Hermeneutik oder Szientismus?

Hermeneutics (meaning, understanding) and scientism (causality, explanation) formed and still form opposites that make it difficult to adequately conceptualize self-determination and positioning of psychoanalysis in the theory of sciences. The first proposal is to view these opposites not as an either-or principle but more as the principle of complementarity as proposed in the Copenhagen interpretation of quantum physics. Then, the communicative turn of hermeneutics as thoroughly worked through by Habermas can be combined with results of empirical research from infant research and primatology so that a bridge between the two camps comes into sight. This bridge is stable if besides “meaning” and “causality” a third pole is established: sociality. Thus, a step forward to a triadic epistemology can be taken which is prepared here. Research on the microstructure of social interactions in psychoanalysis confirms the possibilities of including a social dimension which is extremely important but widely ignored in the theory of scientific debates between hermeneutics and science.     

Passt oder passt nicht?

Differential indication in psychotherapy should be a process of decision making, that takes multiple factors into account, and not just the assignment of a particular disorder to the adequate therapeutic method. Unspecific characteristics of the patient, instead of disorder-specific features, as well as personality characteristics of the therapist having therapeutic relevance are important factors either. In this way decisions for an indication then turn into the crucial question of matching between patient and therapist. The receptivity of the patient is a central component. As a result of successful maching, the therapeutic relationship will improve which has a positive influence on the outcome of psychotherapy. According to the generic model of psychotherapy 4 levels of the decision-making process are defined. They serve as orientation for a differential indication taking into account both persons and methods. The realization of this indication model in in-patient treatment has some preconditions. Obligatory is the availability of a variety of therapists differing in therapeutic methods and personal characteristics. The mostly applied principles of matching decisions are listed in tabular form and illustrated by a case report.     

Beziehungs- oder Mentalisierungsfähigkeit

This paper investigates the predictive value of the psychological mindedness assessment procedure (PMAP) with respect to differential group therapy outcome using outpatient group therapies with patients suffering from somatoform disorders. Within the contextual framework of the mentalization theory the possible predictive power of the PMAP prior to indications for therapy is reflected. As the results of 50 patients from 6 therapy groups show high PMAP ratings prior to treatment onset predict group suitability of patients. This in turn is predictive for an emotional attunement of such patients during treatment, which is in itself a qualification for an emotional involvement with the group interactive process and therefore highly predictive. In contrast patients with a lower PMAP rating should be referred to groups where another treatment concept or technical attitude on the part of the group leader is realized. The shorter the therapy groups last the more homogeneous group composition should be regarding psychological functioning of patients prior to treatment onset (level of mentalization).     

Kopfschmerz: Pharmakotherapie? und/oder Psychotherapie? und/oder sonstige Therapie?

Zusammenfassung  Der Kopfschmerz ist ein h?ufiges Leiden, das sich vor allem auch beim praktischen Arzt, und nicht nur beim Facharzt, findet (5 % in der Allgemeinpopulation). Der Kopfschmerz hat mehrfache Ausformungen und Mitursachen-Faktoren. Es ist daher kontraproduktiv, hierbei nur auf eine Art der Behandlung oder eine Ursache abzuzielen. Nur in der multifaktoriellen Betrachtungsweise unter gezieltem Einsatz sinnvoller therapeutischer Kombinationen wird man mit dieser Crux der Patienten und der ?rzte bestm?glich weiterkommen. Es werden immer noch Problempatienten übrig bleiben. Diese müssen psychotherapeutisch begleitet werden. Man darf sie nicht in die Hoffnungslosigkeit und/oder den Abusus versinken lassen, sondern muss immer wieder versuchen, Weiteres zu probieren, und sie auf dem therapeutischen Pfad zu halten (Abb. 1a).      

Ambulant oder stationär?

A central issue in psychosomatic-psychotherapeutic consultations is whether to recommend outpatient or inpatient psychotherapy. In a prospective field study at a psychosomatic outpatient unit sociodemographic and clinical variables were compared for patients for whom outpatient treatment (N = 129) or inpatient treatment (N = 112) had been recommended. The assessments of the therapeutic alliance were made by the referring therapist and the therapist who conducted the therapy. The main findings were: The decision about what type of treatment to recommend was based mainly on the type and severity of the disorder, including the patient's functional level and personality structure. There was no difference between the patient groups in how the referring therapists assessed the initial therapeutic alliance, but there was a difference in how the treating therapists did, the relationship to the inpatients being rated significantly less favorably. The importance of the different treatment settings in interaction with the severity of the disorder is discussed. The initial therapeutic alliance in the consultation did not enable a prognosis about the therapeutic alliance during therapy.     

Autismus oder „Psychopathy“?

According to the concept of Hare autism spectrum disorders and psychopathy are associated with a strong deficit in empathy. However, empathy deficits in patients suffering from autism spectrum disorders and empathy deficits in individuals with psychopathic personality traits appear to be different. Some authors described the comorbid occurrence of psychopathic personality traits/psychopathy in individuals with autism spectrum disorders. The following article aims to approach this differential diagnostic problem by a brief review of the literature on a casuistic basis. This article reports the case of a highly remarkable 17-year-old adolescent. The case will be discussed according to the construct of psychopathy with reference to the concept of Hare.     

Logische oder metaphysische interpretation der logistik?

Ohne ZusammenfassungPaper sent in for the fifth International Congress for the Unity of Science (Cambridge, Mass. 1939).     

Die Rechtsansichten der Eurasier -- Rechtsordnung oder Wertordnung?

In their juridical doctrines, the members of the Evrazijstvo movement advocated the idea of a Russian special path criticizing at the same time the formalism and coldness of the western conception of law, based principally on Roman law. Their views are characterized by an evident priority accorded to justice over law, to the order of values over legal order.     

Werden Psychotherapeuten,Psychiater oder die Psychotherapie stigmatisiert?

Background

In the last decades much has been found out about the stigmatization of persons with mental illnesses. Recently, a potential stigmatization of psychologists, psychiatrists and psychotherapy has been debated.

Aim

The question should be answered whether there is any scientific evidence for stigmatization of psychologists, psychiatrists and psychotherapy by using the conceptualization of stigma as brought forward by Link and Phelan (Ann Rev Sociol 2001; 27:363–385).

Material and methods

For the systematic literature search in 2013 a databank search was carried out in Web of Science using the search terms stigma or discrimination or stereotypes or prejudice AND psychiatrist or psychotherapist or psychotherapy or mental health professional. A total of 2013 publications were identified which were systematically arranged according to the title and abstract with respect to the relevance for the question whether psychotherapy or associated professional groups are stigmatized. Only four of the articles were considered to be relevant. After advice from experts six further relevant articles could be found which did not appear in the databank search.

Results

The review found evidence for both positive and negative stereotypes but not for other components of the stigmatization process.

Conclusion

At present there is no evidence for a stigma related to psychotherapy or to the professions of psychotherapists and psychiatrists.     

Intersexualität oder Störung der Geschlechtsentwicklung

Intersexuality is suspected when a person either lacks the gender-typical attributes or they are too pronounced or if the attributes of both genders are present in one individual. Intersexuality is an umbrella term for a multitude of diagnoses having different causes, different disease patterns and different developments. Some of them are described in this article, such as the adrenogenital syndrome showing virilisation phenomena with a 46,XX chromosome set or reduced virilisation with a 46,XY chromosome set in the case of an androgen insensitivity syndrome, disturbances of androgenic biosynthesis or gonadal dysgenesis mostly with a feminine gender role. Examples of treatment situations from the psychotherapeutic practice are presented.     

Stationäre oder teilstationäre Psychotherapie?

In a pilot study we compared two groups, one of inpatients and one of day clinic patients who were treated between January 1999 and December 2001 at the Department of Psychosomatics and Psychotherapeutic Medicine in Freiburg/Germany. Both settings offer a similar, multimodal and intensive psychotherapy program on a psychodynamic background. In a first explorative data analysis (sociodemographic data, SCL-90-R, IIP-C) we studied differences in severity of initial symptomatology and differences in outcome (prae/post). Patients with anorexia nervosa and a very low weight were preferentially treated in the inpatient setting. In addition the inpatient group of patients with a somatoform disorder showed higher degrees of somatization, as compared to patients with a somatoform disorder in the day clinic. Therapeutic change with respect to psychopathology however did not differ between the two settings: both groups showed a significant improvement during the course of therapy.     

Wie kann man in der Sozialtherapie Therapieerfolg feststellen oder messen?

The tradition of social therapeutic evaluation research in Germany is as old as the institution of social therapy itself. Social therapeutic facilities constitute the royal road to correctional treatment in the German prison system providing an integrated approach for offender treatment by means of psychotherapy (mainly cognitive-behavioral), vocational and job training, social work and leisure time therapy embedded in a therapeutic community. It was generally expected that evaluation research would prove the effectiveness of this method and generate results for the advancement of offender treatment. However, research results have yielded only moderate findings concerning the effects of social therapeutic interventions. This article considers how the outcome of social therapy and offender treatment is measured. Fundamental methodological challenges that evaluation research has to face are identified. In addition, a short overview of recent results from a longitudinal evaluation study is presented to substantiate the dilemmas and solutions of evaluation research in this field. It is discussed why it is so difficult to provide evidence for effectiveness of correctional treatment and concluded that this can by no means lead to a renunciation of the correctional treatment approach.     

Brauchen wir Richtlinien oder Leitlinien für psychotherapeutische Behandlungen?

In many countries, psychotherapy is increasingly influenced by standards of scientifically evaluated methods and disorder-specific approaches. Referring to the definitions of the Scientific Council for Psychotherapy in Germany (WBP) concerning the differentiation of modalities, methods and techniques, this article points out that clear distinctions between modalities and methods are increasingly vanishing; instead, the tendency, especially within behavior therapy, to integrate all scientifically based methods and techniques is prevailing. This trend runs parallel with a development away from ?disorder-specific“ to a ?disorder-oriented“ approach. Facing the fact that technical aspects explain a relatively small proportion of outcome variance in psychotherapy, research related to the quality of psychotherapists is recommended. In addition, ?empirically validated psychotherapists“ should receive guidelines instead of rules of action.     

Die Kindstötung „in oder gleich nach der Geburt“

§ 217 of the German penal code, which intended a milder punishment for the homicide of an illegitimate child by the mother right after birth than for manslaughter, was abrogated without substitution in 1998. The reasoning behind this move does not convince. We will give a short summary of the history of this law. The privileged status of this crime was primarily justified in view of the denied pregnancy and the consequent state of the mother at the time of birth. Even after abrogation of §217 StGB there has to be differentiated between former reasons for privileged treatment, which now can justify from a juridicial point of view the use of §213 StGB (minor manslaughter), and those pathological states of mind which allow for the establishment of reduced or nullified legal responsibility.     

Die Chancen der Vielfalt – oder: Kann es allgemeine Psychotherapeuten geben?

Ohne Zusammenfassung