I

COJ?ERTA/OEORGeMAlUR
TEHNOREDACTARE/NICOLAETURCAN
REDACfOR/MlHAl GOTLU
Daniel-David :r
CASTLES. OF SAND
Sdence and ~seudos.deJlce ..
in_ psycliQpu~Uology.
CASTELE'-DE NISI~
~tiinta ~i psettdo~tlin~a
i11 psihopatologie
~ COPYRIGHTTR.ITONLC
I
.'CLUJ/ Tui.IF~U.: +40.164.431.655 I
B UCURB~Tl/1'e1Jflnx.: .,_40.21.242,.54.09
e:nnll: edilura@tritonic.m

ww.w. tritonic.ro
__"Vlrww.j~rnalism.ro '

DeJcrleten CJI' R l}lblloLe-;;ii_Nu'l~nRle P 1toan6nlel

DAYU>,DANI:EL . . . .. '<
"FIIstelede 11lsfp..: ~Ubt.ii. f~psmtlo~Uiulii
in p5Umpatologie I Daniel David;'::. Ducu~ti :
Trilonic, 2003

ISUN 973~8497-1.1-J
 ..::"'7""~;,..,--;------~~s-::--:-~~------____:_-----------__,.._

~~~T~
Mndu:
"A:f~ri .JI devi110!" (Ooelhe: .Se/Jge SellltrlldJI)
..
:, Dedicatle:J.Jtcfll(ell.~e,tkdicalii acdorcolcti ~i pro:fusioni:;fi Jlenrm
care ~liinJa eme opl)rtu~itatea 4!= a 1e mira critiC ~i activ fn(i de spectncolul
fumii~i ck. a k: lmcuri\din plitll~:pmpriiJccoAllibnfli Ia aeast specfilcol, ~:nro!
.. !i . au supra vio[uit inca tncerclirii-lnle continue d~ a lc snbotn .

. Dedication: I dndioatc tbis book to those ~:oUeoguell nnd prof~imt

alslbr wllflll\ scienl:e ~presentstbe opportunity lh crilically nnd' activ11ly
wonder -in the facb of I!JC~ wm:ld Bpeclnclc and to fblly enjBy your own
contributions. to Ibis specrnclc. contributitfna that have still resiliently Sfr-
vived your peNisteni:.attempt to aqbotnge them.

. Mnlfutuiref Aparitia,acesteiJfJcilri afost_impulsio~nut dt! oameni

cArora tin sate null!Umesclrimod deo!ebit;ParaMizlindll fd calebrli, Guy
Montgome..y,~i"ilana,Bovbjerg tie Ja r,:lifo1mt Slnay;S~I\oc:ll of Medicine,
SUA, an-btl tr02.it din 'SOmnul tJO!filatic Qi m-au lnvl\1111 ceeuce inse6mnil
flUnlll, certeflu'ea.vi pmi;lica-vtiiqfificli;'lltUnCi dud CfeM'lm t1l ~Jill RCtSI
i1iem fi ell nu mlmlli p~te ~Jirimlani.mi~. ~~rHilis.. d.: la Alben Hills
llrstfrure. SUA. a faar onruJ,Citfcn141 iospinn fn1UOOdineft crilic;ii~i refleJtivd
QSUpl"n Bllll I:CCD ecfiU:~tl:afC't!""ainviirbl sltnll:f~f pierd niciodrtlif iucre-
sl
derea fi sA tontinuu tollStfUiesc Criticlltdnci dnd muldl tumc f:Stc tll\pl)-
lfiw mea ~i a dec&~ me:"AR.Ptl'UN.Bca lucrurllesli stea nll16\, dnr niciunde
nu si:ri.e, t1 lncmrileN\J.'Iltl!llUIJ!sl\ sleanva prosb::um stnu,.deei:c:4}nlinull
., sll construitfti $i ~~ eritic~ tin,c insutl" . ar sptme,ekS,~evcn ~~~n~ ile h1
SUNY ar Binghamton. SUA i laving Kirsch. de--Jn.Conneaticul Utlivo:rsity,
SUA. an filM Jlfieti;nf ljlmodel~tde,atlbldiQe crlliiA fi constru.clivli ~Stlpm
domeniului tlinic, CIU'C ln.:.au infliienJ&tinceelfce lim &ut oict MtdlttnlCSI:
lroftlorcolagi ti prititeni care au citit rextul fi care m-au njutat Siiil n~roximez
itt aoaastl thrmii.SuPl prea multi ca sAi enmnlb' a.ici; ~oi ftlentinnn door
oote.tlii tie In Catedm de Psibologie a UniveuiMtfi DabCfi:..:aiityai din .Cluj
Nntmc~r. cnre anm.ticlind nllfptmntolluciarea in cndml-col~:ctivtilui ile
atfttfrii lltl ft~ut sugisfii (ll!omonrarii ulile. j\tola unde este enzul ii vni
ili~rttionl\ in mod SJ1cCin11~ incepu~ ~llCllroi ,capitol pe tlcei pl1lf~ion i~l i,
s

...
/
 colegi ~i prhder1i, care au recenZHf mnlcfiu.lul ~i r.nr~ ~i-au ;tQl~. n.~;lfel
conlributia lafonualui actualii. Nu in ultimul rfiud, n~ul\Unlesc.srudeJ;tilorde
In Progrrunul de ~aster iu "CoJISilh;rel'sihologicli ~i rsihotempie, de Ia
Uuhernilallea Babc~-Bolyui,. Cluj-NapuCII, penlnlsuge:tliile referjlohre In
:;lruclurii Btestui votum lli [a iitabunnU'itiren OSlJeclulu.i slilislic. Pruadoxal,
trebuie sa mul\utuesc lit ocelot "ptofesionil}ti" ca.remi-nu dat. oportu11ilnten
all itlli exersezsimtul critic prin:;ofi:~mele,:~olemlliliilile bannle lli lruimnele pe
cure le-ou )Jtudus lli pe cure le-ou ridicat In nivelul uuor opere vi d1scur.mri
~liinliflce.
Ac:lmuwlc:tlgenumbi: The writing Qflbis hook was olirnulnled by peo-
tJie whom l especially want to lllB!Jk. .Jllllllpb.,;'rJi~g u fnmous-saying, Guy
Montgomery and PnnaBovbjerg, from Mount Siuni School of Medicine_
USA, nwakened me from the dogmatic sleep mtllnughlme \vhatscicnee,
research ond Jlnlclice meuut iliu time Uhougllt lknew lhi! all lou well and
uothing culllld 1mrprise me. Albert EUis, from Albertfillislnslilute. USA, wns
the mntrwlm. ins[liretl me lo-ba criti~>nl nnd re0e1'ive witU everjUting l did
nm.Fwho taughlrne never to .lose fttith iu myself and to wnlinue to .m1ild
crilir.nlly when mnuy were agni.ttl!t me e.nd my work. Stuen Lynn, from
SUNY nt Bingbnmlou,USA,atKIIrviugKihJcll, from Cotmci:licul Universi-
ty, USA, had a major impac& on my work, being friemla nmlntodels of crilical
ttud conslntctive
. ollltude in the clinicul dorunh1,.
Lo:~l but notlcast' l woullo
tlmuk my colleagues Jrom BnbesBolyal University nnd lhe students en-
rolled in the Master's Pltlgr.am in "Psycltolaglcal Counseling and Psyclm-
thetllpy~' Jmm Babe:t-Bo.Yni University, Ch[j..:Napocu forlheirsuggeslions
.. conce!'niug the slruclureoflhis vo'lume and Ibe i111proven1e1il o[lhe 11lylistic
nstJecl. Pnmdox ically; ll\tusfulso llmnk tlrose "prores&itrnfils" who gave me .
the opport\lnity to exercise my critical s!lllse 011 lheso}lbiarus, trite reatmrb
und tmismsthey had pruduued uud raised lollmlevel ofscir!nlificdisoours-
cs nnd self-declared works of ort.
Prcz;euf:tt"l!IHutforului; Daniel Oavid esle p~iholog, leulllr univ. dr.ln
Coledra de .Psihologie n Universiliijii Bnbev-Dolyaidhi Cluj-NnpOQl. A oblinut
!icen!o in psihologie-{in 1996) Ia Uuiversilnlea Bnbe.~-Bolyai~i ductomtul in
psihulogie {1999) Ia aceen~i Universil!'le. A fi~ul studii .postilniYernilnre
(l999-2002} iu psihologieclinica Qi psiltopalologie Ia MounI Sinai School of
Medicine, New York, SUA, ~in JlafCUIS un progmm de fuonnre (1998-2001)
in psih(llern}Jia t\lgllilivii ~i comporlnmrnlnla Ia Albert l!llis luslitute ~i Aca-
demy of Cognitive 'll1empy, SUA. Esle pre~edinldeAsocinliei Rumiiuede
Hipnn7.ii si P::iho1ern11ie Cngnitiv-Comporlnrnentnli'i.IJircdQr ol Centmlui
Rmn5n de Psiholempie Cognilivli lli Rt!lionai;.Emotivil \{i Comportamenlnlli.
~i Hditoral revistei"Romsninn Joumnl of Cognitive and HehuYiorat f'.syho-
lberapies''. Automleste memb1_11 in=SSillciJ1.Jii prufellionttle iJiten!nJiontde de
Jrrolili desfil~oarti activiliili didnclice., de ccrceJnre, ~i ptacticil pflibolerupeu~
ticii ii 11 publiclll pfina in prezent 4 ciiJii vi p.esfe 3U de urficofc, din cnre
majoritatea in revjste de presligiu diu strninillale.
Volume rt1evnnte:
David, D. (1000). Pf"efucrarilillcolllieule cfe irrjoriuafle. Cclflftnlli-
nar~cr l''iilrologicci in mas:r-mec/i.o, practica cliJlica flju,-iJicii. Edillrm
Oncin: Clnj-Nappc!L .
David !}i co lab. (1998-200U). J::silrotempit ~rtrlpllt1fet"t1J1ie crJglfifll....
comportamentalii. Editulll Risopriot: CluJ-NdJlOJ:II.
Aboul tbenulhor. Onuiel J)nvid isliceru:ct.{psychpl~gisf, )?h.JJ., nnd
Assislnnl Professor al-Bnbcs-BblyoiiJ Univemity, 0eporlr11ent"uU1syclru1o-
gy, Cluj-Napoca. He ublllined his licenllc lnJJ&ycho1ogy {in J!J9G) nl ''Bnbes-
Bolyoi" \]uiversity, CllJi:-~arKJ(:onnd lhePlt.Q. {in 1999) ~t lheantnc Univer-
sity. Ha cmnpleled a postdoc1omlprogrum (l999-2U02) in clinit:al p.:ycliul-
ogy and psychopnlhology.ntlvf,ouut Sinni Scbool of{IAeditlinc, t-Jcw York.
.USA, and a !mining progrom {l998-2002fbi l;ognlti'l'eand bcbnvioml tbcr-
llpies at lbeAlbertEilis lnstilute RtJd A,clldemy otCogniliveJ~u:ntpy, USA.
He is Pre:lidenl of the Ron1nnian ABsociotlon vf ll}lpnosis and-Cognitive
.Behavioral PsychothemlJY, Direclur of. Ill&! Rl)mn~tianCetJies:.fotCiJ~nilive
nnd Ralionoi-Emotive oud Debavioml PsycboUtcrapy and:6tlitnr cpf'~llotho
nilui Journal ofCognilivc B.ntl-BeiiiJ,'Y;iorfll P~ycbodlentpieu~~. The uulbor i1:1
member in iutemnlioual prore!laioJtBiliiiSo~iali~us in lbe nreu pfiuf.erest: nud
is invohed in lenchiitg, research nnd',psyclu,tbJ!O\peufie;)J~ctlce nctivitie!!.
He has nlrendy published 4 boo~ nml over 3.0 urticles, most of these in
f!restigious inlemati,on!lljoumals..
Rell'.vnnl hooks:
David, D. (2000). Prelflcriiri incollflielllc de iTtfontra(ie: Crmtqm-
inme~ psi/Jologicii .f11 mass-media, prticticacllrilcif~l jllridlcf'i (UIICfltl-
~ciortS lnfornrafiou proces.rlirg). Etlihtm Dacin: Clu}-Nu}JfJCII.
Il
David i oolob. (1998;.2000}. P.dltof~mplefllriptmiiUcq,;e cogllitil'-
comporlamenlalti (Cogni[ille-be,lmvioml p1ycli1Jtf1eropy a11d ltipuot!ler-
\
aJ~lj. Edilum RiSOJlfinl: Clt.Y-Nnpocn.
 --~---------~------------------~.:::t

,)C J(lh!JYi!ll(U! ?t hiri;tiH ... ;.u .. .................- ~- ....... ~- .... --~- .. "
).1.2. L Numaml i'a>tlgenu tit: mare ul fonnelunll! tflllllllli:ll\
Sllll ILttlllrtnl\i., M'muummIm. .................................................
.. . .. nn
,
.
nl -

3.1.22. Bre,e in ~lidilfltea lilntificii atnltiiillenlclor. lO

Ecce Mesmer .............._........................!.................... , .......... i
cuvan
~ t iu -, . 5 3.1.2.3. Lobby ;i traditi~ 'impolrivn ~tiintei; ..
c re.~lll Qr ---:....:-n--- . l . - -d.e s1ne
C117.11l shmtt , ...................................................
. : ........ . 116
Pref.'\Cc .........~...................,...................................................................... 27
Povest.ea utvtare1UIVlliJIIarL
- 1111 "-
u.qt alm Rumpe
Istl'I tsk'm .7 ........,.-.......,. 2.9 3.1J. Probleme ale Psibopatologiei cnl}'IOdalitil\ile 1
de: a fac~ cero:c[Jlre ...............:..................................................... l .. l
Comenlllrii despretiin{ii . :.".......,.......:.......................... ,...~...:................ Jj
3 .1.3 .1. Caztil:nlttlir.aliei llntideprMivc $Jill
. . . . ; t.
ti"mel............................. l i?
Pna:tea I. Fundnmeutcn.l~pr>lh~pnlolnglel en llinjlL_.......~........ ;..... _. si Victotia mnrla:ting-:ulurtanpatmYil'~
3.1 J.2. Cazul efe.ctului plncebo smr .
--

citpl_rolu11 ...ne fi. mJtqtpreclzilrlc~nceptuo

r ' 1c ..............
,.........:................. 51
l. r. Defiui(in Psibopntolo(:.ici ctt liintll ............................................. 51
1.2. Slln~lst~ ~i_bonlll ......... v--:.....:...,...............,.......:..;.......
52
1.3. ~olltl11i a~ribu(iiiC: psiltgpp~ologului 'c'--------:------':.'" 5ll
1.4, Orienliri t(l(}retic~ in psjlmpatolo_gie. ('\,$!!tn1ii introduc.ere .... 59
Cqpiloluf 2. S~ruphttn amuis,!ndiu de l<!lZ ~.,.,., ..,................................... &I
'} 1 n ti 1 ,.
r. . IR!'os c ~ evn uare ~mtcl\.. ....~.........., ......................,. ......,.,,.. 64
2.2. Con~pllJnliza~clinici. ,...~.:,................................................ 71
;l.l.Pinnul d~trahi~ent'lj,descrierea inter\ientici ..............:.........:..... 76
2.11~ Concluzii vi ~tirea evnloliei pncientttlui :.. ,........ ,..,.........,.... 78
2.5. Unexemplu dcstudiu dccnz. Cn:zui.Dnn!l ;.,...... ,........................ 79
l'artea:l. Psibopalologl~ P~lh~indot~1i_leit!unlJzl de ta2 ~:-- ......... 91
opifolul DiaJJ:Illoalicnl vi evntiutrcn cliniciln pacientul1.1i
~ .oparologic_:--~ .... :.~.,.....::..... .,.:.,.~--~---------................................. 91
)J. Scmnl!l}isinlptomc.Tubloul clinic ai .. . 3A. Ste.tut:ul mentolalipocieunalui Psihopalologie ....~............~ ........ ~ JG1
pacieritului Psibopiltnlogie .......:...........~~..............,..,....................... 9t
:t 1.1. ProblemcaJePaibopnlologjei cu modnliffitil~ de a fuCG
v, cvol ~l'!rlr
din,.PQ&tt"c"i
... . p1'1n1c~ f ::---:....: ............................... 92
- ......... .
J.l.l.l.liumiiml ~xngern( de mare dp categor-ii diagnostice
lji tendinfl! df! pnrqlo~t~.'Y a vlet\i ~ntidieM.
Mnlla!S Malefi~ntnJ ..,......-......... ,.......... ,.,............................. 92
3.l;f:2. Udli211r~ ltllui ioiii.:;I!JMmlor.~ihologic depil~ir
l}i problcmntlcsau Cm-ut en Hoi ...................... ,.-...:.............. 100
Cum sl i1cizi ell mliinilc -enrate ............................................. 125
l.l.J.3.:Cn:nil psiholiJillpiilor:in psii\QIIOID&tioll.
Victorip dorintei asupra dntelar ~i
Re-zcrvare penlnt locul doi ;...,........ - ............... ,..................... 14<1
3.1.3.4. CaznUnlemcierli.ltJgiceinceroetorea ~liinli tid sau
..Em tJC ciind nu s-n viizut. a2:i o vedbm Qi nu e" ................... IW
3.1.4. Problcme nle PsibopBiblogici cu modalilntj}e
de o face cduct~pct i funl)BrrJtrainhtg: -..................................... 110
3.1 A.l. Slmctum progrnmelor de fomare/lnlining
in psibolsrapic snu HirotQil.iren . ;..................,................;....... 171
3.1.4:2. Provocnrea psihologiei puziti ve .............................. 111
].1.4.3.Jlrovocnre1lpataprof.o!SiORiljlilor ............................:... n6
. . 3.i.4.4. Provacarcm terapiilorautoa:dminisrmrc .................... 179
. ~. :u .45. Contestareu cxperlent;:i elinice ............................... ,.100
3:2. {stndcnl tnbloului clinical pacienl\ilui Paihopnlnlo~;ie
(pimtnt detnlii v~ Sora!I.On 'i Samson. 1999) ................................... lll-1
3.3. htorln pen:onnlli Qi soci"lij <.t p"cicntului Psibopalologie ........... 1116
3~li.B.ezuhnte1e ~iagnosdr.uluiQi.eYnluiirii clinicc 'fl
RIC P.IICi6111UlUi.f'sihOllntillogi.: .~......................._................................ !!.1
~l@Conceptullli-z.u-~ tauloului clinical pncicnlului .
. Jli:ibapatulogi~ ..........,........................................................................... 191 .
11:1. Meoon\sme.le_ntio(ltltogr.metiuespecifice ................................... 191.
: -'1~2. Masani:nne ctiopntngenclice no$pecifice ~nu jJsibopnlologi<J .
psihopatelogilor ..............:........... h u. ........................ 2110
. . . . . . . . .- ............

JJJ ~3. Oingnostic nosologic descriptiv versus diagnostic 4.3, Fnctori de prmectie ~i reziilttntH. , ....... ,;.................................... 203
nosologic eliopntoget~elic. 0 int.Tem'"ire ill proiecr ............ 105
9

.- . . .--::. .....~.:w.~...v... -
-..o~o
 .;......-~M-.:":... :.: . . . . ~._-:

J.J. t Niv.clut ridic:alal capacilifilor intel~ualo :;. :.

ulec )lSiftopatoiogitor --~~1-N-:,.. ,..,.....L.l04
11U.1.;Spiiii\il critical.psibopn.tGtogilo.r:-; .";~~.;:0;.;;.';~..:..~~~ iU4
4J.3. P.reSiu~Jea.cwrelordeasiguriri;dtJiiniJ:IRfr:: .. .
~i Jlnmdigmaniedicinei:!ialidatii\tlii.l\lific ..,; .........,;;..........,~w: 207
4.3.4. Globnlizarea vi inlerdisciplluarltrJI.elil.iiltJei ~..............;. 214

Ca]JitobJl\5 l'mtanumtulpacielltuluiPsiliopalulogie.;.;,....,;;,.,..,...........,. 216 .Ftueword

. to tntneltluLJ1eUtau pn:ible~ueleinmutlnlititlle de a face
..... dingt1~sticft e'alunrecliiuci,lneiiutarea&mntului:GnJal:;_,........:.ll6
)'~(a~ .... < . .. .
The story of heOrent. WiUud of Oz: nnd the slol}' t.Jf Runtt!e151Hl'lk.in
' 5.2. Ttnlnn1enlul pe1~1nl probleJnele t~~lhlifiJild.tle~~ :. Comruent.o; aboutscic:nee ....,1,> :
r~t~ inlet v~jlie ~i lnllruneril; Sfftnla.Treillte ~~~::u..~.~~........~~;...::..~:.......~. 117
r":2~ . s.J~T~lttan~~J.lW. p~p~ebl~Ji,et:!~~1toaub1i'i:l~ .... - ;,. J~art 1. JJus,h:s:o[psycbopalliololfr us.adetlcu'
:'"' de a f~ce Cercel!!re. Cele VBSe.POruncr :.,~..~~...............-:-....":...._.,lt9 Chopter 1. Jlcfinit.lons nt~d coJ1qt!pL~Il1 cloJ;ifi~~li~l~.
"i ~~ 5.-i. 'trntamentulpcnttu.prnbtenrclailrl\ludllliifttrfede a'f~ . ~ U. Deftnil!luwef'pfi.Yhupatij'Ji~8}F!it sci~?: :...
; ~ ":-..
ethn:.ntla vl funoaJ;e/lndning. Bl;iciull~Qeftt .. ,................,''.......""'.. 22:2
1~, ",{.,,vi>';;.:-\ ', ,'',.~~~j" ~ ;"-~'~;,.;:, ',"~1~(.~/_..,.,,"''
1.2. HeahMutti'Utn~s.J;,<''3 ~'! .. . .. .;; '"~
t3~ TJnipsyclopatltolo~Jlsts ~tel$. ... .. .. ?! ,
">',-

\ ~-. ~~{ :_ ''"'

. : t.4. 11teofetica:lonet1lntiunsill pqy~bt1tmt~o,IH~;, ,~]lri~f inlrotluc-
tioo . ' o.,_;,..c"';'''" .. ,,,, '

CllpiJ~lul6~ Jtsiltui(Jgiaclinic,iht Romll.l)iasn.\J fugadit~'(umuf~~t~J,el.

. Un pnJ-,\net fundJ\nle1tat ~tiintific: ........~~..;..:~.....~;.;.~::~.,...........~:..~; ...... :ZZ.'l Clt~pler 2:. Structure aftti:a~e study'
2. J. Diagnosis ana clinical ~\l~luo,ripll
Capiltllul?,. Psihologiac;ttn~
""'" '
vernwrtJsiltologi~ 1\Jllj~atii
~,.,_,, ' ,, . -''.
inJ~l1e dQmenii
' . ' ' ''' ' ,, ',: '
2.2. Clinical COllteptuatilll\i9.:t , ,
sau Cent~iireasa .............!..... :.~.............- .. - ........................................ 213 2.3. Treatment plan and if:t~euli~Jt .
. . . 1::4'. Conclusions 8ltn fqllo\v7iip .,(r h ,.
...,.... Cupitolul U.lteanm-ci linale :;au Un nou inc6pUt.... ~..................:.--....... 2.S5 25. Example of& c:Qe stUd}; The cn1;c of Dnbp.
. '
.
: =
...
~
~

\.
E11gllsla SuaOI!\nJ7 .;....... ~.....~ ......-...........- ...........................-.....:l5tl Pa~t:i:ra~opu~\Jtogr'~t~~,t;:t.~~~~-~,~;eas~~~l'
Clurpl~3. Dtnsl,tials opd cHJjt~l ~~Jt~~~t:!9~~P~-~ts~fted Plly-
llllillug.fl,ll e/1\efcaeces .................~,.....~...--""''""'"'"'''"""'''!'~"'-l-i1 ch~pntltology . t ' < . ' .~ " ,: : ~~ ,;, .. : .;:,;

3; C 'SignS and syn1pioms. Clbtic:uf \lreBenlation of tliejJn\iEUtt l'sycbop

._... . .t. li;ltC...'tC '"-~..-...,.~~..,"_..._..:.__to;~!;-~"'~~~ 2.83 pntbology ~
i} Ane:tn' I. tlata lratwueutelor p&ibotcmlJ~WtiQe validate vtiittlifi~ 3.1.l .Problcm~l5Y.C:bopathqlol\Y has. wiiJa. di.ll;~nl W&)'s-bf conduct-
fi instJttt:lh~nide utili.~.~~o~ ~.. ~"""t"'"''":~r~:--.;...,,.,,,.....~ 7.......... ; 2lU ing diagnusii; and 'clinical evaJiioiion , . . . ., ...
.Anexo~~Gy.Wponc.nte.,vnlic;fole!lliin(ific 3.1.1.1. TIefnrge nul!l~r ~r tll~E~WIIU~~~f,tQfi,t;~!nJl;!b~'l"''dency ttl
diu teln\ia psihoterillJeuticii .............:_:,.:~~~~-~---~:...........- .... 314
At1e:tn 3. S~tul de insttmoellle psiltologict;.penlru ~tb;!Jfen
see everyday life as,vlllli~togi~!7:~~~~~~~~7 ~~.t~~~,.,~,
3.1 ~ l ~2. llte. use of obsolete p6)'cltologt~~~~~~tP5~l'11til~tS; !l~ fhe I}~ en
:.
:rti evnhlilrea COJJijlor/elevilor in vetlereu. orietdlh:ii teofare nprobate Cntt
11riu Hotarl\rell Ouvernului Romli11iei nr. 2 l 8 din 1 Martie, 2602 ----~-JII'i

10 fI

;.

'
 3:1.1.3. Descriptive no.:ologicnl 1Ui!gnosili versus etiopalhugeuelic no- 4.3.\. High Ulti!Uecl~nl 1\bi\ilies of psy~l10palho\ogint:s
solo~ical diagn~is. Stuck in lbe original prQjocl 4 3 'l Critical sense of psyc.hnpo.ltu:.loglsts , , .. ,
3.1.2... Problems Psycbopnlbhlogy bas wilh different ways of conduct-
~i.3~3~.The pressure of Henllh lnsunmce Companu:s and fht p.u.uhgm
ing imerventinn and lteatment of lhe evidence-based medicine . .
3.1.2. L 'l'he large number of trentmenl melbods or the Labyrinth of Ibe .rt'l.4. G!obalittllioo m1d interilisciplmruy scet:c~
Minotaur r .. . Chapter 5 Trentmenl of lhe pmient Psycbopnthology . J
_3. \ .2.1. Breilches in lhi! scientific validity of the treatment Ecce Mes- . . . .:-...& 'n the WR11S fi[COilllU;l
mer 5.1. Trentmenl for the problems encountet~ I 1

3.1.2.3. Lobby nnd trn4ition agai11&t scienc:c. The eliSe of self-~teem ing diag11osis and clinical evalUation. Tile scnrcb \'or l\l.e holy frnnld . 1
3.1.3. Problems P!;ycbopnthp\ogy b11s will).dlfi'e{qnt ways ot conctuct- S.2. TI"eanneotfor lhe problems cn~u~ll~red in "the wnys 0 . COil nr.:-
lng ~enrch ing intervention nnd rmatment.: Holy Tnmty . . . _ .
3.1.3.1.. The case of antidepressive m~icarion or 111e victory of mnr- 5.3. Trentinent for the. problems encoolltered m lhe wuys: of conduct-
l::eting on science . ; . ' 1 ing research.11le six .::omninndments . . . . . . .
3.1.3.2.. Tlie cuse of 1\le jiiloce\Jo effect pf How ll;l klll and kt:i!p your 5.4. Treatment for the problems encmmte~ m llli: WI\'JS of cOO<IIIcl-
luiutls clenn ing edm:ation and tn\ining. Occl\m'c razor _
3.1.3.1. Tho c~c of Iisycboti;CCOJ.li~. in psychosom.llics. The- victory
of. ~ishfullhinkif!g on dntn nnd Appli"Prion.fer the l(CCOnd plaec .p1wf 3 Ronilinlnn renlitles, cmu:lusions nnd discu!i!llons
3.1.3.4. T~e co.sc. oC lo.gical fotmc\llli!ln. in:-~icqtifio research or ll :wns ;Chtipl~r 6. Clinical Psychology in R.omonia or esc11pe from the 'f,wer
when ilcQuldnol be seen~ rodny you,sec h yet is missing . or Babel. A scientificnlly grounded pntnphlet .
3.1.4. Problems P:.--ychopmbology has with different wnys of conduet-
i ng. educ.triou find !mining . Chuprer 1. Clinical psychology versus psychology tt[!plied in other
3.1.4.1. SlntCI\Irc or the lrpil}_illg prpgrams in psycholherni)Y or Tiu'i domains or Cindo!rella
Ordaining ___,.
3.1.4.2. Tilo challenge of pQSitive. neycboiQgy Chatlli:r R. Final rei\\arks or a new beginning
3.1.4.3. 'l,lll challenge or pnrnprofesaionnls
3.1 AA. TI1c challen~JH;~f~!~~l'-help_ t~tmeniA . E!nglbh ~IIIUll11\rY
3.1.4.5. Speaking ngainsc llle clinical experience
. ...., ~ .. ...
' . Bibliogrnfie{References
32. His{ory ~>f lhecliniCllll P~flrariqn of d..-:: pntient_Psychoptuhology
3:3. Pe.-sonaland .&ocinl history of lhe pntienl ~sychopalhology Appendices . . . .. d" .
3.4. Menl.{l! &.!fl.lD.li Qt' tllf: ptltienl Pli}'chop~tlmlqgy , Appendix 1. List qr e'lidence-bosed psychotheruptes nnd &reclJOfill
3.5. R~1ts of diagno&ia and cljnicnl evaluation qf the p11tie111 ~sy- fnnJSe . ..
cbqpnlh!l1ogy ~ . Al'pendix 2. Evir.le~ce-tased cOill}10nems In the psychotherlpeulll:
rapport . . . . . _ -1 1-
Ciu1p1Cf:4 ~OI!CCplUuli~nrion 0~ cli~i~aJ pcosenU:tiop Of the pl!.lienl ._. . Append ill. 3. Set of psychologicnlmslrumenl!l usetl ro~nppnn~m-g" :'
Psycl,opalliofogy .. ... ... . . ...... . ... / . tlrenlp'upi1s for vocational gni~ance npprov:'?d h:y ~.~m.nmnn Go~emm~m
4.1. Specif}'.!-etlop~lhogc~~bt-mer;)lpni~ms - .. o~cisiou ilo. 21 il ol' March 1. 2002 . .
4.~. Non-specific eriopllilhogenelic mechllf!isms or &he psycbnpnlhol~
ogy of psychopalMiogists
4.3. Protective factorS nntl resiliepce

li .13

. 1\. """- - -....
,.

CUVANT CATRE Cfi1:TQR

Sesponeciidiferen{at)intreuu geniu ~iunhnbeci1 e!;tedi

primuhre limite. PsibopatJJlogia .::a ~tiil\tii, s-nprezeutntlanive1
social prm promovurea obseslva a tm~i itu11ghd de .l>ceuit-in
termenii reu~iteblr, ram
{J pre:re.nt(lre.~lad\~l pn~lii n.lhui tel or.
gre~elilor ~i ner~tl~itelor ei~ Ace~ til htcrate.{vqtum) va incercn
sn of~re.incontrapon~ere.o al).ordare t:tlticaa psi,bopa\Ologi.ei.
Lm::rnrea prezetltaUi.aici es~ nllfeh fii,ndatipicllpelltfu peisajul
lite.qtturii ~tiit)\ifice romllu~ti. dat: J'llii regaS~f! ill.eli complel :, I
ma exprimii cu clarita~ca om .~j .. ca profesionist! .M.id prer;is
sp!Js: lucrarea de fatii este uninanJfest ~tiintifi.::.cu elemenle de
pam.flet pentru o MitliiJJaRatjon(l/i.;.'l.itlpsibopatOlogie~i trebuie
,
trata.tii ca atare. lguorj]l'ea a cestui nspectpba.~duce ln pierdereu
rnesajului 'tiintifie. olluc::riiril ~i 1.a anit~ozitiiti fn\ide en $i autorul
el. Sper ca acestlucru s.ii nu se. inUbnple Iii ca lucrare1l. sii fie
privltiica 0 premierii jnl.resanU1l ~i uu modelde'uttnatillliteraturn
l;tiintifica. romaneasca.
Urml\nd logica hegelianli, arttebui ca teza (ln1ag\t)-en de.
scenlt a psihopatologiei) !;ii aui:lte:z.u (ttce$t velum} sit ducn la
sioteza (promo.varea uueipsiltopatologii valid~e :ttiintific). Vom
vedea in psihopatologie, prin prisma acestei logici hegeiiene.
dacli Hegel aputut lntr-adeYar sll gtiudea.scli. gdndurile lui 0-
zeu de dinaintea Crea~ei, gftndire care 1-a dtts la. panioglsmuJ
exprimatprbtformuln: totce e real est.e rntlouulfli totcee-rntional
este real. Angajamenttil meu~tiintlfici epistetriologiceste unur
al Rol;ionalismului Cdtic dublat de uu sceptioistn.de genul celui
promovat de~coala Sceptica a lui- Py.tdton din Elis. Stml insa
IS
F ~-
--~-------------~----------~---- - _..._

psihoputologii mai fedci\i ~i ntlll sanato!ii di1\ tnlllCl de vc~.-\ere

~~~~sceptic mai atipic ~i mai conslructiv. Cred en tlirie ca eel mui psihic 'in compum\ie.en -restul populaV.ei?; (3) Shot ce~cetarile
lllll mod de a te ap'ropia de cea mai bnna . . .. dio psihopatolegie riguraase? ~i ( 4} Snnt pro gramele de. form are

.
:::::::{':"'"
. .
~te niil~~ea crlrlc~i reflruri~~;.:';!!,~~~:
. ll~~c ust; l'jtnO:tlfice. Critica permanenta a acescora
ale psihopatolQgilot bine orgaoizatr)?. iar apoi, pornind de lao
arimdine criticl\. coostructlva, voi prezenta -m~da\lla~i de
~~;.:::,: !:!:.";'~ l~r_:mb semoul inn-ebiirli. sno>l cliilc ea;; ~orectare. noolo uru\e esmoazul.
P..1lcn.rc in a . .una.I~{eleger-e a fenomenului studial Din Motivmea temei. Deee nm ales sii serht aceasd\ lucrurc.?
c ~
ac~eA n-~i ~les ~
5 .-eel ml\l mulp oameqi d Douli. cntegol!ii de f.actori nu-detenninat.ncensH\ dedzie. Pdu1il
inQeUi.tonre Iii anume
pernl.aJ!ept p1.0dalillit{ d .
de a;a:au;adtlU
.. . . 0 u~e ~ cautfind.
cale cttt~gerie dB facrorise refedi ln:nspgcte 11rofesionale. Adevnrnl
c:ontraexemlllele.'Nu~sl.c nfm~o~fl~m~r.e a lor. tgnoriind este di a>Jeam plnnificat sll tdmin _de scris prhnul volmn de
"'"P ~usptle'J.nmctele de \tbde . tJ~u ~n-a cauta-exemple pentm "Psillologie cftnic5. :;i psihopatologie; F.unda.n1ente 11i parrea
ln o scofumiznro a-1-enlid\ 'ire.. re r uclln~acestdemersd~ce .general[" dintr~Ull trntat de patru yolume. intitulat ..Trarat de
conViilqipr.intJ;:.:oigrto~a~::.-o sttlectte a datelo~ enre ne psillologiecl~niclt.psihopatologie'!lipsihoteravi~". Ce m-a fi\cut
pc care~ sl.lsJinerir~ Aceastao .. i\e~~mplelo lnteza generalii . sl\. amlin lJt1blicar-ea ncest:ui velum fli sa public 'lnll.\i aoei\sta
f}tiinti defensivi ~ nroeriint:tf~ne lt.fac~lpemulri oameni de Incrare? Sa e1tplic succiot ceea ce s-n-'indi.mplat. A!lu cllm nm
mecanls&tmldeli spus.mai sus, nngajamentul meu ~tiintific ~i epintemo\ogic es[e
. . ens t.v prototJp
. . e vrei
.' C!laca cnrern sli .e de
. dperforman{li
. . . . .
pcrfonnanl!esre sa-l~ ci\ri tt . . ;. .. scnpt e cntedila de
unul a\ RapeoaHsrnului Critic (Poflper. 1959; I 985). care m-a
rigiditare'':. o clisc:utfe .. 't~~ ~~~ ?llmmdu-le "stereotipuri ~i inv~tat cii pt:intr-o htltudine criticli coostructiva futii cle prot~riih!
este !nterpretatiide as;l ~e ~e :to~re_la_~;oprlile l~r ?rod use crea\ii ~tii~ntifice roa apro~ii cnl mni bine de fenomenullJe care
en n~c pemonal. ceen ce reflec ~r~.. ~s'.olmitl ca ag':e~n~ttnre snn vreuu sii-1 stndiez.. Sigur. nu am o atitudine popperiana ortodoxn
cu.prodnsul acesi:\Jin. Acesli . m.tde~fi!iea~~ropnnlmlor .. E.u.. . ci 1mn 'inti'hita pri11 nsooierea conce.pmlui de ft\lsificabilitnte celui
Cl~impactlimirar.limltii'dat~~~t:~~~~.du~ 1~1 produse ~tiinpfice , de vel'if.ic_abilitate-opera{ionnliz.are (Bridgeman. 1927; 1936;
nutudine din perspectiv R . . . u ce ~ ~l\1-e le-apmdus. 0 . Cf\rnnp. 1937) l}i flexibilizatn pdn dezvoltl\rile postpozitivisre
. includem sqgestiile via~leattna~smul~i Crit!c ne pennire sit (Lak.ttos, 1970-; Perehnan. 1970; Quine, 1953) !ii prin cele
de.vede~remitate dintr oa a e c~ .ed_altJ coleg~ snll puncte noi di!Sctiind clemente de influen(a sociaU\ in !itiintii (Rulm, 1962;
rezultat d~pill}indliniirel~ ce~t?Cnu~n slintitoas~; produsul asrJel . : Feyerabend, 1911). Modul1noaretoate acesrea se comb ina iu
..Cmdo ~tiin{if.ic.. v~i anau:~:: .,a c~pt._Prln ~rismaacestui nngajamenl1ll n1en episternalogic ~i profesionnl va fi n!liefar pe
.. en 'it.iint~ tratfi .d . . . . . . . re~ nctllala a pszhopatologiei , par12nrsul acestai lucdhi~ Yo c6ntradic1ie ell ncest nngnjnment
n -ocnpe. 1m pnci
. . . . .. . . en tcate sa prezil}[li la
paihopntolog.. P. epistemologic.ru}a cum am spos mai sus. arn observat ca n1ulri
oamen\ de ~tiiO\H: au nles o cale 1n*eH\toare in !Hji promov;l
r~spunde la ~;..:;:::e~~i!~::!::i ~~~a::izoi~linice... vo~
cren(iile ~din~ifice. Iii- annme aceea l,ie ale apl\ra . cnurnod per-
. sunptamelepacientului''; (t}Su . . . ~ . and. ~emnele ~tt
lulbudil'ilor psihh::e corecre ... ;r.mod~litaple de dJ1lgnostic al manent mo&nlitliti de aonfirmnre i\ lor,. ignorf\ntl
lltlburarilorpsilliceefic, t~?e,. Clem~?; (2lS~nttrntamcntele ' contraexemplele. Acensta ti fa_c~ dfensivi iar acesr. stil del'cnsi v
. . . . . ,. .en e. ~1 asociatacesteLintrebihi, sunt .
11
16

-.....................v~-.< . -
 . .... .
... .:.-....... :

~~nereaza produse -~tiiufifice ~i stele - "profesioJ~ti" _ de

lan~tru~oc,,J~~~.P.,?,r1u~e. ~~n(ifie pentm_ o.tJiata iuterna~qnaHt ~i . Ratioi.thlismului CtiUc iutr-o lucnu:e. Nu an1iluzii di polschhubn
pr~f~I~R~~~y,~voca~e-~t anveL=gur_iiintematit)nala.Acesle stele ce~a seuuuficativ urimbi priti acenstii Iucrnn~. du.P.maca~ po~ sa
de lact11aroc SU~t .adesea fie fom-te complexnte, crezand cii UU ftu consistent cu mine :jlpotsii dau :un e"trll:lPlu de atiludme
(~Ot fi :omparab.ile cu colegii lor:diu strainatate, fie"d,hnpotriva edtica .'Ji construc_tivli asnpm p.ropriul~tldo.iu~itiuae c::rc_.e~~-~i
l?ru:te unportm~~e, crezand di ~tiu tobJJ~,neayand cultulvalorii ~i practh::ii: Psihopatologia. A~ a ca run mc~put:ceastl,l c?lal~u:
linut!=!lor propntsau_.a.l respectului valorii celuilalt. Uuele stele terap~:utica" care poatepriu mod~lare :}1 invatnre .YJcuna!lla s~
expandate de.iannaroc publica ~de.'ie~ilucrnriin ca.re mereu 1i sdtimbe ceea ce discutsul ratiOnal t1u. a. pt,ttut .sch1mba.
se pare di fac dlt~ orevoiuti~-!n dqmeuiu,.revotqfie p~ insa care . Examinand Hternlura . de speci~lita;te din c!outeUi_.U~
.n~t Q bfl~a ~ seamii-~imeni in afar,.., celorobliga{i prin po~tia lor psihopalologiei, am ob::Pt'!at cfi ~is; e~m;~ d~ llUttlte~lucral1
-- s~ ~ fa.ca (ex. SlUdei-.p). M,-nau sa[Untt sii lTHtl.revalulii de iarruaroc scrisedinperspetivuunmRat1onaUsmCr~lic. Cel~IUa.J_mttUe
!
~.t_ ~n~1 e.~te do; ~tt,'yiid in: ~tiiuta Ull s.til. on;;&t, baz;at pe lttct:ru"i arn.l:ii osjttla\ie ,.rozli.'' a psihopatulogiei, pre7.C11U\nt\ ~~ar
con~~711tiza~-en fu~utelor PPprii ca om ~iiJrofesionist, pe respectul succesete arestd discipline. Este fo\}~te.bineca arat1u.ulucn.nt:
. valonlcelmtaltllt.peo atiludinecritica ~i conslruc;.tivaasUpru n bune. in ncel.a!ii -tbnp. ~te ins a ~i plical eli nit :;e.!n-ezint? one.r;t ~l
ceea ce face111. Mi-a fustdat.sa vijd ncest stil;d~fensh',in nmlte 1" nilele ftu 1dameJttale ale acesllJi domehiu.. invatan:~a li.levol\ltm
ii_ll-er~cjluni cu :uul~i prof~ion~tl ro1uaoi1stitc<U-e m~nsurprins i:tr-un domeuiu sefacceJ mal biue pdnl.r~o c~mhin~\ie ndecva.ta
VJ.pe care 1-a H1ceputru.-a-fostgreu sii-lnccept dupa ce am iutre ex.emple ~i cootJ,uexeruple., cau~ite :flne.teu!iite. ~r~ent_area
pelrecut aproape trei ani Jn SIJA 1a !Vfouut Siuni School of t'elll;ilelor ~i ignol'area lintilelarduce lao dezvoltare~d._e delu-anl up
Medi~in~. ~~New York, Ioc und~ atitudinea.onesUi, critidi ~i eyi defem;iv a dtlmeniului. Alladar, atu-1\utat:t\t _ca sumnte de.a
constructt va este tuotorul principal al calirnjli; Prin propriul fima "'.-til~...aflnte_in
... li.za em'"' . .. . luc.ru
. este__c IIZUl_ . s._c...rnt. u.lu_
. .. $11. . . . .crare r.h
n..
ex~utplu a.m Incercar ~a sclli1ub ce,ra In- atitudinea. aCf!Btor perspecliva critidi asuprnacestu1 dom~niu; lucr~~ care.upm sa
--r-. profesioni~ti. sa promov.<;z prin cotnpoJ:ta.\uenlulmeu uu stil ~ritic se coustitlti~ jn gludulpracti.tt d~ elnb.t:tnu:e ~.une1 ~uctl\rtllespr~
i ~i construcli:v, da..- se.paredi, -~Inc saschiJub ceva,IUn rett~it psi11opatologil! ~i psihoternpie. Am fost i~tcur~.nt J~l nceru;~t1
doarsafmi fac HOidu~~ ~! safuu in!if;pi1I1e~ Unit coJegt Djll optiwn~ de-apadllile re.tatlv recenle apatru lucrllti trp:~~tan~e ll1
IJac~te unii nu sum: capnbili sainte.lel!ga.cao aiitudiue c~Uicii litera1uia de specinlitate1 Cllre abori:leazii 4e pe pou.tu cntlcc
asup.ra cevapoatesae~pdmeun,seiml de-apteierefatade ace! d.omeuiul psibopatol"!giei. Astfel, Roby~1 rd-~awes~ pro~e.wr
Ce\a; atiLudinea cdtidi poate Scoate tqt ceoo ce este Ulai bun din la Carnegie-Mellon University, n public:U . lll .199b _luct n'7a
_lucrul critical a~a cum {llefujrea upui <;liaJ.n;tnt uu duee la intitulatii "House of cards;Psychology ond.p~yc~l~tbc:lap~ ~?~t
distrugef~alui ci Ia.fnfiumusetarenJui:Pm:afrazfind o ntinnatie on my .
th care. este o abordnre critidi a proctich ;,:1 cetcet:.tru m
. . . .. . . -~ ... . . B 1
cefg!Jdinol nu critidiln valepi ci ceca ce apre.ciem, cn~deut di dom.eniul psi~topatologiel. in ac~e~~- tii.refti~ ~~~"Y.. eu~ ~r ~~
\
;
are poten~inl ~i iubim! Restul nu merill:i criticanoastrli. Dinpacate Mark Malik de la Duke Universtty -lil en11f?m~~Umverst?. nu
. ;;~desea n_u s-a :inteles ace.stlueru. Amorsat~e am~sle aspecte. am pu bl.tea t.Am~ooz
-~
o Jucrarefoarte_
. .. . biuc. evalu_atadere~enzoru
. . .. .h . . . ll . . de .
hot.:frfr.t di e;l'te cazut sa fac altceva: sii ex.prim acest stil a1 spec1a \Ul. e, care
l"+nt _ face
. . o a\mrdn_ ... . _ n_D.:tM_.
.. . . .re c_ri_.l_i.di . ... )Jngnosttc
. .
and Statistical ManualofMeutaJ Dtsordel1)"~~~~~1'lul de Dntg-
- ;"~~~..:; .-~.:~~~-.
18
..
-.- -_.-.; . : . ..:- 7-~.
 :>,'unor(int~ts:e- Ji mo~~vn~i. p~s~nale. ~le r~c~~r1.9~~l~--~ ~}1m ~e
pcidt~faee*i~eest~nctil'lSi~l!J1n~ ~~t,.s.~i1ll.dt~c.rni}l~,!!1etft~Pl~)gle
: ~ito~Dcll i\~lo senp'~le lltnJ~~fi(pJilbleme? f\H)n~tlwnl~~r~~,~ind
c:a:fu.aibttfill~lltodq1~g1e~}!trlli\VIU1Sarencunoa~~ji,e~ cure
o av~nYtn n'C~sf~oll"\tmt. ntrll
a spune cJi este J;i pe{fecrlt Ei
birie~~inv~canliiitae,g~~iflie.~lElmett'idolagie ~tiintifjce penrm
. a critit:a o 'luCI11re 1lau ,n~:d~-qienil~ {irirh ,este ipocri#e (mafel
su)1t a~sea ctiticaife; P,c:'~~~ept"i~Brlri valor()ase!). !O .1urirare
:z~:: tintii 'trelltt~ricntic~t~:~!;t!~obl~ttle'~llpl itpontnrc; ~e care le
, ;. nref.t(ltde pro6lemclagencti1elfttc rnete~o1ogiei ijtijntl~ce. nltfct
j\lugemsaicrlticum I~ltbl fiecilre l~cn\re. De llse~nea, n in-
clU.dc:~Uenefbtf.ttc'tJeIDerod01Mgifi4ttintlfibliaifi ,1nei lucri'iri
.. slt;:betll.entlnib."liiliftelen.tmfo11lfii:fliir1(ifice" ~st~1utli~lincorecr
:l <{~tf~.:aoesea!Se0sitlvea.zti:i,Jtttfltti slabel). fn~e~~tlnil sa evil
. ip:~zi.a:~lctiticmde'dtagu1m-iticii,. r&abotdarea pretenmrli nici
~~r8'p~ihopatel$'gi~i~~vai actlpatdoal'iJeeroril.el~i g'r~clile
,.t;l.p!oi:\a~ ate;ac~HIJ~I!}oi'den~u~t'itcib~usclfud lill)i~l~ inerente.
oomeniulni. limite demtminate det.tB'$1lfii '1imitele imetodei de -~!
~tcetae Ia care ~ihta ai1\jnns~dizj; In plus. voi bvim
Clitici
,I

. . .~n.;;ml~~~~~lnep:u.~el: tihftific~fh~thepatologie. chnsider.l\nd,

.::j~a\~cli~,~ ~f},t~'!t ma1sus. metndaftlin~fiea.ca;~ind cen rnni
!f~~~1l~~d~~~~)l~~M!~.dinOO.le.~~iste~te~flt~~'1'~~0llsidCTt
ttl~}~ ~'!~lat tltt.W'"tt~~~ pmfectli-.c:Pcmtruerltltrl nsupra de- ~
.'
~
... ;;
.tl'l~rs;olui, . ~tiinlititJ:~PfOpl\ill-!7.is-. c~ implicpt~i~ti pe\itru ; a
. p#ii~qp~~lP:tiC.Iimte,r~!!LOOflS\llttrr~a ilnot autqrci p,~tcum1tuhn
(l~6,~~,'li,F~.)fet.1Jb,~~,(l97S).f>eliarecenQi n'iilifitm}lenrru o
psiho{Jat.ol~i,e,valic!adi.tiintifie,.;i cdflctt nonst1 vn:fi una
.. ,:ll~~u~it'~fiiiJ(i.fic.:Psihc;)pato1ogia.:a:fostmer~\l obiecru1unor
;;' ~, ~1lord~~r c.irit:e .maf ~1t ll~unmi' putill serio~~e. 0 scutta .
--1
'
~
.
::Jnv~l,lati~ emplri~p!ifnret:netu:tili71lna ori~r:nol~r de ~nutnre. .
! ;
I

=toiirJi.n~ cia 4;i . (!~V~nte chcic;; ''psychopathology nnd . f

t
.' ;: psin1dos&iencet~~au (:p'{inte acciPerlnd nceea.~ir4!Datica, ru'iltlt --!
' .
;ca exjStli rnii de:fi~iere' p~ aeeasta ternii: lnvesrigllocl nn e~aniioo
21

.----------
 ....
-~-~,.:,;-..:-_t

IeprezetltaLiv de l OO.de as.J:(el decone.>c.huu din caleva mii obtinute

piiu motorul de. cilu~are ooo.CLE'". DJ\l aflat ca doar
,:- apw~,~~~at!;!,~!;;~.J!~~'!~IJ~lilj;.s~~e,.~a~p~"~~"~tiit(; "
. !
restl}lJ~i!i~~Etlt,~~i;).~.~fu.1,~~te,; p~~i'-"W~ll~1te .S:att tottfple.t:
u~edo~e:,.:~1,.~1~~~ ~tfrl.g~~;~a,t~Un4~tY.oium,,o[erlud o .
ubordar~.frilic,~ (Uifel~~~~~.&if,.tJ.pc~i!GIJ;:YWeJJl~;eon.stJ;llc-.
. live. pen~ru
, . : r. progresuliJl.dcmu:miq.Jlplll~.
: ... . . " . . ..f.> .
v9itla posibilimtea
. ..

celor~aJr:nu s.tilit de ~S9.@~ ~;~C.U~~t tex~si:lti e:lprime

plHlc~et~\de v~derf~.r&Wn~~~ \~ii~:.in,~i~ta, al:catcied,itor
..
I'
suut: ftg~~ntl1PurJ.la1.o.f..~Wti~~r.B~aviQ~~ P~fcho
~lerapie~/Rt;v~sta )i~~I!l. de Psibokehpii ~gititive.,f
Con~.eo~1fUtet~tale (IlttR;f/~~~p~pb,otbentpy:llll) , . . . :
lVlollnlltnten
. I '
1\e.-
.
~t).ot:dnr&.l\i9daliliat.eade alloniaa:~ a
.. . . .. . .. . : 'r;:- h".
tel}\~ a~tei :lusr~i -va n1Wl.ll 1:11C01Ji~liltita.:~ai Pf~~~ ~pys.
. ''pacjeutt~r~;u:e ya:fi qnaUut pepa.rcurstiKn008teUtilif~ fi va
tqqm,ai ps~Jiopatolegmii!IP fliOdalifi.\~i dt; :nb{j~~ ~~,~~~ta
. toctJliti. iilliLJeb::u,ipipgia .u;tilii:atltinlp~pa~ltigie'c~~~~~m
de-a fo,ce pu:QD ptl.~Zieat:Q.d~varat ;' 'tiU1anZt1 clniici'O,:~. #~ -.
G~t\ cl\ ~itea.s~il nbord:u:e;iq.,~tiip!Iate con~tbuilr~; .'i . ..
. . .-0 .~ni Q.!lnli, caoiep~ a:litllitelilr d,oJI1al~i~lill prio
reliefaJ:el;\:.~lerpf!nte,_lor de nernu.:l.itate {'tiinti}' fii ancl'rnUl1j~te
(p~et,tdo~ti~ltt~)din fl:atiiul a.ceswia; ....... . . . . . . . ..
0 re,ceptat-ershnukat1ii a\lllmstY.Yl~a.Str.il~~ihi ~pul
de pr.oft;SiQtti~ti,~i,pampf9fa~oniv~.a~t P!ibbp!l{qlo~i. <tlWi -
w .
I
4
t

uuli pC\nt!ls;)fe8iom~~'tit1tiblic:hlhlrgtiin~rliJniM~~Jl.~~~a
1ulo&ita aidl Astf(d;.v.silxepatplogji o utiliz~~tnn~cti~.,.~ntl I
ittrpa.r~rofesioui~,lii :;ipublicullar.g ap.aiii.it deeil pin~clkti~i f
(
nuu.e sau.tuti.i .autrait-o ~t.. . .
.Psill'1~atof0gia es,te';dennititaici.~t~d1'Ip-euiU1f~~ijltta~.g!! I
~;r,~ !JGUpli ue\stutQuhU;qcll;lltifiJJ car~eJrif!~~azo~ ~V9,1~ut('~i I
i
t
..__ .r setemlina tiolilepsibice. Malmultecatgorii depr9i~opi.ti
' suntitripliti~leJn ac.es~.dom'rnil,l..ceimW:i11JpQrt<l\lti~~~l,lJar:.,~i ~
(t nditie .ftjJulilsiltologii,clipicte)ti ~i p:!_jhialiii-~~aclar,fell()Jll6l1ele

22.

- . ~- . - ... . .
 cnd\ul c~JpJiolu}ui respecri v. B ibliografia ~i anexele vor 1ncheia
nc~asta lutrm'e.
-E\\ apr.eciez c.n fiind co.ntri\>utii originale ale ac~teHucdhi
urni~toarelei - _
. '."f~t~~.fintTe put!ne!e abordari critice ale \)Sihopatologiei
dm peasrutllltti!n\tudi romane~ti.
o Orilizea7,it o modalirare origin alii de \eliefare a t)roble-
~nelor psihopatologiei. trntl\na Psihopatologia ca pe un pacient
. m ca~h~lunei an~li.ze ~;:lin ice de ca~ _ .
... . . lncea!~lt sa f~p~clar 0 disti~otie intra "descrlere" .lji
m~e.rpr.etare .. 'OescrJenle se ba':lt;aw-pe date dinliteratura de
. specia\itute lar interpnstll'ile pe care le faoem aceston:hite- flidi
a av~a _pret,enpa f<ii snnt singttrsle poail>ile;, ~ .voT fi meaeu
nrg\llllentare in cadr.ulunui diseurs teoretio .!!8ll:prnctic.
ln CP!Jlparatic cu lu~rli{i stmilary pi'Czent{ltc 'in Uteratura
de 'PFialitate intema(ionaUi(ptttine [a numl\r). Iucrarea de-fn{a
ndu.~~ cflteva ~~~l!:~cte .ooi. ca urrnare .a 1:1tjnnlirli laola1tl1 1o
. c~pttolela noestei c~r.ti t\ unor inforrnnpi prezentate in articole
dtsp~mte,_ ~rr_icol~ id~ntificat~,pijn analiia pwprie a bnze1or de
dntemterotl(l?naleMEDlJNE ~i "?.SYCHINFO:
p Evatua,pn efielenl-el prqgral'llelor de farmare in p!ilho-
fernpte.;
a A~pecte ~feriUHtre la psihapncologia psihopatoiogilor.
l?~lgur.,Jucrnreaonr~liilimire,limitepeea~lementionez
tn co~tmq,nrc:'llJteeas~a secpune ~e:cuvant ciitrecititar. pennu
1\ ofen aqest.pul.~portnmtaten de a ave a el tnsu~i o ntimdine ~ritica
a.~npm P.IJ:~~z~nl'e1lucrari. f :
. . . ..J~ _anumire segnient~ ale teJtului lu{!nue~ cere mtllte
prereo~tZJ~e COJ1Qt;p~uqle ii de specialitate de la oititor. astfel cit
nu es~e ~n te:tt~or.1n p~us. Nte:lentm'ea SllCcintli fii punctuaUi a
!t~o_r tdet, uneoti fiirii dotalii lj~ficiente l'efetitoare la_constn\ctele
utJ)~~te . p.~ate .c~~~ citltomlui difi~ultati in a in{elege lnlele
nspecte care IWfC~itJ..p_uno~tinte cu carncter mni general. Ynct!rc
sa co~pet\sexz. aeesrelimitari ~and meren, acolo undee~re_ eraul:
ttimiteri pentru nmi m\llte detalii lo.literamra d~ spe_:mhtflte_~~
folrisind uneorl un limbaj rnii :Col'ocvinl. Fo1osuea m anum1Le.
. sectiuniale lucrl\rii a unut \imbRj et;llbcvial nu 1nseml"ma 1n~a
nictdecum Tenun~reu ll.l rigoat-el~tiintifidi n cr~ntinu~ului ~
;.: Uneori textnl vn iintroduce anumite cuvilife noicme se
rcferii ln wncepte importantc din liter:iturn de specialitate dar
cafe 11\\ fi.U 1nc1\ un corespondenr geneta{ t\CCepmtin limht\
roroana. Desi voi evica s~ fac acest lucru, neola unde totU!li voi
fi l1evoit sa i~rroduccuvinte noi. voi incercnsli le p1;e2inr elm !li .... 1
patcis. Gu toate ncesten. cititorul s-n~rmtea nfln'in situntin sa nu
~nt~lef!gli seml)ificapt\ unor tenneni fii sn~fie nevoir !>il commlte
litciraturii suplimcntnrli. ceea ce neeesidi timp ~i efort.
CGl~.n1ai multe date pe baza caroril tmi fundrunenrez.
lucrrarellsunc din conrexntl cercetarii americane !ji vest ~europe~tc
'i~don1e,~in, astful eli ele .s-lwputea sa nu se potd'lleasdi ll'lodului
inJ~riL'l! npa,re psihopatologin 'in ~He c.ontexte specifice. Tinilnd
tnsl1 cont ~e faptul di t\spectele generale ale d.omenjului sunt
aptoximnt~ tn principal de acf!ste doui1 contexte, cO'Otexte cu o
fort~ ~tiio{ificl1 ~i ecouomid. deosebitli (vezi spr~ exemplu
utilizaren pe scarii largl a DSM). credtotu$i ell generstlizt\t-el\
lor e&te celpupninfonnacivli fii pentru i!lte conle>:.re mui specifi~.:e.
in; plus, voi prezentn 1ul capitol sepurnt 'jn care una din .
c#mpo11enrelo psihopatologiei. p_sil1ologi.a clinic~ este discumtn
SJ?.ecific In conrcxt'fdmanesc. . -
; '* Anumite inteTpretiid ale datelor pre.zenrare aid, deJii
atgumenmte. nr putea sa nu fie singurele existent~. L11s ilsrfel
cititomlui posihilitatea de. a face propriile iuterpret~ri.
In iocbeiece doTeSC siimentione7. ca. peOh"\.\ a fi congruent
C~l fllOda{iUl(ea inediti\ de nbordare a remci. ~i ljmbl\illl Utillzflt
vafi in anumite segmenre mai dit'icile ale textului unul colocvhll
si adesea la persoana intni s1ngnlnr. exprirnllnd i.n\erognti1k :;i
indoielile pel'Silnnle n~a cum a par in fiuxul gfi11dirii, fl'lrilit face
 ~ prelucrare formaHi a ]or. in conse~jnta. distincli~.. dhtlre
0 ~.utext~~;~e~g.?~eririiu !li ''contexlulprezentliriiei'; esti-;ni~d
putlllln_m~anta m aceasUi lucrare ~are adesea ..__., te- sct'1' .; ~ _-t-
rb-'1' u~ _...., samr-un
..
un aJ ( etnterfa~amtre unul ~tiinfific
S t
~i unul del)tipul
'{ ~:~nzarea
~~untet. p~r c~ acest lucru nu. va du.ce la o singulm:izare n
dtscur.suh.Jt c1 dimpotriva Ia impJJcarea in text atat a -_P-REFACE ...
- -- profesioni~tilordi t~ia parnprofesloui~tiLor ~ in p~~licului larg.
,c ...
f '
J
.
lt is said that the dlireretlce bet:Wl!en a geniuiruWl'aniinbe-
Automl
t cHe is;tha~ lhe ftJmter haslhuitaitl6us. PsY.<!hopaU;.ology M sci~
I ence made nn appeanmce a the gaclallevel by prontotiilg it.; .
successes, ,.vltl\but honf!stly ll.nd cl~ndy displajlug i\slimito;.
,~-- I
.I
mls~es a.ndfailure8.This p~per offers .JJs ciounte~t!lgti tt ctlt1.~
1
col approach to J?!iY~bop.aU1oiogy.. '11tufi, it: is highly~\'tilusimJ
'
I
I
and atypical for tlt~eJtisting Ron1tti1iau sci:CnGfit!liU:rat~te. Jn
other words, tlu! presentpaper l.s ~ st!iett'tific'JlJ;anjfesto, COll-
taining elemt!bts of pany_:~~let foill Nlinbna ftatiohali~ 1n p~y
cbopiJthoiogy. and mustbe c~rtsidered as suc!Ii. My sdenlilic
a(ld epislemolQgical COllllttitmelitis'Critidtl RalibuaUsu1,' com-

I
f
bined witha Skepl:icisin lik:ethe eue'promoted. bytlit! ~kepli.cal
School ofPyrrhon ofElis;- yet, I am a riiorentyiUcat aud:ton-
structive skeptic. I strongly believe lhatthe bestwa}' lo approxi-
mate the optimal perspective on a certain phenomenon is by

'.: I(
I
adopting R critical and ref1e:;dve a~tituue about your OWll scjelt,~
tific methods and rest.ilts;pennaneully criticizing, challenging
and questioning U1em is the way toward lbe best uuderstatld~ng
of the studied phenomenon. Unfortunately. most scieutists chose
t a deceitful path, Ibat ofprote.cting lherr resul.ls, perman~ntly look-
I ing for ways to confinn them, ignoringcounterex<mtpll!S- This
makes them defensive and threatened by petfonnmce srum.lards~
l jf one w~ts lo escape the performance standards.; the proto-
i typical defensive mechanism is caricaturi4iug by caUing them
II ..stereotypes aud rigidity", A critical discussionab9u~the.ir re~
sul~s-is interpreted by. th~e "'profe:Jsloimls" as~aggi~ssiveness
l
2G t 27
!

or personal offense. whicll refle~ts the identification of their
ego with il"s -results. These attitudes lend to scientific results of
lhuited impact, limirs set hy the producer's ego. An attitude fron)
the p_erspective of Critical Jlationalism nllows m: to include vi-
nble.suggestfons from cullttagtle~ a.n~t other points of view
emerged from a-healthy self-criticism, maldng the results thus
obtained go beyond f11e limiU. nf their producer.l will furtl1er
nnnlyze th~ p~ent stlltfi:pfpsycllopatholPgy. throllgh this "Sci-
a
ent~fic-Cre4()... trel}liPg\tl!~ p_atient seeking the belp of a
psycltopathologist. ':fhroughout tb"-pa~r..,.. "1he clinici}l nnaly~
sis:- ~pan lll)lll~J:l~the:signs am! sy.mpt.oms ot ~J_c patient",
I wtU try. to.an$Wer t~c next,nuestion&: (1) fs .tbe diagnQsis .of
__ ment~l~isorde~ scif?UtificallY.Sopport~ and efficient'J;(2) Are
rhe (re~tmentsfprmepral disqrders efficjp~t at~Jevidence=-basep'i.
ll1ld lll~onnecti,;m totblSjCJll~tlon,arepsychopat!\Ologists hap-
}ller a~r,l mentallYJlealth~(JJ::I:hnn tile rest afthc population?: (3)
Js the r~SC(l.rch iu psychopnlhology rigorO\)S? and (4) Are (he
trai_Ili1lg. prOgJ:f'lmS for psychopatnhlagists well-organized and
evid~9e~bt\sed? Theq, startiqg with a qo'!)structive criticism, I
W1U preSC{\t W}lfffCVCf the Cl)SC suggestlo~ for conoection JlQQ
impro:vemel~L
.,
28
-~ l
-)
;
i'
---;
- I
POVES'l'EAMARELUIVRknTOllDIN oz
~~A LlJI.R"QMPELSTIT.TSI\JN
.. l
I
- ;
Marele Vrlijitor din -91- a rem;it sa.i.nwte.sioneze pe toura
lumea.. Vrl.ijitoarele din c~lelalte tinutnri se temeau de el ~i de
fo,{a h.ii tcribila. Onmenii .din tinutu1 srio lji din Onl-!lul clc Smnrald
nnde; lo~uia vrl\jitorisl, iJ JiESj}el;:tflO en
teamli. Nll eru.lncru pe
cnreVriijironl din Oz sa nu poaUtsl'i n faclt Ern eel mal mnre :;i !
-
mai putemic vdl.jitorl Inrl\ insl'i ca. in rimp ce printr-o prctinsti
prezentii nevnzmli r~r demonsria for{a r~ribilli 'i'nrr-o incapere in
care se nfl.a Llll,grup de. vizitn~od venit~.f!n il implore sa-i ajute,
Toto. cfiinele unei felite numite Doro~hy, smu\ge perd.:a'-m c11re
ncqperea tm col~ dintt-o 1ndipere. Acolo, mirati. vizirnrurii nu
vihntun on~ulet. Tmbiitr8nit, mi_c-lii sperint:
... E!u sunt morele Jil fngro:thon1! Oz", n.spuli omllk\ul t.:U o vu.:e
tremualinda, &}lenind io(:li sli impresloneze. Vib:fl.nd insii cl\ 11 f0111 d~cup.:.
. til, a contlnu11l: "VIi rog, sii m1-mi fnceti i'iiu. P11c. orice spune~i voL."
Marele Vdijitor db1 Oz ern de faptun om nbif;nuiL TCJ::Hit
I
I
i
vrajirQtiile lui erau iltl7.ii ~i ~:rn-curi. El era de fnpt un fosr arrist de
eire care distra onmenii zbu.l'lind- cu llll balon. LEI o .asrfel de
,et~rezenmtie. un vfinl putemic l~n dus fntr-o a!ll:i lome .. Oameni i
din acea 1ume v~2andu-lzburtind in balmt, 1-au crezur vrajiror.
L~i i..,a plilcut :rcest]ucru. 11~a ca ~i-a intri\l tn 1ol. J-a pu~ pe
loctliforii acelui iinut sa~i conslrlliasca mrpallll de unde-li iln-
zi~na -en mid rr~curi ~i ~mecherii". Spre exemplu~ Om~ul de
Smnmld pn era chiar ve..de. O:tmenii nvedeau a~n deoarece
29
 . ~ ... .. . ..... -..
~ ..., . ,. ...... - .

Vrlijitotul iu~a-e.ra de neitumit! ju,cen de-a treiazi, ~;~enals~r

IJ:inlJ~. ~e J~pa~te~jt'u,~~>~~~~u,te,tiUJne~tei; iip~~~~r~~
~~i~~~ frt.C~\l~Pqtlt!~P t:t~~.~~..;t;lb.utu:u.0Mt11~t~ilttlnH:are-.
cnul:.fl:' ' . . .. . .. ' ... ,,
. ' ~,

" ...den.r prince l c.ume ftotn you . vui ve.ni .!lli iau ci:-i '' tm:u
1 . tnliine .....
t noue cau guess, none can .dnin ciici nilncni .Jt.u ponte ghici.
. i l. .. ..,. nimenl 110 poRt~ fli
that Rumpeletill:;kin is ny name.~ cli RunttJe:b;lills1d.n ml
11c spune..:
r-
Lq_aqzul~cestei VeLi inipiiriiteasa s-a~U(l]PJUtd~bucu.de.
Cand vriljitorul a venit n treill zi i~upft.dltettsn 1-a :~pus.uumefe:
Rumpebtiltskin.ln ncelmometlt vdijitotulr$i-a pierdu;ttualii forht
mitleficfi. i influenpt asupra.reginel. Pe fapt~ era atiU. de fudo~
C<1 aceasta i-a descopo.rit nuntele im..it a iutratto pamant..
r

.I Ca in1paratea,sa din pgyeste. fi psi!mpatologia aiaculJ1

.tnUllimedepmmb>iruy t!.samle~a ujtat. .Ea ap1iORDS prO!ilOVafea
iJniii demers in care serviciiJ'e oferile populatiei &5. fie

I fundamentale ~Liin{lflc; .a promis sit punli ,tiintn inaintea

iotereselor! Ignorate, acestepronusiunl se hatorciJ~lpoyivu ei
Povestea fratilor Orimm m:atl insii. eli. uoeoli, num.lnd>dlul e"'-

I pUcit, problemele creoLe de ncesla se pot reml)!a. mut uw~

Aceasta voi tncerca sn fac ~i ett in cazul psibopfJ.lt}lo~Jei pe
parcursullucrilii. .
A:;;adar! lucJne& va fi :;.i.nJilara:uuei c;i.Ulilorii inlumea 0~

I I-
pentru a-l iotillni pe MareleV:riijitor.,a b:age perdeaua 'Ji n.numi
raul. Voi incerca astfe1.sa elimlu iluzill.e. Cllfe exisUi in jurul
psiftopato{ogi.ei ca ~tiinti. sa VUd ce Se O.SCWlde.-dupt{ perdea~
.dincolo de imaginea de ~tiinta rigutoasa 'i putemidi pe care
~i-n construit-o Ia ~tivel ~mcial Sper d\ uumin" diul diu ;;~cest

l. I
!
domeniu, acesla Sa ii piardi illflUellta JUaleflca, Wlf.l CUJll ~i~a
pierdut-o ~i Rumpelstiltsldn. Sperde as.eme1teudi, la fel cu fustul
31 ~ .
 ~--~----~

~ar~ Vrltj!tor- ~iu Oz. psiiwpatolagia v~ fi mnitumita en

tmngmen ~~ !eala. care va reielihfin analiza prezentei luci,". . .
cnre este ma. plilcuta. in opioia mea, decat imaginea ei de s:e~~~

COMENTA.Rll DESPRE STllNTA I I

: 0 ubordare criGdhmupni psihopntolcrgiei ca ~tiintn neces.ira

clarifica1ea preulabilli n coristnlctulul de Jiliintfi. Flidl n imru
detalintin llSpecte defilosofie a .$riint~i ~ide episten1ologie (pentn.l ..
dera!Jivczi Greenwood,. t 989; 1'oulmin, l953), -voi prc2.j!nf.ll '111 .;
. conlinoare aspectelc cele mai rel'evante f\;>Upra demcrsr.lui
!itilntific. A~aUar., ce. 'insean"lnii o n'bordare ~tiint.ifidi tnrr-uo : '
donieniu? tn primul rlind rrebuie spus c1i $liintaNU l'nlietmmii
cunOlStere adunntii tn sisremJ. cur/i aaesea se nfirm~ "in uncle

I
~
Jucraride $pecialitme. Daci\ am concepe asti'el .!]tiint;1. ~~ l'i
sinucidcre pentru noi. ca onmeni de !j;tiinta. intr~t> n*fel de
per!qlecLiva,.nu ampnteaJatefarli et'iri'cilorcare at1rmn di un
fenomennueste~tih)tific deonrece nu avem inacest mo.menL
': :

I
iJ
curiotirtte necesar.e predicpei Iii controlului lui .~i in coosecinfi'i,
fenomenul_trehuie a};1ordat p1in strafegii a1temttrive !}tiintci.
~;Qinta este un proceso' tste o mbda1irate metoddlog1cll de
aburdar~ a.nnulfenomen 1;are duce In cunoasrere ru.1uoad\ 1n
siJtenl. A~adar. chinl' dabl\ nu nvem initial cuno;tin tele oeecsmi:
., 4
ui1ei nbo~ditd !}tiiJlt:Hiice asupra unui :feriofllen. nceftSra nu ~ ..!
i insearrm~ ~a fenatnemilrespecov nu poare ft1ce ol-,iectul desmdiu
oJ,~tiintei.Dacn. inptineipju. el pdate fi abon..lntprin mijloace
J specifice ;'itiinrr;i atunci este un f~nomen filiintific; o ~stfel de

I abordnrc }lOl\te avei\'foc ulterior. dnci1 fenomenul este i nreresnm.

tu
modele
~liiotn. seJace () djstinctie c~rli mrre asump{ii. teor!i ~ii
senck i Kenrre,199ll).
Asru1lpfiilc. Asumptf e suntlde'i funclamenrale care sum
acceptate ca fiind adevan1te de~i ele nu se pot resta direcr em,
33
 . ~ .: ~ .. .->

plric:imiles~rea }t_?r eitefoarte dificilii, d~i p~s.il)lla in prJ!Icipiu

.Elei (e~. ,.~~.~!1JJ~tHfa decermlnisumlu~. a~\~l11pJi~ ..fcni~c;perU: ".
psillictdut:_ifina!l ~a sistemd~prelttc11're~.t~tuiili~~e1 etc.),
(Qrm~a~a.preulabilul filortofic alod~ilrei mclQqede Gl!ttetare
~m~\ti fip~ J?n(J.~mer,. ;1'973)'~. ~al~a~~lor e.~~1~4e~~_prag
tnaJiF D!lt:IJ,nsumptille aa consecmte PP71lt!Ye .(~X::. ~Juti Ia.
generaren de leorii, modele 4i tehnolo~ii.e.Q#ietire):o.tuncisuut
buuej~l.valoFqa~~; d~t!li nu'O:eteonsec~n~~.ItP~i~~-~.~~~~e~ stmt
fitt;lt~al[l{lf~~i ;probnbil en intin.lp ~ntqhilll~a. itiintifi~a va
r~R#JrJ~;-~e; . r~ . . . ~.': . : . .,.c. . :' ... I
l
! l;eQ.riik. Teor.ill.e.Jitiii~[ifl~e s~q~tfa,~I~~d:iJ5l.det.iv-e din
. a~unm~ii~.earepotft~~te-~IYP~p:rr~WJ.~.~e;aQ~tYalt:~aiealor i
t
de.,aq~v.aq. a~~d~i"t' ~e&~l'~ .fl)e~d~,~#te~ 'R!!flle ~acli este i
'
~tdev&fatitsa\i fntsit' ~is~~~~ #faf~,~~; ~!~.~lWt.ta~ceewce este
I

f
.Jttt -~le1 sau.diceea ce~te; ~~~~. cQns.tif.U:ie,u.,teede:"fr4sii;
nit,,;._r.:::t:::~::-->,'"-{;;;,;~(,.-" ''~.-' ';-
o
.teode ~ste. ,ade"arata cl~iits~.l!l;!e;~~ ."~~e;g=a:este+~j ca nu
: : ".. :,.:. . . - --_- ''

Ste c~eaee uu es.t~fi~atsrow~~p"s.:o.Lt;aFie'~ate mfe\iaralli

citld;c~ero~e'~U:ti~~~-'?~~~$:Qlkdatcle deoas~[1r~e ti
este fttlsii ,c6.od IlU C:~~Ul 0 ~SeJJ:l~R~a C:Oll;SpOUtf6fi~reoriile.
suntsistelUe orglm1iatc:.d~ cons~e~j tiiud nsU"eclfd~te

I
:;'~_Z,->t:'i,' ~ '''< -.. ,.-,-o,;-~/_;~
din
Pr(Jf1Ciu~i: Fu.nc.tiif.eupei_teqfii,.~t.tn.~;(l)'functiad8edp~~~ {se
I . . . -- ;: ..-':\. .. - /- - " . _. _

descr.ie\ un f~n~ltJ,~q); .(2) fl\l1e,tia ~;c.p!ieat.fvti''(*'~~ll~~~, uu

fenomepJ;'_(3),'~~Y~~.~~!:t~l;;{s~~faep~~i~ti~~~fij\~unui
feitorn~n) 'l(4)f~~~~df;~!J~I:e.tmt~{seergatu~~tof!lhtatea l
iof-onnafillot.ttsllprnit.nn!(eno~en,lrltF-&srmeru~~~erf@.
.L1{oa,elet~~,~l?Ji~~~..QJil~iteerii..'ft~ofificel~~ll.~az bine (euinpte, 18~~o).:P~~~xoJL~t ipc~~o~~1118f~
cJelhuitu~~a~1ao~~~~fie ~tJtg~ lllO:~fe~\:i.W,tifice.
iu pmc11fn $tiintific~ ~ illtthllpm.~d-en moiieil.tJ. sa fie ~es- . estcf ijco~{a ... . ..~ :.l,l~1.>:'~i\-)~ri,. )Jll0Jl&;Diliti'f'e1
sisLentatizat --~~.a .de:tW.I)lbt~ 1~Ptt~<\J\J,:~mle tiel
coperit ptimut iar ~Eqf:,a s~d~volte rg:t~.urie pdugene~pirea
uodelul_. Ji l~ufuli tJ;J.~te ~~~~i- sit:uatit
~--t:: -:: \ ,- _ ~-- .
Oncum. ..dl~fta rliinaue
_.,. - .-- - ._.:;,,,:,-,:-<'-.~~:;.',;
:~Locke; B~dtel,ey. "tq._:_.,..'~-~-'~-~~lt"''"'.;-4~ alii~s~;tilfu:tt!~0f
aceea~i:1rpo~el~te.t~~ pattiru.[aralt~Fi~ihdiferent ~are
! .
tum5unt ... . . ..... . . . _ . . , .
uiu cdc QOUa t;:OU~ponente:sedezvokit pru:tia. . . . . sisremall~t\t~i ~ de~~Q\t~t rm~tivisnrol
slnholi~e: T~pnenulde pgzUiv llli
I .. . .. .
.
. . ~ ul"'ti,,,.rui
este opus spec ~ .. .,.. .. pon
_ .tiv inseanma
. ~adar.mteme&nt pe
34
35

:.;.- ..- --:. -.: .. -. '~--~ .. --

. f~l(.lte s.tiin{iflce, -pe date empirice. Termenul d~ .empiric ate in
lunba romiina AcademiaRon:lllna,l9g6) o sen1otftcatiediferit.'i
'
l
\
\
de eea folotitii in ~tiiMfi- 11 l1mba r_omana ~l se refera a esea la
rer__ce~~\ n~s~sre.rontice.. ha2nre pe experienta dfl viata. in timtl
ce m titn(:llit filosofia ~tiin{ei t~rmctnul se referii adesca ln dnre
~erv,n{ie"sistematica enlese prin metode 1;guronse ~i care
ad?Sea as~~rJi genem1itnte11 conclu-djlorformnlnte 1.,e bu7J\ lor,
sensul ~tthnttfical tcrmenului de :empiric este eel pe cure ilvoi
.utiliza 'i'ti ncenstli lucuwe. -~adnr. suport empiric 1nseilmna in
~r.:eltstli lucra~ .. intem~in~ ~t:iintific. PozitivismoUogic apl1mtin
JUL"Ll~ ~~eulut de la y1ena {aarereu_nea autori _precum Camap,
Schl1q.k) fa~e partedm~-:un grop .de ~ol!>li reunite-sub numele de
fi~.o.sofie.-an~litica (M"ar_ga,l9S8)~ ~~~te:~coli ntilizeaz3 anidizn.
(ad~~n 1o~co-matemstic:tt)pentt.~ clarifica teoriiJe coustn.1ih~
de ~tun{.lt us!lpra :fenomeoid.or~are fac obieclllllor. Po1.itivismlll
~~~tc reprezintii cehirai clar Iii tigt1ros aaiimstatradi{ie, As a cum
Sagmund ~reud prin sisremul ~rent de el- psillanaliza -a avut
. _. ~olu~ dtHl mflucn~n dez.~oltar~le ulterio~i:e in psihoternpie {cnre
n~esen s-~u ~&~olrarpr~qtr-o atjrudlne Pro sau Con{!"a Sigmund
F~ud), po:tilJ-VJSapullogrc ainfluen{Rt noiJeqezvoltlhi infilosofia
:;tuntei<laL'e s,-au rnportnt permanent la el tn 1e1meni de Pro snn
~onfJa. Pozitivi~mt~~ ~o~i-& .este, l)"\etnforic spus, lm Sigmnnd
t fell~ ai filosofie1 ~tuntet. S~tetit- prezentat. pozitivismu..!JQIDc
. C'lmudcdi eli demersul !ltiintific presup_llne nnnatonliea secven{ll:
. Obs~area..unni fanomen: -~
. . Pe_ haza.datelor~~ obsefl'npe (ex!srent~sau prod use prin
mti':tventanmu}ui de ~~mpt) seelnbareaia reortile !ltiintifice bine
scm~~l!-ate le>g~~ ~ttuctura lor lagici'i tor~spuoz.ind stmcturli
~:bt~~~ In p07.lttv:smul ~lasic se considem ciifi.mc~a explicmiva
eorot ~r
nu sere~edi lao expl.icatie geneativa. c;acinu pntem
~unoa~~e ~a~ra. adevilrata a 1ucrurilor prin care acescea
Jnflu~~t~mti'i. ~lte lucruri: Noi incepem eunoa~teren de fa
propoutnl~ de.obsenmlie care :ja sunt altceva declit realil&tea
in si~e.(desigur, de upro~timea:zi\.r.el\lltnrea, d<\l" no ~un1 tC:'Iilt~le~
sunt ceJJJ!IWcfii d~eipt.ivealo..aceliteia). Dacli.t~ona exphc~u.'va
bl;\-z~t! IJe date empiiike esre ~onwi ennsidernt~ a fi una ge~e.l'nlwi\,
atuoci.vorbim despre doetlinn l'enlismnlui (Greenwood. \ 91~9,
Puli1am. \ 9&11- ..
: HJementll\ l'uo.dame.ntnl al abor ~ ii oziri_vhtre _{:~ 1 :1 \
filosofici Mali tire 'in.gt'incral) e5te c.Qnce u.itde ven-ficablh,ti~~
Ce. 1seumt~ acest1ueru'l pdmu\.llflnt\!r.ht~orie (~ropoz1:ule
n
mol~culnre.) este verificabiln dacit ea -ponte f1 ~edusa -~~~
(d~coml'\lSii to) prO[JOd(ii de obsen~ntiel!'rotocohm: (prO~l:::?J~II
. nron"lt\re). Propo?.i\'i,ile de observatie SUO[ ace1e p_ropozttl\ n\e
c.ator va\ori da alftevl'u:.s~ s(abilesc:confmnr.'ind du-ecL e~untul
prOpo:z.i\iei ctl datele perceptive-(ol:lseii!Vl\Ut directsilll cu uJtU~r~l\
I upor tilboologii (ex.. microsoop)1; spre e.xemplu. pro~~:cl{Hl
''A.ceasdltnbUi nre culoare~\ .fll!ttgri\.. ese o p-rollO?.t~le d.::
observatjs:o. A ~duce e i:earia ht propontii.d~ observa\ie ~ns:ullll)ll
n d~riva qin ea toate propozitiile de.abstiPii.l{ie din con.1hn1aren
d\rora rezulmteoria. Oat! acoste prlilpozi\ii de observu~iesum
adtwlirate lmulci tamia _a-ste adevnmrit; duclt pro!1oli~i~~e de
observntie sunt false ntm'lci te~nia ecta.falsii. Uneort varrfacm~a
. este posibiH\ .doar in principi\.\. ca atuoci d\nd -~'~mun~l cle
}
!
-prog!)z.itii de observntie G!lte pr6n .wu\fo-:peot~:u at1ll~nve.'>U.lltt\ :..J
fiBcare l'll pnde sau dlnd nu av01n .lncn tehnologlnJneee~ur~
imre&tigiicii,.propfi2.i(iilo.r de obSaJ:\lDli~.{ex. mulre pre(h.ct\1
nstrOllomice m.1 a.u -putut fi vet"ificate inninre de desnopenr~a
relescopului). in aeost GR:Z.. concluzin ~tiil'lt\licli est~ una probilbl H\
i dar care ponte i11 pdncipiu.sii se trnnsfonn& 'in leguare l)e m:I~nri\
I ce.uulcgem date:re.feriroare-lb.:toarn }ilr~poo.i{ii \e cl(} obtterviltl~ h1
{ care se ruduce teoria stn.t .pe ma.s.\"trl\ dez.vcltari\()r ~hno\ogu:e
i .
.. .'
\. care ex\ind sin\\Ufi\e prQptii (eK. re}eSGOpU1;01lSCl"OSI!0~1~~\elC.). i
Deasemenea. confe:n:m fil~sofiei anlllitice; t:onre -propoz1tnle care
constituie lemia trcbuiesii respacte.silitaxn. logidi., strut:rum logidi
i\ ae~s1orn nrupximfind structurn t1\nnii tf~;\\e. Spn~ cxr:mpln.
\
J7
 . ...... . -::....:..
~' .......;,

~
PfOlfOZitia va~ti~l David. este lllUlla~ pdut. n.uu esl~ f~.lsl .ea luum (toar Hp~te dM\tr:;o:;.tumpra,::urn.\iht~'.npoi_~lt:t
est~jfiir~J~~!!,~;~~arece nu tesp~cta siltt~~aJ{niicli. (etiritrirm ;:~_:: ~oJ:aqlpzje.de:;pJt;.i~tli{ffm~tU~ti1wit~tt}1irc~';t1:~te.....
siJ_'_t.1'ei logicei Daniel David nu ~re prog~~~tiq:.~~.iiii,~1uiir tnl~li~ismul ~f~~\~E~nside~prea sev~f'.iil\l~~h\~;
. .'pr~lJ. ~tplus fata de al~-rc~ ~~_tr~~lie,i~~!l~~~{~i~~~111uJ
intei
t~P:i JiconstNct~ia~FS,.tui~t:f!lif::ittij_e,~i~;!ill~~l,~,,,,.. ~ottice
logtc\(l..uss~l .196~} ~~ a ~ezy9lt~f pces~~l;J,,~it~Jj~lein.
qeosebite, ~1r ~are ~up1Jt~~fhyerJfiCJites~t;t~p~~J!~~an-~ale
J953~].pezJttvUJmuHogiccete.cat(Jf1Le~or.s~1fcU,J.efalru,itetu rigu~.-os(ex con"tuts;;.tulde se.hemae<i~UitiYijt'. ... ::.: ..
.elnbej:areaune.i ~rli'Y~rifica&ilt: sit1fil?~ l;ttutl~U9ry-eri,&ablte=
.. (3} R~tionalisuaul tpdt~~Cptt}Bf'~l'~ ~ . . . ,~,I.?~~}:i!ic~nt-cR
. r rus~4tt~r-o pm~eziJi.~~~mqltRf"~r_~J~P:~P~~!~.~~btJic:.~!iP.oatl :disG~~eataadordU1-d~ntE}f81lltl~~~fMn i'e ~~~~ilitale
fi red~set~ l1,!()POZl~l~p~Q.~s,~~~~~' ~~~~ir;~~plu 8 dacii?~nun
J~fnt~ifit;abilltate; o~pf0p~f~.~~ ~ ~~~'tl ea~~
l

mf ~enfic~u-~au~b:uc~l:Jl;~~ ~~f! . .~~llllfhpg_al,l,ul.p~~'acelu

de a p1ne,ac~~t~~~~!J"u6~lntt--o'Pf9-PO~j\i~cl~~en\ata
X e:>te~~~Elf. A.pqJ1 ~c~st1l~Pf,OJ;l~~e!~me~estt:f!(td\1sa la
aetipul:

prop(J?tlV:J-_cle ~~~eJ:;Y,,V~ .lili~ \9.~~;~"tl1 fie ded~~i:lm (J ) este *

ll p.o1~fonnula:dhlersepre~l . Q~;s
{pP3tQcqlnre)'ireatepOt'fi ...
. .1':- ~;;.
JP?
~' .. . d,~"@~~tva\te
~lf..c~lj. ~~~leled\n.
": lelliilltatai'"'n,.;..~t~J:iuqftild
:c.meditt.marettS~t(~~'?.~~t~.~;:~.;+t ;~ :''. . .
.

.. i.nnat0gia eu,c9~\titi~~~ais~a~.~~~Ci!~'t' ctm~t;~a~~tJ~,~seama

. ! ..: u~.?:~f',~tJ.fC e&.t~ ~e:IJl\jJd~;{;:\)<~~~~~t\1 ~c\rp.~~:fotcMud
o,~tnlJ:!~~~~~cl), f;ll!:r;ll~ln~ iS. Veri fica ll'Pft1.Podfies~.trun 'cij~truct
Ii . : .. deeXistet\\tl'tih~UllitQ~~~b~qypri:u.!f~~;~l,(~?~i~leren
este. slt~l~~~W;t:tJ" a; ;Vr~u~lil;~.uu,oo~ 'bmlFI~Ic (~entiil.'l~~de) tettsiunirb!~cnu\i~~1~.~~;.\'~~~P~~~~~eottr'e~ (pritl
verificabrJihite) sau. viiii,lli~l~,J~~j;;r~tli~i!~~;Et;(~pmtleiftdiaare.).
rqpeR~:V~~ ~W~H>.rjt.~(peJitntceucepft~!'ttn~1fcrosc~p.t~t~le JJl t. ""'" .t . . . . ....;~a~e en
AcensUi flenbilir:a~ ~lt} ~~~l.\7~~11~~~ . ..... .

(fo~si!J.~f'":le,Jtev~~~c~.bile f:llin,llfOc~~l~~cli~~!l~s\1~.~unt sGbim&ii ~mu;,lfl.C~t~ IQJt~gjiJ.~Pi~~~fliiD\i.f:ti~~~~~(i~t mo
fi\.ra ~eUf.~<<se!;~!lieqfi:i~fJ~~et!~'"ttiv~S:(jf;~~~Qt1#inlli, ~. ,, '. meut;rull~tfo~~ it~~~~~:~(m~~~ip.,Jdid~u~~~~ (dacn
" elt;llt1i,nt'ti~tific;~~ ~tuftud deat~d'l'i,llJ~~i-~~m ~.9.~ lfpl-e .
exemnl~. . " ... . .. ..... av~l\l _ tooriaJ('"~~.a!~W;BFGli~5ia'~ e~J!I~ftUi~!jrt,entatii
(2) tpo!tl'imt-oye~afietn:l~~Ulu': ..(;~it71{t.). fJ~~ti~ist
pe_~iQp~T.i\!i~~~##:~a~~~~~~Pf~!l ~:;~~'~f1t~!~ta <X
est~ p~ob~,~~~"f~t). ~~ .t'@'O,NI!lZI\iile ;cie ~~~i\le suut
pc~tra.~\)Hnta. a fost~~! extreni:~~~".~t;,,ltl lll!fJ!e ql~ifJline, adei"'1; n;~.tJ:~.~~v~o:~tl~~~-~f!!itU~ es.tc
tna1. ales\ in cele soe.i:o~~.nnat,te dt\J; ~i~~lrt ~~e ~~~iqj, ltttele
i.

, . faf~l. &eli~~~~~~ o1J!f$~:!J,~je.sunt~~~ s). -~~~

.~ol~Sb,l.lc~~ (e~,-:s~~e~(!?g~!i_v~;c:7~~~'(J.tl),~ic1~9ail~t;t.put~au fi
V.tU]fl.:<al;ecdqpi1 cr1tt~~1.UJ.. PGZ1~VI~t ~$~ 9"~te~i~ ~,lost sedos
.lex:ib~t de.~o&ir(na.?pCiatio~~~t~(~it~~~tlllr1927:
. 1936? ~arraaparut pen~.~r~~!1 ~~~-~~~_Q9;9{PQJI;Btestei
dQctnue:,,~!l~~cteie~u:o~l~nu;~~q~~a~~\VPrnpazilii
I 'vaxi8lita'\t~iUC~~\lUitl,\\li.~ ~ie;~X).~re~~ni ~.
tie ()~~~a~ era
.~1(11
ml;~~S~~;IUleYifati\9el~r~~ ..., e de
obs~rVa~~(p'c.citQ~dc?~ft~~~6ll~f'M~:Jtii:~~~~\!}!lui ~
oteoli~~tii~@~~-~~'r~fpb~t:'t\~~s~tk}~~t~~~~u lJrt~
tve.rificabili~* cii. pr~~ ~~~~~\lf:ij~ftl~;:ln:luC;sl in~~iiln,:Ja
de o~ser':~~e CI tr~~~~ ~a.fie opera~~nali~epdn.pJopo4ifii de .Mtsinfex'empie care sa 'conffttne teoria 11\l(':Str~n~i"lfl!buie $i\ .
~bse~v~ifrf.: ~f.Je 7~e(l,~~l:n5~ de n~: ~;~gu& Ia~. !erne1uU de I
I Incerciitn sli gii.siru c~.ntrae'lt!emple~ Da'~;;~~Sim acesle ,
uperalimrali,~an: . u~a~~ t:a,propo~~~ijc;,~eabserva~e aco.pe_ra contrae~emple at.unci cu cerutuditt~-pute.tU:sliiiieiniihuant tcoti..'l.
tloar un ~peet din concept;uHn;vestigat.a~a CUltlpriti oiopsie
1 . Daclipp gasim ace.sle coutrat;~eJ:uple alunci ~S~f:l?t~~~:g~:obabi\
...... ::.: -:~:::::;..~.:~:-. -~~:-:_ . , ..,..
38
39
 sa fie.adevaraHi (na n~ropiem de adevun1l reoriei de~i prol)nbil ,_~ .. Adcvarul
.. unct. JU ~ati csre conferil tie. reu~it;.\
. d-uc. . ilC\iunii p~!
ciiel nu va Liatias niciodata}; Al'}adar, celmai bun lncrn pe care
putemsiH f(lcean daci'itlorim COliStruim feorii ~tii(ltifi~e -est.e
sa ca~ o orie~n~nzii~ - -~ltin1~ i~tantll re:znlmrnl on or infe~~n~e
delliiYiilt1,predictii (r.iscante}cdinacestea ~i sii vedem dacii ac!!slct
... Realitateaesteln . . 't"tadeonmenide:Hunta;
sa - I il comumlntl!! ne111llt ..
iporenceoperar~ L ~ - nuchi area mtiunii 1n-pmgmatlsm.
.

pmdictri suntsan.nu suntconfirtnarc.de dmele din realihlre. in

coiilunitarea.nelumrarn esLe_m . : ailistiL~criei dinrre discur:ml
. . Pragm,~u;i.smul reduce nnlpo~?. dl Avllluai"e aici nrin reu:;il n
ilCeSt context, l:rebuie sa.discoram 0 .alta variaotii de mtionalisJn

tcq~:eti: IJi .ce . r pmct1~... a:mbe ~ ~

lli nnome raf.ionnlf.smril d(scurslv (Perelman, <1970; Toulmin,
irismul pp~gmatic nrara c~.
e a-un ...
J953}. Discursuhation.alismului-cdtic.resre unul reoreli.;:, p1in .
nctiuou pe care o orre?t~a~.:.~r:me an vnlori d~ ndevl\r pn~
.chiar dnca.nm ~cceu-mdqea c~ e(ide&.a pozitivjst!l. el!i nu port~
care -se incearcn .stabi}irea valoriJor de adevnr (ex. fals sau
nde~iirat)illeunei teoiib Par~JmatMrarltch penrnumumite dis- r-aportnre Ju dntele d& observatte . gm"t.Ic~<- ...d,.vamluneJ
f?i[llineitiintifi~ett (ex. drept, mo-t:~HO: un dischrs prMtic cares~ d I . Aslfel maxtn1a pr.q .... u ... ...
stitbthte meta o ~gtc.
..
refurttIa ceea oc 'e:;te jn~t snu inj11st,. folqsitar -san aefalositor . . ".. e cnre 0 orienreaza- rrebtne
teorii estecpnfentd~retl~ltnncp.um-._:J? ., tt'c nrau~a c~<a ltltce Leorill
estemai hnporr-antdecfit nnutreoretic. Awndar. I?erelman insisra . - .E . . mul prqgmn UL

serios valonzmi\. mptns . t un 0 serie de iporeze

cii t.reb~a ia s~ aocepriim cnteriului ~thlphic (eipiimnt Wt;mij foe de aestatli ~i predictlilpdtrrivare di~ eda ~ m...=rpte"ta-111 iporcza eli ura
pmba) ~i :funcfia da~tQudard tih1tjfictfurr-undiscurs pmcric (voi nuxillare. Spre exeal~pIn dnc.n ~ onn1 y iji fac~m predictiu
"'"I "' -
d'i
-'
tcv~aic~ ci1uificliti. asupl"aatest~:~i nspect'Cfin_diliscuram procesut fcnomen X cauzeazri un a!txe~Q~?mi nmnci fenomenql y
deiattemeiei~acuno~rln{olotin cnpitolu13).
dacli producem f:Gf!OI_lJen~. . e l:e'fntfimpln t::n predic{ia sa nu
{4) Emptri~rnlil pragmatic (Quine, 1953) fle.xibilizenzl:i tr~buie sli aparij de tr~J on.:e~J?Oauget:eaza l"fttionniJS!TIU] critic,
~i ll)ai unlltdemersurilc!nnt.eri(ilare.. El repreiinta o comhi na {ie fi.e confirmat~. A<:e~~cn ~r u~.;ps~) 'l~s~ ;;e at~~\tionea2ii ca ~ste
fiu;cinantnfntrepr~gmatism,s-i poZitivisrn, fiinduria dintrecela Jn. infirmaren teoni;t. Qume.(l 9 . 'I 'l'nie s'1111c
mai flex.ibije.abordihi din filos~nn .nnalirieii.. I>c:oarece poaiti- ' . . fi devaradi dilr tpoteze e l.UJX.l h
posibj) Cl:l teonu ;;it 1e n .'}j e~n e~emplul t'le mni SUS esre

Vi$nlllln .fo&t .descris;1naJ sus, inninfe de a prezenra i.f.lei1e

CIJipitisllJUlui prllgmnric sii:t1c~mcateva comenrani de~pre prag-

f~lse. Una din~ !potez~l: au~,~~:~~ rezenta feoomenului X.
_di. metodn/sa~cm~ Z mi\~?::a_ a~e fa~n anmci relaria a~teptulii
mlilis~l. f'l!ag1lraUsmuh-aformtnfnjt;~ntf Clubului Meta:fizirc d~ Dadi nceasta tpotez.~nu_x.t 1 ace~~ Jucrn fnsemot! cu necdih1tc
sn
Htf!at)1bridge Mass~tclntsett!i 0 B7l) care teunea P''()fesol'i ca ~~ ~~u UJ.l~f~f ~r~~=nd 'tn cons1cien1tt acesre n:pecrc, s:
C. S. Peirct;;W, Jaq.ies ~i altij.)'-lullleje de pragmatism n fost
.. noi va
I" ~~-~S:Ji!ultll:lealulpal~}l~l'ifln uexperune?rt~l~~
mai in~fti folnsJl dcPeime c.-nre )-a delivat din distincp.a l.:anrianH
ca teo!ud{ est ttl
- . . d oua~re'ont nflnte in contr:JdJCticJ,
din~"rariuneapra~ridi" care esr.a 1-ariuMa mor.ala, ~i ".fntiunea f parecaestegceu
,. . 1" re ~K rrflno:e1ieinrre .
I ~"!J"l.\CHl en l:i! v ~ - r Tfiatfl, poatesa fie. salvmfi pnn
{Jt'I\Wttadcii'' Ct!re esto tnthme.a ntilitarti. Ideile.fun_liamtmtale ale I oricnreteor!e, m cuz ca esle m n 't'.. e Aceste idei at I fosr
r elor sale mx.1 mr
'r'nodifica~eu _tpo e~. ,. .9-vo)

pr,agmarisniului.sunf.(Mm-ga. 1988; Peirce. l93$. apud. Buchler,
lSNO): . . 1
8 ltttre deLnkato!l'(l ' a
C ruomllui Lnknros (1"970) un
. :
Vin{a 11\Ste ~emeiul cunoa~terii.;. -~zvo . rea:kiltuit din doull componentemaJore.
nncleu pi'OtejaF de .. 'ce~mn. de .sigunm. r.a" :?i cnre
1

. Cu~roa~terea -este activit-are; :s srem Un teoreltc es

'han tine nspectefe centrale rile teo'riei;
~
1
I
II
- .. . ~. . ' .
. =':" .. i
 Ui1 zp~;,.d~prole.cfle formalli din ipolez;e auxili.;re. .
. n.a.s~g~~~~fuile infinna predicpilc fii.cute p'e ba21aniicleului ..
tare, mf.trebllie:~a. negam ad0vfu:ul acestuinucleu ci~putew.
modifita ipolezele aux,iliare Jiiprill aceastn sii dobfitldiut\.Ui plus
de cunoa!jlere; un astfel de program de cerceta{"e riinlli~1e un
program de cercetare pmgres~v. Newton spre ex.e1pplu1 pornind
de Ia te.mia _elahorati\ de el.a inceu:.atsa. pret.ldi orbita lui Ura-
nus. Predio~ia nu n .ftJst insa confinuatii. Farii a considcra ca
r leoria sa este f~li. Newton a modi.ficat o ipotem aux.iliara ~i
I
r
anume di t:irobabil existl1 o alti. plaueta f ,
itJca.neidettlificata
- -
n1
d\rei efect nu a fostluattn ealcul in predictille generate pe baza
LeoHei sru.e ~r de ~ceea predic~iilt; 'nu au fost coufinnate: iufr-
adr'flir, h1cluderea acestei fpoteze; all)ljliru:e a dus ladescoperlrea
planelei Nepl::tut. ,P~ca ihsii modificl.ll"flaipolerelor imxiliare nu
aduce uuplus de cttnom;tereci ajutii.doar ln salvarenuucleului
tar~ al unei tt~orii; atunci l\cele progtame de cercetare suut
..., ..
..
~
r.egre.~ive ~i probabil influenta lor in cercetal:ea ~tUntifidl se va
reduce. 0 alta couldbu(ie a eiupirismului prngruatic este ideeu
di o teorie nu este leslnta iuflecare propozitie.n ei lua~ti iudi-
vidual, ci ea este testat~ ca w1 tot. unitar. D~~i in cerceLfu:i
specifice facem predic\ii. poruit1d. de la iununite corup~neute
r- (pmpozitii) ale te6riei, c:le sunt itlflue-lltaLede tecn;ie ca wi tot. ~i
1. iu couseciu.tli, concluzin. ast1pra lor sc ras.frt\ngc;: adesea:rumprn
I ' iutregnlui sistem teoa:etic.
A doun bad~.t~e asupt~aqtiiufei este uun ci't-s.:-dptl~ii. E~
ne araHi. nu cum ar trebui sa functioneze llliinta"ci CUll..\ ~dese.a
.func~Oneaza COUCl~t iuviata tle z1 ~\1 zi, fiira Sa i~fproguna CU
i . necesitale ofer.irea de:standarde pcnt.ru ceea ~etnseantua ~tiintn.
~ Dadi in prima tradipe s~.recuno~leai'n dife.dte ~de (de1~inwnd
de ~coala).un conslluclivism ep.i?temo~ogic (cuno~fintele ooaslre
\ ( 1) perioada preparndigmatidi;
\
1m sui1t slamlarde absolute ci npro.Uutiiri. ~iq:mstruc\ii ale feno-
tnenu~ui) ~ide cele tnai multe od. se nega un constmq~i vism
I (1) faza de cr.izli;
I
ontologie (darvezi pragmaUsmul), in aceaslii trnditiei descdptivl\
\
adeseori un constructivism epistem.ologic poate sa fie 1nsotillji
de WI COllStlUCtiVislll ontologie- S~n~aga eiistell\n'UUei roolita~i
lndep~ndent~ de subiect, realitatea ilt~a.~l fi.ind c:onsttuita de
acestR-,.Spre e;tetnplu, .Goocl~ta.lt ( 1978) ~rata cup1~etnetsul
unui studhi,poateJl astfel oontrol~pncat~,ebtine~dalele pe
care le a~teptiint oonform teoJ:iei. Suportul eL,1plrie n.u e.~le
obiectiv ~i imuabil..Ci este eli11su~l9 coustrocU~teoreticii:. Adesea
... vederi1 in datele de qbservaUe!' ceen ce ue sputJtttceria. Astfel,
este clasic cazul orunenilQrdp. ~dlnta di.usecoltr.! xvu-xym.
adep\ii teodei preforu1nrii, cru'e privittd-,ltt uucroscop celi.\lele
sexuale nmsculine au vtizut -conform teoriei preali'!.bile - ca
aces len. coutin fiintetniniatnrir..Rtet Astfel;.ln celule seJtuale ale
n(luasruilor au -vl.U:~t caiitl1ninintudi, iu cele;.ulecftitillor au v6.7.ut
c!llui 1n roiuiaturti. iar in cele rue oamenil.or, desigur; t\u vhul
fon.t1e umaueminintudwtel (peutrudetnHi vez;i~rsch, I-999);
in ncest coptext Goodman (1918-) vorb~te despre "[nbric:area
faptelm;"" S-ar puleti replica autofl!l.ui cit d~ioalel~ empirice
.."'. cn.r.e. 1.' tl.\'~tn
nu st.u.ll.imuabi.'le.' elesuntcelnuu rigums...c.riter'.u. .. P
... .
pana in nccst montent peutru ~tiin~~. deoar~ ele .pot Ii e:ut-
minate critic prin rep1lcare ~i ncordul iute.fevaluatQri (ex. t.eoria
prefor_maril a fost infirmatitot emplrlG). Desigltr, oatitucline
cdtica reflexiva asupra llmitelor acest\Ji~r~ti'l\ ~111'pidc ~ste insa
de dorlt. Voi prezenta douli orientat'i ill c::ndrulhe5lei trnditii.
d~criptive, care nu avutun impact mnltnnre in filosOfill. Gtjjn~ei.
(1) Cndrul par-ndigmntlc: ln 1962 Thomas Kuhn a
pubticut corte..'\ numiUi cstructurareyoluUUot ~tli.nti(\ee" in C'a1"e
unttldomertiu al ~tiintel. parcur. . g~de obicei !ja.<:e
afinna
.
etnpe:.
diistoria
' .
.
.
.. - '
(J.) ~ti\nUi uurmaUi, ewpa ln c.at~~\.1;. expluratii!'}i elaum:ata
paradigma~tiintificii;
(4) apari\ia unei !lOi. paradigme.Liinti~ce;
 .(s)Tiizh:~e ~'~~~i~~.~ittttjtn i~r~ ~~~~u~Ni .u,oQa pmJ\di,gma;
~~~~,<~> ~-~~t?!iri' 'ti~~,,a,,,,rli!Hr.~.}~'elp 'do~tli Pilradigme ~i
re"rnmat-cet-en lll ~a~a i:f~~fih1Pi,not~nitt!fi. 1.. . . . .
.. . A:cl!~tlf~est;ner~a~tF\~~i ~~v~illti~i ~~Hn(iljce aexercirac
o putimieti'abilti~'~sit~t-~ruiii1en,tl,o~~.~e ~l"iiQ.ta. cat'le~lui 11\o-
mtt~ll~ffiin'Icl~cttifiii~t~~11.na~in ~~e filai pitate carti .de- fiJ9Sofia
"tiin(ei,tn'lb~ilJStiJct~espb'ciali'ra~t . .. . .
, .;s,Jr(~). :Ji!-~~iltktji~.:,PiiiiiafmaliiL A~eairii etapit a-~.voltl(iei
fiti!Ptifi~~~~erenta\lttWtl4l'fiiipn1furil1~t~ns.Cte: . . .
r~rd~te1e,cib(i~1t1t:e. .sunt'irrtifhiplatollr-f:. ~learonrc fii
,~~1n~dicliale;, ,i ~ . . . .. : . .:p~-ri~le~ d~ tip "Ptlnle~" ~~nci ;~~nil:_ ( l)_ ~n n,~tm~t:Jinare .d~
.~'i ;.:.:~;:;~ e:~etitamo>s~. ba'2'ea~H ~e obseiva{ie {ades.~a }riesis~
:;
, ., l'i?rtll)flf?i~)~n~ipe31l:qterit1lenc;:~;:' ', . . . . . , . .. .
,;!; ::jYD.1>'~.ttJ~~~a~;AA;:ti}nlielor_ ~mllinl simplnl riu cdoiplexul
.~":~'' a~~.Jlf1Jl~,~;~lml!i:dirn:tltlod lm~asot~bre~tn peritPf!qtiva
))) ~~~~ta:f1\Qf!l'lll~1ui;,tn-ngat; : .
...,~;; ~'~~s,~:~9~~i~6lltlfr~PU~~O:SL1riUn cqmpeti(i~ urrelecu'altl}le,
,,,,.. ,.: 8~~~fVfi~~f!Q~i~twf\nd.Olposedl\'ade~,~n'l~1 ci\ este mai
.. ~t.~~~dF.pljt:~~~P~W,iJ;:~;~;~ ':
. t/ttl::'!tf'!l/,t;lliJifl~~;qiA'.:A;~east:QSCJirBcfi!Fi~.prin:
. , :;; . ,i;:-'"~~~Pe11;~!1,1m~~~~!~:ftiillti1l~.BBninificative;
, "'' ';.t:~~~ .,,,~:o'!i.,.,.;.,- <r:llll?.e117ll
.;;;;~e~~~;~:=:-~pi
.:. ::'. ~:ra gmn esre reprezeittntli de ~ump(ij fund~llientale onrd
1U~ pot fi testate in.~o~ ?i~~;D~p~ ~um llfian&Kthn (1 962),
. i e~!~~~er~~f~~lm!~!fl~~~t~~~~,i~ad~1raJnJr.-o paradigm!. 0
pn~thgm~.reprcz~n_tii o ~?l:cpe~ d.~ Rf?C~~'!IJii~J';icJ~IpJ;in care
Cc~c,etittoru SUnt ID~!rmtt smpbcat .1'ce sa crea(Ja.', 'com sa
' realtzeze_sntdiite, ~i 'cnrtl suntrezu It~tele. pe care ar ft"ebui ~ille
ow ...-- 00
,ncre~te. in Ciu:h'lil.;ileipatlldigme,tl~~i s~~l.?ltl~v~t;' 1:or:i
. l si modelete:stare;empil'ic,ndesen cercefB[Ont ptefera sa rezah e
11btemeJde'tip'!'lllta1e~'i t} problemi\ tl~ tip '\luzzl~'!' ~ste o
. .
:~hJellia{dapajeculcWEtcela~ nlime) ae,spre ~ar~ }jthll_,~ :1tt!
caset:t0rtfe1:azol Vil:ji inaihleS1~llql ell~Velll f~tne ptesel,e,~et;~~~lre
::oi i
l
~lvaffiiiei; trl!boieitJ()qt sa combJnlhn atlecvnr .a.ce~te }ltcSC
.
~
'
:dll'p~n.tn;model dihp'nrndigJnlL!'Rlbleln~~detiP.')iu~!e" es~e
. ,,cna~nti\e~1.pawctigma,~ultanal.es~ll,t~; nntlCtp?~.~~.~~!U{Ja
......eijntareste~"'Peetiv.a:par:adtgmfu.;Unanumltfenotl'1en~evlne o
~~tatori dintt-un domen;tusuntlmpllcn~ m FezolvnjR:n lm ljl
.,Ji,(:( ~PeStlt,(!Pe$Je~egj}ijatcidew}J:le obiectul prroejpt~l nl~J!rc~tarii.
,~-. )?n~H;!RY9,.ll~iiqtifi4;~'1lt~l~"pret::a~,'ii h~regrenzM lfSrce~t~ ~e
\:~li-;1~ a,le te~niil()f'i IDQpe~1or ant.enonve 1;1 ale n_oo~rul~r ~111
.1Jerl()at)~l{lt~paraali~atili iQ cadtul sisten~ulm sa~[ teo_ren~,
:utlli2.1lnr:l lenne.~. proprii.:De.;exempll:l.JnpsholempF~tentpln
.:..l , ~(}~i1l?r~"fl1tmr~~ a ~~~~rp:retat.tc:bnicilc psjbnn'nltti~iq,~efmel~~
. '.<1 :~Qkitj fnv.J~iirll, bin~ :vaJ~':\f\tl :stii nti'klP". ,val idare.c11t:e ],, psen 10 ,
;;~~~ 11'66~4B~a lui ~t~nwn~Hlir~lJti. :A:sr~el (pent~ d!!!~t\l)i "~ :Qolhwu
;Ji::.. ~~:Mh!e~~-t~-2:5p,~. tJdglf~;}:.~~~ ):. (l)~tr.aJ,l!!ferul e~te i nr~:pr~tur;:-~ ..,'
..;
'~ . ; ~n,.~specf~J?ec~p~ . .al f~qflm,f?nuJu. 4PiJ!CJ~_er,u1:zn~~::;1J.:~I.'Y!'t5t ~~
(2j''Tepresi~ e~teltp comp~rll1Jnentl~vlltn~ deo~rc.E~ ~a~~.nt!h 1r
. ~ 11~gaihi pfill ieducerea ~mx.ietli,il;. (~jintorore~n~ea esr~~uil~ chi~u
...
d~~n~l5te,1ldt:vibartt, deoa~ce,;_ofe!"~;pac.ieJ)tJllu~ a 1stone
'i;6~rert~ qe vi~{li~r~!l'relwica asocia~iil()f m~ere este folo.o;iroure
. cie.9 arec~ pne:ientul interpreteaz!i aCC!'praren! de cnrre
' . p~i'hoter~eut n verbdlir.ililor. sale automar~ e~ ..ie~lnre., ~i in
ctifl. ~tl!. ~C.f\111~ ~op;:a~a. r~-. a~rtj;t~.Yef"J?ahzfirt se;r~d~ce ere
., fnPh .... tt~etiipl~).11lfadiB;ma s.tii{l{ific~ po.a~e .rroexi~m~.cu nlre.
. . . ._. ,,, ~ atlorditfi/~iplie~fra)~).>mf~~dei pr~pa ra(\i-grni\ti.fe Sllll ztlo
JtW~ttJrnrilortt1ineffipa p&}J~Illdigmnticn. . . - ..... i'<. I , ..
.3r, (cJ: BiiJpii:dc.&iZi. Palnlfjgmn ~~in{Jfidi est~ ~'P?~ptnrn de
cii.tre oa1henii d!! ~liintl ctiiar 1daca ea rin t:X.lllicii tbnre dnrcle
-. <"' -
 ---- ~4---. .. : -~

ob{i IIUteempiric. 0 perloada de Qriz.ii,pur\tine atunc.i ca;~:vec.bea

-
P11~[(~~"~~~~=t~~~~ntl\lii<GU qurueronsep~dicpi;~1hle ~j
t;~!~,,J;~Ilg~:,~e teQyiilol)~irffl~'4:lfl~.a~~,~~pij.c~~~~~ ..
;1 {d)~Ap~17Jii!:B;r;UI~t!l.;;llf:JPi[l.IJ:lflit/im#eflifl!~~&.tJ!tl;eclJea
pn~~ig1.1:1~ nu. PQf:!;f;. expli~.lli,IJ;tteroa~~ {e~~~~na:ri~v~ute
. pen~~ ~tiiu~l\ . fi~ se ac~u~~ :Pr~icti~~~nate; apar~)J.lt~ouii.
Mt7tdlg111~t.A~~ e,ste~p~l!l.e#,i;uli~F,t;ti~.~~olWliei:~mimce.
! (~}~Rc<;lvJufiavtiia(.ilir:ri~(t!tQ~Ear;.t.e:li~fltilpcin 4Jpiul cB:
! ..,.. se ttdan~te a~pecluteo.tlllf~btr;tldJtiue.vecJma,,jt 1Joua
para.fl:igma; ~ :..;
J""'npat.Iucrriri~tiiltifieesccls~lu s~irillH npii:p~~lne
;.... veciJUeidei~suntcoflsider~te fahte~ ''' . . ~
.. . f'.(f;]ReJI1ttJ~.~~awm~delfiinpriJal111dll~u~rlintre
.llm"~~tgllla
.par;a.~ . l:.g.~.~.ec. a .~.t.i&a.~.~'emt.dt
QJ'' lTUU . ....*~li.'edecftt
:.ft..n.d. .. ~ot.!!til~
0 a.;...exp.!tli. ca.fc
'parte~(!Jlft
. . c..ee.l\..ee . al.t.'i
aspectele
:.:eat
..

pattttJ:ig~ei ~~~re S:pierdut VQl- fi reml'el'flMOI:e ~i integrate in

. . . 1 tt: .... ;,;;, . ...... .
s~:stentu ~~eoreliecuparn... rgtllei1 ~fe1ldlitig~": \ic':o'
. .... . ..... .
i '

-- ., jr~~ ;ltnJJnf~i~~ lnet\J.fl~J;. tJ'~~ ~adfu ep'is~tnql~gic c~

. jnfll1~1!1~so:te"ii mai.~~~~-~~~~~~~~~?!~~~llbend
(l~?~} ~el'~~be~~~f!S~.Jle~~\l~Xi~ta o:Jn~~Ii(~tiirffii, ~i cit
. o~~~,ni.id7!tijnfM:~~a ~ra~~~ I~ ~~rli,Jtii~JiP~d}!l~lotiv~
~u~~;Ft~~j~.cJ!!~~.~~~~~~\~~.~.~.~:S~~rw~~claz,
e$~;Tb~e. l~~.~~C:~.~f~~;ftif~~~:Cfl' .~~;~f.~~J~~H~e. este
nee~?[ p~ntrlf ~ a.~,~~li,..~J~ dop~e~y.p!"l(Jr: :~:Y-~f~~nd iss.i
fonu':l~1 c~~~4Il;.ea,t~~deJ~f~~af)~J~fqqc;~tQneatit''
~~~tr~ffi.d~!~~~~ ~"ti~~F~.{ili~ef~~~~.~'~.'l~$~a ~l1(~~~;~:;tr1gii
,t;el19rta~~ Cf~~e{f!-tJ~~f I~?~fse~:;.:H:~W ~~1?:f~iqit~tilor.
adtwliftilP:r~ yo~ :f~ .,vti!d~l\jJ~~~ul~i~' ~{UJL. ~ta,Ji},ardete
~~!~tm~ fpA~~it~~~.ril. ~;e P?~~#~~a~#_~n1~I~i~S ~g~~~~IJ etic,
legntalde,mntotl!!I~p~~~~o~.n~?~~~~Nii lc:u~~;penuu
n-~i c~nsen'{t ~i eJ~.tinde dm1le11i,l,f fl~,aptivita~... ln :Ykiunta
t:Irt~pt~fa d~ TJ!Oinas.l~\lbll, mc;tdaJltijtile:de,i~l:l:u':m$~re ale
parad:i~W11 nsupm ce~torilor ~~q(}~pliUlui par a fV~Plicite.
46
47
 commie-- l.!::itedul en1pir\C - ne njlli"U sa evitfii.ll silm,~ii\ in C;\re
1953). Considerlind 1~r&meiere . - . fiecare avemadevarnl nostm tii asiglli"a minima rut\l.)nn\ili\le -
ntlcleuhare nl validitlif" f' . fi a pnn snportul empiric ca fiind
minin'ianlionnlia- in ctiscurS $l comUI'\\Gare.Alle ubOl'dli~i noi-
snbiecriv s1tJ.- ~"'..ta- .:tn~IJ un[t 1cese reduce l'onder.ednctamlni
mative postanodnrne motluate~i important!~ it1 fitosotia $fiintei
.
Astfel. .r 1-mpunerea
... ll.
. . nnei pitr-Spectwe
asupra unu i
fen omen.
peripecti~n tearer:~~en~~l se_mnra ~snprasnporiului empiric. (d~i'nu nu penet.l'llf practica ~tiintHl.ci\ atf\t de purernic ca
nbm"Liarilc desctise de-noi itici}precmn feoomenologh1 {llusser\.
eel c.. llre.prop.un.e. ~-"'cJa~sun.d tdt 'MS.ratn re.petat!}i independenr de 1947) flihennel\eutica filosofica (Gadamer. 1975). ~are. t\\1
Acestsupar~-em""'"' . an mo . elul
. pdn.val"d

I
-
recui1osc :;t\pOrlulrti empiiicr:olulrnaj-or in standardul ~r.ih1{ific,
OperntionalizaTc:;;~::~\7-~"' :;J_'rimrr prin verificnb;Utat~:
' are mterevalllatori-
pa:;rreaz.ii (Otn~i criterii miniiue c-omune construcl)ei l;fiintitice.
poppe. rhlJJ.a $au a de--Lvo1tli !l~on. dl ttate.(in~.elea.sll in vmiantfi 1
Acdte Ol'ie:ntiid postmodeme n'loderate au incercnt sa ofcre
lr:agnlansmului(ra-tion~lisn'lulilisc
> . '' n or a use de dtferit
. . . . e vanante nle ~liintd stanrl;nrde no..-mative. nlternntive celu1 etnpiric, Asrfel,
lJ.ei acest deme-rs ~ 0 ' . . un;av ~empan:smul prngmmic)]
fenjillcnQlogia {Hllsserl. i947) a aiffmtcli scopul ~tiht{ei nu e!lli!
. nodeul- tate nl dem:mar:. ba~ucye em~iric est~
supqrtul
cttnon$tereafaQrului empiric ci itfenon1enul tli.l\ctul de co o:>ri in tli
psihos..oc.h.lli. n.Ie.n.. rao. n....,l.!.su udt ~tuopfic. desig.llr eli .factorii c:we ne pen~1lte nccesulla faptul e1_npiric~ prin acest tmgajamenr.
. . . . . . . '" ""' an mo e)e des . . . .
. mult sm\ mai''Pritm acesrnucle . . cnpnve-oonmmmeilZfi mni
estetnsli acelnde.a ..... . . . . . u. tara. R.ol~;~l omului de ~tiinlli fenpmenologill anuleazlidisiincpa dintte subiectul cuno~d\tor
. 5iobiecllll ctinoscut.Jnroi\ionismul (Bergson, \934).!li 1\bon:tnrik:
de areduce poodelea fuct .... . . ... . . . ." ar. ulni empirre-~i
' . . mnKmliU pondcren stn d d
. modelele desc1iptive.. 0 ' 10~' contamrnantt. prezentati tn
henne.nc\ltic~ (bilrhe~. 19~7~ insistl nl!,Pe faptutenil"lir~~.? situ
pe fenm'nen. ci p~tdiirealinterpret.!lrea fupmlui eo1piric: la ui yel
subiectiv. Sa exen1plifi_cam cele ~l?nse aicj~ 0 1tn~\lizi\ illungi mii
pnstmodernisteextrem~
AJte abortlt'd normative !flni
r~cen~e._cum suntdezvoltnrile
de undli n culgrii ~9!?U este oabo!:~1l.\ce emlliricn/enotitntivii. 0
1-
199l)~i cnrepeliblnliun ,.asllpr~ !J,limteJ (De_rrida~ 1976; Rorty
excesJv con r nonU-rli n.modului in cnr~ el{pttli.\entien lnnivel r-ubiet:tiY
sus tin ~i un "exre s ructlV1Slll episremolo~c
e2
f . culoa.-ea ROS,"Q :or.uin. o trliit:nflll rerp~t~rn noi, trnire/h)terprl!ti\fe.
snportului empiric.rolul dee r . d . ~ onto ogtc, negfind
.- SlV COOSI:nlC[iViS b"

care nu sereducejn nivc;lll\;\\l~~imH (le.unda :- ~ste l'l ubo~dare

o.ferit tncll. smndarde ulrem~::i~:l~ ecstv pen~..!jtiint~.:nu au jmui\ioni$t'a hepneneubd\ Ct1~ pu ge~-ati11 ~ti inti\ ll'letntlologii.l
*i
lntuatiaincarefiecare{ind a : are sit ne I!Jllfe sa depli~im
cnlimtivll.? A poi. pllntlnd-~n parnntezruobiecml. culonran R.O~lJ
. lui, en. m=vnllrc li tmei im~~i~nu ~mp) are adevamllui ~i ~riintn
in, ,,cest cnz, pu~enHljGnge In fen omen, "!'di9a uctul d~ con~lihl[ii
l'
t~rmehulde~excesiv" I uruce.-in fenomen! Am tolosit
rotnlil a construo~"iet P:!.~~ru.nf_::tflitn~oa se.incearcii relati viznrea (~X.. esenla. prpcll:;ohJj pllrcept(v}.cn~. ptin fnptul en c.xi:>ri\ ~i
es.tJi: cnrscterizat prinintentiGmalitnte(se rcfe.ri\ h\ obic:ct). c,;ri!
neoll~Zltiv.iste
.
(po~irivls"nlul
'" .,.-.mtt ace An vari 80 t 1
. . e e pozitivisre, prerechizit;a !fi fllndnmentu1 annli~oJ?.r;antit~[jve $i ~illililllVC ule ''
11GStpoz1tiviste(rationnl;.....,
.. )
l . l~dg!c, o~erallonalism)
...,. ...u ora be Sl mcurstv e . 1
si
. colorii RO~U[nct}aljta e~te abordaren f~nomenologicn (Hu~e~l.
. mnttc presentate-aiai' d~ . 1947) !lin h~~l1Cllti!:ii filost'>-fice (Gqdamer, 1975')}. In
un mpmsmu pt-ag-
e etsremologic -~i uneQri chiar 1 .
. . ,. c::;t se aceepdl
:on_strnctivism 4nncluzie. d~m~rsul ~tiintific in cndrul pozitivismului.
exis~:c . I nul o~tologJC moderar se
I1eopo'1.\tivisn1ului (pozitivisnml logic; operutionuli~m} ~i
sugereazl:i cii
ua m~t~ standarde m
..
fjtnntifice comune nwjorit~ 1 _t~tme a1e coustrUC(iei

atn oamemlor. Accste stnntlarde

41!

..... ---
 ~.~ . :. .. . .. . .. ...

postpaz.i~vistuului
pragtim4c) ru:e -~JJil~!~lil
(tntiunalismul crilic fi discrusiv; empirlsm\!1
tare suportul ~~~~p_jtk. Suporf.\lletil:._
II

pitie poa~_rf91!tf1i.~~i?wutiversemetor.le~eriercRbli~~SiU4lU1!-':
experim~~tnfn~T~.tuffitii'elit1ic cetJtrolatimt ccl~ nt@;~~oasu: ' - t _
meto~e9iiiiei.pey.ntit ~i genetali$rel!Jr~iUJibttelor~-Desigor di"'
~e:l\istit~iJ\tdte; Jnetode perttru 8:'DU$ti!!:ll'PCt!,DOa~tii pe baz3'';
prlliclpiq~~I!Ji;-~l11P;:iriG'.t;7~t'l~nl. de-ca~,t-~l:i~atta!-s~tet\latiei'f
. .aunliV~:tt~e,! s,iruat(i- pt'oblenta sau.ex_pelieutactinicii~~otgut:e 1~
uoi. C\}~t~t.i_Jl(,,- sff~ ~eq~p,~u~ t)c~te:~lllltl~~iltt~ S'~~t ~s~ _
coulextwd.,>el~:uu ppt~rr:'ge11e~~B;~#~~~~llasnrp;;tn'_core ~:'
cou,tiett~~~;:ace&~tu.-eru:m;~~opl!ijna~tli~~~~sand''
furmtr:l~1ii1eorrcl.uziilepe~bQZ&~91tat8tor:-QbViflt1ltel:n'a~te--
- melode .~ek~ -sntd,in~ -lile'c~) facetil1'$t~1ntit
- "=. ~~ \' , ,, . : ,~ . .--
tit inaatin1
--"----c,-
. , ._': '<
;' '_/-
in a~.
_"!~ -- _, ..
--/~
ulili~iitltzY~tfel>fle;met~tJ~>~!~-r:sttllfiti'dec:9zJ'~B:t1t ., it
getlemli~~Y'l"el~ul~~leob~utitef~t.~~tte~~.Jl .,.,:,.:~:
Pentr~tgeJJernliza:tea-~ultatd:I!Jf&vettl'n.evore des :rtce
coJ.tb:qlatet }\lllflar~;Jn itetastii1luct'a',:ei -~91et'sl!iiii,~ijf . ;~~If;.
tleu1e~;c'S . ill>~e.nteiat. ett\pidc~:rseudl'JI}lJlijrlt~ ;inseanli'ili'iitrna~'
suppn.~;tluJ~~htpit'ic {~. dateleempiiiceivali:taeazitcel~atliiliiite:':
saucutt~~.W~~epre.zentate~aJJiud~atle~'11tratt[qStinca~': I)''

les.tale ~lllf!l:l"jc} sau ullilizarea l11i' Ql:fnml~ex-~ get1~riltliarea \;.:.

concluzi.U9J:\Peb~a.unordateemph:ice. eltiaut:ipnii{met~:>_
care tJu pen,tit.genentli:t.area).. Cu>toatelii11itaelui'~'cutoatcit
presi unilela ear.e este supus defacta.it outamitmn\i, aee&f't~itrrt; ..
~~~~~~W:,iJ~""
1. uimii"='~ .~sl"-~l'Qt.9t~~.-.~~f~~~ui~t;l.ti7,._
~lupiifG$.-~~~~~i;tb~~~J!ctn~evolli~;~e~tritteJ~~bt~~~ ;!i~1. ~ 1,A . r . ,....,. "> -- :
Jtnbi.Ulit~t1~111l'!e,l:l:,ll,.t.tt;(itl,tl1ll,:.constit.umdl~Wffdmtclell\l'.tpte'.Ul-::.
:;tiiutei ci}In~~~a.il;l~l~~f.i;UitiiZ;k:~~:Qledefi:Usin\Jl~dem_t\_::
(c;t... fenotlleP{Qlg~ja\ ~~]~le!llt':Utia,;.i&ui~i'lnismul) nwareu~jt :, :
sii se iu1pulta ~,~Q:~l~ati~il ~-efliter~ul~mpitie-iu '~iiJJ~fdara
.gene~11L abo~~J cqw.pt~ffl'~lato celo.r,emplrice,.cutn~tll.et~
l il
.dolog.ia ~ti~ti;v;~;J!Iell~ unpliattii fJ,l;psillolegie'V6Zi M:Hrtin Jif
'
-.Sugan~ul11.2QRO),.iarpostmodemisntulsextrm:t'(DtSrtida,1916:}'
ou a. adus inca u~inh~. competiti~rtdedit nl~te,'lettuti de sea.di
inleresnnte.
.S 1
50 .-.;.
 \ ~ii/ii '$}~.G- ~i~ll!W~~s~mnhf,O; .ma,..,li) J,"~~; fo<\jle
, "!.'""", "), ", ,c" . :. "i ;"
.
,\<
. ' . .

.-.in1i~~ m>llio~~\'ilP"' fi itl@!iliF!~:~-~ln>";llm ~-~~ all __,

J>'l#~,.i!!fiu,:;i>!.p"llit'lllllll!"bli>C;sim\'lrll_i'< p~@~*-'nd
\ p~;~fll ~~~i"'\'""de~Aaiil~ien!ul (ox,l""'llic<ln de;~ulo:~re
\ ~PWi\;m<>llificOfl1n~}~'~:~"'~
- ~(!e.<tc~ ~~"'p~;pd~e~~1ftpare;1 de .la sym ~:in1pret1na~\llp~e1 n ~ u
k'ldt.l) s~nt-lice.l~anifestlilime h :lii curet\ oftlin ti~'tt.lrfind
1q;~ft\T4rl~ .a~~ .. \~ll!~oltfai"~~i$l:sgnJ:1~p~rientinte d~ca:Gescn" ..,.
1n:nlve~:~(b~V~iel~!!Wfi~1lte~c~l:iniql~ndli)ut,tfit\ir~.
idli_,..,\..,Wi~~""'"""<l<ofdeli'JC1Joclc$eaUI .j
sii!J'tW'~\\~4;~~ IIP'Pl!U>iP'!""'l="'""""~ Oi~ (gr. ..:
Y~ 'ti..,il:<\""""'"-~~plu;.OO.epP
nii_M~~ . . f!e,p~~-JI!"!'P.fliiaf! )Aironf~' ,;...t
s~:~R~til ~~i~!lnl~p,lll~t~minfl~uo"~~dtprnci]~pres.iv_j~~~k }~i
<J!l'!'>d!l11'll'1-!~l~ ~sa abli n enoloJ!I" \flolnplil.
ri$1;~~~01 ~~"~ti~.aip"""i .,a.~m u
~u!~!Pll'li!~~;,.pl]le1lf~ deSpr!!~tpe\1~
~ljl~ ,.,\olil~""'...,..,in'ttl>Cl'ln""''"'l ~e-~drom ~ .
eel d~ bq~tli~~i }lolt1$ltl (1994), 'l'li&,tnmentcl~ e~~e~vi"l.en~l\
dlf:ect retl~1~ere~ .~'siorsniDnH7estl\ti flirli a .scl\inlbaJcno'i.~le l:ii
~~~u;sn"te\~: oal:~. :\e.. atk,genotllt. strnnn~esc tr)atumenre
. , : .' .. .. . . . ... . , .. .. . . . . . ... .. I " "

uiii'PtQ~Jl~ . . . . . . . . . .:[
,,,-.9l~ll<!!'B>l""'"'";.orolt1ai!Ol'tlfl'Dct1Jrif"tt'~'"~icl
c

<~ll},l~iicVal~~1~gl'}, dlptmir;:rii
fiiJnt~~iJ"ftplilttaslt6mdasifi'?"re'n~w~ag~tilf~(!t~\~~elibll,gi~i. .
Dpp.l.!Wn""' JM.<>i elosiftol'Ji>~ ".lSg<>iii'~~ ugenli
.:~nd~g~~j~t.~ rAndul.;\DT& ':A'ge'nt1ieic!igonil'IO 'sli'Ji~ '!1zid (ex. ' .
;:mf!(!AJ'li\tt~:te,:Ulici, electrid; ptlfi 6n~rgie'rt\dilintatitc"J:i dtin1ici
(<;1 ~"'"-1' baoci ~"'!'c). l>i<llois'>:l{e.l 1!Jili*;'.v~ .<iri,
?11~fil7i\i;;!lil1~1~\;dif8r~t~t:m.'la~t8~o1~u\eorgani~~~f~')$tlis~ho:
:so~iaU:{e~.;-str~l.ll~ l!.~tl da:matamul\nl\tos) .:~gcnlu;enl\ogel11
. a;eJt.f1lctori genelici) pot n oonsidern{i primari. ptpdr{d\nc\ di'
+verse tipmi dennomalii eTedit.'lre; in ult~~11!i instanttl d~unt\n;;fl
53

. ':..
....-- . :-...... : .. .

55
:":,
 .Tnlr~'1!~n~~t~ .~ol~~~;~icaleputale~eti~el~tihP;~t~genetiea).,
smn Uri dO>~~~~ :lmt~llft"""ll rue~~f~~~ '!<>l!il deooreco:
~Je ~~~zli.~llislllle~J,;etip~gi~ ~i~rol<l'lnlrt~ (rele .
.Piir<iJi~Wotil!!>l'!io~oi ~n.~i)reJe,sill1!)tomarire
'''' ?n sti,li~. ~iu~\za1tr;,litle'a~~a ~to1hl1or~~ de-n exi~ta piinii ciind
1
~1~ ~!?~fbi~lJ~9~li~istmrett.tn1~rrmtaif.~re~~~~PilffJ&I!nerice Silll
....... ,
[iilnii'c1tnd. ~~-~ul c:Unic &e-atneli"l9t'e~~cl\urmlu-~. a .evolutiei
'ri~tu.ili~a~Jj()~Hf :.) ,,, . . .... . . . . . .. ..
Jn'Jjllz~~Jtll:~s~utia-re;mnisus. ~'clas~can;6I,.l'91 emistic
;Oft.~~~~;~JI ~,a~iji ~David.
:200j,~>J\c~~,Sr~~i:,1llkifJF~trA: consitle~l~iJnillt,n(!!titew:iul
eti~i;'itt"Q~ifi~~c~l~l:n.itoi._;~fine:lltli~larftJtQ.lh-ara.inenteJo,
.' L~ilt.o~aii~e Q{:l!'l~~fl1.otbt~-!fie'1icate penoodj.Veii;e cnr~gori i ~e
lf; :;;~iJUJ~u~Jii.jz:F:V.,;~..~~',' ::;,., ;;t, cyt;. ,. . i:<c<dl;~. ......
.. , .;, '? .1 ~liltlui-Jiii~:t:ilfe oa11~un.
J)~!(. tJl].)Joit eUn~:fonnat ftffi selnne ~i
.<n~~!Jl1Ptfil,.tlfetl~t~a~,~~ii~B~#;~flcaiczirnpUc1i'(h~~(Dinanr
.,,,;, .+.J0):c;. . . . . . ......... ).: . . ,,... . . . . . . :; .....

.;,,;.,1~~Jm.-~~~Ja!Qgfce~.n'itfmente
:.;~~~ ,,, ~IJI(id~ii!l\lltdoar
;~~~lit>eifi \in' vj'~' .. e;;;;.;;,t,blmoluf~;TJibi,.ilrilc :J::
!
1\dbui~t:t::

cnr~ au un 'l~hl~u ~ItJ.c,c~~~t!tigll~,deJ;,semtie ~i . siJ11ptome

1
."''. :I~ .
sdihatr:l.ti)f;:n.~
.'<... ....ilP~~hoiogi~~f.iltNttn't'ii~9nis!l:l~.~~tQgenetiOO;tomati~~cgsirll
, ., ,. vt... ,,~~. ; ., . . . . . . [v~l)4f.Jt;if/ p~ntt~
UJ..PJiM~lr.liln~~~!n ~t~~1el1~~m~dica;li roh.d' iliagtto~~cului
i:f . .. . . > .. ,.,. ...
. Jl' ,. .a~t'~P*Yt-r

. ., ''"~Oleo~ ~!l~filisiho!<>gii~tit Jlj, atendoil .. . . . .J,.

199-'fiJ

':f~:~ ~~;r~~(n.~,.~.,..,.,...,~nt:-
~.~lnpriililit~~J\l,9Ji~~~Plllbolag!li(fn:.&asrn
,"fl!\~.l!Jllaml<Dlii~J~i!~!o~;~-&i'!!Pl!llllllfie :snttji&riiaf
, 1,~~ ~O--e~Jl!t.m~c~oolab!on
_,.~~~~~.::=.~cr.
~~,~R~.,..~., rnii>lst ...
; ~~<po\md)bg;Jo.Wildll(u.S~;np..,IJUllicc;,a<ijuv~l:elor
,.,.,,,.,.,,,:iil~!;.: ...... , . :. . .
~ : :mecllf:a~~~~!Jltlnmfite HiiP*!.i111plieit~s-ernne ~i
'>!(?);)!; ...... ' ! ' .

lfdc 'l1lrot'tfi1j}o't.l
,. s~mproll'~':S"lin'Uti~e>~hftt rt1~ea~islne1o. ~tiopatogc;rietice sunr
o: iu . ,.; . ..
< .. ,, "'; . '. ....

..... ,. .:.!! . . .. . ' . .;,. ! ! .

56

.. .. ..

combinat. Adesea este o p.wvocare pent.fu psiholog a face
p'silwterapjg_~~ ~c~tii. cntegorie ~e boluavi, deo.are~ ~ce~lia,
nvaucl sirilptcin1ntologic-somaticli. nu intel~g gJar ~i.t:lt! flCceplci
tt~or rolul factorilor psihologici in genemre:a d.; nce:;tlucnl aram ..
lipsa tll1:~i..s!-ll~ur1 psihologice ~i prezeota uLtui model"bi~~~~u.:.
col oitodox ~i puternic nu doar la nivelulsim{ului coJnuu ci ~i la
uiveluJ. uuui segmentlarg de profesioru~ti din domcni\Jl sanatli(ii.
1.3. Rvlul ~i atdbufiile psibuvntologului
~
. Psihopatologul are mai mulle nltibu\ii (penb.-u detalii verl.
David, 2003}:
(1) Diagnostic psilzologic ri tWaiUBJ'e clinicli.
(2) lnterven(ie ~i tra.tomeJJt. Dadi psiltopntologul este
psiholog, fonua de lratnm.ent ulil.iz;aU\ include consHierea
psihologidi. ~i int-er-veutia psilio~ernpeuLidi .. Ea s.e referli la
~ontroltil factQ,rilor p~ibologici impiica~i 1n boat~ ~i in
optitiuzrirea subiec(:iloru~nani s~inato~t))ad psib.opntologul este
psihirt!J.U. atunci tratamentul esletn prindputmedJcamentos, d~i
mulfi psihi~td au qi co-mpetenta .in psiluJLerapje. . 1najore d~ dezvoltare nlepsi.boh.Jgiel clinic\:<(J;{SJ,pla,u<'il eulaU.,
(J) Cercetme. Sg,r!!fera la .invesligarea roluluifadorilor
psihologicj lli. fizici impliC~\i lit sanatatf? ~iboata.
(4) Edu(;JJ{ie'-{ifonmu:elcrainiJ1g. Psiholog'!ll olinichin este
ucellicentiatlnp~ihologJe.. ca.re.s~a speciaHzat *i l\lcread in
domeui.ul clinic (ex. Spitale, lal:Ioraloare de SRnatate rojntala,
orgmu;-;atii ~oa1guvemamenta.le). Psibiatml este licenpat in
tnediciun ~i a parcurs 011 progrnlll de rezidentiat iu. psibiatrie.
.' Arubii profesiollifiti pot pg_rcurgeoption~ programe defo~mare
. in psihulerapie care le:oferfi. compctentade praclicant ~i fonnator/
supervizor (pot cduca~i forma nlti pmfcsioni~ti) ln psihole.rapie.
53
.- ._ ...
!
I 1.4. OJ:ientar-i tem:eli~ io. p.sih~patologie.
0 scut<tli inttodut:ete '
Exi:stli doua utnri clasti de orie.O:tad teoretice in
psihopatologie ~i anlu.ue, una pslholog.ica ~i UJta \.liotjtedicuJn
(pentiu cletalii vez;i SaUlSOll ~i SatlJSOU, l99.9).:l~dmn-orletttnr~
confe.ra p~hologi6i clinite ~i psJbotempiei rolul th:ilicipal in
diagnoslicul=?i l.J.lltamenl.ul t'l!budiriloql~ihi
este defioi~.ca fiinrt~tiin a cal'estudiazli factorii pslbologi~i
in~Hnboala ~i'ittt~;ptindzareasutti.e\i ot tun:a..t1is . nto_!t:
Dupii cum rezu!Ui lli din defi.nj~ie, ui1 accef)tptJ.teldc se pune
recent :in. psihologia cl_ini\!ii ~i ~supxn pr.ofilaxlei ~oHlor ~i
optiHtizfui iperfunnahtelor subleetiior ut~iiu1is3llito~i. Jn~cea.'itii
diL:ectie psitl~l'."9giaclinica cun\rlbu!eln .furlli.~lunprt!':bnologli
psiholo~ice de cont((:Jlnlsttesollli~ nl ttrtdrtJblceluri ulimc:.ulnre
dez;adaptna-ve. de autoconb'Oleitlotionalet:C. preveuitld imtfel
tmbolu~virea.=1i optimiZfuia perfmmnntele S'-1bitc~lot'!umani
l.liinii.tt;Jl;i. Cele ddl.di aspecte in care sunl-inlplicf!tifactori
psihologici,.curativ ~i d~ optimimf1Yprof!laxi~~.de.f111esc dit;ectiile
1997). Profl.hmia (preven\in) f?oa.te .fi pdnuu:a~ secuitllt\~il sau
tertiara(Kaplao ~i-colab., l-997). Plnv-etffittp.dil;Jad-:s'e referii In
:lntervenVacare previne-insta1~ren bolii. Ba se adresenx.ti
populnpei sanrltoase dar cu V\tlUentbilltal Ja baalalji sciealizeazt~
adesea prin interventilla 11ivel d~ ~n.ip_ Cse.l~tiolit\t, comuni\ar
etc.). PJcvcntiA secllntltll-K'se refera ..ln b)ler:v.ettia =care are loc
imediat dupil apari~in. bolli' t}i C.rue n,te en: scop prevenirea
complicatiildr $i evolu{iei bolii. (ex.. t~duc~readaculuide su~u
iululburarea depl:CSivatnajota). ~nfia.fpliririise ruee,:tn caz.ul
bomorctouice ~i UriTiafC=?Lereducema c;n11.pli~iltiHoriuouse de
I\
i
complica\iile bolii (ex. crt!terea cn}ita\Il 'Vie.yi ..peft;Oanelor
depresi:ve en tentative cle su!dtY_. Psi!Joterap.ia. ~te itilervenlia
psihologica care vlzeaza -n1odificaten facto~il~r ys_il.mlogici
!
~. .
. . , . ~ . '.~-~--?~:;:'";::--:!.:.~~:: .
I
~ 59
i
 f
I iar D re.pn!zinrii mecanisme1e defensive la care s.uhicW.ll
imQlicat.i ip b0ala ~itle~volrareai{)I?limharea-personnlli. Cele

I
irpetefiia in scopulredttcerii anxieratiL .
r~~~ste 200 de !icoli depsillon~rapie snnt grupat.e tn trei traditii
mujore c-tl~1g;n ~i Garfield. 1994). Elevor fi de&crise succinl in A D
l'tk .. c ~trmeazi\ (pentn~ deral!i \'ezi D9-v'id, 2003; Sarason ~i
~ ... 7

v
,"\,ll"LISOO. 19.99). . : , > . . -

TDJ .JlJ,ordp1feflt1iiutrn_ic-psihtrmlili~;i)pelln-u. yeralii vezi.

Dav~2003). Gao pafn~hgtn1i.ce a fost~l~l)otara pomiod in
apecial.c.lela ebsew9tii ~i intuitii eli nice, psihanaliza a abordnt
prepdnc1erentiml*lcl:\llJnoon~liel')p,ll'JiMPP~Jl~tulb,,rliri1orpsituce
\
I X
I
fiip.sihosomatic~. Asumptiile fundnmenlal~;_a1e acestei perspec-
riv~tsunr:
I Figura L Triung!1iul c~onflic!:ului.
i
1. P.sil:\icu}uman ~rc o-structurli {ljvelarn fiin:d nlcatuitdin 1 (4)Sim.ptomilt npare datodtii unufconfUct acfLiill, care sc:
L h-elcQmpQnenrs (n)ld-tlls~u lne(Ul~tientU carp funet1onenza
reduce def-nptla un confllctbat.nl din11rin1a copiU\rie. .
dupH .i:n;incipitJl;pllle&jifil.cart} contjne:instinjfteJe-namsrre sexnule
(5)ElimitHuet1 slill o.ntel'ior-aTea s1'mptonlMologiei sc face
Iii ~gre~ivepte~~l!Jllli q,naul~i!l1edeiuforqltttii refulnie, asQ~_inte .J
nc~~ror in:;tincte; (b)$go-t'l_ (Eu ..ul) sau can~rientul .care
prin eliminare&/re:rohiar~a conflictului ac[unl. renli'l.f!ti\ pri~1
fu~ct)ona~z~ t19-Dli .prineipiull.1U\Utiitii. prindpiu en,~ dett~rmi~i\
re2otvarea eonnicttilul~n?.'i\l cu njutoml. ne.vrozei dewnnsfer
{conflictuUerapeudc)':Ac:eSt'demers es'l:e s1ntetiza'fn.fJgnra 2._.
refulnrei\ u1.mcon1ftit\t1t .t\ il~faT\llali!lor anxipg~~le cu tocardlrurli
unde Treprezinrl1 r(ilatin rernpeudca in care se manifestli nevroza
sexual~csau..ngres~vij.. Fl.l.n~pon!lrOD;~~o--ului ~lite constrfiosn *i de rnmsfer <~rentlt intenponat de telapeut). A e~re Cildrul d\ 11
de_<\ ~"e!4 ~roJ10nentllp)SupnJ~"n-{tl ca~e.cl)ntine normele :;i
prni3\Ptdet-u~~:ale ii:;ocF\leJn~Fioriza.,t~t de flee~ dintre noi,'in
vinta pad~ncululin caresemanifc:S.tM conffict.ul pr~zei)t, 1iu C
pr.irrtulri.\nd B\\UQ'lltlrf;fl.educ..~ticidin fa ~iii lle. repo::z,inti1 prp.)lt\ copiliirie tmile se n1anifcsta conflict\~1 ba2a\:
triut~ghilwile niici din cndrul tdunghiulni mnie repn'!'l.ii1ra
-(-2) Coq~nu\til refula.i ~Uit-ului finc~n~rienru1t1i) tinde ~a
seexpfi!l1ep1enar.la ttht~lul Ego-ulni (Qon~tiem). him)ghiul conflictu1'uidescrls rnai sus. '
(3) DptJfjC}~pzaren .la niv_elul Bgo-uloi~ a n~stuj eontinut.
,re_fulnt geuerefi~illl'iirUt; em(}\~onnltf'J!~miv,e (ex.nnxietate).
oqnta. _generate ..problemele emo~i9~1lle, ijgo-ti1 .!lp~)Q{l:ili. }a
meca'lusnl~ 'f.\8.: ~pa~qre pen_tru a. qltwa coQ~tientianaei.l lor (ex.
I-eprru;i~).-lt1tregul detne.-s _este.sinrerizft,t sub fonna nqa-nqmi{illui
"triungl1i ~l.{!?~f!icrut~t~'~i(.vez!fig. l), element imparram din
stnu;tLlfJ\ tQ.lbura.lilorpsihi9e Iii psihosornati(:lf. Ac6sta are trd
c~mpon~nre: 4 reprezi11tlt cm~flictul-psgpriu-:zis incon~tient. A

I
reprezinta anxie::rareq gengmt.i de cpn~tientizaren conflicrului.
61
liO
 ' :. -
Figura 2. T~;.i.unghiul terapeutic
(2) Ahordanicuurwn.ist-fP.:W(~nfialis1ii (peuttu detnlii.vezi
David, 2003). Abordare{l Ul'llnRiat...e;tistentiali5UI. pornete de ln
premisa ca palo.logia psih.icn ll~ _psilloson!aticlS. a.cpru:e. caur.01ru-e
a faptului Gii expeci.eu~le. ne_gatiYe rle -viata b.locbeaza'~Ioqele''/
factori i pozitive/pozitJ,viGare sl:au la bnza!Jersonrllitatii uoastre.
DJHIIe ace:51l factori fac parte n~v~ia 9,e.aulorealizare, apreciere,
securilnt~. afiliece.. seusetc, ~colidifeqtc:fdin ace~stu.nbord~.tre.
audat tloudereJnai mare unora din nc~tifactQri (ex.. nevoia de
se.ns-lugotenipie; uevoin.d~.autorealizare~let<.tpla centtata pe: cll-
eut etc.). Pentn1 a debloca aceste forte pozipve ~i impli.cit penfi-u
a runelio.J;a patologin esle nevoie de asig_urarea miu.i context
psiJwternpetHic caracterizat Rrin etnpntie, acceptare.
nec~:m~litiul1ata.l2.i congruentn. ..
(3) A.burdo.rea cognitiv~cuntportcumi~ltalii (pell.tru detaiil
vezi David,2003). Abortlarea cognitiv-conlporlamentalacon,si-
dela pwblemele psihologice ca f~ndrli:;pm1sud ~ezadaptative
iuvatale, sus\inute de cugui~li <lisfunctionale. Pent\:u R \rata
e{.icicul J-lfobletnele psibologice, este ne.ce.'iar sa modific~n.l
comportanwnlele J?i cogni\Hle dezadaptativepdu telmici specillce
de interveupecognitiv-cumpmtamentaUi..
62
I lndifemnt de tipul ~colii d~ psiholcrapie, cmnp.mienlel.e l
I.
f
interve~i.eipsihoterapeutit.e suntaproxituati:v acele.nj~ r
diagnostic ~i e:valuare cliuicii;
.. couceptualkare clinic.ii; . .
II iuLerven~~psiholernpeulidi;
toate acti:yita~ile.aute.rioure se desflcyoara i.It cndruJ uuei
rela#rii de Up ternpeutic;
... p.reven4en redii:leriJor~ iJtU!.gistmt-ea1i unnarirea evolu~ici
pacienlului. -. 1-
Tonle, aceste cumponente suntdescdseJ11 'lucriiri cJnsice
l de vsihoteraple ~i psiholugietc\h1icii \B.etgin :,\ Garfielt:l, l994) .
~i aeyndnr nu suntdetalin,te ni(lt. Unele dlntt~.ele Vl)r fi de.ta,liale
pe parcursul ace8Leflucr3ri llLunci efuld .suntimplicatc innnalirele
.flicute. ,
. in psihopalolog~ este\ abordaJ-oo
A doua orlenf.sre teoretidi
biomedicala (penllu detalii vezl Kap. an fit colab., 1997; Sadock
~i col.ab., 2002.). Psihiald1. iu g.enernl ~i mai ales psH1intrhl
biologidi in particular. suut pt:Gftl@tpurale plinclpnle nle ace."ite,i
abordari. biomedicale, d~i p~il~tria qre.stdU.tse Iegaturi ~i cu
ps.ihologia ~i psihoterapial Psjhiatrial .din punct de vedete
etHnologic, se define te ca ~tiitttn vittd ani/a.m~liodidi
1 urlicilor ps nee tpsyche-su.flet; iatreiR.-viu ecarcJ. Abordarea
bionledicaHi.consldera. di tabl(Jul clinic in.psihopatologie
presllpuoe mec(lnisme ctiopntogc;p.eti,ce pr~omill.at soft1nt1ce;
jo consrefota. trnuuueJ.itele psihiatrice bazatepe ii'lodclul biome-
dicnlincludlJ.lltanlentul ntedicamenlos, terarie pril'rcle(;trol}oc
$i alte proceduri meilicale. 0 tendiiit5.'itllpu.i:tanta i~ psihiutrin
biologica contemporana este aceea conform. c~reia unele
tulbudiri psihice (ex. u11ele tulbu.ran ufective) au. uu su}?strnl
genetic,transnliS ereditar. .
.lit ullimii ani' nsis_trun la ileivolturen lll Peneraliz~eu unQr
lem.linfe integratiVe ill dome1llul p~ihopatolugiei, in cadml
l
i
mode.lului stres-vulnerabilitate (pentru dctalli vezi r<:;aplau ~i
63 :T".
1
 ----------------....... ~~.

c~li\b . Ul9V; $adeck ~l:colab. 2~~2; Sm1tson ~iS1~nlso~~ l999J. psif11ca. (penti'U dumlii vczi Kaplnn i colc.tb. 1997; Sj~dock $i
Confurcni"lc:estlli ;Pi~t1~l. f.a~to"Ei~~psihol{lgici ~i cei. biolo:[~ici au col~6.: 2002). M~ntlonam-ihsi faptulcii in fm1clie de Oflenrareu
acela~i statllLontolop.k:ca:ifi fuetOli' efi~ldgi i~ 'pai_olilgie. Ei teoretid din psihe:patalogie existfl. ~r alte mo!dele_ de
nctronen:dt inten:Iepenllcnt in de:li\n~area ntlloillt.W clinic ~i in psihodiagnostic clinlc~ 'Spreexemplur, tn-esfhodiagnosriul clinic
consecintn tratamelltele tt&bui~' t~ne c~nlplexi~~; incluzfind fm)clion;tl nu sc urml\t~retncndra'ten problemelor pnoientuhl~
.pr,qt;~du(i,me~icme ~i t:lsiflolag}ce_ ;1mlbal.e.procedoli AV.~nd .rntr-u categorie nosolot.rica,. ci ithmtificmea tJnor fndon
aeeln~i stntut. ontologie~ ne,i progresisre~:~eeato reqdirit~ i;lt~~ .psibologic:i. cognitivi-eoJrtpottiUnenta.l:i' (ex. srimull; frttariri
.~9fi~et!Jl~i!P~n~~ d~0c1frt1dadi: n\lmai 'elir~' })sih&tbgidi ~i po~tive etc.) cave sli explioe;problemele 13aaientului (p13t~l'ru
medicalli ~;i 4speetelc teol:"ericc ale disciplinei. prat!tica'cu~enrl\ tlemlii veziDavid, 2003; Satuson fti Sarason. 1999). Mt."'dll) in
11~expd d~!!ll~lt ~~d~n~'ma~.es,~0 1Jtcru,.:pllQmQvi\ndlln modi!l . cal'C sc s-enli7.e.~?:li <(l~~i}to)ili~~nost~Clil:~~i,gl~ nosologic face
';;~il1il).. . '' ~ija~~l~1~..ii.t. 12en~b~- .:Sit.~~ia esre.simiJarat.en (Jtdectultmor ltrc~iiti.dereferin(i: (l) OslVf.:..f:v (APsyl\.. l 994);

. ,:=.tii!~~,.ll~fQ~':~~-;;.:~~g~
.,.,Dlr ~~d~iteei*n~ 1,iL'i\t.\'impnl'{rt p\iterea ~l'n 11u1d. egul. Zeus a
ICD-10 (0MS.l99~);S~ (~h"U~t\'JrBdCli~ic~lJA,r~rylew for
bBsMtJIJtenlhii'C1iWi~ SifticttrTift'p~tfli J:\~Mi Spi~\~ ~rfoluh .
;;., 1996~:~ Sugl}e!fntl 'Cititiil!i.tli'lt' sJI' 5C!Jn~~t&lill~~~e l'ucJlri . ~nl m
rltmns stftpiin !~ ' .' e~ii'; in'. uo ,'cd t1rmJin'i' .eSOEienrcUl'Ar JSuccihfs~Yentele
. p iaftnte~'l"rea
. .. . .
<

.. ..... . .
nm pst 1 ~'i~gJ1listiC,:i:11Ij~clj1o~o1il.
......... :: < . ..
gic:
:, .. 'it' FPttrt'inf6Viritc . .... '~~teStareapst~Q .. gls~;;e.~~!i3~a:z..
< ' ... <

~'.'~C~!i~8it1Li intt\ttftttel\'fo~ble~elilrphilieiltulur. inn'-o'.annmitli(~~f~korie

s~gcTBJ~A~Nuk~;~~nm ml:,.~Az
; ~"""-~ :..:':~'':.\~:

; : ~-l~,~!.a~g~Qst~J~.~l ev~lnarepin~cil
i'''
,,.::_~.~~-: :-".-.->'- -- .- - _-

.
; n&Y;eJ<Jg1cl\'lfaiete1T~ili]jescrise mai,e-s),: . . . .. . .:/ . . . ,
).' .. Prii eyallil~rg;(!Jifiica (fazK ~J s:e partitiiltiriz~nzn.
detali!az'&'r~shiteti~eaiit'da:ter~.cules~ tn fnz~le 1. t~i
trint~1e~fi(t\~hind'd1naiiiieafi~iirl)f in~i vid~ dino~ld d~ c;:nregori~
*
pet~r,:,.l n

I>b>~~9~~;~l;(~:~~a~~~~l;o~-oa~c~tal~ d~~di~ri~~~~de .niSsnlogicit rncarea:~fpst incad~~te;'til0Hteinel~~ld,.De

a~eJll~Jneit1~ aici :se descoriipnrie afagn~sricn'l }ti'ti~9l!lgfc. in
}1~~;~J'}-j1~!~;, ~N3~i~:;9"1~q;~!lter~) ef>tl!'' din pitnc[ d~ \t~dera
p~obleme. co~Cl;ett\ de viatli penitr~fiecara Rtie~~r: .1\.~a(hl:r
~~IT'r}e~~?.,f?,&,f!.t!~~ll~~~~~~n:~aa~~e: Psihodi!fgrlosrictll~:tc?fem ~t{n~ blteiitmal:Wjmupu'ne~!8lfft1ai(Cimincilihllsc~t.nelo,
. l~.C,LIIle~r~fCI.l rJl.pa;ps\~PllJgiini>$J~jeetnJuiumill\l~i\,.18sea
.. ~{si:tilptoljlelti1!)~slnrextti (~tabllirea~ateg(}rtel \\os~T~gtcc l >
.J~}~:{~fe~il~t~ . }i d~~fFr~~ np~~lt~(i :esiho~ingnusrict\)itJ]hic
an\aU%ii>(d~suompunereadiiignbsdriulUil'rtJSologictl~ prd!)l.eme
... ~~F~~~~~~l?: .; 7 ~ ./,~PfQ~Jor;;~sih9l9gi~i cu reJ,~;vantn ~~n~ ... c~ncrotc:d~vinfa)o~Li:,:.Hi ;; .' .. ' . . .. 'l:;,c.(.:
.. ~~!ol~~e~Jrac~.~J~e:.um;ie~vot;;p,rezenta.doBrmot:Jelutprotottp
<
~-,_~_-----~"'. :~( l/-.":;,, )~'(. /"''' ,_.;;_,

.,.it' ps~~odiq~osti~nlLlf r;:linie -psi4Q(jiagnQ!!tic't:lini~ rio~otll~c

. -. . - ' '. -. _' . -"':"- -
;.. ~Il; Faza llntervinl i'nepe.cu O:ffis~upe despresill~~{ij i) care
.._ Cgr~ no~~~::rail:li.cidli\l,~:~~se ief~~;ittai,meatruat:eir!einsificnrea p~tr J!le pncient intr~opozi{ie confortabflii, de itl'~t(.tuere ~i
,~11ilil\1e1orp~~i~J)~ij\~' tnrr7o i\nu~nitl categatie det81lbnt"i\fe !tgnrantn. Aceasradtice la detanxi~tllalui ~i hr.;~~~libiliratea
~"
. J --> -,''.'
,~-' t ' :-;. 1 -- -- ' , i. --. ' - . .., - - ' . '""""'
de
a intFa mai n~01~in comimicare cu cliniciannl, De aseme.nen.

65

; ..... .- ..:.
 in ac~stli faza se inregistreaza num.ttle-~i prenunieie p~cienLuluit . factori predispo.x.anti (persona.Utate depeude11Ui},. fnctorl
,Yfu~~(t~ ~~~~?~:. ~1apo~alitatea ~i-~omicilil!li u~e.Jlill~~tede~~~ fav.od~antL (pl""Oblcmlele fiq,anQ-ia,r~)! ~~t::!f,)Q; ~~.~l~lllb~~~
pncJel!lf::sa~;~~H~Etillaton -ln~ cazul ~.t.nm: tulbur~p.~guav~, Sf.J.U a. 'c_'rinat ue::ec::tii16ni!~~-.rtn~teH'fi)t>~iiti~ia~~1I'"' ~~:~:. .
COll,HX e:npiiaza ~i motivlll trinutedl. Spre e~~\plu3ii CJlljUl '" .; v~zau.ttirm\~d.oualdutcivitituiurnJsiio.ilive!dim:e.
... uttllf~ 1 .~~Ua.fizici. am iu~eput intervlul c:u discutii'~re dete,UataA.~'lJllJl.~~,ent\dl'i-!Ji-oot~Y.ler;Jpslbiee~,,lt~estigatea
prruuU~~ua~. proiecfulep.e J;ll.t~J,f; ~~-~bu~~~~lA\'S:t;rl\ill~atc prin interViU trebuie Sa fie dublata de o.;~-1-"M~tiga:~~o)!)jeeti.va
prilntteeDat::iilerapetitui do:ve~~ ~l~q~tinte lllido~;netiiW. de prin teste--psibolo~ ncoio~unde ncest:l~c1Jlt.. ~~i!~~Un
itite~1~t.'pacienthl;':J,l.qc~nsia~~l:l~'f t'~llbibui :ta dezvol~area exel\lplu schematizat d~.~~,g~ care ttebpi". ln cursut
poxili~l'i~mai rapi;dqJ:-~!,tj,eJ ~~Pt;u~ce. Nu insean:U~ti. ca itttervilitui ~ites~~J:>s~h'!l~Jilce ~~ _ .. :l!l~ pes,
treb~':~~~t'' e?cicl~-'b.~~~!~nat:l?orcli o ev~iafuaUi est-e prezentatltl "~~ 2(p~ptlttf{U _ -IJ.t i~sqw; .
preg.~.~g,n~enoadt -:-f!JC?atu~:m~~~tn cu cu~evoru d1slll- Spitz.er l$i colab:.,J~~~~t;,.~~~q i.faze, dlagllos~c.u1
s-ar}pl,i~~a-. sn fl~ ~U:llTB~Ulnl a,~~~~;:);~~ raportlrelatie C~lllCi nosologic p~l:~Jmiu~se~G~' 1'\0z I
eficie~J~~-:'Apoi, tJ.rep!at1 se. v~reazll ,ff~re. obit;ctul ten1piei,
_. , .
. Fn7..8 m.
in f~'\att;et~~~~~l~~!dltJi\rli clluice, Becpo~Le
"1~~!!~~~\~~~ ~1if#l4~~~b_t~t~~tf~~~,~~~cteristici~eri~~ la tt-eee ta 0 inve~t!~ii~ i~~~ 't!~i~ ~lzeazli su~rin~rea
p~~~t:!:~~~Jt~;. pac1~11t 'Bun, bat aC;J:tm~'lfne intonrcem pU.liu.l~ stru~;tmii ~i,dina.Jilicifinflli:. (!ientului. l.care 9feri
pi0tikrile1ei1o~l:l~~lfiiai;:aims&~:- ~ us u ,ce, .. 1Dro :~,nteletf:outiJ~(core
{su arlt a . i _. 'ft~t' ftebcmfi~ _. puL Deci,ce pro~leme. p d'reli~a
(neca~ti)'~uni:,~ ce _te,:~up,li,:l.;t. ;,;J.ieazii)~!':,,i!~;~putinuare, 1 cme catege;~;ia; neJ~et~gt _ . 'fl~'P1l~u nn~ . . u
intervi4l trebuiesii,vl~ pacientuluipe fQ;\il Aiciseate.i!t~ ~aluarea psibol~idi
!rl~<;fiere~.t?lruilasimp4llll3tpl~~~; . ___ .---'-. ; detalinta a stiini'w~t~ .u :1~:~~J0 . _ 'i a Inodul~Jiin c~tc se
1 _, :;,,;: ~~~~~tul ~t~!~I'-~M ~~~~a; ~~tl~. dlnd a\t' tl)tepu~~; de ndapteazijl~BiiDJ;l@~;~~~~~~~'?~~'-i.E!i.~,~!P;?~~glLefo.:
cful~; ~u .ob;;:ervat aceste modiflclfrj'l; iu~ittte de Criiciun 1T ' (ilit ~;unptolnati,~. a si\t.uatiels~li~ iate'a'~~ietttu.~.ui. o
c!J;'t~llt:it~ pa~iet,1t~J a~ c1~~'!!tii.$i i'1 !'--:~~ ~~.a~i(lti, ~~utul, din~ljcii~i~~~~~!~*; ,.R:~,;,., ;,~,II~!\i:~t~~er-
esteaju~at cu anrorse~ Craciuri;'i~~tlelJ1a~terle"?tc;l~ _ pen>t>,J]~!~pllbCJ:IJ~~~.m~f,,.~. ,~;:,., . rnrs _ . e,afun9,tulor
a).te 'bolj .~otl:l!-~C:~ ~ilu p~~~~.Jn\ernananmttoare; :;;i.i~~~mi~eu,~,,f1:1)1~~~elQJ7~er~ns,vel3i de ~OJ~i1..1g pr~um
. cpndi\il social~;;eononti.ciiititif.'~muatii familiale,silun\ii i g c9nfllc(~l{)r. ~!;W1:1311li~~1or;,a}:';~~~tp.\ll~::~..~~pll ~~sine,
su-esaul~ .. ,,.,. a iQtel1gi:!0 ~ei, a Q,~ifitltti}ol:';; 18: :~~!ilt~D\el, a uetemltnafl\ilor
}. ~a\ s~.~i tu~ ac~s~fK'!F';:. 5~7~~11.'?: diag~o.stic uesrlogi~ , .~~i@.;i:_situ~t~iJ.orc~reQ~"~Yii\a.;~jp~blemelorde ecqlugie
Jpotettcl ~t; Ide91J,ij~~J! ~ntnl)..l!;,.fO.~fl Ipotetici declan.'aton, s-ocial,a.,:;j familiaUi. a cunt-(;)llu:lui 'ii autocontro'~uluj
tleLenuHmti\i, favodU!Jti.predlspomnli Ji de meutinere nsimpt~r . compo~,~~nlultti ~i emotiiloretc.
mnt.olo. ~iei. I .:t.asfat~itul diaguostid\rll ~i evaluiitH. cliuice nvem .nUit o
E;c\e~n lu Tnmurar:;~ de, ~~ll~.cu. dispozitie del!Ju~si::va CQt~gQ~UQSO}Ogicade diagnostic Cat ~i J_latticularizm.~n BC'e."Jtein
(c.qle~c.Jpe: n()sologica), f'actori d~la-ll:p:ll2li (momt(!a n~mn~i), pri!i ~{lfPri'Q.derea (1) diuamicii indi viduale a tnl~ur~U~l~~!lll
' " _/: i) \

66
,, ',':, . ' ~ ~.

\ ,'., . . . ,' . ....

61
.. ' -~-:.:~ ': .;, . . .

I.
_____ ..... -.- i -~~---=--..z_...:_.,~~-
 'p'ati~ntt~hit ~f,,ll{~),P;~Qilttll:ui11.cnre c,~te~ori~ .9~t?PlMiS~ "se
,,~xp~-i01a ~I.j?~9~J~IJi~ .C(\n~ret~: pe :via tliJ~e...I'Itrtl fiecar'c:q1aciimt
.,~<~- ,.,,' ' ~ ''' "' ''" ,.,,,. '"' ', ' )- ,, - { -- ' ';' ,,, ' ,, '"' '

r~;~ 'I&Jiielut~llnn1m1~l:sdlel.1lntb: didnvesdgllj.e a&i'llOllti:\meutulul

'iJ'A4fnntu()rp$Otkt!

. I

~edlotfaJ..
.
R;~y.c:s;y:

W;AJ~i
(Proba41l
tl\Cilttotht)

:- .. . ;_
68

I 69
 gem::ra simptoq_~~t()logia. Spre. exemplu, dadi modifl~aril~
benigne-ate 'fitih:tihii cai:diac ca urmare. a unui efurt fizi~ sunt
adeseailit~r[:mitate ca.senme nle unui imineutstop cardiac sau
ale uuei boll severe, treptatunii diotre uoi putem dezvol~'ailic
de panlca satl nevrezii ~ardiadi. C~racteristicile esentfale ale
unei concep_tq~d cliltice eficiente 3utit:
~ ~a h.e acceptaffi de pacient;
sa ne ajute SU CQUCeplualizam teoretic problemel"'
..
padentului. lrnnsfonnliud incomprebcnsibilul iu compreb.eqsibil .
(atat pentru pacient cat ~i pentru psihopl\tolog). Acestlucru J!Sle
similur cu principiu1 lui Itumpe!stiltskin, descris de nQi in
introducerea acestui volum. Aiadar-, dadl reu~im s~ nuiuj_m
simploniatoiogia pnch.mtulu.i, sa 0 iitcadrlim leoretic, ea de~ine
nmi comprehensibila ~l illi pierdeo .Pa~te din 'Tor{ a maleficli";
a~ sa sugereze exis~nt:a unor t~hnici_de interveti\ie eflciente
in reducerea simptor.hatologlei. ' ~~unlizntea (explicnrea,
_ Deci. a!la cum se observii, com:eplualizarea climcanu este
important sa fie adevarata pentru a1i utiUi. Pacitimtul are nevole
de o conceptualizru-e cru~.sa-i explice shnptomele lli sa-i sugei-ere
o scheLt15~ de tratameut, nu de un adeYar ~tiin\iOc; in ac~le
condi\ii. ctmceptualizmea clinicl!. esle un mit. in mitologie, nt~tul
esle definit ca o. naratiuue ttadiponala emRilati'l. de o societpte
. prinuti"a imagi~1fuldu-~i explicarea concrcHi a feno.menelot ~j
evenimeulelor enigmalice cu e.nracter fie spatial, fielemporal.
car.e s-at\ intamplatln existenta psiho-fizjca a umului.in natura
runbianlll ~i in un.iversut vizibilon nevnzpt; aceste evenhnerite
stmt in legatudl cu destiu~I.condiP..ei cosmice umane, dar omul
le atdbuie obar~ii supranalurale dalftnd din vremea creatiei
prin10rdiale ~i, ca atare,le considera sacte \'i relevate strfuuo~Hor
arhetipali ai omenirii, de fiinte.supranalur.al~rn clipele de gra\ie
ale inceputurilor (Kern bach, 1978). Adaptaud aceastii defini~ie
in psihopnto'logie, mitut cliuiclternpeulic este o conceptuali:c;ru:e
'din.icadespre care uu ~tim dacli este adevaralli sau nu. Caud:
70
\
(e,'{. se face o lista cu pf()blome concrete de vi at~). in functie
de. pacient ~i de obiecLivele.letapeutuluL(cftt! in[onuaUe
considerii l:erapeutulL-eJevanta pe:ntru tmlnntent)~ ~tapa de diag.;
nostic ~i evaluaoo clinicii S,~ poate intiltde iutre J- 2 ~edin\s.
l- St1maridlnd, eta~a de diBgnoslic 1i evalu~re cUnid\
11resupun~ urudiloiiL-eleomnpooe.ulepriuci~e: - ' -
- Identificareasenmeloc :Ji simptomelot;
Istoricul tulbuti\rli; f.
~toria pe1-sonala, sociaUl:Ji medicaUi il4;:t12itilui;
.statutuimental; .
.- Formulnrea diagulsticului uo.sologi.;. (DSM) :ti
concluzi'upr evaluarii clii1ice.
. 2.2. Cenceptuallzarea. clinlcli .
iuterpretarea) fiicutii
tnb~oului clinic al pacientului este
fu.ndrunw1tala lu reducertn
sitnptomatol~ei (pentrti detalli vczi Fronk. .1973). Pe lfinga Q
ronceptualizare genera Hi, fec:ali~aUi pe cnlegE>.cia nosologici in
-~are se incndtea"Lli. tnbloul clinle .\ pneienf\luui,;pe parcursuJ
trntamenltl.lube fac conceptualiziirispeelli~peutt~ piObltnnele
de viata.specifice pritt care se exvrhnii diagnostlcuhl.osologic.
Dl!!ii conc~pt:Ualizarile generate fii, specifice se.lae in fune\ie !le
angajamen.tul teoretic:'al psihopatologttl\li (peJ1tm delalii vczj
David, 2003; Sarason. ~i Snrason; 19.!'19), s~ pat evidentia
nmunite trlisaturi cbmune ale acestora dincolo d:e acest
ruJ.gnjmnent .
Astfel, o lipsa a une) cenceptualizari .cli11i<te sau o
conceptualizare clinicaina0.ecvati4 uegativa, poate.~mpliflca 33l\
genera sirnptomatologia. Spre exemplu, da~~ modificarile
benigne ale ritmului cardiac ca unnare .a umti efort fizic sunl
adeseainterpretnte ca semne ale unui irinuentStop cardiac sau
ale unei.boH severe, treplat unii dintre noi putem dezv.olhl ut~~c
' .. :
71

. .d~ p~!lf~i s~~ 1\~W:;(ezi\ cardiac~ Oarnc~tlsllcile esentiale ale
~ :~: 'tln~i ;Ct1IICJ1Pill!l~i!aai\e:li~tice ~frciente surii: ' .. ... . . .
~.~~:fl~~~~fitatiideitJif~1enf; .. . . . . .
.... ,!\ ' . SiJ.n1und'fireud~ t\uatl~~~~!\11:~~ eltbt!~;a~a Fe.bo]f1a'1ul ps1h1c ~~
. .lln::.. ~-. s~ :mh'aj~(e~sa ~lln~~l)~ali~iin-l.~~fl~t9~1ftroblemele
;, . :P~Pt~!lt~l~~. ~~~'-!'~~~ in~ll1pre~~nsibHiil~1it;~~~l111ensibil
. ...(?tntpen~..~ci~cAt~pcdtrupsthqpatalog). A~El~cm estc
s1milnr cu princi~iul ll),l RumpelSoltsldn, descris de noi fn
i~troduccrea acestt~i vo1um.l .A:~ildlli,; cH\~ii' 1-uu~rn. sa numi.m
Slmpto~~~wa.;g~io)\:ll)lt~1 Sit 0 mcnddhnteOr~tic. en: devine
mu~ 'Cti'ii\prebensibtla ~j~i pierde 0. paife din ..'IOrfa .;,ali:l'icli''
"s~ suo:&-- erl ~~... t . . ~t l A .... :. ~ptfc;~f\Wtl;i~riiipsi~?t~~PQ,~f.ti!{~~f?~~etc~!~W~iR{!uli~~e.
1 , }.:.> y\ 1. .,,r;, ,,~~o;;csoi" ~ . s~,a?~()F. Mlll"Sl ue-tnt,6r-yenfl~ eficterare
ln redl~rea.stmptomarologU!I.; ,; .;.
peci. ru;a cum se observli, conceptualizarea cli11icii nu este
nopo11ant~~:f}~ att,eYitT;;lta )?r;q~cfr,!l:ff:tlili\'Pacientul are nevoic
de o coneepllia1futtecal:eslt-ie'xplice simptomele:;i sii-i sngerete
'0 s~~ll ~~ ,:tf~tn'!~l~~',J"IU;::~~LUI) .,s~!!~E. it~ii'fl(ii.fic;in aceste
: ; ,,qOI)~~~.'l!a'.~~~ti~~}~~~lj~1~' ~ft;.9"fl~itl,ffiimitOlogie.' milld
. .. . e.st'Q:defmr4l 'L:tt o n.a~(li;1ntH1:ndip onalli enll!na:l!l de o saeietnte
.. :.~.. p~tivl n\la~nfi.~?u;~~e~pticaroa 'C~nc,re~~a~enoJmmelal! ~1
;f}..~;,!i.~'?Y;!.mente]~J:E~m~~~t;~~~.c~t~~ter ij~spatj~;jti&tem}lornl.
~'~.1 ~, .'t. ,in'tftifitll~~'f:'tn;~~t~~ ~~~~l~f~ei<lli~ll"!ului~'fn;fialura
:,y,, .... ~1),.. . . .~~n~~!~p~t<Vjiil5il,c).,i-lu~~,z~t;::~~s~el~v~niitfente
c,~;;.~ll"'~~n'itgl.'llli\~it~[ifnf . J~i~i9.o~lnt~n:man~; datdmul
i
,~ ,.. 1~.. ~1JP'l1~iex,.o?ti'~if!$ri!~ ., l~~~~~~nd~.~~c;YtrftmHa ~matjei.
1 ..
. .. I~~t~~"t~b~!flif.Ul~~~~~e~nsidtfli~!lf~ f1it~V~~s'tmt1UYi;ilOT
, arll~etpah ru-..~mctl1ff1. de::fiutrlf s_tlprnnaturaletn;elit~lede grn1ie
. ale l~ce.put\rur'llor:~K~rntiaclt; 191&). Adapt!lnd aceasrii definitie
in .P~Jllopat~l~i~,-~,i~~~~~i~ic,~~~Tap~~t,i.c~rers.coQoeplUatizare
~lJ(,~~i!tlil'!~ ettl'~ 11~l -~t,idt-dac]t. c;~~:it{iJ~'l~taUhsatP ntl.
pal,J~~,t)ll~,tt~31iriatett~lini'Bii se dpve&:t~te a.fiade~ll.nni'::- t!e
~ 0b~,aa~1t~9rii.~Vcl\ti~nte~fiillpfic-:- ~ffl~~rpo#9~iltii~l~~r;n
~.. ;,;:Cll~l~~;~f;l~Dd~te..~q~Ult~de explh:a(le pJi~j~fvf-ernpe~l~icl\.
B~~~. n.t~J~'iW~m_.s!l i\1 fac:em pe pacient sii .acc~pJe,c.a -~i
+
1t~i1eeptll~'lli~iiri'Clinice ~d~vllllll~~in;\l~5.nu esto;~ ~n,g~\ic.
UUI\ilt:cli~iC C~~esa'in(,;leplil}~aB~~i"fl\llC\iR de
Jhitril\CDnSti:ili
.;ttinuepn1nliwe'c1iHitlr(~~; v#~fup~tul~pli~ati~~JcJig~onse.
'f1~ihilnalitic~ ~t~;!: .~~!:_ fe~~trn~ .rr c.~~~. ce crede4,I0>1~c~~,:~
c~n eli bolnnvul considerlin ft adevarJtn~lUl). 1
. . J A~eastli ~za...co'O~~~[Oali~nre,a. elinicit nu Lrfbuie si\ tie
. adevlit&~a pe~tn\ ~t fi'~~1:,l\;~~~~.~t1~~taRi~~.de!i~.~\l!,d~ }nt~lell .;
~)~e i\eceptat pei1tt1H1n~J P~t1Cief1I ~ Ge,lt~t~t~r,t.;~~e.Qr~alJtar~
oiiratt pritilitnnenorms*61-t~~PiiTjnl~nt~l.(~~~i de,r.,Jii ~e2i
.. Frankt91a; ~rscl1f:1?90)~l~xistl[ )l1ai 11l~'I~~d~Pt)6 de
c\inal;"S1iP"7I!Slh:malitHre,'\imnnisf.:eXJ:Sten\IJ\l~JP~lfi:'?~~Ppl12atld
. .~ri~n$Uai.prinl!ipaclc. in'psihopatcilo~:~y~i~~~~id 2.003
.,,,~.P~~iH:,d~lnliU~ Pniipl~regra~v' ~e':~c~~e~~.t\X~!~~~~;~\.f:l\~nicl\
. ''' geilmli. prezentatn.succint'i~conth1tl~!~'(~~~~J1ff~lii ve1J
. . , ,. . pavid. . ~QQQt;~l\:\tid ~i colali~ 2otlO). ~iisi~~~~.f~.}:ubi~cml
~antrebui~.mnU'inda 4 .niveiuridifefi~1rirH.trd!Ji1nen ciil1ne
., ,., ...... . ' . . . . . ................... :'.i.;);.;t,l".l .
.... :.~c~~r:~~.;flJllqHdPTPlf"'~~cxcplica tnlburanle~slt~~fr~!l1llllttce
, ~1p~llu~~Uqt~ti~e~ipre~m Jii ata(-et\ desttJ.1~t~te. .. !:~: ,i; ,. . :.(
.. ,.~:.~:: .... ;./~J.-ffi~~tft!l~iqlpgieseTefetiicla tlfitt~~~~~~~~;il.~~t~~,e .
' .IO:c. jt}. qr.m\m~m~~,n~~tnl' mm.aspett -fitt~1V.~.rc~. a11n{o~n1c .. (
:+:!~M"oil'ificlil.'iie iizicer inouse. de sist~ffit1~ii1 "'ltl\!'Nti'S vegetf,t1"
> . .;<'< '""" x. . . . . . ..... .......,....,.,i';.j' .... . . .
, ~~g~~~~~~J!H9H~1tl\tell:$Eihfii:noa~~em~tiop~li1/~~~piec~ive. : t
r. :c . .. (2) Nit~i;luJ~91[JPaif,ifll1tiLJilif~e ~eteratla'c~i~p~.tn .PSll\0- r
,~;~~~::=;~~~~7~
i'-~'f11lW{~rB~nnresu\l.Co~1ttl3hvnill'lntar.;: .. ;~'; .. ssc'iiD"'........ t
;. . ;y,, ). rJ)ft{re1ill,;,~ll:.,~:s,r-refern:lnprocesibiie.~~for~,a(ioq,lri
:-'.~i 1~. ~9.~\~nui~ll.~~~~tpt$\;.li~istli dot\ati11~pft]e .l!ropek~ri
'':t';itif6rttlaf{o~l\~~: co11stientel si -inconstieateki?rocesl\dle
1 'i~'inf8~i~t1Liri.'ll~;~g~~~tWt.rser~fuil\'la'e~prlmarettlingvist\c~(lll
-retmeaii'st"Jec(fici.snil iitrermeni-gen.erali (pltteft{a vs. absen[l~i
.- ,:, '>: >e> ,';, '.
10
' ' 1
~. ~
73
~. io ~..,Jot a a .. ~ '

- ' - ... .. : ....o. .. ..- . :. ~.:,,.... ;.~!:'~:i;.:'c.~.,
sunmlului sau coupuutului,iuformajiooal)] a continutului mental
~i a pr?ceslit:~or informationale. Procesarile inriJrmatiouale
JUC()?~liy.r~J~ se refeta.la faplul eii uu }JUtem exprima,J,Jngvistic
eontt~~-~J.t!:pl~tal qi procesfuila info.rm::rf.iona!e. Prelucrarlle
infoituatioiJ ale detennina calitatea trliitilortioliSiie eJJtotibnale/su-
biective in condi(llle tmei Bctiviiri fi,riologicereduae si.lu medii.
Dadi ac,tivarea fizlologidi estefoarte mare, atunci iudiferent de
lipulcognjtiilor, trrurileemotionale.suntndeseaneg~tive.
(4) lVii'Ciulsubiectiv se refera la ceea ce simte ~ublectul
uman.El este ope.lfl\ionalizat prin descdexile pe care subiectul
le face propriel atii.ri psibice ~i emotiCn\ole: poiitiva; negativ~
.sau n?tttdl. A~adur; acesta ~I.e opera~ionalizaL prin etichetele
verba~e ale 8liirii euto(idnnle(ex; "mn silnt auxios/deuuul.igitl
n.1~innl'~ etc.)..
Compone.ntele. principale al conceptuali~ii cliniee i11te
. l
grutive ~i Utodullo.rda Otgpni~ara suutptetentnte~Jfigura 3.
. A!in CU!ll_apl~ gura 3, od~tfi .~nerati\ J>.i'in mecanisme
etiop~togen~tice specifice [agenrl .f;\~i~logici (tiechtn~atorl,
fnvorizanti. detem~lnanfi~ pn~clispozanV. de menpn(e) ~i
tnodifidiri patogenetiee (teac{:ii ale organisnni.lui 111 agentii
hlfDlJ!t-aiaro:tsunplolr~at.,logtnl
tle clilte J.uu:itud
. f ~ timpull1i (ex,: modificiiri in ritniul ~ard.iac ca unnare a UJ1~lefor\ ~
I Shnptul~alologH!
#
l'rrsctUt~lue eit\lp.atugeJUiii.cti
~.Peclficc
Fig,ura 3. Mecarus_me itnl,)licate U.1. conr;eptualizarea dn~ica
74
0:: ._. .:' :.-.- . .
-. .
etiolog,\ci)), simptomatolGg[a este m.eu\inuta ql;amplillcaHi prin
intervent]a unor faclol'i uespocjfici, extren~-de cofDpl~i ~i greu
de ~ontrolal: Pentru detalli privindmecbnisn~ele.etiopatQg~netice
specifice implicate in div~rsetulburilripa1bice pot~ censultnle
Jucdirile de spccial..itate (Sarason ~i Sarasou,. 1999).it~ceenoo
priv~te mecanismele eli.opat(Jgenetice uespecillce (i1Jtex:p~;etaren
s1mptoroatologiej de catre pacieut ~ireat:tiil~ ntediului ~ocial),
e\e pot men\ine sau ainplifica siiupLomntqlogia udntif,g~oerall\
prtu me.cm:usme etiopnt?.gene.ti~specilice, A~tfel 1 dad\ sul:.lieclul
1~i- iutcJpeteaz#: siuwtoii-&ttologia liltr.. un mod n~gativ ~j
dezastrt.t9~ (v.ez.i fig. ;,l), nct:".Q5ta duce prin..in~rmediul sttesulu.l
~i tUL"tieta~i generate de aceastii iJllelpretnre la RtU{JJificurea
simptomatolog~ei.. Spre eJte.uiplu, d~diuu padeo~ i~j
inLerpreteazii situptomeleca.fiind incontrolablle, de_uerezolvnl,
ca expresil ale.unei. boli a.Scunse i inc.l!rabil~. c.~ deneinteles,
.en sf5.r~illu lui ca pecsorulll~O~-~ii.(~sle~leQ~O~deci 'l sJfu~itul
carierei, famlliei etc., aceasta gener~clQlres ~f.a,mti~tl1te prin
meca.trlsntul discrepru1tei c.oguitive.(~.; ..... tlll_t!oresc sl\ flu
considerat. nebun. dar nile. ell sun(; yreau .inteleg. ce se sa
'iutampla ilnt nu poi:'' elc.). Stresui ~i anx.iem.te~astfel ge11erate
pot mnplifica siroptOinatologia care >in tmele cnzuri, dacitnu nr
nJost prelucrata de subiect in. J)tod eJtl:tgei-at negativ, nu ar fi
(ost prea inteosii snu reul.atcatii., -dispiir.Dt1d pda~ Cl:!_tteceren
de.osebH: ln cursuLzilei). Un\alrJ.oilea factor etiopnto~enetlc
ne&pecific ex trent' de im~ort~nt, care. itt~l~u~nt~aza
l-~~
.lleefiilo
))lodf~ul .oclat . simptomatologia prin ptecanisrnuldJucrepanteJ deacn~ mat su~.
este.reprez.entat d~ reac(iile mediu,ui-s?daJla.sitn,pt~m~l?logte
s11u La perfotnlan\ele schute ale pacientulm, detenruuar.e de
1,rez.en\a ta\:lloutui clinic~ Spre exemplu, ca. unnare a uuor
simptome {ex .. nmnezie.le.<jin, nnxietu~e etc.} grupul cle prieteni.
.f ~i cunoscu\j tncepe sa ev.ite pacientul, nu il mai ~trenenl.a in
activitii\i c.oim.me etc.lu conseCinlii. prin' mecauismul
I 75
 diSC1'4pan{tti eo~n.ilive (ex:.: ''vreau,s~ fiu.cu ei dar nu pot. nu
mi nccep"ra"' ""yn:;all .sii reu~esc in ceea ce fac dar nu fac fatii
s~roi~ilor ~tc.). stre~>u l~ anxietat~a asti(;l genemtean1plifi~a
I d.cop.tlrile. Scopmile. stah\\ite tt'ebuie sa_fie._cl~re *ipre-
SlmJ?f0fll_Qqlogia. ~cala~Unct'Ll se fntfimpH).tn cazulln care .
perfon~anfele ser,;!duo ca. L1rmare a simprmnelor. Spre~xem
ph};. i"~ Cll7.Ul,onorsimptonu~ nevroticr:;~_cnpacirurea deconrentrare.
~ pacieotulniseJ+;dlice d1:asnc. Yn conecinta. p~rfom1an{ele.t;ale
(ex.:.~~ se~iciu) .se~nc.:an1treni\ndcdtir.i Jii otiserva1ii dh1 pa:rtea
~9rl.,l.~ (f1lt. ~~!l~'ltutea ~efuloi):.Ace:jte.nai conflicte nrqulifich
de!a'Pt~tt~ll9t~~lumpt.oPlatoJogta,dejl:l existentli. putf\nd ndauga
.
cluarelell}O\lte noi..,
..
2}~ Planl)lde tr~tamcnt S,t descder-ea intet;rentiei
- .
.. .. _yra_ta.?len~ul. ~tili~<U_I'Jste str[tns Je_gat de' coq~ptnal izarea
chn1c,n ~I VJZet\:zi\.w.o~t.ficf&rea el.e:mentelmpnt.ogeneti(:e snu de
sanog~n_e:di.,_'~f~bule_ facucK o disrincfie Clara .in~re tehnici
I listed p~llleme cleoarcc~ n-atamentul.roedical\1eotases[e foca-
!I
temp~uucc nmf\lun te1:npeutice (~~nlru detalii va.i David,
2~0). Frank.1973):VorbU'J1.de tehmCl rernpeutice atunci cAnd
pr?c~J':lt'ile _de. irlf~~C:~ti~ ~u:nt ~n:nns legate de mecani~n~ele
ettopat~~?.netit:iS. Apec1f1ce .!il nespecifice cuprinse 'fn
concept\la~JZ~ren,chmcii al tu}bm:lir-ii pncienmlui; uceasrl\ functie
sc_iU.~lire.!i~eD~~c~cJin~.c~nt:eptualizareaclinicn.este!liexplicatl?
chn1cl\. _yorbnn t)e ntmtl terapentic .nmnci clind tehnicile de
intr:nenpe stmtstl"lins''Jegate de tm mit te~a~~lJtic siurVizeaz.l\
mecanism'?. de tip plucebo (pliei'entul cfede ca trntamenhll esre
fiP~ifin'f.len'b~ ttifbnrarea de ~are sufera. d~i tratamentur nu
es~ legl}t d~ ~l!lburaYeQ.:'Pncielltl\'tffl).'tn c-azul1mui rratament
\.~ pslh~tor~peult_C;Lfdesen se regasesc urrniit41tlre.le cornponenre:
. ; : Ljs~adeprobl~e-. diagnooticulni:Jsologic esre pnrticUla-
nzntm I>~hlerp~ (}ev.sn{n. Altfel3.Spus. ne interesifazamodul in
cm.re'tmfilgoriileno~ologicese manifesa in probleme de v1atli
llenl:{u fiec;.ue pacient, ~riuf fiind faptul.cli a~ela~i dingnostic
nosologic se paart mnnifasrn diferit la pacir:mti dirc.riti.
76
cise, eve.nrual orgnnizate perermen scurt, mednf ~' lung..... ..
a PJ1wul de lril/MlJ~IJf,#~llrile Htilizllte. Ele sunr: stran~
legate tie ooneepma]jzatea c1 inicn. ~~sunt ~l1 0prii_ f~ecfiret
moda.liH\t\ terppeuliCI!', ile~i ~desea nsistam in- pracncn lann
eckcristnmet.odolagic. -
.. Qbstnco!e sconlate. E1e n'Gbui~&c.clnrificate de la'inceput
~~ planul de tratament trebui~ astfel cobceput 1Wclit si:i lUI fie
afectnt de no13te JllbsmcmJe,
. RezrJ}tiJteob{illl.l(C. Se tnregistlell'loii tezultatele obr;inute
$i se urmare~te e:voltltia pacientnluiiaitimpulrernpi~i. . . .. .
. Yn caz.ul unui trflU\Illent n1edicamenros pentru tnlburftn
p&illic;e._ see~e,n~I~.sunr ns~ana~oar.tt{I{ap1Rn ~i colah., !997:
Saclopk :Si Qolah,. 2,00"?). exceptfind"J:-se uneori &tabilirea une1
liu'\tR;e. categpr\anasll)logi-cit. Trel:mie m(!ntionatinsal'~ptnl di
nilesea tratilmennllmedit:alllentos l:Ste insoti. de terapie suporctva
unde:se disiilMli n~~cte \)Siholt>giae ~i prC!bleme. .:~pacific~
nsociato trntamenrului medicnn1entas. Pentru multe. rulburi.\ri
lmtmrienml psihelogic ~i.JI!;nlm&dict\l'I.Umtcs se. combini\. Aceustii
combiniltle rrehnieinsii fticudi pebazn tmor studii cares~ ate~ae
ciicibntn combifmtiai deam<ece adesea,nceastli combinu{ie nu
duoeha un rrntamnnt mai eficient-ci,donr la an rrntament mni
costihi.tor. St~re. eltemplu. 1indiile nrotn cii o combina~ie. ''
lratil!rienrulni.psihologic l}i mediean"lenros este indicatli pentru
tulhp'diri. ps1hotice dM nu est4\ n1totrlenunn indicnra pe111ru
..
rulbUI'i:\ri de i\llX.ietnce (ex.. ulili2'J\rea:nmtioliticelor poate inrerl'em
cu 1ipadtin activarii fi:zio\ogice intense necel:lftll\ in rehnicite-
l conipormmentale de.expunere) snu exisdiinca semnedeinrreb~\11!
asupra dicielltei acestei combinatiiin cazul tlllburiirii depres~ve
\
~
mnj'l1re (Antonuccio ~i _colab . 1995; Kaplan ~i colab . \994\
I
t
lj~ .
l
~ 71
'f
 2.4. C~mcluzii ~i 11J.iuarirea e'\olufiel ~:otcientului
' . ::.._~.:...-
-~:
. AC.~~st~:~~ectlt1ne a aJmlizei de t~z include ton~I~ziile
asuprn cawlul ~i evolutiei ac::estuia;Jn filllpul tratatne[ltului ~i
prez~ntnrea planului d_e ur~uir~re_a ~volu~ei pa~ieutullii;dupa
mch~Ierea lra~entu~u1, .1~ difenle peno~dede timp dupa lerapie~
penllu .a .pc:evem recadedle (penttu d~talii vezi David 2003
S<!raso~ ~iSarasou, 15!199). .'.
_11 cadml acestei etape un element important esleinre~tra-
rea ~~ e-vnluarearezultutelorobtinute. int-egistuu:en !;i evatuarea
rezultalelot tn aceao;ta etap~ se fac priil doufi modalitliti:
~~> Sl,Jbiectiv (declara(:iile pacientului);
8 . ~blectiv (iutegistrnrea d~telor comportmuentale
fre~ventei silnptotnelor pe parcursut ternplei utilidud un
iustrumentar psibo1ogic riguros). .
Evaluaiea rezu~tal-elorinter.ven{iei esle in1portanUi ditu11ai
nmlte motive:.
-in primui rand, ea.ofer&turlfeedback pozitiv ternpeutului
11i pacien~uluire~t::ritor lainterven{ia ternpeuticii (este en e.ficace'Z;
putem intrerupe tcatmneuw17 daca nuest~ eficace, ce trebuie
sc:_b~J~l~Jat? e~c). _. . . iul991. Dana s-a mutatiutr-un nlt ora$, departe de pi\rlntii
..-.in ru; doil~a .rfutd. evaluarea este uecesard. activilii~lor
ndmuustrntive ~:hn cadrul in care tBrapeulul i~i desfli~oara
actlvitatea (ex. statistica_interventiilor, a reu~itelor ~i er;c~;:urllor
intr-a nnumitapedoadiitle timp in cad1ul unui spital).
- In W. treilea rfind, datele cul~e pot fncc obiectul unor
nnalize ~liintifice ~?i E!. pllbli~::nril. Pentru. detalii vezi expetiltlenlul
cu uu singur subiect (Catania 11i Brigham, 19?8; David, 1999).
2.5. Un exemlllu de slmliu,dc c:tz...Cazul Dana
2.5.1. I-storiclcl cazulu.i
Daoa.ore 28 de ani, este medic, are un copil, locuj~te c.u
sotul sa~ ~;in ulLiro'ii treiani a lucrnt c.a rezident intr-o sec\ie de
ntedicinii inlema.
. A. Acuzele priJlcipa.Ie
Dana a ptimit trnf.amentul psiholo6io lleotru atacuri de
panicli ~i anxietate genet:allZJf.ta ptezeti\.<'ll iu ~est$tu.diu ~e caz
In perloada dintre sfllnlitul anulul 1999!il i.nceputul onul\.112000
(J 8 ~ediLite). Cu doua lw1i inninte de incepereu trl/.tamentului, .
nceasta avusese deja trei a.t.acud de punica ~i se lemea de
sau probabllitatea de a mni fa<Ze un alLul. De' itsemen~n. aeenstn
mentiona: ..De prin 1991, ut-am sirnpt afP.tatl 11i extreln i.le
anxioasa ln legatura cu vinta mea (ex. "viiJoarea men profesie
de medic"), relapile ioterpersobnle (6X.; ..cu !i!Olegil ~icu sotul")
~i ccle mai irnport.ante activititi ale meJ.e (ex~ "rezultn~le ~eol:u:e,
doctoratul") dtt~Si. sJncer vurbind. sunt mult mal ingrijornta de
receutele atncud de panidi".
B. lsloricul.tulbnrib-Iiprezen.te
ei suprnprotectivi, peutru astqdia medlcinala o uoivet-sitate de
prestigiu. De alunci a inc~put.sa se simUi tleajutoratK =1r sii. a.iba
. atacurl de unxi~tale !li "ingrijorw:e in legtu.w:ii cu orlee.. (si.mptome.
t;luotio.nale). Aceste tdlirl e~ot~bl~ale se asocia':' ~d~ea =~~
tensiune musculnta, senz."lt\e.de slab~chme, \'?b05_eaUl.B.t tulburau
de somn (simp tome fiziologice). intrucat simten aa ti_:este greu
si:icontrole7.e aceste manifestliri [iz.iologi.ce, ea ain~eput si\ wile
activitntile care. presuptmeau efort fizic- (si.mptonle
comporl~mentale). De muite mi se gandea. di toate aceste
shuptome vor arata di valoarea.sa ca persoana .~ompetentii este
sd\zuHi (si mptome coguilive); in conseci ntn, .se sim\ea deseori
neajulorata ~i a vea o stima desiue sdiznm.lntlli tnedicu h~t~ ~h~
79 :.
-
 .: ~~ ....
. ~. . . .: .
flU!i'-aU pen.uis Sa JOCUiasca iUfr-UI\ cfun.in Sludenle~ ~i i-au
im,,liriaL u.u apmtameutpeatru a puten sa 1nvete in.Jlui,~Le. .In
. titupulpli9:tH~~!..an defacu~tate ~in~e~t.~~:~~~Q~U;~p~temiC
. sinlptQfiT~bffB.ti?Q81itri'geneiB.liza~~iinet~.s4ll.P.t~we.~j~~resie
:!~b,~~ini':~~ ~e':1i~tnt~!fing~~.n,;~~t#~~!rit..~-~~~P:~~.,~.a se
.~~l~~.~.t~z~ ,desence (inslttt~ ~t~e m:et~i?~:(~~~~.se~~r~tii.d6
P.~~~!l~et?~~~e.st_e un~l dnt~~~otiy~~~ l'Fll9J1f,C~~~~~~pms
:ttfl:Pp.~~ttil. dt~~uqstic rde'aU)Ct~~t! ?e .~~~~;~~p~ ,ltt.~~l ;de-:n
.. E'~h>#~~ ?~~1d7 ~a~W.~~{1993~'!.~~!~~~~ ':l~zG'~W~l~~~.J;l~:tnedic
.g~n~l}s.~t.Ja ttapsihmbru.~.1""3.U P.~~!"!~~9,~1\\,fl.\~,li!t;~Olln).
BHRA\t <;~~~~~.lL~ni,< ~ana: ~:~~~l!~K~~;g~~~1~,,~,j~'!ece
~,UHij~q~t~!~ ,Q~v,rU~~gllate. ~7!I~f:,~al;a :f.,~~~~~~l!:r1~~-CJ~a
.p'~~~~!:~~1~ ~b,ar:~J:'!_ftcondtttile:l!~ . ~~~p;~~~~~t,o;giel, a
I ' "t ' ... ~2"!ft~i*t
:c "-tea'~:.-v,r
--~--b. ~il.Xl..s;l;l.~qces~,ac:Ujltn ..~....~~~-~?V~:,E ~ d-
..-.~~~m
. . 100"7 """"'

l1l~c!i~\:~ziA~~tt;ln.;spe~.if:IU~~!;?i,.~~ , ,.,.~ ,,~i~f!l~tfft::~tatorul

au.! ~'! \~fl~~~l' peno~da f~a'C:U~~~~~t.~.~ J1~ . ~Yffi~pJ~iitt sot~ pe
ca~c;.iJr'4~t:te qa pe'Un~argp,tl~Tttililt~h ~~~:tc_)ttUultur, cu
.I 5. f!~'-~\r:rn~hin: "~!it:d~cat'ett:cer~tif s-au ptiicuLfi;~p,~ls-au
casiito~tit in -1998. Iu pre~~nt~ ~-I9~~!~t~ H~;B~:t~~l:are ea a
absol:vJl.fa~.J;Jitaten, Dupl ~.-ll!r d~;t; ,1~~~., fl~ J'YIW: i.uUor.
l)?t ittl\~9:~ P~ua f~ii!~c,:peis~~~~~~- -;:-.~:.~fflt?f4hmedict.t. Pe
':: p~~:cuJ:sl!.l.~pllt:u 'de:-af tlo.tl1a a.n_ .o~ ~tr~1f~9~,. 0~11~k ~sta
e'4_Jeri.e.~aziLtlriJUtd:atace~e.~~~~-iy.;~~~lilm~~;{lnO~ca,t;o ill
'-~ 9,?9~uptke:a,~usesed~Jili~l'e~ ~~J;:flct;~tp~,ul\l~;~,p_ar:~J,~elcu
.in~~/;~~Uii\:psil1otetapetttlca; ~t:UL.J(tt~:-9'~~bU\IiJ:tlJ,:atalJ1ent,
rne~i,::~n1t~tl~S>~~~)p~~rlli,~el1l~icqJ.;Ps).!li~~U .
~ i J;J'!'r ' I~ton.c medfedl. ~ _ ;: ., .. _: _... i: "r: ..
; .,O;a,rl~.uuavea:~ciun fel depto,W.~Jl!e ~f]i~~,,~,sl ii
iuf1tt1311_l~fmt~tiQuarea:psibica;prt)I.U~Jl\~!r:R~.lM:e:~U{en:tel$8u
p,to~,~ ~~ Ja,ll:;c\tnel4t. '' ~ ... .
\ ~~ \l:.$f.~sd.tre,,IIJ.l . . .. , . . .
\ ~qci~utaelia bine'orientatii to_~!PP-~patbt~. 4.ojd!spo~(ie
anxi(Jnsa,,\

83

~Ufr~rt-dirrpart~a SO{Ullli e! ~i de:faptol caSe simtMeoplc$ilfi de
~nrcmlle as~mare ~fa(!ton declan~atari). Dana se n~reptase la
surortemotlonal dtll pnrteusotnluisau:; in schimb ea simtea ca
~n~ii ~nsatorie a avutfiimai mnlra obliga{ii decfitinainre,-.~sf~l
mcatacesreill\O st'a~itprin f\ o coi?I~~i. Aces[ moment coincide
en decl.an:;.llren primului:atac ds.panidt
IJ.. .. . ~laltuiJ.eil cogJJifiilol' fl eomporlamenlelnr ar:tuale
.~ SJlllT_Popro!Jle.IJ]lJticii dpic.iiipentru Dum~ a fost ~ea JegaU1
del1 l'lmnl san ata~;: ~epani~iL In tim.p ce isi pn~gliteit exainenul
!e ~~to~atin ~:U?e.nt fil. i-RVllti un:gtind n~1tcimat de genul~ ."N u
Ol.ICU!il s~ ma pre-g~He.ac.cum trebuier !o 1.mnotoara.le zile
. d~O~l\l'eCC. 'lll\- mli. ajutli ~imeni Cll-~t.elelnlte sarcini .fii llll pOl sit
Qb~m mm mult~ml' pcntrua-:I"Ili p.regati ex.ameimr'. bin punct
L~~-v~d~re -~~l~{l~nat. "S"-.a simtit foart:eanxioasa~ s-a opdt din
crt.!i. S-ll_ndtcat dln foroliu. A"pt>i a simtit c.1. nu inailpnare respira
ilt~ durert p~ecordia1e,palpit.'l(:ii ~i tremor incontrolabll. tn ncei
moment
~.,.. <lavnt.un
. . n1rgJlfl
" d~amomatlinterpretare
catasrrofala:
~nn~ bolnilV~ ~~ ~-m;p!ltea &a anum arac de Ltorod.l"~ Simptomele
f~:~enonre s-a~ m~srficttt ..{panicii: despre pnnica - emorie
S71t.:un.darli). inP lu~ea/~nmern i s-:"a pnm~ c1udf\ti\ l$1- fiea.HL
- Et10t~9nnl, _n ~}t~enentutt sentimente deteama ~i dis~onfort
Jl lferm~. A le~at dan ctunedi ~in1ncercatsii ajungli Ia hlliepentlu
~ He spill~ pe. ~U1 cu ~pa rece. 0 a_ d{)ua s.itt~ll{ie tipiclfse referli
.. n~.el ce-.al dotl&antl,lpdapnnidi. tn timp ce: :Oana fl1cea cutJ:i{enie
!n apnrtament a observal eli an: Pf\lp.itn{ii. Gl\odul sl'tu"i\utomat/
nue.-pret~ren Cftta~.~rofalii a fost; .. Nttdio nou! VoinlUri !ii nimeni
~lll yn ~n.l {lVell gtljacltt- flnlmeu~ ..fl! rninufele tlnllatoflre ac.-..tel-11
1 iH\ decJa t . .. . ... . . . . . .....
. . . . U!la un.no11 atao de filnnicn. cu pnlpitntii dureri
P.~cco~d!ale.~i n-en:mr. A.inaercat sfi njunga l!1Lulfot9lit;(1n cnz
c!\ l~~Jlla) f;Jla telefo~rp:ntrn a--~ rel~fona sottllui sfiu (dnr nu l-a
_mn~ sunnt.). 0 n lt-eJa 5Jflll1{ie_a apamtitt tlmp..c~!;i~i pregaten
lncaf~~,pe~lun.conc.T~s~tU,1.1tific.dernedicina intema. Atunci
a
s-a gfindlt: Nu am suficient til~1p pentrit face o lucrare buna.
Nimerii nu mi\ ajnta ca sa 1\Jll mai mnlt timp". A shn\itd\ i\re
pnlpirat}i.t?1, .apron:pe.imtldiat. ba venit on gand o ~nreq:ret:_\rc
eatnsrrofnH1: '~Vai.de rnine. suntcundov&at bolnava. Vm \e!!ma
~i voi didea''. lfi,onreva minutn;a experien\iat_U~ al trft.i)ea ~tWC
de pa\1ica.1osiide data aceas[a tean1ade n. nu-~tpterde contt o\u~
'
-~
4itle hnu 'ionebno1un fosr mai, p~tramic~, A io!iit din c_tnne:a ~\
a mei:s in lillfl'agetie p~ntroa: fi mai .apronpe de td~~o.n $1 s-1\
a~;ezntintT-IInfotolin. inceDCand sii se relax.eze,. 'tn G~~(~l\
asigUditiloTtepetnle.,da_ted;medicnlgeneralist, cl\-nu este ou111c
'inneregulifcn snnlitl\tea sn.Danaa continuat sa~un~ t\rt1Cm?le
sale de panlcil ~1 sti'i.r~ledpnnxictate pe senn1a unetholl somat1ce
- ~ediagnosticate. Asnel inclU. Qe~i!G:tt d~vedit: afi d~schisn hl
ideea t:1rml\r-it. un\ii-tt-tmmaent psihotcPapeutk, nu n foll~.'.tlfel Lie .!
.recepdvhln Q CQJu:eptu~lh,niepsihologicli a.problem~lor su1<~.
C. . Evalriarea loirgilr~t{inalli aDogrfi(iih>r fleolll]JOrlrt
mentelor .
' Dana:acrest1tJnrr:-ll)familieon pi\rinti extrcmde [n:otec[ivi.
Sarth1neiera sai~'vetcbine.in~mp cepal"int~i li nsig1:m1t1 t'c,ate I
cele necesare. Madar. avea snficientttmpla.dispozi~e p~ntru .J
n-!!i or.gmtiiii ttctiviftt~le f!Co1n~.1n oonsecintn.Dana 'era o eleva
foarre'b\lnii.J ~nl~~el'ii4Jlt.B1Bei de :vlatll. s-a\.1 dc:z.vohnl .
n-e{credint~riRli PJ'im/1 cnulintJI-cenli'fllii(scbema cogn1tiv iil .
, --~ lu compl!t!sttli:.".a.fae~ttotubla standard~ mal.te'", Aoeostl.\
ctedin\li este: ftecv~nt evalnat:a: ''TrebUie'Sli fi!lc toltll ht stunclarde
'i
'jnalie, nltfel:;untinbapnbiUi, derestnbiUi ~ltlbN'. Cenda-:-ll dtJW_}
widinf)l>t::ent-rnliiSi:!Tefel~ la rcspons(lbilitate lji control; ''Dad\
'
i;
ceUal\i nu mn .ajutn~ .auu~ci nt\ mn pot cancentra s.i nu por sl:i
detin controlul ~\ sllreuJif!S tn sitt.ta\i'll~:huportante din viata :--
men... AMi\StR cognipe est~:l.ncontlntlnre. ~J/f\hliltli! ~Jl~t'SO(U1Cle
apropinte niie trebriitl"Sli mlli1jute s~.contr61ftg;situatia, l)entru ca
slims pot COI'lCerttra Iii sa:imi at.ing flhlfiotivele i mp.ortnnte. Dncil
nn ma ajnta, este gronznic l!i nu pdtS\'\porta aqtl cevn". Ceil de-
n {J-eia cJ-edin[:'f centmJ;ise rcfera la d:mfort ~i control ~i pare a l'i
B5
 :.... .-
~ .....-. .;.-. :: ..
' ... :- :M. 6 " ... -.

implica~a tn apari\ia-emotiilor seundare (adica. panicli d~pre ___

2.5~3. Tratamellt.!Plnriltl. do intert-'ettfie; 0 a.f!oldn.J;~. din
.
.-.-~---~~-~.:.:-:...-~- _ ;~< _>:,-r,-.- ;.;:_:;._y;,',-,;. ~
paoi.di)~ o~ca suntueajutorntii ~i nu miipat controla, atu.i1ci ~L per:.weffi"f~ t~ap.l~J.cqgnittV6 .
eu ~l ce~alti ~01~ avea ~e ~fe~;~~~.J\treat;l3:. 9{)gt;~itie ~%~pq_i . A~. . lJst.tL 1fe.j1Fgbl~n.es. . . ... _. .. . . _..... 11
e~.~t~{ll,~~~~kt::-~b];U;~~.-til~UI~:fi~J4.Lrm~, pt~e~~~~~~~11ie -~'~ .~t.~F~il~~.P~~~.Iileililaitd.; ~!21) s~atlnt~'!~!~~!~gt~-
::tu~sup .I~.... :l ::,,~~ _ .. __ . . ~ .:::~~-~::.t ' . jo~aW:itl'eg~p..~q qri~.~~~t~n~t*~u.eyniW;!t~!fi.~~~esJe
1..
.1J. :fMl{~-~i!Pf~i~~.e~~JJ~tfi~~. t(U"i-4lf!:pa~ietztJtJ,J{ . .. :;ubiURi~);.{~~~Plii.C,~~W\"'li ayJ8td~3J.!poQipe ~~~esta
--
..
._'--P~~~-~t: -~- P~[S{)Bll.~J~~b"k~l!lifrc~.q~~~~~~.~~i~~tia .
ll:lbe.-sten~~dJCJJn\ 5il este foar.tediseiplitu!L{L Ea d~t;~e~t.p_ua
l-~r.\1~~pf~g.~~~<4)sti,fflii.cl~siue.~ilsel1bdtatesc~}~te'~~~~illi\i
scicin.le .~e~cita.:e. . . . r; i
ce est~ JP~l ~till pe~t:J:u.: ~- ~i f~.ij~~t:JJ~-~-GO:l\S~ilil~llici un . . ',) : $t,~./}Ml'JteJ!afleutic . .. . ..... _.
efor~ 11}}.~~-ef?F~~ J~~~f~!~~n~ ~.QijtP:!,e~~t blem,k.tE!lWaaltrait .,Jl) ,lM;lu~~~t.aQ~mtlhl~~-paui~:fmt!~SiY ~ .
cy ~~!~t~fr~~e!"~~li9P. ~np~P;P~~p~;~i~ltt~i:~ti
'?am,.: mecitt,m:.stuele de coptnJJ. uttltznlt;rap- ;fo:st:<~Vlt:itfea ,,:::;::=;-~~~r,~;t
$Utnularea asertJ.l(f,ltll~U '~?~~~,;~l~l , ~~.tfl{
de
p[9b~~u~F,~f~~l~area ~r;u~l!li :fq.k_-fi.i.stqdinl.intens(f : lfl . . .. ...... _ .
.E~~j :ri ;~CJ?qt~,~~~t;r~~:,,;, . . :. .. prbbi~l'l1~peutw. a~J]h~~~~tfi~~~~,~~,~.f~\q!~~'et~~t~ten
. ,p~~J~ -~~e5~!1Jlf,W;;ntlti,~tale'getJella~tli?tie()~liCtf~lf~e d~,re~otvare a_ ptobleni~~R~~'!R,if~~~~. ~~.'1!:);~~l~u~iit~?rea
ei.~e\1tJ;wg,({~orl;J1_~~,.~t~)a~t 11iBUt-'"o~~fiJf~~o .abUita\ilcrsocialeeu.tm,p~~~~:W~"~~~~W~~~dt:~pen;ol\1,\~t~le
g~~~~~ 1~~-~g~."'d~. :situ~~H (la~t~rl d.ecliftl~:!torif~}i~1td :depe~del111i. . .. .... . . , _.. , . , or -~ .... . :.:
at.~Jet~u~a~are: Pm~abil c~~lta~i,n~'u?~'~~~~}'let\1p~ WiC~ _ . PlruJ.ificar4!~ t~C'!l''~~ r; ~ , , __ . ..z , ;
-: :f~~~or!iAA\YP':Z:~\11 ~-~ex-,.un (l~ne~""' Bl~~c~l,C:f!~~~nt~Jt:; .re~. . . . - ., .Plattw'ge tmtall)~uty~~.tH.iiJ;itD~t~~"'~du~n~(lfilor
ndica~e de~t 1tllte~u):.au precipttat~x;;ennea;;genelitJ{ilttli.li de~~uid~ \~~~.~~~.gz#~~~~~,~~~~j~~Ji~i"l'~~~i~~~~~~~ret\
depres.iasljbcli~tica,~ctiv~-~teei_ -.. . -~e; .i mult, aim ~~:~ei~lgl\~1;\f,~i~e*~~~l~l.llia~~";!~ea.

:~,~~
hlp~~~~i.latea8isteil'l\l~~~'~os'v~~ tfii .~~!~~ -
~illet!~i~}~~pEinletill!rel"tii!e < \> . _ '
ale,perso~~t.li~ildeiJ~l'ld~~t~a.efj;~ij!Jf ... . -~1!1 ..
r~\18~a . . uti~le~~~lf~-~li~~~~.J;l)~.f~l~Jbl~trodvs'fl1 !'~~!""In
Ja si~P~CJ!~~ologia.UJJ~~i;tQ~~i dq1re$ivlt~~,
UJ~dqr;J~r, ~n~nsociet:ti-"a~el(Ui~oiiGf:$:.~~!~ . . .J?.~.!l~\"1 .~
'"..a,,.u_ -?e~reverlii"~-a,~,~~Jilor. ,.;', . ,; . _... ./ .. :
(factorp~filisp~z~tt)cu ClJtn:esiuitt~~~~~~~~~~ .. '' ._:ri.e:\ii ~enti'tJ,~a,<;~~~,P~ti!~!fqlt}sitntlltJe~i;\e }~~~~~IJ,ent
de diJt>a>cas;tone:lit~~rl) fru~t,J:ru"ca dlltlt~-~~~Ptii~ ... . ~iS;~e ' ca~cttit\r~e: '<if telu}ici de res~~~~ti\f!W(~~'t!'95)
stts\ill~~~~!Ji\t\-~n~~asotu~~~,~~o~~~~~~ti)~,~~'t 1 ;$iPt~~ J?~~tru ~~~~e,~,~rp~~i:l~~~f11~li~nftdei~~~~f~!?;~l~~~o:
nt~C;:;\U'~e.~elp~t.llCa; AcesteanU rc;,stsfi.lltutat~ ~~ rtf;l"\:lfe~l;i,le mat~? ~~.:(:l),l~L,t,p~~~ely~~~,O."~}fl~lfJ;~e~D~,ol~.r'TI~~\let
~nt~~.(ale\~rl~~te:de;}L}$Ula:i~tcil"pretc~i.~'cli~~-tl~c -4~v~p.t)~ ~(Ost,l93ll'P~P~~ a ex}1lj.CJ1 tiT!llli1Jlle)~lflr!Jll~la~Ul!l:!~~ele_
m:;talaretttnnucntl~pre panrca:: u~,ii~c;(\epani~~-Oe,asell1Sllea>l1nhlrle_pu~lflnieN~u1l~Hi.Iost
\ttili~n~~ o' tdmi.~~4~'-dis~re ~aten\ltii;am.t:ihieoitditt"'tllc (a
1 I , .:...

I
86 87

~ .... :
 ,,'~fita rel~tia dint.L~ ~L1gnirie ~i ~tnotie}cfit ~i tetapemic
(manageme11tul rnpid nt sitnlll!mmelor): 'Apoi~ paclletul de
. }'~~went\t;~lll)l amcul de p\nic~a'fostattnpfarpenUl1'aroti:rnte
. .~~)"l~r~l~t~i depJ'esie :mbe\hlica~ ~H!anst1lnd1n: ~ilr~~~~ici de
ft!JilJ;~tt:rjtr~e ~ogniliviL(Beckjtl976~ Clark; }99~) !l,en~ru
~C;t,0dif"W!Jr~fkgl\n6u:ri1onuit~il1atrifii:a ci"Cdil\ t~lor cl!~rhtle'!! i {2)
teht1ici de relax are (Ost. J 987) pfentnt:-rl!ildeiba ah'tivlrii
. fiz.iologicc crooice. Ne.:.am c~:Litmtt.d~28S~~nen ~i pe modificareil
. (l~d.i{~d~t!ii~lp.d~al;JstFaet~Eure)t~ogni\iilUr~evat\sntiv~aso.ciate
.<;~~~teJ~~~ilttn!~:~~t,~~\~tebsertivirntea~ia~it~jbi\~tnti
... il~i~ifi.im~:Jro~~~~~~~t~lo~it~~!'lif!~ul ~ntmsetrl1ilrateNit1in
!'ili~E"lir lS~f~~~ . . ~ . ~t~r"~ ~~~~H~filor s.9~1~1i de l'etolva<re n
:Pl7bl:fent~toi t: .; . ,.. .. o1~~~t.c~ls~9nuJ':de a ~ aji;Jta sihrleyi,iil:mni
:t~iif:datia~ttri~fili~i\~~tt#mJl1 ~~p~lld~otiL Pa~h~tuldetebnici
r~~f~st apU~~t: dtlp~ .ct~nt.ti\-n~t:az~.: ~ ~. . .. . . , :.
..~;~~J1
.\I~ R~tm:liritltd~de p)ml~i.pilhi~nta:afost jn~arar~pJe]lnica
de distnigere n ntenriei {ex-..sa ~~ie detaliattonre Q.biectele
din eamedJ ... Ac~att~ ..ttJlmicita~ 11ote~: (n);.sli.~ombata
. . .~py.v,ial~&.an~i'Cli'niVa~ c9iiirol asup~~~a~i~t~tii . ~,nle;(b)
'!~~lii,.'Q:teidll~;m,.~~~me~tli:'silh~qfu~tpr:. A~i!il. i~ptru
,.sitt~~.riil~rtta pnrrea~da!fettlgiil'ilci~Uir'anto~t~~r)n.4!ftciJ~~;.i~c)
,$~.~o~~"~ui~one~n..f;I'J1{r~fleli'~n\:t.al\i~'~e.t~t.i.i.ccig~;rtiv at
.~~~i~!~,ll!~~f~{li;clcc~g)'ltn~ai'Q~~~~ttii~ert;~i&r~r~.I~i.~c~put,
,',~;tlnA\:i.~1,,p~zeanlt:rliRfta1cJ\~~~ti&i~ft~(p;~~~~ia.~.f~Cium\
.~'Po\~!!~ ~~ifie8t~1l"'inf:erfjtet.iini catit~'ffOfale a' se.rii~~IHor
. corpornle C}(perientinte de P~na lll timp\ll,otim~nlord~pauicli.
:..... ~trJ!nJc2!~~~,~01ttmli . ai;;:tespit1l~.nrost 1tfe.agemen~J~losita,
.. t~tru~r:c:tl,J:Jcb~nrcntilalin ,, . . :' / /

,_~i~l~t~tt=~i"t~VJ~~~
- :~~~~:~lat.~.=t.ellnie:hde;,;rces:fln-ctur.ate eo:~~.1tfv~.-)i--!'e;f)nlci
..~.~fft~~p)t~~~~;'!~~e~.{le ~aseme;nea; n~~atn' :f&ca.~~z~~; lli pe
~ ~f.l.c;l~fie~re~ ~Pffll'i~iilqtrevru uatlve priifihtelVenpc la liiferite
Il
88

I
 ... 4: ..
.
~ ~- ~ ... - . .. -~- . -.~- ~

f;.
. ~ .. -.~/~:...~;..;~ ' . . ~ ~~\ .
2..,1:--Riizzi.ltate,. concluzii yi u.rmiirirea ev~lufiel
pas:.i~ntuJni . . . . ... ... .. ' < ., : . ..~
.I.~... . f'rn~enLuJDanei s-:~ ~~.~ p.~~fl!Ct,U-:JUhi:~B '~iii'e~l.a
~~~~Jwii{~~tpijillchei~ tercipie~~ tm,~z;:~.!\~m~gi~fir.aculi
~.~ clll\9~SA;;Sau ;~in1ptoole de ~~~~t~;~~HJl'fJi~~~.i;lJt~Ltf,", au
.11e~is,~at tf1tele,simptome~an&el~t~~g~~~'~tmii:~~ttm
~\,.,~~t,~lm;J~1~1~p~~t: ~ri~~~~~lY!~l~~P,~~tnij~~~~~ de
a!:l~.l~t;~ gem~Ealit.a~ AsL"~Y~t\~l;l;~.P~IW! ~~' ab)Jitatfle; sale
s~c~af~\s~EJ,Q.'intbuniita~t :Jef~~~y;,/f!~t~ ~a:vuftliil;itpact
~c;J-dti;v:\~l,lpta 1-elaSfiio~ ~s;t~:C,f~~lf!s~y.~~ \ltUi :;1 pa~iili~~ ~i a
Il~~~~!,~~iiLr~a~I?f' se~J1i~.4~;l't!fA~~~t~'ff1~~~~~~te.
Toa,~e ac~~terepr:tlta~ a'tlfu~~ Q;R~WA\\altzateuJ:lt""'~rt.'aestgn
exp~fh~en<~l:~uun sltiJtnr~~til~t:,~.u~'etUJ.i;~le~&!Jia{,i ''1' o,. lr,
it':,c~~ 1(~1tp~(jn-te!~r,{P~~~;~~~Li ""~~j<!atam~!i'B
l9;7,;J,;lQaNI~;l9!?SJ)~ ' ; ''"'
: .... ::\;.. ,. :. . . .

,<,: ""''' ''

3.l~.~~~;~tslJap*~~ .. ;~r;.;:i
Tablotll.clb:d~ ~J~p.;~~~t'll.l~ui~~}i!~~~Juit~ri~"
,, ~,,",,>,; v . ' '~:,"'<;',;,.;;''~;5};/-->';,'<-},.''''<b' ,, , '.

.. se~rinelefil~Iwp~~i;~~~~~t\;~l6tuattit~ .. ~~it~l~gia
;"capacienfvor,l:) an~~ait;.i~:t'4lle>een,t~~~~~~) ,.~9:~1~t in .
. ctfreel~se'JI11Jriif~li in.c~~;,~ltcntegorlil~ti~p~ .. eJ~~'~tijlor
pliil1op<tto~9&utif~Q$~,~~pitalul~~=.~~).~~'; .. ~~.~ie,:V;~l,\~n:
clinicl(;(2}:id~~oope.~i tmrmneu~ (3)t~.rce.tare fundatneotala!}l
aplic-t:lta ~i (4) educatie ::iforumll~/lrauHng. ,.,:./':.- ..... .
: .
.. . ::. . . ~~ ~

90 9\
...

3.1.1. PPobleme alePsihvptltologiei Ut motltllilnfile
fle a face diagnostic # eval-uare clinica.
Semnele l}i simpromele care mara llrezentaunor probleme
'in ceea ce prive~te diag11osticul ~i evalumrea clinic~ ill
psihopntQlngie.$untprez~ntnte!it11:-on~inull~~ D.ac!cdi~glto~cicnl
lli evnloar~a:Giinit!i~I\ Fsib()p~fQk\gje s.4ri~aot-~ctc ljt tdic1ente
nmnd ne a~repdim. ca (l) numnn1l categoriilor de diagnostic sa
reflecte iiMele ~tiin[ificec exist.enre; (2). sa fie renJh:\re CLl m1
jn.slrumenrar p.sihologic ~igLh:Qs ~1 (~) .sliJie bazn.te pemodele}e
&f:le ma_i dgnroase tl\ (\~\ll~ohl (ex~ ~lod~lutetiopatogeneL_ic).
Sii urmlh-imtn conlinuaredacl\ acest9IW(dlcliisunt ~on~nnat~ .
. . . 3.J.l.1.,NtmJ{Jrni.n~~agtJr(lt d~.ma~e de oateginil
tliqcn.o~litp ~ih{? ds pcrtillogt.ars: a t'is ii cotidisne.-
nllpus ll!lale.fkarum . : .. . . . . nttaparat deseo1"Jedrii mv1r holi (Hours . :oo.~~- Cr~:;f~re!'
__,~--,l:taptu\cK s?iisti [In fl\ln-ui.rmare de ~at~gm:ii nosologjce
psthinttic~ lltl este o'.pra~leroa in si11e; Dimpptriva, un num5r
11\are de ~ategoriinusnlogice identificate ~i cn;ate pfin1.\.i\CUI;n nr
purea aratfi rohuste.~ei\ cercet~rilor din acesl dorneniu l}i
miittwitntea acestnin. Oneil acest mimlit mare de categorii
nosologice nu are insn o justificnre ~tiintifidi ci lUlil socio-
ectmomica. atunci. ncesclu~n~ dt;~iqe o.ptl.lbl~n:'ii pentl-q ~tjin{it
S1I vedem cum stau 1ucntri~e ...De: la apatitJa primei edifii a
DSM-I ,(APsyA. 1'952l.~i J?'fin.~ 'ln edi{i~i n pnn-a DSM-IV
(APsyA.l994) nnmaml categoriilor diagnostice psihiatrice n
crescnt en 300% (Ht\utS, -2002}~ tlnii anlori (Houts, 2002.) au
nriitat eihlceasti1 cte~l'$reae'ste nltiific'\'lliil l}i l'lBQb~mlirti, ~1 d\ ea
nus~ t>a~euil peda:le '}liintlfice ci pe condifii socio-econotnice
~i politico. Ap\\ri\toril D~M (Wa~fie1d) 1998; 1999;l999n) 11e
dr
Splln p~ ~~tli parte, cllnceastli cr~tere nu este una neabi~nui t~
'penttu ~tijop.IJllediGaUi~i di ea gstejm:tifieata t1e dezvoltarilo
~tiintifice din ae~asta pel"loada. Allfef spus, eerct>rlirlle din
11sil}opatologie at\ dtls.la descaperh-ca unar-noi h:ilburari psihiee,
dl.tfll\ cnm~i cercetarile medinale au dos Ia descoperiren m1or
92
.... ,~.--
noi boli somatice. In Ot\:lUl. bolilor somntice, numarnl .:1~ Crlt:el:{f~i ~
dh).gnostice -a crescnr_pri n:. ( l} idc:nti~G~re:l. t1 nor _l~ l~_urn_n
i1ei(lentiftcat~ prin metQclel.e de diagflQSllc,precedente; ~~ ~~) pn_~
ace~sul lJUC\entilnrhl serv\ciile Inedir:ttle- (Wnkefiel_d. 1'9?.9). ~P ~
e~:e~w\n. nmlfiJ.ftl {I~ cntegotii 4~i1gnos_ritte ~1u b.ohlo~- Sl~~cr: 1:1 h~
circulator a crimcut cn.200%rtar cel.al srstemulUJ ,thgeshv .t
. . . . . . . . 91}0) 1. y'"'O-HY{J990)
cr.escnt cu i23% de Jai~D-:8{1 q _ a L: .. .. . . .
(W!lkcfield. l999)~ Daca aa11astl1 nnalogie elire co:ecd: ~l~n~~
~rt{ltiimcil fnct(llilcare till clus htcre:jlentll numnn)lmd?.c.ategOlll
diagpostice.pcntrubolile solllatice sii fie"Ili_spun~nt.on ptm.ln 7
cr~terea otU11limlui dr; cttl~gQI1ii dingnosttcil p:nhmtnce. L.\ o
n1l~lid. al:entfi, 1nsil0 naeasHi anal&gie- .esre. er~nala. ~fe~te~~~
nnrilan1lui rl.;: R}egorii dingnostiec in ICD ~stc-1 n pnnclp!tl. (hu a.
a 11~ exclnsi v) "ezu1ratulreeodarii unor cntegnri1 pree>d&tente nu
nutniirului de cntegorii in DSM-lV este msa m' pnnc1pal
l'f:ZUlratulad~ugirii lll,OI' C{llegorii noi (Houts, 2002')-_De wr:
dfi- Iun gul tim . nlni. din DSM s-au sflos i s- u ndau- uran
rn func~ie de presiu nile ~i sc 1imblirile ~inl:. Spr!!: ~>ternpln, ~n
p1imele editii ale DSM homosexualitatea ern o carc~on~
noso1ogicii iiwlusii: 'in lista tu\burhriloqlsit:ice. Sub 'pr~~Htm~;\
. schimbl!\rilors.i mijclil"ilorsociale aceasta afosr scoasli dm 0~~~1
frr'@ ramanand nsocin~ _en ntlbtidirile psihit?e numal ll1
ml1sura fn care este\ ego-disbnniqfj({pacienml o pef'c.ep: _t:_'.'~0
surerintii)(Houts. 2002). S.imilnr, mt~sturhat~n n fi1cutc:f1t1emu1
mediciria &i psihiatJie.cr~ ''baala"'sau.on factor impo~tm'lf io t.li-
verse pmbleme tnedica}e i .psibioe (~tengers t;i Viw l'leck,
2001 ); .'in sahimb. astazi iUt esre-oon8ideradi un emnpot'tament
. ''
.
.
sexual :;;nntltos i'n mi1sora 'in ca-renu se mardfesrn ego-tlismnic.
. '~
- ..
_ .Probabil ell psihopatologia~.aroueaza scuze multor oumeni C<lre
tul fostconsidcrn{i de.. a tungulrhnpulul boh1;Wi psihitt den~,re.ce.
erhu homosexnali..IHHl se masf~lrhtlu! 0 1\naHza concrern a
n)oduluUn ca1:e lulbudhilc de somn an njons 1n DSJ\1 Wat:\ !\~
93
... - . .. . -~ . ... . --
asemeuea di ap~~itia imornol categorlinosologicein D~1vlnu
este into.!~~~~~)~~ ~~~ll;(ltul cerceliU:ji fltiinP.tice. inainted!H)SfY.r~
UI-R, t?lbij~alil~ d6-sonmt~u aufast~ous1de.mtetulburliri p:dhice.
Ele. ntt fGst coi1ceptual.izate en tulbuliirfpsibiGe incepfihd. ell
DSM-lll:"R ~i au.fos.telaborate ca alBre In DSM~Iv. Dadiaceasta
conceptunJ.jzarearfiunavtlin@icaatl.wci attrebuisliidentiflduu
rezuJ [ate impolian.te il,e ceccetiirii ~tiiutifice asupm tulburarUor
de 30lDll din acea pedoadii (rezultate.crociale-cutting"'"edgl'! re..
search) care sa arate c:H. a~e:~tea SU11t tuib.uriid psihice dellili mp.
de .40 de ~ul u~ ~JJ.fos~ cobcepute nstfe!. 0 armliztl aliteraturii
de speciatitale atata eli aceste ~rezultate cruciale'' cnre uu
res~nuifi~t tulburlirileAf!.sol\ln ca tulbudiripsiliice nu au exist,at
{l:lolJts. 2002). Probabil di introduce-fen lor in DSM s-a flic~t
prin vot, pardort,adicli prin'consensutspeci.ali~tilor"..... .
!n p~us,numarul extremde.m<l1-e de cntegodino5ologice
psihlalric~ ducelao teudinta.cle pntologizare a yjet~ c 0 ti~iene
(Beutler QiMalik, 20QZ; Groth.-Marnnt,~20.00,).lntr-ndevar. o
succlnta exnmina.re a DSM~IV (APA. l99.it) va reliefa cat~g.or-ii
nosologice precum:
- Rroblem;U relatioQala cu parb:meml~
-Problema profesionalli .(ex. Jnsat1sfact.la la lo<;ulde
munca);
- Pn;llilentii ~coladi;
.-,.Noncornplianta 1;,:t tt:atainent;
-Neglijarea copilului;
-Problema relap.~mala iutre frati;
.-Problema reluti_ollalaparinte-copil.
E~aminaud a.ceste oat.egorii .nosologice. se .pat:e cii viatt!
normala, tara pntologi~.'inseatmlaconditia pdma,radinroi. Ea
nu mai. poatefi gasiUHn lumcniu.::are \l:~lll.c Viata pare sa~o
mare boaUi .sihidt! EKe.lllplel~ prezentate tum S\JSrelleclii prtl-
Jlcme de viata, a esea care f;in de domellittl socio~nmral, dur
iali1 di eJe sunt considerate actun tulhurari psihice. Dcfapt, daca
94
retinem acest exemplu ~i adaugammo~upg care se. define~;Le
tlillburareapsibic~ - -tl!odificadpsilnce ~il~mu ~Ottlport;:tm~tuli:l.l.e
.~Qciate cu o stare .de dislres ~fsau disabilitate sau ~ate cresc.
rjs~ulsere di~tres ldisabilitate{vezi DS,M-IV~APA, 19:94)-,
observru.n di.estefoarle gteu 'Sa s; evire incadrat-ea.uhor pt0bleme
care exista lli mod{recven.Hu viati\, inJP..u~categoricno3'oiogidi
psillia!-fidi. indefinitialullmtarli psihice dl{:ivatenneni sunt a{ti.t
de WJ.lblgui: ~rtclit.utilizar~a Jrr deviue .P"eJ:iculoasa ~ifi~care ne
pt.ltem treZl ca am pulea p{ltriviun ilingnos.tic psibiatric. sn
nt1.afu;atn ac~ti tenueni.
Modificare psihicii qi coanporttmaeutalii. Cfit de JUO
dificata tre.buie sa fie nwi:litica.rea peul.r\.T. a ielli diu sfera
uot.mnlitatii;t Cilnpldiscut.linldespt~moclil;leiid laniveJ biolt1gic
lucrurile sunt mai cl~. Aici se po~st@.ili8Lati.sticmtwhiteliuiile
in care Un pru:run~tJ:U. ppate.Hii varieze, dar sa dinttiliU lOtlt!ii in .
lbnitele honn;tlitii\ll (~~i ~iaid pot.in t\Parliunele excetl\il). in
ceea ce pdv~te aspectele p~.ibologice !fi comport~unenlale,
luc;rurile.sunt ins5,Joartecomp1icate, UnJ!rimtd~'lu cure a
fost propus pentru a.delimitauonunlutde~tnomml-(pntologic) i1
fostcelsta&Uc(Delay :;lPicbot.l~Sfi;l971)~ Cbl}fonn:acestui
crfieriu, nonnEirins~mnn.eeeac;.e.aproJtitnea-zti t~ediapop~latiel
(~eeaoe fac eel malmul\i.oameni).D~i Wletite.iiu util,-ncesUt
uu este satisfiidirorde unu.lsiugur. Probabil ciiel Jlllll.tfunctiotm
eficient nici macar in.domeniul biologi.c~ Carla, spre exemplu,
este o pYLel1t~ trecveum 1& major!latea popma\iei, ft1rij'Caace;lsta
sa o. facit stare d~ uonnalitatetApljcat id domeulul psiho- -
coll1porbunental, acest critenu are probleme se~ionse. Spre
e:r.e.tllplu. pt:obabil a tu Bvul Medi.u, -un sill degandire i1on.nnl
!li non-patologic em
acela.-care cousideraca pamt\.h.t1.ll~ste plat.
iar un stil de gandire patologic. deJ.irai.ll, era acela care sust i nen
di pam{lntul esle rotund.L Ald:uilea criteriY ptop!JS peHlru a
deLiuuta uommlitalea de.anonna1itute este edtedul cultural-
ideal (Dealy ~i Pichol. t955; 197l). ConftJtm acestui criteriu,
~ ...
. - c ' 95
 nonnnleste ceeace sea~reapUi afi nonnal iutr-osnciemre. idealtt
pe care gmpul.social'i1 stabile~re uentr.u star6n de sani\tnre.
~adilr, ceea ce .este considentt uom1al fntr.cuncontextsocio-
. . cultural, poate sa fie eonsidernr. patologicin alt contextsocio-
cultnra1. AI b--eilca citcait este eel fmtcfionol(~lay ?i Piehor.
1955; 197l).Elar~~a;t:a noEnlalulinseamna capncitatea dtla-li
nringe scopuiile i-mportante in v:fat~Lfilrii"'a. inter.fer.a ct
runctiqnnliratea celuilnlt. Asdj~i. normalitarea este ddinitiffn
pstlmpn~Iogie. inh--un ~ndm delimitnfaprotlimariv de cele trei
crite~i ?Jenti?nate~. cu nn a~cent n1ai pntet1Jic pe crieriul
{ funcponal. .6-f;ia:dar,. dupl\ ntapfi ,ani .dlb'- cercetare, no.ooalitatea
{
t~~:l~~~:::~!:i1;:~=~:~~:l~f~~:!~:~~~f~~:~;!:!i~~~~~~l~
1- ~is:tt~ ~1-disablfitnte, !? tiropee torm~nul de disnbiiitate
~~ ma~ cl~r ~efini~ ~incapa~i tqre"func{ionalK),. stras-ul'i distres-
~11 s~tn~defintte mattmprects. Stres:.tlleste o pre~re_nta corratanHi
~~ vulfn;no.nstd: Bl este unu14in filctodiinrportanti-pentntviatii
~lmen{me&"et\ ~ (S~lye. 1976)Wistres:Ejfin sc.himbeste definit
caun str~care~reconsecln e .. ibolo ioeibiologicenegarjy_e
CS.elye, 19~li)._Dar unda e~te litnira intre stres. qi distte:;?
1?1ferentu d~e at:J'eS.:jJ dJstres c.ste cantitntivli san caliri}Uv!?
--pml~epntologm r;m pmnte TaspundSnc8 r.iguros ln acesre j"ntrob1iii
(Ellas.l994; LAznt:os . l99l).ftrplus. Etdcsen distinctia dintre
~fr-es-ul ~~~~!! (eus~rcs};i distres se faee a posteriori . ndica
.. Lluplt npan{inef(!cteiorlor,Dacli efectelele.suntnegarive ntnnci
str~-111 t:Ste i!ll~trpret,at aa distr~imt~acii efec!Cele stint'(JOzirive
stre~-u1 est~. lJttf!rpretat Pa.Ellstm!!-. ~adar, acea.sradistincfie-
' ~~1st~ v~. dtstt::- llUJl~tnc~ vnloare predictivli sau,explicativa
~ doartJ.rta cl!lstftf;nt~l"Je<,-n posreriori:;.. . co~. i(iilefncare ~tinl eli TtJr)si~qpllt'?lag.ie.~rliUlmf}niJd 11U ~sre
... ~}p~c sp1;e dish:e~ "i dis~bilitf.\te. Acest element ttl
d;f!~~ttn~e~terlnttl.co~adev:tratporicnlos pe1ltm patolagizama
VIO{It cotn'IJ.en~. Ce inseamif dsc? R.ise IltsBtunna pmbabiJiraren
de a apiben tevu:negntiv. Prin definifia tulburl'irii psihice mni
sus rrtentionilte.risc'i.l} presupune predic.tie.nsupm lparitiei slttrii .
le distrcs~i disatilitate ~i sugereaw di noi~ p.silloparologi i, putem
face ncel)sta predicti~~ Slltrebarca lle care Ltebuie sit(} tJUnem
1nsa es.te unualoaren~ esteunl\"atament hazar pe ncest okiY!I!nt
tlisc{spredistres eyi/sau disabiHtate, justifioar in.cnzu~ip.cnre
l~ilci~nwl ma are 'inca int rablonfclinic mas\\fcst? Dafe;)&,~tiintifice
pe cdre1e .avem tn ace::;tnJornenl: ne ru:atii di N"'Ll. nu este justifi_!!al
(O~wes, 1996)., Predicpil~ ,\)e ~are le pt}tenLface privi..'!.d
, de:?,voltarea llOOt viitoare QTPbleme psihicesunt ex.trem. de i 111-
precise Yn acest moment.Chiar cunoaclind factorii etiQlogici de
-risc;(ex.. favod:z.ap(l . p;;;cllspoznntirderenninan\i;declan~atOJ;i)
~i eventualele cnracfedstici,@le Il!~dililui pl!CientuhJi.
prohnbilitarea de .a faceo pr~diptitJ:, aot1rat~ nsug:r~ dezvolfarii
uno~ tulbudl.ripsibice ~ste e~tteii\ de mica (Dawes . 1996). .~
'
Pro~abil cil de7.VI)ltih:ile S~tiintifice vlitonl'6 ne 'f'Of oferi
(~tmine~elJtm aJace predict]i mai precise. darnu esre cazul
sa crede~"l Ca pntenJface acum acest luc:m. l)aci'i cineva .S~lS{ine .....)
conlrariul, prob_abll di a~cunde foarte 9ine llarele emrJirlc~ pe
baza cliront 1-'ii bnze.aaii icJeen! Pentru a prg!.mJental1l muichw
~ceusta concluzie. sa. n~focali~lim.pt; tulbvrliT~,psihic:e presnpuse
a avva o componentll genetiga ,pm~rniclL Astfel, chiar
pr~upunfmd cl.\ prin consiliere;~eneticii Sa .esimenza Ca cil\eVa ._e
nre'unrisc pentn.1 a dezvol{a llchi~Q.[l'!i:nic de 7~%. tutt1~i nn
put~m fi.siguri cl1 U.\lludi:vid .::u acestris.c va uvfia:sc}\izofrenie
pepnrcurslll vis:{ii. tn sj;himb. esteposibilcu u11 it1divid clann
risi.7 calculat de 2j% d~a dezyf.)ltll sch\.zofieoie~ al\ nibl\
sch~2ofrenie pe parcon;ul vie~i.i. 10A:Jadnr,; pt:t;dictme noil3l.g!
. .$~sti~ennS:.'l eX rima Cll neoesitate Jan;velul jndividului. fn
n~li11inistra( unui "paci~TI ~tatistic" ..P1.nml! fl8Cientanulf\t slat\
nc~ste trat~mente au l,li .a m~l .me de e:fuGte SttCU 1dan}(Kapl;;;;
~i ~pi<}h . l
,, ; .. a oc ~ ~i coh)h.,2002). este evidenta problema
etiQa
..
in jtlS~1ficaren
.
adninistJ:li.riiunor trannheme pe baza unui
97
. ".-.- .....""....,.,.......
 ris~ calcula~ de a dezvolta o tullmrare psihidL Pe aceea~llinie a
?rgumenijidi:ideii t:;ii in psihopatologi~predictille nQ~Jre sunt.,
uu~~~i~~.}~~~,~c9estmoment., un altaspect c~ trebtfi~'alstut~t
e~te'pr~i1~c,\fit;f?~h;azuun~ ~uaUzeiclin.iced~taUat.e?lls~pun;
~de.'!,e~ cap~e~IC\!aiacuta an unna uneuunhze climc.e (ex.. Q!:in
mt_:Htul chni_9 esle:mai precisadecijt o Qredictie statisticaJ:!e
bazl\ includerH pacientului1n auu.witedase 9i c-.ategQ[ilinu.{ma
.examit1fuii CU anutuite teste psihologjcesa.Uill1.l}]113 \UlOftlflafize
'. ~-
2emografice- diagnostic stati~tic.: {pentrudetalil vezi Ffa~.
. ~
1996). Ll1 primi!vedete acea.s1'i1iio~a este Ull;t reiouabWi.,
Printr-W"l diagnostic iudhr1dualizat cu ajU{oml iftterviuluiclinic.
pulel"!lana infonua\ll.relevante.:;;l detaliate penttu pacient. neac-
cesibile prin alte metode. info:auatii care ne pot ajuta apoi in
predictiile pe care lefacem comp.ortameutu.luiucestui padent.
@jire exemjillb o testarepsihologicli nepoale sp11lle.di padentul
no~tru are un coeficient de inteUgenta 1lle9iu.pdn r:apoitare la
etaloll. La 0 analiza clini .. a. ac .te . . . .I oate
dobaudi st::muifica~ii noi: ( 1) pncienluleste uu1i inte ellt, dnr
este e.x.trem de anxios la testare; (2) .pncienlirl afost u1aiirJleligent,
dar ca unnare a un~?i trawne cerebrate s-a delerioratcpguJtiv
sau (3) pacientu.l a fost mai putin inteligent. dar C:a unnarl! a
unor programede il1Jbogiitirecognitivn aevoluat u~o~ etc.Tbate
,.,.-. nc~te dnt.e cutese prin a_nalize clinice n~\,lc un bagaj intpO[tant
(
de infonl1Btii fat11 de di!lgnosticulstatisti~ infomllllii cu~npatellt
''
ne pot ajuta in predictiile pe care le )'OUI face,des,pre .
performatttele a cestui pacjent Pare evident, dar a~ a sa fie7 Ce
ne spun cerceUidle7> 0 metaaualiza sumarizaud rezultntele n
peste 45 de studii (Sawyer~ 1966) a arlitat clnt ~i iadi dr~pt de
apel di aceasUi ipoteza este falsiL Un diagnostic clinic
pnrlicu!Einzat paclentulni"-nu estetnai eijcl~ntdectlt pu 9lagnos-
tic sta;tistic 'in prediotiile p~ care le J_:mlem. -fnce asupra
comportamet1telor pncientului. Ac.easti:i concluzie a JQst
cmJfimtat.liin mai rnulte metaanalizepublicatede-alungulanUor.
98
sururuizand rezultatele -nre.ci de stu~ii (ex~ Dawes ~l eolab.,
1989; Meehl,1954). De ce.se dovedetepi:eijietia slutislicli eel
pu i u h\ fel de e.ficientii ca redic ia clitti,:;~ in ciuda.ru:te taril;r .
coutrru:efYuadin e.xplicatU estecau1etodelestatistice uutihtsl el
Conuepute indit sa poaUi evidenp.a I.Jl}.ttern-urile e:.tisteliteintr-p
colecpe d~ date ili,ncolod~ z;gomotulliisennialuldish1rsionat"
nle aces tor d~Dn'Yes, 1996). Onnteuil, pe dealtnpaltt:, fie ei
~~ cliul~i~ni prof~si?ni~ti. pti,nX~s~~ a~tc~ra ~or~e~ni~vli a~
dificultatilil a oombmamfo,piapt calitauv difentesaumdtcaton
rar. asociap in viata de .zi cu zi (ex. fre~'Y'ei'li-a inotului 15i
perfonru.mteleJUanagei:ialeo 11tiut Uindf'apb.il dtadest;tatnl:,l:e ac~ti
indicatori exism o corelatie' pcttitiva, setfiuificativa stl\tiatic) -
(Aud~.rnon, 1990). iu consecittf.i. adeseautil.itlilll sintetne de
decizie descriptive nu normative in p~~~c\.iil~ pe ~areleJacem.
Ast{e.lde sisteme de decizie .descdJ?tiVe ne:dir;~orsi.ouenzii
preidicVUe. Spre ex.emplu. doua din c::ele <mal C.Utlo.scute
distorniuuisunt introduse de .accesibilitateatti .ir!p.lJ.'2'eilfntivi{Jlt:ea
informatiilor (pentru detalii vezi, lll:aJluel11an ~i Tverskji .1972;
Tversky ~i Kabneman,l973). As~ aqtW~aincent prediel,ii.pe
bnza ioformatiei nccesibile la un ru1unut mom~t. i-goortbid
hJoouaUn care nu este accesibiHi inconte b.ti at dar care nr fi
.os.t h.npo..
. ltllitta...
'.
tn P. .redie~..e. Pe de t11Ui parto 1 .Q~ca'cevn-este
' " --, ~-
foru:te. reprezeu.tativ plllnttuo categori~ nceo~mnu tQseaumltcli.
-acel ceva. esle ifoarte probabiL DaciL spre.~etnplu, se iuezii'ii.it
....uroJatoiueledouaafmnatil~ .
f.. eieJunmtoare;a fiioutcanc~r.la pliimaru. (m~op..~. runn
- 0 .:l)e.m.
pul.monar)
. - 0 femeie a fiicat cancer ln pllitnihd. '
Majori.tatea. subiectuor afmna di primul e.venilllent estetuai
probabil dedit eel de-a doileadeoarece siutagma "o
femeie
futnato!lre"esle mal rep~ezentatbti\ penll:ttc.ancet'Ull~ plamftni
dedit siotagma ..ofemeie". Desj.gut~ o anali'llilogidillmt!l. e-vi-
deu( di a d_oua shun tie este maipro~mbiHi.
99
--------
 - J.~.~~" ' .iir!ft~{i!~tzlillit~1iidrlnn~rtl~(.~kt11olQgtc itej,~fil
'8;~tt/!~5'~~~~~,~derl:~vi .... ; " ,, ....... ;~. r+:i~ .
~ ...... Ad~i~~~taYiU~f!aui~li.dilig'1~sric nosologte P~ll~~+'f!Jc
~~il!~~~~!l?li~Me 'de JttUtn1atol: rez~it-Jt~ cliu testa~ l\silu~lo~dt
~~~~tnl1lca~attilt'0i1t~lle ps~t,~}p~e~ au HJ{I~i~~m,te.4ir~?Cl
~\,\1Ba\t~lii~cn-~a~reS'i~1o~ m6&ih~Ie (Nfey~~~i~pJa~:d~W 1:
p~~dl~~tiivczi~lf!Y~rh.~~~~:~~lilh, ~001). Bin.~~~~m~in !
~i~l~~.fa,tt~~JJt!:~i~ e~tti?'tl'~~ilisM.l~rit~l"'l)si~ol!>~o. ti'89r9s. J
~ ....J!

'~~~~t(.l~i~t4q~t;f<seQ~i~t,.~ta~t~ drl,~$~~~. ff;~~~;f!'~?"

111r11 . it.i!H~!i~~~~,til!:c (I~~eh>~.uAstret:;'EI~nf~!<J.~r~~l~b.
. '. ; ... s:9t~~~~'fft.lJJ~~t.criti:dit$i. ex_tensiva:~~S'iefor
ti~~itti~; ~~~l~~~i~~:j:;~':~~:s::=::.:~~~tl
'fii11i~pd ;d~ r~~~~)ps;bal~giclisi~'da:Bi~ninl
;t.. ~lif11iJ:;(: .~.l}~e~!AA\~k($tetneatrimJJ~hH:e}e
; m1tFn~ .g~qg!~~~J1.,p'*al~~~ljnipii:.(Jcllriro~feldilJi
1~:~a1f16"~~ ~~~~-e;~i illsr~~~nrnrDP$in~I!gic
f : .n~l$e .. ., . ..... . . ~~ ac~crn~1il~i\:;I~~Jgpp~are8conilor
.. ''~~!\i'i;ifr~il$~ii\l ~~e>tpfi!Sie a:df.rioJtitt'ii;etcetllfi1ar

.':::z~~t.~
:: teot:~trc; "S'tiiiittfif'dizlftJ'".!if ~tnion;atg; :a~N;,QC .!~st 2R~iJ10Jijgic
(Anasrasl. .1958.;. '4ess~cJ,:_ J~S,.Q). ~J#e ~~~J:lltt, dl!$i .studiile,
:. , . dt{~~l.Qmeimp1wtifaupertathtr1i~jadan1eniulclln;c.:a4'l.t.~uh.
~

~ aspeeiteorericcftt fil aplic~Uv '(ri\t":i:J; ~UOO; ~c;l~~r~:~~i ;TnlVing,

1994). mr aycm inc1ic't~ t~~t i:l~''ii1etilll}!ie iQ)p{i~i~.fl1 ciuda
~*ite~'el1 1ll)~nn:lit~fl)ilS,e:~utti~(~X.~ltril1}e;.{~~~ ..de'.;tnel\1orie
;: h\lJllaii tM91~~~i1~rl$'Yi!~ ~f.~t~e~~~J\o tn.gien, .t~)~~'"'P::.m~ni~1rli . .
.. as.~iinlffttb~tltl~~if!'il:ak'mfilisifiirli :4f!''l1ieilliamenre,:sia-.,.
t~~~~-itu:as~a,~~~~stti~'Zffi.,~fi;~a/.~eti~lri't'.~i' i~i~~~.a
sistemlllui mentfn nl1,histii1nt~ti~rpQihofpgfc adesea depa~it !}i
.,JIOQ.

-:.
.; . .. . ~-
.:-~--

~ -~ ... _
__.,.,......... ~.
~ue~~.n.i.~J~~~l_(Jfcdef;:ns~ ve ~u con=?tie~tizeaza ~cesi)il?{~,~~~(3)
u~dt~.~~'+..~J,~~~!eaza (d~1 diverse motive care uu tiu dl;pafologiq .
c1 de u1Lerese ec~n~nu~ spre exe~plu). A}getsvus,Jn groput~ .
. eelor_:-~ ~par ~a probleme psduee in unl}a unei'astfel de ,
,~v~ll~at? psJ1mlogtc~ a~e~1 de fapt eel pu~u doua categorH de
l:ldlV~z;l:.(l)~~ll~tO~l p~dll~ ~l(2}cU osanatnte psiltica iluzorje,.
~:1~trn ~CeJ?h~ dm U~lllRO Ullerventie tJSihoterapeutidi.-nr putea
.' mlfla1sa amplifice stre~ml \li psihopatologia, caut1nare a abnrdudi
~necaJ~i~m~lor def~nsive cme au asigurat p sli.niitate ps"ihica
Iluz;~JJte. Stgur. Ia ceea. ce am spus lulli. sus,. s-a( p1;1tea .aduce
I .. d~ua conlraargume~te sulide. Pr.(mulconfi"111ll~umentat fi acela
en aceste scale de JiUtQev.aluare nufost:;erlos vali,te. A5trel
pe b:U:a 8corurllor otitinute la aceste scale (p~f!di(!tori}se poat~
pr~ZI~: un specl:tu la:g~e !ndicalori psiho~com,pertameutali
( cntet~J) ..E~ ou spun msa ca aceste scale nu s.un~ valide.. Spun
doar (veu ll~ ShedJer~ic?Ja.b., }~93) cavaliditalealo~p~djctiva
cr~t-e. atuuc1 ca~1~ scorurlle mdica :psihopalologie ~J.fll~e .ninb.igua
a~u 1cJ. dind sco1.urite lor indica si:tnatate psihidl ~t'.:ltistic, :acea:;Ui
SJ tun(:.t(;! VU atC.OU8 coeficlen!Ji d~'Va)jdi~te [1fedjcti va. dar HU Va
.. elliui1J.a seii:mificaP.alorl Cu alte cuvin.te, v~;~lldHatea p~edktiva:
j
n ncestor seal~ ar J?Utea ariit.a bil~e. ~ilr validitat~.cotu:;eptt1a.Ui
.este problemnhclil. In plu~, mecanJSt1Jele defensive care rute:J:"eaz.ii
si::orudlela aCestescnlepotnllera=lj sconuil~Ja.~tiLeriu fieel
subiec.tiv sau compurtamental, lntr-adeyat, cerceUidl~ ati aditat
di atuuclc!lld sunt l!tiliZI.lte critetii cm-esunt mu\ greu, ixlfluental.e
de: mecibusme defensive lucrurile se schi.\llba;. st:ddatii. c~
apfu:eau ca fiiud sanato~ipsibicla scru.ele de nutoeValuare av.E!au
~m1~ mare pro(Jabilitatea s~iaiba tulbudiriemotioIaJe ~i psibice
J.n tnupttlluptelorl (pentru detalii ve:d Shedler ~.i co lab~, 1993).
AI dm1~a cr;mll-aa.rgwneutar .fi acela disc::aielede autoevaluare
utilizale pentru B. evalua saniitatea psihica au jndlcatQri de
~uiuciuna cu ajUtorul dirora puleni ideL1tillca indiyizii c~lfe ne
mduc i'u eroare. Dirl pacate cele mai multe sc.;He utilizale pentru
a evalut~ sanii.tatea psihidi nu au scale de ulinciuua, ~i cJiiar in
102
.... ..
'
cazulcdor cate au. llllilim dac:;atu~canlsmcledefensive uu au
alterat Iii s~prulla acest~ sCale;ln plm;,t;<;t\leledenliucimJasunt
bunp1~ pr.hlc~pal it!.a d~t~ta.iu~lviz;li {;nre suiuilenziinuaUlt pe,
ceicareu!ilizeazii mecnnistne defenslvel A~estelimite ale teslt:lor
psihologice pun sub selUnul intrcbudl concluz.iile .umltor
cercetmi diu psibologie C_ru:e =:IC IJa~azii.Jle Utiliznrea t\llOT scale
de autoevaluat:e.Spre exemplu~ psillologia pozitiV'a a ~ditat cu
s~nata~ea psih~di. defin~e de.. capacitalea. iudi~izilor d!! n
distorsrona reali.tatea m favhm:ea1or{ftlylor,.1993) 'Jntitntl ce
un sill realist lllll"e sa fie BS,J.X;ia.t cu pr;oblen.psihice{eX.. t'-tlbururi
depresive). Trebuie.ins9.sii.tneution8tneainc~uldepi:esleince.st'
lucru este vruabil doi\r penuo o fbnna deiutensitate.U!iUnr.iL ln
cazul m1ei depresii,de.itttensitate medic ~nu severastilul tle
gftmlire nu mai este realistci distorsjouotsprelaturn uegativa-
seexngerewza Bspectele uega.ti.ve...Rnpqrtulcpgrdtii.poziti-ve ver-
sus cognitii Jtegative in, ca:z;ul nonua.litii\Uidepresici ~~oare/
r~speetiv depresielniedil-severe este de :i la1/ Hal/ respecliv
lla 2. Prill prisma eelor discQtate 1li,ciapeste rezultate pot tusn
sii fieinterpretate ~7l altfel. Studiile .de psihologje pozilivn
utilizenza adesea scale. de nutoevaluare.. A~adat. f!.._tup~i de
illdiviziuormali COllpUe nt,tindivi~ JJOrtnati cat~ilndivb;i CU 0
sl\natate psibicailuzorie,. a~tia.diu Uflllii.justificilrt~l'eZUltatele
cnre ru:ntli. di cei cu sijuiitate psihlcli ~"aluata .cu ~cnlele de
nutoevaluare distOrsloll~ le~litatea mai Jnultdeciit cei cu
pslliopat~Jogie (ex. tu1~urare ~.e.Ptesiv~ m~Ybdide iat~ns.ilate
ttljmu.-ii). In ~este comli~i, rolul ilJ.l~<lf: pu~tive en' fnclOri
protectori alsanatli\il psihice arputea saf.i~ sbll.f?le ru:tefl!cte ere~
ale prin utilizare net-eflexivil- auU\lLinSt)]JJ))el1~r psihtdogic.
Prubabil di studiile viitoare vor cla.riUca cat ~te iluzie din
nfnn1atia di i.luziile. pozitive :mnt factori protectoti. peutru
sanatateapsih.id\ ~i cfit este~-ealiJate (pentru detalii~i informatii
suplimentate \1 ezi Ackerman ~1 DeRuheis,.l991; Sltedle.r lli.
colab . 19~3 ~i sec~iu_u.Ue 3.1:2,.3.; 3.1.4,~. ~i 5.4. din nce~'il
volmn).
lQ3
__ .. _,.... '"'I

O.a dowJs.itwlfieinteresandi (pel'itru deram vezi WaJ:!;qn eyi
P.~nnebake1i,1989} este aceeain care s-ainvesrigat relatia dintre
distres .,-eya1uatcu sca:'le d~ autoevalunre- ql siU}ptori1atologia
somatidL.Scal~\e de auroevalliare a sanatatii psil)ice, respectiv
n I"everSl.\ltii-ei. srarcade distre.s;indiferentce aspecrevalueaza,
co.releazi\ ~tii.tdepu~en1ic intre ele tnditincarcii un singur factor
in. nnalize1e factariale. Altfel spus, siinl\tatea psihica, respf!ctiv
rpversuLei. staren de distres, sunt considerate construct~
multidhnensionllle. Cer~~taril~ au arittat cl\. salelc J!p
antaev-altUlce.n cdi.stres;.llltli coreieatii .uremic qi senmificati v cu
-scalele de autoe"aluare asimptomatolo lei ~o atice (Watson
Jilliennebala-.r, l9B9). e e e& cercetarile. au 1lrlitatcli
scalele dcl{utoevnluare a sim tomntn1ogieisoma c('; coreleazli.
ermc ,~1 semnificativ en indkat()rii obic:ctivi lJ..!
~ strnptomatologiei somatice (Watson ~i Pennebaker. 1989).
-coroborlirlCl a~~te doualfuii de certcdid. uuii autori s,-an gdibit
indivizHor considel"ati slinato~i psihic este nn fa~~or d~
1 traintuitive descnse mal
distorsiune cure generaza re2.n 1tat~ e c0n . . ~. . .r
S\lS PJ-ezenta acestt\1" ind\vit.i CU sanatate SlhlCU. I}UZ.OflC ~Oi1 e
re.d~lce semnific.ativ corelatiile inverse el{isn:nt~ inrre sannra:.~
-~~]~ ~~ . . .l"tii~ Cl\
~ scale de nutoevaluare tsnnptomntolog._l'
~ .-aces~r }u"ru
.. ,- evr.l. atli lrin incticaton. obteCllV1, t.
estc_,.
somauca ' if 1 -resent a1
sus imu de stndiile care nu ariitat c" un Ul ve (.; :--
~nismtlor de~ve de ti negare (care generea~~ o s~~~~~a~~
pst iclfilnwrie) dtlcc a. t'ln activ_are fiuo o tc crescu .
tulbnrari somat {Pennebaker fil Susman, 1938). .
l .3.1.1.3 Diagnostic. nas?logic. dese:riptl:"' ver.su~ ~:;nas
~ tic nosologic etlopatngenebc.. 0 tncre~erur~ ~n p-.:. o~~ . .
tqointe de K:raepelin. diagoosticu1 tulburl\nlor psdu~e ~ fo~t
'In haos.lsaac Ray i-n cmninuatpe ~quiron !l~ Pine11n d~stl~Ctl~
diotre nebllnie [includnd mauia ii demenna prn~~~, (a~t~z~
schizofrenie)l !ji deficienta m~nral~ @ncluz~nd ldlote~?la _lil ..~
inlbecilitata.a).s-n neg;lt'itlsa eonsmnt in aceast~ :pen?~da .__,j

sltle considere ca dovezi ~;lle modeluJui ,llsillOS!Jm!lLic-facrnrii validitatea unor clasific~ri mai sp~cifi~ ale (1.l}l:l~ra~J lot psll~ce
psibologi~i au roletiopa!ogenetic to t!l~~urarile somatice. Diu (I~i1 1l~trom~ 2002)~ Krnepeiin(lB96) atnoerc.a.q;~ fl~h-~e ntd~lul
plicate ioslllucnrile :mntn1ai complicate. Cercetarile lllterioare rh.ei.li~al desctis it~ sec{iunea1..2. ~i tulburl\n.lor pst\nce., nnmte
. na,t at~ tar. 'i!J~r-Lln mad .Sl.lprimatot, en retapa directli c:linh:e di~tres de a continua, treb11,ie i}T.siL.sa elim,ttli~ in acesr co~~e.'ltl, o
~ evaluar.prinscnle (.Ie nntoevalnare-f}findica,torii obi~cUvi ru . ~ir. acare. eXJ.stll i.n lirerat.tWI. psi}ll:\p~.to.,,o. g1e1 (ex.
., .,, t'.
concep 1te gre., . . . . .. . . . . 1 . d. . r cu\ .: ...
tnlbud\rilor somntice nu esre sistemntica (penlm dtalii .vezi Sa~:t\stm ~i ~nrason, l 999)" }Aodelul-tne~tc~ ~~ loagnos .'
\V~l!lon.:Ji Pemui}l?lWf 198Sl.) .Alrfe1 sp_t~s. de9iA (clistres-ui eiiop~rogenetic nu insean).nl\ un ~ec;luc~olu&m luomedlc.l'll;
evalllatpriusca]edemltoevaluaf!!).co:relfi1li.cttB(siptmt1aQlogia lGac[lelin n ir),\eles prin mo!iel {nedtcnl, unmodel 'in.cnr? boa1:~
sof!lnticaeval.'tatii.pri.ns~ale de ~utoevaltlnre} i B cQrela~a en -
nreariumitetntmifestih:i(tabloulclinic).ca~rze,(~ti~logte)!lt_:n'!actu
C(sill\ptomarologia ~onl~tiblifvalutlll prii:rindicnlori obiectiyi). nrogenerice (veii Sef?t\~mea:1.2. a aces~etlucr~rl l: m~camsn~ele
nceasta 0;~ 1nsc~mlt en ~i A co.relea:zliyu C. Varinta comuni\ ~tiopatogentic.e nefiind doar biomedlCale. Cl !il p~th?SOCIOl~
dintre AqiB nn ses~trrra.pune cu varianta con)tma dintre B ~i C {Killlsrromj 1002); tn consecinfii., primele propu~er~. at~ !ul
de~i 'B ~i: C &e presnpune .cl\. tnl\soar! acela~i lucrn! Aceasta I.... .'. . -1. ... "llfo~.r
u-n~pcm.. ". d...e .n. . . oclasifioare
face . . a.tu1bnd\nlor.
. " P.s.1h.'ce
a' -
pnne sub sentnnl intrehli.rli .tante concluziile ..mollclnhli (nosologjcli) ba2.atll peffiiliatoge~l de a evt tn ~ln .. Hignos
.psil~OSQl)lntic .pazate pe rezultatele '?btinute. prin uti \ilarea tic ;rzosologic descri}ltiv, bazal donr pe ~erLlne_ ~' ~t~pt~m:
pte.pond~renUfa sc.nlelor de autoovaluare.Probabildi din nou, {Kililstrom, 2002). I{r-.iepelin s.i-n oat seama en tlm pncate ms.a,
pre.zent.n nnui grup cu sana tate psihicll iluzorie fn cadrul
185
104
 cuuo~tin~ele limitate din acea perioada despre etiopatoge.uez&
tulburllrilor psil1~G6 nu ii permitrut sistem de clasillcare ai.~torn
bazat ,P~:~!f:cjpj(9$~n~za. A~adar, incerdind din u~u sa ~Ji{~,~~ ..
diagnostic nos{)logic descriptiv,a ao\.\a propuu(.'!re a lui~l.l fost .
penln.t u Ll sistem de clasificare bamt pe evolli\ia ~i progn~sticu
\ (gr. prognosis-a llli dinainte . pro-ioainle; gigno:Jkein-n W)
Lull.mdlril (Kihlstrom, 2002 .. Kraepelin conllider~:t cif cee~ c~
fact>; capsihozele inaniaco-depresive sa fie sim.ilare intre ele ~i
dife1ite,de schizofreuie nu. se reiera atfit de molt la simptOJ,ue ~1
sem11e cat la evolut.(e: p~i{IOZele rmtllittfU:-dep.resive tind sa se
nmeli~reze pe cfind schizcfn~nia tinde~a se agraveze (Kih1stmrn.
. 2002J Ace~s~a a dou.a propunere at-e iosa o problema mnjoiii.
Un d1agnosttc corect poal~ fi fiicut dmu: a posteriori, dupa apru]\in
~i eyolu\1~ bolii ~i a~~dar, elnu _ajutii foarte mult in procesu.l de
tt:atament. Deoarece ICIaepelin(Kraevelin lJi Diefendorf. 1907)
~1-a baza~ acthdtatea ~tiintifi~ p~ asumptia eli tulbtuacl similare
s~ e~ prin~H ~rin shuptoUte ~i se1n.t1e sinubu:e ~i a.u o etiopat0ge1)ie
sJ.mlladi, ~~ deoarec~ uu putea cunoa:'jte clar in acea vreme
nspectele de etiopatogeneza o. ttd.bw::arilor psihlce, n acceptut
provlz.oriu uu diagnosticdescrlp~iv.. focaliiat omnai pe seiuue
!li simptotue. Paradoxai.. iutentia tui .Kraepc::lin de a evitn un di-
agnostic descriptiv a dJ.Is tocrnai acolol Problema ~te ca piina
in ~ilele n.oasne diagnqsticul nosologic psibialdc a rantas llnul
descri.ptiv. uiUi.nd angajamentul etiopatogenetic ante.dor
(K.ihlsu:pm, 2002). Acest diagnostic descriptiv, de clasillcare a
semnelor~i sllllptonaelorin diverse categoriinosologice, es.te
tuml prqulemnlic. Clasillcareasenmelor ~i sin1ptomelor se poate
face dupa c;tiverseciiterli (in priueipiu o iufmi~tel)~i nu putioe
au fost cazurile in care. s-.au construit categorH OJ'i s-au ,s~os
calegorii liosologice din gh.idurile de clasificrue. n li.tlburariliJr
psiliice pe baza unor criterii instituite sub presitiue .sociala
(Borges, t995; IGhlstrom, 2002); cazurlle masturbiiri.f lli
homosexuaHtlitii mentionate autedur suntilusl.rall ye in acestsens
W6
(Borges, 1995). ~e ade:vllre.linsii,.cii iu ullimele edi\ii a~l
(ex. DSM~IV L. APsyA. 19~ incearcli.gi\sirea un~ cri~i
yaJldate ~tlin\illc de clasificare a semn~lor ~is.iroptotn~~. DJ_!!
plicate seiguorliinca dlagnosti,cul ~ti~patogen_etic.ln cott!leci.nta,
~ cunoa~terea uoastra rlimftne ln ni~~l:ilescdpilv.. adesc:a ;fiit:'li a.
~unge la.nivel e:xplicativ. A~adar, ~~ ttntamenlele a(\tnuuslrate
!li elaborate pe baza unui diagnostic descriptiv au uml. pu~n~
11anse :sa atace mec~misme etiopatogenef:ice re.\evanle. fimd
ade.sea simptomatice._ f.
@ Problerne ala. Psilr.oJJUiologlci c~ m.odaiUiifile ..
de intenren(ie i tratmneut. . .
Problemele fsillopalologiei relbtltoare la modU11n can~ se
face trntamentul tulbnrru:ilor psihic~ sun.t dese.tisc in cele ce
urmeazl\. Diid.i tra.tm.netitele tplburl\rilor .J:1~'~.i4ice sunt eficiente
lSi valide ~tiintific attUiclne llliteptfun en: (l) n\lmfu:ullor sa fie
constdlns de sup01tul elnP.iric; {2.) .sa exlsle J.a:e empiric: ca~e
sa SUS\illU eficienta lor :ji (3)pi01U()Vatea ~Of~Q fie iacntii [lflll
suportl.'ll empiric de care s~ bucudi. Sa urm~nm m?dul it\ c~e
nces~tli suut coufm.nate de.starefl e. J:stentli.. U.l.domen.10.
Jt..
. ~ Nmuirul exo:gerat de mare al [ormetor ile
ualnment SDU Lnbidubd l\'Jiuott\Urtllui . . . ..
Pnralel cu. cre:,terea numiirului de categoriluos?la~ice
psibiatrice asisi.UtU ~i la 0 CJ:elil:erC R ll~tlti.~~Ui fotme!or d~
trala1ueut (l3ergin ~i Onrfield. 1994). Dm tulU. 60 p~uti manu
'90 nun.tfuul de trntameute psibote.rapeutlce a crescul cui@:"O%)
(Miller ~icolnb.,l991). Numul in psiboterapiea~e~t f1e$te_20~
de ~coli de psiho~eiapie :Ji peste 400 de tehtuct. ~Be~gt~ -~~
Garfield, 1994). Acest lucru este fonrte bun, ant ftlen~\I sa
sptmem. Cu dl.t oumar:l de trntatne~te ~sp~n~bile esle m~l.n~e
cu a.lil.t ~ansa de ameliorare a sufenntei pmluce esle matmm e.
t A~a sa (ie7 Din p~cate ct~terea UUl\.1~-ului de tra~men.l~ B.
in mnlel ~teren ar ic.inHi a nu.marulm de: ca\egorn
!.-.--~- 107 ~'. ,~,

~.~
n.~tim L.o......1: c.elucru?
o. . . . u. ucest psihmhice, ~adatea ins~i arhficia~D
Hat sa0presupunem
ind e. t.leste
di aceasta c~lere nn
mtificioila ci~xpresie a celcettirilor ~tihl~fioe care an dus la forme
noi !li diciente derratament. Dnca acestlncru esLe adevarnt:
o Prevalen{ll (mimarul de tullll.trari 11sihice ex1stente la un
n10me!lt dnl:) tulburarilor p.sihice trebuie sa se reducn odt1tii cu
i'omulpreafratamenrelot eficiente;
Trebute~"Q. nsistlhn ln clarificarea unor modele
etiopatogenetice pent11.1 foarte nmlte tull:;mrari psihicc_
Dilj. pacate n,umli.rui maro de trammente nu aduii ln sdlderea
preval~n[ei pl'tncipale1or .tnlbltrari . psihice sau la clnrificnren
semnificativii a unor mecanisme etiopatog~netice (Lilienfeld si
col_ab . 2003).1\1ai m.nlt._preva~or tulbndiri p.!!_bice !!:_~.
tn
deti e resiv)a crescnt ulilinelei decenii (USDHHS, 1999).
. igur; ~e po~tecorimntrgtunerl_ID(modi .tcfind o ipotezii "'1xiliilri1!)
.. Cfi Qt\n{fi C~ dC7.VOltarea SOCietatii S-aU dezvoltat Si . iversifjCI\[ i
- i!Ctodt.'Ca"te detertniaiHulbnrlirHepsihiee {ex. srres~ul). Aceasla
E;i~nacl tlet}itratamenrele sunt eficiente avemrontsi mt~Ue
tlllbnrari pslhice deoarece ~vern mai inJiitl far;tori eti~lo&ici.]
Aeest Brgument esteintere~ant. dlir-la o examinare logica atentit
no ~E:te s~ficlentde. utero ia, D~cn el esre.adl!:v~mt. ne~am llJirep~a
cam prm1nl rQn ncideJ1 trdbilrarilor psihice {nuiJl~rul de
tulburltri sibice 1\{)l:careaua .. ~utirttr.,o arittrtlitn~o.lldii) sa
creascli,JlU Beapa~tpr.ewalenta"ior(pv~tlpnn nd cli cei suferinzi
sunt-tratap ef.icient}. Or. noi ani ad\tat cit prevnlenta u~or
hllbur~rilorpsihice afos ~i esLe 'in cre.~tere. irtaercan9 sa f;alviim
rorn~i ipote:za en rrntamentele lunlh'ii!'iciente contin\mndcu o
. . - . ' ' ' '
ton1~ula ile t!pDuhanes-Quine (Gleenwood. 1989) 1\m puroa
' ', ' ; '- -- .-.'
' ' ' -
modd.'i':n o nmt ipt1rcrli au)(.iliadl Qi um pi .rea spune c! tratume~
;ttunt eij,ciente dat_cei strferiozi de tulDurlbi psiltice nu au aoces
}a ele: ll' _nadl}r. preval~urlirilot psihice este maa;. Cei
sufer.m7.lqu mJac~e$laace$te trnramente eficientedeoarece:
108
.. ,.
';'
. 1.
1
. nde, '"\. "
~ sonr f~arte scun.llle.tntr-ndevlh. costur"ile trnt~tnenrd~w
m\tom~atUor ps\hice suuturia~e.irrSUAam~~lc~lcl~umdu-se m
nr de 100 de miliaTaedeUSD {USDiffiS, 199~~ ._ ~
J ~ nu sunt Sllfici'ent ddbiue disern:innte. Stud u k ar?r: _c~ ~/
3 din cei diagnm>icabHi cu o mlburnre psH~idi mt canra ~~ nu
prhn~sc nici\Hllllltutnenr (USDHHS, 1999).
.TinlimHnsa cbl1l ca: _ . . . ,
.:_ mlburlirile psihice .suurp~intre cauzele p1i1~~ipale pe~~tru.
morra1italeill {lltile dezvoltnte, eJtistiind ~adar.un mte~escr:_,~t.tt
tn n le rrnta {bx., conform-e&ti}l."llirilor OMS. tulbnranle gs1~u~e
. snntcauza numnruldl!ii pentru.morbiditate Jli mortalitat~: m l;nn1e
de7.-.ioltnte~USDffilS, l999}4ic~ ... . . . ~ .
;~ dntele empirice arad\ ell tmtnmentele penrru. rulburanle
psiltjce stmt . nrltJseo~rnptontatic~i didto~a ~~~storn e~ri!
departede afi I\llll{umitoare [(e){.irt cazul toll?urarudep_rest~e
ma}ore~ iutuma rrarame{ltullli ~11edicament'os doar aproxu~1nt1v
4S3iO%dintte pnCientU!J1 an1elioreaia simptomntologia mr ~~l
!nfi.imp~rea ,acestufa, tauloul'clinic va r~apare~ ln5_0-'t._O% dJ 11
cei. cnresi-au arnelim:utsin1ptomatologia'(Antanuccio $1 e?lnh:
1995; D~kersbach ~i colab. 2~eo;1)~Rubeis ~i.eolaq . 20? l) l.
~otbza confonn dlrcia avem natttm~~ce foane ~fic1enre
rtarele Illl:'ann 'l. ei . erin?.ieste u n rol:lab1l s fie
~de~litati\.Consider mai degralllftvezlfli Daw~.l99(l),.'fn baza
date1m; pectln~ le-am nnaJ~zi;, c:iimai pro'brlbila est~;"; concluz~
. con:fotm cli!eia aven1 tpttunlenre fonr~ . !ea).nml~~7.lnUv
e. JCJeore en e rctent mnltum1tonre penttt1 anumll"e conc.htu {ex.
1 ~de anJC.iet:ue .~imalpu~in eficiente. pennu al:tecondi ii
__
(e~:. tulburlrl bipolal'e ~i gretl _nccesi Promov.a~en
ah~udlid-lot mai b1Iie vah ate ~tiinti"fic .{ex.. cognlttV-
cot\lportamentnle~ biornedicale) este c~1e~ f?8T~ ne -~~~~~ scoate
din a.cestlabirint form~t din sme de tratm11ente aruftcwle care
.
erlitacesc sicnreml ne i:tnc nidiieri.
. ,.
109
 c1~ lh~~e .in v.nliditnle."l
Ecce lVfesnu!t:.,; . -
:;tiiu!Jlid.i a tratame.tJl!!lur.
:
~e!~-g~~'4bode tebuielqe jnterveutie p$iboteia~~~tidi
(Ber~m 91 _Oar~~ld, 19.9~) au ~ost ad~sea-inte1neiate pe
exper~en~a ~l8tudiide caz ~~ rar.eon au fosU11vestigatei.uatudii
~xpen!nent~Ie sall.~tudli cl.iuice. controlale. Putinele studii
ex_p~nme!.Hale ~au cJiuice coutrolate asupra eficieutei
PSlh?te,r?,PJ~lm,eXlsteute. totu~i. au fostsum.:'lrizate.inluetaauaUze
canLHatwe(ex. Latni:H;!rt, 2003; Lambort ~i Ogles 2003
Wa~upold~icolab.,1991) . . u ar.U~ clipsihute!1lp{ue 8m1 ~
~ntru uns_peetru 1arg.de wJturhip~ce, acolounde
sun!_eficleute au,efecte petermon lung sip.revirrrecaderil -:
b. . . . . . .. . ........ . . .,. ..... . ...... emru
we. . ~li:Ufia. _siliotro ___ asi. _ _ ._?.~ e.Iedintreil~ele,fomre
d~otetalJ~~ nu su.nt s.e~Ct\tive;(d~iexista(lu ll,10L' a\Tt!fitaj
al psthot,urapulor cogmtiv-comporta~hentale fata. fie celel~lte
fon~ede p~;jJl?terapii). Mlllte pin aceste Sll!fJii aufosti.os~cciticaLe
subaspec~ttlngorii l1letodo1ogice;~acllrezultalele ~i cou.ci4~me
LUetaaua.l:iz.elor bazate pe ele. ~uot discutitbile.
in li!OUSe~inta
A~oci~ti~PsU~p~o~ilo:.:~ericatti (APAJ:;;iSodetateapent~-~
Psdtolog1e CI1n~c~ ~tlint{fidt(Soci~l)r for Science for Clinical
Ps.ye!!l?logy;_,SSC!') di~l cadrulDivh:ieLde P~Jbologi~ CJinica
(D1 VJU.aJ2J.au i!lcep.ut U11 pmg,riitm de stabilire a cdteriHor pe
care o :>ll'(l~egie de. ~ntervenUe. paiboterapeutidi trehuie sa le
respecle pen tru a deveni validat~ ~l:iintlfic {peutru detalii;eti
APA la h(-g.J.;.Ywww:C{):za.mg ~i AI1Qa l). Ctiteriile mintme
sWJilile d~ APA peg.ttu C un tnttamentpsil~~e
':~idatUiQ.tific suut firuictisem coh@uare. . -. . ~
. , Trebz:-ie ~a existe un manualcaresiihrcrie cfarsfJ-ategi_a
~SJgur,uu estevor~a de,algoritn1izarea interven\ie.i
clunce. lntervenpa psihoterapeuticii trebuie particularizat1i
pac:ie~Lului cu care lucram. Este vorb~ despn~ u~te strategii
eun:;ttce care apoi Jn functie de condiiille pacientului ~i de
{exapeut, suntindividual.izatepenttu fiecare.caz. Prezen~a acestor
110
strnlegii euristice repr~iinta ~fiitl\a, ~llJ;!Um:ficularizart!alorin cazul
fleclirui pacientl~eamnli:;tiiata:ntcuHfcuattlt
Iii 'JraLanJenlJ!!. gm inv-e,Vigat_ fn cacln~l Stuclii/or C/ifiiCJ?.
controlatc (randomized clinjcaJ aials; Ret). Phcien}ii- sunt
distribuiU raudomimt in. eel p~1p.n doua gmpuri ..u.n gmp de
co11trol (ex. nu prlmqtetratameut; este ttlacds pe o llstli 9e .
a~teptare; primelj~ Ull tratameut clooicdeja validu,l)Jii Wl grup
experimental can~ prim~tetratatnentu~!nvestlgat. A~tt cummn
mai afi!Lll:~t. smlt con!itlen~ de faptul cii_ exista metode dj{eriltt
p.enlru avansarea cunoa::;teh.i. Studiul "de caz, observati~.
sistemati~ analiia unei situalfi problema_ ~nt1 ~xp~rintapUuica
p.otducela noi cruJo~tinte, spre e~emplu. Ace$te cvnri~ti.ntesu1tt
insacontexluale, ele nu_p.ot:ti gen~ralizc'1le. iitJ.ttiisuptiucate se
con~tieutii...eatii acestlucru~l se exvrimiif;lceastii id~~ ~uci cnud .
fomtuli1m..wlclllzlile pe baza. rezuitnlelor obti.nule cu aces~
metode (ex . studiu de_c.u; . . ~acem tii. _ lL_.fn_tll~sura i . are
de
uliizaiu ilstfel de metode (ex. #;iludiu citz)darill C(,H~
ge.neraliz.'Un rezultnte. h .. d . este se~lclOllliiii\n.
teJor a"en11evoiede att\~liiclinice
conlrolalel GeuernUznrea uUliziirilUllPl'.leluilci.de.p~,illolet~pie
care nunu fast testal:e in slttdll cliniqe c;ontrolnte e3tepedculoasa.
Dat:a Ott sunt e.ficienle {presupun8nd di J;lU .reduc d.w f)ici _nu
~llplifidi5h.uptomatolqgia4ejaeltislenUU)el,educlacoitur-t.!/1
\ laprobleme etice.Dnr uneori trnlamentelepsibt;J.t;ernpeulice nu
} consecinte n~alive-il!lificftnd shnntnltlatol~ pfttdi.la JO"'o/;
. dintre padentipot sa:..~i amplltice shnpl91tUJlolof;ia cnurmare n
efecteior s.ecundare nle p~il~o.terapiel (J~~tbett.!Ji()gl~,200]).
Sa exami.nanrcum ig11ornrea celorp~euta.t~ tu ~~easta scctiune
a Iucrarii poate avea: ronsecinte negative serioaS;en~upra saiJat..=t\ii
padeu plor.lmediat dupa atacul teror;ist diu u; sepletnbd~200 l t
segmentelargi de populn(ie ~i profesipniqti diu SUA au prim it
servicii 'psilloterapeutice de .asistt;mtii penlm situatiil.e crilice
slresanle (critical incident slres.s debriefing -CISD), Unele
Ill
 ~ de \a sine de
, .. 1 ""Orill '> pre7enrata Inai S\1S) s-nr cMmnua . . .
segmente de poptila[ie :mifo~; ~\liar oh!ignte sa urmeze astfel de \..:neg - _
. oo:entiind de fapr un reac{ll pato1ogJce ct I
, , -eactii ndnptatrve
. . .;
tratarnent~(ei.. p!lmpierii.polili~fii !linu)ncittniiimplicati.direct repr . . . .. . te ele ne l\j'uti\ sa prclucram
ale nrgmusnmlUiln l:ntnatn suesnn _ _d
In acliunilt'Hle salv~re etc.)! P$ ce !HI utiHzar. pe scadUnrga . f . t'-1 traumatizame asimiliindu-le 1n ~ttu~tul 1\ noasrr~ ~
aces~ tip tie seDI'icil ~chiar s.c;:dogat!n caznl unor subie~{i care m OTmntu e - . .. d' . d <m e acestea ~~ sa
CllllOStinte. tncun'tjfifld snbleC\11 sa lSCU[~ e~t 1 "I)
_ Ilu dore~u nsisl~npi >psih"ologicii1 Sn expficnm ceeh. ee s-a le cot~trolezt~ in C<izul unor subiecti (ex.. in ca~wl celm rept"CSI\'1 . :
.,.. inrimplat,!personal~ am:parLicipat hquocesut de elaborate a unoc
ac~tB renotii emntionale nJ!gau.ve
..: .1'n.ense SO nO[ ac:cennla Sl
~: - ~
mafcriale ~ S"ervi.bii pslhologi(!C penttncei afecta{i de evenilllenllll trrinsfeuna tn psihapatologie! Iat~ cmnutilizarea pe ~cara J?l'g.
din 11 septcmbde1,00 1 "pnn Ac&l_demy of Cogniu ve Therapy, nerefteXiVli, a UD01' pTOJ}edUri care Utl a~. fost l'ncl\ mvesttga~:
SUA, nslfel ell. am i\'\!Ut acces lln:doar la datele expetiment~le ri.guros (ex. snb aspectul generaliz~ru lor) po~~e du~e. ,
~are le stis(in~ai:l Cl ~ilaprocesulde implementare !ii promovare consecinte negative severe. Probabll ell studulc ~hnt~e.
prncticll ~ lor)~ lit 'bnxaunQr il'na,ihe eli nice "Efi studii de c~:ZJH1 contralate var arata daca1}i in ce condipi CISD ~sre ~ficle1:'t <1_~ 1
obset~at eli t~~~o siruntie tranmati2nutli avem eel pupn'ttci .
reiall:ntele pe care le avem acum,
ba2i\te ml\i mnltpe ana t2d 1-1e.
.. ..
cntegorii ae rea~(ii psihdlo.git:(l) Fc:acfii de st~ AC~It SfiU Sh~ cn.z ~i studii eUnice necontrolntc. nu just~fica utlllznrea lm pe
posr~n~mntic; (2)reactU :emopona1e negariveiintensedar c~re . sciulHal-ga. . . .. .. . . . . .> ?i ~ b' n ~
nuJndeplinesc criteriilepenlni t:r';'!ategotie uo5ologid1 psihintritl\ { PttrfOniwri{F,I.!Jll.lJ?ului cxper:i.tptmrM ue~u!f sJe If11!1 'J;, v

(ex. stiirHntense;,1e strea. tehmli~ tristete. uemu1tnmire etc.) ~i
(3) Jips~ 1mor reric{ii eJ~otionale negative intense. In mo(tnor-
mal, pent.m ~ublectii cnre experi~n\iazli prima caregoriede reuc~i
psilto]~gice se bf~rn -astst~l}tade specialit:ite hazatli..pe.studii
cliuiceconlrolare" B:-.a observl.lL'Insa tnpracricaclinica ca unii
subiecti car.e nn reactii .entotionale negative intense tarn n se
incadra intr--a categori.e nosologi"ca vor dezvolta ulterior
prob1emede stress posttraumatic. P~ncru a evitaaceastasitnape
.s~apte~upus, pebliza Pn\?ticiiclillice, di ntitizarea CISD in
ncest ~az pof!te:pl'eVeniacest 1ucm. 'Scurt spus (pennu dJ!talii
. \lezi Kagee, 2"002), ~ s~ referli la temple suportiva,ventilare
cmo[iotJa1h. incut:ajareadi1cntitd1 everiime~tu1!)i tinumatizani !ii
expdmltrii emo(ionaleetc. f~tr-adevitr~. a~alizele d.e . c:az
nn~deare "ntl ~tgirateficien~'! CISD!:Iara ins a ciistud'iile eli nice
control~te efectuate receiit, nrnl:a ca crsp poate amplifica
sirntltomatologiain lac san reduea ~~ su pt:evinli ap11ri\ia stres-
nlui pot~tln\tlrp~tic (pen~ detalii veri KrtfSee. 20oi). AI tfel s pus,
t'lacihm s-ar utiliza CISD, renctiile psihologice negative intense
. dxlitprufbrmilil(a ce!uld. control (sau c~!a -ct~.anc~Juro. d~L9
~niptd dei wn.rTiolprJm'qtt;. Qn. a.-atam.tm(.clnSlc.").. in evnl um .::_a
... ianl11 calcul ntat
rezllltatelor nnm plogram d~ }ntervenl.e. 8'"1 . . . : .. "< .
"' ' ' .. . t1
ciiteriile shitisticc cat !li ce1e. eli nice (eco~~~lc~t.Rd~Vlll~~~
si:atistiea :hsigudi generaliz.area' rezultatului ,m .P.oplllatte, ."11
"~levantit,'ecologica nsig\lrii implement~rea lm tn praeuca
c~\rentli. Spre exemplu, dac.itse apliel\ ~;grocedurll. de relax<~r~
... c~rc reduce tensiuneaattetinlli sisrolicli a~la 200 l_nJ 80,.acen:;ta
djferentitponre siiJie semri"ificat~va statist~~ ~e!li no a~e }"e~e~nntl\
i-:'t inidi (pncientu1est~totllipertllnsiv). 0 1nterven(le efic1 en fa
(/a reduce ten1>hmd1 arterii\la sistoliciid,e 1~ 200 ~nl~O. c_ee~ ~~
1nseamnii semnificatie stt\tialicli ~~ ecologi?~ ~~ac~e~ tu1 s~m~~11_e
fhlimftelenollnalltli\iipenrm valoarear.ens1unn artenlll~SJ~roltce}.
'. Aceste criterii minhne pentru en un~ ~rntame~H
ilsihoter~peutic sa fi~:validat eytiin\iflc n'u fast in~a lm~ogiit~te
~eoellt de cl\tre A~ A. adaogftntlu~se elem~ru~ nm. . . .
:' . c Clindcrm 'utd~ .. . . . 1 . UJ?Ull~ Jipsn trnllll~1Cllflii~T
:~ml Jjs{Jl de nt:tiJptare. este 'necisnr l/11 lJ] treilt;l1 grupJ grupul
113

, . . . - ~- . .:-."."'i:.";!!Y'-- ....
 . .. .... .
.~- -~~-...-...:..::- ... .
pla~cbo. G:upu~~placeb? prim~te un lr:lfaiii~Ilt care se p1-e_zjntli _ _,
pnc1 :nt~~ ~1. c~JHn.d eJicJeu: p~ulru condi~ia.lili; d:ar t<I~-~-[apt :..
flU l' I:;:e~a, tg~7:~W~S!llele ~tit>patogenetiee presu!Jiise iiiJpli- .
c~te IH .sufcnn1a pacientultti. Ca exemple. de tr~hiJftgute
psih?lugjce placebo autiuti.m discutiile libere, clisGutiLcu i~ti:te
specd:1ce (ex. despt~ nuu-ipe), temple suportiva ~tc. ca
ex~~uplede tratamente.tnttdichl~placebo amiutim a{lminisrnirea
tmei:cttp~ule care d6t este prezentatii paclentului .ca.r11edka,..
JuentJJ.u ~ou~ne ~ciousvb~t:anta ac~\(a f'rezenta ~mpului pla-
cebo ne permne sa fesfli.PJ sunllltau pUQQ<tr eficienta inLervc1j{iei
ci ~.;: t_e~~ir p~-~~~u~a aJqstifica iuteliev tia ~pectiv.U. lnllpsn
g.upwm placebo pute.tn spu~e <;loru- ca trat(llncntut este eftcient
dnr nu cuuo~tent cauzele aceslei e.ficie11~e. Adesea taridse
pwpuneu11 trat~~ui: no~ (snu unsi$tetu oeucle tera.xt~e), at~\a
. . npar:. Cil ~m pacb.et continflnd tehnic.i de interventie ~1 teoria
"l [a~?c1~ta lo1. ~~adar, penit;u a fi co~sidernt pe depUn vqfu!yt
( ~~~~frfic, tlO {J~ognu~de. l~lterventie~lreb~e ~a~aibaaUJtteb~ci
." efu:aente~tennl vali.de . care.salejUslifice. Dadi fncem
disjuncp~ !ntre cele dotiif compo"nente, putein sa lijtingem la
si tuatii ciudate, in. care c~Ilnicile de mesme.ris.o1 pn;~haoil nrfi
cousideral~ !lli.intifice, Sii.Jtrgumeutfunpdn aualogie eele afmuate
nici,d~Cl(iind succiut evo1u~ia mesmerismulu.i (penirudetalii .
veziG.auld~ 1992J~~~erafostunJ1Iedicvienezcareaelalmrnt
o. Leo~Le confom\ c~l'e<Ia planetelelihte1eJe 1te influeutea~a prin
. .iu~enmxli.J.\ ttuul fluid uumiltnagnelism i!.ltitlll.1J.: Mngn~ti:u;nul
mumal ~te preze1~t in.{iec~~ din noi ~i in mediu1 iuconjuditot.
.Dadi ex.isGi un. e..'{ces sau dudwcilde ~guel:iSm in \lrganistuul
uman atunfi~ap~re bo~a: Cmus~ face tratamentu11 CI.Jnlm a6ea
periond.a s7at1 descoperit magnetii {obiecte interesat]te.care se .
influet~tau-se all~~eau :>au;serespiugeau ~ recipi:Oc., care atlilgenu
$i inf~uentau alte _corpuri}, Me.sm~-esupus.c~ nuJglle(H A,U
-PJlli?fLetutea de amtluen ta n:mgnetisumi animal, 1n co~lsecinf.i,
e1 a inceput,sa foloseasdi in tratameutMaineUi era p~i p~
u a~f.cidoar tratamenle validaOO. :ztliupflc sau nev<tlidate
II<!
. .. .. . -:~ .. . .
zonele boln.a:ve sau acoto undeapareadutfll"ea petll.ru a reduce
dezedlililmll de mag1~ptism anitiJalpt;~upus a d~letmiilaboala
afi Mai t.1rziu,Me8m~r a sustinut en elpreui~~abllitati spedale-
.esle mai sensibll.la tuu,gnttl!,~~ul t\l)bna1 - pdn: cate . ponte
modifica direct deficitul care cnuzea,znbpa1a, .flrii'amai it.til i-z.a
iar cu necesltate magneti..A.~Qdnr. atltlg&nd b.cilnavii~u ob~gheta
1 sau fiicand pase ,lnagneticede-ailulgul zonelo.rbolnave.MesJ)ter
elimina de1echilibrul nmgneti~mulul.an.imal ~i r~ducea .sau
dimina '~stfel sim.plQW.ntologia.: Utillt.lucliaceste procwtui se
afllllln di Mesmer n au1~ltor~Lsau. vius:lecat sufe~ntu n peste
20000 de j)acieuti .(Gauld~> 1992). l'rObabil dt dadi.. aeesle
strategiiru: Ufost (X)lll.Parate cu un grup de control(rtirl\ tml~ent
smilistadea1jleptare)iutr-w-st;udh.Idimcconttulltt,ute51U~isluuJ
a.r fi fast cousiderat~tlin\iflc;:pe baia criterlilut tnitlltne. Mesm~r
insl\ a ce.rllt ca ~i. teorla l ul >su .fie nreuuoscul.ij ca flind ~tii~\ificQ. .
Ludovic al XVI a .oumit () >coiJ.l.i,sie regnllic~udusa de Benjamin
Franklin (ambasadorul ~pA,i~l Frnutain acea pedoa~)() 'li
compusadinpej:sohalitatile acelei yrer.ni (~K.Baiiy. GuH.oline,
Lavoa:~ieretc.). Penl'IU ~.(~tuteoda.Iui Mesmet,un gr~p d~
pllcienti afos~ rilf?smeti'l;{lt 4e ciitte ~esm~ tasu.,iia.r u~ n!tgrup
afost indus \n eroare: li s ..n spus ~a suutmesJnenzati, dar de
fapt JlU nu fost Cv tout: ocefle.a ma~if~~rile ~i n~:ti9!'ilre~
suferin(ei au fost apronruau.v tdenitce m cele doun grug:Llrl,
inflflllflrtdu-seaslfelt~da.Ni Mrstner. C~nwluzUl~ cotnis~ei au
'nrntat eli mllguetismul a.nimnl. nu
produce uimlc.Vind~cruea
este data de sugeslibllitpt~~ ~iimaginatia bolmtVilot, c~f1 c.e
astiiii ain. numt efcctltl placebo:. :frltl prisma n:ce~l\li exe1nJ?lut
poate di intelegem mai t:l?t httpox-tall\i unui gtttp .placebo i~1
5t,udiiled~;: eficien\a a diversel.ot" fonne.d~ tratameut Probabtl.
ci\ eficientn n:mltor fonne de trnt~lUeilt~~ ~attumitcle ~tam.eule
al:temati ve (ex. bioe~tergle), poate fi ex.plicaUtprin efectul pln-
~.b.~.i.e. _me~.~.tiu. t..c~.Rri.n. p~j. ma_ti~u!e~:
. ceb o . ...-.in. a.ces. tc. .o..l.tte.x.t
..lr
.. na. . s.
[ nu ex1stii h1ltamente titntifice 1 allernatwe (ex. de ruetbcum
'"
::::---; us ..
.-.;,.
 . ~ -- -

vr,
, r

'''''~1i~0i:t's'"'''''~fiH\!i'~~1lit~ili~i;:l~~j;~~H!l,l1,:.Sii,an~l1~~~t~;:ilsrfel
.; ! de'cazl ...... ' . ~~ : ::;;~~ ~~iil~l~t,:I?"Pnlr~.~~~~le1JjR~tt:ea\di '~~
:l~pi(J~lei.V~t~t~ ~~~~~~~otog1qe,S,ta~0~m~4e.sift'5~~~zut'a
:,:.:l('{le1~~fii'HEfatt1!~t .. a!~.J996)tlMli~ai.ostimacr4sc~ra.fnta
de~l~rrilil.fi,ai.~~~s,~',ln'itl~1,.lct~J?~;~~<l.Si1lltibinei.~+t1Jrr~i ~i
lc~~W~rt.alt}elir~Iepi-o~sq,~i~lp ~()f fj,J1lai1 F!~.~roase.~1Jteo\~i~ nil
. :,:;;=~~::~:~~ , , , , f~~;l~~;~:::~:~:~~=~:l~:
\;~~~%[f[li;~~te1 ll~tl''" lh n . ,. , ~;~:ih 1 9~~~qint~!lllllOi

~res~, .,~"""::~~iE
.~ .... s~a'{itilti~,~~parte!~i~~~ .. si~;p!g~i~irde
k. '" .~ .. 0~1~~!~~~~iu~fi;~~n~~iril!~~r~1fM::,~1~ J!~t1~,IJ>~W:es,
,.~~~@i~~11a.pa~~~~tiiuta.nu~st~'r~(1.)f!1PPr~l~f~U~,in#~
,jn~~" ,:r~Afe':'~'~rilti;ilsf!il ~~~!;~J~Mi ~~i~i~} "' .rJ,$i. a
crt!\...' ... ~~~e,\l.lrs~~qle'ea&llri~ina~e~i\~l~ri . ~i . IJ\ ~l . Al .
~;~;~1 ~f~x~!:i~4~:in;cdn~n)j'are~~~Si,s~~u;,.,. ,.> . .:E~~1~!h~
,,f\l ,L1!iD~J,,ptiJJl\Una.inc1aJrieni~~JfiJnt~i .. ,. ..UJpf\ce
'K ".~$!l~~Jzi,iate~iJ~i'~P~!t Fti!t~''''.. 'I;?~~Htl.
R lu'Jp;?til,..nwitW;'l?r.tt~teritodn' ...... i~f~~b~tiil)fit'Jcii
yt;;u;:~~~~~~:~~iJ.ltt~~"
.:. ,... ,tJltm~ll,~~ruJ,~~hn :V%lscontellb!1 dht sr-nti\l di\lifo~:nin.
-
~'.(:it.~,~il)r~JJ~flJ\{lt,dt::pov~nie(ienU'hl1~~\f . t~f!!~,
~~:.~~~~~,"~:~~~~t~,n~~"rifj(ilte~fii!l~ific)~inr~;att,ta
I ...,. , J~Iar~ ,

3ti,i~~9~ ~d,~f:P:~~~~~~:cl~~oJ'l~fi)~nrepr&Zerir~tl'&i?liade.
. si~eJ~~~l[n~~#jt.f#p4 . . ~~t~~nflu:sanata(ear!iiiiS~ajl~iilicit
tta f>i=hp~~tt}it;fui~ fm ,. . ~ful.sJII.@1n;~~IUifon1i}{~;~:.*c~e~t u11.:,
f

. gftrfj de'ltt~hf '(Tasli,Frirce) pentnl ne~~i~~supotttL1h1tiH1tifi.c

O)JCbHsttUCtllltt)' Stii{l~ d~ Bine~i a poi a pTOlll'?Vil acest,~nSil:l.tC{.
. I

111
Guv.ematoruLstatulul California George Deulunejian a_oferit
un buget .acestui grup de lucm in 1936. Rezultatele attfost
publicale intr~~ ~~f:~~-e inlitulata. 'T'llcsociaLimportanr;eP:t~eif~
esteen~".J:f;iJ.t~j:f~'-1 colab., 1989) iri l9&9~;_,CoucllhHle
fundame11~~r~-~ieacesteilut;rari sw1t: . compm:tamentalnegattve. Mpraln este ca $luna 4e sme trebUie
,. 0 Sllu1~ d~ sine crescuta duce la (c;.mzeaza) cm;se~inte
psihO'-COJ1lpOttall1ei~title po:citive; . preacrestml~ putrlnd ducela pro~leme pslhologicei : .
., 0 s,tima de sine scil4~1Ui duce la{cauzeaza) cottseciute
psjhoLcumportamenta1~ negative;
Progrn.mele de CJ:elllere a.sfunei de sine trebuieiu.cur~ate
Ja nivet individual, falnilial, de grup. ~omunitar 'ji. social. :_
0 anal.iz.ti. atenta adalel01: pe-baza cliror~s-au elhllocataceste
conduz.ii aratltinsa o cu totulni.uisituatie.(pentrudetali.i.vezi ~i
Dawes, 199~):
. Cele ~ai multe &LudU.exauunate ~i u~clu~e in.lucrlrea
ll.l.enth:umt[(Meca ~i colab.J 1989} eratt studil corelation.alei nu
exp~dui.eiit~e. A~adru\ a concludzioua eli. stima de ~ine tiste
cau~a pen4:ti tfiverse "specte psiho-comporlament.."lle nraUi
ldmufulipo,lt?Zei:'li dorintei asu.pn1 f-enomenuluil
II' 0 11~ parte diu~orela\ille semnillcalive diutre stima-:l:le
shte ~i diver~i ~udicatori.psiho-comportameutaliBU{Jvaloare
sca-z;ut:a. a marimii efectul~i. Spre exemplu. corelafialtte-die dintre
stinut de sine ~i pe1fom1~ta academic este de p. J7r Intr.:!Jll
limbaj mat simplu, ac~!lSJll ara.ta cli stimadesh~~.e~plic~ ddar
3% din perfonnauta ~cotarli. Allfel spus, aceastainseamnii di
perfonnart\a ~c_plat:a est~ detemunnla de alfi (actori Care SUUt
Ult,tltmaiimportall\]. (acop~ 97% d1n perfonnant;a ~co4~r8) dedit
r.Um~ de sh1e _
.a. in plus, .o s~4na de sine prea mare. duce .adesf;}a la
comportame11te agresiv~. anti~sociale~Temiile c:lasice {f;}X.. Beck;
7..000}, flirt\ a sugera cu uecesitate o rel.atie cauzala, aratli c.
, ' ' ' ' ':'
a ca
iluiraclodi ipersoatlele ~gresiveau o stilna r;ciizuta f.nta de pro',.
pria perso<nl~i.. Cercetaril~recente au nunn\at. Iusa aceast~
\
concluzie (DiGiuseppe ~i Tafrale, .2003 ). PelSilgi\. ceic~ s~mii
de sine scazuta, exisUi un grup de J?erso~e care au ~l sttma _de
s~1efmirte crescuta, a.st;fol cll.udceiilcongn\enta ~tredot:in\ele
lor ~i ceea ce se intlimp~a qttce lfl reac.Vi ~tn?iiodale_ i;ote~tse ~i
sa fie rincleva la nivelmedil1, o stiui5 de sine prea scazuta sau
,. Stima de sinese c,{Jnstltuie priu procese ttationll~ .
(dezndaptative) de preluc.qx;e .t,l jnlunnn\ieJ.._(peq.lm uec.alil vez.i
-Ellis,t994). Astfei. ndeseasliiim de sine sti ~azea1;1i.pe faptul
cii noi facenleYatuii.d.globale asupra prQtlrieipersoaill}pomim\
de la coto.portntne~tele t~oa~t.re \intl\. 0\ud. cQmportamente\esJ,tnt
perfornuu1,te atuuci m~ evaluliJa:f pozltiv fti experien\l.em triliri
nfective pozitive,iarcfuul !;omportnnlentelesul1t.llepc:tfort\\ttute
ue eyalutUu (legD,tiv ~iexper!en\ie.ln trniri ufec~y.edmfpnc;tkmnt:
negaUye:(ex. de tip 'depre5lV). ~ceste evnluan sunt 111v~tate ~l
l.ncurnjote social. Ble constitule noimaiutr-o soci~tateinot.le:nti
bazatii pe autonomic, iudepe[ldent~ ltlivalopzmea, e)tcesivil_a
proprie~perso<Llle~ Iuciudaacestui l~cru, eval~Uirlle ~9bale care_
stau la baza constroctului de stim~ de. sine nu su~tjustificate
logic ~i ~liin\ific. Ele co1espund unei etorilogipe uun.Litil "sultu~
in nrgutuentare" (vezi pentru detalli sec\i~~~h 3.1.3.4 ~a:esle~
lucdiri). Astfel, pomind de la c,at~vn comportameul~ltn.t.fi, uot
face111 o e:-~illuaie.globulii a prop.rie~ per~oaue, ftUa Ct.' legl\lura
sitfie sufi~ienmlogic. Spre exein}_)lu, dncii. nu runluu.t un exn-
meu (~i am inca eli\evn perfornum\e scazu.te) 8lU teudin\11 sl\
_p?n
spu_n cit sunt n~~perf~nnnnt ~p.r-o.st) :ji u~are, .um~uri_intr-o
astfel de siLuatte:vm eJtpeneup.a tr1lin llfective dls.f~UC\lOll.Rle
negative (ex~ dep.resie). Din llllnct de vedere Jogjc, eticl~~ta de
neperfonnant sugerea1.il di ~icompmtamenlele 'tn~le vnloare
vor fi neperfonnanle, ~enU11 unin_d.iYld neperf!'mumtare ~i
va avea comportameute neperfonnante. Pe de alta pat~te,
ceicetii.rile aram ca acesle etichete ~i trasalurile de per~9~l~tate
. . .~.?~~~:::~ "~:.--; .:.;: . .
~~;.: _.:. .
119
 -_ . . . . . .. , ' . ~ disfllnctional~ {ex. depr~sit). E:\e: .c.
acopera dour U}lTOXin1aliv 30Wo-din vnri<\nta C()mpurtamentului fui'.evoualetcX.. to. s.te\e.J llU . 'l. ro.rJi'>{. ;; do n1rionitl. tl:Hc
no.stru (Mischei.1968). A~adar. ncest prpcesde ~valuate glnha\a ~. ,~ 1 , gl\!U o ca e ap 1: u ' ' .
mpdahrat~ pragmatt"'~ ( e a aza mistil de gandir~iralianr1 \ ~
este unnl ita\ional dic.i el permite cnn(l:adict\1: rin ind1vid 1ntr-o
. so.c1etate ca. repro.
. ~moye
asa(~ :0. awc:s.
. 19 n.::} .,..:,..en ce. twarl\
::;;~u ,.._._..
neperfonn_ant.poateavcn*ieomportamente perfonnailte!.Deeyl . A~adnr.1aoana,Izangur~ . . de .cine esteasoeiatl\ cu '
irrttioual, acestpro~este util atuncicfind nvem cornportnmenle ... t d ......~1irare. eslc en stimt\. . "' .
$\_ndll e e Spet:h : .. . tale Ac~:tastansodefel10flt~. '
riP ~te n~tho-comportnm~n . . .
. . . .o a }:luna Joafie . . mare.
petfnrmimte oiici ne face sane simpm hine :}i va1m-o!ii. T[ebl\ie .I
anu nuLeasy-- ~"":>
insa sa COOfitiefltizam Ca i\tund cfind COf!tpOctame:ntele SllUt \>( d ln una foa,;te mtca pn.n . : . .. ......

s1 vaneze e . .. . . . rein Uteramrn de specinhJntc, nu
ne.petfpnnantet()t el ne aihncain suferin{~ emotsonalli(e:x..de Uo1,~ndn-cne -pe date.1e e~stc:-~d .. . . e&teJn general nn factor
rip dep-msiv). Avem nllll vnl'inntfiq P~~ o vnrinntl1 mtio~alii. pnten\ afirmnJnsi\ cl\ sumn. !~~~= sihr.rcompor.Lan1enrnle :;i
Varianta m(ionalii este. de" a tnlocui'concepruf de stima de sin~ cauzalfundainentai pentru nsp . .. p . 1 de ilezvolurre
Cll celd ,.. e tarenecondi i~nnt1t careesle logic eorecr ~i mni . sa{li1tnt~a ps~l~ica, fii ~.cons7Clfltl\.J?r:~::~:pob1l~'\. Acolo
P'.agmntic.{BUis. 199 ; Roger:s. 1961). A.!iaclar. in variant:. ale stimei. de smetrebme SUS{lfiUte.t~~gl\. aoeate pl'Ogrnme cle
rl)tiona11i. noi .ev~lu.i\mcomporfann::ntete noastrenu per.sonna. unde s;au impl5mt.ntnt ~e s~r. a a consi.derll .s~tiosidi:tte.le
. PerSI!IiU)a nt)nstdt" est~ nccepftl.ti\ necondifionat intllfere\tt de aezwlltare a sumel de $\'"le,,..,.r . . . . ' .. . . ..,
p~rfor~an{i\.:~licies.te prea co\'nplexa itncontinuirschimbare sfihttifice, eitelocul node po\!tiCJ\ 'in alhm\li C\l S~ mtul COfl1Ull ,~U
penfrtl a fi evnluat 0. ill, pomind doar de \a Une~antion..de :acis,~ti1n\nllrin lobnyl
cotJlptirtnmente c;oncr~te Jl sitthl{ii c~ncrete. Spl"e. ex.emp n,
antnoi cSind am un efiec voi ::;pune eli am nvutun cinnportament 3.1.3. ProblBm.i: nle PsiJwptJtologieicu ~rtulalitn(llc
Mpeiforma~t nn cii sllnt neperforrnamcn.persaan~ .. Aceasrn iJe a fiti~'d CBJ'Cetare f'
filozofi& se tegru;e~te llHnm.ile 1-e,ligii ale lun,ii; spte ex~mplu 1n .. il . attit o latudi de ceci::et01"e fundamentu :l
:slllopnto ogla aTe . ~ Ccrcetnrea aplicatii ulilizeaza
Cte:ttiniSll'lea este fo1ule hine reflectatade formula "pedepsim
. cnt ~! lma de ccrcetare npl~cata: arolo- ie tum alre cliscipline
plicntul dtll' il ierdi"lll pc }lociitos 1... Acest mod de evaluare este . ce,celm;-ea foudamenmUi dtn:pslhop . ~- . d 'ld''"''e" de 1'~
onul logic, Jar darele empirio~ (Chamberlain Iii Haaga, 200 l; : . )ropne pontlll ...... "
David flicolab~) 2002) amla eli in1plementarealui fn via(a de zi colarern.le. (lar, are !' an~poi~~:~eoill. -En cretl d, din pacate,
en zi<este un fac'r6r protecliv fatli Je evenimentele stresante. .. PT~blemeco~~.;relet mt~=deinflexibl}a ~j obmzli la rez.ultutcle:
'Psthooatologta es f\ eli. ~ . . :\"' eotl\ \\
SiguT, a ~e."\liz!l ace~stl1. imple.mentare esre grcu, caci en este ~ . d Pi{lti)"'t\tologia pare oarb' ~~ ma.lJt;r . '
cer~etanlor. A esen :.; fi .., 0 di!seod dorin\n'in f<"lt~'
onntrl-\intuitivlt. Ctlrcetlb:ile suge:ibazlf{Ohnm'(}ednin ~i Hnagn,
J.-"
-ntfi.mpHi fn cercemre. pun 1
. 2001) ct\ arunci ci\nd SU\)_t ltwaf,a\i:aceasta 'fjt~sot'ie d~ villtli ficeea ce se: . DRcli ae,:cetavetl in dmne.t-iiul PsihoptllO lpg~~i G:-:t:e
VfllidatltemlJiric. ceirnai nmlti.ol\meni () asfmileazii rnnl u~or : enom~nu m. . ~ . ye:tl\1tnrele cetcetan\ s, Ee
. J\Slfel: cf\nd an pe.rfotmante -pozitlve,s!} ~~1uel\1l. pQ:z.itiv {in '(_rigtlrOa~ attnlCI ne "'"~ep~n.,p. H\ ::ndofensivli (aid vo\ anull'z.t\
promovezetntr-oman~er o~es ~ -n\icnbilimte ll
. tennenii :itimei oo alne) i11! cnnd au perfonnantencgativei~i ,_ "d . lor) (2) sl\ emste o oarecare .... L_
.. ca?.u1 ant1 epres1vg - ' \ . \ ~ :bo) (3) Cl\
eWtluea~comportamepul &r!t-a~.!fl evnlua persoana (in tennenii rezultatelor (aici voi aurtliza cazul efecm ut p nt.:e : f

ncteptihii necondi\ioniUe) accasta ducilndla emotii negative rezulttHele: sa nu se generaUzeze. dincolo de date\e extstc:nte ~t

120 l2l
 ::;

..r..:- . : ....-~-: -~-~_f!St". -_-_: -~:--; . .-.

< ;,;.. '

. -.- . . .._ . _ ..-.:. _

3rtnu ex.ist~~d~de:duble tn evalth1rea rezulmtrlorpeicelam daca un tratamenteste s~ I!U nP.llVl:m.~iiJ-~tJttU1utiiz~eJe:seadr
(aicijvoi'~fiali~n~~~~li{~silio,te~p~~r-.ip"Jl~~p~gmpif~:ii,f~l~cac, ....~~~~~~,te~i$9~.~.~-~~.l4~~~~~tL~~i:~~~l!~il!~~~.~s: .:
cr.ill.
1
e..tif1'. ~~1 .g ~ !.~-.:~, .i ~
.e. .. .}l.. '.t.ci.i.. ..i. .:. .
cerc~ta~~mn;;9,QUJ.enih~!i1i~iwrah_Wii'U. . . .'p.; ;_'iu .
-ui,~e,se- :_a ..... .iv1;
. :.i.SE;
d...e
....
... '.,. ....:.. ~..il
.. . . ' . :.,.' . .
1

p ... > ,.,..,_.'.'.. J...'. ._.... :c ~. u . . . pruia:~l?~~r~~q~p~~~~lfl~~~~!l.~~~:m~:c~~m~cute;qt'wtU.

tttiJ,i?;nten1,~4~~~~!~~j!~i'!.~ti~~pf:f4v;~ . ~ ''tlr,
re~(~~~~:~~-~~f:el1t~iJer~i)~m~~~ tht~rs~ttt~ut . .~~i[~iit~ J\l : "''':f : FluaX.etioa.~.ro2;ac)
-P:tiii~pt\ttJ~bgiet~:si4Vetlei1rt~uaiserti~~-a~este'titi{lti~W.iu i1, ~~i) .~.
. . ;;J.'.<r}< _;
f~21iffl:'l \,~c
d~at.~:'=~:;~~~~;~~
madt~l:i~~~~t~ mtf.Jfj~~!!a ~ihf~i o_,~*-~~~~,P.~~~Q~cl
1
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'i'.eoil~b~1~~0~):;L ,,,,,;,,,~~(-~' r1'''''. ;~>' ';:' '.y>h ,,. :':

:o, ..... , ,q~qp~li(~~~~a}
lD J.~~~8st~secfJuu.~voiEidf4cuii,'' .~v~tttl~tun,en~ . :st~~i~~.~ti~n.l\rQu~:,.I1.1'lJiA>all\Jitt~<:leeiua,cJl~ a anr0t'a
iu:f's1hopate\J:ogie'nltc~o~: . . ,,,,,, ~~~l~fulli~.

..;J. ~~~~~~mk~~~
1 ~.ercejt~;r~~~~l~~tfil~,!~~Jl~~R~~,. ~-~,~~~~h~;,~~~l . !!.~I?u
num._~~-~"~llrtW,J?:; ~~~ ~t~~-~~~'~tJ!,"i,eliclenpt.
UtUizai:ea QCestOf Wllidepresive au fost l.v\.'"'U'L Ul

~ tue~ut~~h~~\lW.;-~;g~,pl~~P. c~~~ 1 ~~~" ~bi~il~.r

t un~~~~,~~~~~~!J,,~\{j~!I-P~ltl~~Pf!fPUf8G6l'flltrf.iU~
~ Ltret em~:fVSJJ,f~~~rT?2~g;(l)\~~~tJ:tl~:acJtt~ni~il 1
E -un~r ;sn~f+~.~.~~. ~~~~~Ji':P13M~,11..~. ,~~'1i#~~g~ t}f~JZ<tele1Lui1im;
l orgau i',~1~W.~t,~l.~~c~~tm;~~9!ll'~i$eazlb'nl.llgrt1~
1' res[ra.,_. ":' .j~;tl;i~H~~J.I~fi~eJ~~ul~J\~~~~,se p.n=iupt].n~dio:
~. :.tratao~.~~il~~~~~~tti\~gnqti~ .~t~l)l~~tafe,fe;ittitnelor'.
~. ~~uli :. r~~f,;~~r~,"~EH~J.tt~~~ftt, .lfct~n~.ntedicamea~ijf ~tee"
; l!JV~4~!~t:l~~~'~w,;a~Jfle~p~n,~~easmurtii~Zitrei,
1 Ioturfde ilabieiiti..Ob. Iotde paci~\i~~~ b:artini~ttij:chi$i~.
:;a~ (~~~~~1:1?:e~igp)_ ~~i!ID,trnJBmetl~,tlllf;JltIet,tieVost~n~h
Jll111l~t~,!;l~t,.W~~u:tff~ti:qe;:,!;!p pla@&Q1ti.se;sprlne''t:apr:f~.:
medicape dar in scllimb priu,esc capsule care nu oontin niCi: o
. I . - . . . ... .,
substa!lta artiva. Un al b:eilea gmp prilll~te ti'atfu11enl.\tt'~3re se. cate e~e~tul>pJ~~ebd
dore~L~ fl:.fi,~wve,stigalCa~sa fiea@robat.tt6alcniedic;al\1~ttt!fr~~f'ie ulilit.'ili~He sttidlile 'linjc~J~illlml.~~,qu d~Illenilil fmmacmogiei
c. _1

sa.riet1tatepcietttpcincomparat~ec'='tetetaliedoult.i.1ii1W~i0.:: ; (pentru,~~[aliivezi l999iAstfel: -.~~_t:t(::~_Y'

...~ .. ; ---~::..;;.~~.
SUA, ?t-gmli4a.tia care ex~mine.1za aceste studii ~i care bQtara~tc ' .. ,-
' .

122 123
 '')tn...P. on. enh~. cu e. recte ~nid.:in tirnp c.~. co.mpon~".'.t.e..w,_tlm~. c. :i. d_u~
..... . ~ f t l niedican~t
. o Adest;{r'S-ll_lltiliz!lt 110 pl:lc~bppasii' ~i nuwwl uctit'. \ conttibulin ct:a mal uwrorU\Ota la e ec e e <' . . :. ..
. . . . .. . . ... . h 1 . -~1 . e'te. 1gnmara ~
Madicatia are 0 nml~ime de efi:cte biologicc nespecifice (eK. nnl:ideptesive \; con1Eonenta ps1 Q og!=l- 5 . ... . . _ .
cre~letell temperat!lfii) Gn.rt~Itl[~fesC 'fncrederea pacientului ca . .. ..... . ~ Altfel
nepromovam. . ' 'in. laesa
.sons .... . .......!iahmaXliJlilhian1
.. . .incerdin1 r..'
e -r ati<\
este tratat cu medica tie ac~va. in grqpul placebo pusiv aceste .salttilh.l\ro eftClel1tefecml tnm Ollentel lace ~ (lll' ~~ ql.. :.'
efecte lips esc fii subiectul poarerealiZil ca se,at'111tl grupulpla- nnti~Jell"eSiva-eare aco ra80% dif.ll" z.ult~te~ .lD IUPllobse::;l~
cebo.. care nu pdme~te untratamentreaL A'?es~ lucru afectea-za ~. "~ ri.s.
..mcer~.;<~l . ~I:)Tomova.m
_ c. oml{Onenra
- hio1agic.
. nati. viicare
:t. acopera
nde~"'n
negativ efecml placebO' care se bnzea7Ji lo~m~i pe faptul-ci\ --20% din re~u1rate.Tipic penrru indu.stna tarmacemu::u. . :'"''.
pacienlql crede cu U\rie ca primet~.m1 cratapu:ut activ {renl). 'VIihzlirilt.~ g.;ahn de. a .pnne tn.vanzarfilll'.nou protlns
Utilizaren unoT gtupud pln(.l;ebo i)Ctive (ex. se utili:z.eRzl'i o medicmi'leriros de~i inca 011 avam suficien~e date de.~pr~.l\\~d~tt
substantii care nu ace efe:c~ specifice nsupratulbt\rarii tratate in ~are ttcesta ftmc\ionea2n- s~mt:pl.ls.einamte d:ltelo~ !ltuntrfk_e
dnr are efectc nespccit1ce-crc;.~l:\ tempernturi~} ar fj de dod[ c.1l .,.... r -mai.
Ill.nneo1'1
. . si..g1
.nt.e. .. '. r.a...n
...tei..H.
. . . . tilor.
1.' nc.ien. . Pn
. . t.ent
J da . . c ~ej"
. . ..nnm.enla.
~l Rr .duoc:; }a 9 mni COr~cta ev.nluare a efec~\ui Specific al exemple care sli i~tpnfil'llle c~]e nfi~m.at&. }utii~_dl::-o,, aZll
medieapei., antide~ 1 ,cJordescris-maLsus nrata vtctona van7a1tl~t ~~l~P:"'
o 1n cdc mnimulJc:. stud.ii. paci{UJ{ilo.r1i SEJ spus cifc.:dstli diitelor ~iintit1ce. iar exemJ?lel~ pe. en rtf_ le vcn .1~1-e1._t? 1 ~r~\ 1 ~1
50% jal1Sif~lifi~1n.gwpulcu tmtamcnLacds1 o11:50%_Fims1istf{ic cOntinuare~raLii victorin vfutzl\dlQr asllptta;Stgurant~t pacteu!JlOl.
i'u gFtpu.lp.[accbo. Aceastii. informa{ie iej:}ucf! sen1nificativ Spre exempm.RezuliJJ-un nfost un medi~nmentu~lizat i~'l ~~ab~r
efecrnl placeb() care se hazeazJl, pTill natQra lui. pe faptnl eli cat'8 n fosr produs de Wnrner-Lnmbert Cmnp~ny 1.ac:~u~ Pfi:r.er~:
pacientul. c~cid~ cu tarie.{spre)OO%) eli prime/ite tmtrnuuncnt In tmnl2000..tnst\ FDAa cerutretrngerea lut de pe:Pt+\\a (delll
activ .l.!lJliactic~ clia)'icji_..i'ncqnditiileJncare se administreazn ; 'i'n~inte a foslapr.o~~at deditre F.OA) deoi\rece s-a qb~er~m
medicatie placehp,p~cien~lesre convms cii. . rim~e
-( llctiv.ii.. n aceste.con i{ii. c1inicianul nu n .s tme tll\cientultii
'poateJtt au. me ica te.. ont& i i dau.\m tt llan1ent plncebei...
ca.acest n1edicament. arc~ o multine de efecte Sa??unlm~ st:vcrt:_-
(ex. nfecteazilficatul)~ Ut\ alt exen1p1u ast,eT'Cilot~o}-tJl (protlns
de.BoehriT\gerJngelbeintCompany),un btonhodilatntor.~nre . :l
A~a ar. studiile eUnice cm1tr.oli:)r7. sobevnlueazli _impa'?tul -iosn.ttilizatpentrll a hata astmul hToOI1$ic. Dinpi\car~ el gen~m
efectul1\i placebo-, Ufia cum se manifesra el inpract:Jca clinidL . en efe,!te-secundare tplburari cardiovasculnr,e i dupac.5 a fo~r
EcoulacestoJi.rezultnte extrem de lnleresanre afost redos uti1izfitil'l ~tnmedt o"tmnl\_perioodadeJirttp a fost J'~lr~ de pe
il).gn1pnr de psiblatn,. ~i?ro.exed1plll. Asocja~iilepn~fesionale piata.ExempleleJ'ocontinual . .. . . ... ... .... ~
jn\portmJ.te Jill 8.llluato :atitudine. ~ficialll]a ncf!sl:erezultate~~e. . 3.1.3.2. Cazul efectulni plneebn smi Cnf{l.sii ucizi en
'asemenea. pompaui!J~ fall'!1fi~lltim continua sa .prQmoveza :ntMltile enrale (pentrn detalii ve-ziDu~itl ~i Iv1on1gomery,
medica lin nnt}d~presi~a-fnrli a menpona insa explicitrolulfun- 2001.)-
damentalal fnctorilorpsillologici- efectul placebo- Q~reacoperii . IntroduGere,
cea n_1ai ma~ parre din efide!lfa ace~tei medica(H. Esri! ciu(!aL In aceasrii sectin,ne voi arlita; prinl)naliza rnodului 1n care
cum aceasrn "schizofreni~.. in don1enin duce la focAJizarea efectul placebo estetmtut 1n domeniul inedical. cun1 cetcetnrcl~
. resurs~lor: de timp, hnni ~i energie pe investigarea nnei
125
124
 din acest. !,kii~~jiiMl~il genernl~ ~1 deci ~i cea din psillopat~ltigie .
in special,,esle rustorsioitatii de fa.Gto.ri extemif}tijntei. E,fet;tul
placebo este. gr:eu <J.e defiuit intr._o maniera satisfliclitoat~ in
cercetarea:
. ..,_ clinh::u,. placelm
,_,,,._---
.- ..__ .. ....
- --_
e re(era la tratameulele
_. __ ... ---.- .-_.
;.'._;-.
of~rifc
__ ~
grupurilorde COlllmt tratatnen~ &inJ.il~e cucele.ale gcupuri;!ur
experhnen.ll\le, insii film comp~nentcle acti~e .~i spedfice ~
] " acer,lora. Efectele tratamentulut pl\lc~boJeJmm~c. eiecte pla-
cebo. in~el>and cu anull950, instltutfil~.J.~cale au in~epqtsii
recLmot\sc.ii. di Ln1tan1en~le cu plnce~.o au e(ecte pul~rl}ice. S~
..-.. presupus a.~unci dt tratmueotele cu plnc~bd auutJmare.gradde
e:ficacit(\te fli':lidi. in.lratarea~i.nruellora.re~ -ttnui ~IJectl\\ larg de
tullmriiri. e:f('}ctele placebo Jiind prez.eu~einnproape35% di.lt
ca7-nrile clilliee (Beech.er, 1:955). Utilitar.ea actualii o.
lrntamenlulul ptacebo 'ill. cercetarilc de.f~.~nuneologice(ca :ji grup
de t:onlrol). porn~te d~ la asufl]ptia di ace.sta pPuLe ameliora
. setim.i fi~ativ simptomelem.ultur boli fi"Lice.sllululburliri psihic~ .
fj ind _in acelo~i ti mp unfenomell biue.dtJcwneutatpd.Ji cetcetatite
aHit diu domenit:ll mediCal i;!at ~idin eel psih:Qlogic (vezi.Kir5cb,
I990). , r
. Ill ciuda aces tor concluzii apare.ntra~uste. dinlilerJllUra'de
speci.nlitate;,rece1lt.HrohjaJ.t:;li9n lii Goetzsche(20() J} ~~publig.t
intr-o relist~med~calaprestlgioll5aJill studio de metna~ati~in
care a'7incorpo1~t Lea.te sLudi.Ua clitiiceconttel~tte asupra..efeciliJ.ul
place.bo versus. ~rup de cpnb-olefectuate.piln1Hu1998~ lutiet;~re
sluiliu ei:i!iU.CoiUpru:atp~rformanta gtupuluiptaeebo en eel\ a
unui g111p de .controt(mi primea: ttatmuentsau empcotistli 9-e
a!iteptare)Juand 1o calcul o singt1ravatiabiUi dependenta (ce:t
m.aiilr~port:antli.penttustt'tl=liusail,dacli.uU.sepreciuaeest;lucru,
I . . . .. . . . .
c.en pe care a.ulotii met~analizeiau aonsiderat-o cea mal
important~ peutru pacien\i). Conctu~ia studiului . lor. esle
surprimJ\toarn: ex,is~~ dovezi cares.a nleste efeclel.t<cliQ.ie
--.pute_mlce al~ t(atamentuluicu placebo ~iprinurn1are, nllM!~Ui
.__!1itnic cru:e sujustifice uliliz;area acestuia pe 0 scad\ larga in
126
practica sau cercetarea cliitic,2-: Aptorii aceslei mclaaualize.
t:antitatlve sugereilza ca efecte,le putell\ice f,\le t.rawmenlelor .cu
placebo obtiuute Ul s~':'diile artterio.a.re' pot Jj, si1pp~~ rirte[ncle
sau se pot da~ora unor.g~eiUu deniersulmetodtilog!:j Daqii
acenstli. meta:-analizil re.alizat~ de Hrobjmts~Oil ~~ Goetz,<::cbe, co
rezultatele ei pro~o~atoare 11iuan~cum nen.~teptate;ar fifu~t
publicata ltJtr-~ revisUhnedicnUi mai puliltpn~stigioalla,nb a.rn
pinut probnbll. atentia cuve1Sitl\ tUn pruiealntilii.~tiluti.UGtk [)ar
.flind publit:aUiintr-ttnndiJ.i dOO"~l/iai,prestigion~ere"YismJl'ledieal~
-"NewBnglandJoutn.al o{M~dicio<J'' -{NEJM). revisUicnle
ure un ractor.tle itnpl\Cl injurUl valorli. de 30 (eeaitiai.tnnre
valoare intre revi~tele medicale) 1 ~ceustli !te.fCelrue meJ1La p
analiza n1ult.rnai d~l:nta ilr conte::ttlil.atndizei ~tfir~eilij
pseudo!itiintei in domeniul psihop~lologlet A~itd.ar, peuttt' '-'
inielege. mni .bine Iaclorii restionsatlUi .. pe11ttu. te~ultaie~e
COiltradictorii ob\iftiltepna l\C\lln de'sttit)l.ileasupra et:elt.dttf
placebo. an1 fenli1:ato ailaliW:psihosocialhun~tlUnllla ul\ttt\.t~r
cer~etiir:ilor eUnice iucluse 1u metaanaliz~ .reali~i1tn .lle
Hrobjartsson~i Goetzsche. Amfostiuteresati '~adi'', cuu1" $l
''in ce 11.1as:udi" factorii psihosm::ialL (ex. pt%a~a ~ro~ioimla
a c~IY:!etatocilor) au nvut o contdbutiela ob\inerea re~ult.!felor
studiilor asupra efectuluiplacebu. Ace~tl\idl:enu estelo.sli Utla
uo\larsi.uicilipsitB. de=$upor:tlo&c.Douii aborc:l~d ~lilll\ific~ vln
in spdjhJ.ul aeestuideme~ ~Ji a ::1cesteiidei.
Prima. nboitiare este legilla d~. cercetarlle privifid ..e.fectpl
experimentatoffil.ur. tn 1'961-. Rqsentbal ofe.roa. doYez.i 1~1
sprijiuul ideii con.(orm cateia (l) inesajele .iutpU(;ite ttJe
experimentatorului pot influen\a perfurmau~a subiectitot" l.n
sarcina experimenta\a ~i (2) re7..u1tatele cercetaril pnlfi p~U\ial
prezise euoosdl.udu-se catacteristicile exp!;!titneMat&ru{ui.
Studiite lui Rosenthal au pus iu evjden\a fa~lhl c'a ot:ieniarea
e;tperimenl.alomlui, pd11 expectan\e sim scopu~J..:catre rezultalele
cercetiirli, poate influenta ~i determina par~ial aceste ~e~oltu.le .
127
 . .. 'i'T . - .':':---:----

Acest uefe~l nl exlle~i,tllFntntot:nlut pnte afi }t~~sp~ct ~omun

~nr~~.;ei~~~~~~~~~e,~~~~j~~~t;i~e.:el~!pttt;ep~~ll~~E4~
Jl\B\1~\u.c~p~mnt~Iqrc;xpel;tl\1!?~fntt:)fl)l~!' ~"flra.re~lt~teJ~, '}
obt1utite{~~sen:~t;.l9~7;I!~94};p~ve,i.i~1ilf:~lll~ijld 1f~st: i
efeel sllinttadrure ~~> erircetllri ~~n tlon'l~iul meili~il\et, .ai .
.,.
. .l

p&il~l~i~r:cl~m~;~ ~fulli! ~e1r~li.~~!'~~.~b~~~n,~s.au.~....

ceJ;cetm!il~CJtpeti~~1~8Srtpt~ coth-eol"tanf!lltnluJu~ll' Gvcrd:> _.;.
p~tpulJe~,R~Ct1tliJil;i~6~l.}994 ::t~:~T!ti~~!nt~,~.e,pu.Unn'P~
n'~~tlltea~eet'l\.~l~l~e~t:im ~r:til.~i~~.~ibl,;\ln ~lllP~~~.J
Pl\~~~~~~~r"~,l,~~te!?r,~ ~a~~ll~ .t~ri~~~~,~ .....i
p~9M~~ce~~Ltl.Qua.lm"Otl1c;n . .. . . .. ., . tnrpc:~p . . rr~mt
~;r,n~~~-"~ oi'YSontic~Jare'~eiex.pe0ia-fi}~ ... \1.,1~~9!
l~i16l~4f~ll::zex.peeafl.{cle pa~e~plCrt-'s~,~~fa~to.d Il
f

'
'-~~c41lffit~rnci!n-.tujlcu~:plaect1)fi ~111l\ltlne\~.
~ tie ~e~Jl~f!ea~ivli~tn,qbfinetea~"a:es~nl:.'~fe~t~ ~. , .
t1n{ ~~~~''?1l~ind,~n[l~iiplU1:abt&:c~n~ahJafi 1 ;. \.
~-

~t\}llQ~~.4~~J~stimuli<'Sall am~~~sitnati~n~l~'' ;
: .. .:)~~~)~ 'dn:.1lrm~j ~fectutiplfl~alo~a!~: t\t'r ,c !
Vb :;l)'l;"~{t:.~tul~~p~rbneotate.rtlt\1i~;it1compiffiiti6.~ i; ......

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. ''"t,cc:ru~ ~J.l':~~J~!'~ !r~q~ti*ft,:~lltlu~.,t~~d~ <i" U'' ~ ::.. . t

~~j .opregJttreli ~r!l 'ntn!nibfeslal}nlli a.cercela~l'iJru}lli;!t;iil_. )>

cip4l;t'l' .,~. '':ct'r% ::; : .: "'
,0; . ,: ;,,
:coie~thl:ffzfc'J~. ~nt~ ..e~J:cet.iitor;ll.l :
;.

ex~~l:;~~(~'~prO~toritoqiasia*
renfUllF (t~'eeilJefa~~ P~.~tim ~i tie l"ela[ia lni ~u ~~e~tia.,
' . ', "~' ' ' ' . ' ,,. -,. ,,,~" '" . ,. ' . . ~

l:!q ]29
 ...
Ull efect plac.Y,~in.sLudHle efoctuate de cercetiilorii ftil:a p~~gatit ..
medicala:.fo\Jivitteoriei emisc de Roseulbal {1967). pfudi~1fa
.genenllapdvii'ul it:Upactul pregatirii profesiomtl~ ( ce~ratori cu
.sau .flira p~egiitire t11edicaHi) asupra rezultatelor stttdiilbr care
investigbeaz~ efl:!ctu1 placebo ar fi putut fi iutfiunatafita prin
lunrea in conside~JJ..re a uuui factor adi~ionai. Aceslasereferi Ia
~filierea acadetllli~a (tnedicalii vs. uoit..,tnedicala), care este legata
de cviJlextuJ fizic .in care. se desfli~oa1a cercetarea. Cu 1.oat~
Q.Cestea, 1m al'n putt.itinclude aeest .factvr in acest stucUu din
mmatoarele motive: ( 1) nu a fast. ill' mod clar .specificat in
articolele nnalizate ~if sau (2) chia:r dac5 acest aspect a Cost
specificat, a fos~ nml~ pren gene-rallJenrru a putea deduce corecl
nlllie.t:ea acadernidi Sl'lecificii (context medi~al versus c~.qtext
non-Iuedical) a cercetiitorilor priucipali (ex. cercetator lu
\Jnivei'sitatea din t..oudra). . .
A' doua abordare itiitJfilica cru:e su~tine ideea itJfhte~tei
fuctorilor psihosociali (ex. pteglitirea profesipnaUi). a;supra
obtiuerH efectului placebo decivlldiu. filozofia 11tiintjei, Astfel,
unul dilJ fnct.orii care ru- put.ea infbienta rezultntele cetv;:eUirilor
pqvind efectul pla.ceboesl.e cont~xtulsocialiu care .este .realizaill
ccrcetarea. Dt,tpacum ~nua Kuhn (1962), orice. eel"celm:e este
renlizaw intr-o p~ni:digm1i. A=i~a cutn anrmai 5pu,s. o paradigma
reprezinUi o colec\ie de proceduri )fi jdeipdn care cercet~toril
Sllllt instntiti hnplicit !"ce Sii creada", uCUlUSarenJb~et.e.stud.iile.,
~i ;"car~ suut Jezultatele pe cnt:e at lrebui ~a 1e acc.epte".
Cercelatodi tncenrca se rez:olve donr probleme de tip ''.puzzle".
0 problema de ~p "p~zzleu este congruentli cu paradigma. :;i
soJu\ia ei inthe~te .respectiva parndigma Efectul placebo t:."ile u
astfel de. problen:1a peut:ru cercetiitorii .fiid\ pregatire medicala
intrucal cerceliirile asupra. acestuifeuomen intiiresr. ~i e;'{littd in
-. aceln~i timp paradigmalqr delucm {ex. pentnt psil10logi). Dadi
e[ectul placebo ar constitui o p[oblema de tip "puzzle" pe~tlru
ca
cercet5torii cu pregatire medicala, ue-am a~lepta diferen\ele
130
:
~. . : .
dintre ace:}tia ~i cei fiira pregatire medicnUi iu sl\ldiile asupra
efectului placebosafie ruultntenuate. ~a cumairi mniafinuat
p~ pnrcursul a~es~i lucdu:l, 1111 nnumit feuome_n tlP''ille o
probleina.de tip ..l,uzzle" aluuci cfind: (1) uu numH.r mnr~ de
cercetiitori dintr-un dotneuiu sunt itnpllca\i in rezolvarea lui ~i
(2) acesta nu e5tet\eglijat~i devb1e obiectul principal ai.cen::e,tru:ii.
A~adar, cu ~at ~st.e .mai mare nutntirul de med1c.i care
investigheazii eieetul placebotutr~un ilot'tteniu Slle~ific, cu ntllt
c~te probnbllirnrna.dea gll~l efecte pro-placebo in studiite r~
spective lli cu atilt difereut~l~ i.q rezultatele ob\lnute diillre c::ei
cu ~i ffu:a preglitire medica1a vi,Jr fi ~11ni reduse. Iiesigur, snr
putea S\1\IUe ca st\ldtile BllaliZate aiel ~i i~lC}US~ in tnctaau~lizn
tul Hrobjartsson ~i Goetzsche a.u f~s~ ~laborkte ln Bljll f~lmc9t
sa evite distorsiunile aduse de erectuk experitneutatomlui"
(Rosenthal. 1967) ~i de pm~di gmn in care s-uu reali~t (~uhu,
1962). Spre exemplu. Hrobjarl.sson ~i Goe&zsclie au ex.clus
am.m1itestl1ilii dMnpersuana co,r:eevalun rezultD.tele ~linin care
grup e5le pacienl:ul. De asemen~a, 79% din studiilo incluse il1
metaannliza .nu mentioneaia ca_a[tioctiv explicU evnluarea .
efectului placebo. AceastafnseUlllldi. cii in act:Ste studii. efectuJ
placebo nu este chlnro probleUia d~ tip ''tJuzz!e. In pt~ts, s-nr
poten spune eli '"ef~ctul experithentntol:tthil'' .uu.e5te chim o
erOate sistematicli itJ cerceliid. Cu. tonte cli Rosenthal (1967;
1994) araUl. cit acest efect e3le .puteruic, illti autoti nrnUl d\
distorsiuue;t prmlusu de- "e(eclul eKperiinentaroruh~" ~le
aproape neglijabilli _(Barber. 1~69.~. J~~ssen~.l9'13). ~01\91UeC
aceste contra-argiunente d.rcpt wtreblih emp1rle'!e. RvscnU1.al a
nrtltar faptul ca 'ex.isla mni multe m~dalit~\i ?rin catc
aperimentatorul-poate iufluenta raspunsunlesubJ.OC\tlor. Uode
c.Untre acestea nu se supun controlului experimental. (vezj
Rosett11al,1967~ 1994). Spreex.emplu.. cereerntorul princitlal
ponte lntnsnlit~ expectnn\ele sale asisten\Uor Sal de cercet.nre,
iar ac~f:ia pot }a rfin.dultor iufluen\a inCOU:?UCllt (ex..lJri?}nodul
--. . ~- - ..
~'!... : : .. .
...
 -- :---~-~-:-.-

Opstofi:idi; Nl Medicini\inre.nl\; (5) Chiwgie ~\1\ne:>tt:t\ologi<.

de inter~ctiune
subiec ito' P- s6"iai!'
. ~; . a, pnn~no ~ ..
duldecomunicare) . raspunsurile
Aln.exdus 11n stndm. seffil1f\tCU un ps~qdonrm (l3Fecho. U2.92
, ... 1 tt .r.. _?tUtmlare. daca ..efectul ex:perim6ntarorult.li" e~"la Iuset1~.Arc iGrepa, il9B9) d&oarec~cercetl\toriavean pregatiti
~ ~ ~u-emltn"tle~tudlilor careinv6Stlgbeni;llll!ctulp~a
diferit.!!(atat n.ledici cat ~i cercetl\tmi fi\d\-prcgatiremedicalli) ~i
ceo, :~tnCl acestlucnt ar trebui sa lranspad\ ih investigatia
i
nu an\ pututafla cine este autmul principal al studiuh1L A1n mai ._I
noastw. A~adac ar trebui -a oh . ... . . .. . . . . . excltfs doua srodii (Bertedetti f1i CC.Iab~. 1995;-fJ.allshish ~\cu\ab.,
rl1spnn!lUTi plac~bo - . .~ . . ~~em patr7rn-m:i cliferite de
t9Rll) nl~ Qlicor :nuteri{l) au pubUeat un 1\lt StL\di~l (iL~clus.in
'CO.Ih.pam .. ~ .... .. 1. ........ l~ cazu .. stu.dailor e.feetuare &..me. dici in
.. . .P"""en~ ~.reahz.ntedoces;cetl\torifti ;Ji ... a ... .anal!~ deJa pi), (2)stttdin can>; ave-a acelaQitell.1.a !li (3}'tn cure
DacU in scbimb ac~st ~~~feet 1 . . .
tent. 1\tu\\ci h\1. va fi us 1 .. n ~~JCpCnm~~mtoruloi.. este ineJlis-
.; preg ure medical I\.
nutQ~~i all obtinut 1\c~leru}i a:e~ultat~.nAm -exdus aoes~e studii
profesicinate a.. .. & . 1\ ?' l~el\(a ftlC.t UD efect a( p'regatirii pen~i}1a ~"'il)lposillilitrttea ca datelesi\ fie inVluentate de t1n au tor
in studiile ~r fte:ed. ~ fOl;"';llm n.s.u.pra r~zu1tatelor expe~i1tleutale ear~J~Clny-tllllil> ~.111ai rnult(\eo cercetnrepe aceea~irellla,'. cu
!IZ_ n e~.eorul p1uccbo. ace\~~i Tezu1t.nte.ln totatruninclus I-ll stud~i dintre sntdiik
~~ad~r. un p-rim.nbiectiv nl.sturliullli de tatii oeste J d cn~iau pattici\)atlameta...annlizanriginal1\: . . - \
a reaUza o analiza psilros6cia1~ li . a~ a c pri . .J
tn ll)etaan..ali2~ h)i ]:1 bj am ~un{ttll acerccrarilor incltise . '{Se\ectia daiclor. Au fosr ex.trase -darele vitoare lt\
asumptia eli mzunaU: -s:r:~Qn -1I Go~~C]Je. Pnrnim de la pregltirecel:'::etiitl;)miuillrincipal (pdmul,autor al stodh~lul). Am ..t

- profesiorfal'l( . ... n l or vor fl. afBCtate de pregntite!l' folq~jtresutih drl?ei~temet. iadtibnt_tlfll citre acesteinfonnnti i .:....Il
preglltlrc'lnedienlii)11 a cereetatprulni prin
M
1( .
ctpn cu Jil r~pectiv- fl\di
' n~. ~~'lluto~fi e1ttras~ din atticolulintl~i tti roetannnli.Z1tsaL~ de
pro-placebo 1(l sm~x~~t,. ne a~t.ep~m eaproportia de efecte .. pel,dternet,I\n);cimtactatdirect ntuori'f.< ; . ... . .. . . . '., -!
Sir"fie mtli mans tl.,.,..At rea. lz.~r~ de eel fiitlt.nregiitire mfihcal1f' ; ~il\t~~.4~f\\fll' J\_rQ _fticut. o. anr1lizli
. . .. . . - . ' . ' . ...... . . .
~loball\{toate cele I

studiile ac:;e}erru;i ~rcetlitorl

.-.a proportta de e~eote
ln . .,. .. 1
contra- I?. aceh~
, . 111 stucJliinC1l1se/fn aler.aanalizli) :;i ct~ b. aonli21\ pentm fiecl\l:e
ne ntteptilnl ca :pro . .; cazul atydulor rea\iwte de medici cat~gode1nedicala speciJi~~.= ( 1) PsU1iatr}e~ (1) Neuro1ogie; (3)
~ mai micH. sau. s:::~~::~:are obpn e~ect~ pro-placebo sn Giljecologi.e;";iOtistetri~n; (4) Medicinl'iJlterol\; (5) Chinwg\e
Qtknesteziologie. ln.ftecni'~ analizt an~folt)sit do\ in.dicntod.
celor cme ab"'n eti t _. mod sel)lntficativ de proi)irtln
predic~ia conform dt . .
,. ee e contra.:Elacebri Fa d
__;_ cem e asemellea Pr:trnul indi~lllJsereferl\ ~a te~q~t~ r:f~:<:tUi~l i placeb(l {plac:t;~o
1
profesioila.le. vor fi ~ul::~~l!~~re~te~e datorate pregatiTil trend ana\y~ll\). ComP.atftnd grupul p\a.c~bo cu. celd.e contro. ttn
>roblema de tip...p.;zz]e" ac e et::ilJl placebp deyine 0 c~iulsnadiUor
.. . ......ct~ .. . . ,. .depende~te
va\iabile . .. . . .
dihoton1ice, un.risctellltiV
medio_aut robi"'"'""' d ~~ ~eptru:i Ct:rcer!torU en pr~gittire m~i ~nic del indi~l\ un i!frict. pozitiv al trl\tamentultti pfru::ebo.
.,.,.,.... e !>' ozz eJ' -n d d - . DacariscolrRl_ativ.este mai mare snu-egal cu l, acea:;tn.t!$r~ o
.Dl1ml{ul mare de ers . . un efinlta atcJ prin
~-....:c:.:~~o:.l... .. P _o~ne z~pJzcau; in -studiuJ.efectu~a- d~vada impottiva ~x.,tst~ntelefectului placebo: ?enrliu stlldiile
crip~ au utilizatvariabile den~udente continue, Hr~bjartss6n ~i
. . .. . S.cl~fi~sfndiilor A .. . llz81 Gotyscl1e nu cnlcQl~qlifet-enta standard d~ nwdii intre gp1pn~
l.Trob.d.IP'.rsso~ Qi. doty l . mana. tQi\te a~udijle folosittuJe
. . .
4

. . ~ . ~. 'LJ . SC lC(2001}'iU ID"'ta }j y.

nnaltza or-iginaUi ei au.inctus 114 .. ..E. ana za lol'. m mota- p\acebo *'eel de contrpl. 0 valoart} de --1 semojfrcttun.efeci
5. categoT.ii:Jl) Psihiniri.e ('l) N-li~dn. P.e cnro le:augru{lnt ln p\acebOllutemic. 0 vnloure de 0 san+ 1 el?tg o dovada 1rnpotrivn
.. - e)llOlQgle! (3) Gtnecologie ~i
113
132

.---~----":.~:~ .
 ~xistentei efectului placebo. Amt in cazttl analizei s,p~e_F,iJj.ce,_
pentni.J1~Saf$~tegmie medicala, clit~i In cazulan~liti!fglobaie~ ..
. am calcuiatpe#liu cereetlitorii rara pregatiremedicala,~i pentru
medici propor~iat:fe studii p9-placebo !Jl cot1tra.:ptad~bo~ Ccl
de a/ doilea. inrfiaatwl" se raferii 1a implicru:ea .in dotueuiu -
.illll'JliGare in sludiefea.efeclutui placeba, pe bazanumliptluide
articole incluse !n .ptetnimaliza 1ui H.robj~J.rlsson ~i Goelui.t:he.
Am luatin calcul propor(iile de cemeliitod pro ~i contra-;pla-
cebo in fiecare coudit.le medlcaUi spedfl.;::a separatpentru
cerceUitoriilild\ pt"R~atiremedicnlB., J;CS.,pectiv pentru 11Jedici in
cazulaualh;ei globale, runluatin,calchl proportia de cercctatod
Jndi. pr.egatire ntedi<;ani ~i edici en tin indicatOr preliniinar ~I
contributiei generale.fu domeniu.
Rezultnte
Catege.rla stu4iilor efectua~ .<le medici include 42 .de
cercetad ale cnrot: cerceUi.tor prlnclpal este unmetlic fJi .5 cei:ceUUi
ale cawr cercetlitor P.Iincipal este (.) asfull::ui.ii medicalii. Ca~gona
sludiilor eiectuate de cell(etaturi fua pregal:i~ mecUcal.ii~clude
62 de ~ercetari ale caror au tor priucipahire tiuut de tJQCtOr ( e-:t.
lll psihologie, ed!JCilfie) ~i 2 cett:;etiiri rue caror ll.lltor pri~cipal
este absolvent de program de Master.
':!.<Analiza geuerl\la . .
TelJ(:/iiJ{.a erectufuiplaccbo. Rezultatele no~stre. aratli di
73% d(ntre cercet!itorij.ilirli pregatire medii::aUi nu gasit o tendinta
pl.n:i li va pentru efectqlplacebo, in tin"lp ce doar 27% au giisit.o
lendiuf.i negatjvii. {IK0.01). in caiul cnf:egoriei medlc.i doar57%
~ntre medici nu g8,sit.o tendintii pozitl.va pentru efeclul:pla-
cebo, ill limp ce 43% diutre ei nu gasit u tendinta negilllva
(p>O.lO).
CoiJtJibu{ff:! generala fn domeniu. CerceU1rile asupra
e(ectului placebo incluse ill studiul nostJ-u :;>i in met~annliza
realiznta de Hrobjartsson =1i Gotysche (2001) au fost realizate
in
de calr~ cercetator.i fiir~ pregtitim medicalii .ptopoJiiede 5B%
~ide ditremedici itJ. proportie de 42% (p>O.lO).
l34
\
\
Psibiatrie{~3,de sludii) . . -
1biidinta e.I-cc.tului placebo. Re-z;ul~tele noas~oo nra~ c~
7l%. dintte cercetiitorii flim pregatire medicala au gis1t..U leildm\a
pozitiva pentru ef~otu.1 placebo, in timp ce ~~nt=:29_~ a\1 g~sit ?
teudinta negativa (p<O.(J:l). Ul cnzul culegnn~l meilic1 don1 439to
diutre"medici au gasit ot~ndintn pozitiva pentru ~fectulpla~
cebo, :m utnp ce. 57% dintre ei nu gil.sit o tendintiii~ega~v~i.
(p>O.lO). . .
Imp/ica.rea Jil JolllMf-t.t. Imptioate.n cttrc6tatorilor .adi.
pregiitit-e medicaiii in cercel,area efec~lul plat:~IJ~ in psib.iatr~e
e:~t-e_de 32tH% (dintre toti ce.rcetntotilftrli preglinre med1cttln)
inr iinpiic:rrea medit!ilor estu de t4.89% (~l_intre tO\i merlicii).
Medidnil:. intend& f.l8 de studii) . . .
..
TeJuJi1JfH e:fl!ctalui placebo. Revsltntele no.nstr~ nrnl~ ci\
67% dj nlie cet"Cetii.torii flirli pregatb.untooicmlt-a!J ~lt'O" teodmti\
poutivii pentrJJ efeatul plo.ce~o. in limP, ce do":f ~~%~~.gas ito
tendin\8-.negativa (p<O.Ol). In :c~z;11" ~aLegope1 medJci, 64-?V
au
dintre ei giisit 0 tenilinta poutivn peutru efeatul placebo, 111
timp ce 37% au gasit o \eudiula I1egatlvlt.(p:>U.10). .
Jmplicarea. fn domaJJiu. Im;Ucm-ea. -eerc~l=itotilor farii
_ pregatire medicaUi in ce~tareu. e~ectului ~las~bo ~n_ ll~e~lid_u_n
iuterni.i este de 37,5% (dintre .top. oercetU:tonl .fiirlt p~;egauu:
medicalli} iar i~pli6u:ea uiedicilor estede'~~;78~ (diot~:e lo\L
u1edicii). . . '
. Cltirurgie ~i Altesleziotogie {33 de studii) . ~
TendiJI(B. ef~ui placebo. Rez;ull.atele ll<Jnslt:e nrnl~ en
7 l% di11tre c&cetiitoriifilra.preglitire.m-ed.icaUi.auglisir:o Lru.llh~\1{
pozilivii pentro efectul placebo. in limp c~ dua~ ~9% n~ ?as1t u
le!Jdinta negativa (p<O.OOl). iu cnzul ca~gone1 m~dic1, 69%
oinlre "tnedici au gi\sit 0 tendin\a.poz.itiva pen~ efeslt:tl pla-
cebo, in timp.ce 31% au gasit o Lendinta negati:va_(p<~.OOI). ~
Implicaren fJJ! ~ome.niv. lmpUenre~ c~~~e.ta~(lr~~.~r ~~-~
. pregalir~nnedicaUl. in cercetatea efectul.ut placeb~,m~cmr~rgre
f35
=li al\estezioiQgie este de 15% (llinll~ l'?ti cetcell'itorii fara
pregatlri$ 1U1(:dicaUi) iar implicllrC;a medicilor este- de- 36,17%
(dintre to~i mttd\cii).
i
Nen.-&logie (6 studii) i !
'--
TPlldiJJtaeiectuluipltwebo. Rezultat~le noqstre arata ca 2 -~
dir~Lrtl.c:ercet.:~torii tam pr~gadr~ rnedic_nla au g~sit P tendintfi ,!
.. ~

poz.itivi;i penta.l efectulll!acebo. in timp ce.nici uqul nu a glisit o '

tendinta negativli. tn CI\Z.Ul categodei medic\, 2 diptre ffiGdici: 1m
gl(~if 9 t.enclintJ.pol?itivllJ?entru efectul placebo. in ti~p ~ 2 nu
l}ltsit.'o tendill(anegativ~.. ~. . . .. ......
. . I.raplicarpll .in dD.manin. TmplicaiFet\ cercetatQrilQr :fftrli
pret;litire medicnlit'iJ.l-eere.ern.:ea-efectului plac~bo fp neurologie
esrede 3.12.'% (dhtll"e top .cercetlitt>rii flirl:tpregltire medicalli)
im: impl\c1\reamediciloreste c}a 8.51% (dinttetoti medicii). .
GineonJqgJe ~iOl)stohicli (6 studiil . . ,_j
'lf;mdia{a fJit;t:ltrluipf.nc~bo. Rezultntfll~uonstrearnUi ci'i 1
ce~-ceui~er flira pregalire medical! ll giisjt o rendintii po'-Zitiva i
p~nnu.e~octuJ,J.lla~lJ.o, Jn timp ce nil;i un cernetnt0rfiirli pregalire _I
medicnlKnU.a-gKsit-a t(!ndintfi n~gativa. tn oauit Ciltfe.gorlei meiliei,
2dlntra medici su'l'gMsito t()ndintit.pozltiva pentrn,4f-cctul pla-
cebo. in Lintp ce. 3 :ltl g;ll~Uat~ndintl\ negativli.
ImpfJ;:huCa m. dD/l'le:nju. In1-elica1ea cercctl\torilor flirli ... i
pre-glitire medicn1l t~ cc;rcetfjr~ <;fec(ulul placebo.fu;gh1ecologie
~i ol.>stetricii e&te de 1.5% (dintre toti cercetlitorii flidi ptegatire ..J .
rnedicaUi} ia1: hnplicaren medicilor este de 10.63% (llintre to{i
medisii).
. Con.;lnzil~l ~ise1ltii .. :
l11 ce~a ce. privefl(e tlscnl relativ fii rnfirimen efectelnr,
eetcetirea nons~ii a evidentiflt cam;mltrul cercetlttorilo'r rnr-l\
preglititn.mdicaUfQare llll i.'1\&it ltn' ef~(~t pozit i v alinterventi~i .
de ~l? placeb.o este ae.mpificariv; mal n1are clccat numlhnl
cercotlitorlll:Jr.flirfi pmgatlre n1editru1\ care nl\ a\1 gfui~t ncest efe.ct.
Efec.tulplacebn pentm cercettitorii flira preg~tire n1edica\a e&te

116

..... - -.....: t . ...

 ui:fllito~~l.~ .9ategorli: studli efectuate d~ cerc~!JUOif.flirM
Pj~~?;- :~al~istadU!;ef~~~\te4t~eei~~lli~~~iZate
,c;leb.
.. ,. cereet "r ..~ ..: ,,> "''i_'mtr'''''
: ,, .. ,..'fRncn;r;eoatfi.t;em.ediGM:a :,~~-
. cllb.'l' tu
!,~f~.tu
.

:IJU .J~~~ite':lJ:l!J~' a'.med.t~tl~(~lJlSI3t\t~;:~ej"~~r. . . . 1~.;J'if:Jiin

~:,l:~~J~~~~~dl~~:~f.i~~~}!;~~fl~!Ji
.. :'f. .. .e v~are.ar.Q:ebm sa.mves!glte?;eJa~~t!a5pBb'J''t"
\~!~f2~~~~11iiJ,__L~uiiduzijm. . .jf[~~~~~
: .. ~elt :tilu -ii;~'l~~nsilaf:,cliiili~p~rnsm~a;cicie{{S~it1bllt-o
. , ~~.P~g,~~~d~,~urnp.ff eeP:js~~~'d6tla:ca~~ti'tt('J ~le
\-~"tf"'~~D.v~i~&liscut.n ri:~11ltf1tP,l~~tlP.~ in1w.ltij . ~atm
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,... lll,\l~~~t:~~tl'nl)'\ .nrt;$r~ ... .
ntenhnt~tin~f~ultii(Rt! ..............6~~ehsote~~ ~atefioi-\tbiri~~:pe
, ,ss~e~w~:~l1a-r:at~aAj~tsfloJt;~\66~~~\~(~Q9l)[!l~)i:~;t~it.~'l~;~ .
'n""''bdCbe~~!6i!llti~!ttli~fd'~"iili~l1'!\~~,;,
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f')~Rjl~fla~~~l~t>!~B.~f~f,"!{j!~~i!i
;o;.P,l~C~t~e6'1'~nuran~~a1tsrdetaredsca:ep~~\i},~mt~~.~~ll~lu\
reaJ;ic'\~l.i~rcl'~i:metaauaUu,nn1eduare
.. .. {peritfb;o
. ttece~eiild:
.. I in
141
 r~v~s:U, vezi Kirsch ~i Scoboria, 209ll ~upra efecfillui placebo
~l 111F!.'.!t~!;!:lt nu cileaz.a aceste mela-auali"Ge. ,"':c'"'';.:;
. .: }4#;f'achu episremo!ogit;. mai SOCial~~ Illai ej:fr.~trlfst este.
-
. j.:
pmpus deFe~erabend {1975), A;; a. G,~Ul)U~~iuni.spus .
F~y~~abuend sus!u~e d.nu exista o Jogicain ~tiinta. ~tea omneuii
deqhmtacreeaza~l at!~ratateorii~liin~{icediu tnoti~esubiective
~i.chiar ira\io11ah~. ~1 fac_ oike este. necesa.r peutru a ~wansa.
Evident e.U n u apar probleme in inte.gtarea n~iultaelor.ob jJnur.e ~
i_ de.noi in acest cachu.epistemologict.Cercetatorl fl~ilpregallre
m~dicata par afi dispu~Jsiifacii oric~peht:m a.ex.tind~ domehiul
lor de :ercetare, iprm~dicii o~ce.cons~rvlLnbordar~a propusa
de 'ei. In ac('-st cadm. se poate ridi~S. q l'ro1Jlema.de.ordin etic,
legatit de n:JetQdele peciye oamenii de~ti.iufa.Ie.utilizei!Z<li peutru
a-Ill extinde domenitil dt'e. a&t_ivitate. In paracligma pr~pusa de
Ku~m. modaliUitile deiufluentare tnu a fi iiuplicil~~ iarefec:t11 t-
1or. poate. fi medint de exp.ectante!e hupJicite a.le
:!{P..edm~ntatoruhti. P.erspectivaluiFeyt\\abend l\U maii~pune
ms~ aceastli constrtlngere. Pe altfttl,J.ll()dalitiitilepqstulalede
acensta diu unna. perspectivii :SUnt. coHgruente Cl'; utiliza(ea
,_,., p~ittnii suciale (ex. p.~iuu.ea.s[Jonsorului,. afi)ieren) ~i.auuot
') metode nuti .. Pll{:iq orto.doxe'' (e;~~;.. ueiueludt;:rea. rlt s tu!!H n
aumui tc:n:. rezult~~e l}a~e. 1111 sustin .ipoteze_le, dist~rslu~Ii in
.r .. modaliUifile de pte~entare:~i in,terpretart: alf) dlllelQr). fu conte]ltul
'1--CCS.tui ~adruepistt:~olo.gic me.n.tip.nfun feuorue~ul.de ~oEt}.~~
. .. .. . eumenl;l~t'trlo ,_, .. .....1.le .01i~ a c(,etuliJl ex l;.!duleo,..
~~i"J c:tre. ~te,foart~~uno;:;cut in.cet~lii!iJecit!1[:ee~AII eJ,
.nlilt .metm.mnllz~le .cnlitalive ciit ~L. ~ele . . canlitativ~. nra,ta di
- vadabilitatea. re7.:ultatelor stu<liUor .eUnice ei~te u:ro~iata- c;u
.pre;f~nteJ~ qi .e~perti~a echipelot d~c~ce;l~ue penl{U un aDUillit
tip. de t.J:atament (pentru o anaJjza dnta.J.iatn vez.i c;ba(ubless ~i
Holl<?n. 1993). Autodi (Chmnble.':is ~i floJion, 1998)prefera sa
creacl.a d\ acesle d.iferente sun l date dei11~apacitntea echipei de
~ercetate de .<l huplemeuta.uutratatu~ntconcwentcelo1 pecare
142
....... _,_,
-~-~~..;..__, ... .. ..
,_.~ ~....,, __ __.,~'""-''''
ei Uprefera ~i nu tie e[orluri rauvoiloare de a iuflueu'a tez.ull:atel~.
in orice caz'
a.ce5le anqiJ]aliiparafiinn\iJ.nportanLe_c:lecl\L cted.eul.
Posibilitatea unei conduite UtWti;il~pfice ll1Jillinta a lnceput sa
preocupe tot JJl&igmlt comuni!ale(\ ~tilntifi~ :Ji~~ ca at.a~-e.,
examinuta foarte serios .. Spre extmplq nscul !fl coudtulK
u~tiintifica in ~liin~a ?u fo::;t ~is~ulate de Scha~;hntau{l993) tn
infloenta revista ..Science... Mai tecent, "'New England1ounwJ
ofMedicine" a publicattmeditqrial d.spreSJl(}IiBorizare.dreptmi
de qutor ~iresponsabiJ,itate. fn nl!estedltorial sediscutti diierite
nonne ~are. sii incerce sa fprotejeze. cercela~en tnedicala de
distorsiuni in cercelare~i c!e div~e lnterp.:re(ex. aspoDs~ntlui),
care au devenit prea mad pentru n tllolernte sub etichet."\ !l\Ult
mlli inofensiva de "efec~l-expc,titnentatnru.lui"; J3tlitorJalul a
fost semnat de 13 f;{)itori ai celor mni influent.ejumale luedi~te
intemationnle (Davidoff 11l cu[ab.,.2001),care'~i-n~ expritnnl
iogrijornrea cu priv.ire.la cen::ctli.dJeluedicrde '.iIa cercetarilc
psihologice complementare.ln. coutextul n~estei paradigme
epistemologice a.rfi. fost interesanln. investigorea efecl~lui pe
cnre il are spon_sodznrea de calre eontpP,niile [nn~laceulice a
cercet.=trilor asltpm efectului placebo -- cu un posibil cazdc
presitUltl sod;llii: Recent, unii medici -~ farmnci'ltl (espans~hi li
nuluat ntiludine fa\11. de presiunile cotnpnniUorfarmaceuUce nu
door in manifeste .teoretjc~ de geuul celui nteulkmnt tuai :sus
(Davidoff ~l colnb., 2001), ~i !$i b.t acUvit~ti prnctic~. AsfJel,
uuii dintre ei au aldituit gmpul numit 'No Free Lunch'. (/JJJJJ,:/1
!J'WW.notiey;Jg,I.wh.aal umliirindsa reduca inf1ueutacot?pnnii1Qr
farmaceu.fice ~upranctivi~pi lor litBSUptacercet~rii Ill J'rB~liciJ
in domeniulu1edicnL Din picnt.e. informatiile refer}toare ht
spm.morizarile -;e.rcetllril de ditre cpmpanii\e Iatnmcculice nu
sunt 'intodeauna lransparew:e in s~udiUe pnbli.cale~ Spctiim ca,
um1findu~se nonnele p.ropuse de .editorinlul mai sus mnin.tit
(Davidoff :sicolab.. 2001), acesttip d~ ,informatJe sa devina-
nccesibil in lucdirile pubUcate. puUind.astfeljudccaintr-un <:On-
text mailarg rezultatele ob~inute1n diverse sludii.
.... -..;-...:
143
 ,.
l
.W ,BJ ~i!!11'l'. ~-~ll!li;i~!'J} )lin ~l(ql~ ~ ,\ui J?:olli?~<t'\<,
i;:, ci0

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.:.}.:l.l.. :tn

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,;~a~,4Pw~~~i:~n~:~rfi'e,' .. , ,s~parat~ b\ipiui\1~a~!s~;f,ell?ftt-
: -i
- l

~\
....;;~,i~:PPe~ '' rilli,l~~~ootli~ll'tl\\ltli~"ltiileYdes:pmt~l\bv.tl\D'le PS\li\0-
.,. ~~A"t~P~, . l~Qq~,,psjb~.~0:l~gice~ehp!ni\,::li ,~teimfl!nul
~~Ji~~QW~;ti:~i~Pj:gj@;~lr!~liiile a,ar ;/~~:J.:" ~~;,,;;,:,~:,~~z~~,~~~-
:t.rem'lin~:fii
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. ;t~}tl1iii~:)t981~4~lburitilil'~inttsomati'cte!iif'to~r?~~ti~c' . 'tt~
. ,~~~~A?I'~i~t
,,::::;::~~~~~li~~~~~~~~
i.~'i _Th16tolifJ"U:Onfe"riWOpit\iil'cJf C~~ttte;'ols'tin~tia lfinf~;tlc\!sf~ .
categorii estoextrem dein~eUitoare ~rpornind de ln osi1.-nl nu
.... \!
'
;

145
 .<' 8 ... _ , . ,. . . . . ~.~~-~v ..-........... ~ .... .... . ~ .

.I i . . - :'
m.ai rJI.ist; catego:.ia 3epa(atfi i\ tulburaril~~ psiJJO~OllJ~~c<:;e
(K3f1fflR(,~tf~l:~~':;,. J~~?~ ~~~9~, ,~,,~B~~~'~ ~'1+~~~1-~~~tu ~
ui?lttfl~,~~~\~~~~~#:(!~~!!8 aet1r.de!i - t:r.
_psiho~ .}!\~tt ~~'~'''

~~,. ,,.,J.~~~~~~ "''''!''"'''

scflh~~~~rut=~~\~wy:~'m~~~~-~~ .>.i.~mr~:J:~F~
SO!Wl~~; ,:~J''w;}J~Ilt~~~.~~~~:~~!!.~~,Sl.~-

~~t!ta$!~,,,:
cola~. ~--+P~t), _/\c~~~~tl:rt~~~,~~~~'~fi~~f@~h>f~cij~~~,~,~;:
.
,no~~_iJ~Ui~fl~t;iJi+?t~f4ii~i!Jci,~~Jh~~~(#~'~~~"$i~~~~. . . ;
cl'-.s.1ea_,l'_.a. ._.il.. ~I.~q_i' ~- .'.-._'. . '_~._" -.~._.;~_.~.h.J_s_;_~_~ -~..:_~~-_.. ..,r'.~.--~
. ":s. . e _..'._;_~a~~--:.~-~.r~a.a.. El~-~-_,lY50.J. :
pe0nr~.JI~~t:Jil1lo,C;iel"~Jgs~m~;:m~r:utp:"de;~~PHl'te:a,::&
' .-. , '"!~~- ~1- -~
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COIJ.t~1f~~~~~',~MIJ~eOfl~~~tC~mP?~\~~~J,t;~,P~lq'~~~W1' .. : ; ' ' . : """""' . .. '

san.ititti:f;,(i~ajiJJ8lQ>~i9lab~;;,l'997l;,s~m~~e~,.ilmf~}rQ.r
,.. I : _, I .. ~ . . . ' . . . + .. ' .. " ; ", '

nurn~ ~lat'~~f~'i{t;Jlc;:,a~~IP~tT:~P.;~eatfli!~'eii:E$:,te. -cel~.del!I:Jl~f~b~.

bto;~;f~~;
en SatJ:ii~.~~t:ilegt-lifalp~iliJ!c~aa~~~~eil:i''I!Ulv.l:'.
cruci~latif~t~milv~i~lfMn;mfdt}rpsik~t(')ji~le;b~~tit'lti~'*'

',r-~~e:.
sHnata.t~- ~~~~it,i, li:~alla '~J,o-Ms.tie!t:~~~J-Ii~~~ilat(~if._ijl(i~5-
corJc~.(llif!ale:~xp1liJ~e,Jwln:Qd~l~:bio~~~s~eiat.'Ia{fiiy~ii~. ;
~Lilei~ps,b,qt~~icefinldlihale. tita~j~~~e~P~ft$ie~lii~~~l.
.dla~ de;,~~niUl~~i~ltta\ji.pue;a,v:a(ltial.lai 5s'tt~lil\~!a~ . ~l ptitiiJ'
i uforma1. itl ~111.1eui _dpaliqli,. bazi1td~~se:t~ 1ltad~Ju~if1i~t-_.JIOOi;
ca~:f!{fod~t\t~'~i~tiledicaJ.presur?necli'fiLcrotJi p8jtielo~~~sllu~
'.tloarart~}~~~;~~u cifi~potfan~lur in 7~0~!l1Jit~~~+~Qliloi:
sun1atict:l~ste:piarmia
! :; '! ; .
De&"\:eillp1u~1t(t/20:ne8.itti~iiiNUi'i""N~!:.
. c:: :

146 ... .:t <

.-.:~- .

- -".:
"".,L.,._.~-~~-""~-
-: -. . '._ . ~.... ;..~~.~ __ _______
.......;_
 . . I bon "n.,.inntdc de ra:wnns
'1i trfl ~~ J1p ace . :' .. ,..,.
In al doilea :tan d. pare -ciudat d\ pan a ~i asrazi unii stin~ {2) Ln ces?-.refer. e.c I ~t logive (b) donr ln ldocte
,i
I

pl'ofesioni~ti Llin t'tomtniul sanatnrii nu in{eleg en efecrul pla- ;i.l'fo&t: (a) ilmw la efecte ~~~~~ice ci\t ~1\a efec:te bio~og1ce~ .. i j
-~

.ctb(j se realizea~a printr-un mecani&m biologic plamjbU ~i nu biolo'giue; (c) atat \aefec[epus. 10 ""en"onre,nu este corect; (e) nu
egte dour un efect psihologic -pur asupra unoi factori fi2.ici ~-
Cd) nid unul-tUn ~aspll~
. 5ID1. ellth "" 'd
~ 65(}1i rrnn:e medici consl er ca
a-
(Kirsch; 1~90). Nu mai vorhimde dificuWitileunorprofesioni~ti ~tiu.!j.te1.nltntele !l~' l.uatm: ~a . o i-nsiho1ogie ~1 donr 35o/~
deaintf!legeciim:iceinterventje sihotera euticaarecons. in e ,. :u-
efectul place o nt
:e un meuan1sm P' l.'
.

le snnt atllt psihologtce
clir s1
.
I 1-Jioo)timioa 'tn creler. altf~I.ruw c1r tera ie este
cbiiniotempiei(Futmarl::.~ colnb~. 2002; K.ixscb, I9!?0)~FactorH
dintre ei au sposcl\ mccant:~a intrebare. doar 5'3% d\utre
bio~egice; p-ntn\ c~a. de~as 41% au-ales vnrlnnta (a).ln c_aw.u\
psih()logici can:i sc .considerli_ c~ afectoa!Zll difcrite nspecto rnedicitm nlcsvmianta (c) "1 " .c stsbniltui:SS% dmtr~
. 'h ~ . attern-ut gul:llt a J; 0
biologice ,il.! fl\tOtQ~ttl!\8 t:tn:substmtbiologic- flU Sll~[ de Sine gropului deps1 a ~gtp. . 45 %vaciartta (e) 'In cnzul pnme~
statlitod .. 11i acest .substrat bioldgic voate media inipactullor cost\ a no nJ:es vnrumta (a) !Jl b n3% dintre -psihoiogl
... . d douatntre iU'e, a .
rumpradifetitelo aspet:le biDlpgj~e{{GJisch. 1990). () expliAare intro\llhi; pentl!ll cea e-a. ", a..l:anta (a) Din non. trebule
dhr punct de vedi!Te hiologlc;(ex. 11eorona1, bio-cl1imic} a au ales. ~punsu xBJ '1 V :\ ~i 1'1% au rues v .. ' .
eZU}tate ar pntea avea om:
d o T
:.1
meeanistnelocefectului place)5o-arfi _ pvea coll1p1~ fji .df!taliatit sl p.nemcont de faptUl ell aces;~: reglitir:en. profesion~U\ ~
}Jel,ltm crt" artrebuidescl'is, de ex.etrtplll; comportamentulunui val~dit~te co~tex.~'l~l~ Ieg~t Rorn~nia. tn ciuda shnilantatn .i .
nnmar fo'J.rte:mare de e&l\tle-neurol1nle. Din nceastfi cat1za nvem Psihologilor ~~ roedunlor dm .,;. ' .l.l A""'V6S. c efe.otul placebo.
-1 ~:.i pBlnCdJg r.. .
11evoiede un nivel de at'rollzti. mai abstract iar pent:J:u. aceasra moduloi in cn1-e. me1;1I~tl 'i d ... de di.ferirli (chiar~t in
11ivelulpsihologio est~ c~l potrlvit (Aridersi;m, 19!)0)~Di~ltcnt!: . o dau ~ste esLt11
jnterpretarea pe cn~et- . ll1) Adeseamediciitin~sall ~ru a
~ :r .
'.
!
inloc snin el .. dMicderile biologi:ce !ji cele psiholo. ice litfiratu:rn ~tiinpfiellnlemt\~t~na. . ....., lat si. exclns"'in i:lifentele
suut doJ,U1 Um.bnie dif-eLitcf"elosite pentn.l nceeatrea Itare,(a~~~i _-s-. rei:re;bulesiHiecen"o . . )
oa pe-un.ln1c:aaotca nidi a nonor medicamente ~~
realitate ~stc...descriali ln nlvcle difedte. folosincln-se limbaje studii medieale (~.. test~ ~li e biti1ogice mni n1ult san rna~
dif~rire .. iacl :1 "ta 'lebielogicli care nn este-roedtatden1el<3nl8rn: ,..._ .,.~.,c,lfl 2001). :Pede nlta

I l .. ihQl-ogi~l.ca fiind dinnire. D . . ' ehiitlt c . . 1 .11 ex.1 i\

nlcilm l\1r:ea11~mp.s1.m a c : rl\-unsubstnitbioJo "c(I<lrsch.
J!)l ' . tcbrer i:colab.. 2002 i, _ rini,rmare 2 ___ tnfeno _en
l,sihqlosic.nrt: atlitconiteclnlc psiho1oglce cfttt;lbiologice~. . en .
pnpn cnnoscllle (l
""
ren\ lji impoTtan c.
.
_ :s b"attsson 1 \Jou.... ''
.,ro ~ .

t are are atut-eon ..

psibolog!ce;J.lnn ur l .
n are este nevmc
t!l\ un fenomen psiholflgtc
narte.psihologii:'tind s~-l pl'iea: . caps~einte biologice ci\t ~~
t
. ca na~rn sl! fle seno~
d'i'. ~
1990).t\.tltfeldeconceptii llen.e

. '

n o~sl!l.vtrmodulin cni~~ce&te idej ~unt~ereze.nt.atem grup~rile investlgat~ldezvoltnt~fr~ch~inecnaoscu.t Iii displtndit nu pot

. de r~~~tici~i. i'ntt-!Un $lUdiu recent _:rea1izat pe. 60 de medici despre un fenm:nen re :ahv .. .
(vtlrst~111edi~ 34)-~i160' de psillologi (vftrsta medie.31) Ml pus ' 1 lb' nsiho-somal. . . ~
prGnlOVa mode.tl \O-r rOll1CllJei- 'Din pel'SpeCtiVu. .,'
U11Jllitoare\edouii mtrebitri:.(-1)-P.rincc:mcclltJismes~rea/iZ(;llZif. 0 stratsgte tlerczoi>Ya-re'R P d 1 lbio-medical.tiebuie
.~ . te menetl!8. roo e u l
1'/cotfJ.}J-'hlf:ebQ?. rl:ispunsnrila posibiTe erau: (a) pnr psil10logice; P sihologi'Ca, pentnlapu "~= ti.unctele s1abe n e
. (b)pt'u~iologice; (c) in ncela~i thnp biologice ~i ps.ihologice; d ft v puRctele tnn ~~ 1:' 1l
evaluate non- e. nsl l l . sihosomaticmodern (mode n
{d) nici mml :din rnspnnsurile anterionre nu este corect; (e) nn vsibologiei in cadllll mode u u~ P .
. lrl& li\.9

.__ . - .- : ...
-- -~- ~ . ": ~ . : .:-.
 bio-psiho-social). ref~rin; Ia ceea ce in nmd trt~~itional
fiieflua
numjm. s~in5.tat~J1zic~ ri"boa~somaHca. Prin Ufmare, i~l:ceJe ce ...
0 trecere in rcvis.ta a dateJo . . . . . .
unne~.~~i~)'.l?t ~'i{filii~ rol ttl ~i statutul.i nteryenjillor c~giJtti~ @Jnfluent~'lia fncforii.psi~~!oglc!.J,lezvoltpr~ :jf. evulu{ta .
bolilor orgaoi~ ~!ale nlton;-oudi.puJte(l.tc?l!'?
comportrutteutai,e iu m~cjuapsihoagm.aticlfmiilfel'nit N:Uivoi :' . . . .
.. ' .xll.urop
: . . .. ee:n"uhtinrofesiotilij.t l ar. f;:Qllles.tn.lnfl.. u ... enfa'{ac.(O.~1lor
centra_ast.Ipraintervenfiilorcogtutiv-cotnp.artamenlnietteml!te:,, . ,r< t . I;' . . . . . . . . . . . . . . f1 .. e con llln) .
.1 l ... . ea stilul de Vif!ta (ex. dletli, exe~ctru . . . ztc , . ~"7 o.
(1) reflecta<intpac(ul psibQlogieicu b.aze empiriefdlitiinJ.ifice
nsupm cerc~tarilorpsibologice; {2.J,sunt investigate p.rin design-
~::1 :s:arllorde com_pprtmnem (ex. 11
ConJ~liauP,I !n,.tra~! ~ht)
asupra evolu~et1 t' bolii' organice t" sunt md~tq.tm
r mulri . b r
uri e~peritnenf:ale rigw:onse ~i :Jtudii dinice contt'olate .eare 1 PftV.tn{a
influen\ei directe a factQri\or psibolo~.~c~ hs_up~ eyo t~e~ o u
implicafolo~irea unqrlotiu:idecoo~t~lplncebo:ji (3)~desea. or aui<::e (e~. Relmanl1io A~f.l, 2002.). Pnnu~ueutn_d~recl5.
:mnUnvestigate.luaudu-s~.ill n:alGul atAt ~peetele ler: teotetice
dit ~i efff-lele lor prnotice.. PrincipaleJe aspecte ale intervei11Ji1or
inrelegem un. ~feet
uemediat ~ factor~or p~dto!ogact (~x
..
L d. . optimism) asupra meCi:lJusmelor biologn:e llllt lUI efect
cogn.iti v+c:;:umportamentale sunt: (..I.) factori.i cogniti viu&emazii epre.sae, .. diOdiri ale
iufluen~at de alti .factori psil,ologlct precmn mo ,,
im paclul mediul til asupra aspel!telor .uoustre sttbi~(:tive/ compliantelsau ;Ulu1ui de via\li(ex. sclllrub~rlin co~p~rtantent).
emolionale, cogr1itlve, comportnmemale; (2) aceiJti factod D . ur factorii pslhologici nu sunt de sme stltaton cl au._ un
cogultivl poLO idenqficatifpiagnos?cat[ i apoi.(3) lllodificati
pdniu[e.(ven(iicognitiV-comportamenlale.lntreb~rilespeciDce
su~::at biologic. Piu urma:re, chia.i: \!l\~f~t,?~ediat al.f~ctonlo.r
'h l . ' care nu se r~Iedi la sclumban m complmnta Ia
carora iocerofun sUe gii.Sinrnn rlispuns in ~;ea,slii anBnz.:t ~ticli . p8l 0 ogtcl tiluldevt'"'ll&rtrebtd tolUifi'.inteles cnfHnd renllzat
tmtrunent snu s ~ , . .. )!
a impnetuloi iJlterventiilor cogoitiv-~omp.oitrutieutalt: ill rin aeeste n'lecanisme biologice plauzt?de. 0 tr;c~e m re:lsla
meqiciuapsibosolllatidbunt:{l) in1Iu~ll{eazafncl.cJdf..psjfi~!Pp;it;:1. p ll . de specialitate a relevnt fnplul :~exist~ nu.tlleroase
de~voitru:ea ~i evolutia .~olilor: organi~..'Ji. ale Jiltor ce~.difii n dt~~atui J!. .~ 'ntlpnctUlne.u\ediat al InclorilOrpsi\itiloglci a,SU}Jra
stu 11 cnre <UU<q o't': " U tl t Oo

medkale?; {2) interventiile psUJOlogice afectaadt factlilrii/ de ll" . i evolutiei lmlii organice. 1\Suel, a,..a uratntca :ac oru
mecanismele psHIOlogice iJ.Ilplicale in ~e~yotmr~a ~iev(!lutia . -~hvol ~~ Jnfeet...n"'a
ps1 o og1c1 ~ _
hipertensiunen (J'I:Juas Qi colab:, ~997)y
- to ~000)
bo1 ilm orgnnice ~I ale fl.ltgr condi ~ii ntecucate? i (3) intervegtijle llfV/SIDA (Mayne ~i colab.; H196; Lesennau ft. co ~ .,
psHt~logice imbunata~G evolu~f} clinicain boille qrgan'i~ %i Qi cancemL.(Everson ~i colab., '19.96; Watson~-~ colali..1?99).:
nlte.condifii med1Cale~&tisptiuzilndlsacestelntrebari, am put~ D Ilea studli prospective Bllur. dovezt care sustm ca
e as~~ne .1l ; 0 g 1ci influente~n c.re~terea ri~cului bolii
~omparn mal biue \'allditateumooeJ ul11i. blo7medical aaresll~\in~ . faclom p31 01- t ... ~ l\t: "li
di ftclolii psiltologici sunt.iil prineipril artefacte saH ~IUJt niai t:OIUllafieue ~i 11 mmial\tll\ll din urice ~zlitl\ pop\t l:.\t~ 8 1~ l~ru.
putiu imp'ortanU pentru ./i~hii'll:atea ~~ boal~ fh~ic[i, cu cen a (And a Ill. co1a b 1993' Shekelle $i colab., 1983ht ca eXitS ticatltti
un
mod~lului psiliosomatic ntoderq car~ sus{ine cadit~ pu11ct de cfect puternic al facto.rllor psiho~ogi~~ _asupra pr~gnos . t
vcdere etiopatogenetic, fac'torii psibologici au ncela~i sl.atut IJUCJ.eI ltil"'r
, u cu . boli camuBriene , stnbdlzate
. .(flrasftre-Snnth ~l

ontologie bu Tactorii fuici ~i oa.inb~rvel1Jiile psihqlogice:(ex. col~.. 993; Willlrun~i't!olab., l992). . .: ..

psiholerapia ?l consilierea} au aceia~i stutut ontologie cu '. (2 . tervenVUe psllmlogice afect~azlif1'1C.ton~~!~u~smele
Lmtame-Itlt:;le Juedkalep&ntnr diferite buH orgatJice. psiuologice hnplicate iit dezvoltare~~l e"olu\ia bolilor mgaulce
~j ale altorcondi\ii medicale'l . . ....
150 f 151 :. ..
\
 Un numnr.m<lre.de ~rcetfiri sumatiiatein meta:malize (et. ..John~ton .~i colnh . 1993; Montgomery. Drwid ~i.:CJlf,k_
ea~itnti~~ 'ij cunutativ~. nn nrntat i~ lilod clar ci\ ini~~en iilc 2002). De'eX:elllpltl, illlF'Q metaanaliza realizatii de noi {~l~ntc
P~lholo i cori.silieni otafr'*"'d' -.~ -
T 1 "ce(el(
. si\ietenr
. .......u. en .~,acton gomecy, Pavid$i colab . 2002} '3.ul'Qescopmir: oa fli:'\Chmtueare
~~~ ogict7~1n-7lln1~orrnn1cnt'la cognitii i emntii ~are s~
10
nnna11 a [t operati (1624 de pacien~l) ~i primeau rnnan)enr
tlt=m~nstrase antert?~ ca .at' fi rela[ionuti en diferite. condipi comporta~uental pulangacel}nediealstandard fiUllVlllfC7.Ultatc
med1~e (eJ(. 4Yflnn 1JL W ~ds,l993; Friedman s;i colab 198 mai bnne dec at 89% din pacion{ii din gmpnl de control .~are ,
' ,,, Dtn )"1i~Pl:li1$~ile. hu::e~~ rlou~ intrebM) analizate ptl~ii llCU~ primeuu ~oar ~ngrljire medinaH\ smadard. Aces: 1-e:zultnte se '
~lm fi renratr.;~EI~ndu-~e p!!:un rntionament siJogistic (figura 1): refedat.litla intlicatori subil!tctivi (ex.. ematli negi\tlyH,dnrere)
cfit 'ilft )ndicatori. o~iect,tvi ~otiiGa\ie analgezlcii, indicntori
~~.(factc5ri
orgt101c8.)
psfhologici} __:_ (afecteazli) p_ (~ond:itie
fizlologi.~i (ex . cntecolamine. presinne arteriall\) .}}i timP, .u': :
trptaunenr>(ex. durat.a spitalizarii. d.urata jnt~rvenpe1
. . S O~n!ervettfie pili)lOlpgicn) ~ {afecteaza) M (fncrori chilurgicdale)]. .
pstho1oglci) . _ .. .
Efectl!ll'$ interventiilorpsihologice asuprn bolilor mganice
.sltcon'*z1onamtH;. . ... .
~i nsuprl:' diferitelor conditii fizic~ medicnle nu snnt_dc.nr
-~ inte_tvepriepsiho]ogi~a)
t)rgamca} .
-~ (afecteaza) P (eonditie
. Qemnifi~~tive: . din pnnct d!}. :yedere .statisticcompara.IIV cu
gr:upurll~, (1~ -~()ll ~ol(tr{lta~llt -mediQ~l standard. tratalnen~'
metlicntstan~f\rd p1u~ PT()CS~~J:i plaq6bo) ci efectql ~[e .!Jt:
S!!lll.ll~fiC.at:iv .c.li_R-i,c (i!0010c} (pentmdgtalii:a Se vedea Johnl)tOI~
:ji cola~)~l9~3;.I.,lll}g . lfi.co~ab. 2000i Mo~tgoril~ry, D~vid ~l
colab. 2.002Jt Mai multd~i\t . atllt. acqstilt;<'efecte:sunt.utLle suh
aspecrec~oomic.De ~x,emp1Q, Lang Iii" co~ab. (2002) nu,aditat
cii, ~ostul n~ocit\t.cu J:eclarea stanllard.Sn .lin1plll dife~itelor --i
procedu'riradil)IJ?giee e11w de.3B USD/pacient, compal'ativ Ctl
300US'p pen~ sedaren in~otitade inr&rvtintii.comportamenwl~
ndjuvaii~: B!i~tlnr,. utili.znn~ainter\lcntiilorpsih(l1tigice a dus.'a
eeoncmlisirea a~'338.1JSD.}lentt'Ll fieenra,cnz. .. . . . . . .. ,
{ .
C~ndu~U ba:tatep~on:qalba litern.turii llesnedaiUnle.
. cQIoborlln.d riispunsm:i)cla c.ale !rei tntreblhi s-ar puren
spune l:a nveln. sufici~nra pro~e .enre sl\ sus{inli .asu~Jp(iile
model~.lui psihoson1atic Jitod~m:. iutBrMenti ile}!sihol.og~e
inflnen{eazaJadorii psil)olqg!i:i oan; la randnlloi, in~za
l Jlir... rilor or nnic6 i ~1le difer-ilelor

Jj)

....
~ .
. .
~ -~-
..-..... v~..-.- ..- .
 '"''" ...
Totu~?i.-.:U~'aro di.utr.e acesle
conolut..ii nu fost t;;.ttk~te.
Priucipn,ie)~11f:9bleme ale acestor stQdli {Jo ba~a- caiilt~'8~~u~
elaborat concluziile sunt (pentru detalii vezi.Relmait ~iA~1gell,
2002): - ' . . '::' .
@ Vtt.qaeJ1e'w-(11imdari!. Multe. din studille meu~i~nntemai
sus nu au c~ntrolnt clar variabllele conftmdate ~i. prin Ul]nnrc,
e.ste posibil ca ,rela~i~ apa.rentii dintre uniifactori psibologid :Ji
unele aspecte flaicasii eiisw doar Qiu .cauza unei'li treiavadabile
fizice confuuda.te care ~ec;:teaza atilt.fautonit psihologic cfit ~i
raspunsuHizi.c. ,
{ acest tit-adel no este S<B bil *~ cit .or tre . 1 tleDJeutat in
~-valoiUr:Sr:lizutifflmlfdmiiekctului. Uneledintresludli
aurelevato mfuime aefectul;ui scli;;utlllli, a1?adar, rezoultatelelor
sunt ll!jOt 'de distorniont~-t de &featele v.nriabilelor confun'dnte,
cunoscule sauneounoscu.t:e.; ,
~Se.fec(ia uateloJ~ Aceasta se referala combiuilfiile
iutr-un nu!uar mare de r.ezttltate ptlua cil.nd,ln final, unuldintte
ele este senmificativ statistic (ex.. 3 rez.ulWte poz.iUve.din25 de
masudi.tori): !11 aaest caz, rezullatele arputea;fi determinate de
~ans' ~i nu doar de o- vadabila G:Ontmlata; este mai degraba ~m
artefact dedit ~~ fenwfneu real~ Mtllle diu stud.llle descris~ mai
sm; au aceasta prohleiua.. '
~CQnfundrutiil. Clli:IZei cu efeclul in multe din studiile
auuqlili!' ante1ior ca~~a poate fi cu gt:eu separat:ii.de efect De
exen~plu. iu sludiultw Watson- :'ii colab., (1999) ill h)c sa
Cr)I~~~U:ioufu.n Ca .u:~uto~ea ~ du_s la C~terea 0Scu{Ui .de
recJdiva sau tnoarte.m c.azYtpactenp.lor cu cancer Ia san (neo-
p.l~stn m~mm.r), s-ar puten spilne cii. ue9plasmul manuu: iiltr.:o
faz.a~ avaqaata cauze~ii.sentimente de neajutoare. \ =1i citalopram (Celexn)]. in baza .datelor prezentate, ncesle
"0];1i1fCipr:et_liri distoJ~iOJJaie.. De cele tnai mulle ori ele se
refera Ia ~ltagerarea aemulftca.tiei eUnice a unui rezultat: De
exemplu, ~asirea unei legaturi int:re u.nii factod psibologid r;j
un indicator biologic (ex. anticorpii-penlnl vimsufbep~?.s sim-.
plex)' uu spune nhruc des11re efectul acelor f;Jctorfpsiho.logici
'
154
\
t
~ -:: .
asupra bolii organic: A~adar, adesea apare o ~oufuzic Jttll-e
impactul unui factor psiholo.gic asn,tlra u~mi efeot .fiziolagic ~i
. impactulunuifaclorpslhoto~ic asupra bolilto sjne. _
Tinand contde acesle ctitici, o concJuzie nmi ec1Jilibrala
ar fi nceea dieste foarte prohabilcainterv~utiile psihelogice .sii
-inlluentez.elaclorii psibologici. care. ](l.r!ndullor, pol iufluen(a
evoluUa ~i rognos.ticul bollor or aniae..l ale difedtelor conditH
me lcnle, dar sunt ne~;:es,an< 1Ilai. multe stu care sa arate ca
toate mediile me c. e. otu~i) eriticile aduse niodeluh:.i
--+--p~lhosonlaiic modem ar.pu~n fila fel.debjue alili:lse ~i slUdUlo&
b8Z(lte p~,modehtl:bio-medic:al. Sa argunienUim nccst luctu prln
analizeledemaiJos:J r-! .
(l) Vadt~bilc coJJfuJJdate. :Fuarte put~ne ~lntre sludiile
medicate controle~zii poteuti,alele vadabHe psihologice
. confundate care deja s-adetnotmtrat eM 'at fi legate de dife.tilele
er~cte biologice (~x.. optitilism/pesimism, sl:il db viatli.
religio:z.i tate, mecarilsme de CQ{Jing). . .
(2) Valoarea scazutif ain8Jillliiaroowlui. Uuele stuuii din
a.c~t domeniu au relevat o n1ariine a efeclului ~chUUi ~i. D!fndar.
rez;ultatele lor sunt u~r.dedistoxsionat.de efect~le-variabiletor
confunt,iare, t:unoscute salt necttntJS4lt~tt:e. De exem'plu, ,[u~a cmn
run mai. ruxiititit.antl!fiur, recent Kirnch icobi.b. (2002) ou antl.lizat
datele de e.ficacitale ale eelor ~ns9 antidept-e~iye eel' mai fr.er.vent
. prescrise, aprohate ae Food mid Dtug AdlllilusfraUon, .SUA.
iulre 1987 ~1999 [llnoKetina (Prozac), pll{oxetina (Ji'ntd.l).
sert.mlina (Zolof), veolafaxiu~ (ffe7lor). uefm.oddlln(Set"l.Qne)
medicam~nte au fost aprobate en tr~tlatueille eficiente ~i sigure
pentru depresie in SUA. Kir!ichfll colali au descoperJt di 80.'fo .
diu dispunsulla aaeste medicai;neute ~ra duplicat in grupuriie.
placebo ~i diferenta mediei diiltre uivelul dep1:esiei ill. g.nlpul
care pri.mea authlepresive ~i rrivelul depresi~i iu grupul tiire
155
 prirnea h:ataritenLpla~elJo era de 2 puncte pe Scala de Dertosie
Hamiltoncnl7itemi (SQd.Gpunctehi 21 deitemi (62depuncre).
Clli dacil acest efeot este ~enii\ificativ statistic, eftictnl ~au eli nic
{ec:ologi~) este nesemnificntiv{~ p\.lnGTe) (Kirsch 1i GQlal) . 2002).
Totu~i, chiat: dasa efcctul clinic :al m~dicatiei 11ntid~presive
cmpparativ en eel al condi[iilor placebo &$te ambiguu ~i schut
-...l

aan~ch ~i c;:oijtb_. 2001.)....tpedica~ia mu:ideptesiva elj(e ptezentatli

ca ~incl cclllUli eficien~ fJ.:iUan1e.11tpentrli depresie de majorllittea ... :
practiqienilor, minfmi~ndu-~e rolu1 'h1lt.a~f!ntalor psihologice
nltornntive (Kaplan Iii cotab., 1997; Sadoclc ~i co}ab., 2002).
(3) $e:lac(:ia d~tu:.Jpr. In. n1olte dfntl'e studiile
'Pfiihofarmnco}Qgice... numlirul vnriabileler (l~p~age11te se t~propic
de.l5 (pentn) exe.rnple vezi stndiile luCinse. in -tlleraanali:za Jni
Hrobjnrtsson 41 ~ot:.zsche. 2001). - J
I

"(4) COJJfimdtJmn CliJ~f;ll ekr;mf. fn znajoritntea studiilor

bazate ~e model~le psihiatJI!~ibiologice, est~ dificil 88 se sepnre
cauza ~~ efootnt Iu aeost Up d~ stndil,Jnlf!!e sa concluzionl!rn ca
o modificaae biochimicli (ex.: un nivelscnzuc .al .semtonlnei)
~;enore~za nn anun1it.si~prom ,psiho.logjc (ex. dispozi{ia
depre.stva) o aitJl concluzie. plauzihiUi ~te aceea cii atiit
simpto11_1u1 pslhaJ.ogic cat ~i modificmea-bioohimicii 9unt geno.--
nte ~e: un mecanism.psij\,f;){ogic {ex..t.ll.ecanisnu~legnte ds.sh~).
Pnrtne stnd:U..:au.un C!esign-.care lf!i permitii ~leger(;a inhe ce)e
douav.adnnto. Al;adar, ide.ea !!On'fonn cltteia o1ice concon,irenta
a tmui efect 8iQ1ogic lli.l\ tmnia,psiholllgic refleeta. de obicei, 'o
.relatip cnL\zaUi, plirnul determiolindLJ-l.pe celdyafqoi lea (~hm
lovers), ~~re.rlllldxul nnei trndit1i veabi, reducrioniste. ~i 11 u a
unet teon 1 bautttpe dijte. .
(.5) InttU:p.rct/frilo distar&/QDJite. De exenwlu, bnzAndu-ne
P: st~rdiilc,ma{ sus amintite (vez.i, de asemenen, Kirsch,_l990;
Ktrsch ~i colab 2002} ~t~ t:lat eit: =o) SEJT1nificntia clinic a a
rne~i~a{le~ antidcpresive ca tm agent farmacologi~ specjfic ~i
actr~ este exngemtil. Este cindat ca. in cinda tuturor probelor.
156
157
 ....... - .
~~ ~ ~----- ~-. .- .
"":. . . .-.. ~ _. ... . .

i~tr~ .tn~itlidi,c~iJib~:,EJ:illtir"'Ull:tf>tlfl:t\11itiit
~~.,s~b~~~~ul:1:fl'~ufllllle). . . ...... .. , Jc .:~,
.. ,.,,,:ftatm~~a~'~tmEieP'~it {v~~i 5 lt~,~~Jil~l\U:
~~~~~~,~~~~.:rezuita~~~~eci't~~'; ''.:~r .,. .
(1~;0~-t~G~

1f'e; ;~f11~i~ ~le.~rg;gn)~~~{~~. itl~~:;~~~&f}i{~j!Uiia'liJ!8; ~i

J~.,~t)?7!':~r:~~7

- c~l!~~t!.,~~i;~1:~iulall,li~t3;~3l,pe ba,bu.fr':jil [e'l~tei:tJu'gf'tl,pllti

de co~t.Vr~1 tiitaluent ~i a obse.t:V~t di tralarea tufurg,pa~i~n\ilttr
I
1'
..
-- -':;;-:~ .:..... ' -.:f_j -~ ~:~:~:: ~;.. -:.
I
.... ,, ......~-"-'" .........------- .....
 I
..:J

.,J

r ~
?

_.,

J
.i
._.,;
J
:...1~'
:
~
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t
l
:J-
--~:-t
;-:
... -'"\.
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-

.
.
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.. ~.- ~. ' .. ..... .
 . '. ~~ ... . . :- . ..~ .

.0Or)~ratorolmodaJ; :&;lede preS~I)JUS d\ , 1993),)arapoi vulnriita-cum a~estea se manifesliiinlitera.tura

. (i doi1ditii de exceptare a operalon~lui mod~: .Oadi nu psiho~logiei. . . .. . ' . ft . .

cumva ambii pannfi sunt striiini H- (ill..J!roriln teza de intemer.at (concluz.r.e) il1Ut~lapa nceslel~
. : [)acatet:a de intemeialderiva cuoeces1tate. dinmijloacele cu mijloacel~ deintemejere . ,
de itJtellleiere .atunc;i vorbim des pre demonstratie/AceasUi Imprecizin lczi!i. Acenstii etonre .ap!U'e atunc1 cllmlteza
.modalitat~ db iutemeierf:. necesita. insa un sisteni.tco..-etic cotttfueuo.Lenuenimpr:ecis . . . . . . . .
!formnliznlln1atematizat a~ a ca nu;eori vom regasi acen:;ta _. . . lgJ:lQrnrea_tsr.ei. in l~mbaJlogic, ~QCSte et:on s~ nume.<;e
J.llod<lliWte de intemeie:re in !ltiinfel.e.sQcio~ntmme ~tiU n1edicafi:!.
DB.c5Jeza de iutemeiat derivacu probabililatedio mijloacelede
igtlo~o,;:~:~~:~:::.:~~~:~~~~ ~~~::f::;lt.itl.fap~ul
.lnten~iere atunci vm:bimdespre nr~~lenblre... . .... . .
ca seiuvoc~ autoritatea cuivn pentru n inlelneia '? t~zit .E,a ure
a
' . . ~n. tiin edsta. do~a ti urifJt} clistr~uri ~/ mol multe fomte: ... , . . . . . . . . . . . .. . . ,
. oAutoiitatencut~llbzatuare: spechtlistuLa spus astfel
.. teoLr;tJc ~~ problematizenz.li pmt~tia dea?evlir a ~iuitUor;. o Autoritatea dogmatici.i: ..nt~n s-a stabili~
--S.e urtilarqle realiz;area unuistf\ndmd al par~Idigmel go~itiviste
0 Autoritatea prot>t plass.tl1: "a invoet~ :ceea _c~.~ spus
~i ueo oritivistetn care valori . . le a<JeV3r a.le unei ~qt"ii"illnt J3il1sleln intr'-undOlneniU ntrii l~r;litud.t e,~ 1i~1cn . . .
.fnt.portanle . (prh1 lnten1eiere 1o forma dei1Jomm:~ 1e1 ~~
nr&umentarii . 1fiiscv~u1' cticse roblematizeazlt 'relf!J:ttia
Autoritatea
0 venefnbiU\: ..~tle 1naii)\Ldlfiinclca eiJ~C mal
:.
in vti.rsta sau mni exp~rinJ.entae! 1 . ..
~ejus~ete.n asertitulilol:' cu .rivire lo.vnlod. o~ue. ceea~~ tre uie . .. A_rgwnencumadIJpmiJiem.]$te 9 e~()~~~sen.lau?tonre
Jllcut .etc. Acesta este un l_.nose~ priu .c,al"~ .se do\]~n ~te cuargumentum ad verectUidiarn in care se mvoca calti\~tle sau
~rupului la teia_unuivorbitorin cadtu1npeic0 inuttilli\i defect~;:le cuiva pentru alntemeia o t~t.k ::]1 eJl n.re rnm multe
ra(u;maJ.e de Qo.meni (prin'iutemeie$lnJounaargultl.entiii1f}, cnt-p tonne: , . . :. _ . . . . . .
au. un litilbaj comun ~i intre au;e e~tista rela\iide recuna."?tere. . oAbuz.ivi;i: argutnellle7j valonrea tez.elUil~.l -vmbltm Illtn
in disd.ustd . ractic . e unnar . te ades~at:in etea . rimdard experieutcle s1'1ledeviatii . .. . . . . .
pragiuatic. it1 carecormecintetevr~eticelle unel ~rfi d;nt~r.loare 0 Citcumstantiala: se sugcroaz_n dl.oponeutul nre '"!
.a~esteia;~~~l ~leas._a ~a ~liint~ ~t~oilirifc ,. i ~lli;fde htleres persortalio a suspue olbza ~ls.stfel stib.ndne'Z.l
nUugere a eersuad~ru - Joaca a,de.sea uuroltmptJrtantm tl;tscursul ., t~zarespectiva .. . .,. ., .. . .u . .1
practic. ~i in argu l11Clltare in generaL Discursurlle te vret[ce qi ~ oTo quoque: a inl~l1}~ia o t~z.~ m:nlfuJCl c~ fl1_fponet~tu.
cele pragmatice suntfundamentrue in psihop<rtofQgiti ~1. ln 1, a sll!!tiout-o i:iinuva sau a ~-~spulge q tez~ anl,lfiud ca. Iii
consecinti1.. CUOOaJllerea erorilorcare afecleaza aC,eSlediSt;UfSUfl 1: opon~ntul a respins,.o c~n].vn. .. . _ ..
esLe f{}~.rte importantii. Erorile care apariu Pmcesuldelnte.meiere " Argvme1llU1 ad ig1JO~WllJlJn1. Aceas~a,ero~~ ~pare ~aud
se clasifi.dlin trei categorii. corespuuzfin~ celor~i~ompol~Je :de ia ca argument ill favoareanneiJero ltnpo~IbJlita_te.a ~e a
ale proc:esulul de t11tem~re descrise m1terior. in ~lece Uf!.lieal..li dovooi ~ontradictoda eb."'esl:e a~n ditltl ::= E_oate t.1ove!=h ct~
vqiprezent:a cele mai frecvente erori{pentru
', '',
delntii veziM11Xgll,
,:-
' ...;.. esten~a". --
l63
- J6'l
 n ;t.iJArgtlbieniJJJn alljJdjlli!fun: 1\:cid~'ta ~tp ~fO,~~~~ in,~~re
se accepta0 teza deoarece ., . ai muJti oarri~)li. c.'.' . sa'!: .'
1vz,~f!'~JWirtiliiNJit~ .. ltitr fl~f~laf',<, ~ ~~re
utilizeaza crinsec.intele pozitivesnu f!hgative &le?hei t~'{ien'fiu .
.. nsi.l~fine,.adeidinus:atrifrilsitbteatu;~sleia:
.. ' .. .', ..... ,. J
... Arcum~tum ad h4cultmi.E8tt~rdaiea cnre'pt1!sl!lpiiJ1e
)' u~~9P~~fqq~i'(~e.ll~jhbfoglce. eauia~p~~vaitn~u?e'
sau a.r.:mp~f:1$&G,.. ~.;Y';!1)~1,tJ::~~.h;,: .;,:r . r.'~' .:''''" ,f .t.'pi 'i~
\,,,.~..a~~~UJ~..,tli
,,,~~~~~:.o~:::--alo
~gj/aa.tio.r.~~st~.~a.~.to~rM,care constll

:~1&\:~;~:::::
..

..
-'
.~ . J'ctiUoan:Juctpii!~~li~s~' '' 'iif~M~~~~lit9 t;al>tul en

;~~~,.,~,,~,~:~~:~:r;r-
...:J"

,.~~;,, ,,) ,,;.J,.~(~ijp,,aJ~ c:ontra~:>a.,.ln,.facest caz. fn ;ac~~I pro~ ~e

,.. fntcllleierc. se opereazli cu Brgumt;nte. contradi~rii;'Wdesi:a
,,,,t,,~c.~~~~,iPHSlilJ!I!V~~jfat~~ff,a~adi~ntfllor~te'lmfseatli de !lll
':1i1iibaj amb~~:ilU sau.t-Bnr:1lp~~3~eu de identif1cat datoritl\
/tEX!i-1.,.1111~t':~:~t(~~':j;~~.J~,,_.~~~K. i
~ '

ep~nQ~ ~~ ~ ~.~~=.}~ ~:.generalii

I
.-'
~I?hBn
:.-. . ::... d.r.
.
u~~. i_esQn{hi.
..~~~,:m~~~o~~~~~!js~~~l.tr(:~t~:ti{ele
l
... ..... do. . .l .
.. . . . . .. ,a.-.re u.
... ..fu .. ..-.
... . . u.
.l.:o....--re....g ... s. e.
care f?c
.~;'}1\' ~U,~~.. !~;;~~t,~'l~.(~rpa1t?~du~~-!l~mtl.p-tentulu1);
w,. (~) . ICil''lt eazc PR'J.1: . Ja t~ngr.lunet, . t;~gtdJ generate
(emareaconverali aac1 )~l. .. i,iJ'~.. .... '
' '''' :;~~~<i'4i~;~:;iiitnbtl.ii(aJ1.i'8r~
, .pr~~tat~'flll~~ce~oll~i,nfl"e 1imrln1Wefit~iteili Jst~Htegari1r~
(le~sen{iiiUt-m) lJDft logic:{ SiJU L1e Oecesitate.

..
"" "'
164
16.5

'"-.... ,-..............:ac...... .~--


~ ArgupJeiJ!IJIJJ ad ve.nxm1diam. in gene.r~l. psj.b~llaliza
s~a Imp~~ ~_a,t~-~!a personalitatii ~i autoii tatiUui Sigmun_d;frud
t~u dat_onta supt)rtului ~ti1ufllic .. Putem argmneilr:.'{di_'a~a:~ta.u
lu~rurd~ urmari.nd Aaexa l, uude obsel'vam ctt. tiier'~slazi
P~~ha.nalJ.za lllt figu,r;:aza prln fonuelede psihoterapie ~ali date
l}lilll~~cl. I?-e al~el. S!gmu11d.5reud~ avutgrij~sa i~ipas((eze
nuLontfilea ~}((:OI.l"l.U{l~~findu~1 ~cetca.renveaparetidifente.
d~ eel~ ale lUI(ex. vezt C!U.ulluilung ~c.). _. - . ..
~ <~rgumen_tum ad horpir1em.Mi.tl~i terap~u tl . C()~llitiv-
~ompor.tanum.tali. au uu angaj~ment t~ot~tico-r11 eJodologl~ nu
..
J n{UllctJe ~e rez;uitatt::le ~t:iiniifice .ci in functie de personltlitatea
~
l .trebui6 depa~it~. etapa- in cnre atu(1Gi_ cllnd s.~ dlscuta despre
u nor .a~.ton. A~tfel.uui.i practidatti evitit:fofosit~u 11 pr sl.r~tegii
c?g~1 '-~Yc9?rup.or~a~entale tin0 datmitafaptuluidi uu np~j~
unelf! tJ;asatun.. ~~ p:rsonhlitate ale prhtcipa.lilo.r p~otnQtori ai
a~~torsrrutegu ~llllil [ex .. AlbertEilis (arogant;.directiv)_sau
Am:o.o :aeck(noudirectiv)] (DiMattia 1jil.Cga. l990;Ellis.:ZQOl;
Heery. 2001 ). .
._Ermik~ ... tulinb~ltl~fl.-ii st,mtlara fmme
rijspnudi~e iu cercetareadinpsihopat!Jlo~i~. Psihanajiz:a a fost
<tdesea CI . 'cata CQ opetea~ Cll argmnenJ~ QOUt(adJctoriiput~.titl
e~plica ~rice ~op~er, !959): Ac~11sta e:i~ eroar~1lde tip-.peU..:
r fJo;de c?n~r.De ns~mene:', ~rfi.Jn_rJ.amentalis~ .
' !a Jreiruse f .. e ~nttu~ denva o a,nunutli le~li este o re:teuta
w
_frecventi\ inp~illop~tologie.. s~ ru;g~;t~enk)\rq .acesqu.cru, l'.stf~l
d.iu ca~za Jipsei ~uui adeviiratpm~<deJ-ec.enr.je 11ia prezeutei
sunullane a unnl mare numar. de ilbOnlad leorelice aflate in
competitte in cadnd psibopalqhJgiei. e:Jte (recvent Cc"~.ZUt it1 can~.
pentru a argun~ellta yaloarea unei. orieuta~i. cele1olte odentitd
sunt prezentate intr-q ruaniera distorsio~f;a. ctu'e apoi trebuic
coreclalalnaftelucdlti. A adar uneoriinl.ocsa. re uicevtt
r-:-no . evollltia~~J?st~ ln t1. corecla. eJ."G.rile nef\>r ate ale alton.t! Cat.u
I nbordarii evohrtiouiste iu _ siho nlol . ie-1 aratadi sib() a 6Jo 1~
Iltl este ferilii.cleerori infu.l]damentul1ntetueierii. ~a4analiz:ant
166
..."
sucdnt. iu psibopatologie ex.istli o kudinVi.impoxtanta tjlin p\ina
dez;voltate ~are cooj;eptm~liieazafuuctiile psihice 'I. ilSOdal
~ce.stora, \uUnn:arile psihice, prin prl:mmpsibologiei ~ibiologi~i
eyolutioniste .(Buss ~j col~b 1998, .Gimld,. 199_1). ~r.o~esul
[,evol~tioli!i}e referala schhnblkiJD structura. orgauica a unui
organism, sclumbari care nuloc in l111lJ!: Dill piica~, acensil
abordare d~i. promitatoare ~iihteresantli este unahts~ticient de
dgutVasa din cau~ faptului cii. in psihopatologie~eseunu. sunt .
ulilizate corect constructebi)ps~IOlogiei ~ibiqlogi11:i evoturiooisl~
@.uss !ii colnb.,l998)~ A~?acum arata Buss ~i C\lllab. (l928)
aborda~ea evalll\].onistlt af\UlC\iil~rS~l) htl\)urlitllor pslJice. ele
snnt trtttale,dOtlf~rln pristna e~ucelJtubJ}d~ad~ptarel Psill(~logiu
~i biologia evolu\ionista. au _detaliat~i clarUlca.t concevtuJ. de
. adaptare, clari.ficiiri carf1Incli. uu. a~t p~tietrat lncEi dill pllcule
.psihopatologia de itsiJlJ:~tie eyqlutiou}Stt\ A.,!Jf~, in'J.lSlltolol{iu
i biologia evolu on.ism se face o dis tine eclarliltJtiY.i~ ~ ~ arele
conce te impottaute{vezi m.ai s . ea tlidistinc,ie tr~buiud
sn fie preluntii: e psibepat.:,l<;J _ 1 . ._. . . adtse do
urous:a unc 1 Ulh!tdt 1.or sibice pHn prism.u
evoluponisnluluL ... . . . . .. .. . .\ . .
~dapt~UonJ. Adaptareaes~ocanwt:E:dstidi
im1ascuta eare a. npfuut~ ormore n sel.ectiei:natur~:njul.iinf-t.
directsnu"luclh-ect~producc~;ea1ut.i~lPUl,apUliti~j S~f;~ Allf~J
spus, est.e posibUca o cm:acteristicl\. sa fie adaptnre dacaa ajuhtt
direcl sau indirectrepro~ucerea!J.l trecnt. cl.tipr.aincliJtt.pre~ent
nu mai are aceasta tuac\\e. De~l adapbJ.rea ~le pd~1cipa\ul
produs nl evolutie:i, ex,istil=ii nlte_prmluse Sf!Cllllda~ nl~ n~esl.eirl.
l Diu~re proouseie.secumlare ale e:vol.u\i:ei cele111~ilmporlanle
sUt-itarlefact~le!ji zgomotu~l"tefuc~!Jt npiirut deoarece prit~
I
\
inta.n1plare el a fost a~ociat cu o adaptare. A~lfel, culonrt:,u alba
a PQ!:elor sp~:e. exemplu.nu este rezultatulltnui.~lroces. de evululic
d este Ull nrtefact al faplului di oase:le col}\itt calcht care Je
!
tl 167
I
I
~--------. -~ -
 I

mu b\,;~e in\ele~e ca ndaptari. exnpt'ari, spandrel-mi sau sil\"1\'lle

qsigura. re.z.ist~'mta (adapt~1ea 0. calcil\ care 1\re cnlnate .a1ba. Mai
'Laproape de noi. uuii a11t01i au sugerat d\ unele fitnctiil 6 psihla'e
\ ai1ef;\etc.'?
j~ plus.
:
mvr .tiwd.!lmC. . t~ incura'at e

f~. tl~l_ca
'
___ ;I

1 p!l!Sl~p~se a ~ te2~1tntnl unui v.roces d~ evolupe prin sele.ctie adese ''' retica ate ro riilc revi~te ~tnn 1rtce
.na~1 ala (ex..l~bDJnO nn sunt adaptari ci sunt :1rtefacte ale unui ~i prapi:ia eon{unilar~ tiin~ D~n pacnt~ dincolec~ivele'd~
crcJe~mare ai bine organizilt (vezi Buss !li colah_, 199& penn-u
detalia). Zgomotul san efeetele int.litnpliitonr.e tlu snnt legme
...:ednc.tir. ale. tmor rpviste de ncest gen llpsesc eclupele ,d"'
spl!cii{li~ti cu orientat:i .diferl ro. A par astfel ~viste de ~usa cln": .,
!
l

gnnereazli efecn1\ de ~oroupt11in~ (vezl pentnl detain Breh~ li'

d~ adaprare; 7le pot fi. prod use de mutn(:i! care nn illfluen{eaza
reproducerea. :
. ~~J,lfl.\l!e (EXaptn_tion)JE.xnptar~se refedila fa}~tul ca.
selec.tta nl\\1.!1-aUi a ac,~aonat dln nou asupi-n unei ndaptari
antenoare. t\.!;tfe~. mez.en&a J.lenelor la plislirl.este. eo11siderarli 0
_;
Knssip~ 1989) Iii care.geoe1~a21\ conceptii gre~ite f}i per~pecnve
\im.\tfite tn domeniu. Penttu testarea aceswi idei fil!i exnminnl
catev~ colectivede redac\itJ ale revistelo-r: din domeniul' ternpiei
cogoiov-carnvortmnentale (lnternationaHollrunl of Cognit~~e

l
.
8~ilptate Cl\YC: l\ ~JUta.t la termOD;~jtlM'e, ~j. astfella SUpravietuir-e
~l' i\CCf\6~ mduect a a,jutat ln rqnodmeiel) Ct\nd acensti\
ndaptl\1'8 .a'il}OCB.Ut Sa fie Ulilizata pentrn :zbor, atunci vorbint
l}e~pre p~eunt~nelm ca o exa:ptar~. Bxuptarea are functia de!
a aJutadtl-eetsa,;stndhieclTC r.oi:l~erea.tn prezent.
Psyc\lot11Ctnpy -revista ,A.socia{iei lnternationale de Psil1oterapte
Cog~itivl~Jouma\ofRJ.\tionnl-El']\OtlVC and Cogniti~e;-Beha.~~
'ior 11terapy -revista !nstiturului Albert Ellis de Ps\l10terap1e
Ra\ional..oEmotivll 1 ComportamentaUi}. Rezu\rat~\~ au
-confirmnt ideilii prizentnte lflll:i sus. Spre ex.emplu.cotecuvele
.....t.

.Spandrel {Sp~~drel).:rennetlll e spandrel tn limba
~gl~zlt e.sreunulut1lizat fn arllitecturlt ~i se refeii"Ja.spatliJe
goa!e c~~e rii~i\&l :n stmctura linei cllidirl. Aceste spatii pot fi
n~m ntthzate m dlvetse scopud (ex.."ca loc de odilmli 'ntnr
. ~tvene ani~al~sa?'oameni Iocuin~)
fl1rlt de!}fnu so viznu.r:runci
. cnn~l s-a ~on~l.nut cUidtrear ac~ste functii. s.pandrelol este
/ re&"!t!tul unuL prOCC$-de sclec{lenaturallt care a action at
i'mm ;xtefiict.. . Blare rnncpa
. a . as~m:~
. e n aJnta d'1rect .sau mduect
o cerea.tn rezent. . \mjuconljtient cog11ttiv !Ji tehnicl specifice cogua.ns-
. 7-- Artefaclt~l. Artefaetulau influenten:zn tlire.ct sau inditecfL
.. t ep.roduaet'ea Fl esre mztilratul i\nui pPoces de evolupe care a.
- .nctton~t a~upl'a mecn11ismului cat"e il pm~u~.
de redacfle. Stint compose doar din poofesi:oui~d CU .orientare
comitiv-conrpoitamentall! Similat!; in nproape tonte lucrari1e
Clt\s,cc de: psihdternpie scrise de profesiOJ!h)ti fl\dt odenra1e
cogJ]itiv-cornpnrt.amentalli. pantnJ a se evideu~ia cof!.tribL\tin
t\mdamentuU\ ti psih"anaU2i la studiul incm}~tie.ntului~ teil\llia
cognitiv-comportan:\t!t\taUi este preicntatli eronat ca focal Wind u-
. se ntlfl1qi pe cognipi con~tiente ( e~. Kaplan !li coi~b., 1994). Se
igno,lii-t\stfelde~voltaqleilin ultimii 1.5 ani care. pron1:ov~~zl1
i
~
cpmport:amentale de mcidificnre 11. cngnltiilorincrin$tiente (Do':"'d
qi Chonn::l1aine. 1996; Eysenek!li Keanne, 1990). ln, aceste
-- ca1..mi ma indoiesc d. tnechipa de tecenzoii aaces tor lucr'ilri a
; J, ' ' ' ,'', ,' j

. El bme. c~rce~ti~ite de psil1opatologie ar arlita nltfel, mu1t . fos(:i11vitat vreon ternpeut~ngnitiv-compnrtamental. . . \.

rna~ compl~~ /iltn.ctl nguroase. tlt1ca ipoteza di rulburlirile psihice- l:}n sftirs,i.t. erori~ein procede~de 1n!~e\~~are_$e. refe;rfl.
.. pol fi exp~_Jcate dm perspec.tivl'evolutionisra ar hl." Atn calctll .la toate eronle logtce care pot.sa apara m dwerse fqmlf? d~
'""-1 ~ dn$cdse mai sus nu doa...
rntionament, sunt iar~l1i o pre~nta constanta tn psihopatolog_ie..
roa te p.ostulltaple d .. 'd ...
Su t.f ..1 . . ' . cea e a aptate!..
n :n.nctn _e pSlh~loipce. ~~ asociataces!Dm. tnlbndiri1e psihicell' I

. -~ I__...~ -rr-+..- ... ~~ ~~J .. - .

rn}~ ~&lJ., ~ ~
:>(.: ll' ~ ~UY"t::; -iWf.JI"'"'l.a HiiJ

fr!- ~~n. .
 .
Sa vedem cum SWJt ace~>t~ pr~dictii s.us(inute de refllitatea diu

i. j ~~i. ~.~-1. 8'..lht..,. ~(u: ~~"~;1\i~!i~ti~:~

''l'ii~terapi~~au.tnrt:ort!lllt<'
..
q.
.~ h

.:el'iliru:ea'~sii&J
X"tonf~mru~t1f'~ri~t1ti~.~
:tJP&ilio~p:iei!pri~D . :~
7'd~lii bttp11~\Y~eiti:c;Jfj'f
(l}.O . . . I

>d~ ut:lt~~f'i( .. .. . r ........ C:,.,a uui~m~~a;eat-r. de

'-~
. . . .....,. , . .lf'1.f!J~,re D~~f:7~. [-q,-Jn~f~P,r:.JJilfit:/.~t(iJ .~sili'fl~pic.
. . .... Iii.
:~~~~t mo
,J~1,~\\ip;~~1:t~~~lu(;::Si~l\l~Vt\~,:;~~:
t:iNi~t*Yil!il,l~rs~ut in af,te~Qlg~'~za~~~~~ .. . .

ns~~~;
t .rpsi~ttit~.[He~s~riftiowlwa.pi\i
,{;P;;,wn <!i'\~tlisc&elna]~~~~'ei.
.forma speci~cli.~ ~~~ti~~
lcOli t}epsiJiot~fllpi~i~ .,

:1:~--~,~ ,,~
Tdffii~ d~ trittal11ent (p.este 20~de, =J~pXi.fll]Jes~e.:~JtlQ.ll[~,,tfdmicJ:j
' . ' '"> . . .
., ' >/';.1 \ ' ' ' .
,..
' -',
' : ~ ~.,, . ~

lJ.O l71
:~- ~"'!

"-- ..,......i
B~r~in~j GArfield2
peiffi~:rcficitiita 1\'ti%8tor u-nranilen1Itt

: 1"' ,-.,
;

-.
I
I

i
,

113
 ... -: . ..... ..
~ ..... :
~

tl111ofii negntive cu E1notii pozilivecit tulburtkitor somati.~e. nstfelca psihopatologieii s-a refuzahnull
.tilnlrStatutuldc ~tiiu@ ln compara\ie cu l~tul meclicinii.. Pelltru
B,ctivnre tt tore (e:t; uctiVii~inare (ex.
: -furiqlii~!I,-~i~,&j
; .....-... - ..:..:.--- ... -
ext~(l!t} .: -, ..
,.
.. ' :-: -. a ca~tiga.ncesb<ltatut, psihopatologi~ a copiat modeluJ.mediclnej
-in abordarea proplemelur psilucel}i de compmtamel~t, ceea cc a
Emof ii negative . ~lto!lipozitive duslafoca1izw:eae~cf!Siv~pepalologie~Alti nutOrl(vezipenLru
cu ac!ti vare 1nedie : cl.l acfivare detnlii.Pierce ~iLynn, 199 i},de.7irecunosp n.Cc1.SUl foc~lizm:e
(ex. trisl, i.ttgrijo- 1'-----,.........--__._~__.,_ u"Jedie (e.~. ve asll~::Ftul ~orectlv, spun ca nu este nicidecmu vorbac<le.c;prc
rot} rericft. un c01nple~ ci despre odecrzle pra~t~nnficiJ., P&i,hQ{ill.tologia s-a
rllutrmuit}. dezvoltat acolo unf1e era cerutii. Oamenli;Jae npeLhl psihoh.lg.
satlla psil}.iatru atune~ c~d S?fetii .i (}Alldl\U)le~ole de ajutor.
Emotii uegntivet:.u
r~
at:tivare uicli{e.x.
Emotti (Jozitive cu 1Rconsecin~a, psihopatol{)gi.a s-aorientat pragmatic. uu defeitsiv.
!
depresiv, letarg~c;)
acrivure micli(~.
cahu, Hrti~tlil;) _._' i11a~enslli
1 dir~tie, ~(J.restll~~ue;d1~inei dealtfel~tJiZ ~n;i~:
de Juterventte v:al\date li~utific -~
cm-ele :v fern u < ,

figt,tra 5. RelaJiile d~ntre emotiile pozitive ~~ ceJe Mgulive
(pJ:elucrntdupiiRusseU ~i CanoU, 1999). .
~~discorul i_n p~s.tiest~te IUitl S<!Hzilitdepatscorulin ptetest{~i
m ColJ.Ipar?tte cu un. grup de control);dn. dar aceste rez.ultate
ar-ala.~oru: cu_s_-a\1rtr~us emoli;ile negal:ive, Ce s-ait~f!lllplat~u
en1otiile po~1tty~'1 A Aus tt:atame11t:ul~i la ere~~~-\ frecventei
aceslora7 Astfel4r; i,litrebii(ll}u fpst luate seriosin discupe obia
lnultimu per~pada.deo:ttcce psihop~totog~i lt\J e~ pregiltifllu
cadrul pr:ogrruHelorde l.ra.b~ingsilcousidet:e serlos aspectele de
op.ti.n~~re.lii_dezvo!tarepersoaaUtapaclen\llorl()r.Es~adeviirat
dt pdn definitie, inte.rven~ia U.t paihopatologie-vi~aia otnt
~e!Itut.tulburltrilocpsilllce~t$idezvolt.areni.ohlit~a .
pacientd?r. Este.lotl~felde adev--limt ins~ di i.IJdise ignora
; .- J~SJ.?ectul d_e dezvolt~-e ~r optirn.izare care. a fdst preluat ca uu
l psihopal9logiei11sa ades~aacest lucru nueste b.im: l~li.efnt,auul\i
dez1derat important de ciitre psihologia pozJtiva. Uniiai.ttbti (v~
pe~HJ:t.I det~lii Pierce-~i Lynu,193l }au argurnenl,.atdi focaliUU"ea
pe aspectul cmectiv este o consecintanatutaHfa complexului
p~ t:al'e psihopatologia it are fat~i de medicini. Dome-niuf
lulbudirUor psihice a fast malgreu cuantllicabil decfit cefal
tulhuran _epsiliice 11" IQ.~ f . .- --~.- e naUt.{veziAn~~a 1).
. ricutn;Jn l erenl de n\ot.ive, su.nt evidente in psihopatt)logie
]_ jg~:i~ftipsa,e~~,~~tor rlr:acle~'"fl~aspectel1elo~
~1ec __m unl3II ll' ;oca~tZP[eR,eXC~Ii vapeaspec liLf! ~- _ ~c ve
(Seligmmu;i Csiks~enntilmlyiJ f,OOO)~ "l~oate ~~sten aunt ltlt
. JeUex allni!nina-ului pe cure pslbopa:tologul U llrine&l~, tl'a~-
_!gg_ focnlizaf pe p~tolo~Ie (cotectarea probl~tn~i) 11u ui llo
no.nualit~te(ex. dez-volb:trea as _eci:eler. orltive).~pte e~~rnplu.
m multe Programe ely_ preg:,itirehlp$1bintrie din Rol.llauin. umuiirul
preJorde pSiJlO~Qgie este [oarte .mic (adesea U!.l CUf$ tle till
se111estr.usau de ~n). Our n~Sa cum. inaill:te de astudia
fiziopato.logia. se ~tudill-z;i\ fiz.iologia. !}i tnnlnte de a stud in
anatomopatoiogil} ~e studiad1 anatoouia, .Elf lrebulca. mainte ue
a studia. -sedQS psiliiatria sa se stmUez~ serios psihelogi.a. in
medicina studiulup.nnalitli\fi precede studlul_lln()nl,lalilfi\H! ln
psihlalrra\ill;ud cllno!ltlute ntiuimedespte fU1tr::tionarea rmrnmJa
~lpsihicu}t.d utuan, Cum nut putea _ argumeutance~tJtlcm?
E.'-aminandlucrad de psihiatrie, observfunca mCJ<JuHn cnte sunl
t:onc~ptua.lizate fe.uomeuele psihologice su_nt J_~ nivelulunei

f74 I. :.
 ----~--- __________ ___
_..:_

psih~~o_gii cle simi comun sao la nivelul de inceput. al psiholngid -l

ca ~fitntiL Pentrn a piistra un discurs ctitic 1a dorneniu nu la
perso~na, .voi evita sa_ exem1_3lific.cu.luctil.Iri care potrivesc
~e~cneren demai sns dar voi folosi o logica negativa. Astfel.
voi spune di in cele mai nmlte lucrari de psihiatrie romnne.~ti
(Sfire deoseb_ire de cale intemationale. ex. Kaplan ~i colah. 19g7;
i
._j
Sadock ~i colab . 2002) nu regasim teoriiJe consactate ale
se
emopilor atun~icfutd vorbe!fte tlespnMlfect (Smith !li Laz.'liliS,
l993),nureglisim tem-iilemoderne i\le pc;:rcep1iei.(Marr, 1982) ... ;
c1Jnd sc ~o~~~te despreil~H~au Juducina{ii, nu regasimtcoriile
~

modem~ asupra memoriei cllnd se vof'be.lilte de$pre memo1tje

(Scl1acter ~i Tulving. 1994), nu regiishn. ideentln~li inconsLien
cogaitlv .(Scbacter J~i Tolving, 1994) atun,ci cliud se abon:ien-z.a
fe~omen~Ie. ipc?n,lJtiea:lte (se rllml\ne la a~a~i tradifie depiisirlt 11
psJitnn4l,'~et). ~' ~xemp:el~ pot CP.rttinua. DacjJ en ~esc. ~i
dacli extsta cllrtJ de p.!uhJatcie scrisc de autori romliini cam
incor~oreaztt aceste curul~tinre d~pre nom1alitntea. psil1ica,
attincJ Ul\tascunse.4?tfgrtjlU .
,1.,.4.3 PrQ"VOC..'Il"~a pnt;aprofesioni.!ltilOJ .
.. c.nn1 am Viizut nnlorior.. programele de training in .'
J'll'}.lotcnrpsf? ~u~t .complexe Jii orgau.iinte de-a lungnJ unei -~.l

peiJoade lun~ de l:llllp. Efortul flnanciar. inreJecrml} ~I de timp

este remarcabtlpentm n puten obfirie o cemperentit inlr-o formn
St\tl alt~:de psih~~erapi~. Dacli &Ctiste resurse ar fi nlocate altm!
~Olnen~~ fJl:o?abll Ca 8-ar putea Obtine douft licente in donil;
dorpenu d~f:ttc. A~ada~. estc de ruJI"eptatcl\acest prognnn com-
plex ~e trarfl!ng sl{ duel J_a profesionjl}~.!lhilidi~ ~ performnn[e
. ~npen nrc celor care nn au parcurs aceste programe de train-
.Jng. Ce ne sp~lO~nsii datele ~tunt.ifice Rezultate arntli eli dlfi lfa
~nn~ profemo~,l~ti ~ : . esJOniiti (onm.eni :fiirli. o pregllt!re
m psallpp!ltoJogt:J sftu.f:!mtte profesioniti cu pl'egatire..m'li..lunga
9f ce.1 ot~ o pregatlre ma1 scurfli (ex. niveJ n 0 ~1 :_,
l\tfnster)m ceeace riyesl~.eficien &tratamentului rulbtuMrilor
116
177
 ...
....
cu a~ei pacieJJt:i c.i au urmat un protocol clini~creat de
- . ..,. .
ft
pt~.eswm~tl. . . . . . : ,l-:'~..- . .
(!J)i!:;~/:,iceJ:. inaintc ~r;i fn ti111pU!/lpficiililpJ6tiJ&~illlui
. cl~?Jic/paroprofesioaiftii fl" fostsupe{~izllfi ~df!
pm{esif!ni~ri. pentru. a f1 :;lgurl di protocolul cliulc se
. adrniuistreazacorect . ..
. . lata a~adar; di 0 .ttoncluzie uo~~defe(l~ ca
= p~~mfesionit~tii sup~rviz;JJi ~i c~ordoua~i ~ep~afE!SiQt~t
obtt~e rezultnte ef'lctenle .:m pslllopu.Lol_gg~e.J,it..,con~nJu,.
progr~Illille detraining al psihopatolO~JilOrar lrebui iucluda Sa
. 'qstfd de module fu. Care
p!.Tifesioru,~ti.i Sa
invefe CUm slr
' ,.QOrdou~ ,siifoxmeze ~B.(Jt()fesioniti. e pare di
psihopnl~logi,a.l~IJ a itwatatdiu . is~orie~. Ali.Wdineadef~dsiva nu
a dus la :mccesr;:;.lm!!.diat dup! celde:-a.doilea.razboltuondial
psi~i~lrii au iitcercat s~:.j l1loc;l~ez;~ p~ psilJ~lcjgi in a c:lobfuJdi
comp.etentairi psihote.rapie.f.aUi . ~.,ac~JUxllmbelec;iftego.rli de
profesioni~li .au ~ceea~i c~mp~~~ntain, psihutenrpiede~i.ponte
. d\ "politiditn.ainon-d~ensi va.atmibiatrilorat:fi putut.ducela
pastrarea COJl[foluliJi. ei putand spperviza !3ifonuapsihologi crlre
ar .fi .r.racl:ic.atpsHtoterapiu ~uperxitatill!I a<ieea$i :;t~tudiJw
del~silliatrilauin~ercatsahlochezepsiliOlogliiuteteJlti
~dobfindi cQmm~tentetn a~ministrareade me~kalie
..psili()tropapdn. t.miningauplimenlar InJ?sihofannacol6~e. full(
<;:a ac1,1m JE\ ni:velul.Armal-eiSlJA. psibdlogil au o astel de
co111P~~7n.tii iar recent, aceastacompel~n~Ka fost tecunosi;:utli in.
cfiteva. zone :;i .stale .arnerican~.(ex . Ourun-~i~e\\' .M~xicn).
Predictia. Jllea este. Ql aeeas.ta compelen~ii se y~ ge.U~r&Uza in
viitori:in alte truidup!f modelul i'n c~re psihologH nu dobaudit
cpmpeten,nJ.n-psUIOterapie. Ce trebuiesaJn.vat~m diutoate
nceslea7 DaGa psihologli :ji psitriattiin.uatluptao ~titudi.rienon..:
defensivafaUide studiile care arataefidetl.\B parap~nfesioQi~tilor
3-arputr:a sa Hibasurprire. Pe masura cenceste stud~i yordeyeni
Lot 111..ai cunoscute; s~ar pu_lea ca unele esse de asigm_ad de s~al.'lte
178
su prefere sa pHiteascaparaprofesi~ni~Li.ca,t-e ~unlmaiieftini :}i
in consecinta, ace.itia sir i~l organi~e.~e PraP~i.ile prograrne de
fonn~e !li training. 0 atiltt?Ule!lon~d~f.euSiv" ftr'fi ~~amiuurea
a
critiC\\ a~estor studii ~id.amtltnrea dea1pi ~W!illl bltte coiltt.:OID.Le
. de cap:e Asocia\iile profesionalerep~~ut:IJ.ti.ye t:lle psibologilor
i psihiattilor. Daca rezulta~ele niett\fonat~ 1\tOi se .(loufinlla
psihopatologii ar trebui s~ i!li asuwe l"Ol\1.\ oe St~pervb:.or si
fonnatorpentcu practica patnprofesion.i~lilor, practicli
. recuno:;cuta aces~om penlf_U anlttuit~ ~o~dipi identificate lb bnw
sludiilorxiguros condtis~ Allfl;!lo inviltftnd dl.{l islorie, {l.redictia
. noastdieste. ciidisputacu paraprofe1;ioni~lil. c;ltJ.utih peutnt
ruimn:ite seNjcii de psilJo\erapie, va Cl p~etdttta. . . . . . .
@.4J) rr~vocnren tel'llpiilu,: m.~to~dlJlinlstra~t! .
. Costurile. programelor de tratru.nenl peutrll.tu.lbudintc
psiillce sunt url<lli" Auunl Jo SUA sc pllcltul(:Sc peste 100 de
miliarde de USJJ .pcJtb1l$iinatatea psihicEi{USDlUIS. J999). -
ln cons~cllll~ ca nlte atlva la ttatai[lent~l e. de.
profesi?ni$li a';l-api111l .. r . . tele de Ler . ie. ~~ttoa(,lmiuistmm
in ca.repacjemtul.il .aaministtreazitte.rapia ~iOJ!Uf. ~a a .
te;;plUe ~utoadruiuisttate pot slifia aplicat~ de clitt~pa.bientt~\
insu~i. cuo interventie minima diu- pnrl.e!l te,rnpeuiului ~i. tn
consecilt\ii, ru:e coslvli..reduse" Ce ara\ltstu(:\iile: c1e speolitUI.ale
cu refedrsla e:H<;letl\U nG:estor _progr~m~l.Gf!rceUitile de
metaanallza cnulltativn. sumndztiud peste 40 d,e studii arutu m.
_}iferei!\a ~in~ pa~hote~~pie- :,l;te.rn,pln hu~?ndnJ.il1istralii ~.s~
mi.niml ~1 ue e 1 . . . .. . Sc~ colab., 199U).
ceste conclUt.iiall fostapoicohfiJlllBtelllll\.l.lll~t{jnse alle S l l l
{pentru detiJ,l~ vezi Christensen ~l.ln{J~~(]~n, J?94)_.Ju c\ll~l!
acestor~ultal:e clare, r . r. .. le delralliUig Jtlpsillofenl le
- coJttJJma r;a ignam impnrtauta: JlfU&edurUor . . e. terupie
;- . . . ' ' " .. r~~ - \.. c"eutdebittC UPft:Sioni~l\i.
ln-!1ii~eslQ.m in. prnctic:llot cJ.inica (Dawes, 199
i ,--~--.-
\
 . .3.1.4.5. Cont~ta\e~ exflllricntei cli~lic~ .
Pentmmnlri profi .. - - -. . re:z.ultrttelecercetfujiornsupraaGestei U:Ine. (Dil\'>.'es., 199.6~ G,u\1.
mnn
.
. .~cl(.
.
at lltlCt ~._.d. esm.-.~.l.~Jti,e~pe.;n.~nraclini.c:iesteAs-..111
. .. ..can nn Slm[ bme ~ - ~ - . " . . din 1989;:199B}ml ~ratat ca e~pericmta. clinicli n~l f~nbtmaro{e~te
'll1ndamenhitastiintin N . . . . 1 ~egnhtl lnlr-o dtscu~ie __petfor~mmtn~lini~]- Com de se inUimpUt acestlucru'? Oare.* ~u
c .. 0 1cetm<lltureriamauzitdenenumarate
en
_. u ...
01'!ctt mraven1 inoa, ~ - . ' este evidenrdi toti 1nvatam din ex;perienta'i Nu inse11mnn
,.u .. . . - - .. ~ .... oexpenentn cltmc5~ cl1-sunrem lehnicisli si
t:!linaon;;ccmra ar trebui s- .. 1 a - . . ... . dadi nvem mai multi\ experic:nta
atun{!i avenrn1ai: multe
nusa varbilll t;isa avent pre~~cn~~mye ~elmaa..experi~enta{i, cuno::tinte ~i In coosecin{a. sun rem mni eficieQ\i ca profes~oni!lti?
. eli nu ~thn dttpll c.llt lim ~ . pe pa~n I Trecaud pesrefaptul
s. tu.den.t. .......... xd . . p ~ncepe expen.en{a-cHnicil (cllnd eram
b lll\o Orient cle ,plan:z.ihil! ni se pareaceasta ipoteza. eu nu esle
~_.... teptate mi s . . . . . . confitnlatl\ d~ oatele ~tiin\ifi~{Dawe~.1996; Garl>~198!)). Cum- ,
___ i
ctmic1Ldirr "l i\com d .'.... . . 0 repJ;"o~a cauu anl. exp'erientli
tot n1i ;~rf!p:o~ea:zl
de iU'l.l...c.'111 nu Jim "'.X
d::;!laT d~ Practic~ ~l~erceta~e clinh;:li
J. CD e.gtCU pntc . tiC. afil Cereetarede 30
am:p(lleae,.-;plica acestlucru1 lp primulrftnd trilbuie ~li.facem o
distinc~h~tlltr~inviitareaun()~dep)inderi motori i (untie practicn
"' ... pel!renfulor)l M este fnudamentaUi),ii.i'nvti(a:rcatnlor .cuno~tinfe de~la~ative ~i ...i
dl!fensii ce ~. 'lr . ~. lat..~"v
. . edeJn.tn. li.-ul.mod. no. n:..
este ca?
,. lll.!IOI\ml111 OX:pertOI'lfi\

}' M ... "
, o nucn ~lear_ de jmportl_\ntli . proccllumle (eJC. con-.. sa c111Sifidbn p~cienpi.cum sl1 fac~m
predi~tu.cUJ:l1:safacem diverse~ntecyel~ti~~tc.). in ceea ~e J?dv~te
m-primulrind experie { I' . 2i . . :. 1
- ani deprnetic:c 'TI..,.,...~ ~ a c. mtc nu- msearnnl! doar mulri cbsificare[[, rroieli. 'lori.lt diverse cawgo1-ii noS(ll!l ice . -
n. --~ea UJ11pU]m:fl\r}i - 1 .
1 .
Jlll este e:NpeTien"{lt cr . ~ . . - runmJ area de cunOijhn(e c..tctii~~tiicute{:.~~maeesteic~l ..cnn.. cercettltile.~ep~i~o_l()~-ie
1''Th-lP'OL.UI 0 . tm~~ ct clonr SJPLA TRECERE A ..Ogq.ltlvii i\Ui nwcatf-attnmfunda:mentah lmphcan 10 bun a
lreoere efie1cnU\ a timp 1 . eaf:znrea acestOl"activitli i . entn1-deralii vozi Ande'7oq, 1990):
unor cuno,ctjpte C" .."" J'nfl It u utpiesnptme asimiJan~n
Y ,, ...... uenteaz~:~ pozitiv ti M - .. ~'1tt:garh1~/rclmiD Q/ardi::/irllte. Adesea acest li1cru. nu
nJe psil1Dpllto1ooilo.. A . ' _ ac Vltntt1e Jmportanre
- c censm mseamn- -l( . eJd~fJitn psihopatologi~ unde avem numerClase cate;gorii car~
ps~hopnrologii mi experi.en11t ctlniclt m a c~ ne a~t~ptltm en
decl\t cei .cu experien{it. eli . .. . .. ~re sa: fie m.a1 eficienti . ll}l ~pnt clar> definlre. Ca exemplu ,ill1strativ este DSM care
nude rezolvat. Paf'-.ldo I ~len ~~c_a i'n .d.IVersesarcinitJe cnre le pennite_int:ndrarea . uoorpacien(i cu.untal;Jl.:>ul.clinic.:re1ativ
l-)eja
xn !il conl:raitllmtiv lu ~ 1
~tim, din ftl'lR1i2ele rezen _ . ~;;~n e flU .stnu a~a.
heterogen in nceeai. ca.mgorie dlil:gnosticli;. acestlU~tu. se
paraptof-esionillt"a ~~- pro~ . - .rn~e.~nrenor. cl.difemnfele dJnlre 'int~mPlii !ieqare~tt at}esea paci-enlii trebuie 81\tnd~plineascit u n
tCSlGlll'itl ~~-eel d J}~fl}llr Iirnitat de. Cl'iteriide diagnostic dintr-o Hsdi tnai lurgii,
trnjning oo1uplcx ii ex e .. ~ - . e mtre _profesioni~ti eu
- 7 '"t

- mni SCUJi~fi experieniap ~~en.talnare ~~ ~r?fesioni:;ti cu training . . _astf~lcit. pacienti dif:n{i pot potrivi (:.l'iterli difetite di,n lista - I
. eficien{a tl.'atan'lenteio~~~:;~i~:rcwm!mef? ceca Ge in:iv~te.. geij~rnlli~i rotllfiiintrlituaceeafti cntegorle diugnostldt
fufboJJfrt psfhice. fn ac ll .te de-acehfl pentru diverse -.~cgu]jlc CIU"e 'dc:/irJ~-c cate!Jariilt:-trebuic pre.zcn'tnm
pre
. athre.i rof,.....
.....mrlnll last
. secpune
.. a Iucdl..i~
4
cUn.
M!ita en
: -~
. Jh.tiiJ;lle .cl{J'JI/iu;a alasiffa.aa:a $EILJ./rebllic ilt!acopiYftc qe $l1biect
cor-ecl"itndillet\ closificli 1 1- ~ __... .... , ~
J?rip!_t7~~a(?k, ~~est l~cru owse reglis~~[e 1~1 practiea btinica a
- .. n ~emelor
. Ciltt!gor-u nosol"'~tt"ce . .. l
ienrl . ~ d"
or m 1fente p!!Ulopaml9giei.Presl1PU.nfind c~ psihopatologul fcen mcadmre
. ... n1ct t>rec1zm-u ~ ..1 .. ~ gre~il!al)'foble~lelorpncicmrului inrr-o categorie nosoJ~gidi, el
.compoitamenre

pe baz;\~
-
. ~utoar o
a~estor cla~.aflclln~-.
L nupri~~ fee]bnckin,1ediat, dici dae~ ar existn nprlori,un nstfe1
lflO
fie
defeedback:'atunci nu nrmai fi fost cazul sa fiicut dindnostknl.
lB}

: ... 1-
 ,..
;

: ~.

..,
.
r~

..i
;

-!"

~- .. ,. .
_.~

~;
- ..., _______ ,...,,.p --~~-- .. ii
 .. : :....--.

:I

J I
... ~~

_j
,a~.~<lstoriea\l~ta'tilcnllt!i;:cuil~/t: ''
If: '~~'111fcieuttiltlt:~!(ti&ia~logi'ejc'1~
} ;:!~'. (pen:ttil .cie~DliiJt'~i~ata~uti'it' S'ii1tsiln:,1:9~9)
_f!:t~~J ,tf-J' .~- 1 :!:f; 5~ !HJcf.:,:< 5-i:? ~

. .,,~,i~;J:l."~~i!}t.:nali~:ltifost~~;f~a~qt1ntl'dWl_lSiboter'cipie.
.. ,,.~\JJ:-pn~!"!iA;ci
1\,~~Q~r,t~l'Jil~~ d~pit'~tnd0lilltirel~psiboparolO'giei
. ... pltruntf\pd in cultm:l. o innre p~e-din fun~ament:l~' ei'se

~ .. ~-- < ;~~~7~~

l
. ..J
.. <

. ,i~g(eJ1!t!~~ti~1jl.i.~$lk0par~:toJ}ic~u.ITHatlnd .:.
. ~~ ~C!i)ll~~~e~tli18em:ne)~l}lsimptomele: .
~'*'~1lt~~~~~i~(~) intewentle ''iJttnttqlient;
" ,;~Piltf~,!~f9~rl'ei~'j 'iti;,.?'':'iJf ,vd:',~H .i~ .
~~!~~P:)jniti~lQ:~P.ifeel~e,aliloilcmrlizboi :
,gtJ~'Q~l.inU.tpliiiilc:a~goriilerfleS,alogice .
~' . :i.i~~~~\t,l:qi~~,~~,};p ~mlin~~~v~~; de.-~
~.u~~~i~i~~~<.m~u~l~: !ilMnlild;a~~MDe\
jP,~9 ...... :Ji.i~~~g,if~:t p~>ptote~iti:ni,ti .
..~en 5 ~patltti{:~ll~e,a{lu$laJncorpoFtlrert
psJllilJr~aJ]tzn clilsic,a. Din pacate. nici psihilterapia .....1!;...,.~
CQtnpiilTl1!UT!l~ntal! n11 a putut eficieritiza acest sislem ile train
184
185

.
 .preluaud aspectele sale fundamentale d~i uu t;rau verificate
"tiiu(ific ( ve~i stmctura progrnJ:uelor de training in psiliqterapie .
~ PeL!a~dal!w.J/uill1edJ.~uldeca.Autichitiitii.ca bmu.a psihid\
1 ta d~
~
Ui. .. Bma. . .tut.ui..sp.iritr.a
. . . ... . U. .a...d
.... .. este .d.eletm posest.Wl.ea . .evamt
...
. .. . .. . . . . .
dom1
.

co gnitiv-c.coiilppr.tan:tentaiala hup:!Jw.w.w -~1bat~o~11), :n~ul1&"' ,,

... . nau . : . o n~vu psihicierndeclarati vdiji~tu:i, noseda~i'd~
.utitl tnodelulbiomedicill.este tnai b~ti~ on~W.Uzt1l:ji ma~'tealist
'deoarece elf~~ parte dh1progrruttelc,de fqmmtedirt do.tiih"'iiliil-
~. Rl'p.Ie~c. .. (1Ja.r.trata.t
. .. - n.e.ntel.econ. .u ~Jnlocun
. .. . . . . . .. .a ............. . nt.....
. . sta.uiu.izolarea -..~L""
, .
ll11P;opru . egati ..m !antun), exorcism ~iuu~ori.chia( ~xecu(ja
. acnd~ruic (d~i a.1a cum atnmcil t-ional>nnt(!rior~stefoculizat pe
.aspeclulde patologi.e, ignodind.neju~Ufi?atno.fma).itaten), mai
d~ca;a~sL? era mteresul:_bis()ricii,1vlod~lu1 :mprauuLuraJ a
I?'
pr~u~t ~1? duuens.mne mo.rala, cares~Jgecacliuueori.iu1bl.lrarHe
fle::~.i.~ile ~i lll1U permisl ve,.la noHe.q.ezvoltati ~u domeni~.
psih.i~e ~ 1A de comp~rt~;nt ~u11t l11;t~u~onat produse de cei
3~:l. Istoda pcr;soruli(tji socin~a
sufe. jJ .~... u. 1(!-
. . n.nz .. '-.'..n .m
. .. od . iax:c
. ... 5IttJ
....... ... u. c.ompor.:k-un..
. . . . en..
. .tu.J crumuq . . I. -d e-
... .. ....h

;mnt. n Epo~a.ll~.(11, ca ll[Jnar-eaa sllbiJifrol.ului bi4ericii

a .padentulul.J?siltopat.olQ.gie
.fin soc.Jetate,modeJu] antic
~ . nform.
. . . co. .. cru:
... :t.d. a. b.o...
.. al.a.. .p.st'Iuca
. . .. esle
. un
euomennaturaluu:epesti.diwinadontina.ut. Acun, . d"
Aparitin~onllaUia sihopatologiei~avutloc.sptes(a ltul o ro.r .. . ... . .. .. . . . .>. np;u- lver.:;e
1 ..
. . .,.I ten . . t !:;3ft~, .Jncearca.sa _expfic~ CUill 8p~t:e boala.. p:;ihicll,
secolul:XIX-inG~putul~ecoltllui., x, Desii?;ttr, prf!~dl~ile ale, .. ~cllndl)..~e ilP;eUa Ja?t~ p~llt?soclall ide 111ediu (ex. P1Jiltippe
constltuirH.fpql!:dea psil:wpatt1I0gi.el exisUit cu mult tin~p in' au 'J!Inf!lJ. :fac~2tJ, orgarJtct{Oues.toger, ;:raep~!itt)..~au psjJ1ologici
urma(pelttn.tdetalli yeti JlJ~laceanu-Stohlici.. l981). . . (~~m:r, Charcot. J~Iet, Ft~~~).Ej]()Ca. co11ren~po;"UIJ.i({sec.
, As tiel, ~ul!.roistonhfi Anticbltatc idenlificfuncloua cur:~ute ~~~Xr~~esle cadr:u~ 111 care .PSihovatologiaad~ve.nit 0 ~tiinta
Cllfe releva rolu). facturilor. psibologiciinpatolQ~ Primtd curent cfe.,~ll_e.stii.liioare~u J.mpact major la nivelsocia13i cu o.rieutliri
este tJjlul d.e i6cginle tnagicii iRcareJbolile eraq com:;~vute sa ~~retic7 dt~e~e pontre care cele.mai ll1JpOrtnntesllJ.ltorie.JJtarea
ftiud ex_presiafaptului cli bolnavul ~taposedat.I~ .un spirit. Dacii ~~oiuedtcala
r0 .ru1
~t cea psihosociaHL
. b . d . . . .
Ae;:sle~
. .
,tiltd iu ultiJtti . . "
. . . 1 .auJ sa
.., spiritll.l era.rau (c~kmai udes~aln cazul in careholnavl)l ave;~ ~- . eze .o. a o~ are mterncponista IJ.n~Ui pe mode1ul;stj"{'.s-
... . j elioJatrj~f d~~
..... c'l1.~.. d. . . . ... . ..
.,1 e nut Ht
cornp9t"la\-p.~nt~a1ltisocinl~ sattautl)puoitive) t'fl:nul.etllUlOOllS~ v.:.....J:,d.Jlerab.
J 11 - d Ii. a.cLorj.
Incluzau.
ilit.a.te . . t>
in eijnl.inilrea acestui spirit prin anumite ritua,luri r~J.i:gloa3~ (~ Cfp.tto u .' f~tortmcndru\clhoxafo.CtotitpsiltologiuuaceJa~i
exorc~z;area) sau anumite.rnijloncefi:zice.ouf\Uldnmentreligin~ ssntut ontologie ca ~i tei fizici. . . .. . . . . . ..
(treJ_>ana.tii). Dacli spitltul era bt1IJ(comportal1letW .~Q~JlDVUlut
nu era periculQS so.cialsau penlnJ.pt(lprl~pe~oa1)a), bi,Jllla era .3.4. Statutul mentalal pacicntului Pslbq~utologie
consider.ata sacrliiar bo l.navul enr col.Siderat t1l1.Jlll1t;t,liJ.trli.Jute . ~ . ... . . ...
religiQase(ex:. profet). Al doUeaeutent c6oc.!J!e<l boala.menta.lil J ~xaminan~ageuenua tt statullil~i.tneotnl se refetii Ia
cafiind determinntiide cauze naturale. Spre exempJu, HipocNit e~~runarea mod~lui in care PsihopaloJogia con~tieutiz.en 7;
definea epilepsia nu en o boaHi sacra cica o .boaUi. detenn.b]atclt ~tJ?ble~uele m:nttonatedeuoi pe parctusul acstei Iucrari.
d.e tulburari ale ~reierului. In aceasra p.erioada modelnt -~fieasy~ exanunaro treh eJ1icuta ra" .u lz~hulla u. :-loarele .
SUlJrm~aturala.fostdoti1ilmnl : 1 IULI.-eban:

186 JlJ7

' . . . . - ~ .. ... - . .' ....

-~'""''"'-""'-:........,_ _ ~:;..--~;,.o.."'""'.,.., .......
 .J

__ ;

-i
.........
..

ell eate nevoic.dc~1i~ir~lre11ltili.

funcJionarea sistcm11Jui. . .. . ! .. ..

,~/,-.;~~~R:~~: _:~:-~:-~i-t--4:;-Ji-3[~~~~:%; :i':~~~,-tj):_: %;+-:- _- _ _~- __ -, --~-.

t~tcl~dtagn~ticnl~l ~i. ~v~l~~~~li~~ .diJJic~ .

.. :;~JI!~tVt~~tulbiPsiloptdol~gi~ ,,.~,;tj~.; :;,ji

:~7~~~;l.:~er#~;.~~t;
pli~pirrc!li~i11 . . ' , . j,sr de:~ofinranduifcf'cu liierntt!f#l,.~l~
. spe~1~1.ita1te.~r' ~ifpsil;op~talo~c al Psibopatotogielh~te cei .. Cte~tetii DUmamJui de :;. [lt:l;J.iiJ(I~II;
prezentat maijos . o Dificulliiti 1n n oferl ttatarnenre.bine vn
ftiinti fie; .. ."... _.:.- .....
v.
189
 ~:Z.~
..
-~ ..

. :
, CAl1 1TOLU~~ 4
p -.-;bleme econou1ic~ . . CONCIWTIJALlZ~llEA TI\DLOUL'(J:( CLlNlC
.. 2~ins\1Ii~ientil,p~ntrU. "~ .acopei.~
ALPACmNTULUJ PstliOl'ATQLOGm
.. . .. ~versitu:teas~I.'Vjcillor oferite deps1bopa.tolegl,
1 te de medlulsod.al:
Prob1eme egn . . . . . . 1 -- SUA olung,a
.. l Con~epL"ttalizaren cliuic3{1tlc~~a sereliefeze mecanismele
- o ~ninare.Sp~~e~~tnpu,J~l. . . _. ..... . etiopntogenetice speci.fice ~i ~f!specifice..E:ate expUdt tnbloul
. _ad".a.u-'.e_._u:n.
-~ ltulburarile . ce_.nu._ _ir_n_ r_ost
P_.fl_lhi_
P.erm t - . ~- ea clinic a1 PsHtopal:rllogiei. Pentru .n siu.~plific~teX:lul, in cele-ce
'd at"' la nmitate. cu <::elesmnancelll ce umteaziivoi pt-ezeslt~opOf-f<epLUallzatf! cliniclgenet~!f-pentru
consl! el ..,.. .. 1:" d tal Abia. l'ecent
ce.priVe~te :Xt~:~~~~:r4~~~it~a Asociatiilo; intregul tabloulclinicJuat!Jll.lnsamblu ~i pr~~ntnt 1n capitolul
~~:::~~s:-11: rec;unbscut a<?eastlip~itnte;
3 .Conceptualiziirile sv~ifice nq fostpmzentaLe PriUctliscutiJJe
pti.vindcauzele ~i evotutiil,e pt~blerue.lor~peelfice pr~~n~tte in
-.omblem~~ucat!gm.dr ._. . . .... _.;n1.( ti c.apitolul3; el~vor fi d~t~a~e nichnnnal peuu;u diagnosticul ~i
-. ~ ~o c"~ urnc _ulltirta_
. . ~- dec_ v_a__Hi_c
. _ _ e_. r_,_ ntel_
.. .o_r_ .soo _ _t. e__ .. ve .
> tlimeleue t'lvaluarea cHuicij,.
comentarlil~l~On~tre.refertlonre~.apt()~_-.-
training). r b ....l~ ""'unc\ionarli. Ar...a5 4.1 . Me~istnele ctiopntugeuetice spe~ifi.Ce
r.: ~ l evaluan~a g;lo ...u u .._ .
Axa 5. Sexe~.era a _:...t l:obalii a nivelulul gene-
. .. ~ tiu a face o evru:uare g . r
este uttlit.ata pen . t1.llJ ' (' djceJ.e(iA:f'>.Evalu~ tretlUJe Mecmrlsmele etio a to enetice specifi $C refedi ta Ul<U
lnl de.funct}onare npaaen Ul: socinle evitlludu-sed.ifictillii\i ult~ cntego.rii cle factori... Alia CUlil am . t.nai Ptt;":teutat. pe
sa fie focaU'9.~ pe nspec:teld~ ~~ l~c:~icaie s~u )imitiiri ol(ntlediulul .Pl!rcursulacesteilucdin, factotli-cl~cbut1fatori se retc:rata.acei
d unor con t\1-t llle\ "' 0 . 100 u
cictori .care in mod dii~tproduc suupt01ll8(()10gia.~:ai suntfalori
. care se ato~enz.n Scorul este cuprios mtte -.~~ " ' ~-.
v

(ex. condlp.a econ?mtc:)~u atll.tfunc(ionnrea estemru bm~.a. ~ Hecesnri .dedan!liirii tabloului clinic, .~ar ades~~ 11\lz;i.mt ::l
ciltsco.ftll ~te l~n:uir 'ho atologi.apUl'esanibau~ mdi~~
unnare a e'Vn.luarn tacute~ pst p ~:. . ~nuna si\nptonte !ll sem\te
~-ilb.ci~n.\i. De.
asemeuea, .mai lrebuie sit <li(ereuth~trl f'l,ctorii
. ti" 55 A.ceast.'l. ms"-= . ~. . ~ o~lanl}alorlde~i detcnnitlrutti fctctoriide~rn,l.Untolj nu~acele0$i
GAF de aps:o11-una:_
~
.. . "'=""'cul.tat\ moderate 1n ce!'!~
detatii precutl:\ ~1 UJ.U! "'
~.~rnc\erisud.~~ei declrutQatorHlar eisunt ~p~c.l~ati de un.
de ioteos1tn.te mo \' a\a tnbloul ~liuic (ex. bac.iltill(ocb peutn.:t tuberculoza~ in thup ce
ce privel)te fuoc~ia socia\.alp ~Cllpa ton .
factodideclrull,latorinusuatspeciiicJ~gi:!UdetU].labJoul diuic
ex. stresul poate gener~ tulburari d~preslve ~a\1 amdonse).
Fnctor.i.i predispouuiti st1ntaceifaclQri~are au ~tl1 c~w~crer gen-
eral, apartin pacientului, au fostpre.zentiil~ainte de itistala.rea

.
r t~bnslalareatabloulul
U st _l0_\.lh~i c.li. m_ __cdue
_ -_fnvonzanp, ~.i-.e.are. pr. i_ n_ te
_Ja _....~a?lmtl
clune a fost
in. . r.a.c._till'.J.ne_.__._ caztll
cliluc. ?._-_. _o_-_r~i dec.. a.,_- _~....!!:.a~OJ~-i
a.ct.P-'stl~~g~t~logt~l:.
._c:._.__u._
declan~atns~ .n~~d~~azbume
._f
.. _-l
.

1 a.r ,actQiii ~nvorh.aup a.u fost retfrezenta\i~po~1l\)1litu~

JYI
190
 fo.:nrilor politicede a gasi solntii rapidela iucapaciratea sisten1ului
medical{factari predispozanti)de a fucefata noilor siCUfi{ii aduse
de ra~b<laie: Astfel. prezenta razboaielor a dua II'). aparitia unui
numnr mare de. pacienti suferind de.nevroza de rnzboi sau alte
tulbnran psihice asociate rhboiului. Deoa(ece in acel perioada
tmta1nenn11 pemttu ~lllb(n;arile psibice e1a. fliq,ut do a de . caue
medlcil pl!!ihiattii, ace!jtia s-au vaziJtcople~iri.denumih.-ul J\\nre
de bolnti\/i. iq pllts. un alt element pr~ispozantpentru in.stalare;l
tabloulni cllnic alPsihop"atolo~iei {>axe sii:fie continuarea nnor
trn!lipi depli~ite in prnetieii. in cerf:ZI:are fii i'n prpgromelc de
fonnare. La nivel guvernolnental.s-nu clututsQlu~~ laaceastit
prob~eJ(I.ll: Opropunere imediiuU a fost ca psi11~loglisn \)rmeze
nn training snplimep.tarpentnt a prelua 0 parterliii competentele
psihiatrilor._Ac~asta propnnere ufostacceprata nipid, argtimentul
plincipal fiind.. nccla ca psihologii au 0 preglltire ri~lronsi1 in
mf.todoJogiile de cercetnre ~tiinpfica -"'"" rrregiitire care.lipsea
metlic~ilor -fliplin urmare ei ar putea sli acopere deticltnl de
speeill~i~ti t?-domenhl.lfi. in plus. sitdea.o llOLlii f.qtii prncLicU 'in
psih()te-.:apie,. pdn promovaiea unor tratameote Vt1Hdate ii
sustin\ltC ~tiiiit1fic (Dawes, 1996).'74ceast8 decizie u dusla o
de:zvoltare.extrll()i"ilil)arlt a psilioi~giei i la diversificarea
serviciilor oferite de psibologi, dezvoltureneuntidpatii 'ti c~re
oaTecum i:a surp'rl11s ne[lregliti:t} pe llCe~tia.Spreexemplu,dadf
prinoJp!tJn :funcfie .~ psihQlogulJ,Ji clinician em tliagnostieul ?1inic,
.intlt ca acumfun~{iil~]ui er.m extiose .f!ltmgfindtHe hrpnritate
cu psibiatdi. A.rnbete gmpur1 dc~r.nofesioni~ti. psihoJogi ~i
psihiatri. au ca Iii competente:
;. Diagnostic ~i evaluare clioica;
loterven~e ~i tnitament;
.. Cercetare;
l3dncatie Qltiainingial dometiu .
ln Ump ee psihiatrii ~i-an pastrat compett?nta. de
ndministrare I! m~dicatlei (COfllpetenta carein~a 'in unele stnte
192
arru:ri(;a!)e este d~ja recrumscuHi ~r psihologilor) psihologii ~i
au pasttllt competen~ad~'D. utlliza instmttuenr.nrul ~i resb1rea
psillCJlogidL Aceasti d'e2.volta_re extraordinar-~- a psihopatologiei
ca unmtrc. I.Hlll&i nevoisociale de servicH despecia Htnre a dfis
Yasaune~tila~uncren serviei ilotuferite iflalnte datelor ti inti fice.
. r
Acest b.1cru s;-n ~xprbnn.t in modulmni l'lDtin perforn'lant' cia a j
face diagnostic, fratame~t ~i eercetare ~Hnlipsi~ preocup11ri1cir --J
I
pslhopatologicicle a-~ivnlida~tiintlfic prngrame le.de .fom1are. i
S~nrizfincJ (v~zi ~lPawes.,.1996), rfut.b~iele er!n 1
consecmrel~ lo.:negattv~ prlvind cretera:tb!umatuluide bolnavii
crue ne~e~itau tralll1llcnte ;peqtl')l. hJ]bnrfu:l. psihice (fa"Jt;;ri i
dool~ .~ro.d)au.'e:~sit Ul) S;isldm: n1elllienl"oornp]ar nepregiitiTCa
~ . e ro to .. odelede . . . tare IlL progran1~: _j
. de fumune(fn(}tori gredi~pQ~n. i . . erwe iunea acestor a~ tori:
: gc~t:,rat ~.de~v9~r~w J:!ruSeli.i ~replat~rmco og2ei 1
~n tunt'!i. ~u av~lat.lJ}~clar $thesunlqdoSo/1S~1lo aceJmra . _;;.
_!vt.:rns,Acea.stf1.d4!ZVQitare-1lf(lstftlvott.izatn(factorifavodz.nn{l)
;.~~1t;i:;::;:;~:~:~.~::~~!~~i~~D3~~;=~:
d~f~q~ ap rolpl dgasusuoe Slmptomatologia;aGest trol.
~ar.e. !l u~nl l~-J .roriLilecla .sa.ori . v:odzaa1ti;.sau:
pr...~ts . oz.~~~-om11au.. .. ....... tabloulc)inipc1ar i.4e:l!l{c . :ap ori
_cat.e -~" a?;Irut dneii g~~e:pt~~.,~abltll.ll~ll clinjc. :Qintre. actorii
de_meopner~.celmni \pmortantj . pe.lrtrntfi~l
Pstho n lo. . intil)l (v~zi pentru fletqlii Bet}Ller ~i M1lik.!
2002; Dawes. 1996): !
Ineqinumti siste.111 fnv~chjc dar bin~ organiz1t- '
Sisrem inflex.ibil ~i ID-eoi schimbare
~-;
m f
4 Unnumiir pr{tp mnr~ de pmfe_siQoisti 1~ domeniu ceea ce
sfimu1c,~za atinj~in~ ps~w!q~ti,izitifice;' 1
"fnctori socio--econon"\jcj; I
* ~.obby polHic. -
--_-s_~ exemplifica{n rolul fac~orilor d~ menrinere a
sunptomelor ~i sernneJor_legnte de modu I cum. se faee
193 !
 dhtgnosticul t gyaluEU"~a cliuidi in psi,hopalo1ogie _(pentnfUetalli
vezi B!:!gtt~~illiiMallJtj .1002)_ Numar~l m~de dh1;iul7s.tice
\
' t\OSoloSiGe:~fli.lit;u~tificare
:, '' _, -_
.',-_ .
t!JEtificli, a foste_?:.pl~catastf~l.: .
',' ' ' ' ' . ' ' ' - ' ''
: o r;:aie,gqJ.iaJJ05r:llogic.ii;u-e WI raJ ale;Jti
discoJifQltll/pxvfesiai)i~cufui. Gonfrunt(!t c 1. contppr
ie~ile din 5fur.a nonualidi.fii, profesionistul i~i ~a,ti~{<!Ge uevoia
de Pfedlc(i~ i conr.tcil pri~l. utiliznrea lUll){ nl.egot;ilp()sOlogice.
11. pl~s.incadrarea. problemeler pacienl~lui intr:o categoric
nosologicl\. ~Qget-eaza o schema de t"!~oment dattd coel-en\K
acUvlUitlpro{es.lonistuhtj. Adesen. c~.~S~~.deasig~idesunatnte
plii.tescttatatnentele daciele core~pund.dblgpo(lliculllistabilit,
aslfelcti_ptof~i91U.1tli ~pqt UlCUEajdp sl utlliz;~z;e llces.te.ca~egorii
no~ologice. Cu dl.t avemmai.n1lllte GUI1!gori1Itosologice ;\l alt\l
futtC?J~ :tj roTtliS~i~nlpsillopatologu1uisunt 111ai biuc servltc.
o Utilinres. tzQ.teg(}}riilor. ngs,oJogice oferrKc ..ideJJCitllte
proi-esio1J:Jil.. J)iagnos ti!cul acopera peste 50% <:Iintotal~t-alea:
ac.tivita{lloi:des.fil~u.ratede. psihopatologi (Humphreys, 1996), .
fiind m1a din atribu\.iile pfotOtip ale-aces tel pJ:Qf~ii, aliiLIJri de
cea de tratamentt Pqnb:u a-~i pastm ideulitu.tea profesi?nal~
ad~ea interesm devagseazli Of.ltele ~tii.l!\.ifi~ I..ilienfeld ~i colab.
(2003), tiu .adtta:t cum anutuite categorii ~iagnosUcepsihialrice
{e;i. ADHD,tuJ.bunuea. de personali.mre multipla tU!bttl"o/e de
itleittltatedisocialiva) del1i illca n~Jatifica.le "ljfam\itiguedinpunct
de vedere ~tiiu\ific, sunt~:lcomovatepepht\a ca certe :si inp1u.s.
se adtnit1istreaca1ttdtamentt:! pe baza lor. . tratamentul ntedicatueutos in cuz.ul ADHD.
oSii exnnlinfitn doar cazul AD.HD (Atlentiott-Oeficitl
I~yperactivity. Disorder;.Tulbtmtcea de deficit nte.ntional
~i hiperactivitate}. . Siinpt~mele acestei rulbtirMrf su.nt
defi.drulnterip6ilat(ex. Ueflcltin concentr,area ate_n~iei)
~i/sau hlperacli vilate"'-irnpul.sivilate. Tn\tumentul piiuci-
paleste eel medicaru.entos. cu Ritalin, spte exeroplu.
De ce este cont.roversat a.cest djagttosti~'/ Unii ~ulori
~(irlnft di acest diagnostic esle Uhlll polilic care pjllta
sa {aceru fa\a cOtJiilor nenscu1!~torj. Diaguostica{i
psUJiatric ~i pu~j sub Ine<;licatie. ace~ti ~opii" deviu mai
'. ......,_,
coutrolabifi, ceea ce este in inleresul pfuintilor ~i al .
peatru educatotilormt atat al c::opiijor.-1,\utpdiilii ba~eaza asl.fel
.uente de ufimla,ti.i pe lip.sa uttor me~~UlisJ.ue etio1mlogeue1 ice
clw:e{biok-.gice.saupsihulogit;e)~u.J,rU.aceastii rulbufare.
Altf-elspus; pel;mza uttor c.:)"iteril sod ale se instituie un
diagnostic ntedicaL p~fu;indnc~stgeJlde crllici leorefice
(care se pQtrivesc 1\lai multo.r eu:tegorii uosologice
psHliatrir;e ..,. Itiud vorba d~ ~opii ci1rora Ii se admini-
:treFt2:ii psibotrvpe cufect!Hiecundare ~i ell potential
ri8C pentrude~Oltar~ .lorpsib!Jbiologjcii, eJc SUnt ntai
indircaleemo\iolial"incozul.A.DHD) voi men\ionadouu
(;'ril.icib.ine validate ~ti.ioti.fic.
Studiile recent.e ara\.'t cl exism o tendinta de .
ndmin~strare e~cesiva de ntedicatie penlru
ADHD. Un,s.tudiu .recent at lui LeFever (1999)
. a aratat di procenb.tl tc:a.tamenlului uti lim~ penlm
AOliDa uepa~itdetrei Ofi prevalenta estbnat!i
a aces.tei tulburati; acest lucru ue ruttiitt~te de
criticii ~.aCinna ca-acest trotament este utilizat
penLrucpnfcirtul educatorilor ,i.afpfuintilor. nu
Jlelltru oopU. .
Exista o foculizttre ex.Gesiva :ti nejusLificnUi 11e
igo.orti.ndii-seinlervon~.ile psihoterapeuli~. E:;te
ade~iirnt cq:. studiulJiUJJic randomiznt '"NI1-JM.
CollaborativeMultisite.M~~nl.odulTreabueut
Study of Cbildten Wilb.Attentiun:-DefficlhHy-
petictivily Disorder" (lVl,-A) (MTI\.cpopera-
tive group, 1999;_ l999a.) l~ o itite.r;preJr,lre
cantitati.va sugereaza cii rel.mni. efici~~~f~lf'lllent
ne, -. '" "'<:~'- . .... -
este eel medica.meutos {a.u fostc.oihp~tfitep~ln.t
..-~ .:.- .. -~-
195
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 . psiltotttrapie). ea are. conse~in~e {l9z.ilive pentruneeta care au
avut de s.ufedtdin cmJm.E

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(l1~~!~J;;ii~,~~~~l,~~DR~)~{lat''~ni~;'?ifs~a,!~~nfat:u1\~p'(je'}'~','
s,~t;;rmmi:~P.syd\l~lagism~~l'l~tittt'l1sibolti'giil\eilel1den\i ~l.e 1 ''~
nl~onlJ\~;;':'.H:i:~:;;;; . .,. <;,,:::,. ;,;t:,+;):~

tekl~~,~~~~~~~~~
freev'"*~! itt

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 di lm;~t!t:!Je,sunt cop1plet d.ifedte :;i anaJogia nu sejttstifidL Omo~llll\ele psibep~tologilor suntiluz.ij carefunc\ioueaz.tt
FaclfJrii;~9P~~ogeneticiimplit~{i in tulburaHle psi.fii~-ii1clud o petltrtt pacien\l pri.n efectl(l pla,cebo. in cons~~iuta, ele pot
das~~}~~?PE~'a~~}ii d~ fac~url psibolOJ!iici.poL~upal.~ont!~hibULlh ameliora sufer.inta uuui paci.ent dar lUI a ceJuj c~e ~tie di i!}i
tin~p ~e {Jtiten1 con tro1a tn~i greu facforii- gel\~lici ~i bi\)l~gici, administreaza un.tiutamellt placebol . -
~actq~ii psil1o!~gi preEtinJ; ruotlulin ~~-gftndim,ue.e~l)1portant ~din acestedouaexplicatii.estetttaiptobabil~'/.J?.rima
sa
elc. Stlllt pCJtent1al eonlr~IabiU. Este ci\ldat 8J?UipacieutiJ!~j: explicatie, pare sa ai_b~ 0 pbtuzibititale nuu lllare,potd:vindleoriile
~an- yt:i nj~ta sa i~i~~olve problemete ei.n.otioullle l~vatiludu"-1 asupr~ distiuctiei diutce experU. l$i R\lVlCi! se poi di tn
~tln.:t ~~ i~i COil;f:n?lez.e Gqtuportatt'~ntcl~ 'i co~.Jiile, dst tu, en psilJOpntologie di.mfin~Jll,Ui!ile "'-v,e.-;t\ic ll(lv.ici" pqrl~nd baht~
psibopatolq~. conlitmisa sqferi eU1ofkmoll Este ciudats~promi\i cu. J.narca de ''atJaretti e:llpbr\i,". Tolu~i, dac.ii 11e BJJliUL-im dl,.
(l]toraFa iiveUuva.t{l siill.lefilQr~ntaibin~~ siiiacore~tdecizii, cunq~till~~~~ doba~dite prin prnctlca cll\1i(;i\ nu. ne fa~ mai buill
s.a.l!il coJit,rolez~ emotiile~_. sli.inve\e {l~niorepede, (}ar.tu nu inp~c:lictiile; :jill~tiunelJtel~.pe carel~ndt:Qinis;l;l:Wb, n.tu11cf~j tt
llltmure;I ~au tuve~i'mrubinecaEll\il. nuiei deciziimr.U b.IJI.lelli doul! explicaUe. ponte. acuperi o par,Le .dht adevnF; cerceUU-Ue
nu ~~li'mni stabit ~UIO\i~mal. Este ciudnt sa spuidi poti 5a-i iiJve{i viito.are vo~: trat~~a pwl,Jnl:tlllntte. ace.qteexpljcatii p1'0puse a ici.
pe .ttl~~i CU1l:\ Sa, iqi tdiiasca Cfi.(:i'entvi~fa .,iCtlUl Sa fie;:; fedci\i ' Sigur~ d,isc\lt{b.td aceste e~plicatiiam ex:clus posilJilib.d:en, en
~find lu nu ~ti Psihopatnlogii suntmaSl1cbi:Jti -de~i i.l inva(ii pe alpi;Sn fie. fe.rici(.i
' . . .
cnpabil
. .. ..
s!i obt.U. ac;csteJucnu-H
.. . .. .
t:V~pHdi aceasta sitl.)ape dincqlo de- .fnptul ca prafesj~ de
' . '
fn. . plu3
. .
.cuut se
lor le place sa ~uferet
psiqQpatol~g. esle cuu.n grndlid,ic~tde. ~olicilare is~ (Guy. . 1\_.doml. categoric qe mecanisme eti~patog~neli~e
1981):;i in c1udafflptulul cit 70%.dintre psihop;_tlologl pa~urg uespeciflcesereferalareactiilemediuluisocia.t.Se parecaitt
Ull modul d~ te~apie petsonnlii en pbtt~a Jraiuiug~tdui Lor in ceeai~e priv~te ~aztil psiboputologiei .eJdstlio oficlaJi-,o.re
p~ihqt~ra1>ie (Guy. 1987)7 Ejtistlt.do\Ja expllca{ii po;U)Ue: iustilu\ionanl a tablgului clinic. ij&nc{iile mediului sociJJ.l ~d11
Psihopatologii-;>tiu cum ar t,rebuiaU.~e cQnJ,potte~ll\ru .a ~ileasupraPsibopntolo.ldeicnsistem (ex.Sza.9Z,tf16.7),prln
n ferici\i "iipenln! a evitf!b.Jlburlidlb . sib1ce ~\tcoJ:ll}]~~~tu} iti'
cw a ~itua\:i ilpr stresanJe,. d.ar acesle cuuo~tinte rlinliiii-;b,.ui've!-.
-d-eclar,nuv r;r.o.u s-.e roceduralizeaza.. llU ~e .ex. .rimaJn
I ~lu~a
me

-~
peJltru. tcataute.l'JLeeficicnte gi di1Jgrwst(cer dt;urouse,
---- ensiune asuprn PsjlJpp,atQlogiei, cnl'e'ponlc

~-D .. .. Ji.mliiu .e.rftip;umta'lPeutnr ase

expri.IJl.a in erfoilllktl a cuno e .e..(le;c a nti-..e trebuie 4.3. Fnclori de pl'otee\ie fji rerlsleli\n
prgc:e uraUznte pdn.pra~ticri asvpr:nt!ropriei. persomi:c:;,-~n ce
d uce,Ja t;On te1tb..1nlizaren lor si Ia utiljr.nreJJ.lor aU:lon\a~n .itt di- ln ciuda tabJoului'cJinic prezentat exista e serie d~.faclllri
v~esituati.isl:resante (Auderitm, 1990)-Pin pacnte, pdnlrnin- de protec~stenta care Hn.utenz.ndez~~taQlou!vi
iug-t.d .lor !ji prln aa.tivitnten. profesiona\ii, psihoplltologii clinic ~i care constituie pt-erecbi'citel.e pentt'U.\ltltrataruenteficleul.
prm:eduralizeaza cuno~tin~le lor dedarative in primulrfutd
~Ull.lpra,pacien\ilor.1lu asupra pro[lriei persoane-

21D :-'"
102
 :.-:.

4~$J: ,lfn~'eltll rillltrti til.ctttnicitiitiliJ intelettJ~ale . .

ale ;p$lllepat6IriftifuY. ~ . .,. :: .. ?. : '"'' .. .'. . .-. ' , .. ... ; .
-- ~ 'ledes. ~ii- . . ~cJ.u'ac1~r.J9~~}pua~a[ar
cl\pro1 .. . 1~t~ibfi: .... :~r.. to ~rsil!Jtdintr~el~x~~. ,
fill s~e~tir . . .... r(~!: f~S'{s ............ ~~;tgfa~~~r~'t,~~f:Li. .
..
cxanulltaOOrr);'fli G:AR.'(gmde.;pCliqt nV>etii:,Se$r~~~~JC. Pi?~lfl'

~m1$t-~
.int~ll&~ta~li~rtif~~~1\ilor RiWittesr doihe.~ia (~~ltrYn\i'.'~U:;
Wi~ooQsin Jt~nd4lefsea} este.C~i'mni'rl\lnrtti"cbliitfAriitie'2

:~~~~;;~
20~?-)~.~i:gutti:t~a~'llcesre~st11diitre1lt1iev~uta'cttli1\~rretaior
(ex. marimea-~i repreunr~tivltnteli ~antiqanelbt;f61d~ite1 ~i.

.<
. tttf:
..;; ... ?f,, .Jt!f:t'~:;;~~~llt~
~ ~a1ri,le.ripnilbmkpii(tcriticfnd01nenin~ urmlfrind nn
fd~ol poppcrinn, fli ftnume ca Cfetl mni bunli calc de 8 te apropia
de adeviireste critica pcrmal}entli pe care o faci propriilor
constructii. este op(erechizi.tli sanatoasa a domeniului. A~a cum
2M
 . -~
n.ite. Varhmtele alterualive_ BSM-ului sunt (J) o tlasi.ficare
calegetictUi desmiptivu p~ baza d~-pmtotii1nu-pe baza ~~~-sdterii;
{2) 0 c!l!~j;~s~:e etiopatogenetica a l\l]bu.t:arilol'p~ihic~~n~ ~una
dt~script-{ynf:,t3) oclasificareditn~llsio_naUi a~tulb~tiirilQr.psiliice. .
n~t uu~ _P~tt:&oriaHi ~1 (4' un diagnostic focalizat pe shifptom. Sa
le nnaU'z;amsuccintin continuru:e~ t cste um.il categodal. Uu diagnostic psi11ologi.c altertlatbi"s-ar
. :1 jJ}id.giiastic ca.CegOJial~baia." unoraifelii ~~usptoco@
1
(p,en~ude~'llii vezi.,I.iUeiJfeld ~i Matilu1.1985; 'Y~len~i.~htl,l.,
2Q02)_. .Diaglxosticul DSM-este until Cil;tegprinf, ca~~#?~J"iile {lind
in5tltuite pe bazn tin~r cri ierii c!lare. U!l"CU dev!11_e ntembm al
ca(egoriei pfirl'Compdr~tie cu crlterlila care d~fiuesc r!ategoria.
CercG!1idle diu. J?Sillologia cogi1itiva atntil iltsa ca. noi rw:eod
clas~c.8Julucntdlep~ bata_u~orctite~ (Roscb; 19'13). Sist~u1ul
co~tutrv. uman claslficit.}uCI}l.J:il&::. gr~p?nd.erent pe b(tzii de
. )n;>tC>tjp:Termer.iul deprototl.paredouaiutelesud.l)uul.diu tHe
~ ~ ~~~tll,Oltl~l\l?~~tcatlt iAsumeaz~ca~nteristi~~malumHm
.. se.J:efer~ In l1n i!xeniplar~p,iot t)e:~~b.lt :s~ 1'e~Iaun e;temp1ftr
ideal.
.. . .
. mbn N categof!%!. A~adar. ~tuuc1 dud elasifidim Uil-oblect
intr-O f;Ule~crie,nu il.(;OlUJ?llrlilll~CU ,carac~eristi~~enfinle lllE!
categoriri ~~petive, ci C\1 \lll ~Jlemplru: prototip.. P~utru a
efittioutiz.adasill~apsilliJ~IJic8..~i 9ofaceeco~cg,c;a, lJ-a sugerut
utl(i~a~(;ltt pr~tottpv.Iui:pent):u DSM. .Ptopuner.i.cptlctetc.peutru
l\ll ~iagr}gstic .nosplb~Vc p~jhiatri~ p~.IJazitdeprotOtip. s-au-l1tcut
(pe\ltJ;U detE,\lii $i. e;emple vezi "'f"es;ten 11i c~lab., 200~). ele
urmntld a .li investigs.~e ~ub. a5pecl\,Jl validitii\H.lor iu_studii
villoare.
\ ~.f;lagJJosiic-n.o~c)logicetiopatQgenetie.(a fostdi!Jcutatde
noi}llllerjor, pe p~u~"SUJ.acestellucmri,6.1.1.3.; veziKi:liliiJ:rorn,
20~):& p~ntJ:t.' detalii). ' saniit~te. a dus la apari\1a .unor tni!Jcnri dept:umovat~ a '$fjmlel111
I)iagJJoatic dimensional. Confunn. acestui Jtiodel
1
:
clasifi~adle . tt,tlb!ldidlpr psihicear trebui f.iicute tii~te
dimensiutii care saexp~:inte trec;erea trept.aHidela nortn:.tli~tt~ !a
patplo.gie,la till p:rag delerminatotatistic. s--a uu~erclttp.nlpuherea
i
. 106
unor.astfel de dime1uiittui(vezi pentm detalii Joiner ~i Schmidt.,
2002) dar cum lista lor uu a fostdar cmweriitu indi.nu !:Hl
generaUzat&c~st~isl:t!J1ldeclasiEic~fe:., _-
.. [Jiagnostip carcgarjal YeJ."Stls disgJ.lasiia.foeaJJzat pe
sii1Jpcom(penlril detalirve~iP~rsot1S,.19a6). Diagnostlc;ullJSM
focaliza p~ fqnct,iil6 . psihologice afectat.in divers'? tulburnrl
psihic~. fun~\iic;}fenpatirxtnai t'IJttlt~ categ9riiJ}osologice~ Spre
~~:l~;~~~~=~;~~~~:r~~~!~"t:::~:I!r:!~~:~~-c~:::.::~
abor(\oiC? ar put~.a duce .la cln.d.fi~~-ren m~anjs.mhlor: cure
ge-11ereazli aceslesimptome.speci.~r;e, PP1l~chule~inc~r.cetare
n unor pacieuti cu . shnptomeumogeue;- yol ~v.eoi cu delalii
asupram::estei orieutl\ri tu sectiunen deh:atatnent.
Cure!JtulpenirvutiJjPi8J_-ea ll"llt8JJ1enll)Jor6tr~fin.IJ.le ;;fiin(ific.
Asoci11\ia Psibologilor Autericaui pr~ Divirl<.}.P .~ pt;qpus o
IU!!todologie prlo care sa fie promovnte b.l;ltflU11l:l1t~le.sustijutle
=ililn\ific (peutro delalil vezinnexu J li.i <lis~a\HlediJt3.2,.).
4.3.3. Presiunea cqselot de asiyu,,-ari ~ $iJ.r',iJJate
~g~m medicinl!F val.idatif ftii:tJfifM: . _: . .
. Ca urm~? a bugetelor retluse, cascle de nsi~l\tnrl de
snnatale a"oinceptllsa pJ:OJllOVJ:~e 0 politicli UttdlpdllC8fl:! S~Ul\
sl.ls\inute fi.n~cif\f donr.acele servicildesi\ri.Mate (l~e suut-vnli-
d~t~ :Jtiintific.. J\ce!;te t::ollstrttnge.ri au luat prin :;urpriridete
siste.mul de siiiJijtateobi!ibuil:;~fi~sustinut-ftn~~!nr {itin sit~J?lU
faptdiscopulsau-.etteunu1 t,tmanis~ -arilelionu;eu.sufe~i~l\t'ti lll
promovarea ~~atlitii. Aceitstapolitica a c~sel~ d,~ nsig~-~1\ri_ t~c
dmn,~niqlpsilJQpatologiel prin aparitia mediciJ1ei validatil ~tlin\ific
pe (evidence..based mediciuei EBiv1) ~i psihoter1\piei.v~H({~ile
:;tlin\ific (evidence--based psychothern_py EBP). EBM (~ackctl
~i t:olab., l996)nu esle 0 \dec noull Qriginile ei nloso~t;:e pol n
 \I
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.s:au efectuaunai routrell1amowam~"'"'r'""*'i

209

..-.
_ --..
 identiGcat mai mull-e tumori belli ne. Autodi slt~diului au
- surrerat
? .. -
~ '. -~ - ' b
:a a~~- ~n .. s.~_recomandaaceasHitelmi~ih_pacie.oUi tre!@e
'~~=reitq,~. n~est.rJcrnv~
_asociat :cr-~toaH) :lara ~aei1:~sta-sti ~(:!ada -m,ort.aljtalta PWl~i-
cer desntl. _, _-: ~,. . ... . ..... . .. .. . ........ ~ Tahelul3ieda astfel de eslimllri peltlnt uneJe cfltegoriimedicale.
i La i1hreluf sim\itlUi comun t;i chiru: de catre unii.medi~i se
iucufajenza rep~osui:l~ pat in cazul dure.di aellledg sputf; R~j;ulv
tecel~f.. uu~tuc{jui .Glimc coutrolat (.lviahni:vaatll~ colab~ ..1995)
~ co~~&r~t ra?'e.nfll.cu astf~ld~ a~ecfluuedi~l:ribtJi!,i.,raqf.J~miUlt
m t1-e1 ~upurr (l) ~Pirl~ care $nb~a ftl rep~ps lil pat}~(2)
grupu} ~llCl,lnya~ safa~a-~~~area ?bl~llult~Lpeparcursul zil~l=ij
(3) gl}1_pulyilre~cea ~~~E(!Itti speetfk:ede rootiilimreaspQteJuj,
-- Rezultntele pubbcate m New ltlngl-ar-tt:l Journal-ofMedicine au
:_u-rtta~ ~a ~~l~u~~i ~u11e rezui~te~~au;ubtilluUt1 c~tiJ gn:prllui
mcunynt_s~.faca.UlJ~careac:Jb.t~ntutll_p~pa~ursul iileHJt::Cbiul,
sfatr?ed~cal ~ii.lo tuipia 1e siuJt.Pomum dat;a te doorespa(ele
aLuuc~o_oclJhn~n:~t~~j rlimft.i o vrerneillrepaos-J.a pnr, iata di:s-a
dovedu;ce~ putm m acest caz, un nut! : ,.
. J?aca)uam lit cal cui ~r estJJ.narile recente(1999Ji-Jire
Insututult1fdeMediein~i"a11\eadei~IieiNafiouaiede~t,jj 11 fe.din
SUA (N~ti~1al Ac:deuw of Soiences"lustitJ.Ite o~fllle<ficil~e).
~nrenram .ca rutualHI SUA mor panala- 98apo tle ()aQJ.enidiu
ca uz:'l e:?J:il?r 1~1edicale, re<iL~n c~ meill.cinn 1'oljdaqt ~tii1 1~fflc
estemca un 9ez.tderatnu.tJ.realil<l.te.IJltr.:;a(levt. ~ti.rnmilefiicute
Ju auU: 7ol?; '8(~d= ditre US Congress O~ce ofTecbllology
Ass~s-.nentarata ca doar aproXinmtiv 1tJ---20% din procedurile
m~rcale ~u.nt validate llillnlffic.. Acetista. inseanma ca nu :Jtlin
daca 89% ?m lratrunentele pe.care le prlrueautlnaceianl erau
sunt sa~ nu ~tiinlifice, ~taiprcjs 5pus~ dacii ernueficiente snu
u~t: Dcura Iua!-u ~'~ calcul!.i validarea motlelelorteoretice baza .
cmo:a_s: adt~lllll~tre~za_tratameutele ca-un ~;;;riteriu pentru 0
me(hCHla valtdata ~llin\llic, atunci prebabiJ di proceJltul de
~
10-20% esle si_ ma.i mid Stau astazi lucrurile altfel? Se pafecit.
Iucruiile s-nu lnllmnatli\it. darnu fmirt~ mult. Estbnarile recegte
arnti\'un procent u~or peste ZOo/~ de procedud Y~lldale lil.lJ\ifi!?
'(ifr;totalitatea procedurilor me9jcale-fo1osife~ Sigu~. dig~'lle
protente sunHHferil~ in func~e c:le domeniul.tnedical specific..
Clns.illciirileimi in cnlcul valldarea paah~~:tnluid~iuterventu .(nu
uenparat ~ja teo.riilotiJ ~j se tef~fli la. u~~toarele f;{lt~gQril ale
v~Udam =;wn\ifice:.(l) Tntl~leiltel~ sunt v~i~pte ~.Uinlific ...._
ex.istii stutliic:Huice control(\\e care ar~li cli pmcedudle te:;pec~
tive sunt.mai eficiente decat tratamente anlel'ioar:~ gnJ.p pla~
cet~o sao de control; (2) Tr~tamenle cvasi'1tiin\ifl9e-lt\l exj.sH\
stuilii cllnlce coutrolate, dw: praclica cliuicii (ex... annlb:.ade"caz)"
~i constnsul profesiooi~tilor sugerea~ cllac~te f.rma.ult~J.d,e l'a.l"
sa fie eficlenle ~i (3) TralRIDP.Dte pseudo~Jtiintifi~c .- Ull ~Ulll
sus~inule de studii clinice controlate, procticn clitlicli suu
consensut profesioiu:Jtilor:Jifsau uueuri acestea chi~lrlc-nttiln'_PiidaL
Amintitidu-'ne limilele aceslor studii, Jimite c~detiva diu
in.s~i limite]e n1etodei liin\ifice (ex. ~ant.lonrifei(~ difictiltltUe
de genenuiza.re a re:z;ultatelor),-ribuilue impresit;rnant fapHtl ca
uu numilr ex.tremde mic de lratamente mectical.e surn l.lioe )Inti...
dl\le lllllll\tfic. in cnzul psihjntriei, mai apronpe; d~ demc;:r8ul
ncistru, auallzfind tabelpl3 cerceUtrilo uraUica.:J~.fii.dil"P:tt(lcLul
de- vedere R1 validadi ~tiin~ificp stit nai bioe -en alte dQt1le:Uii
medicale (ex. chiru1-g!.~) procentul de tmlluncmte vulidate !itUll\ific
esLetotul?ise04Ut lufiudin t:alcul:
o stundardele.domeniului;
0 discursulin domeuiu.:..plufesioni:itii argumententil
$i prez.i.a1ta iulucrari de specialitnte di Lratumentele oferit~suut
validate ~iliiutific;
.pe o credin(ele pacientiloqi in general rcytepl!i.rile omuJui de
sirn\ comtW de la medicina.
--:::::-.-:=._; 2U
.... ~
 _j
Tonte dilte1e prezenmte anteri C . a fllndnmei\tatinre~.-.-ventia ml.a fostiuvestigarn scparat5ntdeget11
reznllatele din anii "]0--'BO . _ _or _m ta~eltJl 3) confirma
Dr. Robert Cnliff, DirectoT" la Duk~ U ni~ .
A. n'lt. ~ d - ~ ar.tta ca .progresul 6Se infi01
d. . astfelcii declara-patui ._J.
.t ~ d~augand faptnl ca adesearearia care
" zan aceste . ates A
versity Clinical R~searehlnstitute1urevistaTitv1E 1a datn de 12
OcronlbriliJ 1998 ~i .anunu~~ eli doar aprox.imi\tiv 15% di':l
TiabeluiJ.l"rocentnltipnrfl
medlcnlfi (!lin SUA "f r.-.. . )
1 . .
or f e trataJUente niUizate in lu-a~::ticn servicille ofe.ritr. de medici snnt validate ~tiintific, este en.1nsa~ .,__t,
v a!dll"opa
bine vatidarll. ~rlin{ific.
OotllBlrlpl-fi T:nttatnen~e Trntmnan1a Tm1.nmeufe Desiguf, d~i focali'LIDtea absesiva tr-Gbuie-sa fie p~ validm-ea
lrtu~_lllla:peba:zo ~duta A'!JSiftlll1- P:VBlldo~tUu- fitiinpficli a. tJ:atamentelor utruzate;tn:;buie-s.n fim .1-eali~ti: pacien{ii
cnroras'-au fliintifu: fke 1-ifim . au nevoie de !\.iutor; ei. nu pat rustepta:un studiu clinic controlat
_
fon~"lulaL ac::esta
pnicaut.e - penttU. a primi un tra.trunent caie sli le-amelioreze RLlferi~l1!L P.e ..
de nl~a parte,; ea profesiomqti,nu putem si le oferlni oricel
Psibiakle
fl\JllUU6(S
(1299) .
9i: colab.
.
. 53%
. . IQ%. 37% -
:~dil<, ""':"reo< trebniermotUn alegeron_!!l)tanentulul_
Mlldicln& gooer&ID. 38% 4% I .5~&
_entrll un _!ll:;lent :anume .de_.dltvR no profe~ I
I

SI.lUQpV acola. f'l . l'omoveaza l!tiinta in Il!ili.opatGlogie es~: . . .

colr.D.c.lOOtr\ . Trntnntente validate ~tiinp:fic atilt snb nspectnl eficiet1~ei ..
ModicinUrt9ma 500:,o 34% 12%
.. /

1-l mditl.-Job.onu~ Ji cat .!;i sub-nspec:tu1validitatii tooriei; dnci1 ele nu existli.

coJi!b. Cli)()(J)* ). __. atunci se utili2earta~ .
'CJiliuigl~ gwrtat& . f:J% 64%
. X!'J.t Trataln_ente validate ~tiintific sub llspect:nl eficientei;
Lee pl-col6b.2olim
Cqntn da k~tam6 n! .t duc.li ele, nu exista, atunci se- u ili:zeaza:
Triltamente consid~r-ate ei:iciente prin coilse~sul
249(. 21% JS%
eat_cancendai.(SUA)
BjUibe~Jc ti
~ole~).~~ ?99) .
. s~ialiljtiim; dncl elc nu e;JC.istn .att.))iCi se utilizeuzii:
Chhurgi11_'VUCllllit! Tratamente cBratle~i nu au fast investigate .!jtiintific
How..., gi col~.
14% . 11% j%
deriva diutr-() teorie testaftl .!ii validarlr~ele tlebuie sii aiba
(l~~ .. . ncordul gmpului p1ofesional ile apartenen\li. sit fta
. Detlllfl_l'ologic 38% 31% 23% potential utile ~j nepericul0all&. Dnci\ acestea nu existii,
Iomcc .fi cula.b
..(_15198)'
.. anmci se "Qtil'iz.eaza interventii derivate adhoc' din
ChimrEie pedifd:tica 11% f 66% 23% pr.eglitire!\ profesionnlli (tooreticJi. 'li p~nctidi) '~i pe cm:e
Kcnny~i coiflh.
(1991)
acordu1 celorialti colegi lejustifica in cazul cl~t cn:fiind
Aneslo~ia 32%. 64.7% 3.3%
~potential utile ~i nepericuloase. I
l'oillrlr:ii pi cnlab~
(llil99) . .
*.;1%- l~pectly 7% reprezinlM dificul ~f d
.
''
hntamentelorYncntegntiilestabilire. ffi.l. e dnstficnre n
212 213
-~
 .Loa diudul ei psibiatria Lrebui.; su!.i reconsidere po-z:i.ti~
serlo:~.lnlc~ socii!taleluodernam~~dldca scus socictntU
.....preot'"I.Ji.;wlatliJfit~~t!jn\~di~t!rl~~~~-!~~~~t-~iJ

ECGI~~
Uil R~Qf,.~i~in~!JU l~l~,ap~~II.... . l"J~~~~jJJiatri!l~~U;,'
tnwtapJtielpsibi!ltrtipr. f.le~cu. 8$~4~pm~pr~,fesit>JJti'Jti
in servl~ ~~~anitate ~lfi sliull~~ Jltenfl.illl)~~P~'lil\lgi{It-,4!~1
inclu~1psn1' ' ... ;,tinmltierreterL.! us~~~~ii$~~ilib.r~tU~tt
uu rol tot . al!Jittifittnt11tiif~ste, ~~lllit~~hO:'urmnre a
nparitiei coselord~il$igu.:~l;~s~~taie.::.~ie;indome~tiu
11u :~lt\l ~~~\lo~(npanaJulf:llt.~:icil6tr f::~:"#rl~llii:;~,p~ill)e
uniww~i.tafe sp~Ct? i:~~!p,t.~ga~ ~~teli;filitlo~~liWil
s1il1illii\ii.Acesteschil~il\i!~~irt'~1~~~L. . ~~
si\QiiW~im~i~JliQ'~orG(jntt;ib~~~tUJieativ~
~iJ~pfttelqgiei;.,mn~:Mtfet;~~~'litlll{! e
nu~}!~"'P"'tea i1}ttor;a .lllh;infi:~~p~~i~~~,eet,~~t;oo~
l\e~,~ljlJj~tlsU~f3t..i~~~lQ~d~eQI~"':~uiCicu~;,'
~~~;~;~~;~:=:==~ti=:t::~~93il~~jv''Sa~,~
j~!ij~J~~ij~l'J~i~~ilotll~,~~~i"
llOtltic ~i't~Oc iar Sttti pre}liUUel\f cei: . ',.
u~
Ll@ t,.;.'
.. .'tems ..:.~ .
i'p~ ..,.,. ,~~~1:11!; pa'tl ~
!'\)~g
l a ..
.
v~aJ~~~~JP~ij .. .; ... . ......... . ! ~~;W~~{i\j'
gt~~~~,!l).~~~i~~!:i...liit~t~,,cpliB~fl~~~~;;mill~llle",!
d~~~~~~~9~ifl~'ltti'.d.,~tJl~l~*'JJ.t~~i$lt:llf~de..'(~e~,
<- ,,: ' " .. , - i '- - _,,

,.f ---~

:.....-
 . . CA~lTOLlJL5 .
Tn.A.TA.MRN1'bL PACUlNTIJLlJI PsiHO~aro~oGm
. '
Modalitli{il~de at'lle}iorart5 a probleme1or se1i1nalnte tn i
'
...J.
cail11 Psihopatolsgiei.~orfirezerit11e in c01ninuare U1111ii~~
categoriile lorinlpOrti\n _: ) Ungnos~c ;i evnb1~re _clinica~. -.
interventie Jii trata.llli!n ((3) ercetare !i~ucap.e ~ltr."ltamanL j,
Urmoiizlica d-.mpui sli arnr.c eftcient~ lor 'in aa~ulin c~re vor-fi
implemoma~c-coract qi mo~ul in care vu evolna'P.sihoparologill. .- '

5.1. Tratamentnl.penau _pr.oblemole modtlitatilor

den face diagnbstie. !Ji.e-\'aluare elinidi. , . '
in:.diutarea sffiutului GFanl ,_._J .
Problemele djngnosticului (ll elnlnnrH clinice.menponato
'in tablqul clinical Psibopntologiei potfi n.me orate sau vindecate i'
utilizlln urmlitoarele a .. de trata t J
"' .Pezyllitiin#l unui .diagnostic tbcaliznt pe mcca.oisnJ(}
@opatb.ilBntU./P{:)(pentru d;etalii vezi l{ihlsrrotn. 2002) ..
'. Modaljt:aten de diagnostic al bolilorsomatice este strftns legatii- ~-. .
. de.. h:lentificnrea ntecanismelor etiop&toge-necice i1nplica.te in
rabloul clin\c. Diagnosticul nllburiirilckpsihiee este in,~~ un di
.. _,

\
','~ ' ~
..agnostic foealizat P': .sintprome ~.i semne. elementelepr~ale
fiirld identific:area. lar npoi clasi'ticarea lor entru a genera di~
I versecaregorii noso o ce.
.L
:.J
~ 'tiJ;(lUlll!JI.li diagn~scip.sillologlc_pcnl.Iu to,lburJi.dfi)
psibice (perftru detalil ve:ti Persons. 19B7). Diagnosticul
Cfltegotial poate duce adesea Ia situ atii nedodte: A~tfel. categoriile
nosologice se pot :referi la p:acfenft c~ un triblou clinic par(i!ll
. I
diferlt; aceasfa deoarece ndesea pentru a potrivi o anumWi
categorie nosologicli.. pacientii l.rebuie sll prezinre un -numlit de
shnptpme dintr-o ljsjl1 mni 1tmgU. Acel numllrpoate include fnsli
t;imLltome diferite din lista dat~. Alia cum nm mai afirmat. on ..
diagnostic psibo1ogi.cs-arfocaliza pe acele func{ii psiJlologice ;...;
nfcctate. care apart~ mai multe categorii nesolog(c~. Spre
216

co.mun, intcgr~tiv, .Bclectismultemeticpce:mpune ulilizaiea.wlor .
leurii {t1ferite ~~,!!pra aceluiafli fen omen ceea ce adesea d~~la
con tradic~~-Jife[opriul disGum ~i ilt consec.iillii!rsbt,lie ,~yliat; ..
llU.a\~l.J.lUlf!llfOfOsi .~i. teor[i,~jnaqliG-pSih<lt~alltice f;i. UliiBtJist-
eJt~\ellVnlisle ~l cogtutiv-coU1pottarneiJ.hue.~i bi~~tledicl]l~~~upl-a
ncfl~liayi J:enomeu deoarece adt::Seaace~t(:!a.s.unt coup11dictOJ;:i(;
vo;m f()losi doar acea.teo,t:iecare esL~uslinuUide dai.ele ~tiiJttiJice
~i care poate ashuila J?roccd.uri .cUn. tradiUi~ifer~te. (I teorle
~tiintilidt reinterptele~zq 11i inregreaza asp(:!c.tele. v-ruide ole
leorUlot ~1lerioare in cad,rutsjstemultt(sau ~oreUc~ uLlliz.and
Lenl1eULIJr(lpdi. Afla~m am m~i:.$fUS~ iu psihotel"llple, ternpia
comport~rri(!Jltal~ a rei!~terpretat rel;wicile ana]jti~.ein tenuenii'
. teqrleiiiiVa\iiti~ca;rt}Ups~a$1\ abor4tuelluiSigpu~ud Preud.. De.
e:teJ~lpl(.(l) trlJllSfe[U..~te \tlte .retat(;,Q\lH:~~pecUpt;pific fd
f~!lJillleuulul. cf.e gen~t"aliznre n ruv.~ttWi;
(2:) rep~J.a ~ e uu
cqmp?.rtament iJ.ll!i,a deo~~ ~le tntaat p.t:iu: red~~
n~Il~retama ~Leulilfl.chtal: dacllnueste.ad~Ylitat ;
tip>arec;eo~entuJ.. . istQrlecoeret\fade~h\\a:Ji(4)teuuca
ns,a~rli.bt~1!L~olositoarepentmob~it~fleln~ .
ili~?!i$Jlt~derum~g:_p.~-
~.~-~v~JllaUz8L:i!orsaleca ieJ:tate.4Uit!firetlnt~iaU1
c~st~ ideise ~educe etc. (Udolf~l98l)- . . .. . . raspectele tipi~ pentru cerc.et<,trea. clitaidt Astfel~ rr~buie sa
.. Testarca eficiep(!iproc:edlldif.~a ceqiiei:;c!Jimbani A~ a
cu111 am' de3cris anterior, un trntnrtlent;;Liilltific trebuie Qa fie
tes~ataU\tsubaspe.c~ul eficientei proredurii cat 111 suhaspe'ctul
corectit'-'dinll teorieicru:e stli la bazti.eroeec1u.rU. 0 dL~ocie~ i111re
ncest.e d~ua con1pone~1le poate tluce la. sinratii in care de!li
lra~uJ1etttuJfunc?.on.ea.pt,,c~u7_Jtn~s~i efidepte.estealtadf!cat
cea care ne este oferita de teotia pe baZ(! d\rei~ s-a
elnui?tat
tmtameutul. sau poate due~ la silun\in inc~ dql~orla r'~re
co recta, .~n.Ua.uielltl.l Lest~de~ efi~~ta.\e inclolelnicii..S,igui~ atunci
din~ var~bim c1eJes'-?rea l~oriei .tl\l:intel~gem o ,~esta~ in s~us
dasic,.pdlitivistsau neopozitivist ldeile etUJJkismului pragroar.ic
213
. -:. .-:- : _._ . ~ . . ~ ..... .. -- .- .. .: .
; ~ _ -- . . ~ .
.@ca nu se pot testa t~~-te J>rOJJoz.Hille tmui sislem te~relic d
doar opnrte diuele ia.rapoiteotja estevali{{ata sauJnfir.utaUi ca
iutreg;~a test;p-ea iimtez~h.lr spec:ill~~~ pres~p~ne prex:.en(a
in1plicita a unorlpote~ au.'tiliare (el{.~~un testmasoaiiiceea .
te vrem 5i\ 1nvestigfun) ~1 in cC)ns~cht(a. Jipsa t)upprtului enl-
piric. poate sa iJ.u;eUJf:!O "prqbletne ill ipoteZie-l~ ituJtUiJU~ UU tu
cele specifice, suni. deja o parte integlJ1Ulii a testm;ii tiuei. Leorii.
i!:.-::::t~~;:::r~.=;=~
pe caredorinlsa-l ating~mtini\nd.conl.de-fap~uJ di adesea
cercetru'ense(fes!fu;oarii iu cad.ruiu~lol' l'llt:>dele.d;escclptlve d~
tip paradigntatic (vezi pe1\tntdetalil.Kuhu, 1962) $i socio-
institutional (yezi p~::ultu detalli Peyet'Bhem.l, 1975) ..
5 .3, 'fratamentu.l pentrn J.n:nbletu.~le 1\lOdtll~h:]f:Uur
. lle a face.cercetare.. c~le qa'le, P~l}ti I
Nu.ru:e sens si1faE~maklsugeytU.d,etal~te,.~efeW6itre la
1nodul com trebuie sti fie eercetareaJu. <Jol:t,l~n\ul(:.llnic.;~inici I
ca ~i in alte domenii nle ~~inter. cercetnren trebt:Ue sa resper.le
, metodologla ~tlln~cli. Voi llen\i~mtt iii ac:estconteJ~.t. dQar
men on:~ntclnr dHnflu . . iifttndattlentnle u .
in .rac:tioa inicli se fac;e pr.in 11enetn'lre~ uno~ fll:tre succes~!
Aceslefill.re nu au QU rol t~ret;Jv!penttt.l~tiln\ii ci ~utulprotectiv
l?en . Secve.ll\a~te ttrmatoru-ea: . . .
"' Cercet~a TuJ.!damentala descoperiturJ princ~ o
regii[aritst~ 0 roudi\ie importantjiesie caacestprmdph.i Ha fie
relevant. domeuiul clinic~ J\Ueyca acestc priilt3fpu sf! .
t!lll:tU
de5coperli prin analiza su\JtecuWfmnmd si\uD.to~i as\fe\di ele
pot sa UU potriveasdi [UllC\i,onan~a 5Ubiecti11JI Utnatti CUUL\'en;e
fonne de psllmpatolog~e~ Sp,re exel,1.ph.J . pr~ncipiul disonii~l
2rognitiveafostbinesusp.uutex,petimental~es~t~!::r~,~?~7);el
r :z_ -~-"-~-,.,...'.._~:_ . - . ---.:-:.~-:" .;, .
~ 219

,.
ne sp nne ca- d l1 ca a pare -:o::-....:d~i7s~o~n:.:a::n.:.!t~a~.;c=o~g~n:.:i[: i:. :".: ~:. . ;_;IJ:::lt~r,:e
comp?rhwnentuhlostrh~i cre-diHfele noustre 1n rlm l c~dintele
Se 1-educ la nhLelu comportamentului". Acest principiu pare sli
nil fl.lnctioneze la .fal de bine 1n ~subiectilor suferluzi ue
depresie ~unjorii (li\e(;k.~i calab.~ J 979), Asfel, ace!lti pacienti
se pot im lica pel'f~nni\nt in ~v~e activuiiti(ca lUI\lare a
sa~cmilor r~r:Apeuti~e)dar contmun s . &uapu . c .sunt~
incapab.i\i de a fn~e oeV!\:Chiar ll~mcic&nd ill studU ni se spune
c.a
s-ainVe.s.tigatarudetarea san d~1n-esia, o nnnlizli atentli re.levli
a(}esea prol;tlenre aubclini~ (e'JI;~ scott\lmar.e an~ or stlbiecti
normnU. .Ja o .scala i:te .tuix.ietnte) :nt1 clinic a (ex.. pacien~i
dlagnosricati en diverse rtllbudlrl de nn:x:ietate).
'1. C Odafiigiisitll11 p.riaGipiu cti~lcYJW(Iiclinicl ~trcbuic
~~o.r;a~atD:tJ:-D proccdtJrXdointeiVcnf!cclitiie:!- Dn~e
po~te fa!e ncest ltlOJ:l) atunei deseoperilCi\ nre valoare teoretid\
dar !111 aril.unimp_a~asupra prncticii.clinice.
, . . P.rDCIJdum 1rtJbuic t~tatl.IIJ ~ttidii dciJiicif.llltlf(Miiency).
frt nrimn fn:Za SUn~ CX.fltlfli ~estoc Pl'O!;el(uri S~lbiec(i sanKto!li, .
pellt~ &se nnnari.!l10dul fq;~~~etionaazif.$ubii!Cti umani ln
acesre procMice. Oacit li~Cste proeeduri se :doveEI~c
' n~nedcn1onse(ex. nu geaerottzit probleme noi,subieefllocsMn{it~i
t;:liroca lP-.BU fostadmiulstro.te~ nt~nci cle var fi aplicnt~pllcientilor
pentru.car~~ll fost ~la.borate. $e vizeaza cqlJlparatii grupnri
de control i placebQ.. ad~seatnn-un meoiu .controiat, de
l~borator. -aac:l1 procc4unl Si!i'dovede~tc eficlentlt statistid\ ~i
clinicn (ecol~.liic-o marimemitre aot;fc:crului) atunei se trece Jn
.m"Jliatorul:filtm. .. . . . . . . .... . . . .
.... . .. . ~..llroi:edll.rilc iWdtU!IiJ.SllJlfoSllpuse UIJQ( ,fiodiit(iJ. cfiaiitll{lf
~{affe~llvellets)inf!1aliCIJ cure[ltli. ~1~ snntstl.tditue
cum fiinctmneaza .efectiv rn pmctica realli. (CJC. in clinic& X).
Uneori e$~ posi}?il en o pm.cedurll d.o:inc~rvenp~ gtfxirii efiRenti1
tust~tdit de labprator silnu functioneze in practica want (peritru
de.talii pdvind dif-erenta clirirre.efficncy ~i effctiveness vezi
221>
:-.::.~
NMhart 4i colah. 20Q_Ol;.1nstudi~ ile lilbmatrJt adesea ye
iltilizeaza tl popillage-self:(4ionara. (ex.. dbarpaci~nti cn.~u.lbm~re
depr&Siva n\njo~iiHn ti1Dp cc.in practic~ reaUi ndesea t~~b~nnea
~Iya majatii este
~c~n?paniara ~i d~ nUe tu~b~~r11n (;x.
anu1niteiLllbnrliri_d~personalltate) . A'.easr.a.comorb1dlrote.po.tte
face a o J,lroceduraeficientn m liiliorator slt nu mai func{ioneze
~li\pracilca re&llL ..... . . .. . ... . ......... . , .. . . .
7 PftjcetlLJdl~. CJJre.llotcd~~ t'1 tilldentlf ~o!ogicli f'mt
< .... . . .. ,
~..
sup~sF'analiz. i c .. . . ........ or. cost-e-'ffcc~cpffsJ- nacTl
h11p emenratealor intr~oclinioll duce 1~ rea~ce~$=<1Snl,li1t,>~ ~an ..... ..
-, ,
e . .. tivita cosfilt"ilo ""'nm ortcu b~n~ Jfl .
. a9ni~ an11l '1 . ~ua:~afiirnplen1entiltlt' Dadi uu~eint. n1p a
- a!ia.,',~tuncitnci~da eticlen eiclinice untala~ Sisr~mul se;-, . .
. ed,~a. i-lk ~bl!jnnit'Sit ~e trarar preferential; prin sh'npJul'filpt
c~ sc.optlril~ snle BllOt'l'Unaniste~ Din patare in sa. chiar ~liind 0~
on.ce .
padent arb;nefi~ja de' 0 interventie psih(llogicl\ n\\
fus~hn1.ntt (:,nt~w~uTile treb~tiolllt. sted!ii;m~ Sis~n1ul s~ulirar 'este
Uti Sistem, ciire~urselimltate. Dacli re\lu~e1-e arfi. nelimlrare
atu~ci am ptite~s! qf~rirnfiec}5nJ1 pacient-c~lemaibune ~i'mni
noi i~mamerlte {jncluzflllB asl'!tten tn psiholo-gi eli penfi\l fiecare
boJ~~v), . f)j]l pl\cnte'i'J\ .Ptactie~ lncrurile n~:tpot. s~.sten '.nJia,
res'1..sele flinil'lirnir11te. ,A'~dnr-se v01ln.1plementa D\l mni 1\Cele
cu prooeduri (}are-sunl:aft-Gien~e din punct de ved.~re.~tiintific ;~i al
costiln1or. ..' .... .... . ... . . . . . . . . i . . .... . . , . .. ....
, .) oUn uJtini filt(l.m:ste eeJal lm lc;JD~atlfriiprdtocof,ufui
~. com fl. hili 'Jti. -lUim ... u .. :c . .. . "laltJl . n~ori
anub1itef!itO"t:eduri m1110t fi hnpleHlentate din cml2.a spn{iului,
perilonalului etc. . . . . . .. . . . .. .. ... . ...... .... . . i
i Accstefiltre ades~ acluc-un ~nrecal.(! decalaj intr0 ~btinerea
u~zulmtelo~ cercerariifunda!Jlentn]c ~l nplicittin lar.. Aee.st 1Ltcrn
.esteinsanptuobi~nuitill~tiinta. Nntoare rezultntale cercetlirii
f~ni:}amentale din g~nenca'-s'-ail conatituit d~ja in ap\jcatii ale .
ingineriigenetice, du.pa cum nu:toare cercetiirile lli rratnm~'rele
e~perimentalc din psihafarmacologie sunt exprimaLe i'n
l
.. Til
 trata~ue~ne medicate aplicate pe sccua latga; ele ti6b~it! testate
privin~ ,~,!g}JtJUita i eficieuta tor.De asemenea. Jal~dQhteniul
psifmphto{ugirti Ull toate trntumeutele eXpednl~JJ~(e .s.1mt
hnplementa.te lit practica. Pentt:U sigurautapnci\~ritii9~. ele
trebuiesi.Sa l:reaclipriu fUtrele.m~utlonate D;lai.~us, ~labia apoi
"orfi implem.entate pe scartll..'lrga Jn practkn clinicli,
5~.:1. Tnlln,anentul peul;s;u pt:obleutcl~ UJoda)itiililox:
I
de a face etlu;:afie ~~ foxniart:/lr~ning.
' -
J :Uriciullui_Uc~
Corectarea proble~uelor legate de ed~ca\.ia ~(fommrea
psihopalulogilor ar trebui sa urmere unuiitoarele nspecte:
.1 Utifiz n e cit 'ini viJlidace $tiin{lfic..
' Ac~ ~rograme trebule sLudiate :in tJ.nsamblu fotoslnd stra gtn
. !:
i evalunrit globale a progranwlui de troining sau speclfic, foJosind
' Glnttegia descompunerli pro&rrimului. de lroiuing. Su-ategiu
f.
descom(Jll(lt?rll prog7;f.llllU1ui de trainit1~ a.duc-e-u~i plus in
.:.I ~ .
comparape C1J stt1!-l:e~;tia globaUl d~onr-~. pennite imuadrea
efici~u tel unei C<Jtnponent.e a progt.1l.JUutui cleformm.e: Ungrup
1 de vii Lor psihqlempeu~i eate pregiitit CQJ}fomlprogrrunu).uidnsic,
' unui alt gmp i se.- aplidi p.ro~ul~i~IIli!JUS o.'rummitli
'COlllJ?OUenUi. D.iferen\ele rezulb,tteltleficl,el'l$a~iuici\ -vor ex prima.
1 ponderen componentpi ~eclit~iJ].PJYJ!llU11f.!l de 'flaining.
Ace~te progr:ame tteb~~ iJ.npUll!le. irt fn.~a. plistdiuo 9 po~i_ti.~
.-
~-
\ ecbilio~ validaJa tiintifi~U1fre ll~sitatSJIDui \raining.
fle:tibil (permifnud tprograme~'o/'atl:tofo~ilnvataren p1-jn
expenen~iuda opozitieitnca e21.istente iu do1neni!-l fat! de
-
. r
1
... .~
, .;~~:i\i1}f.zan~-~.nnmr-sb:ueturi~~nii . .
' Avmovan:a ii1 PfVl!lllll~elc; de tipiuiag a tra.c~r
: validate ~liin(it[c. Trata!Jtentele validate *liinVfic, cum ~uut cele
cogniliv-cmnpurtrunentrue. trebuiepromo\'ale,r~ta~ ad\tund
!d\ele se genetali~a.Uipescadi larglt.R'-CC''t,inMaroaUri\altie,
'doar programele de terapie cognitiv:..comportamentaHinu fnst
22"l
re.cunoscuro. ~i in cru.tSeciuta platite de casele~ asigurari~
~te ca terapiR at\ju}'iU~tii,nted.icaJiei petltru tratmnebtul
.~ c .Ut
Ius. ill .SUA. pr()gvamele de
rez;iden{iat in psih.iat~~~ 1li tograttlele:de psJI:tO Ogle-r; intca
acreditale , tre@.ttie UbJ1gattJ{lU SR t, U a tn QUrt'lCU n
~.!!._. . .~mm~ psiliQ.ter~pi~
1.--rl. . promovarea. co?uiti~crn~yurl#IDe!al@in. . .P.a.c.a~.e.
unor as.tfelde lllteb'V~Util::lll'pto~l~le de traitdng
.se }OVe!fle adesea df!,Ie7.iS~el} .l'.... .. . 1.. cl .. "e. f:i .. a .Vi iJ:igoareu
, *ti'~Mc!~>naibuul~Megie-~o7ti~gp.
[ rigiditate, iar pe <;ei care o promovenza-; tehniciGU fl:i tipicari.
'1
. Aaron Beck :siterapia cognitivi\ au.fustndesea ~terWlt1 astfd
df! aoel profesjoni11ti ~aie. j~i inve~tau. ~ropria
psihoterapie 'i care nu sc: de;o.sebeaurJi.~ veehli\.cu ().eJtpetjeJJ\:11
rm5 de
boga,li de v.iata''. Chiar atunei cllndace;t!,Frofesioni~ti ~qfnscri nu
In training-uri d,e lel'llpie.e.pgnitiv-comportatl'Jf:J.ltQJU. atitudiuaa
lor ern exttem de defemdva, Ei aqteptE\U tblla st.tpervi~on, sli le
confmue experlen~a. ~i ceea. ce. .taceau. dejil. .tn praelidi. -dar
e~perienta ~if?ll\GtiSll ptPnste.nu pc,lfi ~lt~acoitfim tate I; in plus.
prin interfereuta proactiya ele li impledlcl1llf:ll?.~ce.1ti :Jpecial.i!lti
Sa asimileze iuWmiB~iile RQi<P.in. progt.'Blll\1119-ca.re S-'f\\llnseth;,
D. analiza empilica fiicutii d~ avtur:pro8J:nm~1Qrde trnining de
la lnstitutul Alb~rt .Eltis (autoru1 este supervizot' in ierapie
c:ogni.liv-cvmportmnaqliaUi l" JJ~&titutuJ Alb(l(t Ellis dht New
York}, a aratat ca c~i car.or~ li se refuz.a cerli:fie.area in
psihotempia cognitiv.-coro,portumeu.taUt tlbl c;nuz;a dfnu au
parcnrs efil:!ient progtwnul d~ lraining(cgi1t~tprpfesiuul!$li care
(1) prnctla\up5iliol:enlple t\e tl,l.al multiwu, Iat'~-a ftvea arn'egatit-e
spec)ficii intr-o UnutafO.L'lUa de<psiho~en.tpie{eJ."a\1 ee.lectici n;
(2) aveau oaracteristici urucisisbhil)trionice l'ji () stirua de sine
e."lagetat de crescuta ~i (3) adesea erau. 1nai 1u y{{rsta; Do
_ asemenea, ace5\ie p6rsuane au problemejn a. face ter~pie
personala, ei considerfind.acesta sub d~tunitat~n-Jor\ Murala este
ta traiuing-ul in psihoterapie ar fi bine s{i pro~oveze tetapii
2:.!.3
\
 .I Seligffia~!li Csikszenmiha!y\.20~0): ~l:re1. il~fi~l~:.l?ozjLi~e .
validate :::tiintific~i elmeriti\:ineeptlt cu oameni tineri saucu \ gene.tea:z:li ceea ce nm nuoul an tenor Sl}latare psJinca Iluz.one .
profesim1iJ1ti C4f a~ dejao formate in~ltaformiide psihoterapie, . iScl1edlti si colag., W93). . .. . . . ... . . .... . . . .. _
fonnare.carcli face s~Hie mai pntindefensivi ~i foarte rucepti vi & t.f~etifriih nsnpra cficien(ci psibotmaplt::l c:Jcc{lla(c ~~e
Ia rolnl de sruo~nL fl<Jrr:msJi s~oJubl.iX'Kilufost stmlmiZfita $1 Jt_[f;.Zentate ~.Ctll!
.:L11area . ;tb considt!ra.ma stl1diilor i:Me HIJJIR elfcienta .- . . . :s.LtC.rB:J:C
:Jnlr-o , . . . . 8 . ..1,11.L
... ..~.rt ,..
...m"
Ll..... i!a
.. o..::J
":?\. ... . . .s.a
..-'J In.s::e.. rcand.- . .. estnueze_.
psrapraf~onittilpr.fi/e;mp.jilt!H' autoadm:fuit./Pata Profosioni~tii contdbtitia di,verse:lo1 con<poncnte ale t~nHt.mentultn
ar .trebui pr~aUtiji ea,it'n-:111ator-i fil snpel'Vizori pentru aa;sle psihoter~peuric asopra eficientei IICesteia. rezulmtelc nrar..11
g.;npttri fii fonne de psilioteropi~ Rolullar s:.arimbog~(i dtidi urmatoaiea sima~e{vezi fig\lfa 6): !
pe Hinga forma:re ckrnol-=speciali~ti.in cadrulprogramclor de
tralnin.g ar .dB&indi:oompetente . i[l fonnarea.'~i -BupeVb:area
ptiraprofesi~ni.jjtHor=i i~i~pervizarea. apl!d\rii terapiei
l\Ul"OftdMifliStrSJ.te. fn pl~ls . profesiOl1ilftii 31" ti:ebUi SR includ~ Ill !I
J

acavlllU~alor. P1lTft)?-rof~ili)ni~ti:dup~mOdtdnlfncare ll1~diClll a

inclu:ri~.activiratea lubal>ilitentole.ol>lfwlcul-facc dlagno.sticiql-si
elab()renzli schrtma- d~ t(atamertt. Ap19it unele,tFntam~nte (m~l
comrJlexe) ~unt flicutede medic In timp ce :.lcqle suntflJcure de
clitre. n$f.ste;J'ite. ~~~ \ften sli viid ~i tn 'psihop~tologie (l?i
psihoteraJ.>ie lllai:.al~lopera~op. (parnptofedo-nrfiti) cnre ilplica
divC'rs~ teh~icidup.liceQil speci~lista.fihmt,diagnosticul-~1 a
, elf!boratrsdi~ma .ms .1r1ltmnen:L Ailull'lite.feiUtici:nu trehuie apliqate
de: c~tte-profG~ioni=iti ci .put fi-aplicate tJe clirre pnraprof~~oni~ti
sub :mpc:nviznre. .
_. Luaitfa .fn -toriaidfJNirCHJ. ndJJm~ o:onccptualizliri din
I
lom"niu,._mp4Fticularcclcntll:rscda-pSi!JologinpOzltlrdi. Tml}~lie -
insitfiicuta odistinctie cliU'5 intre'a9pectele validate ~ti inti fie ale
psih~lugieipo~ ~Vy'IJ i eJiageralilp Cafft ll~ tndeJ?llrfea?li devalori
confum'n~ precum roalimuil, !JC:ceptarea .necondi{ipnar5,
tncro(J~~o b~arll pe o-evalunre COl~dl, etc. lfi carene apropie
de ideen cij sanaea tea. psihiolt dcpinde de. alte valori precum
...:
autotm;elarea .Iii autoilu2.iomu:ea {vezi peJltru tlerelli Dnwes,
1990). o:pend~lttr~ perinauenta in.~e r~alisl\1 ~i iltiziipozi~v~
tuinit'ne genereazii.l!111! opti~nisin renlist; care esre .calea Spre .... -~
I
slhllitaten noastra psihicii.(Dawe.r:;,}996;.chedler ~i colnb., 1993;

225
224
 ~ '"":

' :

lmportuule ale rela\ieilerapeutioe. Rezultatele acestui: program

.
... .
de cen;et~r~:~.,_untpreteutate ittAnelUI 2. ... . ... ":t.~
'
o Td:.uicile de interven~ie psihol:erapc:mtica aco.tiedi 15%.
- oEfectulpl.acebo ac(Jp.era l5%i in tu::estecci.llclitii efectul
placebo se refgli la speranta_$;. expegtanta deins~uat{f~.ire~i Ia
-i spt>Uul\ad\ tratamenbJlunnatvaduceJa atbelioraren tt~filoului clinic. .
o Factorii petsoJ.tali ai pacientului acopera40%.Elel\lentcle
factorilor personali pot fi impartite in trei categoiH. Prhna
cntegorie include .factori. psfhologici lli de_ educatie Precunt Pmtea a ~1-eia a 1ucrJtii parti~t1lar~eaz~"o componer~Ui
iateligenta. A doua categode include factuii econoritieliar. a importanta a psillo}Jatologl~i JJi atmnle.psihelogJncliu.idt. -Voi
\reia uategorie se referalnsuportul social pe~i:lare pacientul. . disquta aici sitt.t~tia pslbologiei clinice iu Romllnhi (cnpit.olul6:l
in duda acestot date, dih pacate, prog[fltnelede b'ahiing ~Ltolul acesleinln dotne~hil~lJsibologieJ.aplicnte (c.~pitdl~l 7).
se focaUzeazlt obsesiY pe con~ponen~de telu.1ica fiiJ?toced~di. Cnpilplul 8 de RentUliei Fuude vn suuM.u:i'.tn ~i.iJtcbeia demersul
' . A.ceste1-ezultate arotlica prognunele de u'clining t:re\>uir
~giJ,ridi te acesteiltu;:rfui~ . . ..
1
cou1plet difecit. componentele lor apr(I'Ximfu1!1 pqnde~ea MotiVl1l care a stat la l7oza aces lei: u. Lreia puf~in lucrlirii,
pre~enta\.a mai stts.. RestrUcturorea lortrebuie.(iicutli peprincipiul parte scdsii iutr-ulllimbnj pro&rnmalic qi cu un ton a~~ea critic
ariciulU iJui Occam" care ue spune ca LTebuie sll Pilsniint doar .
I
11i acid, estf! conslruirea tUleielite lltiin~ifice . roJ~.~l\ell_tiiu
acc:le componente simple ale .training-~llui care}ustifica psihopaLologie in sp~cia{!llin psiholCilgie.tu.\gt!~e~": Separe ca
petfonnanta. elhnioand e~cesulde ~ning_car;nu,1ldUfe un ntiludi:mm neutrii a cercetliturilur !li practiciFliilor romtini de
plus depet'formauJ* Sigur~aceste_ c~z~l.tat~ Jttl.trebuie vnloare'indomeniu uu atlit<UtalLcevadt;cittsat.JeiU~tlly,prostltu\ht
interpretatelD.tr-omaniera.exagerallhArP,qteilsiifieU,nii_autori
_~;i trn:Ucul'' psil1opato~oaiei r't>tnl\n~ti !li ~pari~~ unor 31.';1_9tdo?ti
. care sa sugereze ca prdgl:amele.ile.troiliing~.ar putea . ignora productitod de solemnitii\i ~anale. semJdoc.t p.e c~m 1~ gi\sm~
con~poneutadelebnlcii ~l pla~ebo,~hiisei~~ p~'celelalte
tnsa in pfi.rghi:i de pur:.ere fii decide. Eu c.t':d~ii o a~~\U<;\!ue ~-~~
doua colllponentecare acopertt 70% ditte.Jlciert~tnttBJ:I\entull\i.
ci:itica cnre si1 plltnnoveze. 1ro:loa.rea _Ill sH. ~tac.e e"-phclt
j JtacestCO!lleXt deiriJn Sa lUCllpOBR~\Caiudiferentde pondetea
uo1niato~rea este siugura modalitnte. de _11\rezi orgoliul
lor, . Loute C~l11ponehlele sunt neCetiare, ele polent.a~dU-56 lji
profesionifjUlor adev.llrn\iditt dou'leniu 3i de. atc:~~bi.Uo scnra u
constr&ngandu-se recipr~m.Jmaginap.,:vl{ o interventie
valorilor tn care elita ~i nu pros tin &it fie in -varf.
r l
psihoJ:ernpeutlcii.in carenu ~eutiliwaza tehnJcl deJ~~erventie
(ex.' de di.aguostic :p evaluare clinicii. de concepti.taUta.re. de
, ll'atnmeltf) ~lin care nu se dezvolta spenu*' de insaniilo~ire (e](.
efectul placebo); in aceste conditii.nu se poate dezvqlta nici o
. 1- relntie
,...
terapettlica
. ~ ....
adecvata ~i wei fac.torulpersonal nupoale fi
< -

1
utitizateficient.
: .
.,.
''
22'1
 '::.:.::-:-;:.-
.. : .~

~~tro,pefut~~JG!lologist(Qit:V~~~~~~~~:~O.~l. n~tldar. p&n~~~;

.d!fl'f}lii:~i :infonna\ii snpliq]entare ~g c~tno~a1 sl\ ~ml&Ulm peel '._,'

i,La~{~~i.11
. MED ' C6tiil'ftl:\ y~~l:JJ;hla~.a,.lfi'' 11~1: J

;:;;r
.;< *"+~;;"
. :a=~-.!
. 'P*'~ii,m;:~~~PstllOt4t:~1ili~~~t#r
....

.J
:

. r:. :,. . ,. 1J'l. '.1

. . A!}a~lar. sp~r cacltitorii silrilFeoililtlf!rih1a
lsml!~~~\ft(C:ci,,~~nu::s~simti lctap. ptoiee~dtJ-se rn
.'~1~~;,~~~~~M~l'~!~~~~~t~a~~=;~~~~~fti;
.,. . ... t!~tiltivc~,.w~-!1~,onttif.l~e~~!
a.
11~,~~l~iy~f~r~;z,~i~ti\tfl'f;aict.M'8i :muf~.,;~entru 'fi~iltiita ~ :'m;~~~~~~4~~~~Il,ll\tipn,1Jl~J~~. ~alt,Jfi~~~a . :t.. ,
. . <~ SC!;~ ~ipill)-l~t Rl\IUB t~XJ"CU StBb:1JapmffilPe " <'~!iinti{i~.~~~p~~.m;l\r.,Q~~d;~itc:eroc~~6 :_,l .
':li, ;,,, ;;(;;;:;. ; . ~!!=!~i;=~~t~:~ii:t:::!~!t:
' 1 fCo . ' .... . . . .~~~I :!
.:
~~>IJf]:!:lk~~~r~~~~~li}:e" 'I
' &Ul'if" .>'. '
;;f~:'(it~i'1~j' t~!Tjf~ }l,.,, : . ~ti,Y~~ ~~d ~l!ll~~w~nrl;!S.ycbo:
.::;,;;~'.' .;, ; ;r. < ; :;,0 "'"'"'' :. ; ;, ,; ;~~~ J;Je, P~l!l.OtO,rap}l:(C()gniJUVe< Sl ~~!iJI~~p~1;!!\1J'l~.. I
'~;;"':~~~~ll'fi~::~;,,::n:, ,;,,,,,, ~r .:~~ .,,:. ' . ... . Jnt::\~:pentt'i:l;~Qep~iUmj-=, .
... .,', f4iho a0.4~.sclp(ina:acadenli~lUn:depertdenfll:arfost 1

z.~.~ *1.;~~ :~{~{f:J)C! 1J'>Mli '~ *'':: ~ ::'~'';!. :~ff~~~~l

1

':.f:l)enfl\V'' i "iii~ujift'll ''': ~,, : : , . , "" ,,

~t~'-'Fl"r~? ~' lt::'t!ki?;!:t':. ~-91 ,,~l~J~ClOJ-Napoo:adedltre \eil'P. .~~~;aeademml~erincltunn~mli~
~ :;:9J~P.&~~li[~ ;11}~~\i Wi,lt~{lll1Wttnh<>Jstorin ,.~~~~t~~ta~l!leblliivezi~1!1n~l~~~~ilt~!t\ii
g ~''"''~~\;Jln~~~bllclumatil~ymultt'W*Vtrerite "~$4il.1~~tlthilOJ=i~:l)iplame.(IJF."fl:.,;.J}tn~t,t;t;jo4
.. ~ . Wl~!~~,~~~\l'~m~tqis~;S~talisbnmmt ~ti~~ljj;;.rar.geneml;peritratil.ll'-lt~e:'fl!~frs~t;
. '''""Jdeolagiei a ua .. uvoi iutra aicl tn detaliile acestci isoorii ' ;Dt$flii~#~N~hnnell'leautot~rha~oiil~Je;ilf~$ei
: "'cnres~\n~pr~n~ate pe larg it\ alte lucrfui ale mele (DaVid, 2P81; M~ilit,~mtab~;tiinta1~ itltenlistip'lii,iJa11lll
2?0la; "Qav1d ~l colab. ~002; David ~i Miclis)~ 2002). V.ol ;,~~.. F~ \r ., . .,., .~""_A?.L.\.(y: .. ..j.
~' isjf . . ~~~letitll~e}f:ale~n rlolllcnm S1Ult~'7'~~li!J~i1~a~
;-:,-':: .. ': .. c'.',; 01' >,fo . . . . . . . .. ..

PI ezenta f~1 c:ontiJ!uare do~.sratnt;ulnctual al psibpl~giei l;linice: ~mt1W~~~~~~i!aJ:~P~)~~~t:~\il;li~;:'~'~0fiiJ1~n''c~~i*~~~l' .

ro~ne~ts! 111 Cftd~l cercetlldi f!sibolqgice inte111arionale, ca
J

Ull:~Utt,)l' paate 'scrie4 volume ~ingpr ~i Sit-~i aiij}ljo:fi~tlll~~~~j,

reh6ffuld aspecte~pmbJemari~~ ale aces~i discipline. Aceasta la. ute.nnura ~tiin[ificii! Adesea aceste volume suntjdOa~
.I

prezcntnre est: o sumnrizare n unul articolpubJicor 1ecenl in sumati2Jiri ale nlror lucdiri f.irli sa adudi 11imic nou rlin pund d~
~ ~.
.. . " j . j .
Z'28
229 !' i

l
 ra\Jnc1a~ li indepJine~ttlTtll:tctia sucial.ii
..
- .. -::_.\ . .

230 ... :231

1

\I
.\
 ..
. .
!

-
 .... :' ~ _. ......
, I.
! :
i
Proiectul de cercetqre cu clep:lentele lui p.rincipale (ex.

,.
I
' .

dlitelf
. . .. :~ '1\tttelumniitipo~~~~ .,:~~~~~~~t-l~r,,,.,"i
;1\ifr'el~rl.i,udtd~~ijtj .. "~'v~~;~.~~~lf!,~t.eo ttu
... _::t--~~;~~!;~~~~~~~~rf~K~~~i~l\m~~;.i~';~;ers~l
., 'fiiP i1J(l'e , BSte ciUS:ie.ii ititfilQ.flallht ~}tfiuia Plntre

:~~=t;&!fi
..
r.~ -v-.._.

dentara ce,reet~ pr~pr~~::;i~li~ .t:',~~;l~~~~,t9p,tiu-zisa n

! ....
-~~~~il!m:q7~t~fi~~~~~~t~lliti,~:1:el'fi . ,; ._.-C
- :: r:!JiJ~P-_~p;.pu1Jl~q~lluc.t;~ti.(~.~Elf~hdtJ~Jiitll ettl~~~~er{\le
'$tlig.~fii;.$innpolflnlle illciut:laJ.trior~mi met.udo,l:egiceftugmne.
,,., ' ' " j' < ... ~ "' .,. . '

:.,.,,;_:~":~~-.: ~=-:
'"""1-
::! ~

235

.. --.... ,.-... - .....,...... -....... ,

- ' ...... - . _ .... ' -
.:." ..
 ~. '

Nuvorbescaici de erolHn prelncrareastatistidimartmnticii (de

. se poate datpraprogranm~ul stlttistic sauuaoretori de tiplhire) ci
de erori . metodologice '1iu1damentnle~ Amimesc Gil exemplu,
.
... 1
utilizar~a eronntli a testitl ui statistie (e.t~ utilizm-ea unui test stat m-
ric el~borat peritrn-e~antioim;e;indepenilcinte. in cnzul unor
~anlio~nedependente) s:tuutillzarea cu obstillnfi~asenmificnliei
stal"biil:ice tadesfta Qtilizaren'e,ste ~i ea gte-9idil; vezipintrudemlii
Cohen,. 19.94). fliFli a lua fu consiiJ~mte ~i miinniea efectu1ui ~i
c~lllP:ll"Rpile l"l~nhative, (vezi pehtru metodologia adecv;.,;a
Ke?dall1fi"col!'h... 2000): Un a]t cnz ripic e.sre utilizaren fntr-u 11
mod c~mplet -neprofesiopist a cpnstmctelor de "mediere~ ~
"~odeJ_~; la,i Bl.\)."on ii~eruiyau nr~tat din 1986 cum 8e
daf~~tilZii a~ts~n~vte la.niyel~tio.Jii 1n analiza smtistidi.
~u~~~ mnl'lln~hl9fi lC: t1tfli~nzlfcasinf:!nlmeprqdtlclind aslfel erori CJoi.fieiQntul ac-. lrill.-ib.- i i
collCf!J.)ttlft le .IUJPOrrante, .~poi sunt 'ftecvente erorile . cazul
m -u~ llid~~
.. :: .

com'J>aratlllo~ tnultiple.ll\stfel~ dncll BVf!m trel comp8r8pi~l testul

J.') ... . . . . .. . . :
l,.EGI~A: C~lt;Jrci va!ori !-fispu8llln linie tn~CCftl"ro c:elulA II t~b<'!lnl~ti
"~ pra~ullitnHJi de seirinifi(lati'?. stn1fsilblt n~ mdi este n.os ci ..cor~punilcal~~.tr~id!mcnai~J1ia!~ ll'.~ri~lil::fcctlllu~ ll'i~ept?t(de ~~~~~n~n
....,
. P~05:3~~.qls~nf:rt;Idetalil referitoa~e lamodurtn cam se aplica . (a drt'.i]p~) (dtlpllColtcn. 19?2): (l) m~nme ft cdi:etu!m mtcil L0-..7o)~ <;~
a~east.\ ft>rectre -Bonferroni.- veii David ~i colab., sub tipar). miirill1ea efci!tqltlin'll!die (:20~.50); 1T1ilqme~ 1\ efectuhu mnre f'"7"0pent~ll
Oare dite. c~ncluzH .suspnutepe" .nstfel de aualize sunt de fitpt sau">;BOin eelelullt: condilii). ... . . . . . . .. . . . . . .. . . . . .. . !
11..2 vnrinbile flrt:llictor. b-'Jvllriabil predictor; c4varinhile predu;tor, II
v~r1J.e goale flhii supmt ~riinfific?l In vern, neluareaJn calcul a
- l
. .. .. .

puteni ~hl!istice.(ex.. numfiru~ mini~de;subiecfi in et~nntioanele . . . . .. i.

~onstmtte pe.ntnt ~ Pl)tea. detecta e:feciul existent) a dus la
mlerpretarea unQr re;~ullatc seml1ifi~htivo cafiindnesemnlficntive.
On~cilte ~on.cl';'Zii lnteresante au t;nurlt astfel'?! Prezint .rnaijos
. (v.~ tabelal4) pentru diver~ design~url He' cercetare nnmtlntl
nllntlT\'desutl,ft;n{i neuesati penub alestn ipoteza.Las cercetiitorii
sa seproie:!~ 'Ur acesteinformarii ~ish-~i autoevnlueze Jucrarile
incarenu tu..J ~b(iriutrezriltate se'rnnificativel
_. ~in ptinct de-vedere t~reti~eatelnf"ric~nrort~ntru acest
d_omenm eli se perpetueazlt fn prac.icl1 nn dualism ~arreiiim
ort()dox.. Qolegii~medici nfinnn adesea ca daca.exism leziune
btpchintica atuncieste elat di mr avem. ce sif f~cem cu 0
int~e-ntie.psihological Se~uitliatat de Ufiqr~a imerventu
psihdlogicli~(!Onse~in{ebiochimice (Furmnrkfil c~la~:. 20~)2:
KirsPll, 1990). Uniicolegiips1hologi . se '.'imhntn" de pU\cfre
C!\l)d:oesco~ril ca al')Unlitef(:nOmenf p~ihologice au c~o;spon..:
i
.J
dentbioctiirnicrunti ahitre ei au aJUli!i sJ!i.,.~i fttcli. un nllu! de
prnfaslonist chestionnnu menm subs~mtul biochin,ic a~.. nnor
. fenomen~ psihologice Probabil. ca prin . aceastli- atlNdm~. aLl
certirudinea en ceea-ce:stueliazli ex.istli (1n sens fi2ic)l_. dar Ste
pi\eat ciimai au nevoieif~'il}\!ea.st~ certirud~ne Cfilltl<P_~iho1~gia
en o-:nintn s~a j11stificnt de zeeide nni:j\ce~ttQ. SUll_[ uceta.pe care
eu tim~mesc cei n"i"ai buoi psi110ldgi dintre medici ~i cei mai
putin psih()logi dintre psihologi! Prin prisma acesrui dualism
237

-- ...... .
 feroce, am vfu.utrenasdind.in Romfiuia cercetari cme murit au F2
iu .alte tar~odatit cu evotuUaJ~ un model bio~psiho-sociai. piecum

.\::J~;.A::\
cele .lil.~~!1f~t!.~ratlidi fen~n~uele b.ipnotl.ce suuL a~o~npiolale
de 1Jl(~d.tfip~n; ~erebrale etc_ Ac~te ~erc:etfiri c~;i.viieaza
substratul biological unorfenomene ps.iltologice;sullt de
liT~UraJat. daca ele. UrmarC{iC Sa descop~re. pat~e0-Ufi
ne~roblolog!Cf!~~biochi.n~cespecif.icepenlntas~tepslltologice
sp~cifice; in aceasHidi~ectie. eie .pot contrihuila(}ezvoltarea
. . :
mor uoi tehnologiiin psillop~tolC?giel.Da.<;nt~sa.o.ceslecercet5ri B .. F1 .
.; arata uu!lmi;. (cu~ a~~ea s~ illtfu.npl~J :di .atiUI"J.tite T~nomeue
psi~o~ogice (e'll:. fenoJnen~ .~lppoLic~ .ef~~uJ.. pla~bo. slari
eJ~10\touale ._tull:J.ur;;id cerebt~le. et~.J au . _0 corespondenta
ne~JOcerebi.<tJ.a SUI,l bi()(;himicli alupcieleSl)Jl{; SOlemnj:tiitibannle
.!.. ~~'ealeae .seutidocti~~~a.~laju~:B$m;ti sale~nlJobulpre-
i .. frontnldeapr?~.P~On~eJenomenpsil~ologic<ex.. deladurere Ia
: ep1~tie r;.i g~dir~I). P<B.i ~~u~tintd~ ze~ide ani catJ:Jihit!w ~te
...
: ftltJctie a ctei er~ui7 De ce v:a.:ruirati~iva bucnratt afi,tnci drag.t
r 1
cole&i ci4td ''d~c0perit_i''cafenoJueu~lepsihologicesp.l!cifice Fii!lllll1. Rebt\ia di1llre psibic(l!}~ibiologic (B)in ouzul n
:p~ (!l.\fe !e studiuti a\t corespondent neuro~erebrru'll)q;t~ttu ati douii.feriomeue (F: F , ~i:F1)prezenblta iu douillJ,Odlll~Ui\i grsficc
\c~zttlcaaceste -feuomene pe care 1eexperienfi~nlcU l(ltiiexista ~~~ . .

:ln ae~:?l fij.dl. .a Rvea pretenti~ envoi c!ari.ftcaa.i(;j relafiadiutre

ipsibic . lii biologic . (eanu._este daJ"i~c~tiinici-~-.lltenttprn de
11Slle~iWf~i.tt1)votprezentait~conUnunre.~ucflnt.(peJ.ltJ:~detn.Ui
~-
1vez~Iti.rscb,.l990), l'l~oduliucaret(~buievazul.3.aceast~rela\ie
pe.baza d11telor pe care lenve10 ln. ncest n~oment F,igura 7 .
prezeJJtallimai jos ~rata di.dis~sul psihologi.c ~icelinedical
. '
~unt~ulesea.d~crieliqiferilellleaeel~irea1i~\i/tetio~~ue..Altfel
~pus,.~a cum Muhammad Ali lli ~assius pl.uy su~.ttpume
tiiferi~e penLru nee~i persoana ~llimbajul!lSjJu;logic ~J:~l bio-
J;nedi~al sunt dC$cd~i diferite ale 1_1celuia~iJenqm~L1.
estea\Jsurdsltspunem_diMuh~nmadA.li este.cau~al\JiC<tSsius
~laysuu. Cassjus. Clay cauzeaz~ pe Muhau.wdl\.li.nu are sens
sa ue; puuem mereu problema da~a biolo&ictll ~a~lzeaza
233
.
psihologicul sauinv~rs,fact(Jrli p;;JI~olggid Cl\Uztnzii ~nodifidiri
bltdP.gice. in figUFcJ.7 ~.P 1 ,~e po,ate tefe:d.~prc:e:t~itlPl~tlll sc~l~~e1e
coguitive negative.D~t;Jgureleuu~-usUi!n~e~. P1oba~!l.ca l?~
.>.
le Gorespunde 0 anun:uta realitate neurPtl!O~Ogl~a(B 1pl'l!(":l.t~
tta.s--ar putea referi taun deficit de.$~rotoutntt. Scltema cQgn~t~ya
negativiteste cautil"pettll:U o ~rilr~,d~m:e.aiva {~2):}\ces~Hdiul:
desigur, i.i cot($pundeo reaJ.itat~ ~'~ur?bi()l~&,-pli ~ 2) (t~oteti~.
0 amplitttdine sdzutl\ a pot~:;npnlull:lJ.. posl81naplJe excttu\orJ.
pupa cum Afladr.tr, teoriapsihologid\ ad~p1-esiel!1i ~a~l;Ji~logicijno ~~n~
in opo'litie sau altennnive.Ele sunl descrieudifelJte nl7 ~celum*
feuomen;'in Qcest cOllleKt, ~is~ursutc~auzal" (febuie UlCU~i~llll
in cadrulacelulru;i limbaj . .1\.fitnt.a\ia: _sclw:mde cogmtJvc
239

!
:

... , . :~o-;,-..~-""!".c..,-~ ,. ,_..,

 depr~i va'uryurea.corespnnde inlimbaj bio-
ldiirea ipo~
cauzeaziiurmfind
'~wnutd4pli~e:!"'
i
peno..mmirll~ i<l\i<'lisc\plinarll. dP.<:<:\l\P~- In ~riin\ll. rounC
lngrup ne ~gndl c~ P"'dUSUl li!1lill>le eelhi
.!
.
medical 0

. de sem;onina d.eter::~oastra a~ten~oli., sfiro1.apei eli: deficitul care l-a ereat. Sp:""' uemplll. gruput de psiholngi de \n .. ,
.Universita"'lll\btJi-ll"lyal.~in Clnj a(ost recent illlpliCot intr-
. 'I
pos_tsinaptic excitntor. D~:c~~t~~t::me l:-~\Sa a potentialu\ni l
scheme ~ngn"t' rotonma nu ne face sa avem nn piplect ~e.~are i\nvorgurll tare ~it,nllrtntre nl(l:le ~~
elnboi-a~ea unor~t~ ~ii~.str.mnentare
0

~: 1 tve negative ci ea este d . psihologice.lmi am1n-

:;chemelor COgnitive n . I . O escnere btologica 11
egatave Asadar dac"' . tc-Se clar cl\ ntunci ci\nd !1-aell\h~rat U\\l~l te~re,
din uo test 'de
Pff[llt~itnte deeizitiri~ll\, prime1~ -propunel-fin~ividu()le
.rc
.enome:n avem ntilt teorii 'l J . a nsupra Ull\li
pst 10 ~g~ce dit !ii reorii biomedicule nle utuli
cnre este teorla P"" c
exempl~;~. 'am pntea sli facem o m: epm e de situope. Spre
... are o prefera ? D d . !"ll"'iml constitlli~ d"."' ~c.nd< dt ~~;,_Mnncll) ~iPl\n
dlls l~ unprodns cpte nti rlJ.ai sea~linti"c\1 prill\a sch i'l\ .dar- Cfire
este,prohabil.mtul.dintl!e ceie m~t -bpne testa tle cnpncitm:e
deficintlui de scris-citit A nnahzii neurocerehmlt\ asociatli
psihologi~li n aceswi deftcl;~ute; Ynsli sa face_~ l}i o annlhli. ~iiion~Uie\abOtttte:Dl tarli\ Dacl\;nn arfifost'in final ~flt(ib~ltia
mai util~ in acest caz? Art .li nn: mtre cele doua abordari este
sll claborez progn\me d ~ zta pst1l?logjcl1 'i'n.at;estcazJnli. ajutli <"iP..., ~~~prob~\lci!varl;,tl> lino.m .~~~.; re$< ot
. f:i.. fo~tl;lepatt.: d~-c~a
ezvo tarea ~cris-
. 1 e tn elvenftB penll'\1 d l ctt:ne-am prepo!l ca standnfd ilecalirace.
~
cttitu tu. Nn ayn au-zit incli de " .
.Din{liic~te aW.tu~l\ fjiOJCemplele care-infhJ{\al'. tezl\ cl Il1\mca 'in
.l . . . . . . < . . . .. . . .. . <
-:1 ..
mtl. invete cum sa s~riu' t 1 . pa:itsle Cftrc odatli tnghi{ite sl1
rermenl oi~lo,Pci ~ten.:ai ~'~~;;;nbn 'in alte siruatii. o nnnlizii; in
f!.lJ)V'.c;srerlpipii~ilun cer~tnrea-romftneasd\.ln~it~tJiinr.lln ~

Spre e:x.empln. p.rezen ttt halu ~ t. ~tna in termeni psihologici. mlt\~lnl1nr,.:e~itli\i1e pilrticulare sit suspn un .curs de .fl11Lie
psi~ologic daro teorie din cm~tulor _P?at~ ~ :-xplicatii !li psi~?l9gie<$.nidi. an1 avur;pUicerea sn_coordoneadt~vnln~rari
maa utili\ deoaiece ea ~110pec~ ps1hia:tne1 btologice este .. delin\~-~\es~ilert\llord~acolo ..Proaspatintors.ditfS"lJA !ii --''

care pot reduce inte .

s-a ex:pnmatin trata ~
mente me<llcamentoase c~npnut\~l.d 11aivpn\9lict}de acolo aiel. in Ronll\1tia,;m1linlplicut
Rezumfind renlitat.. ""esT~.St~atea. ~i fTecventa ha)ucinariiJor mnl'; llll)l\i stu~Onti to. a~i p<oi<>ot' de """'"'"~ J\.~~~ar. .I
..- ,e complexa - 1 . .
'les:cderea noas-trl!i. fiicutl!i. a~e -~ mu ~~m~chuli. A,!ladnr. !li
t
tuig~jllll1!!!~tul'tc.>;oreJ:.i~? . nlJucii\l;totera a&elfi!ii. (chil\t C\l uncle --'

mnlriniveladi. Linib;ijul sihdlo&~et ~ealtt!ip trebuie sll fie . seg\_nen~~ Cc:illlUnl'tde teXt) dar ipotezele, obiectivele,llietoQa ~i
descried iliferire ale aceli I p ..11 gtc "l:t eel b\ologic par sn fie
vczi Kirsc;b: \990). ~ad~::; e~men ~enU:! deta1ii $i implica{.ii
a~ti~ar~i J'@lltat4lr;qlWJ1Cluziite~nu fast comp1et. alte\elu t1ecnre
sttld,eut. ttl1ll~1J}~d f\SpecteclifedtR nie a~lninl}i fenomen. Ei~ine,
J
neurobiologrc ill llno (! raga colega eat-e snldiati.. subsltattil deitr ln.:!rlidleJ~P(!ctiV~ lW:fi.p.untt fi publitnteJn revist~ de .. i
B}'ltinemflacum dt'tpa"'r t=tnomene p&ih?1ogice. tlebnie sl mai pre~tigiudi~; shain~~at. ~tudentii erau pe cale sl\ fieexmn[riclllati
l1 n a Vl"Crrje. en. Q.,.; '-' p~lnoti;t\l d1lllct:eL\zltla aocen~i temli :Ji atlliJcrliri dediJ'lon'le
idciltieel.D~pK efortn,i!&-mele ~ wn11inge comisi~ d<
are corespondent-.. . ,,.ce ..:enomen psiholooi.-
.lenrocerebral si dec- d "
cert:et~rile voa~tre ca an
t>"-
I, act, nu ariita(i in
profesioni~n ca h1edirild sl)nt. diferlte dat aborden-z..l\ acel~\
u

-nu mni voroes:c de~~-a o.fieasr.n co:r~~spondenta este una specifica

decilt roisme si h.ic n .
vJ carea'te1aiei cau-l</ "
l'l
_ r feU'omen. amob,in~t Gastudentiisn nofie exmatricnla(i ~i p s-<l.
dafposihilitntea sli-~i sost1nn:exa'menul "!mill vii tor! Atund. mi-
;uuc,eot- nn produce{i
0

9 r n necesare promO\imi p ofi .

a pan1t d\u pennu impUcaxea mila in alte nniverliitati romfi~e~ti.
-: Jn rnrlfllll ex.istlitndi b' d r esJOnale?
A~ a Cllffl am mai mbnr,tona.t peIneparcursul
ezvoltat.cnltul munciiln gnlp.
lucrlirii, ~tiin~a
modemli
2.'11
240
I.
 .. - , . ..

~i mi-::ruureditnenaionat revC!JlU\iil~" 'li stilu[ de a face ~tiiuta

dJJp~~.a,zll~~Qf(.t.j,l~q~~~;\~J;i.lfq~t,W.~~c::bq~l
r M d' ' ~ SUA A .. . 1 .. - . . ~lll,;f~\~~1,~~~
'!!. . I
.<!~ . . > ~:,lCizi]~~;~U.. ,. : : t:~'l.t;O ~,a,~,

asp~et stitistic nu ~J!r~.oiez tuctiidle;m~ . ,,ht~~

'::~i~~:~~r:e~~~~;;;t.rtr$~~~~~~,~,~~~t~j~f.te:;au'
. . . , .~lS,_,Q l
,. . ~... ,_, < ~ 't .~,,~,.;q. ~~ ::.t~RU,\f:!~.t~l 'I~.Jlll1
,;iuce,!J:at s&l~llhie-$&Jiln!ilAt-e;;.~(~,lJUl~~l\aee~Lli
.. pl'tibli:sualluer,ld~~tifi,iai~J~1pll!Jdtttel' liiele!.din
""- perlondaromanticiiexp~e nJipsei!Y'iiUi.Jitdd~~~ii!~hsWlos
de .a !ace Qtiii~~ iu ~ameniul meu de inteJ;eBfL\rcdu"ile scrise
dupii;, l,Qij(J!SU.UL. eel~ C8f0 JnJidef"meSei'f care''e~prim.ii. Ull
ra\ionnlism critic ent~nst in tot ceea ce Ja~~eu Hl'aUi
resil!'~'~~lat~~~J.:Jf~;.~; ~;~~~,~~hP~.~~<;., ... - ~at;' ca~e s~ .
p
,dofC#.~l!llla reyotu""lta~~; dej~~7f~;4~jl " poate n
l . \eotl:sid~tli ca: a.tar~:;,p~~ eft@ 11 -~ 'j l"ecet1z.U
Jo.- ,, -
. intenta\i(Jilale i mn(~~,.pr~bit pu . '~'? ., e (chini
~i tit r:eiuniaf!). Safili'cfal-itn~i~~U!! .busta
eSLenumala&=a ' attlUnn
:t.]!
. . i. ''
on~li :;isin~;;ea care, . . . s co.lri ... . . . ,.
psiliologieltn Romitun p,_-in pUf:ilicatiiin ta .,. .. . . insli lfi-ou
ditnensiuuat ,corect luc~rile 11i nutut Pretins eli ;,t\l~~Bl(f.Jibu\\i
.t:evelutie,nare"iJil.d~~a.lC!llJJ:ttlttlii~!tjilltifl~li~iiJjuSJleDBci
~fregu3jie'l~abli~~i-~li'~~~~t~taf~ ~lli()J : e! . c~,Ji'~cest
~\lOil~~nt~n~aUit ~Ji8]9~lu(;1tt~,Qi' .. . .nvalonn:a
' ~~ .u'eniQltJ~.-.tti.,tit~i~~u:I,l P~~r..~~l~Ig :~JJr;\.~p,:j~~plogia
cliuicli romlneascii esteghidaUiinclidupatt,~;e~ba ~t-e;sbiga
l: ' ---:;] : : ~ ~- _: 't '

243
, -
~
'l' ~
.

'

;~"''"''"~' :::.:':.:.... "" ".~"-"~.:;;:.,.

....'"'-'>"t;,;.";.:_-"'-"=""'
..
....c -~~"'-'-
''""'';;:_,"' " - " ' ...... =---~-------=-..:....-:~""'-.,.. ,,
 ..
~. ~- d'rniclrom~-\ocascl\ e'::ltc
;

:
.ca- -ps.~ al. . ' .lucrurcmarcau
11 0 logta. . ~.~ 11 \1nfi.nd c...ont.
-': . . .. .. v . . . .. ,

..R ez.t.lltate1e
,,. .i\t.n..tl\.
' . . i.k.
eel mai rare nu
~ ' ' -' . '
n valorii srji'i1lifice. Probnbil ca'va rrebui sil
vi?.ib.i.lii.p. pla. . wterna. t.IOll. ..le-aavn
. .. t;~.'t?-travel:ZSat\0 perW<ldi\
a~teptiimun thnp'pfina dind l11tmrile se vor m;eza. SLalele i:le .-- 'heilogta --1
I:I..

u.... . ..
ii\rmmnc au tel\llinta sa-~iaduca lfingliele ~isa lllTlllllWeW (m\mai
itltetdict}~le'{leca,te ps~ ... . . h . ~nelyai, prin publicillu e
st..a Umversttatea B. a e~ . .. \
a
pan laim nivelinsala care nu se sin1t AJl1tmintnti !) iobagi ~~ cOffitlUl .. ' . ,

mu~pronstenumi~e oamentde ~tiiru,a ~i eX!)erti. nu piOfe:.~oni~ti

care 't\n. sunt impvesionat.i de srriilucirea din iannaroc. Cnm
&pun~a nn htlTIPI~i~ten :d~-al1.1\eu.~b:ehlliea li al}tepili~"l en n noul\
gener1':{ie1spe~mai madosllt; mni i~riricii fii -rnai at;itoretlexivli. sa
njunglffn pftrgbiife de purere ~i sa scllimbe ceva, aducand
normalit.aten ~ dt1menit1. : . .. . . . _ ...
Revenind la investig~titl nonsh1i- earctfc altfel va:confirma
cele afinuntc t'il'a'i sus .... tez\ilflteTe ob.tinute pli~annli:ia ba:zelor ;. i
der;laten&entionnteanterioistmtprezcnt.atctn tnbcle5 ~16{pentru
..:l
dett\lii pilvllld aceste reznltn'te ~i metod.ologia lor de oh\lnere
....
I
:. ~
vezi David ~-i colab 2GO:!).
\ . ~

Tnhclul S. Vhiliilitnt~B inh:rna!i~nnla n psilolngld dfnice LECJENQA . : . . . " . - llotl1l dt: ottlcol~ 11ublil
l'nnt!ine.~ti . . ,~impnCIUl direcl cttnn~tfie81lt ~nn~~~;r;e clhre me~'lbti\ cu\elh"~-
ea1e ill ~v\ste,_c!Matc1AlP8"?a 16 ~00 1 l~ri\
. de ""iholoJl;o Ci'' 1\lnc.tte tn llnul 2 1 . ,._ \
~
nrririule publican~
.. ' . de. .: . . '. 1,

Iar .-- . d. anfific:at prln .numw" . . . . . . ,.__

U)ld-impnelul . tTeJ,: cu ...f' biil catedn:lpr (le l'sinoiQJl,t~ llu
pllnll tn 1001 (lltclu!i\") do .dttclS.'y ~~m u unfac.IOr de \Jrtpnct nlil.i ntnrc ~il
fnnctie~n2l}inrevlstecotnle . ~tc. . > . . . . . . . . 1

. l,~ ... .. .. . . .. .. . - . . ....... .. . e re!lnrse~ E.1 s'-a cntculat 'ill'\pi\1"\l!id . I

_. .. .-lR'-ialpactulJ&pOrtQt la nt~mnn:i d sibologie (.in func{ieii\'Bn~l2001) .;
lo.rlja. ~~tc.IOT. ~ 1.. d.-... res. u.;.e
I
... ,. a,-,"1.1. llllirultllc
ID . mbri.
- tlflep numant "" - El. s-,a
. alC\Ih\t
c..

. ~'
lRM~impiiC\lt\ mnr,r rt\P,OriD - . . [ted ... \or de psihologle {il' funC\\U
- - . . d ,.D,.II la lnlmi\rnlmembolar en re .. . . - . ! .!
lftlpltr\IU l 1Y - !
. !
fu~) . . !
IiQJ!NpA . , 1 ' . . rest:rllns ele colegi. este cea c:tre, a
. . . VJ)..:vizihilitarea di#ia. s ..a cnlcuhu prin n~tmi1rul !lc artieole puh-
hc~te de c:lltl'\:1 l\lCJ!1brii ClllCtlreJor depsihofogie. (fn ftm~tle in2()01) pllnll
nutamlui ~1 ale unm grill? x .b:li.. ate date.le ararfind d\
. . -~eativ la aeeastn VlZl I u
l1\ .zoo l .Cinclnslv}~ . llrti~<OI<; HisponibUc pt:-. bllze1e. de date men(ionnfe contribmt-semnl'' . . bine dezvoltati\ ihn
psihoiogin eli nidi oe la- C\ll~ ~~ c~=ceste ana1i_2.e 1-evisfa
'~ ..
VR--'fliibiUtnlea xnp0\1arl1 :1a Teslitael~ catedrelor. Ea ~a __ cal~ulnt I
tmplh"Jfnd VD Ia Rl}{Bi\l}ll mcmbritor fieclrei caledre de psiho1ogie {in tftrli Menponez cl\ la da~ cnn am - t.rnipe C:reie.r
ftmc(ie ih.nlllll200l} , . . : .. d sn te Comlitive din Romama. Co.,
l\SOCJfttlei e . m, o ,

245

..

Compvmummr, riu. eraJnc;lvsa iu P~YCHOJNFO. Gnrpul.de
la GluJ are Lendinta sa publiceJ:ezultatele-~tiinlifice in aceastii
~evjs~ n~a ~afaptul ca psibologiaclirtica delu ~luJnre,~nru
mru-e V;i2;i~llitf!l~~interua~onaHifiira ca ea sa fie detennin~ti{d~-
publicatiil~ nute~ilor de la Cluj in revista proprie este un:lucru
de ap~E!ciat. Din,. pacate. aceasti,i vizibilitale este redosit dadi.
(acell1 co.mparatil cu alt~~psibologii preGux'l.rcea aineri.cari"ii sau
c,hi~ JitllaQdeza (peptru detalii vezl Dav!d ~i cola b. Z002).
~entru a c~te yizibllitateapsiho!ogji eUnice rinnlt~1'1Li- este
nec~ar~pubUcarea luJ;rarilor in rev~te vi-dbHe ~i hilluellie tliJl -
o
Ji~eralttrA .~t.iiutH1t1a inte:matiunala. 'Pn)habH .cit mfti plara
c~ndi\ioilare a Protnoxlltii ncadeniice pe-bam neestui. cri~riu ar
d'clt;e;ln o mai ll"llU'e vizibilitate ~ psif19lrigiei CJinice ro~u&n.e~li
P$ scenainternatlomda. . . . . . . . >. . . . .. .. .. de cerceJ:are celO{ care dej~ ~i-au dc.wedit'competentn prin
A~1aliza factorului.de impat:t Mpsilullogi.~icllll,i<:eron~~~l~ti
arat~i-o, lmng~ue similadi. Fact(:uul de irpp;~c~ .a. Jostlll}'Uizat
cL~atl!iU.dlnd numarufde.articole3aulucrad publlc:l,llein ftliviste
cotatt:lS!, ~,>i auurne.deditrelnsti~tul pe!llru1nfmmare ~tih;tifidi
(I 1stitut.efor Scientifk: lnfomlation~ISIJ.x:te,vi3tele cota.l~ISI
cohstitui~ elita mvistelor~tiin~fice. Sp~ e~e~11plu; Jv1EDEINE
include .Peste 4 ooo de reviste,- llU-I'S"YCJ-UNFOinj\fx:de qoo~
Cu. toate acestea, ce~cetltilf! re(!f!L~a~ aril.ta~ ca doar 150 do
re~isle'acoperiijumatate diu toatf:cltllrile indoJUeQiu~Iun,kfert
din ceeaestepublicatf.Ooxfield, J990; J?96). ~up~us, 2()QOde
rev~sle ~coeedi 35%. ~11 toate publi~le ~195% din toate
a1t!~o!elt: citate. fiiecare-revista cotatllSI..J;tee,.9t'lc~lat . uu faptor
de impact, care ~UUn.Uuenta nt:eleli)!Yis!elndotJieqil,l. ilnr~
desprien~ simpla, fe.ctqru.l de imp~ptnl. unei rhviste *
calculeuza imp:irtinlllnull.lar de ci~i {in,tlt:QJii~orU doi anide Ia
se
publicarea articolelort:itate) pe.~Je-auprintifin altere-ifiSte
toal~ artlcolele publi~ateinrevistaXintr-uuan.Jh numfu"tjl de
artit;ole publicate in revista X pe Parl;ursula~l~~ al). Cen:et,arile
au ar.I al~tca factorul de impact
. . ..
fi}revisteiesteun
....... - .
bllllprediclor
. . :
246
............
._~~..r-.
a1 cit~hHor viitqa.re; ale articolelor publicat~ in ace.asUi revislit
D~i UnivemitateaBabell-:Bolyai. prinlUeEiirile.autarului. ure
celmaimareimpactdiutafiiinpsiliiJ~ogiaclinicahtterua\ionala,
psibqlogia clinicli rqmaneaspa ma. est~ ~n jucator hnp?rtant in
~tiinta internationalii (pe~~t.ru detalii veiiillavid $i colab. ~002).
A~odar. chin.: d.{lcapsi!tologia clinidiromftneascaesle vizihiUi.
-P~IJS~le ei nusunt, indi, _cotupetitive Q.i. in oonpecinHi. nn jucam
un rot semuificuliv p.e st;ena tii.nfificaJntemf1tionnfiL ~robabil-
. c:;_ o.s~te~e ~licien~a pen\~~ 11: cre::;te u11pactul psp~ologiei eUnice
I()J11BJ1e~ti .pe scenn mter:uatlt:tnaUi.ar fl: ., .
~ Condi(ionarea promov;,idlor acnd~mice ~e publicatli in
rev isle cotate de cli.tr~ISI;
Alocarea p~ferentiala de J:csJ;tll!e finnnciare ~i granlmi
contribu\li 11tiiutificede valoare iulerna\ionalii(ex. pl.tblicatii in
ve
revlste lSl).. Meotionez ~ci un COl: AAre utlconsidel" ilusu-ntlv.
Un.grantdecen;etare care aJOstcousiclerat excelent ~.'flteslote
df (he art" de ditre recenwLii lnternn\lqnaU ~j ctu:e n pdmit
fblaJJ\f,lre in~ematiot}ala pentru cirlci a,(li -~ fo:lt lrimis (jnlr-o
varianta:adaptnUi pentru R9J,Jl.fi.llif\),.p~ntru nverifica f}i modul_
de alocare a .grnnturilorin \iUii~ la Consiliul Nif\i~nal nl Cel"Ce,tfu ii
Stiin~ifice din iuvii\lhl:tfultul Superior (Cl':'fCSIS). A~est gn1.nt a
fost evruQnt cu 8~.33.d,e. punc~.dintOO pos~t,ile.11i l(Jcolizal
undevain a tloua tteitne ti~n- totalitnt,ea aplic~~fihjt; l'fu mai
m~nVon~z.detalint fa.ptul eli aeea.stlldecizie s--a ll1nt ~Jh'n n ~i :;c
.romunica ~melttariUe recen:wrllor(mltcar inTe-LQtnntl)pebn~n
eiiroQI. s~a fiieut nceqs'ta. clasifiearf!. practici\ norJualti lu .orice
irultituti~ se.doasii car~ oferti foriduri pent.rq cerc~lai:e. :m binc,
apeasta juseainna Jie . ca cdlerillc~ CNCSlS suut ex.Lrem de
rJguroi}5C iar receuwt:ii f;lceslora su~t lideri de ~e.tcetare ~n
psiholqgic clinidi~i psil~{}patologi~ la.niv.ellnt~laPoa~nl(usll~!
ei a\1 Jdentifi8ltptobleme alegranlu11il neiden~cate.de expet1U
it)ternati_onali) fte ci alocarearesun;clor de fiiumtnm se face dupa
1<17
 :-,
i ~
...-,
'
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; .;
....
'
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.,
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. ..:../..
..

. . . . ..::...
~
..1 .
\
 re~ul.l~ ~e1 ~P~~iJ~~ Iogieini~nci i-iJ~dustrip.lc~orgal~i:al\ioi}tiie sul\t
adesea iJ~~~.l~?.".~te i ~valuat~ Pl'idprism~a~LVJ staudaid~ Sp.re ..
~.xe1nplu; ru1-alt~6nd cornpara~v .(llidilf}~a ut1or,instJ:gmebte _-
psihologlceutiU:tat~in domenittl aJJJinfit~Ff~5eiectiE{d~per:.
sonal(eK. testul: de ~bllitliticogni tive, i~lervipli~~lructu!~t etc.}
~,i frecventa lordeutilizare inpractidi, Judge(19~J7.)qbs~rva di
.In pnlcticilutili.~ren acestorj11strurJ1ente ~pri ~~~gbi(Jatii de
acUunide validnre:C:Peficie1ltuJ de comlatiei~tb;e VBlidi~atea lor
~i frec~enta lor dt? ~tilii;are (!~te ~e :- OJ(1'7, ceeu ce in~ennmit
u~matorullu~nt: cucat .l1Ll instt.1lt11~ntpsUtolQgic~tentaiputin
vf.W.d. _c~t _ al~.t .f!l _ este mat d~-- u~;?:.at. in prncuca psillglogiei
n,tu,nicii...i.ttd\1 s~ial~;.otgtm~'Zll,\~{)Ual~l Chi at- ntqnci t;ft!Jtl, exista
Cfl"Celiiri rlguroase cu implicapi practice, npar p-robleme in
p::;ihol:()&ia lll~tu:li-inauslriaUl-'otgoni.zntjntt.nlli_ priviud
dise~nimuenlor (Judge,l997). Este, vorba d6 r.re~erea de Ja
dpmelli.l]l~tiinpft~, dJolaborator,ilil'i"actica.Adeseit fin.i'tele de-
coJt:;u~t.alltu, tltt ~unt ghidat:e de rezullatele cercetlifii:~l.iii1\ifice,
ci spmtttumagedlot ceen ~ea~tia.dorese ~iiauilih inptus, ele
. s~n; ,~fl~;~o . founat6 dit.LJ,teprofeSioui~tlin _psiliol(Jgie,oferind
sci,ni<:if d~a:;i~t~htltpsihologica ciupa uneurs de c~teyd:luni!
~\~ desic (veuClutrcb~ 1;991 peulnl detnl~}c~zulclisculat in -
"faUS~reeqournai, in 1~97, care a aram~cli'o frrma iJ11p6rtaota
d,~. t;QnsllJ tall\~ psihalogicii-diniSl.JA aspus e~act a eel~~ luctu
la: Z4. de coropanU n1ari, diagnosticfutd acelea;d prollh~me ~i
S\lgerthuLaceJe~i stfategji de"modj.fic~b;ellf1 phtS, Jn~een ce
. prive:;te pr~gt'al).lele de uainlng ~ferite de dif~~ite.fh:t~ de
ccin~tiltimta~rareoifele suut validate :;tiiutific~ 111iji ;ties atunci
di.)Jl{ ele suntofedte de profesio~~U:flira o-ptegaJirep~_illologid\ _
(1 ~dge,l997;Pj tadtr, 2000): S~ pare
C<~adesen tuulfi. angruati ai
unor firme deconsultanta n\l Sut\l:interes~\1 in a consjdern
r4uJ Uttele oferi~ de ~visl.~le :jt~npfiC(! de sp~jllilate, ofelind
1nai deghtba servidi care se vaod ~i nu cat"{:.~unt valjda.te~[jintific
(Church, 1997; Pltariu, 2000). A!ia cum sugereaza uut?tii de
2.50
in1pactiti doriieniu (ex. Church, l997;Guioll. 2000; ,Judge,
1997; Klimos.ki, 1997; Latha~n. 1997) suntn~cesare!'
(1) spotiren numfuu.luh:le ore tle.IJainiJlg lncer~etare in
~druJ prograxuelor de fonnare itt psiholagia Jfi\mcii-in"us\i"iala-
organizatiouaUi;
. (~lo ma.i buna diseminare a rdulta.t~l<Jr .exlstenle ln
cercetarea fun~arimntala ~i. aplicatii dbl.piihQlogia muo.cii-
b)dustrlala-o~ganiza\ionalli;f..
(3) promovarea i.tt.aceste s~:~tv.icii n profesimtiQtilor .ct.
f'?nnare in domeniul psiltolo~ic. ei p.uUtnd aduce. ltll piu.s de
rigoare ~i prncticii vnliduti \ltHn\ific lll domeuiu. _. _. . .
Un_obslacol in"!(JQrt~n-t pecarestud!ifc lJtiiUtlfice in
pslllolo~ia_an\,ncii..hld\~~-Jall"'9tgt\Lli't.a\ionali ttebui~.sl\-1 trendi
3C. rr;fer~ la ctiterille de eUc~eiJtii folosite. Acles~-i, qcensu\
efici~u\i\ este evnluatii prin u~illtalea uxp1irn~tll lu b~nt (l..uw.
_1995).-~acumin psihologia.cUr~icthte in~reseaza redu~ereu
simptomelor .pacientu1ui, in. psibologla nnn~cii-iudustl'ialli
orgoniz;atlqnnUi adese(l nelnterese~2Sa ditect redueeren
plerderilor ~.l c~~lerea veniturilor en unnare.ttiuterventiilor
psibologke.l\c~tcr.iterh.t e8tetnsa=vnul.:kt~m deprag.malic
ceea ce J.te pQ~tleJndepiirla un~oride angajw:nefi.lttl ~liintHic. Sa
nigutneJ)tatnacestlucru~
lnteiventiile de psihologia lm.lnfH 7lu.dustdaU\-
organiza{ionalii uu :vizeazli dir~ct cr~.terea -venituri\or ci e'e
-yizenza modificarea mmr .factorI" p~ilJo-sociali(eJJ' Sfl.tisfactia in
muucli, a~tocontrolul emotiih:n!uegnU-ve), modifica}'e cll{e apoi
poate induce cr~terea ve.niltlrUo.r. Ei bine, ~l)nf1contde ocest
lucru, \lll program de interven'i~ care
duce ~tfello c[t:t:lereu
venitnrilOCJlU ppate fi asunmt automat cafii11d -::auzfi a acelej
cr~~ri- Altfelsp~s. dacliA(pr~gran;tulde ittt~Jventie) cauzet1zn
13_(i~blcJnatiitirea comunieariiintte atigaja\i),iar.H cauzeaza C
(cl~le.rea veniturilor fmnei) ~m putem fi siguri di A cauz.eaza
2.5!

C~ este p~s!hil ca intre A ~i C siifi interveniL alti factori (e~.
.fluehlat.iile pietei) GAreau dusJtt aparitia luiC.
.. Chiar 1Ji. -~- conditiHe !n care programul de interventie
este ea.uzil~llistaUi a_modifidhilor in veniruri (cauza proximalii
fiind factorii psibologici modifiCD{i de programtihkinlclVentie),
acensr~ nn fn~~nll\nlt.nnromnl eii teorin ~~ madelulteoretic care
ao gPP~.I"i\t acestpt"~grtnn d_e inteaventie aunt.corecte. tn principiu.
pc.nmtn:eas~ ~ficient! p_ot fi n~gajato o. ~nfiniatede explicatii
. pruJ~ole~'ce -~- de,~lode~~teQr~tlce A~adar. daclt robd6lulteoretic
nn este vnlidat scpa1:at fatlide ef'ieiental\li pragmnticn se proclnc
m~medsme.indusrrial~-organiza(ionale!
; ~Tt.vreau.-sa exager~z sugeriiqil ca 1ri prociica psihologiei
~nul~c~l:utdnstdole-:owgttnizatiotra1~ nusu~t pf()gl'ame. de trn hl-
mgJv.aliQ8.~1! ~nu eli nu se Incearcli _promovarea unoraspecre
vahi!at~ fjluntific (f?etltnrastfelde pl'Ogutll)e veziBriner. 2000)~
~fi~1 doar, nlhturi de ~lti autorJ (ox. Briner. 2000;Chureh. 1997;
JudlJe, ,1997}, ca acest nngnjament nu esto inca. dominant in
donteniu~ fn plu:t,cred eM psihalogiei .muncii;industriule~
or.g~uizutionale tl va fi mult nuti gren ca p$ibologiei eUnice sa
realize~ un model de pn1ctica vatidaUi ~ciinpfic;din cauza
fa_ptulnt clj.d~meniul incaret~desfli~oarli ocli~i~ten -indus-
trullleconon1!C - e.ste gJlidat de principiuFprofltUlui nu de
principiul v~liditiipiftiinpfice. De~i adesea aceste dbu~c1ite,-ii
por sl1 m.eargl}mprcuna~ tot la .fol de bine ele por d. nu se
intalneascit . suport s~r~~s p~n~tilezvoltarea acestui nucleu ri~rbs in
~i~i i~ ceea ~-~-- p~ive$re Pfibi!!loQia eduo.s(ii:Mlnlli-~calnr~ .
hl~nmlr~~tsta,__rmu bn)e. :Prin.~piul ful)darucnral in domcniul
.educa!I~J._ m ~e_eJl c~ priv~~teinstituiren \mei _curricule
.ednl!~ti011ale e~te atlttSea recun~terea ei de clttredivf!.tStifomri
stntalc {ex. inisterul E4ucntiei).,Rnreori stabiUrel1 unei cnrticule
~u~~t~9n~le sefna~.!le t::.a~a unor studji .care sa arine-ciflcien{a
'1 ele1 C\~rrmule,efictentatUprim&tltin VQlumtd;de cuno~tinte
Lledafi\Hve san procednt-.ale asimil.ate san in lll'[i indicato~-i
-
rekvhnti. Peotru i\ arguruentil ~ele.Sl1USe aici, men tione~ca abi a
recen~ Cons.iliitl Ct!rc~tlitiiNJ\ponale (t-lnrionalReseruch 1on)l-
eil)'i11 :S-rJA ~iAI];e~tin.deFormar~ &llrof8orilor{Teacherrrain-
mg Agency) mlvb~a.Br't~ni~. qrganiZil\iile celamniimpor~anle
car~ se ocur)a cu fomlim~a.profesodlorpentrn inviitiimfintul
pte?l)iv~sita~~; ~~ afirm~t oil. est{} -Hflilf!Sara pcomovaron! unei
e:duCllpi 'Valid~fe ~Jiin{;i.Jle (eyi~enGe~b.nsedccj~tc~tion; EaE~ dnpa ~
nwdelul_med\cinei 'ialioarc~~inpfie(BBM)(WillinskY.2001 ).
Di.; ttou_ nmintescd\ o psihol()gle e{lp~l}~ona1a-$CO~~a y,alid~ttti
~tiintific-tl-ehuiesliinvestigl1c~ntdtefit:jen.t~_pr(lw'ftmult1ip~ptls,
cfit ~~;vnliditatea re()rieisau amQ(Jelul~i r~oretic cun~l-~1ge~era1, -
.. tJltfe! vom produce mes-me'risme ednca~Julle.:~cola!'"e nprpbate
de Guveml _ ___ ..-.... _. . . . __ _ ___ . _ . __ . . . -i
..._ ._ ._:; Yn.poncluzle. d~it'a~urileaplicnte ale.psihol()gi7ipu au
.. fosr,biA).odatijJ1.tpte de.ce~tare. ele 8\I\lnele Piublenle,.~enrru
a(!eslea. cereetarenfundatml1taHtdinpsiti~!Ggiea fqst meren o -.........}I
snni~ de cn~o~_tin{e" Yn plus.-pen:etnre~ aplicptli ~ni~i~t~d_i~pct in
.n~te dp1flenii ~i-a adus prortriul apon-lallagnjul,tforcttico-
. a11licnn v. Din plicate insli ncestnucleu satilHes a fostcon.ralttinat
.de sf~mdardele domaninlui.tn-care llC"estuaiscipline f~(!{io~e~z~.
Psi~ioJogia clinic~. umnatjnd mpdelul medicinei.~-a fgchlizal
pe.efi~ienta pr~gram~orde -interventie at:eastad~clind ~1neori
laigfiOf~ren ;v~tU11\rii mt}d~l~lorteore,oee. _lVIi>J~n!ea m~dicinei
validat~ s;tiintific (evil.leoe.e:b~sedmediciue; EBM}es~e rrisli uu
psi,1olotHa cljnic~.,"ViiroruJ,Ii'areroaiputindal.penh~celelalre
d~liirni~B.le psU\olpgiei ~plic~tte.Ps!bologianmncii-indt~st'~iula
m:g~uizatil)hala_aft:~st~e p~;re contamjnarli_-r:lestand.ardttl
nu
yti1deriiproclu~wui~j profi('-ceea cea dl}S doar htignorarea
t1rlor.mo~~l~... tt!Qf~tfce.yi ~iJa p~omovaren'nneoria unor. 1
prdceduri cnr~llUauvapditata ~tiintifjca. Din pacatedo~eniu t
industrialleconofi)1c nu par,e pib~i s.cl1imbe shmdardu l :Qi sa
promoveze o prncticli industrialn validara tiin{ific" A~at1ar. o
253
.;_;
 m~cnre pen tnt a psihologie a muncji-induslliata-organiz.ationaUt. ou cred ace.stlucru (ma baz.ez c{md fac acen~La .nfirn1a\ie pe
: -~' "
'
'-
- vulidati\ 17tiin~ific (eVidetice-based-Y'()t\ifln.dustl~nl/Qrgtltl~Uon . ltlOde\ele- deja ex.istente de practica validati'i. ~tiin\i ri~:~ln loate
psycb.olggy~}~fJ:WlOPJ_ trebule sit vil1~~hiat'~~la~H!~#1t!niu domeniile psibologie1;d~iele nusunt intotO.enuna dowinante) .
al psibolqgi~i~ -?sU10logia clinicl\ poate s~ fie l~tf ~lpdelpeJ:(fit! o pute111 acc~ptadtexisutun.demel'salt~mati-v.. tn.aces.tcaz~nsU.
astretde'iM~\:lare. d~i trebwereounqscut yapr~durn-~riiUHlor pentru a nu fi ipoqriti, .trebuie sa nu mai-ptelindt:lq .c.i\ practi~~n
clioicec"Pn-tt~late. {RGl) trebuie sall~modifi~ntlpentni a .pu~ea nonstJ.a este :validata .~tlinf.ific. En este nl.Jfel . con~ormii cu .
n aplicaflitlmn,eniU1ui industrial~org~lizatlbll~l(e~. ~te ~nai greu detne,rsul altematlv. oricnrear fi el.
in acestdomeniu s.a cbnstruim e~anlioaue ~chivaleHt~ peutru f.
studiu). Siniilar, psibolbgi&.eaue~~i~.JttaJ,a-~coladt a Jost
cotitaminaUi.de standardl11.'deqiz.~ei prin:v9f'.~teaclevlitatcii . CAPll'OL\Jl.. 8
adesea ea aincetMt'sn.p.t'otnov~z.e l11Q~ele.deintervenpebaute
RElviARO FINALFlSAUUN~OUiNCEPliT
, pe teoriif~ndatneil~u.e~tiintiticptinsercetarea din psihologie
_.--
I(Willinsky, 2{)021 ). darr~ori 11 te&!atempiric(l) va(jditntea
! . Am njuns !li la capatul acestei analize edUce a psiho~
i. nce.'ltl)l" ~Odf!le .teor~c~ apli~at~ tliiecl coJ~textului ~dtrcational
patologiei en ~tiinta. Ce at!l rem1it si\ Wfiit pe JlOCUT$ul acestei
.sau(2Jt;~~ieuJa.pteooedUJ;Uorde.inLervett\ie/wn1su.lael.abol'ate
'pe1Jazaaces~o.r J~odele. Din fadcilte, in:educafie au ap5rtt~ voci lucrari7 . . . _ . . .. .. ,
, (l)Ca psihopatologii atlprobleme cu si~(emul Jorde d_mg-
(WilUnslcy, 2001) ca,reprQmovearJi o eduentie validatli~tiiu\ific
noslic ~ide evaluare tlini.d1; mai nnJlt. am ~tatat\;t\ p~-ofe."Jiun~tji
(evid~nce-based edltcation; EBJ.!) dttpliJuodelulmedicineivali~
dnl.f?. ~tiio\ifie (EBIVJ). in consecitlta. psihologia educational;ii.. . mai e.l{perimentap nu stlllt ~'" performw.tO ~cc6.lpr~f~ionh:Ui
mai pu~in ex.perimettta\l in a face. ppedJctii asttprn
~co{ma. va putea: beneficia de enetgia acestui n?u valdin
comportamentelorst.ibiet;tilg.rum~rl; . . _ . . _ .
~om~ul-e:c.tuca~i.ei.~-trebuieiusli gij fie aMchi~~aceslei,lnl~cB.ri
t ..

'- (2} ca. intetventiUe ~i trawmentele utillzate mpsdmpalo[ogte

~i gnl& a se nfln pe vaL. altfel va :ft inecat!\. :Sumarizftud, exista
~a11:;e mru-i en _prdu~nd modelul psihologiei olinice, 58. asistlim,
o
sunt de ~ficientll indoie~nica l}i elt .adesea .perf.ortunuta
pi:u:Bp1-ofesioni~tUor este identi~ c;u ceo. a pl"'!~iolli!ililor; tn jJI\Is,
ju vHtorul aproplat, la un 1mtdel generaliz;at de p~acticli
psihopatologii uti sunt mai feLiciti aau mni saniitoi;i dJll. pu11i::Ldc
psiholqgidi vlllidati\ ~tlJntifit:: (evidenee-bnsed. psycbologlcal
vedei-ementnl decllt restul populaU.eli
J;rnctke; EBPP). Aceasta esle pn;wocarea care stli}n fntu (3) Ca -cercelarea flkuHi:de p~l~oRatologi e.o;te adese-a
..
I-
~ .
g~nera\iei actuale de cercetatori :'li pr-nclicieoi din psibologie ~i distorsiouata. condusa de iuterese socio-ecunomice :?i ,_memi
care da acestei genera~ii posibilltalea sa redefiueascl.\ prof~ia
de psiholog :;;i modul in care se va.fa.ce psjh.ologie. Ti1llpuJ va
chiar de fraud a; - . .. . -.
(4)Camo!lalilaten de thdnlng~ifprt~a.retudome&~lll efJ~
alala t;at de- blne am utilizat aceasta ~ansiL Sigur; exis~1 ca
una dep~itM, defensiva ~i ~xperienta cJJIJldi Ill~ ducc Ul mod
po:;;ibllilatea r.a argmmmtlim di, pentru anumite disci.plioe obligatoriu l~ exJ?erUza lii_performa.t:t\a.
a plicate ale psihologiei, modeluluneipractici validate l}tiiupfic
nupoatefunctioua di11 cauzu parliculadliililor dome.uiului. D~i

254
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' promote 11 ntore open aud_lc~s tlef~nsive ~pptu3.cli,. e~pt~ted
- . Here we are at the end of our critical analysis of psycho-
! .
" pathology a~ scienc~, at;tal.Ysis bt!sedonour. e;o;.te"usiv~ revieW
of nv?ilabl? da~a ~nd oru{iri d~sum!uariz.edittp,nwious books
-
.--.
I i ottUus top1c (Beul:ler8l;_Malik,2oo~~~Ja\Ye&i 1.9~(); ~iijenfeld
}
et.at~ 2003; Pnm&Rpss, Ji?9S)~ "\tVboXnretlle.gpints we man
aged to mal<:e tbroughoutthis paper7 ' tioJlB proves. still difficult (see the ense of psychophanuacology
i _., ( 1J P~?ycbopaUu7log!s~ encounter PJ:o~lelns with their di
~g11osis _u,nq clit~ical"eyj]_lyalion. S,Ylit~u; l~o~ver .. we have
showu thatprofessionals are not better t~~~,P~Qft!~:d~nals at
1~mking predlction~ llb~!Jtb\lJnan subj~ctSbeha"lJot, bnsed ou
the cJinicallillalYs~ they perfonu; . . , (4) FLexible trainlng programs, scjen\ificalty validated aud
.(2) Tbe ~trqetilS a11cl flte ioterveut,iriqs tis~~ in psycbo-
patJjology ~ oft~n of questi().ll.fl:ble eJf.u.U~mcy 311dfrequehtly
!
.the pt.:r(Ofl1)anceofparav.I;qf~siou~is identiCilltcitbat of pro
f~sionals;Jn 11ddition. psyr,:bop{ttholggis.br are uot.hs.ppier or
mentnl1Y bellllhie[" thau the rest oftbepopulatiou; ;
(3) TI1e re~eareh performed by psychop.ntlto~9gists ls of-
1 , ....
.ten distorted, driven by.socio...ecormmical.iiiletesis and, some
.I... limes, even a fraud;
. (4) The methods of trainii1g in this area at'e_ obsolete, de~
f~n.sive,_wbile.cUnical e~q;u~riencedo~nolnece.'is~ily lead to
performance ~nd expertise.
Despite U1e5~ limitations~ that must he consi~eced reflec-
tively and constructively and uot by ignorantly denying psy-
chopathology as science which. fosters wilhdrn\.val and a de~
~:rensive attiludefrom ps)rchopathology. 1hereisa 'beallby'' nnd
rtgorous core represented by lhe coguiHve.:.behavioraland the
. 253
biomedicalaJ_Jproacbes reliJ.IilcdundertlJeevldence;-bascd mcui~
cine (EBM) paradignt ortnore gene~lly the evidence~based
. pr~~tice (EBP). Witho!lt h~ing perfect (tlley toQ'ba:v_e been cdti-
. ciz~cl i~tiilsbookl), lhese 'new p~adi~~~~S""- E)3M. and EB p -
. <IS:
(1) Evidence..based iJiago9sis nnd.clluicru eV:al\\atinn us-
ing rigorously -valldate.d psy.Jhological.instrumeni:S <ntd 1abora-.
tory tests; . . . '
(2).Evldence-,ba;;C:dinterventlons; alfttiou~bprC,moUng.ex
perifuentalresults incongruelitwilhsystetn ~yths_and ellpecht-
(ield);
{3) .Basic antl applied resea._-b condt.tcled dg~nvW!Iy. -jn
,:
, accottlan~withthe ~datnentnlprindpl.e$ ~fsc1entifit: researclt
f methodology adapted to the clinical S~lting;
adapted to the requireJnents tJf a couthtuou.c;lychauging profes-
. sional domain. .
, TI1e evolution of psychopatllOlogy as science r.ests on the
. de\elopment of tll.iti rlgoro\ls lln:oretlcal and metbodologic;al cote
and the coumge to promote it. For eiaruple,lwouid be pleased
) to &ee Sig_mund Freud listed in tbe historical references sectlo!t
. ofthe current books on psycltopalltology, itiStead ofthecurreut
trends aection. Honestly aud scientifically speaking, without
emotional biaseS, in the era of evid~uce-basetl litedicine mul
.;evidence-based pl-nctice, Sigmund F-reud's place is iu \be hls- .
tory chnpte5 or, at IJie most. nuder the probably efficacious
1 npproa~hes section.lt is a tnisforlunate habit of the pm;~l9 be-
.ginlhe theoretical approaches section in altnqst eyery boo}~ of _
'" Jisychopalbology witb Sigmundlitaurs psy~lioiliaiysis,,iu tl1e
lack of data (see Appendix 1-the list of evig~ncc-based psy-
F-hotberapies) to support the scientific basis pf most ofl.hisa~-
. ~
 proucll {see also the f;fiSe Of Other dynamic-p~ychOi!Oalytical
and humtu1istic-existentialapflmacJles). On,()e. othttrl1aqd ,. if I
nlll. mislaldng aud.thetimasupporting the yalic}ityo~ Sigmund
Fren1.slheo_riesdo e~st:,tl}llY are extremely well hidden and :i
guarded byth~ii proponents. This does not mean thatmnny of . I
;,J
Sigmund Freuds thc.s('!S (oro~ otherdynamic-psychoaoalytical
and hnmanistic-existentialapproaches).couldnotbe confirmed
8~lentifi~ally. bttl: wenn.sthave fl1e CCJurageto say thnt Until A~den'tiuRamfinii(1996). Dio{iomuul oxplicativJJJ limbi~
now most of thern have not been confirmed (they wer(} romn~l]niV~t'S~ncir;.lopedic;'Bl]cure~ll~.;' . .. . ; I
djscontirn1ed or wejtl~L lack sb.tdies about them) and that psy- . ,6..~kerman,R. ~iPeRubeis. RJ, (l:9~1 ). ls. depr~ss1ve rel
choau:nl.yal~ proved to be just al}.htter~ting_.story. If tlterlgor- aUrm:treal'l. C![ialcaJPtlyCbCJlouR~Jviaw. :IJ.,565-584~ \ . i
ou~ c(lrc cop~q.nted by~ cognitive-:b~l1a"'ioraland the bio- At\;.\stasi, A.. ('lo9SS).DiffCJ"PJJlliJipsyaholagy. M~o~1' llan1
medical approaches reunited under evidence-based ntedicine.is NewYoTk... . ./ .. . . . .. - ... . . . . : ... i
suffo~nted:by>tbe pset)doscientifi~ practices described. in this . . A?da,:l~~ ~i colab~ (199~). Dltpr($sed nffect, hopeles~ness.
andLhetisk~r~~hemi?h~rt~iseasdn a cohoTtofU.S. ndults
boo~ and t~l&::lack of C?'uage to dispose o~ pastha.bits, psycho- 1

pathology wdl probably end np an inpatient of history. EpidcmioltliJY. 4,185-294.. . . .... . .. . . .. . . . . .._. .. . . r

Andecion~ J:R.. (1990). qo~Jliti~c_pSychology and11s Jll'1-

. plif:nlions. WH Freeman'fl~d Co~pnn:Yr }Je":' York. . .
. .J\hgf!ll, M:(l9ll~?: })isease as a raflectl~l1. ()f_the psyc~1~
r~cnmtiai].,NB11il. .T. :Nleil..312.IS10~1512._. ............ > 1

Antonuccib D~O? lii colab~ fh995). Psychoth~r.npy-yersn,s

roedieatioh{Oll'.rl~pres.sion:;Cfiallen:ging tire co~vention~l wi1~
I. ~
tlomwilhdntaoPmft:SsioJ]nlPsychology:Rese~tre/1 mtdPPt1G
. -~ -I
tlcerb; 574..585., .. . . .. ~- .. . . . . . .. . . . . . . . ' ~- i
.J\PA (20U2). Gtiltluate Srutly Jn.psyehology. Amcl'tci:)n
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.;APsy A(1994}..Din!Jf1Msticnnd&tnti~ticalmnntJ~l o:m.efJ-
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Washington. . . .. . . .. . . . ....... . .. . . . 1.
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263
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. . . ,. . . . Q~~d~t~,1f~ij?Jmi,t~~l~~'f.9J~~~~. ;. :".i~l~~~8r1t~cit
..
' .
.ttitowledgean~ impucaijons:for~~~t~~~. .,!~ft\&tUtt~c
RSychotb~ntPY~ JiJ.(f!nJ;gjon~l fR:TJfll8l.of ~ ; :~~f? Ps)'r::ll~

-- ..r.-(
<'~~~\~i~~:~~~;;;J~
( fess~c:tn~~lU.p~f~~~JQ~~Hl~lp~~~~/?{~~~4i~!{~.fJ,
96,
&();:..92.;,." "< .' ...,,.,,~"" '. :\i . ... . .5.:'t5J"
j !.-
. ... : . E.!l,.i~t~J;t~- q:i .Q!JJ'!};_~!J-:Q~~~)f~~tk. )lQ{es,.:;
. ;.. ~l~ij, :-p~i,,,~f!n-\~~rJtf. .. . . . .. ... G.}~~~bood
i!ftiuina and"O:dult fi.IJlCtloniQg. Ill. . .'llll'I!S,.~~leg: Re:.

'~--~~~;~~;
. ~y~,,.~t-{~Q{):t.)~ ,g;~~yclt~~ogyl:&ongrpd~tve.r.~ollll'or
on P.\")~olDgJ';Vel. 32,nt. 5i. . .. .. Y:f+~:-~t~f\~: ;":~h~;:,: .
, _.....~:~l,l$~m: ~~~.lfh~tJ. f:l:~~fi~J'I!ci#pil~s\trt~r;bttdJ;fsk. 9(
.~~r\l!i4iM'!IfiJ.E\~~!l~~~f:n..,:yo~~w Wailttcancer.

l~
-~~~~~;:..#' ;:. "''
.
I
i .. clJology: A stutfenrs' ha1Idbo,ok.J3l.ll:i
' .. Fawz}';''F~t 'si tolalJ,>f~~9D)~ :.
lene.tltiOll f~r c:anc~ J?&ti~~:;srf~~ : uu
h?t n,0logic~P1el)&utes~ ;k:roJJ~ ~~ ;.,.
. . . F~tia!Jger:i~~{t95fJ). 'A'~''' , . : 'lBnet:;
Stanfun:lJ.lni~ersjty Pres~: S~.B~'Sl~f ,, :.,: .,/ : 1'; ,
.. ;'.:' 'lfeye~\jen~~~P;.( t91i15)tti#lif$tD!iiili~ V~~~~k~ndort.
. P.tallk, )J). (1913), f~iltlPnllJl'r;#b~:((~J()lJi)HopldJJB
. Ifu~~~."";~.~~~wiog
u1yooarolai,ibiflictton::rtnpaci1otfl : .llqdiSurlr)~. ~1tJ,27q
1819i~ T, ~~,(~t~~lp ""-
p~l bood now in patients :WitlJ tnJCiaf(Jno\iia'J'feated With

l
1.61
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271
 i

t;:r.""p~li~. I!:{t9n9), 'J"h!; /lingntilis andpri!!t~pfis, ,,tpe- .

. . Kenclall. P.C~ ~i colab (1999) N - .. nron~pljJCCDX- ~rpr.....ied at the 20th q>~-..if Sooth-
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Szasz~ T. {1961). The myth afmentalillness. Dell: New . Wnso~, D.!fiClark.l..~A.. (1997) ..Th~ ~ne1wo~ern~nL a~d
Yo-rk. mismasurementofmood:. ~ecnrrentand.cmerg~n.t~ssue,s. lot~-- '

Tayl~! ~ .R 9Q93). f>{}$1tifttll/1iJ9ian~.: Creative siuf-dB .naJo{Pm-sonsBtyA$stl9s.oltmt. 116.261-~96. _. . . . . .. . : . i

c,p/ion llfl(Hhc"hciUflty nund BJ\Sic Boeik:S; Ne\vYork. :: Wa:mon,D, ~~Pennebaker, J. (1989). Health co~npln~nts,
' Thomas. ]j_B'. fjfcCil<ib. (2002). R.artdtnni.zed trial of breast stressi and dis[(ess: Exploring the cenrrnlTolc of negnt1v~ 1)l'fec-
self-examinAtion iJiShanghai:Finahdults. Journal ofNationlll tiviw~Psyehologicn1Review .96. 465-49,0. . .. . . . . . , ..
Cam:eriusi:illUB" 19,. J44.5-1457. . >Watson, D. ~i 'feUegen;A.(1985).Towi\rdn~on~~~stla\
T-oulmin. S. '(1953). The philosophy of sCience. srrucn\reof mbod. P.~choloJ!icnl Bulletin, 2. 2"19:.~135.. I
Hutchinson: Londnn"
2.80 281

\ ~ ...... ~.--. - . ~ .. - ~ ~- .. ,. .

. Watsou. M. =si colab. (1999). Influence of psy~l_19~~gical
resrioris~~~if survi~aJ iri breru:t c~mcer: a poimlalj~~['{jfised co-
hod st-u{,ly:-.GriJcet, 354, 1331-1336. . . --~;; ,: .. :.
,, W~t~il, D. ~i colab. (2002). Silllplifying djagi~cisisusing
a protqtype-nmtching approach:Implicatlons I or ~e next edi-
.
1
tion: of the DSM. in L':ti, Beutler ~i ML~ Mafik. (Eds.), Re-
tb/IJldiJgC/ieDSM. A psychalbgiculpenpeccive. Atn~clcan Psy-
chological Association: Wa.~Wnglon.
Williams, RB. ~i oolab. (1'992)". P~o~uostit importance of
,l . -.. sod.al and economic tesollrces amohgtnedic::aUy tteat~d patieuw
. --
' wiLJt angiographically documl?nled t:oJ:Qnary artery disease.
fA1VA. 267. 520-524.
Williams, R. B. lli Schneicleimau, N~ (2002j. Resolved:
Psyfbosocial interventions cau im~tove clinical outcomes iu
i org*nic disease (Pro). PsychOSO!D. ft{ecf.7 04,.5:)2-531.
' Willinsky, 1. (2.00 J). Bxte~tdiilg tllepr(}&pecw Qf e'lidence-
basf:d education. InSigh~ 1, 23-41
Witlgeustelu,L. (19.:}3}. P!Jilosopflica/iJJve.riigations. Da-
sil l3lackweU: Q;>tford.
Wood, J.M. ~i colab. (2003). Wllat's wro11g nitlJ cheRor-
5c!Jach 7Science COIJ.Ii'OIJC$-tlJe conlmvessi~J iJJkblot ~t Wiley:
r New York.
. Young, J.E. (19.99). Cognitive t/Jerapy forpersonalityws,
o1.ti~;s. A /)C/ie.ms-focasctf app.I:vitcb.. Professional ResourQi!
Pt-e:js: Sarasota. . .
"
r:
l-
282
......
ANEXE
.
ANEXA 1. Lis'rA 'I'ltA:t:AMENTEL(m
PS~O'rERA.PEUTlCBElyALIDATE~~'IDN'flFl ~I
lNS1'ROCfiUNl DE UTILlZARJJ: A LOR.
Copyright-ul penttu aces_le jr,rom1a\ii (~Ude pe bnz.n ~ote1or dis-
rronibile 11Anll in 20tll) opar(incs Asocia(iei Paihologllor Amerj_c::pni -APA
- (fmpY/.www.lfPa.OJ]l).lnformatiUe APA n\i fo11titrtbogll\ite cu clnriridlri
:::d e:xplicntil ale. auianlui. Mulltrlll.esc domnlfonre( p~IJr(l(og Bluncu
Mocsvei penlru ~utorul dat Ia pregiiLi~ uceeteianexe. I
Terapiile inditate peutru fiecare tulbur~i:e prezentaUi mai
jos au fost evaluate, din punctul d~ vedere n1 eflcieo(ei lor, cou.-
fonu unor stimditrde 11tiiutifice rigtlro21se. Pacientii iitclusl tn
acestestudii, care au fost ltBtatlcu tehniciletnetlUonate tn aeet\SU:\
aitexii {1) au avutre~ultau:i mai bttne dedit pac~enVJcareuu au .
primi t nic:i un fel de tel'apie, sau _(2) au~a:vtit remltnte eel pu{in la
I
fel de bune en-pacientfi tratati ~u l altli~ronrii de torapie cares- "'t
h doveditdeja eficientii. 'thrnpUle lunb: tu discutie fli-nu tfoyedit
eflcienta in mai multe studii (eel putiJl dona pentru a fi uuu:ute-
terapii validate ~tiinptic- :,i eel pu!ln unul pentru it fi.fluntite -
Lerapii probabil eficilmte-), t:eali4u.te de iuai mrnte echipe de
cercet:Uori din centre de cercetare dife.tite. in plbs, acesle
iuterventii tenipeutice sum descrise delaliat 'in uumtiale de
tratanient. care pot .fi folosite de alti lerapeuU inlr-.!_JIJ mod simi-
'- lru=, pentru pacie.nti preieuta:nd acel<i11Hip dep~f?.leiite.
Majoritalea ternpi_ilor luate in discutie, ~~- .!p~i: evaltlate
folosiml un anunut tip de studiu ~liintific -:3(i1iliUe cliuice
283
 controlate (randomized clinical trial; R.Cl). Accsfea suhtfolosite ~ ;~ii.W,.$,~~~~~#i~ll.,._,.~~.~ l{l
pacu~ntu~ .A~i\iiar, dac~;~n~lll~ltlt.e;::hA~~n~ r.~e,dllM~ld;re
in mocl curenttn miUorit-atea rnvestiga{iilorpentru a detem1ina
cnre re~-apii sunt eficiente pennu o anumiti ulburnre. Intr:..un ~J~~.~~~ . ;f~J()sjrea,qngtalt~~~arclrri
sl'udiu slinic contralat. pacienfii afectati de o anumitii tulbufllt-e ia~. , . . . ,ta )l~t. ;;tJqs~ fn~iitev~ltil.ftJ~m~~':I-tm
{ex.. depresie majori\}$1.11il d~$ti-ibuiti randomizatinrr-una dinrre
grnpele afcrcflte terapiilor ~.hate. sub investiga{ie {a. tempie
tnterpCl"S~~~ tf?rnm~~~~lifq:lh.~l\~~Ul~~-~~je antidepresivn)
:!f.~ .-.1.\l'. ~. r . .~ ~. ~ ~~. re . ;im . . i:l;u.~i~. im . .~~.~~.: ~c. ~J~.
tiJn
.e~~~l!lJ~~ii{Jti,intit:iii\it}stlfilp~t~tigie
a . .e.
ltJ~ . '
. ...c. . .'.nm.::. :. . . ..
....
)J.'..
.. ..

....ll.I

c~a$.mb
.... .. . in
e.
.... .... . . ..... . ..... .. .....::.:.
i,pa~t~t:[anQn'i~'bSre~~~~;(;.~lf.~;r;;
''l'tel1cie rei
~i In tntplil~~T!antrol.'(~x:!J]\l ~~. ~a ..t..primesc un
~~~~~~Mtt~UtliUa!ili.P~lW-1d161utb:Btlt. . WI!Hlo). Modul
de nfe.g~\;~a ~i~t}~~l!lii;!~litll)\i:~~1~fllttmfailtt$'el mni inatr grad
posibU (a~ ~i~mplii;rratnnlentele s~mt de;ac~epf}i d~mrii,
oferite. !!f te ti:, v !Ji.~~~perie~tfio e't'd1)!tpe~tru" a se
.. ClJ ~. . . . ;~l~kcl\~fJE~ixp~~ndi canstii
.l.
~J

e." .#~~~~~-~:: . .ml'"

E'laltl~ eficienfeiijceg[i,i'toi-rhecle't~~pie~~a fli.::t~;dupli '.J
'
.

criterli $1liif\tifice strict de~ina.~~te:al).ll)~ttn f!~nsiderate

~;''~, . ,;~,~ateJ1i'~~tecil'Yl;Y'rt'''nu,:~&~~'~!n.~tP~~:ria~~i~~~~~Mliiteril~
. atunci se lltilizef\ZI interven . . 2ti~fl''.
''sa
~.reJ~.h.h
ltt~'chr;
he
~
....
. ,
.

~~':ti~!lti~mt~~.opiiHite'wr~rn~~~r~~r; }~~&.m"lill~,~~lf\ !5itdii ~

':::~~r!tl=:~~~f:
!l~~~!lfF.Q~!f.letiau,dt-iff:C:'s.~~~e.~~~n'' :t~'f#~~'~i, . ., ~~ui,t:on:.
~~lz;'~~"~:r:sDntd~'oU\tfb.ut~!fn'liindiile ate1it 'Cli t11t~ .~fera
.;f~~~!:( . . . ~~lifO~nfiril~&pre~fiei~ft.\;p'S~.i&i i~i, ,,;,, ,.
. . ~ \I~. ..t~iA~'~&J!tl\l~:f~~te'i;urr~~clt~ae:~ ...... ~~!?~~ vor
~~"~Jl~ntirei.~lf~ tf\'tii:jq~~ '~~ '~jlili\s Mest i\tc<u ~e ,:1,.,:, !,C\}n!i~~fn~un,stl1dft:r~l1tl~~rautenz~ ci1 aces{l\ vq..fi'Jl;t>~i. He
.. ,, ,,.$!, . .A~:~~pt~ll\~' ~'~JI~ea~tf'#~ati fost~gy~#i~F~".i~~fludii ' ;eficiefit perttm oticnro dintr~ iPel'.soanelo. chl~'se'r'pr~~#tit Ita
,,., :s~l~~~~1pttrMtlpifnier~tf mtmjiiJrillfl~n(i!ri~~~'{~)ii;eutin .fl.Sihoternpie~.Pentru~~ stabili duca acest\Jcm esre san niMnlu~il
, . ;(:OO~i!\qJ ~~~,~1~~ s-a1:'fil''ttb\re~t,in~t.ici~li(eI~ii. (lti,oxitiai<e: tn cr.znlopei UJlumire,persoane. este recomantlat en rer~pcn~ul

ddc=~~~~~~(.: ::fi~ .
. ":'!.' . :!~Hi~ ~~Ji1J~uifostfriell in~~'!lt~tt!:$~nr}jii~~,~~X~~~~~Ei~n1e
, . , .. t,o,~llf~r.lq,.a~teqJndi~lfest~ recilm~~darcapn~e~~f~isbUGlle
' ' 6i'ti~~of~~~p~u1~llnd.\a~t~t;rttfun-,entecate'~~~t1Adti{;e(}it
~Rifltl~lli~~a fa ~a~-atf ut.otS'kldiidontrofate~ o~fil\,,nici mjicar
}n. colabor!lte eu P.aci7mul: (1) sa. i-7i stal-,Ueasc~ (ll)~ei,U)e
.terapeuti~clar~i (~Sa ..stal:lflensca dil1ttinre cum V()r ievaU.a
ptogttselt flicure in ating~ea.scoBuulor; (3) sa monirhtize~e
a~ntprogresele im~gj~trate ~i (4) sli fadi modi Iicari rnl p.hmll
l}e trammthtc.find,qpnstata Cantl Sff inregistreaza pro!ve:.;ele
sconrare. . ; \
. ,: . \1

284 285
 .. .: .. .

-.

..
.
'
.

~---
.... ::. ~ . .

287

'
.
.. ~:
. -;.... ..
. , .._,
;~.
~ ~.

.- -
 I
..
1~ Agol'ajobia fl tulburarea tle ttlac tlc p;Lnicij disfunc:tionale. telinici de respiratie penLru a controlil l
i
Atamuile de panica se caracrer!zeazi prin dec.lan~area hipervb~tilatia in ~azul at~culll~. de pan~~a. explln~rea . 1--
bmsdi a unor episoade detonma intensa.1nsopta de mai mulle interoce(lliva pentru e\in1innrea reactulorco~dltt?nale 1~gat~~e
simprome fiziologice en: pnlpitatii. tahicardie, tremuditnri, senznlille nsem~nlitonre panicii. ex.pungrea m Vlvola Sltu_atul~ ;

nn.i:.iog~ne peimu a sHibi asocierile e'xisrente intre pamdi_ ~1 : I

tcanspira{U; senzafie de sufocare, durefi. de piept, greata~i dured
nbdominale_. t:~zatie de ame[eilla lli l~in,.dificultati respiratorii.
frisonne sau puseuri de clildur~: fn cutsul \lnUi atac de panidi,
por apare frecvent renma)e moartc .!iilsau pienJerea conrroluluL
De reguUi. in primelc empc nl~-lnstal~rii tu1B\lrl1rii aracurile de
panicii !iC d~lanfieazii_spo.ntjlil. Ulterior.-acesten pot fi insotite
de evititrea agorafohlcil Persoanele cu .atac de panicii se tom
nneod slt meargltn locuri unde le-ilrfi.grou sau m~inos sliobfinli
ujntot sau de unde arfi dificil sll se reintoarcli acasli. in cazul in
care or avea_tlfi atac de pnniciL Evirarcn daro~-atit faicii fa(il de
posibilc ntncuri de paqioa se nume~te agomfobie. Situntiile
f-recvent evitate inclod: m2}gazinele aglomerate, staU1lla rfind,
cpndnsnl maljiQ.ii. folosirea lifcului, restaurantt!:le, Wsericile san
d~J:1ilrtnrea de casa. . cronice insotite de mni mu1tc manifesdiri fizice ale nrausal-ulu~
Tcrapiile dovedh:e clar n fi eficientc in trntarea agqrafobiei
inc)ud: (1) terapia co~itiv-comportaJ!lentalii vi (2} terapin
.comport~mental!l prin ~hnica expunerii. De asemen~a. el(,ista
lJ!lel~ date care arati.cii troining-'nl de comup1care inpuplu poate
cre~teeficieuta expunerli in trat&Jlll!lli:Ul agonrfobiei. Temp in cen
mai e.fici~ntli in ~o:tarea atncului de panicii s-a dovedit a 11 terapift
.C
comporl:amentele cvi_tntive. De asemenea, ~n_cazul ngomfob1~~
. tehnicn eX.pl.ttierii se utilizes~ ciind e$e pos1b11,1n cuplu. dutonm , i
:...I
ezultatdor superioare obtinute asrfel. . . . . :
Ointte srudiile. empirioe asupra eficientei acestm tmfll!-llCllt:
enu~erlbn: i
-nndow ~icolab. BehaviorThernpy.20: 261-282, 19&9;,.
Craske ~i co1ab:, Behavior Therapy, 22: 289-'304, J 991 ;
lQosko lli-colnb. Journal ofConsulting and Clinical Psy-
, chology, 58: 77-84, 1990. .
. ~-.r
2. Tulb11rtirea tla an:ri~tate ganeralizatli
: Dtlpl1 cum sngereaza ~i denumireasa. tulburnreu. de
anxietnte generalizalii se caractelizearl\ prln p.rezenta anx~et~l'.i~
fiziologic ca: tremuraturi. nelini17re ~i tensioriare. obo5eaH\~
difieultl1ti de concenttave, iritabilirnte,. tensiune musculnrar
tulburari de.somn. tn plus. persoana se ingrijoreazlt excesiv dr;
lncruri.te negative can~ is-,arput~ intmnpla !}i tntiimpinil dificulfit~
'in a-!li conuolft aceste griji. i

Terapi{\cen mai efici.e~ta in tratarea anx.ietrltii gen~mlizur!!

.. ,
.1
;_.!
. cognitiV-CQmp~rta~eqtaU[ ,E.xisUi fji date care sugereazii c!i s-a dovedii n fi. terapia cognitiv-,compmtarnentaUi. De asemenea.
fi
rcla~a1ea -aplicatii ar putea nJiUi tn tratamemul atacnlui de ex.istii_ unele date care ~rat5:ca relaxarea aplicnUi ar putea fi utila .!
pantca. . .ln rrniamenmt.anx.ietatii generaliznte.. -: ~
~raramcmtulAlbany pemm c{)ntrolul panicii in mlburarea 3. T(llfmraren. Qbsesi.P-compulsiJn
.. de n.t~~ de,panicil . fii agorafobic (Tnravsky. J: ~~Barlow. D.H. .Obsesiile reprezihtli gl\ndmi repetitive inrruzive .. A.cest~
, The Clini<:~l PqychQlogi~t. 48. s-6. 1995). s~'intemeia:d. pe .gllndud se pot referi la: ranjrea cuiva drag fttlii inrentin de tl:l
persp_!!Ctiv~ cognitiv-comportamcntaU\ fli folose~re merode de riini~ contaminareaen germeni sau mt1rdiirie fJi teama de n n_u
educar~ a pacientului referitor la specificui arec{iunii sale, tehnici
de restrucmr!lrc- cognitivij pentrn corectarea credintelor
o
. fnce greea}ii groaznica. Cornpulsiile sunr impulsurj exrre1n _
de P\ttemice de a repeta la nesfarllit un am11~1it comporrnment
288
. . . . .I
289

."""' . . . .
 .... . .;
sau actlune, ~i sunt legate deseori de prezenta Ut]ei obsesii.
Exen',[>lt'}~.compul5li rep.[ez:h,ttii::>pal~~earepetat~.~l~lainHor,
v~rificatea sobelor sau a u~ilpr ~i p~$tt<it~ c~ifedt.e~or tucruri
de~i a9~stea. ~u.au nlcio valoare ~~filimentaJ.ii s~u~:nuu1etara.',
Pecldru1'eie'cfri.ulburare obsesiv-complllsi vaprezintn' fi~ ~bscsii,
fie compulsli,Tie ambele. . . .. .. ... . .. _. ._..... . , .
E"Jtpunerea ~ipreven~iarit'iptfusu1qi wnstiluie. o<:~~n~inatie
.:-::....
de tehniei ~ompm;tament~e dov~ditli ca ~iuclellclenta in
(T~tatJ.Ielltul tulburaritor (Jhsc:siv~9()mpulsive. J:)e ase!neoea,
existii 1.m ele d(Jvezi care aratli. ca terap!a cugnitivii~. I?l1tea fi un
.
,-
I
tt~tament util1Q tulburarlle gb~iv-comJ>ulsive.in pJ~s, o suWi
de date .sugerea.za di utilizarea ~1.0ui progr~1Jn specific d~
preve~1ire a recaQ.erilqr ar Pt1~a ~\leepr(Jbabi:liLa.tear~padtiej
probl~tuelor dupici lnclJ.eier~ntr.ata.tne.nluJIJi.
4. Tulb~t.rarea de ~tres posttrlLrr1!lj.c
Persotiuele, c:arc. s.-atl cqufrunta.t c~ ,()_.situati~ ~rauumtidi,
a,
fi~:din ppswe:i .d~ victim :ijediq postu~ii demad.oJ:, attuneori
diJl~;ultl1Jiln a~~i rev~nl dup~t.ra.wua.A.c~ti~ :t:~trruesc uneori
eveo~J,D.elllul Bl:lb forxui~cptnar\1rl ~B.U ''fla&b,\Jac\r,-urf:\ Se sintt-
aJlxlO~ilSaU qeptimnti, $~inl.t.incapabill sareacVOJlezeemotioual
.~a.usontnemult9inill deviatalor. Dacaaceslesimptmncsetneu\in
~n~lo de o at,umita perii!Jac]a co.nsideta.tanoruala penlru
rendJip~ade dupa tramulit persoru.ta at.putea~ufeddetuibunue~
de strea postrawna.tie:(posttraumatic stressdisotder + PTSD).
EJtistil. unele dove?J carearaUi ~a terapiacoiriportnmentaUi
prit,t ex.puuere est:e eficienta iu tratamenlul stresu1riipostttim-
. i.'- U1t:l..tic dezvultatiuurnta.evenituenle1or ex.tt"ertte apat"'.de in vin\a
l cotidiana sau pe:campul dglupro .. E::tista. de asemeoea, uuele
date care sugereaza ca reprocesan~a ~i de.'iensibilil;area prin
r' ...
mJ~carloctllare mpre.rint~ u metoda util.a(ffiracateoriH acestein
.'
'
sa fie v.ruidata ~tiiu~.fic!) in trata~nentulsuesului po~~traumatic
clezvoltat in. unnn eveuimentelor e.:ttreme aparute in -via\a
-. colidinoa (cum ar fi violul).
~
290
,: . ----- ...- .....
Terapia compottamenlala prin expunere repre~i.tila o
,~ategorie de. tehnlci care iuclud~: deseJ.1si~ilizat:ea pr\lgfesiva
. Onvlvo !JBU :inhungjnar), fl<mding-uliiuviV(J ~niuiu intagjnar),
. ler1lpia imploziva, de.Seasibilizar~:tprlnnul~~1Jlrol, m.odeh.trea
prutidpaliVa:ji alte tebnici.asendulalu~..SC{)pW: u~liziltii nceslor
tehni~i penttu tlntamentulst.resului posttraunll1tices{e de a accesa 'J
emotiile asociate evenimentul~i .tr~llmatic. 11i de i. sustine
. p.tocesacea eJtJ.ollonol~ vaz~t.'t de unii t;~ fllild. elententul cbeje.
in tratareaace3tei tulb~diri:. oe.t:~g\lla, l:oamJonnel~de temple
prin ex.punere (in vivo sau ill imagitutr)"folosite tntt:tttatnentt' \
PTSD presupun confruntat-en. inu-o an\).mita mtisurH., eu stinmli
~SQcia\i .evenimentuiui_Lrl)uii'latlc, proctdJJ~ e~ ppate sa fie
a((Qmpitniatli sau h~l de incerca.reu de a 11.1en.tine.1.1 J;t.nre t\e
t~laxare. Dintre studiile elJlpirice asupra ef!cienJei. act:Stui
\l:al<llU~nt enutneramt . .
~ stu.diiefec~uate'pe v~te!Qlli thboj: de
Bt:.udewyns{P.A. ~iHyer,L...lleh~vior '11J.erapy, 11,
63-87,1990; . .
. ... . . . . . .
Cooper,N.A. ~i Clulll G./\ . BebaviorTllernpy.20,lH.-
39J, 1989~
K.eane.T.M.~Fairbank, J.A. caddell,J.M. :JlZimtqerlng
R.T. Behaviqr Therapy. 20, 245-260, 1989.
-:. ~t.udii e[ectunte pe femeicare au trecut prin e~perientn
violului:
- Poa, JJ.B.; Rothman, B.O., Riggs, D.S. ~I Murdoch.
R.l.\., Journal ofCoutJSeling ami Clin~cnl Psychology. 59, 715-
.723.1991.
.. ~ nlte studii
Keane, T.M. ~i Ka.loupek. D .G., 11te CliuicalPsycholo-
gist, 49,7-8,1996. . . .
. -. :::. .. ,~ Jlneori, abor(\fuile clinice ale PTSDsuplin1~ii~aia tei11pii:t
p.dn expunere cu diferite proced\.n"i cugui~ve cafe -vh.em.n
sentim~ntele de vin.ova.~.e. distorsi~nile .cogl~itive~ credintc1e
iratlonal~ sau valorile disfunc\ionale ale padeululuL Ace.')li
'l9l
 :"'--:---~--.----

.. --Willirtms, s.L.is,i Zane. G ... Beha~ior Resea1'Gh .mitl j

ndjuvantfcogqitivi au atat snstinere leoretica. cat ~~ valonre
intuitivli. in~a sarcillA de aledovedieficientaempiridi rlimfine \ Ther~~Y? 211 '>37-2~-.5, 19119.
6.F.obiile.socitl1e ~i(ln;l;ietatea dtut vorbl m.publt,c
. . . . .. . . ~
._1

(
un obier:tiv prin&ipalnlstudiil()1~ viiOare. . i
5. P.okiile specifics . . . Ilersoanele afectate .de fobie.godala . S~\nt e.xtrem d'e ~ ..'
J?obiile s:pecif\cc se ref~rl\ til ex.perieo(ierea unei frici in- an')(_iQQ.Se insitnatii carermpb(:a interno\lllnea cualrepers?anf
tense p iraponale ]a conractl;ll cu un anumit locro sau sittlafie. l?enri:unnii, pce)lStii ~~~m~i est~1inuradi1av()rbitu1 m.-pllbllc s~u
cum lli- fi~ iniUtimile. fu~ronile .conclllcerea>ma~inii. vederea nlte sitn\ii s~cifice V~l}trn ~l~~.oti~e ~toa\1~ rn 7nr7 n: puc~n
&1\l"lgelui. diferlte ua~imale sau )ns~cte. sau ..patiile inchise.be~i iriietn6\iont\ c~ nlte pe111oa(le .~onshtlll'? un. n-.ou~. i:le tea~~a
mtdte p~rsoanese confn.Jntil~u ilstfelde te111eri, nu lf; vom numi extrernli. P~t-sotmele cldo'biersocjal~ depun un ef~rt substa~(lrl
.J
.
fobiideciitdaci.acesten.interf~azliputemic cu vjata individulni.
petttrl.t aeyitasituatWe soci~_le~ ._ . . . ., !_
pcQduc&.nd lis~ 4ilsao disabilimte. . ExisUi dove~ ~a~e arati\ ci\ In prez~nt CXlS[~ mn~. n:u tl,~e.
Cel mai eftcient tratament pe1"ltro fobtile speci'fice s-n trilt!lmente eficiente R~nt:n.t fobia socialif. pl"intre cnr~ ~era!~'~
dovedlt ~.fi t:erapia conlport.amenti:lliifolo.sindexpl.merea sau ..:J
cbmportamentallit1tin expun~re fiidesel~s~bilizlu-ea progn~sa yn
dobitqdireil cornpetentei In plus. existi1 unele date care aratll d
$i desensibilizarea sj~ltematicti, o fomiib asemtinlitoare de . ~i 1ernpia cognitiv-compOJ:t~mentalli de ~P . . . . .. . . . . I ~ l
h.1\tamenr, ar n cficientll in rezolvnreafobiilorspecifice. Terapinprinexpunerellt tra~amentnl.fobiel s~c~a15 ~~.e~fa .i
Tratamentul de do1Jiindiie a competenteieste. o'abonJare deJaasumptiacaanJ(.ietatea legt1tlideexpu1lereala sttua{ns~~t~l~
terapeutica baznta pe performantii. "derivo.ta ilin teo ria social- .vadesct:e!ite o datli cuint~lft.iroasistematicli ~i repe~nl~ ctlS!lm~.ltl -I '
. co~itivii; Di11 puncLul de vedere.al acestef leorii;disal)ilitarea a1nenintatin~i~A~e!iti stimuli varian de ln o scurt~ dasc~;~~~~ c~~ o ...!
4i distresul apin1tc in fobli se datorea2li :faptului .eli indivhi.i Qi-
nupie~ot S!!ntimentul de a\llo~ficacirnre sau inc'rederea eli pot
perso~n'ti:l.leC.unormu~a~pfinllaodiscritiefoTl1\ala Tnpttbl:: iYn
ca21.llfobie.i. sociatt. tempia :prin expunereeste iogreu~1.litn ~e
.. I
i
'

sn f~cli fatli cu bine situatieisan obiecntlui fobic:~ f'-stldar. aceastl\ <\nQii> aspecte;. (l) <vari~\)ilita~a sittl~tiil~~ fohiC.~ ~i .(~) '
fom1l\ de terapiepune accentUl-pe interactiunea 1lntre terapeut inpredic~biUtatea p incontrnl~bllitnteasltuatulor soe1ale, c~1 e
$i.pnc_ient.'in .car~ prinmtapeleazala diverse telmici pentn\. a-~i i' .
tngreur.teazaexpnnereainvivo. . . . . ... . . I ~J
njuta p~cientul sa &e implic~ ~i sa :rezolve cu succe~ diferile 'Dintresu.tdiile empiiicensllp'raeficientei ncestui wuamynt
$arcini, dobilndindsentirnentul efici-en{ei liicompetentci. Dintre e_numeti1~n: < _ - . : _ _ _ _ ., __ _ . \
studiile elllpirlce RSl1J?f!'-.efii~~teince~tuitrarament enumeram: . : "J\lsJ:rom, J.E. Norlnnd,CL. Per~son. G., Hi:lrding.M.
Bandnra. A~. Blancbaril. E.ll. ~i Ritter. D., Journal of
"_..;

t;:iLjungqvjst.Cc, ACHtPsycltiatrica Sca~tdinavica,70, 97,..1l 0,

Pers~:mality and S.ociat Psychology,l3,173--'l99 1 1969i
Ban~~Jnl, A., Je~y. R.W. Ili Wligllt, C.L., rournal of 19S4; . . .. . . . >. . . . . .....
.. . E.mm~:;lkanlp,P,M.G~. Men;cn,'P:P.A.. Vissia.E.~i.'-~1\\\
< !.
; f

.Abno.rmnl Psychology. 83,.56-64. 1974;

.. den)lt;:lm.M. HebavlourR.eSeRrch ;.md111ernpy . 23,365-3f9,
Ost. L . Salkovslds. P.M. ~ilfellstmm. K. Behavior
Therapy;22. 407..422.1991; ... . . .. .. . . .
.1985; . .
,1 Feske, U. ~i
. . . . . . . .. . !
Chnmbless,. bL. Behavior Therapy. f6,
!
: .
Williams. S.L Doo~eman;G. Eii Kleineld, E., Journal
. ~fConsulting and Ctinicl\1 P~ycbology, 52, 505-518, 1984~ 695-:-?20. 1995;

292 293
=.
 " Hope, D .A.., Tl.te C:linica!Psycltologist, 49; 8-l 0, I 996~
.,ytazlo, z..
Sclrroeder-Hartwig. IS. . ~-Iatid~ r:, Kaiser,
G -l?i Muncliau, N ;. Behaviour. Re::;egrcll aud Tber\tpy, 28, l81-
19~,l9~Q~.. . . . .}.'fl~:,~, .
~,.~~-t~l:ripia cogniliv-comporf.IJ~nentall\ de gritp ib,piica pe.de
o parte iden~Ca.rea gnduritor negative, disputarea ncestora !?i
inlocuirea lo_fcu raspunsm:i rationale altemative, :;;i pe de alta .
7"".:0
t
parte stabilireade scoputi comportamentale concre~:e pentru cli-
eut; iu situa\ia de. expunere.
Dintre. studi.ile e1npirice asupra eficientei acestui tralamenl
. L.- , euumeriim;
Heimberg, R,G.,.Dodge,. C.S., Hope, D.A., Kennedy,
C.R., Zollo, ~- ~i Becl<er, .R..B .., Cognitive The.:apy aud Re-
search, 14, 1-23, 1990;
H.eitnberg, R~G.,Jusler, H.R., Brown, E.J., H9lle, C.H., .
,...
Makri, G.S Leung. A.W., Sclmeider, F.R., Oitow, A. l?i
Liebowitz, M.lt. Cognititve-.behaviotal venm~ pharuuiculogi-
t:;nl treatment ofsocial-phobia:. Posttreatment and follow-up ef-
fects. Posler prezentat la Annual Meeting .of th.e As~ociation
for AdvancementofBehavior1berapy,SanDiego;c.aliforuia.
noiembrie 1994;
.. Juster. H.R. ~i Heiulberg, R~G . Tht; Clinical Psycholo~
gist. 47, 18-20, 1994.
7. EJeni.m.en.tele. stresw1:t4
Uneori. persoattele irttfimpina.dificultiiti atuttci .caud se
confruutn cu stresori ca iminenta unei procedui.i 1nedicale
I
I
htvuzive sau a unui ex..ruueu importanL Deregum.a~a devin.
i
!
Lensionnti cu mai multe z.ile inaintea respecl:ivului ~venimenr,
iaL unii al probleme de somn. Oricine s.imte o aarecare tensiune
in estfelde situatii, insa unii sunt afecta\Hil n~a mn:.;irra incfilnu
Isimai pot continua viata in mod normaL
Traiuingul pentru itJ,oculf\x:ea stresului (stre.ss in~oculatiott
training- SIT) s-a dovedit a fi eel ma.i e.ijcient tmtameutpentru
expl.tnerea la diferi.\islJ:esorL _ . . .
< SlTesle utilizatca fji b:atam.eut meiliha ajute indivizii r.~
faca fa\fi ell bine efectelor expwu~rii J.a stresori. pteC\tm !}i cu
metoda preventha pentru a "'jnocula'" pcrsoanele in ~fSleptnrea
even.imentelor stresante. Ace:;t tralam.et1t cuprinde trci faze
superpozabile: ( {) lam d~ cpriceptulllizare, ~)foza de fonnare
:;i exe.rsare de deprlmled ~i (~)fnza deimplet11entnre ~i umdirire.
Pe parcurstd pdmei .faze. scopurlle .principale.vizate sunl
educareapacientululdespreimpnctul coguitrei.as~tnn nivel'ulul
stresu],ui. foltllarea abiluatifde n percepedife.reittiat.e:;tresorii ~i
de a segmenta s~,orii complec11i In tinte pentru coplng-ul pe
term en scurt. mediu ~llung. precum Iii concev.tua{iznrea
problenl.eL in faza a doua. se invn\a ~i se. exers~di depriuderi
copjng. initial itt cttdrul clinic, apoitnmediul ecologic. Fazo u .
treia ofera pacieri\~lor posibnitatea Ue a !'Plica depliuderile
tnviita~e tn cazul unor stre,.;ori diferlti. Diutre tebnicilc .utiUz.ale
amintirn teboicile imagistice, jocul de ro.l. ntodelarea, e;tpunerea
gradata in vivo, repetitia comportameutalii. D.intre studiile
empirice nsu,pra eficientei acestul tratruJ.leJlt enmueram: .
- peut:J.:u trntamentu.l strcsorilor acuti (ex. pregnt.itt:a J?enuu
pmceduri Jllf!WCDl~ mlerventli cbiJ:m:gicale,perfomtall\e SpOJt..
iveetc.):
A:lunaier.. E.M Ross, S.L.., Leary, M.R. ~iThombrough,
M.T., Jounial of Counselbtg Psycbol~gy, 29, 3:H:334, 19~2;
Jnremko, M., Journal of Clinical Psychology. 36,73:>-
738, 1980; .
.. Jay. S.M. ~i Elliot. C.H . Jourhal of Counsulting and
Clinical Psychology. 58,799-804, 1990; . . . ..
. ' .: .. Kendall, P ., Williams. P.C., P-echa'cn'elt;'P::F.; Grab am,
L~fL Sbis.slak, C. ~i Herz.off. N., Jotit11al of~ourisulting :-~no
.. CliJlica\ Ps_ychulogy, 47, 49-5B. 1979~ 'i .. :;.,

19 11

.-.. . .. ,
,_:__,~....:.-'
' ...
---- .
----
: -
 . I

~
0

~
... Ross. M.J. si Ber-ger Il (' . J.- . snfletesc ~i fOTie 1ntens1i, nccste persoane fiind ~i foane labile
0
'

o-

CJinicalPsychoiogy'. 6.4.. 4. o'6\.J., .ouma. . l.of Counsulting and emotional. ' 0

-
.. .--'tlO 1996

_\\'~lis. I.K. Howard 0 S

Jpurnal ofCounstllt"
N ' .
. ..... ~~ owlm,W.P. ~~ Vnrg&s.M.J.,
'Existli unele date Ctlre indidi faptul eli ternpia
compattamental.'\dli11ectidt este eficienta in rratamentu1 tulbl.1rari i
1986. . .ng nnd Cluucnl Psychology, 54.811-835
. 7 de persoriulltatea de rip borderline.
~ - penbll tratameotr11 :.ai:es -1 . _
nldllare. difetiteprobl . .. . . _on onntennttenp (ex. actiuni .
. ., Hnlruy 1 r~e . . _emil ~l~edt_ca1e~j!Curente ere.) . . . .. Ill. TulbuHirile depresive .. . . . . .. . .. . .
Tl . .. . . ' " u:.., AndJ'Qslk; F sf We 'tb k .. Depresia dinica nuse ccrnfunda en st1hile de uistetecare
. l~~apy snd Research~ l,12t~.l3i 1 s roo. T .. Cognitive Sllf'Jin.uneori tnviatn fieciin1ia di.iltre noL ~ersoa~ele afectate f
..... . 977 (
ed. 1.- penrru fell . . stresorilor
ramentUJ c . de depr~iedinicit s~ simttri~te~i fiidi speranta sl'ipti\miiniile-n
Ul ...cnlecronice boll" . 'I . .. . .. . ronJct (ex. prob.leme
Fomln~ S J . .psi uatnc~ etc.) . .. . . . . . . .. rfind~l. De cele. maim~l~e ()ri. acestea iqi pierd .interesul in
1982; . . ... . . oumalofSchoolPsycllology~ 20,<l80- J87, l1.1cfurile cmeinainre lefiicen~-pl~cer~ ~i au probleme cu somnol .r'
~i a.lirnentA\itl. Totoiliua,le vineogreu sldepunl\ eforrul de a gasi I
Rolcorflb . W.R J .. . .. solutiiJaproblemeleJle cnr1~ ap, jarrineodnu se potconcentnt/ f-l'
864-872. 19~6;.
0

. . ournal of CbmcaJ Psychology, 42, !J

.slificieptt nicimlttarpenfi\l.a>J?~Vi latel!!vizor sall a. citL De/ .1. ::
_,9.. ~Moore
rr
n... ~~
~ A
1 tnta1er
. . . E c . . . . . . regnl~~ pers~~nele deprin'la~ p~lrec .mu1te ore gBn4indu-:se 11~
~ . l-98Ji ancer Nursmg, lo, 389- f :1 '
J < .

. '"Wem"k RL
. .. ,

.. ' . .
.,

.
ta
sinucif,Jere1 maaa:te SI!i;l ~ faptiJ~ le-ar fi mai bine dftcn ,nu at J,
. Jl'! Jnretnko ME T . mai.existn~Aceste silllfJtome:mnt.usemanlitoarecucele int.alnirJ
ofBebavtoral J:vfedicine, 4. 103,-l09,l~Bl~ylor.P.W.,JournnJ la PerSpaneJe ClU'e lre(! prill Si~u~tii de dOUO,. insain. Cazultiepresie~
ll . . ... . cliuit ne 1ipsesc iwerHme~tele de pierdere. fie 1nan ifestarile.
~.Tolbu:r~~~a de personalitate dnreaia co mlllt mni multdecai: ar .fi nonri.al'in nsrfel de-situnti i.
T . de till borderline . ._in .prezent, eXiEitlimru flitiJtetipuride terapii eficiente.1h
ulburarea de personaliraf~ d ..
un pnttorn de durnta~ Cll . ~ d ~ tip botderline se refera Ja
tmrar~a depresiei c1 in ice, prilltre care: terapia. comportatnenrtll *
ti punzan o .In1 agme d e sine, dispoz.i{ii ... tentpia cognitiva ~i te~piai;:iie-rpersonaHbDeasenl~nea,exisUi
. a ecnve Iii re1ntii im:tabile .
pntlenl care debuten... ~ d precQr.fll compottnmenre impulsive
cl
unele,dovez.Lcare ai:ant ternpia dinamica descurri\ durarfi.
Pe -.. e ll}guJa tn prima ~ . ternpia prin ai.~rocoitttdl<~i tei'apiile care mergpe rezolvareu de
. rsoanele afectnte d pam~ a vie{ii a"dulce
probleme in cadri soej1li:a:r . putea aduee b~neficH.iQ cnzul
lsingudttarea viata 1 e aceasta tulburare nu pot suport;
I .. . or caracterJzfindu . . depresieimajore~fn. pltis','o 1l'1Ullil1le ae.dnte (!ulesedinstudii
le afumstabile ~intense. In lus . ~se. p~t?tr-un ~ir lung de
0

.efe~tu.atepf!personneinvar~tiisogerl!llzhdiutiliznrea teraplei
la ~~mportalllente de P ' ~~tlmdJvJZI apcleaza frecvent
. . nsc ca alimcntnrea . . ea
colJiclitive ~i a terapieirei~iiniscentei. ~mintirilor) nr putet~ fi
neprotpJat. consomul de "lc I d
""t D
... c. e lllUlte. ori se ~
... oo St rogurl c00d
. -
compulstva, sexu1
usul cu virezn
ntilrl'in trat~re_a deptesh~i ~ per.soanele devlirsta n trein. > . i
. afe
mreg1streaza . ' Terapia compGrta1Tl~l1~aUi pleac-a de Ia un model dasiG ul
automnnlare. La nivel r u . h!ntatiye de SUJctd . sau '
L1epresiei unipolare (Lewh1~oh11 ~i colab. 1979), care se bazehli
c tv. tnunle curente snnt cele de goJ
296 297
-. ...
i
I
 -f.
.. .. . :: .. ~ -~~- ...._,_,. .,_ .;_~:?.<:-::;: :;-~.-
pe asumptia di depresia poate aparea din:- c:auza Jo_ui stresor
care per:tn:b~ pa~tefl:~ul ~~U:porlalu~I~.tala! _indivit;l~t~~ dUcfutd
In o rata 8cazuta a_ Jntar:rrJlor poznt~e; 11~ con~f_Hlc iti care
pe.rsq~~~~;n~ reu~~te sa eehHibreze balantar~(i~;~ipenselor.
acea~J~ .. r~ Ulcepe sa -exp-erieu"ieze
: -''''"''-::,~"='': - __
simrltom- I -:-:'''c --: ill--
-- - _ ~ _ -- . _.r- m~pspec Ice._ ..
_deprestFc1w:t~. Ca wmare, obiectivul terapiei comg(}rtamentale
~al'e decurge dtlllr-:o aslfeld~ teorieestede a_l1Pistapacient:u1 in
~Qcerca(ea de acre~te. ft:eeventn ~~ cl1lllale~ acti vitatuor-pliicule;
-- 111 ~c~tsco~. s~fplo~es~teJ~ci defoanare aabilitatilot soeiale,
te~uuc~- de relaXlJJ:e ~l difente-met<Jclecare putesc-111odificarea
sUl~lu1 c~e ~fuld~re de.presiv. Dilltre studiile ernphice asupra
eficientet acestut tratamentenumerlUm . recuderilor. Dintre.SllldJile empltice as~tpra e.fiCJ6~1\e' nce1;t~H.
-iil caz.ulil.dulfilor:
"!Jt:owu, R.t-\. ~iLewit1So11, P.M., Joumal ofCoilsulting
nncl Cluneal Psrcholog)', 5?. 774-733.1981; . . .
. " Hobern;ta~~ H.M,,. Lewinsohl) _fl.rvl. ~. i l11sott; M., Jour-
lltt[bfCo~sull:Jng .~nd CllnicalPs.y~~o!ogy. 56,393~~9,8, 1988:
.. Steuunetz, J:L . Lewitwofm,.P.J\1. ~i AfitonuC(!io, D.O.,
1~~~~al of Consulting and ClinicatPsychology., 5l. 331-337,
Ted, .L. ~i Lewinsop.n, P.l'vl,Bebnvior"fbecany 17 2!5-
223, 1986. . ....
-in cazul adolescentilo.r
Lewiusobn., P.M:. Clru:ke, G.N., Hops, H. ~i Andiews,
, J., DellaviorT.herapy, 21, 385-401, 1990.
r .,. Sim~ms, A~D., Mul'plly, .0 .B. Lev.lue, 1:1... ~?i Wet~l,
~ ! -. I : veJlttuper$oa.1leJb. Vllrsta
-
i . . . . Teri, L.,Logstiou~.R-y. (Joru~tQ,J.,~i{\llcCuny,
1S.].Vl.. Jqumal of(Jerontology:.Psycflologi~ Scienc~. S2b, 159-
16?,1997.
! !e~'tpia cogui~~a,in depresiese(undar.Qenterulipe_leoda
--
!cogmtiva a depresJei (Beck, 1967). Aceasta este Q.. abonlare
i
1 terapeutic:~activa,. structm:ali"focatizatatJti problema_ 9i:de scurtii
1dur~Ui, care pome~l:e de I~ 88Umpfiudidepresia rt.')ten1entinum
293
: -,_ ~ .:.. --~- . . . . .
. .. ' ...
de procesarl informationale negn~ve~i de distQt:siuni ~ognit'ive~
-Trahtrtlentul vizeozlti.nvata.tea pacieo~l.or 3.a gtiulleasca
adaptativ.- nnteliododt-~i ast.f'el tru.irile. nfective,
A
c.ompottru.uentele f$i.tnotiva\ia. . . . . . . . , .:
A . . . .
NtUileroase sludii.nr.atiica terapja cognxtiYfiiD dep~e~ne are
efecte superioare . tratamentnlu i .nt~dicntn~u ~os, LEntpiei
comportamentale, listei de a~teplart!, _p~:ecum ~' o.ll~r f.~rm.e de
ternpie. Mai mult, terapia cognitivii s-a dove~.tt f?l pu(lU !a fel
deeflcleuta<:'lmedic~t~aut.ieepf_esiv8~1n(~renL_de.s~ven~lea
tulbw-iirli, ~i mult mm efictenta decal acensla ~ p1~vcun-e~
. . trntament enumeriim: . .. . ... . . . ;
Bfack:bum. LM., Eut1-;on, K.M,~iUisbop, S . J(lutmd of
Affe~tive Disorden;, 10, 67-75,1986; . . . . .
Dobson, K.S . Jounntl of Consulting nod CIJ.UJ.c.;tl Fr;y-
chology. 57,3,414-419, 1989; , .
Elkin, L, Shea, M.T. vVaUdns. J.T In1ber, S.D. Sotsky.
S.M., Collins. J.F., Glass, D.R., Pilkoni$~ f',A l:eber, W .R.,
Doclu~rty. J.P., Fiester7 S.J. 11i Pndo1T~ M.U~; Arcluves of Gen~
eralPsychiatry, 46,97.1-982, 1989; . .. .
. .. '.. i< .' . s . J{ovacs, ]\1., Rush . A.J,, Beck,A."L ~l ~IoUun,. S.D.,
Archiv~ o~G~ne,:all'sychiatcy, 38, 33.:39,1981;. . .... . . . .
Murpl~y. G.E., Simous, A ..o., Y~et'rel, R:D. -~i L~~lluan,
P.L. Archives o{Genera1Psyctuntry,41, 33-41, 1984,
R.l)., Archives of G~oecal Psycbiahy. 43, 43-48, 198~. .
T~apia interpersonalli este .utili\in_ c::_,nz?l pa_ctet~~ do~
depresivi, nonpsibotici, tara tulbu.tar~ af~tiva-~1po~ad\, tl<~la~
ambulatorlu.luitial. aceasla fusese felos1~ii ca terngte de scurt.t
Q_urata, ullerior.fiiud utilizntii. qica ternpiedel~leu\];e~ ~~.n\.ru
.. paden~icudepresierec~re~ta.Se:poa~~~~g~~1~~~~2~,J.Jlf.ltvtdual~
' :: dit iJi in asociere cu medicatta nnti~eprestv~ Ii1 ~ndl1Jl ace.~lcL
lerapii. se face apel la slralegii erietlt~t~. ~pee: evaluarca
'
299
 -#.
i
simptomatologiei depl;eslve . JiJcar . .
ameliornrea-relarmorjnferpers'o .1 t~aren._pe proble~e {inta, ga~rroe~terolog. pennu a e1iminl1 posibilitatea. prezentei :nlro~
o fo. rmn delra'tanile. ~ . . ... na e. Peventrea re.ciidenlor. Bste tulbudi(i~u simpmmatologie ~emanaroare. . . . . . . ! ..,
'.,
n~ care st-.a doved fi . . ..
~pisoadelordepresi.Ve acute 1fe:. ClC~{il ~tfil lHh1\[itTea at '" lri cazul sindromnlui. i~testinului iritul1i1,_un tratamen,t j
. mstallirli l]norepiseadenlre :.c~. ~llllpreve~~re~ san amilnitrea eficient esr.e. telnpin co~por~a~entalamultl-com.poneil~iul~
eficienrei aceshti trat:tl"e. . rnom.e~ Dlnrrc srudrrJe empitice asupra (Progr.imulAlbany pentr~.12indomnl intestinullli irirabil).. . i
... . .. . ... ~ n .enumera"1~
~ Carnes, C.L. si Fnu1k_ E .-ri;e cr meal
. iit.cadrulpiogritn\liltiiAlbi,riy pentru sindonitll inrestinnlui .J
.lJJ: 9-lO,J 994; . P::;ychoJo gist. I iritabii. profocoln~ de ti:atin1:tent cuprinde: .monitoriza1~a
F1'ahkB p <. . .. . .... . simptoptatologiei. gastroiJ)test.iriale. educaren pacienmlui cu
. I
.l
: . . sycl~9t1lerl:liJY. 28: 259-266, 1991.
privire:m ft1ne.{iomrren ~pnm~llifdigestiv. contracararea nsumil~ii .... J

n f\1'. P_.()bleh1ele feg~te de sfu:difute . $e

rolului ~~ bolrlnv. fn .plu.s. }l~lizeazli relax.are~ prcrgresi \~a
tnlre problemele de siin u . -
nmscularH ~lbiofe~blcl<-qfc~loric pentru a cre~te sentimen~ul .i
. Cefalea ~lnte, cele lnar~ 1n d1scu[ie sum: de control al p~cientnl~i a:Snpr~ funcpilor: biol(}gic~. precuJni l}i ..:.!

. Si~droinul inteslinului lritabil tt:stmcturliricog[litivepl."ientpte.$Pl-e cpreetarea dis!o~iLU) ilor eli n

Durerea gandire. cu ~mpa.cl. a.supp{s~i\rU. dt! .l\l'l'derare. pintre Sfl!di 1le
Maladi a Rayn~rid empiri~.~sup~11 efir;fentei ~r;~tqi tr11.~amcmt ~ntl~leritm: . . 1
.'.
Fumatul . . :l. ~.. Blanchard~)3,H. On!~~. B., .St!harff,l...... ~i Schwai-z-
Ccfa1ea McMords, S.P. Bjqfeeqbll~}c anpSelf-Rc:gulation, tB,l25-131.
1993; . ... ... .i
Peste 90% di11 oameni s . < . . ... . . ..
~u_n ci eel pufm o d.utlt pean ii
d . . < < . , ... r

donre capuJ. Cilnd accsie .. Greene. B. si Bl1mchard, E.B:, Joumal of Consulling

CSie C82:ul migrcnelorde tipu~l:e.n ..su~~ fi-ecyente ~i severe, cum nnd Clirtica1Psycf1~1ogy ~~76-582,1994; ... . .
prqfu nd vinra persoanei. res CfOQice_ ncesrea pot al"ec(a en_sltr Pnyne. A. ~iBlincJ')ard, E.B . Jourrinl of Consulting And
peraoane. acestedurcrl aju:~~:~c:rcaz~ll u~~ numar mic de
. . . . . . . . . . . . r

Clinical Psychology. 63,779-786, 1995. i

Un trntamerit ef" a dtsnbdttate sever~ Dnrerea.. . '
co 1Cie'rit tn cazu) cef: l . .
lll}?OIJllmcntollf. Bxistii de ' a ees esre terapia :Dureren discijraUi aid esre cauziltl\ de unele afec~iuni
en ~l biofeedbacl'-ul
1\.:
C"l . ~s~menea. unele dovezf care ara"
.. one msoflt d I.Q son1atice em nice c:umsutit ~olilereumatice sau u~ele forme de
lfuc Ia rezuJtate pozitiv io. ~ - c antrena.rnentul aurogen an~miihemolitict;_cllotfftf)S~it~re eredittwa .. t11 ca1.ulunorn~tfel
cr .Y !!'JU caz1.d aeftSste~t afe t.
~mmolmu intesti .. l i. -
Clj 1..11 ll zn.tabil
c mm. . de afe~{hmi. exp~ri~~p~t~l\Jrecvenrli .a durerii ponte diminlll\
,;a nd! omulmr:esrmnlui ititabJI eruifateo. vie~H persoane)or ~fectnte. Dureren ponte nccet~mn
co9sUind in prezenra relativ con tin ~te ~ tulb.~rare fitnctiorwlli, anxleratea. depresi4~i seri~~~prele de neajutornre. De asemenea,
u crampelor. De Qliemenea ua a durenJ abdontinaJe sau ~.nxietate.'l !fidepresi~pO[:deJellnina apari[ia sntl intensific~1re!1
nal en dial-eea. const'ipntlii por apare tulbuta~ de ttanzit intesri- durerii. .. .. . : '' : , ... . i
astfcl de cazuri, este neces;~ san o ~ombin~tte a eelor doun. tn . .' .Terapia C9gnttiv~fitpq~mental~multi-compbnen[iulli s-n
. . n exanunarea dm parfeq unui medic dovedit a fiun tratamenfefipientpentrn dnreren np5rutai'n qnzul
' - - . ' i

300 '

301

. .. ~ . .. .
 bulilor J-elunatiee; de asemeuea, Liuele date sugereaza ca aceasta.
forma de tratrunent ar duce.la n~zultate pqzitiy~ iicfll ,cazul llfal.t.uJ_i.a. Rayrumcl cleaz.a vasele de sange i:lin degele,
amunitoifonue de anem.ii fleJnoiitice cti t&msmiteiiereclitara.. -r:l~ladta_ Raynaud ~in ustiiril capllarelor diu aceste ZOIJC.
-~~~t~~i ?i!te care aratli ca d~rf:J."t!i\Cf!Jnic~.a.rputeil b~neficia qi ~
urecln nas 1 se=se !bserva
depigmenlat<: pllii, }~
d.e:l(!f~pia (!OmQ()rt.~entaHi multi-coPJpO~JenUa1a, bio{9rJU:ck~ La expunereo Ia . .. d e,.....,icatnris.au amof\cala m.
ulE1YfQ}'fetapia cqg~IUv..,c,omportmu~ntala aa9d~te. cu . .
tuteon pac1en,...t.
ti' acuzii fil s~uzatu e ~.........
... ; r: liiri continua, ele pot devem
Iizioter.apie. De ll$Cil1enea, terapJn cognitiv-coiuport;.uuentola ar 1 afi tate Dacli aceste mau.u.es . ..
zone e ec . ulceratii ln nivelul ptelu..
])~~ea fi eficienta In caz:ul d9fe.di l~I}1bare CrlJliice. sau ~~t cau~d. >! b. feedback::-u
u

cogidtiv-t;owpottat.ne!ltlll~ in. controlut durerii

dureroase l caloric cafonua de
i . "terapia
ple~ca dela UJUnodel cognitiv-:-COli!por~EUent~tl propu~ de Turk
~i colab., (Tur.k;~icolab., Pairt an~ibelJa"Jorai medieiue: A cog-
I Datele ex.tstente m lCu 10 .
tratameu t e.u r=:clentiiJ incGazul mruadJcJ
t:
.
Rayu,aud. .

I. fti~T~atuJ
,~

oil.j~,e~beJiavjoral persp:eclive,New Yotk:: Guilford.Press, 1983), Fumat.ul ... ... . . . . . _ e ca.re

D_ato
__ rit_"a_ e
___ilectel_{Jr llegali_ve H_
. . . ._._ _. . ._.
Je are asup1it
r_. . _,. tre. acestea
Co1tfon1t acestu.i .-.ruodel,,.qU.rer-ell constitu.ie o ~:xperienta v-~ o1 I - are U pracbdi. mt.U~e t'm . .
sanatatu gersoaue or ~de.. enclet~ta denir:.otinU este dJficd de

complexa, irnplicfutdaspecte de ordinfiziologic;;cogn.itiv, afeGtiv iucenrca sa renuute, ins . P: .. 1 . r~ tocel\rCa sa se lase de

~ . M . itaten pcrsooue ot c.u .. .. . . . . . .
dep~1t. tyor ... . ~ ~diJ.lprimul~:~n.Doleleexu;tentc
. :Ji cosnportalnenh!l. Tratamentul.propus.are tll!icompouentede .
i baz!i: ( l)o:dUcarea paci<ntutui fi cun..,ptuOUzoreadiJte)ii; (2) fum at, i~Ji r~iau acest obtc~J.J~c . ntuluiin eambioape culerapia
I fbrmarea de abiJitii~ coping~ C!Hntpleureu~ ~i meDJinereo arnt.a_ _~a_18
reducerea_.u_ ep:_a_ mn_.. ~n
... -~\:iat_K_ co_. n~tituieun.tr_auuuent
abilil~lilor CQpiug dobandile.. Piutre sludiile 'empiric~. asupra
ccotiioee"~:
1taUi. mulli-compone .....
cont[Jol m.e1 . ...... 1-. edoresc sa renun~e lafuumt. .
Ie@cienlei "=!l.lU lrnfutru:nt ill <azul dumii eficietWpeiltrupersoane ~car . . . .
"Bradley, L.A.. Young, L,D., Anderson, J~o., ;;rumer! .
I: .
',
!R.A,, Agudelo; C.A., McDaniel, L.IC., Pisko, E.J., SembJe, Y. Tulbuxiirilc nlbnento.re . . . .
~ I. .
. . _. . . . . presupun adpptnrea unut
I .
I.
,E.J, r,;iMorga11 T.:M., ArUtdtis &: Rheumatis.rn; 30, 1105-1 U 4,
! {987; i"' !
.
Tulburanl~ n.ltmentare odededieutdevinut~.Priulre
taro nte nlltllentat"e sau me,. . . ,.
. ! Keefe, F.J., Caldwell, D.S,, VIH1iarns, D.A.,
., Gil~
K.M.,. !
I
com
__ por e .
iidi ..iofometureaJn
._ . . . . te"n;onaUi saU_l__rg
a~tea sepmn . d r Jltc (alinlet1taren C()ntpUISt\'3
\" .. _..es_.
ba. .uno,
. ~)
-:..
D.,
lvtitcllell,I.J., Roflt,rtson, Rol>etll!On, C., M.mtJ""- s., i'!untey, cautilii\i ex.agerate e a J~e tulbu.rliri se .git.ndt;:5C excesiv tu
1., J3 eckhmn, J.C. ~i Helms, .I\II Be:J1a\lior l'bernpy, 21; '49-62, Personnele afectote de aces e t sau.aliUJenll! ele.pot l1utiit
1990:; . utale nspectcorpora , ~ l
J:;llfutcare. gre . . . 'onderale sau _ subponpera e.
. . . .
I "'sytjala, ICL, Donaldson. G.'W., DavJes,<M. W.,
~ippes, M.K ~i C!u:r, J;E., Pn.in, 63, 1B919g, 1995; norm.opcmde~at:. c!i~ Ill suprap t duce la. problettie med.ica1e
IntrucHttulburlirilc nltmcn!are.o fi ctap de t~eesle Lulburari !;a
. r-- Turner, J.A. ~i Clancy, S.,}oumal of Consu~ting anu .s e_v_.ere, e.<Jteiudicat ca pa_ clen__tti a ~ t t ..tn sani:itate melllnHi .
f Clinica1Psyclmlogy,58, 573~579, 1988. . consulte. uu me d. c s a t1 . un specta . . . lS
.
ali t astfel de problcme. . ._ .
/ ..spech. za pe. . abmentare
- . _.. Tulburiirile . . . .. .ab...o ruatein'ctlnfuiu3tesuut
.. . u

" Tulbt.rrarea de a1ilnentare cornpulstva

302
303

i
t-
 ~\indirii 4ii,otomic.Olv"'\Wi!SO.a:r..1'he c\inio\
niSnmlUi s,i a
..
"
Tulbftrnrea de li
.Bulimia nervoasn
(jbezitatea
. .. . . ..-...
.
. .
\
i
l'sychOl<)gisl. 50. 1>.~2.1997). . . . .. . . . J
Tempi iDiel'!"''on)a Mre "fn>A .curt~ de P')nol\'\"P~

~-djr<C~" ce~uatil ve cont<Ol<tulnt_e~:

noncirttettifelll[ivl\ ji
ing dJNm-ded . a_ P!Bl!lare,eilmpnb:i>oii (Binge Ml-
pelSonOl. lji carea~~ pacient~~m ~
?bie<li.v pdnoipalajntll<eo'
lvful~l
-oamem simt uneori eli ~. t~i jd<Ujifi ~ sll i~i !J'O<)ifiCCJ.lr!>b\emcleintet~l~ s~~~e.
~nuucli< P""~ipli~ sa)~ de bo.>B o rae in~omJ:!IlliOilii en .'""'~in
~
lrebui.1n mlhurareade ..... . manl\nca mai mult declit ar . I
- ... lllle.ntorecomptlls ~
mgerenza frccvent cantitiiti ex.ccsi . ~~a. persoana. afecratn cogniti\l;.e()mt'Qrttttn~n~ll.Pl'()llr1u:.7..iS~~ unii autori (F~i.rbn~n, :J
episod compu\siv esredublnt d :v_e de ~l11:~ente. u n nstfel de ovw:omlnK bing1> e>liii~ New)' on~: O"l!ft>'C'f ~'"F'
o~olosesc tn """'b!nO!i cu ~ogrUln~ do ~~~npi
CJl'
nsnpra P.ropriei alimentatii 1 e ~entimenmt plel-derii controlulu i 1995)
: .f i'

""'~dd.UniBUa"' ("self-1><11!") ~"""'"1"' abotdatea c~gnill

'I
trai~re sentimente de rt.ro; u (~nor episodului. deseori persoana
.
:.1
Datele de pftni\ tn. ~..,.me. ezgust. deprimare sau culpa ..,;.,pmtam"'"'ll!, Dji,,. ,.P,~i\1 empirlce asupra efici~l<i
cazul tulhuriirli dear pre?-ent amtit ell- tratamentele 1n eficie~t~ .ac~roitrntl.\fll~nteiiomel'nn\: . . . . . . . . . . .. ....
. I

....F.aifbnm; t;l;G ..JQnes. R, Pe~elor. RC:' CBH tiJ.,

l
comportamentalii ~itera . - .
. - tmentarc compu Is- li .....:
> ... \
tv snntrerapiacognitiv-
\ .solQroll" R.N. oeoniui MR. norton. t jl.fla~e. RjA ..
B 1 . T ptamterpersonaln
l.t tmm nervoagli. . .
r . _Bulimia nci-vfiasa c~ptlnde . . . . .
.
- i 1\r~~i\'O$ .,f<lentfllJ>sjidiiairy;4S, 463-469; 1991: . \ .
a mentarecon'lptdsiva dtibi .}d . . . . . . eptsoade frecvente de .. ~ Fl)i(bnrll. C.(}~.lnn""; R.,l'evolor; R. C., '!fOp"!. RA- <i
o Connor, M . Arehives >of Qeut!.ra\ Psychirirry. 50; 419~~28.
nlim~ntarii _eompul:d~e~. ;!~re~ ?Jom~l-de_& con_n-acara efectul
. autoprovocntllinfotnetariia .. . . ; :. incerci\rl mclud; voma
medica mente (ex. laxative).exercl.fllle fizice dure, utilizarea de
tn preze:nt, extsta
. .dovezl
~ra<arnenr in bulimia ri~
.. .
. . .. .. . ..
o":: ~K eel mai efio]enl
arntli
I
.
! .
)99~:
..

Obezitateit
.

-~
.

. .
Fairbu~n. C;G. ICil"k. J . oeonnor. M. i.Coopet. P J .
)lebavinurRes""""'"~dTImpy;24; 629:643; 1986. i
\
~ompbrtametttaUi.Peasemerirv s e~te terapia cognitiv- In mod ctrrtl"ll, obczitat.. so Conslderli ~ fi p<=<!''~ .atond
mte~P~J.1lona.lli tlrfi d . . . ea;unele dat~ .sugereaza cli r.em .
? trinnmenh~l ptt~ \! el)ndio<Jivldu11111' Cl\~ .., mai molt posle g,eu.... ~"''ippmli\
rulhtJdin... . :. . I . nsemenen. eficiootli. tn . a '
.-m..Qa<l pen!ltl o 1\~D.n,ltl(inllll\mC.!n p.-nr.<Ste geperal
:;,.-l '

e~. p~ntn\
. .. . . ... veS e1
. TerapiR. cognitiv'"'compo~tatn . ... ~ - - . / . : recnnoscut faptril oh.eiitatea reprcuntli un pericol
.pleacltdelnuinnotielca . . . . . entala m buhoua:nervonsa snolilatea ind\v;.in\o\.. puteJo statistiC& aF.>tl\ ci [Ot lnni tllUlte
. . . ~o_o~t ~
cognitiv' . .
_111 celor comporrh
tnl\)~rln. Tratamentul . .;. ... mental& tn menttnerea acestei
pot~n{a
. re aru:entueazli atar im . . .
. tactorilor P""""'"" dfn SUA '"""'"~~nto,de a-t8J!TOblemn. . i
. "t<lpia FO"'P<J<\Il!iiel!l)lll coiJSiitUietflltlu1ntill de ellio
co.n.lP_I)J1n.m.en.. h~_lor . de a11-.meQLBre vtz~e.l\ziio. p.e 1l. a.n. gli eliminare" Jn Ci\ZUi obe2itami att\tJ~ ~du\ti, cfit ~i.la copii. E)(.ista ~fi pnele
te: . .
.ftvenuen .. l.n. pa_._lte._rn u. .'1 . . _d ~l".li ~i.
._. 1. '. . . . omp. u
"
efim. in_nre . dare care Stlgerdazi ell (, co'mbinntie de tCTllpic C0~1itlV
~i bipnoz~ ro:- avea. de asernenea. eJecte p~:z.inve
d . n.e e a tme r
g n llnlor l}iemot}ilcn dist\mcf .aln are ?Omlale, corectaTea toDlportamentala
pefsog~lii a aspectulul :fizl !on eref~nt~are la fiemnificatia
. . .. . c. precum ~Jltmitarea perfeetiu- in tri1tmi~ obezi&RtiL \
1

305
304

. -. . ... ... . . . . ~.

.- -. ~:
 . . : ............. ,~-~-:. .., .. -
.. : ... .... :.

VI. Depeud.enta de substnnte 1'

_j)e-pcndeuta de alWJI ~i~t~&~Q C{)l1Slituiep!ob1~JU!'! m~~Jie
a-lli efectua activitatil~ ziluice, ptecum :;i_ i,\SUp~ relfltiilor
interpersouale.1ncetarea.bru.sca acm~sumulm aeeste1 Sl.lbs~u~~
1 .

.. i . 11eut.r;~ Loate p.ers~aoele tmplic~~.De fl.lulte_Qri~ (am.ilij tntregi

' s~111 tdtslruse f?I can ere promi{atoare ruinate. Multi diU(~e ~.ei .care esle insotit:a de simp tome de s_evraJ -ca obqseala ,n~centuat.l,
cosmaru;ile, problt;mele de sonm, agitalia psi~l.{Jmotorle 11.i
ar aju11s sa ~e,~p~tJ.genti de .a.lcooj sau drogurfiucea~ella un
t~lomenttlat:s~treuun~e. insa depenclentade substituteestedmcil a~titul crescllt. . . . . .., . . . _ . . .. .
di uepa~il:. . . . - . . . Penlrud~pentientade cocruu~. eel mru eficteottratn~t~eut
1 fu cou tinuare. vor fi abordate unnatoareleprobleitl~:
s-fl dovedit n fi terapia. comportamelltnla.Totodatli, prevem(c~
1-:
.:
< A.buzu.l ~i 4epeudentade afool . reluarii consuuiului!'le coc.aiuii clupli tncheierea tralntnenlul~J

,
I .. Abuzul !ii de~-ndeu~de coFo.llt~.
_Abu~ul~jidepeodenta d~Jletoiuii"
po_ at:.e._n_ e:_n__c ie_n_. t abo_~-_
. - _._ ._ ___.P_.r_ _._\.n _._.___e_.._r_m
n._.l_ _ _ _ t_t_._.__t..
terapia:cognitiv:...compo.ttanit!htalapen~~vemre~reddeolo~.
. _. _ . e. di _ _ -~__.
P
. _. JI.-l.l_ .._ .u_. _w u~nnl
_ _. _-.. .u_ .g..;a_m
.I .. Abuz~l.~idepepdenta de_Lrat1r;iliUz;1nle 9{loare ;: Abrlt.Ullfi def!t!l,ldenfti tie het;?'"-a - . ... . . , 1
] Abuzul yidependenfa li,e alcpo[ . < > . Het()ina apnrUue une~ calegprJ! de stu~e~~te mumtll_ .
l~ l~qol ul es~e subsmnta cea rnm l;lliliz.'lUi iuStJA. lproape
..... 1... opioide.din~care m~ fnc.pzwteot~wdina;.codema.~ltnetaf&o~a.
9q%dJI?tr~adultJ.cgnsll1Jland-o1P.llll:l'llQmerJtdat.Aicaolulre' f!f~et~Je CQJ.1.$1llltuluicl~beroiua jnqlud senZJitla~e semn. vmbrc
du,ce ~:~;itatea s~stet~ului uervo~.-cu .ifupat:tnegativ nsupra ingreuu!l~. probleme de atentie tJ-ituemorie,.ndC!Iotll.reR pupHe.lo.~
capacttatJl_de a ravoua. di~pozifiei afecti ve, t.impului dereacfie, :ji responsivitate scazutlilnsUnulli?~n~diu. Ab~zul de.heroum .
_cowdo!~ani. ruotdce ~i capacitatii de COllCCHlrare: ConsLunul nr~ efectenegative.a~uprn cn.pactt.atii pexsonne1 de a efecltln
lll~den~ de alcool ponte ofecta capacimtea Jndividulolde a CQ"eS_(}Untlitor sarc.i.ttil~ cotidie11e. .__ ...._.. . . . ..
rea;cliOlla corespunzator in mec)iul soc~al 11i plJ>fesionat. Pe de . Datele ex.islenle panlin prezeut mdiclt ternpJa tfl~lalnt:U
a!~ parte,. cottSU!l}ul.e)tcesiv de nlcfilPl;poate duce la il:lstalarea . de scurta durat.~ !li tera;pia cognitivl ctt !lilrnta111~nte !!flctente m
coz:neJ .s~y_a l111eis~ide stupoare. Pe tenneulung, coJtsullJu{ cazul fibU~ului ~jdependenteide herohtll. _.
de alc;Jol se poate solda-cu boJihepatice l7ittilburiit'i tmii!zice, Abu~ul si depettdel'{.a de Lrancltilizante it.f.oare
! E;tisl~ c5te,~a . abo;(.<Jij.ri_.care~i-au.dovedit eficienta in Traucruiizantele u~onTe sunt 1.1tilizate in tratameutul
Ir_atptttr:ntu-J pxqbletJlelor severe cnu~te:de consumul <lealcoo1. nn~ielatii, atneuluideptuuli!U.:jiptoblenlelo~~e sor1n. Uu gn!p
l)il~t.J;e p.cestea. lrat~neutul comportament.'ll de e;,:pl.lnere la de tranchilizante ,Ufioare care :pro~uc: dep,et\det,tta .esle ~el nl
attu?rse,_autrenamenhd pentn.r fortt(area de abiHmfisociale, henz.o~pinelor,printrecare~elh:;crium:tllll?.a,rel~,su,bstan{e:
l'rofectutCAL..IYl~i Progriunele.Cmnuttitare. Xan:ax (alprazolam)~.Vhlium (~lil:~pam) .Ativan (lorn1.epnm),
I Aln(.Zrtlri clep,mdenra de cocainii ; Senn( (oxazepam) ~Ji Klonopi1~ (t:lon;Jzepaln). _ . _ u

: .Cocainaeste o S~b~tan(ii care pmvine din pla;ltade toea. Efe(;tul aces

tor substante -dureaz;ti.. df} r;eg~Ut. o tJemntdu
Consunmi acesteia produceseutimenlehtlense deferlcire.~istnre scurtn detimp. ele ptodudind depertdentii chi~.~i .atunci cihJll
de hine, generand totodnta ~io puternica depende1J.tit Abumt sunt prescrisede medic~ Re.ountnrea.bmsc!l~-?~J~l~?rea ~cestom
de cpcaina nre efect:e negative B.Supra cnpa~Witii pet-soan~i de ",; :<:>e,ste lusotita de simptome de sev ~~ ~~ ~~ansp~;ra~ule~ tt:en~uru~
... -~"or, dificultliti
mauw _. . de sumo, senzatte de great~, agtlatie ~~
306
3tH
 .
~ nllie~.t1eis~~9n 1~oio~i11:a,a~~tot slil~st&n{~ilt1ce la
\ j
~~~~~i~~.a~!~~~CS:IJ~I!>~maimari
~'f~i:apih Crignifiv:..l!ompottatnentalii s-a ctoveditefiicieutai in
trataren.s~v.rruti\ui..la, p~Q;oan~lecate anaj~as,de@endente de.
J
?.heili&ffi~zij;i~~in'.:itr5~ll~ta~eotull~~penr~patncde'panica. . "l
'l
''i
>'
=..........:;f!~~~i~.'0\}~ \. \
i;J;~t%<.. . obiceiuri nesii~ittoas~cunlar fi
. . . .. ,. .,~;, ,.t!~~~ftr~!ftL~;~;rosj~i1~~. ~au
.... sm\llg:Crell n;!pefil. . .. . .... lf:)rd 1' .t~ (JilJ!d smq~~ plrulu1 so
;,;~iJ;"so1~.zii1ct1~titem~liO:ett .. " . :. ~f!fi!~re~~~~;::~~~~~rF?aJ"tii .
,,,,;,,. .numel~Etc'lmootil'tfifiaftie;:'!ZB'nel'c 'i:JO\'uuac fiate'fi 'Sm\ilsinlinl
.:~;::t.i~~l~;;~j!~~~~ll~'~~~1e411~ifa1e~iii)l~S'ifil~tea
.:.{co ll~Jhli~a a*}IArUllli*p&nte~uritenrfieperrl~M~gedfte a~ump
;Jfi~;~mal.;::lt;~:~~:~;;~. :/'i ~

.~ episaadelor .crescllnd tw pcH?tVad~fc"'~lrcsifute; ~e~ ft;fitl1a.

.,.,,:,, per~91~1~ .~~fa{$'!8SC.Dnd 'acest mlJi'dli, evifiln1. sfnulgerea
-r
.... 1 i:;P~~~,~i~i,f!!7 ~~$:~"1~f(~~~netc~iu~:l't~r1'J' :. ''"~' ' ',,. ,. . '. ."'' ,,
., ln caz.ul rri~9ti,!9ftl~ai~i; ..tp;il~auqenielc'~efioietirc includ
. re~~~~U~~~~~~!~~~.,j;~c,qf.f~e~t;l'hl?";aeo~rr,al~tt\~:
zc.,, . . . . .ic<;,,,cl;I .ld'. i(v,!::. : 'ix:~lK: l ;cl;{::'t!I,r . f;;::':l;'''
;'VJJI.,~Ahle~~Je'll1!initale~ . . ''i'f;' ::~<'~'
'"~"'i'~~v.J'"P'' /~ ':9,J~18~~;peikctL Dini"Qcferfeire.
~t,ti~\~~~tjil~e:ilel\Wctentn
~~~-...)~:.!~\ ,~J.fplnlti~iont
'f'. . n~rl,,st8billr~8.,~c,scopurl
i!fl~~i;,(S1 ;;r,.~r~.> :{rc.?:'it
~t~~~.d~'f?Up)u eonstiluieun liiclrament
. ~i~l~,~~nic.!~amm.16Jiett;ex:mtil\'t~e1n :
ilnire'hn''l'l''~lj\tJ'.,;;,;.;.n\7 ... i~piil,dC.cupJtffAl\ali~~l~P~emAtie ~l
_," -' '{~,l,1i '/,. ., "'" ',' ,, , ,.,, ,, ,

-:.
308
 b~frac{iwt.ile .rexuale
~j (7) esle urmarit iudeaproape,; lratatnelllul.med_ic~utem~s ~i se
- lnfractorii se.x.uali
_ _ .sum _ _ barbal.
_ _ de regula _ d ..
. i , care a opta fac.eforturi J:lelllru ma2WW.zaJ:en complitul\~i la nct:~ta~ Diutre
C(JU~portat~lente:s~x~ale mndecvate, .Prinl.re ca,re violul~ abuzui studille empitice asupra eficien\ei intervenUei de f~uUie fn
sexu~l asuprnq.unordor, ~xltibip;c:mi~Ji1Ul$i im:estui. -:;-.- - schlzoffenie entnneram~
_1n ~~z~~~ ~~estor persoa.ne,.cel.emai bunereiiri~L~-s:-au "Gingerieh,S.L. ~iBellack,A$ .., The CJ.iu.icnlPsycholo-
1
ob\u,ut pnn.hite~riediulmodillcarilor com.portaiDeritai"e. '
. gist, 48, 24-.27, 199~.; . . __ _. .
Leff. J., Kuivers, L., BerkowJtz,ll. =11 Sturgeon; D., Bnl-
X. Sdtizofrcnia ~i altetulburii.d psUJc~ 6e\ti!re isll Joumal.ofPsychiatry,146, 5~4-600,1985; _ __ -_ .
: _ _. :~chizofr7nia ~i celelalte tulburfui :psih:ice severesu.Qt de Xiong, w,LPhillip,s, R., Hu, S . Waug, .R. EJai, Q.. ,
~egu~a d~tenrunate_de ~-rezenya siruplo~elorpsibotice, prlutrc
1_

Kleiumnn, J. :ti Kleirnnrut A . BritisbJournalofPsycbioL~y.

.G ,care cle~JI"lll,llalucma~ile (~IZuale. ~i auditive), derealizareo, 165, 239.-247,_1994.
F.m~1.g~ t ta;Urent~l .,dezorgannat, .vorbi rea dezorgaJli:laLa $1
rPlati~area afectlv~ ,
,--. XI.. Tulburarile dhii:ttosticnte de regf.JUi.-penti~u
J-:~ista (! a~e c~e arnta di in caz,ut ~clti~ufreql~i ~:i
I.

, -n" - - d- o1..esc~lltu
: . a
! . J~ "' ...
prima w.ta mcop

o;rrb-fJNl ..:!!: . .
tulbufl\rdor psilu~e severe celenuti eficiettte fornu:~ de jnlt;!f\'entic
D~itulburilrile spl!:cifice adultulul seregase.~c ~Uu ~azul
~un~ ( el_e.sunt adJ.UVattte ~tmuentului J)leilicame~1to~)= Letapia coplilor(ex. depresin, atiAietu~ea), ad~enuee{iteaabJU~lifestUri
de fatJ.lilie, terapJa _cogo.1tJv-couw~r~1leutaUi, ~lnl:{-ennu1entul
tipice yftrstd; de,exem~lu, anx.icml;e~ atJart ~I.e~ ~ltJt~e~nte ~e
pen tnt fo~marea abilltliU~ot sucia}e, p1-ecutn~i sosfinerea Ja Jocul
r- c~e mu.nca. . ; . sepanrre. In plus, apar proble1ne legate de ~:llvtUi\J:l~~a.ngonle
respectivei pe.doade de dezvoltare; astJ:el~ ~t\ coud!\l~de stre~
\_ ._ luterven(ia psiho~ociala joacaw1 rol critic in tr~tamentul ~o-piii adopHi.uneori conlf?OifHJllentespeclfice utlel varste !lUll
pfrso;.Jelo~cu schizo.freJili.e. r~ P8.{'CUSUlultinti10{ 15 aui, s-au mici dedit vfu:sta}or Cl"OJlOlogicii, l"t;fU~.sa,l\).eDJ'gltJa-~Ct.lBll\
u"e.~~st~-atpfl]gres~ hnP.crtante ir1 elapor~t[Ea intervenpilo.r de etc. D.iutre pmbleJ.ue~e apiirut.eln coplliirie~ladolescen\u, vor l1
f~nuli~, ac~tea ll]ilnd "QCJ.1lijl:oarele c.nra.t:tedliti~ comu:uer (1) Iuate indistu\ie IJnnatoarele:
ll,ll _ac~eut .~eo~(!blt cade pe eilue~ pacienlultii ita familiei . Amdetatea de sepaxare
Dl)esl~J~ ~espre parti~ltl.ari~file .bf)~j sale:ji p~lpiil terapeutice, . Enct>prezis
(2? fanJJ,ha este tratata ca :jlalil;lt.f"I.ittdde:;curll.jate senf:in.telttele Emuezis .
de culpa s~u- invirm.vatire. aceluilll.l:t,(3}latnceputuJ
Cumportameutul_opozi\ia,uisl~llfovocator
IJ~tatHel~tulut._s: ~rgantze~~~ o intAAt.ire cu familia pacientulu;,
asl.fel de utUU.mn f"uud orgamzate ulterior periodic, (4) jnr:erve-ttlia
. AnxictaJ.ea dc st?parare -. _.
Ace.5t tip de anxieto.te semanifesta pdntr-()teltlnii inlens5
.. eme.~~ .rJuratal~nga, de regulii merg_fuld panaladoiani, (5r
.fmmlul~ beneficm:di. deasistenliiin tmbunaliiliti!a abilimllior de
tie abandon, de a Ii separnl de prulnti sau de alti ruenabri ai
l familiei, de a fi rap it sm\ pierdut, de a pie~~~-E~Pr~o~niUubili\
CO[~ing ~ide comunicare. (6}se folQsesc ecb.ipedeinte~enrie . .. s~u apropintii, precuill!li de dificulta\i mru'Cailteiaia Clonui d:pmtt!
lnultidisdpli.nare,_tuembrii acestoralucrand in stransa colabo~e
de casa l!i prezen\a co~marurilor. Aceste frid suut UlSOUle tie
3HJ :H u

i
 acuze. somatice C" dtl. .. - d . . .
- . .. . ren: e stomnc d 1 . d
ntunct cand copHnlurmea23{ sa _.lee~ l re J ~cap etc. care apar
ten_lp_ or_._.ar de pann_,: .D. . . ..... p . . . la-buntctsau sli Jiie_separat ,i . .--~Jiouts,A.C.,llennan. ~.S. ~i Abramson, l-1 . journ.=il of
' \I. e reguln astfel d
ulterior unni e-venimentne Ui~n . . . -~ &Imptomese dezvolta Coil;ttlting and Qlinical Psyp}lology. 62, 7'37_../45. 1994~ ~ ,J
i
mmurea ungi per'.. 0- i P . t .:;bn vmra copilulni. cum 11r fi ,;~ Iiours; A,.C., Liebert, R.t-.Jf.. ~i Pndawer, W. Jcnlrnal ~f
~ . . . . .. ne aproptate sn\1 .. .
mceperea scat . . .i\ unm nntmal preferat AbnbrmulCI1ildPsychology. ]1. 513-519, 1983; . .,
n san mutarel la o tr " . '
domici1in. o boalli somatld\ . a .a !lCoala. mutarea ln uri nil ',.Houts. A..C. !Peterson, J.K ~i Whel~m. J.P . "Behiw~or
Exisrll d!lte barn nratl( tern . . ell
.: J'hel"apy.,I7...:462...\i69, .19~6; 1
esle efieie.ntJl.Jn traranlentul anxi::: ~ogmtiv-compoltnmentnUi , . '.I-Iouts. A..C. Wl1eJan. J.P.,~i Peterson.l.K., Jonrns.i. of 'i
:r
Enc9JJreZ:is . tti rle separa~e.. : . CimsultingandGJ.lll:icarl?:;ycftology. 55,902.-906, 1987~ ' ~-'
Encoprezisul se ref~rli 1 . ... : CoutpoJ7ta~nent:rtfopQzi(ionist1 praVIJCilim .. . ;
. fecaJelor. soldata cue. . . . ; adrucapueitatea_ de conrinentlt a :. CCJmpOJ'tlln"L~llU:Ul o~~ziti;onistapare ntlit ]a pl"~col&ri, Cfil
. . IUtSlUnt e scaun ... "' . .
. pentru flcclil:il: (pe bain j . . , . . . .....u ~ttuap11nndecvnte ~1a'_arlo1escenti ~j se Iflc'tnif'eslji prln~ pierderea controllllui, ce:rturi
co_n_t_i_nun_re. an.O_l_m nJ"a. ;c__.. np,a~.etc..),Stn
__ r_ea_._._P.__oa_tf>reprezent.a_ o cu )_):iri(ltils~u profe8o~ii,,"fQi;~ ~iiritare, b) lliTU\reanltoJ~n pentru
,. ~naontinenre n r r
. o pietdere n Jncontineu( "' l .l ?n nntt e, saupoateconstind ptnp~Hie_g~li.1nc~piltH.iiare_!iirefuzull;lea face compmmisuri,
etu tenor ncbizipei contro1ului ..J'
sfincteaittn. rentztd~e .a CSpeCia ~g~lf~ ~re~Ulll ~i irit~rea intelltiOrtatl\ il
'Q~etc d\\te indian mQdiflca . . . celofdinjur; .A~t_;PJ1l~~!~"[llentse manifesto, de reguUl, nc~sli,
__ o_Rt_efi_"tci,._nt_-: . ~
lin trnra_m n1e co_ mpol'h\nlemale cnfiind
.l. . Ynsl ponte npareasl'ia ~coal}i sau in public. . _
-D .. .... . ln cnzu encoprezet' . J

.r.:.nllrem ' Trnrnn1entul doveqit efi6ient tn cn~ul comporramennllui

_Enul'ezisttl-~e referiUa :. ~<; , .... opoziponisteste ti:ainjog'-lllplidn~ilor. in'cndrul aceshlill.parinti i
CltJi_sia ~~'\trilllhtnrvenilld To ~np~c~ratea de reten(ie urinarlf, i~i formeaz.li de{n:illderf ~are _sa ti "ajut~ sit fnqit fata
fll srntaltl inndecvate pen~ he P!-11ztJe ~au P...e pamursul noptii cmnportii~"fenmluicupiilpr. pj-egndrea include _fmni1 iafi;zarea cu
poate_ reprezenta l)con'ti" .. .. . est?-{.pef)J}me,mpat_ e_ tc.tstnrea priuqipiHe1nvtltai-ils{lfiille ~i ateh11icilor derivate.. Terapeurul
- . nuare anorm Hi . .
ll1e, snu ponte constitui . ... . a .a UlCOt)tinentei inf.an~ of~ra o s~urta expl}ilere ~ conceptelor de b~zli. ~i t:~hni~il.or
.achb:i(iei contmlu1uJ't . o pterdt!l'e a mcontinenrei nlterior propuse. ghldftn~ . apol pliyin{H in implea'nepu1re1l . _nctdstor
. lnnnr.
. Datele e>cistente i d; n . . ... procedurk Modelelt~ .:le'i~.tt:rnctinne ~i procednrile fnvlitaie in : iI
~om~ottmnentalet~t.llatun:n~~ enclar. eflc.Ienra- i~terventiei cadml1]ediil\elor surit uJ.rerior aplicate ftcnsn. J)intt~ studiiJe
......,
. tn1phcti, dare.guUi nt"l"za .. .1. .1rez_asol!u. A.cestttpdeternpi~ 'empirice asupra effcie!l{tincest~i forme de terapic. ~nJ.m"!ei"ihn: ..i
. . ren ' e a atmc (e"'
sen1nabzenzit p 1:ezenra . . . . . ......:al)f11nale sonore) ce ' Dumas,. .J.Ia~. QlitlicatPsychology Review. 9, _197-222, .
e_d_uca_ _rea "pliri_nt:ilo._ .. .,.....;n~~IIJ. e.fdP~__ .luune _Bau in pat, precmn si 1989; . . .
~. u. "e stu lilt em
acesrei forme de terapie enumerlinl . pmce asuprn -cficienfei .:_ Forehand. R. fli Long. N., Advances in Behavimr Re-.
. . search and Thempy,l()d29-rn.l988; .... . .. 1 .
.. Long1 P ., Forehand."R.., Wiers on, M. Iii 1v'forgan. A.i, "Be-
tl~Vior R~enrcb arid Therapy, ~2. 101-107 1994;
312

313
..
- ;:
 .-... . :~.;. ...
. "'~-

recontood~bu con~ulnu-eil unot: lucr~ de. psih9-~~1..11p!~-3an\8Un

i sb,1ts~il~(t999));. ,. ,. ; :~:~p~~; ;,'i;"~7:~:~c~'y)f'(~.: . ~:;Y) . .
~ EJementegene,n/tJ.afciTJlati~l ., '~.i.~qj~J!lj!illl!lc,!liinlific.:
BnlJ?!ltie :;i cu~ne'tVli teiitp ,~~.~~21 . . .
Colaborm: ~i.cu~f:e?Sc~~~~~~;~ ~~7~ ~erop~e};
. Alianta t~tap~\ttibiile~:srr.IDiJifeati opnn~lnre)~
.,. EIF-f:D;tegen.enzlelll~"laliel,te~'t! J{l}Jbf!,,. ~t!icien~
~~t6tific~~!Jx,,~2-~~ t,.,n
. . ;')i'~:A~~p~aneeoliciliti~nti~Congtta~::r
.Jl~db'c~~, '"':"'r .. i~l .. '
.~~~.~~\~~~iW~ieo;~~~'li'ii",~~o~Y:WlYi.~~~;jtnpi~~iren
uuot~specte pemoumei ..., . . . .

""~~~~.,:=~'~
pstliot~raJe a unorpro.ce . Jl dea~9:!~Y.;;;(~.J\g~~ . :.
la persoa1tele cu tez.isten'~ .mnre io~ tetayl:a ~a! :i)rec.ttvft
fuuc~iolieua,~Ane}~i'?~~tj~~~~~.~~<tP~!l~~l~c!'UJ -~ .. i
Dlfic~Ititpf\JI.l~\9Q5~ , H~ .N~r~i5<~ffr:
...,!J..~!Ffi;'f!.l"f4/llf!~Jifl~.~~Bf(i9}l~!~f!UfiJ1 rfle can1 proln1bil
u-elliJiefi]I{It~iiw:iiicfl!;#~!:~l@;~~~~f,Cil supod ~riinf.iiic
pai(ffiiW:i'all11Miiinu.aufolt S:~ijpi,~~tf.p.:pli~f!!J:
Stiluli;Je copi1Jg; .. ~. , ,. . ...
~teptilrll~.~~i~t,t!;. .
I Capacitatei4qt ~~lA~~'&pcrt.J_o problemnu~
.! StadiuJ s~!~~~;~J.~{)!'~ .J?~~~'ta)' t~94 pentru
,,>";' .,,-'' '< '. '<\

uetalii) ... . . :[' ; . ; .... '. . ..

." , .. A.'s'pet:t~ rf!lat~~{i[!{~~'Wa.~~ti[lt~{el~eu~;l:.~':::~~-e~ Jl~V.b:b!l
trehuit: {imrt ~trllf~"l!Jp-r..l!aZII::s~'!,l!..~$Cil"f'-SJ1f!CIBiJ.~tlloJj Jrl
ilOJJ1iniSfnll1Ul teiaj}iel dBI"CaJ:e lJU 8U fncll rJicj JllifCl.lr till SUJJ.Orl
"'-''.
I'
~Tiinlific partiaL
:ns

.: .., '

Siilnl de ata~all)ent~
Ernin~ti sex.lll;
Religiozitarea ~i spiritualitarea;
'I
\I

twe)~
tl) Kaufman (inteligenta globall\

e) Bluet-Simon {de ,-eeraloni'lt):

ciN.E.M.l. (RZazzo ~i colaboriliO~l) -nou,,st-rl ,\
~~ stlluri c_ogni-

..
I

. .,,. , -~
I
. _j

Preferinte~ lnetricii a \nteligen\ei ~

l
u
. ... . . . ,., . . . .
T1.1lburadle de p1';>ona1imre. g) cubnrile l{ohs pentm nd~l.t_t. de uokl.stem ..

ANIDrA 3 ..S.~TlJLUE JNSTRUMENTE PSlH()LOGlCE

.
J
I h) cuburileKohspentru copn. de H. Snntucct,
i} teStul dir~mizilor;
I'ENT~U Jq(PERTIZ~.DRA ~l EVAI...UAREA ~OPIILOR/ J) testul Coiu-q1bia. .... _ . i

ltLEVILOR iN VEDEREA ORIENTARn S,COLARE

c. Probedeinteliget~\fispoctficii: . . . 1

a) probe de evaluare a :t:unc_:ti~l percept~ v-mom\1 ~

t..l'nonAm 1~ntN lloTXnA.nEA GUVJ!:RNl.lLm - Santucci(4-6 ~n)i . :
RQNfANmi Nll~ 218 DJN 7l\1ARTI~ 2()02 ,...Uert:der~Sautucc,i (7-li ani) -,etnl'1n1\t
............ . i
de 1Cu1csftr;. 1' . . . . . _ .
Textul de maijgs este reprod9cerea. paT!iaJll a. Hotnrilrii >b) J:m3be qe ev~h1 ~re .a c,npacita{ii de or;ientarf Sl
. ' . .. .. . . . .
Guvernului R?mllniei nr. 2~8 di~ 7_M~Itle 2002, privind }'>~
sttncturare.spatut tt.. .... .. . ...... _
I
1

np~obua:eft Metodologiei penlrtt ntillzarea ~etnlui de insh~mlente: - Kolm-Goldstcin (aduptl\t d~ Sa~l\\ccl

deexpertizafetti'ev~luare n copiilor/elevilorill. vederea orientllr ii l}ietalona~deV. Preda); . i
~colare:n ncestora. ~ub_Uf?ntli tn Monitorul Oficial. Patten I nr. c)tuobedeinteligentli penrrudesen:
204 din 2.li mnrtie 2.002. - Goodenough;
tl} e'Valul\l"~a caJ?acitittii_dediscrlm.il)alie 1\
l. Evnlaunea ni'Velulni intcleetuah identiculuidesimetriciu structunle grnfice: I
.1\- Tesredein~eUget~fli ge,~eral~: -Jl.V.E.R.S.A.L.~ l
q)- mat}"icele.progresive Colorate-Raven: . e) ce veiletn imaginileRorscllach:
b) matricele progteslve Standard-Raven! f) dOinine. ._. . . . . . . . ' . . .. _ . . . ... ..
e) Dt!!t~rborni 2. Evnh1twen rooJddtntii ~i psiltomohicitntiu
tl) fraze abs'urtle;f .. t a) prilha Ozeretski-Ouilllllain;
. . . e) ce. s:.nschimbarl; h) Gpsell, sc~a de dezvoltnre; _ . _
"< > f) ce s;...:uc11in1bri.t 2. c) scaraOdetreBrnnet_!ii Irene l~eztne;
ll. Teste? de inteligenta globaU\: d.}proha delnterl,l1imr~ I~a.rris~ , . _. . :.
..a).W.P.P.SJ; s~antW~hsier-Bellvue; c) lestnl pcntrtl gnozia di gitala, Gerrsmann; _ i
b) WISC; semf}Wec!lSler-'fl~llvue; f) probapeninu:inkinezia membrelor supenonre;
e}\VAIS; scamWect)sler-Bellvne;

317
316
 g) test de 5lukinezie a ni'embrelor superioare. C.limbajul: .. . .
Stmubak;
a) scara de dezvoltate a limbaJ~llm, C.
h) proba de uiotricitatedigitala, 1\. Rey:
l 1aui1escu; . . .. _ _
i) probe de asarnblare (patralt triunghi); X b) ptoba de evalunre n capncttlifil ctttlulul. M.
,,:_ :j) proba Piaget-Head (orientate;,} spa~u)!. Ldbmt (Bovet);
k) testul Head (tnilna, echi, ureche); c.) Beuder-S.autucci;
I) Denver;
m) Portage. d) probe de flexibilitate nsocinti.va:
~) A. Rey adaplaUi.
3. Examina~eapsihologlcii n [J~IsouoJit.Ufii: ])~ imaginat}a:J
n) cbestionare de personalitale; n) proba e
desenliber;
b) CAT, testu.l de aperceptie pentru copH; b) proba Wartegg: . . . .
c) TAT~ tesf:ul tematic de apercepfie; t) probn Colliu (comi_J.letnren lacuuelordmll-.
d) Lucber, testul culori(or; tmdeseh);
e) Szondj, proba pulsiunilor; d)desenulfatniliei, Corman.
f) Call!JJ ::,:i R. Zaz:z;o, proba de peiseventre; E. memmia: .
g) testu.J CRSa-arbore-Omj
a) proba A~ Rey pc bazn de cu~iute; : ...
b) teslu1 arborelui; b) proba A. Rey pe bam Qe figun geomelnu.".
i) testul Rorschach; c) lestul ugm:ilor complexe. A. Rey;
j) Freiburg; u) proua .Pieron; . . .
It) STAI 1; . c) WISC (proba de memone).
l) STA1 IT; F. nten\ia: .
m) tesLuJ cu 20 de propoz.it.li netermiuate (eu suut) a) proba Toulouse-Pietou; .
(TST).
. ..
i
~

4.l'rohe pentni e:valua1.ea ncti:vitiiJii psilaice:

b) proba de dublu finny, I~. Za-no;
c) proba Bourdon-Amllmov;
1,
A. pemep!Ja; . d} prob11 Pr.aen;
a) testul figt,II'iloi .t:orn.plexe, A Rey; e) .lablrinle; :
b) lestul de orienta~;e spa(iaHi., H. Head; . 0 completnreal.acouelor; .
c) teslul fren.y vointa, A. Rey_ g) proba de discrimitm.re percepll vit
B. afecti vilatea:
a) testul de frustra\ie Rosenzweig;
b) completarea de pove.stiri;
c) asodere de cuvinte;
d) fabulele DUSS.

318
319

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