Krikken Mulders L T E, Tonkens E H, Trappenburg M J
Citizenship and Humanization of the Public Sector, University of Humanistic Studies, Utrecht, Netherlands.
School of Governance, Utrecht University, Utrecht, Netherlands.
Front Health Serv. 2024 Nov 22;4:1388906. doi: 10.3389/frhs.2024.1388906. eCollection 2024.
Alongside the logic of care, many Western welfare states have introduced market elements or a logic of choice in their healthcare systems, which has led to consumerist behavior in patients. For the medical field, it is well documented how consumerism creates complex ethical dilemmas and undermines ways of thinking and acting crucial to healthcare. Little is known about these dynamics in mental healthcare.
This study used a qualitative mixed methods design, combining 180 online patient narratives (blogs) with 25 interviews with therapists in a grounded theory approach.
Findings show that articulate behavior can be divided into two categories: assertive and adamant. While assertive behavior is understood as an integral, reciprocal part of therapy and is stimulated by therapists, adamant or consumerist behavior is experienced as damaging the relationship-the "commodity" the patient is seeking to obtain, as the single most important predictor of treatment success. Findings also show that articulate behavior in both varieties takes a different shape over time during the course of treatment.
Adamant behavior clashes with the internal logic of care, which is especially problematic in mental healthcare where the relationship with one's therapist is key to successful treatment. Therefore, patients should be taught and helped to display assertive behavior without resorting to adamancy. Individual therapists cannot achieve this alone; this endeavour should be supported by their organizations, societal beliefs about therapy and policy choices.
除了关怀逻辑之外，许多西方福利国家在其医疗体系中引入了市场元素或选择逻辑，这导致患者出现消费主义行为。在医疗领域，消费主义如何制造复杂的伦理困境以及破坏对医疗保健至关重要的思维和行为方式已有充分记载。而对于精神卫生保健中的这些动态情况，人们了解甚少。
本研究采用定性混合方法设计，以扎根理论方法将180篇在线患者叙述（博客）与对治疗师的25次访谈相结合。
研究结果表明，明确表达的行为可分为两类：坚定自信型和固执己见型。坚定自信型行为被视为治疗中不可或缺的、相互的一部分，并受到治疗师的鼓励，而固执己见型或消费主义行为则被认为会破坏关系——患者试图获得的“商品”，是治疗成功的最重要预测因素。研究结果还表明，在治疗过程中，这两种明确表达的行为会随着时间的推移呈现出不同的形式。
固执己见型行为与关怀的内在逻辑相悖，这在精神卫生保健中尤其成问题，因为与治疗师的关系是治疗成功的关键。因此，应该教导并帮助患者表现出坚定自信型行为，而不是固执己见。单个治疗师无法独自做到这一点；这一努力应由他们的组织、社会对治疗的信念以及政策选择来支持。
