Aktuelle Entwicklungen in der Psychotherapieausbildung und der Ausbildungsforschung

In the journal Psychotherapeut, issues of psychotherapy training have been repeatedly published during recent years, especially related to discussions about a reform of the current training system. This reform now seems to have been initiated. Besides a historical sketch of the training-related discourse of recent years and a proposal for defining core fields of competence of psychotherapists, this paper summarizes current trends in training research, which seem to be gaining importance within psychotherapy research.     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.     

Stellenwert der Psychotherapie in der Allgemeinmedizin

Diese Arbeit befasst sich mit dem interdisziplin?ren Einsatz von Psychotherapie in der allgemeinmedizinischen Betreuung von Patienten mit psychischen Problemen oder Krisen. Bekanntlich ist es nur einem kleinen Teil der Patienten von Allgemeinmedizinern m?glich, psychotherapeutische Hilfe in Anspruch zu nehmen. Eine zus?tzliche psychotherapeutische Ausbildung des Hausarztes kann die Qualit?t der Patientenbetreuung signifikant verbessern. Zudem k?nnen nicht nur die Patienten davon profitieren; psychotherapeutische Ausbildung und Kommunikationstraining stellen eine wertvolle Bereicherung des Arztberufes und eine ernstzunehmende Burn-out-Prophylaxe dar.     

Psychotherapie der Psychosen

In this paper the psychotherapy of patients with schizophrenic, schizoaffective and affective psychoses is outlined. Psychoanalytic, cognitive-behavioural and systemic approaches and their theoretical concepts as well as the therapeutic techniques are de- scribed. The settings of individual, group and family therapy are also presented. A survey of the types of psychoanalytic therapy with their eldest historic roots is given with the development of the various psychodynamic concepts for schizophrenic and affective psychoses including schizoaffective psycho-ses. The different kinds of psychotherapy are compared to each other with respect to the aims. Finally this paper deals with the effectiveness of the therapies and discusses the pros and cons of relatively short randomised controlled trials compared with long term psychotherapies without control groups.     

Hausaufgaben in der Psychotherapie

Homework assignments are part of many treatment manuals for behaviour therapy. Their effectiveness for treatment success has now been shown. Far less is known about their implementation in everyday clinical practice. To offer topical data concerning the utilization of homework and the attitude towards it, we explored a sample of 140 therapists with different theoretical background and with varying degrees of therapeutic experience. Most of the participants frequently used homework assignments. Behaviour therapists use homework significantly more often than analytical therapists and have a more positive attitude towards them. Interestingly, the degree of experience had no influence on utilization of homework. Nearly all participants are familiar with the problem of unaccomplished assignments. Future directions for research und postgraduate courses are outlined.     

Ethik in der Psychotherapie

This contribution discusses some fundamental questions of medical ethics in psychotherapy. The problems discussed arise when ?care ethics“, which is based mainly on the Hippocratic Oath as the basis of medical ethics, is rejected. After a short overview of the relevant ethical theories, we ask for values and principles which might serve as a foundation for philosophical reasoning on the doctor-patient-relationship. In particular, we discuss the role of autonomy and informed consent in this relationship, following Beauchamp’s and Childress’ ethical principlism. We try to show the limited scope of the principle of autonomy in psychotherapy. Finally, we make a plea for a dynamic conception of patient autonomy for which we offer some pragmatic reasons. To round this conception off it is illustrated by the metaphor of the lighthouse.     

Diagnostik in der Psychotherapie

Diagnostic approaches in psychotherapy are accompanied by a continuous and unchanged discussion concerning fundamental questions. Because of its many functions diagnostics in psychotherapy has to take psychiatric, psychological, orientation-specific models and methods of assessment into consideration. Following the publication of the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) the increasing danger of a further increase in the number of psychiatric disorders is evident. In this article the principles of current psychiatric diagnostics and psychodynamic psychotherapy are presented and discussed. Furthermore, the dangers associated with the increased medicalization and over-diagnosis are highlighted. Against this background consideration is given to the risks for patients and societal aspects.     

Patientenziele in der Psychotherapie

Zusammenfassung  Im vorliegenden Artikel wird ein Überblick zum Stand der Forschung zu Patientenzielen in der Psychotherapie gegeben. Auf vier Aspekte wird dabei besonders eingegangen: (1) auf grundlagenwissenschaftliche Modelle und Befunde zu Lebenszielen, (2) auf allgemeine Lebensziele von Patienten und deren Zusammenhang zu ihrem psychopathologischen Zustand, (3) auf explizite Therapieziele und (4) auf zielbezogene therapeutische Interventionen. Durch diesen Überblick soll zum einen deutlich gemacht werden, wie grundlagenwissenschaftliche Forschung zu persönlichen Zielen klinische Forschung beeinflusst und bereichert hat. Zum anderen werden die therapeutischen Implikationen der Zielforschung herausgearbeitet.

Hausaufgaben in der Psychotherapie

Homework assignments represent a standard intervention in psychotherapy. Homework provides the unique opportunity to emphasize patients’ responsibility for therapeutic change and to intensify the therapeutic process. Despite these high potentials systematic homework assignment is still rare in practice. Psychotherapy research has just recently focused its attention on homework as an effective therapeutic method. Meanwhile the positive effects of homework use on therapeutic outcome have been demonstrated but little is known about therapeutic strategies to enhance these effects. The present article highlights the functions of homework within the therapeutic process and discusses its theoretical mechanisms of action. The article concludes with suggestions from both an empirical and practical point of view to further assist practitioners’ use of homework assignments.     

Diagnostik in der Psychotherapie

The present paper gives an overview of criteria and methods of diagnostics and assessment in psychotherapy from an orientation-unspecific point of view. First, some general remarks on the aims and strategies of psychotherapeutic assessment are made as well as specific functions during the different phases of a treatment are explicated. Because of its many functions diagnostics in psychotherapy has to take into consideration psychiatric, psychological and orientation-specific models and methods of assessment. At the beginning of a treatment problem-analysis and therapy-planning are needed, during its course the processes and changes are to be studied and at the end of the treatment its outcomes are to be evaluated. Diagnostic assessments are also important for monitoring and controlling the quality of the process and the outcome of a psychotherapy. At the end of the paper some general criteria for the application of assessment in psychotherapy are formulated.     

Bindungsrelevante Situationen in der Psychotherapie

Background

The therapeutic relationship is a central factor for psychotherapy, which may be at least partially explained by attachment theory. However, research concerning the conditions under which attachment-related needs are activated in treatment followed by possibly dysfunctional coping strategies is rare.

Patients and methods

Semi-structured interviews on attachment-related situations in psychotherapies were conducted with 36 inpatients and then rated with regard to content.

Results

Triggers for attachment-related needs in therapies were interpersonal conflict and loss, beginning and end of therapy, symptom burden, specific interventions, addressing the therapeutic relationship and change of setting from outpatient to inpatient treatment. This was related to themes of desire for help and support, experience of rejection, self-disclosure and desire for understanding.

Conclusions

The attachment system is activated in therapies similar to other interpersonal situations. The results may help to become more sensitive to attachment-related situations and needs.