Department of Psychiatry and Medical Psychology, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil,
Brazilian Society for Phenomeno-Structural Psychopathology, São Paulo, Brazil.
Psychopathology. 2019;52(2):85-93. doi: 10.1159/000501509. Epub 2019 Aug 5.
Despite the significant need for coordinated approaches to the treatment of substance misuse worldwide, there are still major gaps in both the provision of services and in the development of a theoretically unified approach to care. We suggest that a phenomenological approach to care can provide comprehensive, theoretically grounded guidelines that coordinate and help choose between a range of interventions while respecting the values of the patient and other stakeholders. The aim of this paper is to present a framework for a person-centered approach to substance misuse care, based on general principles of phenomenology. In particular, we emphasize a dialectic conception of phenomenological care, one that considers the various tensions and conflicts of human life, and the ways these are managed by individuals. Two dialectics are presented here: the dialectic of anthropological proportions, involved in the existential situation of the substance misuser, and the dialect of decision, which is essential to all approaches to the treatment of substance misuse. The dialectic of proportions in the substance misuser's experience involves hyperpresentification, the tendency to emphasize the present moment to the relative exclusion or reduction of the past and future considerations, and feelings of plenitude, an oversimplification of experience that ignores the complexity present in every situation. Interventions should reflect a dialectic of decision, which allows the clinician and patient to choose pathways that promote movement and expand the limitations of hyperpresentification and plenitude. This phenomenological framework, we suggest, permits a collaborative and values-based approach to comprehensive clinical decision-making.
尽管全球范围内对物质滥用的治疗需要协调一致的方法，但在服务提供和发展理论上统一的护理方法方面仍存在重大差距。我们认为，关怀的现象学方法可以提供全面的、有理论依据的指导方针，协调和帮助选择一系列干预措施，同时尊重患者和其他利益相关者的价值观。本文旨在基于现象学的一般原则，提出一种以患者为中心的物质滥用护理框架。特别是，我们强调了现象学关怀的辩证概念，即考虑到人类生活的各种紧张和冲突，以及个人应对这些冲突的方式。这里介绍了两种辩证关系：涉及物质滥用者存在状况的人类学比例辩证关系，以及与物质滥用治疗的所有方法都相关的决策辩证关系。物质滥用者经历中的比例辩证关系涉及超呈现，即倾向于强调当下时刻，而相对排除或减少过去和未来的考虑，以及充实感，即对经验的过分简化，忽略了每种情况下存在的复杂性。干预措施应反映决策的辩证关系，这允许临床医生和患者选择促进运动并扩大超呈现和充实感的局限性的途径。我们认为，这种现象学框架允许对综合临床决策进行协作和基于价值观的方法。
