediu ~llung. precum Iii concev.tua{iznrea problenl.eL in faza a doua. se invn\a ~i se. exers~di depriuderi copjng. initial itt cttdrul clinic, apoitn·mediul ecologic. Fazo u . treia ofera pacieri\~lor posibnitatea Ue a !'Plica depliuderile tnviita~e tn cazul unor stre,.;ori diferlti. Diutre tebnicilc .utiUz.ale amintirn teboicile imagistice, jocul de ro.l. ntodelarea, e;tpunerea gradata in vivo, repetitia comportameutalii. D.intre studiile empirice nsu,pra eficientei acestul tratruJ.leJlt enmueram: .

- peut:J.:u trntamentu.l strcsorilor acuti (ex. pregnt.itt:a J?enuu pmceduri Jllf!WCDl~ mlerventli cbiJ:m:gicale,perfomtall\e SpOJt .. iveetc.): ·

• A:lunaier .. E.M •• Ross, S.L.., Leary, M.R. ~iThombrough, M.T., Jounial of Counselbtg Psycbol~gy, 29, 3:H:334, 19~2;

• Jnremko, M., Journal of Clinical Psychology. 36,73:>-738, 1980; .

.. Jay. S.M. ~i Elliot. C.H .• Jourhal of Counsulting and Clinical Psychology. 58,799-804, 1990; . . . . .

. ·' · .: .. Kendall, P ., Williams. P .C., P-echa'cn'elt;'P::F.; Grab am, · ·L~fL Sbis.slak, C. ~i Herz.off. N., Jotit11al of~ourisulting :-~no .. CliJlica\ Ps_ychulogy, 47, 49-5B. 1979~ 'i .. :;.,

... Ross. M.J. si Ber-ger Il (' . J.- . CJinicalPsychoiogy' . 6. 4. ·.· 4. o'6\.J., . ouma .... l.of Counsulting and

- • • . . . --'tlO 1996· •_\\'~lis. I.K .• Howard 0 S N · · ' ·· .

Jpurnal ofCounstllt" . • ... · .. ·~~ owlm,W.P. ~~ Vnrg&s.M.J., 1986. . .•ng nnd Cluucnl Psychology, 54.811-835

• . 7

• ~ - penbll tratameotr11 :.ai:es · -1 ·· . _ nldllare. difetiteprobl .·· . . . . _on onntennttenp (ex. actiuni . • ·. ., Hnlruy 1 r~e· . . _emil ~l~edt_ca1e~j!Curente ere.) Tl .·· · .. ·. . ' " u:.., AndJ'Qslk; F sf We 'tb k .. . l~~apy snd Research~ l,12t~.l3i 1 s roo·. T .. Cognitive

- penrru fell · . · . · ···•·· ·· ..... ·• • .. · 977· ed. 1····. · ·· · ramentUJ stresorilor c · · .

Ul .•.. cnlecronice boll" . 'I • . • .. ·. . . . ronJct (ex. prob.· leme • Fomln~ S • J . .·psi uatnc~ etc.) . . . . . .· ..•. ·. · ..•

1982; . . ... · .. • .• oumalofSchoolPsycllology~ 20,<l80- J 87,

• Rolcorflb •. W.R J · ·•· . . · . . . 0 • • • ••• ••• • •

864-872 •. 19~6;. . .• ournal of CbmcaJ Psychology, 42, ~ Moore rr ~ ·A· ·1 . . .· · _,9.. · · · · · ·· • n... ~~ · tnta1er E c .··· . . ·· ... ··.·

J ~ •. l-98Ji < . . · .. · , ., ancer Nursmg, lo, 389-. '"Wem"k RL .·. '· . . .

. • • Jl'! •• • •• Jnretnko ME · · T ·· . · ofBebavtoral J:vfedicine, 4. 103,-l09,·l~Bl~ylor.·P.W.,JournnJ

ll ·. . ... · . ~.Tolbu:r~~~a de personalitate

· T . de till borderline · ulburarea de personaliraf~ d ..

un pnttorn de durnta~ Cll .• ~ d ~ tip botderline se refera Ja ti • punzan o In a · d · . a ecnve Iii re1ntii im:tabile . . 1 gme e sine, dispoz.i{ii

pntlenl care debuten ... ~ d • precQr. fll compottnmenre impulsive Pe -.. e ll}guJa tn prima ~ · • . rsoanele afectnte d · pam~ a vie{ii a"dulce

lsingudttarea viata 1 e aceasta tulburare nu pot suport; 0 • I .. . • or caracterJzfindu • . le afumstabile ~intense. In lus . ~se. p~t?tr-un ~ir lung de la ~~mportalllente de · · P · ' ~~tlmdJvJZI apcleaza frecvent

. . nsc ca alimcntnrea . . neprotpJat. consomul de "lc I • d compulstva, sexu1 ""t • D ... oo St rogurl c d ... c. e lllUlte. ori se ~ . · - • 00 usul cu virezn

. • mreg1streaza h!ntati d · . · · · ' automnnlare. La nivel afe r u. • ye e SUJctd sau c tv. tnunle curente snnt cele de goJ

296

-.· · ...

. I

snfletesc ~i fOTie 1ntens1i, nccste persoane fiind ~i foane labile · emotional. ' 0

•

'Existli unele date Ctlre indidi faptul eli ternpia compattamental.'\dli11ectidt este eficienta in rratamentu 1 tulbl.1rari i de persoriulltatea de rip borderline.

. . . .. Ill. TulbuHirile depresive .. · . . ··.·• .· .. ··.· ·.·. . . Depresia dinica nuse ccrnfunda en st1hile de uistetecare

Sllf'Jin.uneori tnviatn fieciin1ia di.iltre noL ~ersoa~ele afectate · de depr~iedinicit s~ simttri~te~i fiidi speranta sl'ipti\miiniile-n rfind~l. De cele. maim~l~e ()ri.· acestea iqi pierd .interesul in l1.1cfurile cmeinainre lefiicen~-pl~cer~ ~i au probleme cu somnol ~i a.lirnentA\itl. Totoiliua,le vineogreu sldepunl\ eforrul de a gasi I solutiiJaproblemeleJle cnr¢1~ ap, jarrineodnu se potconcentnt/ .slificieptt nicimlttarpenfi\l.a>J?~Vi latel!!vizor sall a. citL De/ regnl~~ pers~~nele deprin'la~ p~lrec .mu1te ore gBn4indu-:se 11~

·· sinucif,Jere1 maaa:te SI!i;l ~ faptiJ~ ta le-ar fi mai bine dftcn ,nu at mai.existn~Aceste silllfJtome:mnt.usemanlitoarecu·cele int.alnirJ la· PerSpaneJe ClU'e lre(! prill Si~u~tii de dOUO,. insain. Cazultiepresie~ cliuit¢ ne 1ipsesc iwerHme~tele de pierdere. fie 1nan ifestarile. dnreaia co mlllt mni multdecai: ar .fi nonri.al'in nsrfel de-situnti i. . ._in .prezent, eXiEitlimru flitiJtetipuride terapii eficiente.1h tmrar~a depresiei c1 in ice, prilltre care: terapia. comportatnenrtll *·

... tentpia cognitiva ~i te~piai;:iie-rpersonaHbDeasenl~nea,·exisUi unele,dovez.Lcare ai:ant cl ternpia dinamica de··scurri\ durarfi.

. ternpia prin ai.~rocoitttdl<~i tei'apiile care mergpe rezolvareu de probleme· in cadri• soej1li:a:r .. putea aduee b~neficH.iQ cnzul

. depresieimajore~fn. pltis','o 1l'1Ullil1le ae.dnte (!ulesedinstudii .efe~tu.atepf!personneinvar~tiisogerl!llzhdiutiliznrea teraplei colJiclitive ~i a terapieirei~iiniscentei. ea ~mintirilor) nr putet~ fi ntilrl'in trat~re_a deptesh~i ~ per.soanele devlirsta n trein. > . i ·

. ·' Terapia compGrta1Tl~l1~aUi pleac-a de Ia un model dasiG ul L1epresiei unipolare (Lewh1~oh11 ~i cola b .• 1979), care se bazehli

297

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.. • .. . :·: .. ~ ·-~~- .... _,_,...,_ .• ;_~:?.<:-::;: ·:·;-~.- : -,_ ~ .: .. --~- .·· . •. . .

pe asumptia di depresia poate aparea din:- c:auza Jo_ui stresor care per:tn:b~ pa~tefl:~ul ~~U:porlalu~I~.tala! _indivit;l~t~~· dUcfutd In o rata 8cazuta a_ Jntar:rrJlor poznt~e; 11~ con~f_Hlc iti care pe.rsq~~~~;n~ reu~~te sa eehHibreze balantar~(i~;~ipenselor. acea~J~ .. r~ Ulcepe • sa -exp-erieu"ieze simrltom· -A I ·-:-:'''c --: ill--: -''''"''-::,~"=·''·: - _ _ -- - _ ~ _ -- . _.r- m~pspec Ice._ .. _deprest¢Fc1w:t~. • Ca wmare, obiectivul terapiei comg(}rtamentale ~al'e decurge dtlllr-:o aslfeld~ teorieestede a_l1Pistapacient:u1 in ~Qcerca(ea de acre~te. ft:eeventn ~~ cl1lllale~ acti vitatuor-pliicule;

-- 111 ~c~tsco~. s~fplo~es~teJ~ci defoanare aabilitatilot soeiale, te~uuc~-de relaXlJJ:e ~l difente-met<Jcle•care putesc-111odificarea sUl~lu1 c~e ~fuld~re de.presiv. Dilltre studiile ernphice asupra eficientet acestut tratamentenumerlUm ·· .

-iil caz.ulil.dulfilor: . .

"!Jt:owu, R.t-\. ~iLewit1So11, P.M., Joumal ofCoilsulting

nncl Cluneal Psrcholog)', 5?. 774-733.1981; .. · . ·. ·•• · ·•• . " Hobern;ta~~ H.M,,. Lewinsohl)• _fl.rvl. ··~. i l11sott; M., Jour- ·

lltt[bfCo~sull:Jng .~nd CllnicalPs.y~~o!ogy. 56,393~~9,8, 1988: .. Steuunetz, J:L .• Lewitwofm,.P.J\1. ~i AfitonuC(!io, D.O.,

1~~~~al of Consulting and ClinicatPsychology., 5l. 331-337,

· • Ted, .L. ~i Lewinsop.n, P.l'vl,Bebnvior"fbecany 17 2!5-223, 1986. . ·.··.··.·. . .. '·.. i< .' . s

-in cazul adolescentilo.r

• Lewiusobn., P.M:. Clru:ke, G.N., Hops, H. ~i Andiews, , J., DellaviorT.herapy, 21, 385-401, 1990. I : - veJlttuper$oa.1leJb. Vllrsta i ·. ..··•· ... Teri, L.,Logstiou~.R-y .• (Joru~tQ,J.,~i{\llcCuny, 1S.].Vl.. Jqumal of(Jerontology:.Psycflologi~ Scienc~. S2b, 159-16?,1997.

! !e~'tpia cogui~~a,in depresiese(undar.Qenterulipe_leoda !cogmtiva a depresJei (Beck, 1 967). Aceasta este Q .. abonlare 1terapeutic:~activa,. structm:ali"focatizatatJti problema_ 9i:de scurtii 1dur~Ui, care pome~l:e de I~ 88Umpfiudidepresia rt.')ten1entinum

293

. .. '·· ...

de procesarl informationale negn~ve·~i de distQt:siuni ~ognit'ive~ -·Trahtrtlentul vizeozlti.n·vata.tea pacieo~l.or 3.a gtiulleasca adaptativ.- nnteliododt•-~i· ast.f'el tru.irile. nfective, c.ompottru.uentele f$i.tnotiva\ia. . . . . . · . . • ·• , .: A • • . • . • • . . •

NtUileroase sludii.nr.atiica terapja cognxtiYfiiD dep~e~ne are efecte superioare · .. tratamentnlu i .. · nt~dicntn~u ~os, LEntpiei comportamentale, listei de a~teplart!, _p~:ecum ~' o.ll~r f.~rm.e de ternpie. Mai mult, terapia cognitivii s-a dove~.tt ¢f?l pu(lU !a fel deeflcleuta<:«'lmedic~t~aut.ieepf_esiv8~1n(~renL_de.s~ven~lea tulbw-iirli, ~i mult mm efictenta decal acensla ~ p1~vcun-e~ recuderilor. Dintre.SllldJile empltice as~tpra e.fiCJ6~1\e' nce1;t~H. trntament enumeriim: . . . . . .. . .. ·. ···• ; ·

• Bfack:bum. LM., Eut1-;on, K.M,~iUisbop, S .• J(lutmd of Affe~tive Disorden;, 10, 67-75,1986; · . . . . . ·

• Dobson, K.S .• Jounntl of Consulting nod CIJ.UJ.c.;tl Fr;ychology. 57,3,414-419, 1989; , .

• Elkin, L, Shea, M.T .• vVaUdns. J.T •• In1ber, S.D .• Sotsky. S.M., Collins. J.F., Glass, D.R., Pilkoni$~ f',A •• l:eber, W .R., Doclu~rty. J.P., Fiester7 S.J. 11i Pndo1T~ M.U~; Arcluves of Gen~ eralPsychiatry, 46,97.1-982, 1989; . . . .

· •. J{ovacs, ]\1., Rush •. A.J,, Beck,·A."L ~l ~IoUun,. S.D., Archiv~ o~G~ne,:all'sychiatcy, 38, 33.:39,1981;. . .•... ·. . . . ·

• Murpl~y. G.E., Simous, A .. o., Y~et'rel, R:D. -~i L~~lluan, P.L .• Archives o{Genera1Psyctuntry,41, 33-41, 1984,

.,·. Sim~ms, A~D., Mul'plly, .0 .B ••. Lev.lue, 1:1... ~?i Wet~l, R.l)., Archives of G~oecal Psycbiahy. 43, 43-48, 198~. .

T~apia interpersonalli este . utili\ in_ c::_,nz?l pa_ctet~~ do~ depresivi, nonpsibotici, tara tulbu.tar~ af~tiva-~1po~ad\, tl<~la~ ambulatorlu.luitial. aceasla fusese felos1~ii ca terngte de scurt.t Q_urata, ullerior.fiiud utilizntii. qica ternpiedel~leu\];e~ ~~.n\.ru

.. paden~icudepresierec~re~ta.Se:poa~~~~g~~1~~~~2~,J.Jlf.ltvtdual~ ' ··:: dit iJi in asociere cu medicatta nnti~eprestv~ Ii1 ~ndl1Jl ace.~lcL

lerapii. se face apel la slralegii erietlt~t~. ~pee: evaluarca

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simptomatologiei depl;eslve .. JiJcar . ..· ameliornrea-relarmorjnferpers'o .1 t~aren._pe proble~e {inta, o fo. rmn delra'tanile·.·· ·~ . . ... na e. P•eventrea re. ciidenlor. Bste

n~ care st-.a doved· fi •. . .. ~pisoadelordepresi.Ve acute •• at '·" ·1fe:. ClC~{il ~tfil lHh1\[itTea

. mstallirli l]norepiseadenlre :·.c~· .. ~llllpreve~~re~ san amilnitrea eficienrei aceshti ·trat:tl"e. . rnom.e~ Dlnrrc srudrrJe empitice asupra

• . ..• · ·. .. . . .. ·~ n .enumera"1~· ·

~ Carnes, C.L. si Fnu1k_ E .-ri;· cr . .lJJ: ·9-lO,J 994; . · · ·· · •· · ··· ·•· e I meal P::;ychoJo gist.

•F1'ahkB p <. · .· .·. ·. .... . : • . .• sycl~9t1lerl:liJY. 28: 259-266, 1991.

n· f\1'. P_.()bleh1ele feg~te de sfu:difute . tnlre problemele de siin u • • . • - •

• . Cefalea · · ~lnte, cele lnar~ 1n d1scu[ie sum:

• . Si~droinul inteslinului lritabil • Durerea • Maladi a Rayn~rid • Fumatul ·.·· . Ccfa1ea Peste 90% di11 oameni s .

donre capuJ. Cilnd accsie d . ~u_n ci eel pufm o d.utlt pe··an ii CSie C82:ul migrcnelorde tipu~l:e.n .. su~~ fi-ecyente ~i severe, cum prqfu nd vinra persoanei. res en_slt•r• CfOQice_ ncesrea pot al"ec(a peraoane. aceste·durcrl aju:~~:~c:rcaz~ll u~~ numar mic de

Un trntamerit ef" • a dtsnbdttate sever~ co 1Cie'rit· tn cazu) cef: l . .

lll}?OIJllmcntollf. Bxistii de ' a ees esre terapia en ~l biofeedbacl'-ul C"l • . ~s~menea. unele dovezf care ara•"

1\.: .. one msoflt d · I.Q lfuc Ia rezuJtate pozitiv io. ~ - c antrena.rnentul aurogen

cr• .Y • !!'JU caz1.d aeftSste~t afe t. · · ~mm·olmu intesti .. l i. • - c mm. Clj • · • • 1 .. 11 ll zn.tabil

· ,;a nd! omulmr:esrmnlui ititabJI co9sUind in prezenra relativ con tin ~te ~ tulb.~rare fitnctiorwlli, u crampelor. De Qliemenea ua a durenJ abdontinaJe sau nal en dial-eea. const'ipntlii por apare tulbuta~ de ttanzit intesriastfcl de cazuri, este neces;~ san o ~ombin~tte a eelor doun. tn

. . n exanunarea dm parfeq unui medic

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ga~rroe~terolog. penn·u a e1iminl1 posibilitatea. prezentei :nlro~ tulbudi(i~u simpmmatologie ~emanaroare. . . . · . ·. . !

lri cazul sindromnlui·. i~testinului iritul1i1,_un tratamen,t eficient esr.e. tel·npin co~por~a~entala··multl-com.poneil~iul~ (Progr.imulAlbany pentr~.12indomnl intestinullli irirabil).·••· .. ··. i

·iit.cadrulpi·ogritn\liltiiAlbi,riy pentru sindonitll inrestinnlui iritabii. profocoln~ ·de ti:atin1:tent cuprinde: .monitoriza1·~a

· simptoptatologiei. gastroiJ)test.iriale. educaren pacienmlui cu ·· privire:m ft1ne.{iomrren ~pnm~llifdigestiv. contracararea nsumil~ii

rolului ~~ bolrlnv. fn .plu.s· •. $e }l~lizeazli relax.are~ prcrgresi \~a nmscularH ~lbiofe~b£lcl<-qfc~loric pentru a cre~te sentimen~ul de control al p~cientnl~i a:Snpr~ funcpilor: biol(}gic~. precuJni l}i tt:stmcturliricog[litivepl."ientpte.$Pl-e cpreetarea dis!o~iLU) ilor eli n gandire. cu ~mpa.cl. a.supp{s~i\rU. dt! .l\l'l'derare. pintre ·Sfl!di 1le empiri~.~sup~11 efir;fentei ~r;~tqi tr11.~amcmt ~ntl~leritm: . . 1

~.·. Blanchard~·)3,H .• On!~~. B., .St!harff,l ...... ~i Schwai-zMcMords, S.P .• Bjqfeeqb·ll~}c anpSelf-Rc:gulation, tB,l25-131. 1993; . • ..·. ... . i

•. <· < . ·, ·• ... < ·•. . ..•. . • • .·· • .. r

.. Greene. B. si Bl1mchard, E.B:, Joumal of Consulling nnd Clirtica1Psycf1~1ogy· §~·~76-582,1994; .. ·. .. . · ·

• Pnyne. A. ~iBlincJ')ard, E.B .• Jourrinl of Consulting And . •. ·. . . . . . ·. . . . r

Clinical Psychology. 63,779-786, 1995. · i Dnrerea.. · · · · · .· · '

:Dureren discijraUi aid esre cauziltl\ de unele afec~iuni son1atice em nice c:um·sutit ~olilereumatice sau u~ele forme de an~miihemolitict;_cllotfftf)S~·it~re eredittwa .. t11 ca1.ulunorn~tfel

. de afe~{hmi. exp~ri~~p~t~l\Jrecvenrli .a durerii ponte diminlll\ eruifateo. vie~H persoane)or ~fectnte. Dureren ponte nccet~mn anxleratea. depresi4~i seri~~~prele de neajutornre. De asemenea, ~.nxietate.'l !fidepresi~pO[:deJellnina apari[ia sntl intensific~1re!1 durerii. · .·.· ·..• .· ·: '' : · , ·.•.·.··. i ·

. .' .Terapia C9gnttiv~fitpq~mental~multi-compbnen[iulli s-n · dovedit a fiun tratamenfefipientpentrn dnreren np5rutai'n qnzul

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bulilor J-elunatiee; de asemeuea, Liuele date sugereaza ca aceasta. forma de tratrunent ar duce.la n~zultate pqzitiy~ i§icfll ,cazul amunitoi·fonue de anem.ii fleJnoiitice cti t&msmiteiiereclitara .. -~~~t~~i ?i!te care aratli ca d~rf:J."t!i\Cf!Jnic~.a.rputeil b~neficia qi d.e:l(!f~pia (!OmQ()rt.~entaHi multi-coPJpO~JenUa1a, bio{®9rJU:ck~ · ulE1YfQ}·'fetapia ·cqg~IUv..,c,omportmu~ntala aa9d~te. cu Iizioter.apie. De ll$Cil1enea, terapJn cognitiv-coiuport;.uuentola ar ])~~ea fi eficienta In caz:ul d9fe.di l~I}1bare CrlJliice.

• · i . "terapia cogidtiv-t;owpottat.ne!ltlll~ in. controlut durerii ple~ca dela UJUnodel cognitiv-:-COli!por~EUent~tl propu~ de Turk ~i colab., (Tur.k;~icolab., Pairt an~ibelJa"Jorai medieiue: A cog- · oil.j~,e~beJiavjoral persp:eclive,New Yotk:: Guilford.Press, 1983), Co1tfon1t acestu.i .-.ruodel,·,·.qU.rer-ell constitu.ie o ~:xperienta complexa, irnplicfutdaspecte de ordinfiziologic;;cogn.itiv, afeGtiv

·.· :Ji cosnportalnenh!l. Tratamentul.propus.are tll!icompouentede i baz!i: ( l)o:dUcarea paci<ntutui fi cun..,ptuOUzoreadiJte)ii; (2) I fbrmarea de abiJitii~ coping~ C!Hntpleureu~ ~i meDJinereo abilil~lilor CQpiug dobandile.. Piutre sludiile 'empiric~. asupra

I e@cienlei "=!l.lU lrnfutru:nt ill <azul dumii ccotiioee"~: ', "·Bradley, L.A.. Young, L,D., Anderson, J~o., ;;rumer! . !R.A,, Agudelo; C.A., McDaniel, L.IC., Pisko, E.J., SembJe, ,E.J, r,;iMorga11• T.:M., ArUtdtis &: Rheumatis.rn; 30, 1105-1 U 4, ! {987; i"'

! ., Keefe, F.J., Caldwell, D.S,, VIH1iarns, D.A., Gil~ K.M.,. lvtitcllell,I.J., Roflt,rtson, D., Rol>etll!On, C., M.mtJ""-s., i'!untey, 1., J3 eckhmn, J.C. ~i Helms, .I\II •• Be:J1a\lior l'bernpy, 21; '49-62, 1990:; .

I "' ·sytjala, ICL, Donaldson. G.'W., DavJes,<M. W., ~ippes, M.K ~i C!u:r, J;E., Pn.in, 63, 1B9··19g, 1995;

•Turner, J.A. ~i Clancy, S.,}oumal of Consu~ting anu Clinica1Psyclmlogy,58, 573~579, 1988. .

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ll•fal.t.uJ_i.a. Rayrumcl cleaz.a vasele de sange i:lin degele, -r:l~ladta_ Raynaud ~in ustiiril capllarelor diu aceste ZOIJC.

urecln ~ nas 1• se=se !bserva depigmenlat<:• pl•lii, }~ La expunereo Ia . .. d e,.....,icatnris.au amof\cala m

. . ti' acuzii fil s~uzatu e ~......... . tuteon pac1en,...t. • ... ; r: liiri continua, ele pot devem 1 afi tate Dacli aceste mau.u.es .• . . zone e ec . ulceratii ln nivelul ptelu.. u

dureroase sau ~~t cau~d. >! b •. feedback::-u l caloric cafonua de Datele ex.tstente m lCu 10 . • .

t r=:c·lentii incGazul mruadJcJ Rayu,aud . tratameu e.u J t: · .

Fumat.ul ... ·· .·.. . . . · . • .. _· e ca.re fti~T~atuJ Je are asup1it D_a to __ rit_"a_ e ___ il ectel_{Jr llegali_ ve H_ · ... •. ··.·_·._·· _.· ·. ··._ •.• r _· ..• _,. ·tre· .. acestea·

v -~· o1 •• · · • ·· ·•· · I -··· are U pracbdi.• mt.U~e t'm . . sanatatu gersoaue or ~de .. enclet~ta d·enir:.otinU este dJficd de iucenrca sa renuute, ins ··. · P: ·.·. ·1· •· · .. · · r~ tocel\rCa sa se lase de

~ . M . itaten pcrsooue ot c.u .. · . . . ·. . . . . . dep~1t. tyor ... ··. ~ ~diJ.lprimul~:~n.Doleleexu;tentc fum at, i~Ji r~iau acest obtc~J.J~c ·. ntuluiin eambioape culerapia arnt.a __ ·_~a_ reducerea_.u_ ·ep:_a __ mn_ .. ~n ... -~\:iat_ K_ co_·. n~tituieun.tr_ auuuent

18 · 1taUi. mulli-compone · ..... cont[Jol m.e1 • . · ..•.... ·1-. e·doresc sa renun~e lafuumt. . eficietWpeiltrupersoane ~car . . . ••.

Y. Tulbux·iirilc nlbnento.re . . . . · . . . _. . . . . presupun adpptnrea unut Tulburanl~ n.ltmentare ·od· ededieutdevinut~.Priulre

. taro nte nlltllentat"e sau me,. . • • . ,. com __ por e . . .. ·.··_· . . . . • te" ·n•;onaUi saU_l __ r•g __ .. es_. ba uno, iidi iofometureaJn · \" · .. · ·· · ·. . . ~) a~tea sepmn . d r Jltc (alinlet1taren C()ntpUISt\'3 • cautilii\i ex.agerate e a J~e tulbu.rliri se .git.ndt;:5C excesiv tu Personnele afectote de aces e t· sau.aliUJenll!· ele.pot l1utiit

· utale· nspectcorpora , · · · ~ · · l J:;llfutcare. gre . · . • ·. • . . .. . 'onderale sau _· subponpera e. norm.opcmde~at:. c!i~ Ill suprap t duce la. problettie med.ica1e IntrucHttulburlirilc nltmcn!are.¥o fi ctap de t~eesle Lulburari !;a .s e_v_. ere, e.<Jteiudicat ca pa __ clen __ tti a ~ t• t .. tn sani:itate melllnHi .

d. · a 1 . un specta lS consulte. uu me •c s t . . . .

·ali t astfel de problcme. · .. . _ . .. spech. za pe. . . • ·. . .. . b ... ruatein'ctlnfuiu3tesuut / - .. _... Tulburiirile abmentare a o . . . u

" Tulbt.rrarea de a1ilnentare cornpulstva

303

.. .·Bulimia nervoasn " (jbezitatea . Tulbftrnrea de li . .. . . .. -.·.. . . • ing dJNm-ded . a_ P!Bl!lare,eilmpnb:i>oii (Binge Ml-

lvf · · - • · · ul~l oamem simt uneori eli ~. ~ lrebui.1n mlhurarea·de ..... . manl\nca mai mult declit ar - ... lllle.ntorecomptlls· ~ mgerenza frccvent cantitiiti ex.ccsi . ~~a. persoana. afecratn episod compu\siv esre dublnt d :v_e de ~l11:~ente. u n nstfel de nsnpra P.ropriei alimentatii 1 e ~entimenmt plel-derii controlulu i trai~re sentimente de rt.ro•; u (~nor episodului. deseori persoana

·Datele de pftni\ tn. ~..,.me. ezgust. deprimare sau culpa cazul tulhuriirli dear pre?-ent amtit ell- tratamentele eficie~t~ 1n

. - tmentarc compu Is- li comportamentalii ~itera . - . tv snntrerapiacognitiv-B 1· . T ptamterpersonaln • l.t tmm nervoagli. . .. . ·

r . _Bulimia nci-vfiasa c~ptlnde .·· .· . . . -a •mentarecon'lptdsiva dtibi ·.}d ..•..... ··· ... eptsoade frecvente de nlim~ntarii _eompul:d~e~. ;!~re~ ?Jom~l-de_& con_n-acara efectul

. autoprovocntll•infotnetariia .. ·. . ; :. incerci\rl mclud; voma medica mente (ex .• laxative).exercl.fllle fizice dure, utilizarea de

tn preze · . . · · .· .. · · • · . . . · . . . :nt, extsta dovezl .. . . ·.· • ~ra<arnenr in bulimia ri~ o":: arntli ~K eel mai efio]enl ~ompbrtametttaUi.Peasemerirv s e~te terapia cognitivmte~P~J.1lona.lli tlrfi d . . . ea;unele dat~ .sugereaza cli r.em . rulhtJdin.·.. . :. . I . ? nsemenen.· eficiootli·. tn trinnmenh~l .. ·a·· ' ptt~

•. · ·· · ·.. . •• . ... veS e1

. TerapiR. cognitiv'"'compo~tatn . . .. ~ - - . / ·. .pleacltdelnuinnotielca . ·. . .· · .. entala m buhoua:nervonsa

cognitiv' . • · . . · re aru:entueazli atar im ·. · · ··· ··.· ·. • . · · .· • · ··.·. ~o_o~t _111 ~ celor comporrh . pot~n{a tactorilor tnl\)~rln. Tratamentul .· .;. · •... mental& tn menttnerea acestei co. n.lP_I)J1n.m.en .. h~_lor .. de a· 11-. vtz~e.l\zii •. p.e l .. a .n· gli eliminare" te: ·· · ··. · · · . · meQLBre o · ·1 •. · "

. venuen .. l.n.· pa_._lte. _rn· u.· .'1 ... _d . _ .. ·1. '. . . ·. omp· .. u ~l".li ~i. efim .. in_nre ft d · ·· · · · .··· ··· · · · n.e · e a tme r · ·· · · · · · g n llnlor l}iemot}ilcn· dist\mcf . aln are ?Omlale, corectaTea pefsog~lii a aspectulul :fizl !on eref~nt~are la fiemnificatia

·. . .. ·. c. precum ~J·ltmitarea perfeetiu-

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niSnmlUi s,i a ~\indirii 4ii,otomic.Olv"'\Wi!SO•. a:r .. 1'he c\ inio»\

l'sychOl<)gisl. 50. 1£>.~2.·1997). . . . · . . . .. . J Tempi• iDiel'!"''on•)a Mre "f••n>A .•curt~ de P')nol\'\"P~·

noncirttettifelll[ivl\ ji ··~-djr<C~"·· ce~uatil ve cont<Ol<tul•nt_e~: pelSonOl. lji care a~~· ?bie<li.v pdnoipalajntll<eo' pacient~~m ~· t~i jd<Ujifi¢ ~ sll i~i !J'O<)ifiCCJ.lr!>b\emcleintet~l~ s~~~e. ~nuucli< P""~ipli~ sa)~ de bo.>B o rae in~omJ:!IlliOilii en .'""'~in cogniti\l;.e()mt'Qrttttn~n~ll.Pl'()llr1u:.7..iS~~ unii autori (F~i.rbn~·n, CJl'• ovw:omlnK bing1> e>liii~ New)' on~: O"l!ft>'C'f ~'"F'• 1995) o·~olosesc tn """'b!nO!i• cu ~ogrUln~ do ~~~npi• ""'~dd.UniBUa"' ("self -1><11!") ~"""'"1"' abotdatea c~gnill•..,;.,pmtam•"'"'ll!, Dji,,¢. ,.P,~i\1• empirlce asupra efici•~l<i .ac~roitrntl.\fll~nteiiomel'nn\: . . . . .. . . . . ..· .. · .... > ... \

... •.F.aifbnm; t;l;G . .JQnes. R, Pe~elor. RC:' CBH• tiJ., .solQroll"• R.N. o·eoniui· MR. norton. t jl.fla~e. RjA .. 1\r~~i\'O$ .,f <len¢tfllJ>sjidiiairy;4S, 463-469; 1991: •. ··· \ .

· .. ~ Fl)i(bnrll. C.(}~.lnn""; R.,l'evolor; R. C., '!fOp"!. RA- <i o• Connor, M .• Are hives >of Qeut!.ra\ Psychirirry. 50; 419~~28. )99~: . . . .

.. Fairbu~n. C;G .• ICil"k. J .• o•eonnor. M. §i.Coopet. P J .• ·. )lebavinurRes""""'"~dTI¢mpy;24; 629:643; 1986. i

· Obezitateit · -~ · · · · · \ In mod ctrrtl"ll, obczitat .. so Conslderli ~ fi p<=<!''~ .atond

el)ndio<Jivldu11111' Cl\ ~ • .., mai molt posle g,eu .... ~"''ippmli\ .-m .. Qa<l pen!ltl o 1\~D.n,ltl(inllll\mC.!n p.-nr •. <Ste geperal recnnoscut faptril e~. oh.eiitatea reprcuntli un pericol p~ntn\ snolilatea ind\v;.in\o\.. puteJo statistiC& aF.>tl\ ci [Ot lnni tllUlte P""""'"" dfn SUA '"""'"~~nto,de a-t8J!TOblemn. . i

. "t«<lpia FO"'P<J<\Il!iiel!l)lll coiJSiitUietflltlu1¢ntill de el«lio Jn Ci\ZUi obe2itami att\tJ~ ~du\ti, cfit ~i.la copii. E)(.ista ~fi pnele . dare care Stlgerdazi ell (, co'mbinntie de tCTllpic C0~1itlV

toDlportamentala ·~i bipnoz~ ro:- avea. de asernenea. eJecte p~:z.inve in tri1tmi~ obezi&RtiL · · \ 1

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· VI. Depeud.enta de substnnte 1' 1 . _j)e-pcndeuta de alWJI ~i~t~&~Q C{)l1Slituiep!·ob1~JU!'! m~~Jie

11eut.r;~ Loate p.ers~aoele tmplic~~.De fl.lulte_Qri~ (am.ilij tntregi s~111 tdtslruse f?I can ere promi{atoare ruinate. Multi diU(~e ~.ei .care ar aju11s sa ~e,~p~tJ.genti de .a.lcooj sau drogurfiucea~ella un t~lomenttlat:·s~treuun~e.· insa depenclentade substituteestedmcil di uepa~il:. .. . .·. - ·.··.

1 fu cou tinuare. vor fi abordate unnatoareleprobleitl~: I

• A.buzu.l ~i 4epeudentade af«ool ·· .. · · .. Abuzul !ii de~-ndeu~de coFo.llt~. •

, • _Abu~ul~jidepeodenta d~Jletoiuii" · .I .·. • Abuz~l.~idepepdenta de_Lrat1r;iliUz;1nle 9{loare ;: ] Abuzul yidependenfa li,e alcpo[ · · ·. < > .•

· ..... 1... l~ l~qol ul es~e subsmnta cea rnm l;lliliz.'lUi iuStJ A. £lproape 9q%dJI?tr~adultJ.cgnsll1Jland-o1P.llll:l'llQmerJtdat.Aicaolulre'du,ce ~:~;itatea s~stet~ului uervo~.·-cu .ifupat:tnegati v nsupra capacttatJl_de a ravoua. di~pozifiei afecti ve, t.impului dereacfie, _cowdo!~ani. ruotdce· ~i • capacitatii •de · COllCCHlrare: ConsLunul lll~den•~ de alcool ponte ofecta capacimtea Jndividulolde a rea;cliOlla corespunzator in mec)iul soc~al 11i plJ>fesionat. Pe de . a!~ parte,. cottSU!l}ul.e)tcesiv de nlcfilPl;poate duce la il:lstalarea . coz:neJ .s~y_a l111eis~ide stupoare. Pe tenneulung, coJtsullJu{ de alc«;Jol se poate solda-cu· boJihepatice l7ittilburiit'i tmii!zice,

! E;tisl~ c5te,~a .. abo;(.<Jij.ri_·.care~i-au•.dovedit eficienta in I r_atptttr:ntu-J pxqbletJlelor severe cnu~te:de consumul <lealcoo1. l)il~t.J;e p.cestea. lrat~neutul comportament.'ll de e;,:pl.lnere la attu?rse,_autrenamenhd pentn.r fortt(area de abiHmfisociale, l'rofectutCAL..IYl~i Progriunele.Cmnuttitare. ··

I Aln(.Zrtlri clep,mdenra de cocainii · ; : .Cocainaeste o S~b~tan(ii care pmvine din pla;ltade toea.

Consunmi acesteia produceseutimenlehtlense deferlcire.~i·stnre de hine, generand totodnta ~io puternica depende1J.tit Abumt de cpcaina nre efect:e negative B.Supra cnpa~Witii pet-soan~i de

306

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a-lli efectua activitatil~ ziluice, ptecum :;i_ i,\SUp~ relfltiilor interpersouale.1ncetarea.bru.sca acm~sumulm aeeste1 Sl.lbs~u~~ esle insotit:a ·de simp tome de s_evraJ -ca obqseala ,n~centuat.l, cosmaru;ile, problt;mele ·de sonm, · agitalia psi~l.{Jmotorle 11.i

a~titul crescllt. . . ·. . .., . . . • _ . . . . .· · · . Penlrud~pentientade cocruu~. eel mru eficteottratn~t~eut

s-fl dovedit n fi terapia. comportamelltnla.Totodatli, prevem(c~ reluarii consuuiului!'le coc.aiuii clupli tncheierea tralntnenlul~J

po __ a t:.e. _n_ e:_n __ c ie_n_ •. · t abo_·~-_ .. --_._··.·_· __ ··_.P_·. r ___ ._··\.n n._.l _______ t_t_._._·_t .. _.·_·._e_. __ ._r· ·_m .. __ .·.·._ .. ·e· .. ·di ... _ ... ····JI.-l.l __ .. __ .u_ .. _w __ • __ .·_·· __ -... P ____ -~_. __ .u __ ··.g.· .;a_m u~nnl terapia:cognitiv:...compo.ttanit!htalapen~~vemre~reddeolo~ .

Abrlt.Ullfi def!t!l,ldenfti tie het;?'"-a · - . . . ·. . . , 1

Het()ina apnrUue une~ calegprJ! de stu~e~~te mumtll_ . opioide.din~care m~ fnc.pzwteot~wdina;.codema.~ltnetaf&o~a. f!f~et~Je CQJ.1.$1llltuluicl~beroiua jnqlud senZJitla~e semn. vmb•rc ingreuu!l~. probleme de atentie tJ-ituemorie,.ndC!Iotll.reR pupHe.lo.~ :ji responsivitate scazutlilnsU•nulli?~n~diu. Ab~zul de.heroum . nr~ efectenegative.a~uprn cn.pactt.atii pexsonne1 de a efecltln

CQ£"eS_(}Untlitor sarc.i.ttil~ cotidie11e. • . __ .... _ .·.· . • .. . .. Datele ex.islenle pan lin prezeut mdiclt ternpJa tfl~lalnt:U

de scurta durat.~ !li tera;pia cognitivl ctt !lilrnta111~nte !!flctente m cazul fibU~ului ~jdependenteide herohtll. _·.·······

Abu~ul si depettdel'{.a de Lrancltilizante · it.f.oare Traucruiizantele u~onTe• sunt 1.1tilizate in tratameutul

nn~ielatii, ·atneuluideptuuli!U.:jiptoblenlelo~~e sor1n. Uu gn!p de tranchilizante ,Ufioare care :pro~uc: · dep,et\det,tta .esle ~el nl henz.o~pinelor,printrecare~elh:;crium:tllll?.a,rel~,su,bstan{e: Xan:ax (alprazolam)~.V hlium (~lil:~pam) • .Ativan (lorn1.epnm), Senn( (oxazepam) ~Ji Klonopi1~ (t:lon;Jzepaln). _ . _ u

Efe(;tul· aces tor substante -dureaz;ti. •. df} r;eg~Ut. o tJemntdu scurtn detimp. ele ptodudind depertdentii chi~ .~i .atunci cihJll

sunt prescrisede medic~ Re.ountnrea.bmsc!l~-?~J~l~?rea ~cestom " ,; :<:>e,ste lusotita de simptome de sev ~~ ~~· ~~ansp~;ra~ule~ tt:en~uru~

... -~"or dificultliti de sumo, senzatte de great~, agtlatie ~~ mauw , _ . .

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~ nll¥ie~¥·.·t1eis~~9n .. 1~oio~i11:a,a~~tot slil~st&n{~ilt1ce la

~~~~~i~~.a~!~~~CS:IJ~I!>~maimari · ·~'f~i:apih Crignifiv:..l!ompottatnentalii s-a ctoveditefiicieutai in

trataren.s~v.rruti\ui..la, p~Q;oan~le·cate an·aj~as,de@endente de··. ·· ··?.•··heili&ffi~zij;i~~in'.:itr5~ll··~ta~eotull~~penr~patncde'panica.

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··= .......... :;f!~~~i~.•'0\}~ \. \ ·••i;J;~t%<.. •. obiceiuri nesii~ittoas~cunlar fi

.· .... . . ,. .,~·;·, ,.·t!~~~ftr~!ftL~;~;rosj~i1~~. ~au .... sm\llg:Crell n;!pefil. ·...•..• . .... lf:)rd 1' · .t~ (JilJ!d smq~~ plrulu1 so

;,;~•iJ;•"so1~.zii1ct1~titem~·liO:ett . ·. " .. ·:. ~f!fi!~re~~~~;::~~~~~rF?aJ"tii ,,,,;,,. •.numel~Etc'lmootil'tfifiaftie;:'!ZB'nel'c 'i:JO\'uuac •· fiate'fi 'Sm\ilsinlin•l . :~;::t.i~~l~;;~j!~~~~ll~'~·~~1e411~ifa1e~iii)l~S'ifil~tea ··.:·.{·co ··· ·ll~Jhli~a a*}IArUllli*p&nte~uritenr·fie·perr«l~M~gedfte a~·ump ;Jfi~;·~mal.;::lt;~:~~:~;;~.

. ~· episaadelor . crescllnd tw pcH?tVad~fc"'~lrcsifute; • ~e~ ft;fitl 1 a. .• ,.,,:,, per~91~1~ .~~fa{$'!8SC.Dnd 'acest ··mlJi'dli, · evifiln£1. sfnulgerea .... 1 i:;P~~~,~i~i,f!!7 ~~$:~"1~f(~~~netc•~iu~:l't~r1'J' : .• ''"·~·'· ' ',, .. , .... •·' ... "'' ,, · · · ., · · · •· ln caz.ul rri~9ti,!9ftl~ai~i; .. tp;il~auqenielc'~efioietirc includ

. re~~~~U~~~~~~!~~~.,j;~c,qf.f~e~t;l'hl?";aeo~rr,al~tt\~: ·zc.,, .. · .. · .··· . .ic<;,,,cl;I .l•d··'. i(v,!·::· •. : 'ix:~lK: l ;cl;{::'t!I,·•r . f;;::':l;''·'·····•

£;'VJJI.,~¥Ahle~~Je'll1!initale~ .... ''i'f;' ::~<'~' '"~"·'i'~··~v.J'"P'' /·~ ':9,J~18~~;peikctL Dini"Qcferfeire.

~t,ti~\~~~tj§il~e·:ilel\Wctentn · • ~~~-...)~:.!~\ ,~J.fplnlti~iont

'•f'. . n~rl,,st8billr~8.·,~c,scopurl i!fl~~i;,(S1;;r·,.~r~.>·••• :{rc.·•?:'it

~t~~~.d~'f?Up)u eonstiluieun liiclrament· • .. ~i~l~,~~nic.!~amm.16Jiett;·ex:mtil\'t~e1n

ilnire'hn'•'l'l''~lj\tJ'.,;;,;.;.n\7 ... i·~piil,dC.cupJtffAl\ali~~l~P~emAtie ~l _," ··-' '{~,l,1i '/,. ., "'" ','· ,, ,· ,.,, ,, ,

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b~frac{iwt.ile .rexuale · •- lnfractorii se.x.uali sum de regula barbal. i _ · d .. _ _ . _ _ _ • __ . , care a opta C(JU~portat~lente:s~x~ale mndecvate, .Prinl.re ca,re violul~ abuzui sexu~l asuprnq.unordor, ~xltibip;c:mi~Ji1Ul$i im:estui. -:;·-.-· -•

_1n ~~z~~~ ~~estor persoa.ne,.cel.emai bunereiiri~L~·-s:-au 1 ob\u,ut pnn·.hite~riediulmodillcarilor com.portaiDeritai"e. ' ·

X. Sdtizofrcnia ~i alte·tulburii.d psUJc~ 6e\•ti!re : _ _ ·. :~chizofr7nia ~i · celelalte tulburfui :psih:ice severesu.Qt· de 1_ ~egu~a d~tenrunate_de ~-rezenya siruplo~elorpsibotice, prlutrc ,care cle~JI"lll,llalucma~ile (~IZuale. ~i auditive), derealizareo, F.m~1.g~ t ta;Urent~l .,dezorgannat, .vorbi rea dezorgaJli:laLa $1 rPlati~area afectlv~ · • ,

! . J-:~ista (! a~e c~·e arnta di in caz,ut ~clti~ufreql~i ~:i a tulbufl\rdor psilu~e severe celenuti eficiettte fornu:~ de jnlt;!f\'entic ~un~ ( el_e.sunt adJ.UVattte ~tmuentului J)leilicame~1to~)= Letapia de fatJ.lilie, terapJa _ cogo.1tJv-couw~r~1leutaUi, ~lnl:{-ennu1entul pen tnt fo~marea abilltliU~ot sucia}e, p1-ecutn~i sosfinerea Ja Jocul c~e mu.nca. . · · · · ; · · · ..

\_ ._. luterven(ia psiho~ociala joacaw1 rol critic in tr~tamentul pfrso;.•Jelo~cu schizo.freJili.e. r~ P8.{'CU£SUlultinti10{ 15 aui, s-au u¥"e.~~st~-atpfl]gres~ hnP.crtante ir1 elapor~t[Ea intervenpilo.r de f~nuli~, ac~tea ll]ilnd "QCJ.1lijl:oarele c.nra.t:tedliti~ comu:uer (1) ll,ll _ ac~eut .~eo~(!blt cade pe eilue~ pacienlultii ita familiei Dl)esl~J~ ~espre parti~ltl.ari~file .bf)~j sale:ji p~lpiil¢ terapeutice, . (2? fanJJ,ha este tratata ca :jlalil;lt.f"I.ittdde:;curll.jate senf:in.telttele de culpa s~u- invirm.vatire. aceluilll.l:t,(3}latnceputuJ IJ~tatHel~ tulut._s: ~rgantze~~~ o intAAt.ire cu familia pacientulu ;, asl.fel de utUU.mn f"uud orgamzate ulterior periodic, ( 4) jnr:erve-ttlia eme.~~ .rJuratal~nga, de regulii merg_fuld panaladoiani, (5r .fmmlul~ beneficm:di. deasistenliiin tmbunaliiliti!a abilimllior de CO[~ing ~ide comunicare. (6}se folQsesc ecb.ipedeinte~enrie lnultidisdpli.nare,_tuembrii acestoralucrand in stransa colabo~e

3HJ

i·

~j (7) esle urmarit iudeaproape,; lratatnelllul.med_ic~utem~s ~i se fac.eforturi J:lelllru ma2WW.zaJ:en complitul\~i la nct:~ta~ Diutre studille empitice asupra eficien\ei intervenUei de f~uUie fn schlzoffenie entnneram~

"Gingerieh,S.L. ~iBellack,A$ . ., The CJ.iu.icnlPsycholo-

. gist, 48, 24-.27, 199~.; · . • . _ _ _. . • Leff. J., Kuivers, L., BerkowJtz,ll. =11 Sturgeon; D., Bnl-

isll Joumal.ofPsychiatry,146, 5~4-600,1985; _ _ __ -__ · . • Xiong, w,LPhillip,s, R., Hu, S .• Waug, .R .• EJai, Q .. ,

Kleiumnn, J. :ti Kleirnnrut A .• BritisbJournalofPsycbioL~y. 165, 239.-247,_1994 .

XI.. Tulburarile dhii:ttosticnte· de regf.JUi.-penti~u J~ "' ... · , ·-n" ·• • --- ·d 1 · .. :!!: prima w.ta m·cop o;rrb-fJNl -· o .. esc~lltu . .

D~i tulburilrile spl!:cifice adultulul se·regase.~c ~Uu ~azul coplilor(ex. depresin, atiAietu~ea), ad~enuee{iteaabJU~lifestUri tipice yftrstd; de,exem~lu, anx.icml;e~ atJart ~I.e~ ~ltJt~e~nte ~e sepanrre. In plus, apar proble1ne legate de ~:llvtUi\J:l~~a.ngonle respectivei pe.doade de dezvoltare; astJ:el~ ~t\ coud!\l~de stre~ ~o-piii adopHi.uneori conlf?OifHJllentespeclfice· utlel varste !lUll

mici dedit vfu:sta}or Cl"OJlOlogicii, l"t;fU~.sa,l\).eDJ'gltJa-~Ct.lBll\ etc. D.iutre pmbleJ.ue~e apiirut.eln coplliirie~ladolescen\u, vor l1 Iuate indistu\ie IJnnatoarele:

. • Amdetatea de sepaxare · Enct>prezis

• Emuezis . • Cumportameutul_opozi\ia,uisl~·llfovocator

. AnxictaJ.ea dc st?parare -. _. Ace.5t tip de anxieto.te semanifesta pdntr-()teltlnii inlens5

tie abandon,· de a Ii separnl de prulnti sau de alti ruenabri ai familiei, de a fi rap it sm\ pierdut, de a pie~~~-E~Pr~o~niUubili\

. .. s~u apropintii, precuill!li de dificulta\i mru'Cailteiaia Clonui d:pmtt! de casa l!i prezen\a co~marurilor. Aceste frid suut UlSOUle tie

:H u

··· .. ··

acuze. somatice C" dt·l. .. - d . . . - · · • · . .. . ren: e stomnc d 1 .· d ntunct cand copHnlurmea23{ sa _.lee~ l re• J • ~cap etc. care apar ten_lp_ or_._.ar de pann· ·_,: ·.·D. . . . .... p .. . ·. la-buntctsau sli Jiie_separat

' ·· \I·. · e reguln astfel d · · ulterior unni e-venimentne Ui~n ... . -~ &Imptomese dezvolta mmu·rea ungi ·per' .. 0- i P . t .:;bn vmra copilulni. cum 11r fi ~ .. ·. · .· · · ·. · · .. ·· ·•ne aproptate sn\1 ·· • ·.. . mceperea scat·· · · .. . .i\ unm nntmal preferat · n san mutare·l la o tr· · " . · · ·· ' domici1in. o boalli somatld\• . a . a !lCoala. mutarea ln uri nil

Exisrll d!lte barn nratl( ell tern . . . : esle efieie.ntJl.Jn traranlentul anxi::: ~ogmtiv-compoltnmentnUi · Enc9JJreZ:is . · tti rle separa~e ..

Encoprezisul se ref~rli 1 . • . •.. · . fecaJelor. soldata cue. . . . ; ad·rucapueitatea_· de conrinentlt a

. . IUtSlUnt e scaun ... "' . .• • . pentru flcclil:il: (pe bain j .·. · ·. , . · .. · .· .... .u ~ttuap11nndecvnte

co_ n_t_i_nun_re. an. O_l_·m· nJ"a. ;c_·_ •.·. np,a~.etc .. ),Stn __ r_ea_._._P._·_oa_tf>reprezent.a_ o •• ,. ~naontinenre • ·· n ·r . o pietdere n Jncontineu( "' l .l ?n nntt e, saupoateconstind

sfincteaittn. · · · · etu tenor ncbizipei contro1ului

'Q~etc d\\te indian mQdiflca ·. · .. · . lin trnra_m __ o_ Rt_efi_ "tci,._nt_·-: .· ~ .·l. ·. n1e co_ mpol'h\nlemale cn·fiind

-D . . .... .· ln cnzu encoprezet' . .r.:.nllrem · ·· · · · · •

· _Enul'ezisttl-~e referiUa :. ~<; , .... CltJi_sia ~~'\trilllhtnrvenilld To ~np~c~ratea de reten(ie urinarlf, fll srntaltl inndecvate pen~ he P!-11 ztJe ~au P ... e pamursul noptii poate_ reprezenta l)··c·o···n'ti" .·.· .. ··. est?-{.pef)J}me,mpat_ e __ tc.tstnrea -1 . nuare anorm Hi . • .

ll e, snu ponte constitui • .· ... ·. a .a UlCOt)tinentei inf.an~ .achb:i(iei contmlu1uJ't . o pterdt!l'e a mcontinenrei nlterior . lnnnr. . Datele e>cistente i d; n .· . . .. ~om~ottmnentalet~t.llatun:n~~ enclar. eflc.Ienra- i~terventiei

. tn1phcti, dare.guUi nt·•"l"•za· .. .·1. .1¥rez_asol!u. A.cestttpdeternpi~ . · · · . · • · · ren ' e a atmc (e"' sen1nabzenzit p 1:ezenra • • .. ··. .. . . .... ..:al)f11nale sonore) ce e_d_uca ___ rea "pliri_nt:ilo._ .. .,.....;n·· ~~IIJ. e.fdP~ __ .luune ·_Bau in pat, precmn si

• ~. u. "e stu lilt em · · · · · · acesrei forme de terapie enumerlinl· . pmce asuprn -cficienfei . .

312

,i . . --~Jiouts,A.C.,llennan. ~.S. ~i Abramson, l-1 .• journ.=il of Coil;ttlting and Qlinical Psyp}lology. 62, 7'37_../45. 1994~ ~

,;~ Iiours; A,.C., Liebert, R.t-.Jf.. ~i Pndawer, W .• Jcnlrnal ~f AbnbrmulCI1ildPsychology. ]1. 513-519, 1983; . . ,

',.Houts. A..C .• !Peterson, J.K ~i Whel~m. J.P .• "Behiw~or J'hel"apy.,I7. .. :462...\i69, .19~6; 1

, .···• ' .• ·I-Iouts. A..C.» Wl1eJan. J.P.,~i Peterson.l.K., Jonrns.i. of : ·. · CimsultingandGJ.lll:icarl?:;ycftology. 55,902.-906, 1987~ '

: CoutpoJ7ta~nent:rtfopQzi(ionist1 praVIJCilim· . . . ; :. CCJmpOJ'tlln"L~llU:Ul o~~ziti;onistapare ntlit ]a pl"~col&ri, Cfil

~1a'_arlo1escenti ~j se Iflc'tnif'eslji prln~ pierderea controllllui, ce:rturi cu )_):iri(ltils~u profe8o~ii,,"fQi;~ ~iiritare, b) lliTU\reanltoJ~n pentru ptnp~Hie_g~li.1nc~piltH.iiare_!iirefuzull;lea face compmmisuri, rentztd~e .a £CSpeCia ~g~lf~ ~re~Ulll ~i irit~rea intelltiOrtatl\ il celofdinjur; .A~t_«;PJ1l~~!~"[llentse manifesto, de reguUl, nc~sli,

· · Ynsl ponte npareasl'ia ~coal}i sau in public. . _ J

' Trnrnn1entul doveqit efi6ient tn cn~ul comporramennllui opoziponisteste ti:ainjog'-lllplidn~ilor. in'cndrul aceshlill.parinti i i~i formeaz.li de{n:illderf ~are _sa ti "ajut~ sit fnqit fata cmnportii~"fenmluicupiilpr. pj-egndrea include _fmni1 iafi;zarea cu priuqipiHe1nvtltai-ils{lfiille ~i ateh11icilor derivate .. Terapeurul of~ra o · s~urta expl}ilere ~ conceptelor de b~zli. ~i t:~hni~il.or propuse. ghldftn~ •. apol pliyin{H in implea'nepu1re1l .. _nctdstor procedurk Modelelt~ .:le'i~.tt:rnctinne ~i procednrile fnvlitaie in cadml1]ediil\elor surit uJ.rerior aplicate ·ftcnsn. J)intt~ studiiJe

'empirice asupra effcie!l{tincest~i forme de terapic. ~nJ.m"!ei"ihn: ·' • Dumas,. .J.Ia~. Qlitlicat·Psychology Review. 9, _197-222,

·1989; . . .

. :_ • Forehand. R. fli Long. N., Advances in Behavimr Re-. search and Thempy,l()d29-rn.l988; · .... ···. · .. 1 .

.. Long1 P ., Forehand."R.., Wiers on, M. Iii 1v'forgan. A.i, "Be-tl~Vior R~enrcb arid Therapy, ~2. 101-107 • 1994; · ·

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~ EJementegene,n/tJ.afciTJlati~l· ., '·~.i.~qj~J!lj!illl!lc,!liinlific.: · • BnlJ?!ltie :;i cu~ne'tVli teiitp• ,~~.~~21 · . ·. . • • Colaborm: ~i.cu~f:e?Sc~~~~~~;~ ~~€7~· ··· · ~erop~e}; • Alianta t~tap~\ttibiile~:srr.IDiJifeati · opnn~lnre)~

· . ,. EIF-f:D;tegen.enzlelll~"laliel,te~'t! · J{l}Jbf!,,. ~t!icien~ ~~t6tific~~!Jx,,~2-~~ ·· ·t,.,n· . . ;')i'•~:A~~p~a·neeoliciliti~nti·~··Congt«•ta~:·:r

··.Jl~db'c~~, '"':"'r .•. ·i~l .. · '· ····.·~~~.~~\~~~iW~ieo;~~~'li'ii",~·~o~Y:WlYi.~~~;jtnpi~~iren ·

uuot~specte pemoumei ... , .. . . .

""~~~~.,:=~'~ pstliot~raJ»e a unorpro.ce .. Jl dea~9:!~Y.;;;(~.J\g~~ .. :. la persoa1tele cu tez.isten'~ .mnre io~ tetayl:a ~a! :i)rec.ttvft fuuc~iolieua,~Ane}~i'?~~tj~~~~~ .. ~~<tP~!l~~l~c!'UJ -~ .. i

•Dlfic~Ititpf\JI.l~\9Q5~· , •• H··~• . N~r~i5<~ffr·: ·· · ..•. ,!J..~!Ffi;'f!.l"f4/llf!~Jifl~.~~Bf(i9}l~!~f!UfiJ1 rfle can1 proln1bil u-elliJiefi]I{It~iiw:iiicfl!;#~!:~l@;~~~~f,Cil supod ~riinf.iiic · pai(ffii£W:i'all11Miiinu.aufolt S:~ijpi,~~tf.p.:pli~f!!J:

• Stiluli;Je copi1Jg; .. ~. , ,... ... · • ~teptilrll~.~~·i~t,t!;. . • Capacitatei4qt ~~lA~~'&pcrt.J_o problemnu~ • StadiuJ s~!~~~;~J.~{)!'~ .J?~~~'ta)' t~94 pentru

•,,•>";' .···,,-'' ·'< '. '<\

uetalii) ••... · ·. . :[' ; . ·; ..•.. '·. . •.. . " , .. ·· A.'s'pet:t~ rf!lat~~{i[!{~~'Wa.~~ti[lt~{el~eu~;l:.~':::~~-e~ Jl~V.b:•b!l · trehuit: {imrt ~trllf~"l!·Jp-r..l!aZII::s~'!,l!.§.~$Cil"f'-SJ1f!CIBiJ.~tlloJj Jrl · ·· ilOJJ1iniSfnll1Ul teiaj}iel dBI"CaJ:e lJU 8U fncll rJicj JllifCl.lr till SUJJ.Orl

~Tiinlific partiaL· :ns

.:· .. , •'

Siilnl de ata~all)ent~ • Ernin~ti sex.lll;

Religiozitarea ~i spiritualitarea; u Preferinte~

· T1.1lburadle de p€1';>ona1imre.

ANIDrA 3 .. S.~TlJLUE JNSTRUMENTE PSlH()LOGlCE

I'ENT~U Jq(PERTIZ~.DRA ~l EVAI...UAREA ~OPIILOR/ ltLEVILOR iN VEDEREA ORIENTARn S,COLARE

t..l'nonA m 1~ntN lloTXnA.nEA GUVJ!:RNl.lLm RQNfANmi Nll~ 218 DJN 7l\1ARTI~ 2()02

Textul ·de maijgs este reprod9cerea. paT!iaJll a. Hotnrilrii Guvernului R?mllniei nr. 2~8 di~ 7_M~Itle 2002, privind np~obua:eft Metodologiei penlrtt ntillzarea ~etnlui de insh~mlente: deexpertizafetti'ev~luare n· copiilor/elevilorill. vederea orientllr ii ~colare:n ncestora. ~ub_Uf?ntli tn Monitorul Oficial. Patten I nr. 204 din 2.li mnrtie 2.002. ·

l. Evnlaun·ea ni'Velulni intcleetuah .1\- Tesredein~eUget~fli ge,~eral~:

· q)- ··· mat}"icele.progresive Colorate-Raven: b) matricele progteslve Standard-Raven! e) Dt!!t~rborni tl) fraze abs'urtle;f · ..

. . . e) ce. s:.nschimbarl; " < > • f) · · ce s;...:uc11in1bri.t 2.

ll. Teste? de inteligenta globaU\: ..a). W.P.P.SJ; s~antW~hsier-Bellvue;

· b) WISC; sem·f}Wec!lSler-'fl~llvue; e}\V AIS; scamWect)sler-Bellvne;

316

' I \ I

l J

I .

tl) Kaufman (inteligenta globall\ ~~ stlluri c_ogni-• • I twe)~

e) Bluet-Simon {de ,-eeraloni'lt): .. . .,,. , -~ ciN.E.M.l. (RZazzo ~i colaboriliO~l) -nou,,st-rl ,\

lnetricii a \nteligen\ei ~ .·· ... · .. ·.. . ·,., . . . . g) cubnrile l{ohs pentm nd~l.t_t. de uokl.stem •.. h) cuburileKohspentru copn. de H. Snntucct, i} teStul dir~mizilor;

J) testul Coiu-q1bia. . ... _ . i

c. Probedeinteliget~\fispoctficii: . . . 1 ••

a) probe de evaluare a :t:unc_:ti~l percept~ v-mom\1~· · - Santucci(4-6 ~n•)i . :

,...Uert:der~Sautucc,i (7-li ani) -,etnl'1n1\t ......... ·... . i

de 1'· 1Cu1csftr;. .. . .· . . _• . >b) J:m3be qe ev~h1~re .a c,npacita{ii de or;ientarf Sl . ' .·· .. ·· .. ·.· .. · • ·}'>~• ·. .. I

sttncturare.spatut tt.. • •.•... · •. ·. • . • ...... _ 1 •

- Kolm-Goldstcin (aduptl\t d~ Sa~l\\ccl l}ietalona~deV. Preda); . i

c)tuobedeinteligentli penrrudesen: - Goodenough;

tl} e'Valul\l"~a caJ?acitittii_dediscrlm.il)alie 1\

identiculuidesimetriciu structunle grnfice: ··· I -Jl.V.E.R.S.A.L.~ l

. e) ce veiletn imaginileRorscllach:

· f) dOinine. ._ •. ·. · .. •··. . . •.. . ' .· •.. . . ·•• _ .. • . .. . .. · . . • 2. Evnh1twen rooJddtntii ~i psiltomoh·icitntiu

·t a) prilha Ozeretski-Ouilllllain; · • h) Gpsell, sc~a de dezvoltnre; _· .. _

c) scaraOdetreBrnnet_!ii Irene l~eztne; d.}proha delnterl,l1imr~ I~a.rris~ , .. _. .. :. c) lestnl pcntrtl gnozia di gitala, Gerrsmann; _ i f) probapeninu:inkinezia membrelor supenonre;

317

I . _j

. ~ .. i 1,

g) test de 5lukinezie a ni'embrelor superioare. Stmubak;

h) proba de uiotricitate·digitala, 1\. Rey: · i) probe de asarnblare (patralt triunghi);· ·X

·· ,,:_ :j) proba Piaget-Head (orientate;,} spa~u)!. · k) testul Head (tnilna, echi, ureche); I) Denver·; m) Portage.

3. Examina~ea·psihologlcii n [J~I·souoJit.Ufii: n) cbestionare de personalitale; b) CAT, testu.l de aperceptie pentru copH; · c) TAT~ tesf:ul tematic de apercepfie; d) Lucber, testul culori(or; e) Szondj, proba pulsiunilor; f) Call!JJ ::,:i R. Zaz:z;o, proba de pei·seventre; g) testu.J CRSa-arbore-Omj b) teslu1 arborelui; i) testul Rorschach; j) Freiburg; It) STAI 1; l) STA1 IT;

m) tesLuJ cu 20 de propoz.it.li netermiuate (eu suut) (TST).

4.l'rohe pentni e:valua1·.ea ncti:vitiiJii psilaice: A. pemep!Ja;

a) testul figt,II'iloi .t:orn.plexe, A Rey; b) lestul de orienta~;e spa(iaHi., H. Head; . c) teslul fren.y vointa, A. Rey_

B. afecti vilatea: a) testul de frustra\ie Rosenzweig; b) completarea de pove.stiri; c) asodere de cuvinte; d) fabulele DUSS.

318

.. _, ... -' .:.:.:.::~'::t'~··;-.;~·:-··---.......c..--·, ~.~'-·-

C.limbajul: . . . . a) scara de dezvoltate a limbaJ~llm, C.

l1aui1escu; . . .. _· _ b) ptoba de evalunre n capncttlifil ctttlulul. M.

Ldbmt (Bovet); c.) Beuder-S.autucci; · d) probe de flexibilitate nsocinti.va: ~) A. Rey adaplaUi.

])~ imaginat}a:J n) proba e desenliber; b) proba Wartegg: . . . . t) probn Colliu (comi_J.letnren lacuuelordmll-.

tmdeseh); • d)desenulfatniliei, Corman.

E. memmia: . a) proba A~ Rey pc bazn de cu~iute; : ... b) proba A. Rey pe bam Qe figun geomelnu.". c) lestul ugm:ilor complexe. A. Rey; u) proua .Pieron; . . .

. c) WISC (proba de memone). F. nten\ia: .

a) proba Toulouse-Pietou; . b) proba de dublu finny, I~. Za-no; c) proba Bourdon-Amllmov;

. d} prob11 Pr.aen; e) .lablrinle; :· 0 completnreal.acouelor; . • g) proba de discrimitm.re percepll vit

319

. --·--·--· ·~··-~. -~.-~---......,··.--.;:·- .. ---.-:-:;~-~""':'··-··

....

,.,·· . . ... -

-.. ,. ·. ......

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