Transsexualität

Transsexuality is a process with biological, psychological and social aspects. It makes the person concerned feel subjectively appendant to the other gender. The own gender is objectively sensed but it is experienced as foreign. Because of this deep internal certainty, transsexual persons change into their inner chosen gender. This change goes along with a psychosocial alteration of role and in most cases with a hormonal and surgical conversion. Psychotherapy with transsexual persons is known to be difficult and disappointing. The aim of this review is to invalidate these prejudices and to encourage psychotherapeutic treatment of transsexual persons. It also will give all necessary information for this kind of psychotherapy. Generally the psychotherapeutic accompaniment of transsexuals is definitely a meaningful experience for a psychotherapist, in which basic issues of human existence are being touched.     

Religiosität und Spiritualität in der Psychotherapie

For many years religious and spiritual issues have been avoided in psychotherapy. In the face of social changes a more culturally sensitive psychotherapy is needed to professionally deal with religious backgrounds, spiritual needs and spiritual resources. A remarkable spiritual turn has recently been observed particularly in psychoanalysis, which was originally very antireligious. Health research studies are exploring the healing craft of religious virtues and values. It is important to discern between an empirically proven healing method and an ideologically founded promise of salvation. It is the task of the therapist to find out whether the patient's religiosity or spirituality is part of the problem or part of the solution.     

Intensität und Qualität in der Geruchswahrnehmung

Zusammenfassung Vier unterschiedliche Geruchsstoffe in je 4 Konzentrationen wurden von 23 Versuchspersonen nach Intensität beurteilt und paarweise auf ihre relative Ähnlichkeit hin verglichen. Eine Systematik der Versuchspersonenvarianz konnte weder in den Intensitäts- noch in den Ähnlichkeitsurteilen mit dem Tucker-Messick-Verfahren nachgewiesen werden. Mit den Medianwerten der Ähnlichkeitsurteile wurde das Skalierungsverfahren von Kruskal durchgeführt. Unter 25 Lösungen wurde diejenige mit einem Exponenten (Minkowski-Metrik) von r=2,5 und 5 Dimensionen als optimal ausgewählt und zur Grundlage der Interpretation genommen. Als wichtigstes Ergebnis erhielten wir eine unabhängige Intensitätsdimension mit Ursprung außerhalb der Reizkonfiguration, die eine hohe Übereinstimmung zur Intensitätsskalierung aufwies. Weiter konnte ein Qualitätswechsel jeweils innerhalb eines Stoffes zwischen den Konzentrationen festgestellt werden. Dieser Qualitätswechsel ist bei den einzelnen Stoffen unterschiedlich stark ausgeprägt.

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Quality and intensity in olfactory perception

Summary In an experiment on olfaction 23 subjects judged 16 odors (four chemicals each in four concentrations) with respect to intensity and with respect to similarity for each pair of stimuli. Systematic interindividual variation can he found neither in the intensity nor in the similarity data. Multidimensional scaling according to Kruskal's procedure reveals a configuration in 5 dimensions, the exponent of the optimal Minkowski-metric (out of 25 alternative solutions) is r=2.5. This scaling is based on the medians of similarity judgments. One of the dimensions corresponds to a subjective scale of intensity, with a zero-point lying outside of the configuration. The quality of the stimuli depends on their concentrations. The perceived quality-changes differ in amount and directions for each of the chemicals.

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Von der Philosophischen Fakultät der Universität des Saarlandes auf Antrag von Prof. Dr. K. Eyferth angenommene Dissertation.     

Destruktivität in Paarbeziehungen

Quarreling couples caught in destructive patterns of communication often cause difficult situations during couple therapy. Such communication patterns range from pure verbal humiliation and insults up to outbursts of violence. In order to remain capable of therapy, psychotherapists must know the underlying mechanisms that provoke and maintain the destructive viscious circles. Moreover, they must have at their disposal the required explanatory ideas and practical intervention strategies for de-escalation and interruption of these destructive patterns.     

Sexualität und Gewalt

Sexual assault as defined by law, psychiatry and sociological research is contrasted to the everyday definition of rape. Official figures on the frequency of sexual assaults as communicated in annual reports by the police differ greatly from figures found by research on sexual victimization or representative studies using different definitions of violence and abuse in sexual relations. Overpowering and violence is not a rare phenomenon in sexual relations – nearly every second woman and 10% of men are familiar with such situations. There are not only biological conditions (individual variance in neurophysiological parameters) but also psychological conditions favoring the use of power and threat instead of courting in sexual partnerships. External conditions are certain popular opinions in parts of society and certain subcultures which may also be more or less in favor of male superiority, thus helping the perpetrator to justify his assault or on the contrary helping the victim to find support in court procedures and therapy if necessary. Prevention therefore has two targets: a general one by changing popular opinions which are in favor of the use of power in sexual relations and informing persons in danger of becoming victims about the risks and the possibilities to protect themselves and an individual one by treating victims to overcome their psychological injuries and to treat perpetrators inside and outside the judicial system. The current discussion on increased availability of pornography in the internet shows both aspects: a general target to reduce negative influences of pornography which produces devaluating views on sexuality and women and the more individual task of tackling new forms of pathology created by the media at least for some of the consumers.     

Strukturen der Alterskriminalität

The group of the over 60-years-old does only contribute a relatively small part to the registered crime – compared to their continuously growing percentage in the population. Crimes committed by elderly persons are predominantly property offences with shoplifting playing an outstanding role. Elderly persons are also overrepresented concerning offences of insult, (negligent) arson and environmental offences whereas violent crimes are rare. Elderly men are also slightly overrepresented concerning sexual abuse of children, but this is very rare, too. As a whole, the fear that Germany will be overrun by a wave of old-age crime does not seem to be confirmed. Elderly offenders are still very rare and the offences committed are significantly less heavy than those committed by younger offenders.     

Interdisziplinarität und Wissensentwicklung

Interdisciplinarity and the Development of Knowledge. The author is engaged in the question how to explain the development of scientific meanings of facts which does not coincide with producing them rather with processes of the scientists' public communication. So long as the facts are adjustable to the conventional theories of those discipline which the researcher belongs to this connection does not reveal perfectly clear. More instructive is a consideration of so-called anomalies. The author demonstrates with an example of the history of science that researchers in case of new phenomena use to borrow concepts from other disciplines for resolving the interpretative problems. It emerges a loose net-work of concepts. In this way the researchers are producing a disciplinary mixed public at the same time. This process is seen as an important phase of the development of new theories and, complementary, new disciplines.     

Pluralität der Wissenschaften

In September 2002 the international conference on "Pluralism of sciences: the psychoanalytic method between clinical, empirical and conceptual research" took place in Frankfurt am Main. One of the purposes was to discuss a research methodology, which is adequate in psychoanalysis. The major points were clinical research as process-outcome research and experimental research on psychoanalytic paradigms with current methods of the so-called "life sciences". A critical discussion of these research strategies appeared difficult and did not reach a satisfying conclusion.     

Kosteneffektivität ambulanter Psychotherapie

Background

There is a lack of cost-effectiveness analyses (CEA) of psychotherapeutic treatments.

Material and methods

Cost-effectiveness analysis was applied to a sub-sample of 122 psychotherapy outpatients who participated in a large longitudinal study on outpatient psychotherapy (TRANS-OP study). Participants received either psychodynamic psychotherapy (PD, n=69) or cognitive behavioral therapy (CBT, n=53). Effectiveness (change in symptomatic impairment over 2 years) was assessed via the German version of the Outcome Questionnaire (OQ-45.2). Direct health care costs during a 2-year period (psychotherapy and other health care utilizations) were obtained from health insurance claims. Cost-effectiveness analysis methods included incremental cost-effectiveness ratios (ICER) and the net benefit regression approach.

Results

Cost-effectiveness analyses showed no significant differences between the two treatments, neither head-to-head, nor with regard to advantages in certain subgroups of psychotherapy outpatients. A slight dominance of CBT in costs was not maintained after controlling for covariates.

Conclusion

Provided that pivotal covariates such as treatment need are taken into account, cost-effectiveness analyses can contribute to a more equitable distribution of psychotherapeutic resources.     

Familienfunktionalität und Therapieerfolg

Background

Even though it is a treatment standard of child psychotherapy to involve the parents, hardly any research has been carried out about the impact of family functioning on treatment outcome. Aims of the present study were to investigate the change in and the prognostic power of family functioning on treatment outcome of short-term psychodynamic psychotherapy in children and adolescents.

Patients and methods

The sample consisted of 54 children and adolescents undergoing outpatient short-term psychodynamic psychotherapy. To assess family functioning, their parents were asked to complete the Family Assessment Measure (FAM).

Results

Patients from families with high levels of functioning in task accomplishment, communication and affective expression were more often treated successfully. Improvement in levels of functioning in role performance, emotionality and control were only found in the group of successfully treated patients.

Conclusion

Family functioning is a decisive factor in the differential indication of psychotherapeutic treatment in children and adolescents.     

Lebensqualität von ärztlichen und psychologischen Psychotherapeuten

In a large empirical cross-sectional study the quality of life of medical and psychological psychotherapists ( n =71, respectively n =103) was examined as well as the influence of the different therapeutic methods used. Instruments used were the Questionnaire on Quality of Life of Physicians (Reimer and Jurkat 2003) respectively the Questionnaire on Quality of Life of Psychologists (Jurkat and Reimer 2003) as well as the SF-36 Health Survey (Bullinger and Kirchberger 1998). The majority of participants in both samples are satisfied with their life. Psychological psychotherapists are comparatively more content with their work situation and judge their own health more positively than their medical colleagues do. Both groups feel their income situation to be a loss in quality of life. A common fear is an even greater bureaucratic burden and financial deterioration. Thus it seems that psychohygienic measures and secure job perspectives may contribute to raising the quality of life of psychotherapists.     

Sexueller Sadismus und Sexualkriminalität

The categorization of sadism has turned out to be a versatile phenomenon, which covers a spectrum from harmless symbolic rituals to extremely violent acts where strong impulses or prolonged fantasies and rituals are involved. As the phenomenon is versatile its causes and appearances vary as well, although so-called BDSM (bondage & discipline & dominance & submission & sadism & masochism) practitioners and persons with severe sadism in a forensic context share only few common preferences. Based on own clinical experiences with sadism in forensic patients the authors support the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) especially the diagnostic disjuncture of sadism and masochism. Sexual sadism appears more frequently in forensic contexts in combination with sadistic, antisocial and borderline personality disorders but rarely with masochism. Masochism is otherwise reported to be more prevalent in patients of general psychiatry, however, combined with depression or dependent personality traits rather than with sadism. Moreover, the authors believe that if use of the diagnostic term sadism is perpetuated the establishment of the proposed new diagnosis “paraphilic coercive disorder” is unnecessary. The diagnostic term is also important for treatment and assessment. Despite the lack of reliable long-term studies with larger samples, it is reasonable to assume that medication, sometimes even anti-androgenic treatment, can be indicated in patients with severe sadism.     

Somatische und psychische Komorbidität

Studies indicate that chronic somatic diseases are often associated with psychological burden and manifest mental disorders. The interaction may be a complex one rather than a mere reaction to severe somatic illness. Early recognition of psychosomatic comorbidities has important implications for adequate diagnostic classification, therapy, and the course of the whole disease pattern. The timely treatment of depression in somatic illnesses can for example not only alleviate depressive symptoms but also raise quality of life and reduce the consequences concerning the course of the somatic disease. However, many questions still need to be answered relating to the concrete influence of a therapy of the mental disorder on the somatic prognosis.     

Die Effektivität der Hypnose

From 193 studies published until 1998 that investigated the efficacy of hypnosis 43 randomized clinical studies were selected that compared a patient group treated exclusively by hypnosis with an untreated control group (or with a group of patients treated by conventional medical procedures). The 43 studies were integrated into a meta-analysis that yielded a weighted average post-treatment effect size of d=.60 (medium effect size) for hypnotic treatment of ICD-10 coded disorders (24 studies; average treatment period: 5.1 weeks) and d=.38 (small effect) for hypnosis as an adjunct for supporting medical procedures (19 studies). These estimates are conservative since all variables of a given study were used. Most of the studies employed methods of the classical approach to hypnosis. In order to obtain an estimate to which extent non-clinical factors (design-quality, way of comparison of dependent variables) have an influence on the effect sizes, effect sizes were computed for all studies of the original 193 studies that reported the necessary statistical information (N=89). For those studies with an average effect size of d=.80 a massive influence of non-clinical factors was demonstrated with a range from d=.51 for randomized studies with group comparisons to d=2.0 for non-randomized studies using pre-post-comparisons.