title: Encouragement to Increase the Use of Psychosocial Skills in the Diagnosis and Therapy of Patients With Functional Dysphonia.
abstract: Clinicians believe that psychosocial factors play a causal role in the etiology of many forms of functional dysphonia (FD). But for decades, all attempts to confirm such causation have failed. This paper aims to show the logic of this failure, to discuss the possibilities of employing psychology in therapy nonetheless, and to encourage clinicians to use their psychosocial knowledge and skills. The failure to confirm psychic and social factors as causal in the etiology of FD is basically a consequence of a principal shortcoming of evidence-based medicine (EBM). As the gold standard for validity, reliability, and objectivity in medical research, EBM is based on calculability and hence the processing of quantitative data. But life paths and life situations are best or sometimes only expressible in qualitative, experiential, and idiographic terms. Thus EBM-guided evaluation undervalues most psychosocial studies. This report of an experienced multidisciplinary voice team proposes alternative pathways for integrating psychosocial knowledge into the diagnosis and the treatment of FD. The difference between the fields of activity of psychotherapists and speech-language pathologists is discussed, and the latter group is shown the potential benefits of using more of their psychosocial knowledge and skills.
authors.affiliation: Division of Phoniatrics, Department of Otorhinolaryngology, Head Neck Surgery, University of Bern, Bern, Switzerland.. Electronic address: j.kollbrunner@bluewin.ch.
authors.forename: Jürg
authors.initials: J
authors.lastname: Kollbrunner
authors.affiliation: Division of Phoniatrics, Department of Otorhinolaryngology, Head Neck Surgery, University of Bern, Bern, Switzerland.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Seifert
mesh_terms: D055154:Dysphonia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D055317:Evidence-Based Practice; D006801:Humans; D008016:Life Change Events; D010551:Personality; D011237:Predictive Value of Tests; D011602:Psychophysiologic Disorders / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D012307:Risk Factors; D014833:Voice Quality
keywords: Conflict over speaking out; Functional dysphonia; Guilt and shame; Harmony and aggressivity; Morbid gain; Psychosocial; SLP and psychotherapeutic techniques