強迫神経症患者の全生活の縦断的研究 : 特にその回復過程の顕在化をめぐって

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  • A longitudinal study on entire living obsessive compulsive disorder patients : especially about the emergence of their recovery process

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This is a longitudinal study of recovery in all the obsessive-compulsive patients that have been seen by us in our university outpatient clinic. The clinical course of each patient was followed using participant-observation methods. Our perspective is that this disorder is fundamentally a disorder of living. Consequently, our goal is to allow patients to resume a life untroubled by obsessive-compulsive symptoms or attitudes. Factors favoring recovery are: good sleep patterns, psychological openness to psychotropic medications, favorable response to relatively low doses of medications, and presence of significant life components free from obsessive-compulsive symptomatology. The therapist should avoid both authoritarianism and clinical indifference in order to fInd a middle way, and should let the patient hperience basic trust through all the vicissitudes of recovery. The recovery process can be divided into three stages: the symptom-centered, the emotion-expression centered, and the life reconstruction centered stages. There are transitional periods between each stage. In the first stage, stress is laid on the decentralization of symptoms and the maintenance of the patient's morale. One has to listen to symptom telling but should not ask about symptoms. After early progress, reactions such as the exacerbation of symptoms, psychosomatic disorders, and acting-out often occur, but they are always transitional and often contribute to recovery if adequately treated. Therapy is foten interrupted during transitional periods, however, when therapy is re-engaged, we often find improvements. The interview becomes centered around the emotional narrative of the patient:s experiences. We interpret this phenomenon as a test of basic trust in the therapeutic relationship and a desire to be treated as a returning Prodigal Son. The emotional stage requires a non-obsessive, ceremonial theapeutic framework, to which formalistic physical diagnosis and art-therapies contribute. Once this period is worked through, patients' behaviros become stablized and require only mild support and advice.

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