title: [Patients (getting themselves) referred to psychosomatic rehabilitation--guidelines for sociomedical evaluation and management of extrinsically motivated patients].
abstract: This paper reflects the thinking, experience as well as diagnostic and therapeutic strategies of the Gelderland specialized clinic for psychotherapy and psychosomatic medicine with regard to extrinsically motivated patients, i.e., patients "sent" for treatment. The objective is to develop a therapeutic concept and to establish guidelines concerning the sociomedical aspects to be taken into account in this patient group. The problem analysis should start out at the situation at hand initially: Not only do these patients as a rule refuse to take an active part in therapy; they all to often attempt to sabotage any rehabilitation offers perceived as running counter to their own desires and goals (e.g. pension, retraining, collection of benefits during illness-related unemployment, etc.). Attempts to elucidate the psychosomatic problem complex of these patients are in addition hampered by their predominantly body-centred concept of disease. The particular motivational and therapy-related features of these patients are illustrated by case studies. A standardized procedure for sociomedical performance appraisals is presented which takes the specific features of this patient group into account and has stood the test in the clinical setting. Special mention should be made of: pre-admission diagnostics, inpatient psychodiagnostics, multidisciplinary systematic behavioural observation of the patient in the framework of group therapy, and a sensitive approach to conveying diagnostic results to the patient. The double role of psychotherapist and appointed expert is one demanding the highest degree of professional expertise. Besides, the expectations of the social security and financially responsible agencies which "sent" the client have to be taken into account as well. The sociomedical evaluation serves as the starting point for all therapeutic efforts and identification of the extent of a patient's extrinsic motivation. Along with a thorough review of the patient's medical records, pre-admission diagnostic efforts are in place in this respect for assessing a patient's motivation for therapy.
authors.affiliation: Gelderland-Klinik, Fachklinik für Psychosomatik und Psychotherapie, Geldem.
authors.forename: R
authors.initials: R
authors.lastname: Bückers
authors.forename: R
authors.initials: R
authors.lastname: Kriebel
authors.forename: G H
authors.initials: GH
authors.lastname: Paar
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany; D006778:Hospitals, Psychiatric / Q000592:standards; D006801:Humans; D007342:Insurance Benefits / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D017410:Practice Guidelines as Topic; D011602:Psychophysiologic Disorders / Q000191:economics / Q000523:psychology / Q000534:rehabilitation*; D012017:Referral and Consultation / Q000331:legislation & jurisprudence*; D012046:Rehabilitation / Q000379:methods; D016312:Treatment Refusal / Q000331:legislation & jurisprudence / Q000523:psychology*; D014938:Work Capacity Evaluation