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#055 Joanneke’s enriching therapy techniques

The story of Christoff’s surgical precision is a story of Joanneke’s enriching therapy techniques

A South African Braai, addiction treatment, and technology: how are they related? As a true detective, consultant psychiatrist Joanneke van der Nagel constantly tries to find meaningful images and states of mind to get clients from A to B. Creative techniques, such as the use of VR environments, can help do this. Now, UT-colleague Christoff Heunis wonders: does that also include hypnosis? Is there any truth in the psychoanalysis stereotype at all?

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Monday 15 November 2021

Detective for possibilities

Christoff: ‘Joanneke, since you’re a psychiatrist, I assume that you’re usually the one asking people questions. Now it’s time to turn the tables. You’re also an epidemiologist. Does that mean I can call you a disease detective?’

Joanneke: ‘Haha, that’s interesting. I’ve never thought of myself as a detective before. I wouldn’t describe myself as a detective of diseases, though. I think of my specialty, psychiatry, in a broader context. I work with people that generally don’t have just one medical issue. Rather, a whole variety of factors influence how they’re doing. It’s my job to detect these underlying issues and to find the ways to fix them.’ 

Christoff: ‘When I think of psychotherapy, I think of hypnosis. Is that something that you incorporate in your work?’

Joanneke: ‘I don’t, but I get where you’re coming from. Hypnosis is part of the picture that pop culture paints of psychiatrists. Like the psychoanalysis stereotype, where patients lay on the couch and talks about themselves to a bearded man with a monocle. That picture isn’t entirely false. I do have a couch in my office, but it’s for me, to rest my legs every now and then. Besides, psychiatry does involve lots of talking therapy as well as medication treatment. But at HMI we try to find ways to complement that.’

“The detective in me is always looking for ways to help someone get from A to B, despite their limitations”
Joanneke van der Nagel

Christoff: ‘What’s wrong with talking and medication?’ 

Joanneke: ‘There isn’t anything wrong with those techniques, but they aren’t optimal for all of my patients. Generally, the people I work with have difficulty with introspection, because of intellectual disabilities or addictions. If you can’t self-reflect, talking about yourself to a therapist won’t help you. So, the detective in me is always looking for ways to help someone get from A to B, despite their limitations.’

Christoff: ‘Can you give an example of an alternative technique that you apply?’

Joanneke: ‘You’re from South Africa, right? Then you must be familiar with Braais. Braais are all about socialising, eating, and drinking alcohol. Now, imagine you had a drinking problem and we wanted to practice your behavior in this situation. In traditional therapy, I would simply say: ‘Imagine you’re at a Braai.’

Christoff: ‘I certainly miss those. Please, continue on that note.’ 

Joanneke: ‘I can tell, your whole face lights up! Now, we could talk about how you could cut back on drinking at Braais, but it’s very hard to predict how you would actually behave. That’s why at HMI, we’re currently building a virtual environment in which patients can practice their cognitive behavioral skills in extremely realistic, triggering scenarios. VR allows you to see and hear the Braai. That way, we can help people with addictions deal with these high levels of arousal and cravings.’ 

Christoff: ‘I assume you encounter a broad spectrum of personalities in your work. Are there certain personalities or cases that make your job especially difficult?’

Joanneke: ‘I would say it’s interesting rather than difficult. Sure, sometimes it is hard to connect both with patients who are highly educated, well-off, and who live in suburbs, people that live in poverty or have lower IQ’s. In general, it helps to present myself as a person, with all my strengths and weaknesses.’

“A lot of people don’t feel at ease if you address them while wearing your imaginary white coat”
Joanneke van der Nagel

‘A lot of people don’t feel at ease if you address them while wearing your imaginary white coat. In medical training, we’re taught to have a professional attitude and interviewing style. That’s a shame, because it stresses the social distance between the patient and the psychiatrist. Vulnerable groups have the highest morbidity and mortality rates but still have trouble accessing the medical world.’

Christoff: ‘UT is currently working on becoming a more inclusive university. How do you think we can achieve this?’

Joanneke: ‘I think providing accessible communication is an important first step. There’s a huge bias in the way that we do research. The selection criteria, the way we recruit people, how we try to obtain informed consent. The prerequisites for participation are far too complex. It’s all very much aimed at our own academic bubble. If we want to be an inclusive university and offer solutions that help a large group of people, we need a focused effort to counterbalance this. As part of UTQ, I’m designing a course called ‘Break Your Academic Bubble’. I like to think that is a first step for developing more inclusive interventions.’

Christoff: ‘I hope so. I have a twin sister with a physical disability, and I have seen the hurdles that she’s had to overcome.’

Joanneke: ‘I still remember my first time going through the gates at Enschede Station in a wheelchair. You need both of your hands to roll your wheelchair, but you also need a hand to open the gate with your OV-chipcard. It’s impossible. And that’s only a small hassle, of course.’

Christoff: ‘I can empathise with your passion for inclusivity. We could probably talk about it for hours. Over a Braai, perhaps?’ 

Joanneke: ‘Sounds like a plan. Although it does have to be a vegetarian one, then.’

Christoff: ‘Don’t worry, my girlfriend is a vegetarian, so I know all the good dishes.’

DR. CHRISTOFF HEUNIS (1992)

got his master’s degree in biomedical engineering from Stellenbosch University in South-Africa. In 2017 he came to UT to do his PhD in the Surgical Robotics Lab of the Department of Biomechanical Engineering (Faculty of Engineering Technology). During his PhD he developed the Advanced Robotics for Magnetic Manipulation (ARMM) system – a surgical robotics platform to accurately move catheters using externally-generated electromagnetic fields. Christoff is currently working on commercialising his work to bring this technology to operating rooms in the Netherlands and Germany.

Joanneke van der Nagel (1974)

is researcher at Human Media Interaction of the Electrical Engineering, Mathematics and Computer Science faculty (EEMCS). She focuses on making technological innovations in the medical world, such as virtual reality, more accessible to vulnerable populations. Besides, she is a consultant psychiatrist at Tactus Addiction Medicine and Aveleijn Disability care. Joanneke has a medical degree, Master’s in philosophy, and a PhD in Social Sciences. She also obtained a registration as a clinical epidemiologist. She is a strong advocate for inclusive healthcare, in terms of eHealth equity as well as research strategies. Joanneke strives to establish a research centre and educational minor on inclusive research at UT.