Recently Completed Dissertations
Interpersonal Dynamics and Therapeutic Relationship in Patients with Functional Somatic Syndromes
PhD-student: Juri Krivzov
Juri Krivzov`s PhD project is concerned with interpersonal dynamics and therapeutic relationship in patients with functional somatic syndromes (medically unexplained disorders). Patients from this group often report a history of trauma, abuse, and parentification, and are often perceived as challenging in medical and psychotherapeutic settings. Maladaptive relational patterns may lead to mutual mistrust between the patient and the therapist, alliance ruptures, and stigmatization of the patients. By means of a metasynthesis (i.e. systematic secondary analysis) of case studies, we attempted to gain an in-depth understanding of psychotherapy process in these patients. Thereby, we could gain better insights into the links between these patients´ (early) traumatization, self-exploitive and controlling tendencies, as well as interpersonal emotional avoidance (alexithymia). These results should help therapists to predict relational impasses in psychotherapy and to find treatment focus more efficiently and quickly. Currently, we conduct a series of mixed-methods case studies of patients with functional somatic syndromes based on the data of the Ghent Psychotherapy Study. Thereby, we study the audio-recordings of psychotherapy sessions, patients´ self-report data, and supervision records.
The experience of negative symptoms in psychosis
PhD-student: Nienke Moernaut
Negative symptoms of psychosis, consisting of diminished emotional expression, avolition, alogia, anhedonia and asociality, are less well-known than their positive counterparts (hallucinations and delusions), but have nonetheless a tremendous impact on patients’ quality of life. Despite a growing research interest in these symptoms in the last years, little is known about the subjective experience of these symptoms. However, anecdotical evidence and the few existing studies show there is an important discrepancy between the traditional conceptualization of negative symptoms and how these are experienced by patients. This dissertation aims at setting light to this subjective dimension by the means of qualitative research methods. A review study of existing qualitative research concerning negative symptoms aims to settle what is already known and which elements should be further explored. An interview study with currently psychotic patients aims to shed light on how patients experience these symptoms and how they try to make sense of them. Finally, recovery of negative symptoms will be mapped with a cocreative study with two experts by experience. Whereas our research aims to start as much as possible from the experiences of patients themselves, we make use of Lacanian psychoanalysis and phenomenology as theoretical frameworks to guide our analyses.
Promotor: Prof. Dr. Stijn Vanheule
‘Under pressure? On the finality of time limited therapy and the effect of a time limit on the psychotherapeutic process.
PhD student: Rosa De Geest
Over the past decades, the use of time limits (when the amount of sessions is set beforehand in therapy) has become widespread in the psychotherapy landscape, though very little is known about how the intervention influences the psychotherapeutic process. In our dissertation, we interviewed both therapists and patients on how they experienced the time limit in therapy. As a result of our study, we found that setting a time limit can interact with several important aspects of the psychotherapeutic setting, such as patients’ expectations and motivation in therapy, therapists’ focus, and the outcome and goals of psychotherapy. Especially for psychoanalytic psychotherapy, we observed that the time limit can stand in the way of free floating attention, free speech and free association. On the other hand, a time limit can provide opportunities in therapy by adding safety for some patients and by motivating them to continue therapy despite the emotional difficulties they encounter. As a suggestion for clinical practice, we propose to pay caution to the way time limits are implemented and a to carefully select which patients are suitable for a time limited therapy and which are not.
Promoter: Prof. Dr. Reitske Meganck
Countertransference in psychotherapeutic work with patients with anaclytic versus introjective personality structures.
An empirical study.
PhD student: Vicky Hennissen
Summary: Psychotherapists frequently experience strong feelings and thoughts while working with patients. In psychoanalysis, this is referred to as countertransference. There has been a lot of debate on whether these thoughts and feelings originate from therapists’s internal conflicts or whether they need to be seen as a normal reaction to the patient’s personality and behavior. The past decade, empirical research increasingly focused on the relation between countertransference and (DSM-IV) personality disorders, demonstrating it’s diagnostic value in therapy. Although these studies yield interesting results, the possible contribution of therapist factors tends to be overlooked. The present study aims to explore the interaction between patient and therapist factors, allowing for a more complex view on the occurrence of countertransference in therapy.
Promoter: Prof. Dr. Reitske Meganck
Power and ethics in contemporary psychiatry: A conceptual and qualitative study based on the works of Foucault and Lacan.
PhD student: Evi Verbeke
Summary: Psychiatry as an institution came to life at the end of the 18th century. From the start, power and coercion have been a part of it. In this doctoral thesis we want to examine how psychiatric power operates in contemporary psychiatry and how coercion is experienced by patients. Power and coercion are studied within a Foucauldian and Lacanian framework. The genealogy of psychiatry by Foucault is used to understand power in psychiatry from a historical point of view. His theses on biopolitics, the power/knowledge dynamic and the way discourse grounds behavior are the most important concepts in this analysis. From a psychoanalytical point of view we start from Lacan’s discourse theory that gives a view on power as something that differs according to the social bond and is grounded in an impossibility of human relations. The research starts from the hypothesis that power exists within a social bond and is primarily exercised upon the points of impossibility of the Real as conceptualized by Lacan. The next step is to investigate which ethical consequences these theories on power and coercion have, by comparing different ethical viewpoints and assumptions in contemporary psychiatry. The doctoral project also contains a qualitative analysis. Patients, who were hospitalized in psychiatry, are interviewed about how they experienced power and coercion during their stay at psychiatry. The interviews will be analyzed according the IPA method. By this, the author includes patient perspective and examines how coercion is subjectively experienced. From both the conceptual and the qualitative study the author investigates the clinical consequences and the perspectives to orientate psychiatric practice in the 21st century.
Promoter: Prof. Dr. Stijn Vanheule
Co-promoter: Dr. Jan De Vos
Moral distress and intent to job leave in relation to team climate in medical intensive care units.
PhD student: Bo Van den Bulcke
Summary: Fostering patients with serious critical illnesses and innovative complex techniques, intensive care units (ICU) make up complex and high cost work settings, with multifactorial ethical implications, and thus forming a source of moral distress (Reader et al., 2008). Perhaps the greatest challenge within the ICU environment is the ethical decision-making (EOL-DM) as a part of the daily tasks, which is highly burdensome for patients, families and clinicians, not in the least regarding end-of-life (EOL) care. Research in different clinical settings has shown that good interdisciplinary teamwork is beneficial for healthcare providers as it is positively related to job satisfaction and negatively related to burnout and staff turnover. The goal of this research project is to examine the relationship between moral distress, intent to job leave and team climate in medical intensive care units. This will be performed by combining quantitative and qualitative studies.
Promoter: Prof. Dr. Stijn Vanheule
Co-Promoter: Prof. Dr. Dominique Benoit
The nature and importance of interpersonal dynamics in the treatment of disorders related to complex trauma.
PhD student: Kimberly Van Nieuwenhove
Summary: Literature reveals that complex trauma influences the formation of fundamental beliefs about the self and others, which find expression in vast rooted interpersonal patterns. This project aims at a better understanding of the concrete nature of these interpersonal representations, operationalized by means of the Core Conflictual Relationship Theme (CCRT) method, and their potential to change throughout therapy. This requires an investigation of the structure of the CCRT before and after therapy, as well as an in-depth investigation of the interactions between patient and therapist.
Promoter: Prof. Dr. Reitske Meganck
Co-promoter: Prof. Dr. Mattias Desmet
What is the subjective change procured by a Lacanian Psychoanalysis? A qualitative-conceptual study based on Lacan’s knot theory.
PhD student: Dries Dulsster
Summary: In his twenty-third seminar [1975-1976] Lacan, conceptualizes the psychic reality through the cross-linking of three dimensions: the Real (R), the Symbolic (S) and the Imaginary (I). This is a radical shift in relation to his previous teachings, where the emphasis was on the dominance of the Symbolic and the role of phantasmatic constructions. In Lacan's later work, the emphasis is much more on the very singular and contingent relationship between R, S and I. It gives us a new conceptual framework for both interventions of the analyst and the creative solutions of the analysand. This research intends to study a psychoanalytic therapy from the viewpoint of Lacan's later theory. We will study narratives of analysands and Lacanian psychoanalyst and examine how changes in the psychic reality can be explained with this theory. The first part of this dissertation will consist of a systematic conceptual study of the last teachings of Lacan. We consider the seventeenth seminar (L'envers de la psychoanalyse) as the starting point of his later teaching. The main focus will be on the twenty-second (RSI) and twenty-third seminar (Le Sinthôme). The second part of this research project will involve a Qualitative Study. In this study we will interview analysands who have gone through a Lacanian oriented psychoanalytic therapy. Each of them will be interviewed at the end of the therapy. This interview will focus on the change that was procured throughout the therapy, how they explain those changes and what was important to them throughout the therapy. We will use a thematic analysis to study these interviews and the findings will result in a first article in a scientific journal. For the second part of this Qualitative Study we will interview the analysts of the patients in the first group. Again we will use a semi-structured interview that focusses on the change procured in the analysis and how they explain this. This will result in a second article in a scientific journal. In the final stage, we will provide a systematic study of the themes that have been discussed in the first two articles and see how we can understand those themes using Lacan's later teachings.
Promoter: Prof. Dr. Stijn Vanheule
The value of the first-person perspective in psychotherapy research: a mixed-method study
PhD student: Melissa De Smet
Summary: The field of psychotherapy is characterized by a research-practice gap. The question concerning the clinical relevance of findings from efficacy studies, or RCTs, plays a central role in this regard. Two criticized aspects concerning this subject are the conceptualization of the research sample in terms of strict DSM disorders, and the approach to the study of outcome by means of standard outcome measures. Qualitative research has been suggested as a potential avenue to bridge the research-practice gap, but the integration of both standard outcome research and qualitative inquiry remains scarce. In this research we investigate what the first-person perspective (FPP) can add to psychotherapy research, by integrating qualitative analyses of the subjective experience of participants in a standard RCT (cf. the Ghent Psychotherapy Study). More specifically, we aim to deepen the understanding of 1) the sample or mental disorder under study and 2) findings concerning therapy outcome, by investigating the relationship between standard measures (i.e. DSM conceptualizations and outcome measures) and the subjective experience of participants (i.e. FPP).
Promoter: Prof. Dr. Reitske Meganck
Subjectivity in phenomenology, neuro-cognitive science and psychoanalytic theory: a conceptual study.
PhD student: Jasper Feyaerts
Summary: In this doctoral search we aim to develop the divergent ways in which subjectivity is conceptualized in the phenomenological, neuro-cognitive and psychoanalytic traditions. Important issues in contemporary research are, inter alia (1) whether subjectivity is susceptible to naturalization by means of neuro-cognitive explanations; (2) if so, in what way this is supposed to be accomplished and (3) how the idea of subjectivity itself should be determined. Especially this last question opens on the classical debate with regard to the rights and limits of the first-person perspective in relation to the third-person perspective. Through a study of neuro-cognitive philosophers like Daniel Dennett and Paul Churchland, classical phenomenological authors like Husserl, Merleau-Ponty and Sartre, and finally Freud and Lacan, different possible answers to these questions are developed and mutually determined.
Promoter: Prof. Dr. Stijn Vanheule
Co-promoter: Prof. Dr. Gertrudis Vandevijver
The interrelation between evolutions in complaints and different aspects of the therapeutic relation. A comparative study of the therapeutic process of hysterics and obsessional neurotics
PhD student: Joachim Cauwe
Summary: The French psychoanalyst Jacques Lacan approached the transference from the conceptual triad of the Symbolic, the Imaginary and the Real. Our psychical reality is constituted by these three orders, corresponding to the respective domains of language, the (body) image and the drive. Even though the interrelations between these orders change throughout his teachings, the orders themselves remain a constant point of reflection and orientation, both conceptually and clinically. In this Phd, we will examine how transference is manifested and handled through 4 clinical-conceptual studies. Each study will outline a particular concept of Lacan’s take on the multiplicity that is the transference. Furthermore, the concepts will be confronted with case studies from the literature and the ongoing psychotherapy research of the department of psychoanalysis and clinical consulting.
Promoter: Prof. Dr. Stijn Vanheule
The Logic of Love. Lacan’s Formalisation of the Subject-Object Relationship.
PhD student: Dominiek Hoens
Summary: In Lacanian theory the notion of object a plays a crucial role and was considered by Lacan as his sole invention and addition to the post-Freudian development of psychoanalysis.
The doctoral research aims at situating the object a within a set of questions that preoccupied Lacan from early to later stages of his work. This set of questions can be divided into two basic ones:
- How does subjectivity emerge out of an initial positioning as or identification with the object? This question relates both to the genesis of subjectivity and to the aim of the analytical practice. Although Lacan qualified this emergence differently as metaphor (SVIII), separation (SXI) and destitution (Proposition (1968)), these processes rely on a specific conception of how a subject either relates to or identifies with an object.
- Why the attempt at formalizing this relation between subject and object? The classical answer to this question relates the use of mathematics and logics to the hope of a non-ambiguous and complete transmission of psychoanalytic theory. Yet, something else is at stake as well, for Lacan’s contention is that it is only through formalization that one can treat the object a theoretically in an adequate way.