The importance of an idiographic approach for the ... - Frontiers

The practice of clinical psychology use to be guided by an idiographic approach, with an attention to research results derived from a nomothetic ... ThisarticleispartoftheResearchTopic PsychologicalIssuesinAmyotrophicLateralSclerosis Viewall 12 Articles Articles References SuggestaResearchTopic> DownloadArticle DownloadPDF ReadCube XML(NLM) Supplementary Material Exportcitation EndNote ReferenceManager SimpleTEXTfile BibTex totalviews ViewArticleImpact SuggestaResearchTopic> SHAREON OpenSupplementalData EDITORIALarticle Front.Psychol.,19November2012 |https://doi.org/10.3389/fpsyg.2012.00509 Theimportanceofanidiographicapproachfortheseverechronicdisorders—thecaseoftheamyotrophiclateralsclerosispatient F.Pagnini1,2*,C.J.Gibbons3andGianlucaCastelnuovo1,4 1DepartmentofPsychology,CatholicUniversityofMilan,Milan,Italy 2NiguardaCa'GrandaHospital,Milan,Italy 3TheUniversityofManchester,Manchester,UK 4PsychologyResearchLaboratory,OspedaleSanGiuseppe,Verbania,Italy Thediscussionaboutnomotheticandidiographicapproachesisoneofthemainphilosophicaldebatesinthefieldofpsychologicalsciences(Schafer,1999;SalvatoreandValsiner,2010). Theterm“nomothetic”comesfromtheGreekword“nomos”thatmeans“usage,custom,law”andinpsychologyisreferredtotheobjectiveclassificationundersimilarconditions,toinestablishgeneralizations,suchasdiagnoses.Theterm“idiographic”derivesfromtheGreekword“idios”,meaning“pertainingtoself;one'sown,privateorseparate”andisreferredtotheaspectsofsubjectiveexperiencethatmakeseachpersonunique. Intheclinicalpsychology,thedebatedealsabouttheclassificationofpersonalityandothertaxonomies,aswellastheuseofdiagnosis.Attheinterventionlevel,thediscussionisabouttheuseofindividualistictreatmenttechniquesortreatmentderivedfromresearchwherethefocusisagroupofpeoplewithasimilarcondition,where(individual)efficacyistestedwithaggregatedstatistics.Forexample,evidence-basedresearchindicatesthatthecognitive-behavioraltherapyhasapositiveimpacttowardtheanxietydisorders(Olatunjietal.,2010). Asresearchers,welookforregularitiesandrepetitivephenomena.However,whenthestudyobjectisthehumanbeing,withallhiscomplexity,wecannotforgetthateverypersonisunique.Thatisevenmoreimportantintheclinicalpractice,wherecliniciansdonothavetotakecareofan“averagescore,”buttheymustassistanindividual,withhisclinicalpeculiarities,thoughts,emotionsandrelationships. Whendealingwithsevereandchronicillnesses,suchasAmyotrophicLateralSclerosis(ALS),thisdebateisveryimportantandsometimesisatriskofbeingunderestimated.Thehumantendencytowardgeneralization,togetherwithasuperficialapproachtoresearchfindings,mayleadustostereotypicalbeliefsaboutapersonlivingwithseveredisease.InthecaseofALS,anincurableterminalillnesswithapotentiallysteepdeclineinphysicalfunctionanderosionofindependence,itcouldeasilybeassumedthat“ifapersonhasALS,thanhe/shemustbedepressedandhavealowqualityoflife”(Rabkinetal.,2009). ThereactiontowardagravediagnosissuchasALSwillvarygreatlyfrompersontoperson.Individual'scharacteristicswillleadtoapersonalreactionthatmayincludedepressivefeatures,despair,hopelessness,butthereremainspotentialfortheindividualtofindhope,andmaintainhopeinthefaceofsuchseriousprognosis(McDonaldetal.,1994).Therefore,evenifwecanfindout,statistically,theaveragescoreofeachpsychologicalissueinvolved,noaggregateresearchwillbeabletoconsiderthewholecomplexityoftheindividualreaction. Thepracticeofclinicalpsychologyusetobeguidedbyanidiographicapproach,withanattentiontoresearchresultsderivedfromanomotheticpointofview.However,incertaincases,prejudicesforaclinicalsituationmayinterfereintheprocessofindividualknowledge.IntheALSfield,consideringthelowprevalenceofthedisease,itispossiblethataprofessionalwithoutagooddealofknowledgeaboutsuchillnessesmayoverestimatedepressivefeaturesbasedonassumption.Asimilarconceptisalsoimportantforothertypesorclinicians,suchasthephysicians,inparticularwhentheyarenotusedtotreataparticularclinicalsituation. Onewayofbetterunderstandingapatient'sworldistocompleteaqualityoflife(QoL)questionnaire,thoughcareshouldbetakenwhenselectingaquestionnaireforthispurpose.QoLisdefinedbytheWorldHealthOrganisationasa“broadrangingconceptaffectedinacomplexwaybytheperson'sphysicalhealth,psychologicalstate,levelofindependence,socialrelationships,personalbeliefs,andtheirrelationshiptosalientfeaturesoftheirenvironment”(WHOQOLGroup,1998).TherearetwodifferentconceptualizationsofQoL,knownashealth-relatedQualityofLife(HRQoL),andsubjectivewell-being(SWB).HRQoLlargelyquantifiesQoLbasedpatientself-reportedsymptomsandabilitytocarryoutactivitiesofdailyliving.Subjectivewell-being,otherwiseknownas“IndividualQualityofLife”inALSresearchliterature(Clarkeetal.,2001),referstoapositivestateofmindandsatisfactionwithlifeingeneral,andisnotcontingentonassessmentofsymptomseverity.AccordingtotheconstructofHRQoLandthemannerinwhichitconceptualizesQoL,patientswithALSmusthavealowerQoLthanthegeneralpopulation,withfurtherdecreasesassymptomseverityincreases,inlinewithdiseaseprogression.However,pastresearchhasshownthatQoLisunrelatedtophysicalstrengthandthefunctionalcapacity(Goldsteinetal.,2002;Pagnini,2012).Therefore,whenadministeringaQoLmeasure,cliniciansmustbeawareofthesubtle,butveryimportantdistinctionbetweenQoLandtheconfusinglynamedHRQoL.Ideally,cliniciansshouldalwaysadministerquestionnairesthathavebeenshowntoworkwellwiththeintendedillnessgroup.EvenquestionnairesthatareapparentlysuitableandostensiblyavoidsomaticsymptomsofdepressionhavebeenshowntooverestimatedepressivefeaturesforALSpatients(Gibbonsetal.,2011). Evenifresearchersmaytakeadvantagesfromstandardizedquestionsandreplies,cliniciansshouldalsoincludeapatient-basedfocus.IntheassessmentoftheQoL,forexample,therearemanyquestionnairesthatareusefultounderstandhowapersonfeels,withdifferentdegreesofsensitivity.Oneofthemostinterestinginstrumentsfortheassessmentoftheindividualneeds,beliefsandemotions,istheSchedulefortheEvaluationofIndividualQualityofLife(SEIQoL)(Hickeyetal.,1996)thataskspeopletoindicatethefivemostrelevantdomainsfortheirwell-being,toratethemandtoclassifyamongeachother.Evenifthescoreobtainedhasbeencriticized(Felgoiseetal.,2009)andhassomelimitationsfromtheresearchpointofview,theclinicalprocessofdomainselectionandratingmayprovideinterestinginsightsabouttheindividual'ssituationandproveusefulintheformulationprocess,coherentlywithaSWBapproach.Theuseofasimilarapproachbyclinicalpsychologistsandphysicianswhoworkwithchronicillnessesmayallowassistinunderstandthepatient'sindividualclinicalissues,reducingprejudicesandtheriskofablindapplicationofanomotheticapproach. 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PubmedAbstract|PubmedFullText Citation:PagniniF,GibbonsCJandCastelnuovoG(2012)Theimportanceofanidiographicapproachfortheseverechronicdisorders—thecaseoftheamyotrophiclateralsclerosispatient.Front.Psychology3:509.doi:10.3389/fpsyg.2012.00509 Received:02October2012;Accepted:29October2012; Publishedonline:19November2012. Editedby: GianM.Manzoni,IstitutoAuxologicoItalianoIRCCS,Italy Reviewedby: GianM.Manzoni,IstitutoAuxologicoItalianoIRCCS,Italy Copyright©2012Pagnini,GibbonsandCastelnuovo.Thisisanopen-accessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense,whichpermitsuse,distributionandreproductioninotherforums,providedtheoriginalauthorsandsourcearecreditedandsubjecttoanycopyrightnoticesconcerninganythird-partygraphicsetc. *Correspondence:[email protected] COMMENTARY ORIGINALARTICLE Peoplealsolookedat SuggestaResearchTopic>