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      Understanding each other in the medical encounter: Exploring therapists’ and patients’ understanding of each other’s experiential knowledge through the Imitation Game

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          Abstract

          The ability of health-care professionals to understand the lived experiences of their patients has become increasingly important but has been a difficult topic to investigate empirically because it involves two distinctive research strands: interpretative phenomenological analysis and patient–provider communication. While interpretative phenomenological analysis focuses on experiences and illness narratives of patients, but not on therapist’s understanding of those, patient–provider communication surveys focus primarily on effective forms of communication without addressing the actual illness experiences of patients. There is a need for empirical research that combines both strands to investigate not only the experiences of patients but also whether professionals are able to understand these. This study combined both strands by means of a novel research method called the Imitation Game (combined with other qualitative methods). This sociological method was developed to investigate what different social groups know of each other’s lifeworld. It focused on the important domain of eating disorder treatment to investigate whether therapists were able to understand the experiences of their patients and vice versa. This study provides insights into the domains in which therapists and patients were able to develop insights into each other’s experiential knowledge (and where they had difficulties in doing so). The findings also implicate the high potential of the Imitation Game as an interdisciplinary research method. We propose that the Imitation Game may be particularly valuable as a ‘can opener’ that enables the development of in-depth, qualitative insights into the substantive themes that matter in the lifeworlds of patients and therapists.

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          Most cited references39

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          Enhancing motivation for change in treatment-resistant eating disorders.

          Denial and resistance to change are prominent features in most patients with anorexia nervosa. The egosyntonic quality of symptoms can contribute to inaccuracy in self-report, avoidance of treatment, difficulties in establishing a therapeutic relationship, and high rates of attrition and relapse. Individuals with bulimia nervosa are typically more motivated to recover, but often ambivalent about forfeiting the ideal of slenderness and the protective functions of binge-purge behavior. Few attempts have been made to assess denial and resistance in the eating disorders, or to examine alternative strategies for enhancing motivation to change. Review of the clinical literature indicates a striking convergence of recommendations across conceptually distinct treatment approaches. Clinicians are encouraged to acquire a frame of reference that can help them understand the private experience of individuals with eating disorders, empathize with their distress at the prospect of weight gain, and acknowledge the difficulty of change. The Socratic method seems particularly well-suited to work with this population because of its emphasis on collaboration, openness, curiosity, patience, focused and systematic inquiry, and individual discovery. Four themes are crucial in engaging reluctant eating-disordered clients in therapy: the provision of psychoeducational material, an examination of the advantages and disadvantages of symptoms, the explicit use of experimental strategies, and an exploration of personal values.
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            The new subjective medicine: taking the patient's point of view on health care and health.

            Calls to respect patient autonomy and produce patient-centered outcomes have recently brought the patient's point of view back into the center of clinical medicine. Bioethics has argued that patient values must be respected in health care decisions. But it has generally not questioned medicine's goals, including its definition of health. For bioethics, health has remained an objective biological fact. However, pressures to improve the cost-effectiveness of medical care have increased interest in the subjective health and quality of life of patients. Perceived health, health-related quality of life, and health-state utilities bring health assessment progressively closer to the patient's perspective. Now even death's harm to patients is qualified by the value patients place on their health state. Medicine's epidemiological transition from acute to chronic disease is thus prompting an epistemological transition from primarily objective to primarily subjective evidence of health and health care effectiveness. Now some of the most important patient outcomes, like patient choices before them, are valid because they are subjective. Pathophysiology is appropriately becoming a means to produce health as it is defined from the patient's point of view. The physicians' job description will be changed to focus on patients' lives rather than patients' bodies. Definitive evaluations of medical effectiveness will occur within patients' lives rather than within doctors' hospitals. This further incorporation of patient subjectivity should carry us well beyond informed consent and the other protections for patient autonomy bequeathed to us by bioethics.
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              The patient's account of relapse and recovery in anorexia nervosa: a qualitative study.

              The purpose of this study was to explore the subjective accounts of weight-recovered female patients, who met DSMIV criteria for anorexia nervosa (AN), regarding their views of their illness following weight restoration. Qualitative semi-structured interviews were administered to 15 participants to ascertain their perspective of the factors that either contributed to their maintaining a healthy weight, or the factors involved in their having relapsed over the follow-up period. Qualitative analyses revealed six core categories: internal motivation to change, recovery as a work in progress, the perceived value of the treatment experience, developing supportive relationships, awareness and tolerance of negative emotion and self-validation. This study provides valuable information about the way in which AN patients experience their illness and highlight the factors that help or hinder recovery. These findings may help enhance relapse prevention programs and potentially enhance our ability to identify and target those individuals at the greatest risk of relapsing.
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                Author and article information

                Contributors
                Journal
                Health (London)
                Health (London)
                HEA
                sphea
                Health (London, England : 1997)
                SAGE Publications (Sage UK: London, England )
                1363-4593
                1461-7196
                03 August 2017
                November 2018
                : 22
                : 6
                : 558-579
                Affiliations
                [1-1363459317721100]Erasmus University Rotterdam, The Netherlands
                [2-1363459317721100]Trimbos Institute, The Netherlands
                Author notes
                [*]Rik Wehrens, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands. Email: wehrens@ 123456bmg.eur.nl
                Article
                10.1177_1363459317721100
                10.1177/1363459317721100
                6168741
                28770633
                a507081a-a68a-45f4-950a-ed67238a7962
                © The Author(s) 2017

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                Categories
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                Medicine
                eating disorder,experiencing illness and narratives,experiential knowledge,imitation game,patient–physician relationship,research methodology

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