Qualifizierung und Qualitätskontrolle in der forensischen Psychiatrie – die aktuelle Situation in der Schweiz

The practice of civil expert opinions in Switzerland is in a period of upheaval due to fundamental alterations regarding the legal foundations which were implemented on 1 January 2013. The new civil code displaces the authority to order measures which restrict people’s liberty based on an endangerment to themselves or third parties from a lay institution to a newly created expert committee. Moreover, patient’s rights are greatly enhanced. The subsequent consequences for expert opinion activities are not yet appraisable. The development in the practice of insurance legal expert opinion is influenced by new legal measures which aim at reducing the growing number of new disability retirements most notably due to psychiatric disorders. In contrast to the civil area there are already clearly defined standards for the insurance legal area which were established by the Swiss Society of Psychiatry and Psychotherapy in 2012. The legal foundations as well as the practice of expert opinions in the context of the Swiss civil and insurance law are comparable with the German situation but there are still some important differences related to the content and terminology. This paper outlines the current situation and recent developments in Switzerland as well as pointing out differences in comparison to Germany.     

Qualifizierung und Qualit?tskontrolle in der forensischen Psychiatrie

At the end of the last decade severely violent and sexual crimes by previously convicted persistent offenders initiated a discussion about the necessity of quality control in the forensic psychiatric practice in Switzerland. Subsequently, measures similar to those in Germany were adopted, e.g. the implementation of a specialisation in forensic psychiatry. In addition, they included the creation of commissions with the duty of evaluating the dangerousness of serious offenders, the implementation of a standardized and certificated postgraduate training in forensic psychiatry and guidelines for the qualification of forensic assessment experts and the quality of reports. The following article presents the implemented measures and discusses their possible consequences for the quality of forensic psychiatric work.     

Transparenz und Fairness in der Therapie von Sexualstraftätern in Haft und Maßregelvollzug

It makes sense to treat sexual offenders in prison. Treatment can be successful even if coerced. However, particular difficulties arise due to the great power disparity between therapist and patient and the latter’s remoteness from normal living conditions. This report will describe the current status of treatment techniques/approaches for sexual offenders in prison (with particular regard to social therapy) and special forensic hospitals as viewed by an external reviewer judging the process, methods and success of treatment for preventing relapse and estimating criminal prognosis. We mention standards for a respectful and positive approach towards the patient client. With regard to the Good Lives Model, it is supportive to develop positive resources in the perpetrator. This also requires a heightened readiness from therapist and team for transparency (instead of confidentiality) towards the perpetrator as to the assessment of progress and status of therapy. We criticize tendencies for a confrontative, if not humiliating approach, which undermines the self-esteem of the client and exploits the power disparity between therapist and perpetrator.     

Psychoanalytische Beiträge zur Behandlung in der forensischen Psychiatrie

Two psychoanalytic treatments are described for patients suffering from severe personality disorders who have killed. These treatments have been conducted in a high security hospital and are part of the overall treatment plan for any patient. Structural changes can emerge in the course of long-term continuous treatment which is conducted within the framework of a multidisciplinary team under conditions of physical security. These changes are described and clinically illustrated using the model of mental structure of the Operationalized Psychodynamic Diagnostics (OPD) system. The traumatic effect of “improvement” is emphasized as well as the risk of further enactment of lower severity. The latter might however trigger considerable anxiety in those who are contributing to the care of these patients. This is of importance for the gradual steps of integrating the patient back into the community. The psychoanalytic contributions are considered as necessary immunization against the contagiousness of these disturbances in these settings and also can help clinical teams to have more realistic prognostic expectations.     

Qualit?tssicherung in der forensischen Psychologie

Approximately 12 years ago the German Federation of Psychological Societies initiated a certified postgraduate training in psychology and law to qualify psychologists as forensic psychology experts. This qualification initiative was a consequence of a decade of evaluative research constantly yielding serious shortcomings in psychiatric and psychological expert reports. The present paper informs about the conception of the training and the experiences with it so far. Furthermore, it reports on current reform efforts regarding the training and informs about some further forensic psychological qualification options that have meanwhile been established in Germany.     

Über die Gewichtstäuschung und ihre Analoga

Ohne Zusammenfassung     

Psychoanalytisch begründete Ans?tze in der forensischen Psychiatrie und Psychotherapie

After many years where manualized mainly behaviour treatments dominated in forensic settings, psychodynamic therapies are gaining acceptance and are performed and evaluated more and more in forensic hospitals and in prisons. This encompasses individual, couple, family and group therapies. Individual and group analysts are starting to perform these tasks again, mostly as workers in forensic settings but also as external therapists and supervisors. All staff members are important in creating a therapeutic community based on group analytic principles. They are therefore required to build up a therapeutic attitude supported by regular external case and team supervision. Delictogenic situations occur in everyday life as well as in professional settings and are analysed mainly in group therapies, considering situations of the past and the effect on other people. Modern manualized analytical concepts, such as transference-focussed psychotherapy (TFP) and mentalization-based therapy (MBT) depthen the quality of therapeutic work of all professionals in forensic settings. The multimorbid and sometimes dangerous patients require good ethical and professional attitudes. The psychoanalytic concepts of defence and resistance, transference and countertransference are essential parts of changing internalization and corrective emotional experience, important parts of useful forensic treatments.     

Diagnose und Therapie der Zwangsstörung

Obsessive-compulsive disorder (OCD) is the fourth common psychiatric disorder with a life-time prevalence of 1–3% world wide. Symptoms of OCD are intrusive, repetitive thoughts (obsessions) with disturbing content. Often, repetitive acts (compulsions) are performed in order to defend oneself or others against suspected threats or evil. Genetic and neurobiological factors are assumed to generate a disorder-specific vulnerability. Cognitive-behavioural models however, may serve to clarify the pathological interplay between dysfunctional thoughts and learning processes. The article offers an actual view on symptoms, diagnostic criteria, aetiology and therapeutic principles, such that OCD no longer stays the “hidden disease” which causes high individual and socioeconomic burden.     

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.     

Beiträge der deutschsprachigen forensischen Verhaltenswissenschaft zur kriminalprognostischen Methodenentwicklung

Forensic risk assessment of an offender is a complex process of obtaining targeted information from diverse sources and creating an integrated conceptualization of the information. The goal must not be limited to an assessment of the risk of recidivism of an offender. In fact, it is important to understand why an offender committed such a crime in order to inform decision makers and enable them to provide appropriate interventions and tailored management of future risks in individual cases. Risk assessment and risk measures have considerably evolved over the last decades and distinct approaches to and generations of risk assessment can be differentiated. This article gives an overview and introduction to the different approaches to scientifically based risk assessment including the strengths, weaknesses and empirical foundation. The focus will be on approaches used in the German language due to specific judicial considerations of the German legal system. This places special requirements on the degree of individualization and consideration of any special characteristics of individual cases for the assessment of the risk of recidivism relevant to criminal law. On the other hand, many of the currently employed methods and instruments originate from other, mostly English-speaking countries. For this reason, an outline of the international research on risk assessment is initially given.     

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.     

Eine neue Wahrnehmungstäuschung

Zusammenfassung Die Grenze des durch beide Arme bestimmten menschlichen Doppelgreifraumes hat die Gestalt einer Kugeldoppelhaube. Alle Punkte dieser Grenzfläche sind durch Greifbewegung gleich bequem (noch) erreichbar, wobei der Doppelarm als einheitliches Greif organ aufzufassen ist. Es besteht für diese Fläche nach allen Richtungen Gleichheit der Greifentfernung. Durch Spiegel-Hand-Versuche kann man nunmehr zeigen, daß alle Punkte dieser Grenzfläche bei visueller Wahrnehmung auch vom Auge aus gleichweit entfernt erscheinen, obwohl dies geometrisch schon wegen der exzentrischen Lage des Auges keineswegs der Fall ist. Die Grenze des Doppelgreifraumes nimmt beim Aufbau des menschlichen Sehraumes eine Schlüsselstellung ein.Man kann an dem beschriebenen Phänomen mit Aussicht auf Erfolg neue psychische Grundgesetze aufspüren. Versuche mit sogenannten Contergankindern können hierzu neue Aufschlüsse liefern.

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Summary The periphery delimiting the space circumscribed by the motional range of both human arms takes the shape of a double truncated sphere. All points of this periphery may still be reached with equal ease by a mere gripping motion (regarding, for the purposes of this study, the two arms as a single prehensile organ), and peripheral equidistance of reach exists in all directions. By means of tests in which the outstretched hand is expediently reflected in a mirror it can now be demonstrated that in visual perception (due to the above-mentioned motional equidistance) the entire double-spherical periphery appears equidistant also from the vantage-point of the eye, even though geometrically this is by no means the case. The periphery of the bilateral space of prehension, therefore, assumes a key position in the configuration of space as perceived by the human eye.The phenomenon opens views fowards new basic psychic laws. Also experiments with thalidomide children may provide new insights.

     

Behandlung und Teamprozesse in der stationären Psychotherapie

Ohne Zusammenfassung