title: Medically unexplained symptoms as a threat to patients' identity? A conversation analysis of patients' reactions to psychosomatic attributions.
abstract: OBJECTIVE
  Interactions between patients suffering from medically unexplained symptoms (MUS) and their physicians are usually perceived as difficult and unsatisfactory by both parties. In this qualitative study, patients' reactions to psychosomatic attributions were analyzed on a micro-level.
  
  
  METHODS
  144 consultations between consultation-and-liaison (CL) psychotherapists and inpatients with MUS, who were treated according to a modified reattribution model, were recorded. Linguists and psychologists evaluated these consultations by applying conversation and positioning analysis.
  
  
  RESULTS
  When introducing a psychosomatic attribution, therapists use discursive strategies to exert interactional pressure on the patient; while simultaneously using careful and implicit formulations. Three linguistic patterns could be found in which patients subtly refute, drop or undermine the psychosomatic attribution in their reply. Moreover, in this context patients position themselves as somatically ill or justify their own life situation.
  
  
  CONCLUSIONS
  The results suggest that patients interpret psychosomatic attributions and even subtle suggestions from the psychotherapists as face-threatening 'other-positionings'.
  
  
  CONCLUSIONS
  When implementing the reattribution model, it should be taken into account that interactional resistance might be a necessary step in the process of the patient's understanding. Nevertheless therapists should introduce reattribution in a patient-centered rather than persuasive way and they should openly address patients' fears of being stigmatized.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany. christina.burbaum@uniklinik-freiburg.de
authors.forename: Christina
authors.initials: C
authors.lastname: Burbaum
authors.forename: Anne-Maria
authors.initials: AM
authors.lastname: Stresing
authors.forename: Kurt
authors.initials: K
authors.lastname: Fritzsche
authors.forename: Peter
authors.initials: P
authors.lastname: Auer
authors.forename: Michael
authors.initials: M
authors.lastname: Wirsching
authors.forename: Gabriele
authors.initials: G
authors.lastname: Lucius-Hoene
mesh_terms: D001294:Attitude to Health; D005858:Germany; D006801:Humans; D010817:Physician-Patient Relations; D011578:Psycholinguistics; D011602:Psychophysiologic Disorders / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy; D012017:Referral and Consultation; D012649:Self Concept; D013001:Somatoform Disorders / Q000523:psychology / Q000628:therapy*