Middle Eastern Journal of Disability Studies

fa تجربهٔ زیستهٔ بیماران سایکوسوماتیک در گذار از درمان‌های زیست‌پزشکی به روان‌شناختی: یک مطالعهٔ کیفی The Lived Experience of Patients With Psychosomatic Disorders in the Transition From Biomedical to Psychological Treatment: A Qualitative Study روانشناسی Psychology مقاله پژوهشی اصیل Original Research Article چکیده زمینه و هدف: اختلالات سایکوسوماتیک از پیچیده‌ترین حوزه‌های تشخیصی‌درمانی ‌است و در مرز میان رویکردهای زیست‌پزشکی و مداخلات روان‌شناختی قرار می‌گیرد. هدف پژوهش حاضر، تبیین تجربهٔ زیستهٔ بیماران سایکوسوماتیک در گذار از درمان‌های زیست‌پزشکی به مداخلات روان‌شناختی و شناسایی عوامل تداوم‌بخش یا تسهیل‌کنندهٔ علائم بود. روش‌بررسی: این پژوهش با رویکرد کیفی و مبتنی‌بر نظریه‌پردازی داده‌بنیاد انجام پذیرفت. دوازده بیمار با علائم جسمانی پایدار بدون علت پزشکی مشخص و سابقهٔ دریافت روان‌درمانی، با نمونه‌گیری هدفمند انتخاب شدند. گردآوری داده‌ها ازطریق مصاحبه‌های نیمه‌ساختاریافته بود و داده‌ها با روش مقایسهٔ مستمر در سه مرحله کدگذاری باز و محوری و انتخابی تحلیل شد. رعایت اصول اخلاقی پژوهش، مدنظر قرار گرفت و رضایت آگاهانه از مشارکت‌کنندگان اخذ شد. یافته‌ها: تحلیل داده‌ها منجربه استخراج سه محور اصلی شد: ۱. عوامل مرتبط با نظام درمانی ازجمله تشخیص‌های متناقض، ارتباط غیرهمدلانه، مسیر درمانی نامنسجم؛ ۲. عوامل فردی-هیجانی شامل اضطراب مزمن، سبک‌های دلبستگی ناایمن، الگوهای دفاعی و شیوهٔ معنابخشی بیمار به علائم؛ ۳. کیفیت حمایت اجتماعی، به‌ویژه نقش اعتباربخشی یا سرزنش خانواده. تعامل این محورها در تداوم یا کاهش علائم نقش تعیین‌کننده‌ای داشت. نتیجه‌گیری: مشخص شد، تجربهٔ بیماران سایکوسوماتیک حاصل تعامل هم‌زمان ساختارهای نظام درمانی و ظرفیت‌های هیجانی فرد و کیفیت روابط حمایتی است؛ همچنین دستیابی به درمان مؤثر مستلزم رویکردی یکپارچه و چندتخصصی و حساس به ابعاد هیجانی و فرهنگی بیماران است. Abstract Background & Objectives: Psychophysiological or psychosomatic disorders represent one of the most complex diagnostic and therapeutic areas in behavioral medicine, situated at the intersection of biomedical conceptualizations and emotion–focused psychotherapeutic models. Psychophysiological disorders not only cause chronic suffering and reduce quality of life but also increase healthcare system costs and challenge medical practitioners, especially when patients’ symptoms do not align with conventional medical findings. Patients frequently navigate long cycles of medical consultations, repeated diagnostic procedures, and inconclusive test results before receiving an accurate understanding of the emotional mechanisms contributing to their persistent somatic symptoms. Despite growing empirical evidence supporting the role of unconscious emotional processes, attachment patterns, and defensive functioning in the manifestation of bodily symptoms, the lived experience of these patients, particularly their transition from biomedical to psychotherapeutic care remains underexplored. The present study aimed to develop a conceptual model explaining the lived experience of individuals with psychosomatic symptoms during their journey from medical treatment to psychological therapy, with a focus on identifying structural, emotional, and relational factors that either maintain or reduce symptom persistence. Methods: This qualitative study employed a Grounded theory approach to explore the dynamic processes shaping patients’ experiences. Twelve individuals with persistent somatic symptoms without identifiable organic pathology, all of whom had participated in psychotherapy, were recruited using purposive theoretical sampling. Drawing upon researchers’ experience in dynamic therapy, the study call was disseminated through a network of collaborators and specialists active in the field of emotion–focused therapies. Written or verbal informed consent was obtained from all participants. Data were collected through in–depth semi–structured interviews focusing on patients’ diagnostic journeys, encounters with medical professionals, emotional meaning–making of symptoms, and experiences in psychodynamic or emotion–focused therapy. Interviews were audio–recorded, transcribed verbatim, and analyzed using the constant comparative method across three stages: open, axial, and selective coding. Memos and analytic notes were used throughout the process to refine categories and explore emerging relationships. The analysis continued until theoretical saturation was reached. To enhance trustworthiness, strategies such as peer debriefing, member checking, audit trails of the analysis, and examination of discrepant cases were employed. Finally, the extracted categories were compared and integrated with the theoretical literature related to emotional dynamics, emotion processing mechanisms, and psychosomatic models, and the conceptual model was developed based on this integration. Ethical principles were fully observed, including informed consent and approval from the institutional ethics committee. Results: Three core thematic axes emerged from the analysis. First was the healthcare system dynamics. Participants described contradictory diagnoses, fragmented care, and emotionally detached communication from providers as key contributors to confusion, anxiety, and diminished trust. Conversely, clear explanations, coordinated multidisciplinary care, and emotionally attuned interactions facilitated hope and engagement. The second was Individual emotional–personality factors, including chronic anxiety, insecure attachment patterns, fear of psychiatric medication, limited emotional awareness, and reliance on inhibitory defenses that were frequently linked to exacerbation of symptoms. Meaning–making how patients interpreted the bodily manifestations of their internal conflict played a central role in symptom intensity and their readiness for psychological treatment. The last one was social and familial support. Supportive family involvement reduced distress and fostered treatment engagement, while invalidation, stigma, or blame heightened symptom severity and reinforced feelings of helplessness. Conclusion: According to the findings, the experience of psychosomatic patients results from the simultaneous interaction of healthcare system structures, an individual’s emotional capacities, and the quality of supportive relationships. Furthermore, achieving effective treatment necessitates an integrated, multidisciplinary approach that is sensitive to the emotional and cultural dimensions of patients. اختلالات روان‌تنی, تجربهٔ زیسته, نظریه‌پردازی داده‌بنیاد, درمان روان‌شناختی, گذار درمانی Psychosomatic disorders, Lived experience, Grounded theory, Psychological therapy, Therapeutic transition 119 119 http://jdisabilstud.org/browse.php?a_code=A-11-4109-1&slc_lang=fa&sid=1 Mahtab Norouzi مهتاب نوروزی mahtabnorouzi07@gmail.com 100319475328460068879 100319475328460068879 No PhD Student in Psychology, Department of Psychology, Science and Research Branch, Islamic Azad University, Tehran, Iran دانشجوی دکتری روان‌شناسی، گروه روان‌شناسی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی، تهران، ایران Mehdi Reza Sarafraz مهدی رضا سرافراز Msarafraz@shirazu.ac.ir 100319475328460068880 100319475328460068880 Yes Associate Professor of Psychology, University of Shiraz, Shiraz, Iran دانشیار روان‌شناسی، دانشگاه شیراز، شیراز، ایران Mehdi Manouchehri مهدی منوچهری m.manouchehri@iautmu.ac.ir 100319475328460068881 100319475328460068881 No Assistant Professor, Tehran Medical Sciences Unit, Islamic Azad University, Tehran, Iran استادیار، واحد علوم‌پزشکی تهران، دانشگاه آزاد اسلامی، تهران، ایران