Mentalisierungsbasierte Psychotherapie bei schizophrenen Psychosen

Recently, there has been growing interest in new methods of psychotherapeutic interventions for schizophrenic patients. Social cognition, social functioning and quality of life are central objectives. Mentalization-based therapy (MBT) is a specific psychodynamic method developed from the fundament of attachment theory and empirical psychotherapy research for the treatment of borderline personality disorder, particularly focusing on attachment relationships, mentalizing capacity and affect regulation. Studies have shown that MBT is able to ameliorate interpersonal experience and social life. The latest neuroscientific findings support this view and encourage the application of a modified form of MBT in the treatment of schizophrenic patients. The authors present a concept for disorder-specific interventions in schizophrenia, including psychoeducational aspects and mentalizing exercises which step-by-step lead to a more reflective work in mentalization-based group psychotherapy.     

Transference focused psychotherapy: overview and update

This paper describes a specific psychoanalytic psychotherapy for patients with severe personality disorders, its technical approach and specific research projects establishing empirical evidence supporting its efficacy. This treatment derives from the findings of the Menninger Foundation Psychotherapy Research project, and applies a model of contemporary psychoanalytic object relations theory as its theoretical foundation. The paper differentiates this treatment from alternative psychoanalytic approaches, including other types of psychoanalytic psychotherapy as well as standard psychoanalysis, and from three alternative non-analytical treatments prevalent in the treatment of borderline patients, namely, dialectic behavior therapy, supportive psychotherapy based on psychoanalytic theory, and schema focused therapy. It concludes with indications and contraindications to this particular therapeutic approach derived from the clinical experience that evolved in the course of the sequence of research projects leading to the empirical establishment of its efficacy.     

Psychoanalytic reconstructions and empirical data: reciprocal contributions

Freud (1905, 1917, 1937) throughout his lifetime sought empirical scientific confirmation of the validity of his discoveries. In pursuit of this goal, he persistently emphasized the importance of establishing agreement between analytic reconstructions and the results of naturalistic child observation. The same objective lead Lichtenberg (1983), Emde (1981, 1985), and Stern (1985) to produce detailed evaluations of the impact of infant research findings on analytic developmental propositions. The present paper examines the relation among clinical reconstructions from an analysis developed through transference interpretations, empirical observations originating in the analytic patient's daughter's psychotherapy, and the results of empirical infant research that was being concurrently conducted by two of the authors. The findings from the clinical analysis of the mother, the psychotherapy of the daughter, and empirical infant research all converged on the same larger causative factor for the daughter's psychopathology--a type of maternal deprivation. Such a confluence of different sources of evidence, each identified by a different method of investigation, provides one kind of validation for psychoanalytic reconstructions, making it possible to provide that "satisfactory degree of certainty" which Freud (1937) called for in the attempt to integrate the patient's "psychic truth" with "actual" or historical truth.     

Die Therapie-Vorbereitungsgruppe

There are different kinds of pretraining for psychotherapeutic treatment. They have two objectives: to get future patients in the right frame of mind for the imminent psychotherapy by informing them about the treatment, and to support therapists while clarifying the indication and selecting patients. Pretherapy training for group psychotherapy is frequently offered in Anglo-American countries. So far empirical studies have only partly been able to prove the supposed positive effects of pretraining on process and outcome of psychotherapy treatment, particularly as the studies showed profound flaws with regard to methods and pretraining concepts. The “Therapie-Vorbereitungsgruppe” presented here is a pretherapy training group in the run-up to inpatient group psychotherapy at a German university clinic. In Germany, such groups are rarely offered. The “Therapie-Vorbereitungsgruppe” consists of weekly meetings of therapists of a psychotherapeutic ward and applicants for inpatient treatment. Ward members introduce the applicants into the concept of treatment and the treatment setting and they explore the psychological background of each of the applicants. Besides economical the concept has clinical and therapeutic advantages. Future inpatients get a realistic view of the treatment, they can build up a relationship to other inpatients and to therapists, and besides waiting for the admission to the clinic is made more bearable. Therapists are helped with their decision on the admission. The concept has proved itself in clinical practice for many years. The empirical proof of its effectiveness and a comparison with other, similar concepts fall due.     

Behandlungsmotivation und Indikation von Psychotherapie

Concepts and results of research into treatment motivation under psychotherapy are discussed with regard to the question whether decisions for indications on the basis of the motivational characteristics of patients are reasonable. Established concepts and broader theories of treatment motivation as well as diagnostic tools for the assessment are presented. Subsequently, empirical results for the effects of motivational factors on the maintenance and success of psychotherapy are briefly sketched. Approaches aimed at the enhancement of treatment motivation before and during psychotherapeutic processes are then illustrated. Finally, it is emphasized that, in turn, features of individual therapeutic processes may provide a basis for the indication of motivational enhancement interventions, thus supporting the notion of a dynamic nature of treatment motivation.     

Psychotherapy and (or) Medications for Depression in Youth? An Evidence-Based Review with Recommendations for Treatment

This article reviews existing research pertaining to antidepressant medications, psychotherapy, and their combined efficacy in the treatment of clinical depression in youth. Based on this review, we recommend that youth depression and its treatment can be readily understood from a social-psycho-bio model. We maintain that this model presents an alternative conceptualization to the dominant biopsychosocial model, which implies the primacy of biological contributors. Further, our review indicates that psychotherapy should be the frontline treatment for youth with depression and that little scientific evidence suggests that combined psychotherapy and medication treatment is more effective than psychotherapy alone. Due primarily to safety issues, selective serotonin reuptake inhibitors should be initiated only in conjunction with psychotherapy and/or supportive monitoring.     

心理治疗中共同要素理论的历史发展

从共同要素的角度,分理论模式化与研究实证化两条线索,追溯了心理治疗中共同要素理论的思想渊源,并自Saul Rosenzweig开始,综述了Carl Rogers、Jerome Frank、Marvin Goldfried、Michael Lambert、Bruce Wampold等学者的观点,探讨了共同要素理论的历史演进、内涵结构、理论模式及当代研究进展。认为它在不久的未来,将与特殊技术说逐步走向整合,加深对心理治疗过程与改变机制的认识,共同提升心理治疗的效果。     

Epistemic dependence in interdisciplinary groups

In interdisciplinary research scientists have to share and integrate knowledge between people and across disciplinary boundaries. An important issue for philosophy of science is to understand how scientists who work in these kinds of environments exchange knowledge and develop new concepts and theories across diverging fields. There is a substantial literature within social epistemology that discusses the social aspects of scientific knowledge, but so far few attempts have been made to apply these resources to the analysis of interdisciplinary science. Further, much of the existing work either ignores the issue of differences in background knowledge, or it focuses explicitly on conflicting background knowledge. In this paper we provide an analysis of the interplay between epistemic dependence between individual experts with different areas of expertise. We analyze the cooperative activity they engage in when participating in interdisciplinary research in a group, and we compare our findings with those of other studies in interdisciplinary research.     

The integration of psychotherapy: Goal or utopia?

Both researchers and therapists stress the importance of integrating different forms of psychotherapy. Integration may be achieved in three ways. Supporters of the “empirical strategy” believe that more research is the solution. Followers of the “conceptual strategy” try to theorize on psychotherapy using psychological and sociological concepts. Other researchers see a “linguistic strategy” as the way to achieving a better understanding of psychotherapy. Whether any of these strategies will enable us to increase our insight into psychotherapy is questionable. All focus on technical aspects, that is, on the means to achieve effects. Yet, therapeutic effects cannot be understood unless they are interconnected with diagnostics. This paper argues that an integrated theory should be developed which includes diagnostics and treatment and which is supported by a theory on psychological (dys)functioning.     

An Overview of Directions in Psychotherapy Integration Research

In general, empirical research in psychotherapy integration has lagged behind the growing theoretical and clinical interest in the field. Even though many of the theoretically integrative treatment models currently available are based on empirical findings and clinical observations, the models themselves remain, for the most part, untested. Rigorous examination of integrative psychological theories and therapeutic programs is a necessary and useful way to increase our understanding of the process of psychotherapy and establish the efficacy and effectiveness of integrative therapies. The present article explores five different research areas in the field of psychotherapy integration, discussing several published studies in each area. The utility of this research for practicing clinicians is also discussed. Additional investigations in these areas and others are encouraged, with the goals of greater understanding of psychotherapy, as well as the further development and acceptance of integrative approaches.     

Meaning as inter-connectedness: theoretical perspectives and empirical evidence

Researchers interested in the study of eudaimonic well-being have devoted increasing efforts in the attempt to define and understand meaning as a core resource fostering human development and successful adaptation to environmental demands. Conceptual models and empirical findings highlighted the pivotal role of relationships and connectedness in the construction and enhancement of meaning throughout life. In this paper connectedness is discussed from an interdisciplinary perspective, encompassing theoretical frameworks and empirical evidence developed within the natural and social sciences. The cross-disciplinary emphasis on the substantial role of inter-connectedness in shaping living systems and human communities will be highlighted. Taking into account these interdisciplinary convergences and empirical evidence obtained from the psychological investigation of the sources and structure of meaning, three levels of connectedness will be identified, namely proximal, distal and symbolic. A comprehensive framework will be proposed, in which inter-connectedness is considered a crucial aspect of the prominent sources of meaning in daily life, as well as the core essence of meaning itself. This approach offers the possibility to explore meaning from a unifying perspective, overcoming disciplinary boundaries and opening new research avenues.     

Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

Sexuelle Funktionsstörungen und ambulante Psychotherapie

Based on a literature review the following questions are discussed: how prevalent are sexual dysfunctions in the community and in treatment samples (particularly in psychotherapy patients)? How many patients with sexual dysfunctions seek help in outpatient psychotherapy and for how many patients would this kind of treatment be indicated? Data show that only relatively few patients with sexual dysfunctions are being treated in outpatient psychotherapy. Deficits concerning detection and monitoring of sexual dysfunctions and in terms of interdisciplinary treatment are obvious. To find possible reasons for these deficits the multifactorial etiology of sexual dysfunctions, the segmentation of care and also psychological variables characterizing the patient (denial of dysfunction) and the therapist (subjective need for specific training) are discussed. It is proposed that routine use of screening questionnaires for sexual dysfunctions should be introduced and it is described how the diagnostics and treatment implementation for sexual dysfunctions can be effectively integrated into clinical practice. Finally, arguments for a broader representation of research on sexual dysfunction in the field of clinical psychology are presented.     

The function of language in parent‐infant psychotherapy

Parent‐infant psychotherapy, a rather new field in psychoanalysis, raises questions of how to conceptualize the clinical process. Previous publications have used semiotic concepts to account for the therapist's non‐verbal communication and investigated the countertransference, including what the baby might grasp of its variations. The present paper focuses on another argument for using verbal interventions to a baby in therapy; they present him with a symbolic order that differs from that of the parent. The qualitative difference between the parent's and the analyst's address is conceptualized by Dolto's term parler vrai. The therapeutic leverage is not the analytic interventions' lexical content but their message that words can be used to expose conflicts. Thereby, one can transform warded‐off desires into demands that can be negotiated with one's objects. The reasons why this address catches the baby's attention are discussed. A prerequisite for such attention is that the infant brain is prewired for perceiving words as a special communicative mode. Relevant neuroscientific research is reviewed in regard to this question. The presentation relies on concepts by Dolto, Lacan and Winnicott and findings from neuroscience and developmental psychology. It also briefly discusses Chomsky's linguistic concepts in relation to these therapies.     

Psychoanalytisch-orientierte Fokaltherapie der Depression bei Krebskranken

Emotional distress connected to a cancer disease may result in comorbid mental and especially depressive disorders. Although psychodynamic therapy is one of the most frequently applied forms of psychotherapy of depression in cancer patients there is a lack of empirical studies which meet the criteria of evidence-based psychotherapy research. This is especially true with regard to randomized controlled trials of psychodynamic psychotherapy. As far as we know no manual for psychodynamic treatment of cancer patients has yet been published. In this article a manual for a 20-session short-term psychodynamic treatment is presented. The treatment is based on Luborsky’s supportive-expressive (SE) therapy. The SE treatment manual of depressions in cancer patients presented here is an adaptation of the general SET manual as well as the SE manual for depression. In the first part the general principles of SE therapy are presented. In the second part a manual specifically adapted to the treatment of depressive cancer patients is described. The treatment manual is presently being used in a large-scale randomized controlled multi-centered study comparing short-term psychodynamic psychotherapy and treatment as usual.     

经验现象学心理学:乔治对胡塞尔现象学的继承与发展

美国现象学心理学家阿米多·乔治基于科学和心理学视角所提出的经验现象学心理学是对胡塞尔现象学的继承和发展。这表现为:在批判对象上,从胡塞尔的反二元论细化为反自然科学心理学;在出发点和基本原则上,将胡塞尔的生活世界、意向性、还原等概念从超验层面放置到经验层面;在研究方法上,从胡塞尔的描述还原过程转向具体的描述现象学心理学方法。本质上,乔治的经验现象学心理学与胡塞尔的现象学一脉相承,不仅完美地展示了后者的基本原理,更在具体概念和操作应用上充实且超越了后者。     

On motor creativity,age, and self‐concept in young learning disabled boys

In the beginning of the 21st century, creativity has been highly esteemed not only in the arts and sciences, but also in economy, politics, and individual welfare. Most theories and practical applications stem from individual sciences and frequently conclude with generalizations that cannot be derived from the specific scientific paradigm. It seems necessary to mark the limitations of individual scientific approaches and to detect where interdisciplinary perspectives are indispensable. This article is an attempt to investigate the interdependence and complementarity of neurobiological, psychological, and socio-cultural, as well as practical, aspects of creativity. It is shown that creativity is often a dialectical process apparent in psychological, cultural, and even neurobiological research. The dialectic of order and chaos seems to be a general concept that is conceived differently by the individual sciences and transports different meaning. However, it is shown that different scientific concepts also contain corresponding and complementary knowledge which amplifies scientific perspectives through interdisciplinary interpretation. The dialectics between coherence–incoherence, stabilization–destabilization, construction–deconstruction of cognitions, emotions, and actions are shown to be corresponding and complementary principles. The interdisciplinary interpretation of the findings of individual sciences leads to practical implications.     

What is the Place of Clinicians’ Religious or Spiritual Commitments in Psychotherapy? A Virtues-Based Perspective

Value neutrality in psychotherapy is widely acknowledged to be a myth, and a majority of US physicians report that their religious faith influences their practice. Most attention to therapists’ religious and spiritual commitments has focused on ethical boundaries, transference/countertransference dynamics and questions about how to relate religious and psychological truth. No consensus exists about the legitimate place in psychotherapy of clinicians’ differing value commitments. Therapists’ virtues are vitally important in psychotherapy, not least in the relational and aspirational process by which the patient identifies with the therapist as they engage together in confronting obstacles which the patient has been unable to surmount alone. Among the individual and cultural factors that shape a therapist’s virtues are spiritual traditions, which encourage preferred or characteristic virtues. Arguably, these include for Jews, communal responsibility and critical thought; for Christians, love and grace; for Muslims, reverence and obedience; for Buddhists, equanimity and compassion; for Hindus, appreciation of Dharma and Karma; and for secularists, respect for scientific evidence and intelligibility. These have differing implications for treatment, as illustrated through the use of a hypothetical case. Attention to differing spiritual and religious virtues in a pluralistic culture offers opportunities for creative dialogue, collaborative teaching and interdisciplinary research.