Schemaorientierte Psychotherapie mit forensischen Patienten

A total of 19 forensic patients with the diagnosis of a personality disorder participated in a schema-oriented psychotherapy (SOPT) over a period of approximately 2 years. Treatment was carried out in three groups which were separated according to diagnoses from clusters B and C of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders text revision (DSM-IV-TR). The control group of 19 forensic patients received treatment as usual and were paralleled for relevant forensic variables. The SOPT was implemented to raise patient awareness for their maladapted schemas and to modify the associated dysfunctional coping strategies. On the basis of differentiated individual case concepts, therapeutic interventions were carried out at cognitive and behavioral levels. Furthermore, activating therapeutic methods were implemented during treatment sessions to actualize maladapted schemas on an emotional level and to enhance awareness. Treatment effects were assessed by standardized self-rating, staff rating and objective measures. The results showed more positive changes for the schema-oriented treatment groups in comparison to the control group. In contrast staff rating for patients in the control group showed a clear deterioration of the clinical features.     

Psychology and violence against women

The discipline of psychology has made many contributions to the understanding of the social problem of men's violence against women during the past 15 years by reframing the problem as one of misuse of power by men who have been socialized into believing they are entitled to control the women in their lives, even by violent means. The new scientific psychology data base formed by integrating feminist gender analysis methods into more traditional psychological methodology is discussed, as are the implications of the resulting empirical data on which are based newer assessment, treatment, and forensic applications. A review of the major psychological advances in psychotherapy with women who have been sexual assaulted, exploited, and battered is presented, as well as implications for national policy. The feminist model presented is one in which science and practice concerns are carefully considered at all steps of the process. The article concludes with a discussion of the challenges involved in making the future training of psychologists more relevant to women's mental health concerns.     

Schematherapie bei antisozialem Verhalten und Psychopathie

In the Netherlands schema therapy is the first evidence-based treatment to be recommended for patients with personality disorders in forensic settings. Initial results show that schema therapy can even be effective in cases of “psychopathy”. The central concept in schema therapy are schema modes which can also be seen as emotional states or “parts of the personality”, which dominate temporary thoughts, emotions and behavior. Schema modes are the basis of individual mode models, which guide understanding and treatment of the disorder throughout the complete therapy. The schema therapeutic analysis of delinquency is part of the schema mode model and connects the sequences of the crime with the offender’s schema modes. With respect to the mode treatment, emotion-focused techniques and the therapeutic relationship are of special importance. The schema therapeutic treatment plan combines short-term behavior-related therapeutic goals with the underlying themes (needs and modes) in order to plan concrete interventions based on this. This has to be embedded into the individual structure of therapeutic options in the respective institutions (e.?g. individual psychotherapy, nursing staff, occupational therapy). This article demonstrates the practice of the schema therapeutic approach with a forensic case study and discusses resources and limits of the schema therapeutic approach in a forensic setting.     

From cultural to existential diversity: The impossibility of psychotherapy integration within a traditional framework

The authors build upon Castonguay and Goldfried's analysis regarding issues and directions central to advancing psychotherapy integration. They elaborate on two issues addressed only minimally in Castonguay and Goldfried's article. The first involves moving beyond traditional psychotherapy territory to include cultural, self-in-relationship, and interdisciplinary domains. The second concerns using more holistic and synergistic processes to coconstruct integrative theories and approaches. Finally, the authors offer some insights into what they believe should be the goals of the integrative movement and into additional issues they think should be addressed to attain these goals. Psychotherapy has become so complex and changing that we need a new view—one that recognizes the impossibility of any final or superior integrative theory and the need for constant change and evolution in theory and practice.     

Some ethical issues in feminist-oriented therapeutic groups for women

Review of the origins of group psychotherapy reveals concerns with social as well as with personal "psychopathology." Thus, group processes have been mobilized for curative or change purposes for ideological as well as individual therapeutic goals. Psychopolitical as well as personal change are the goals for some groups. The ethical problem stems from a persistent assumption that the group's processes are inherently benign and curative and beneficial to individual participants. A more sophisticated understanding takes into account their essential neutrality and their potential use (or abuse) for purposes of ideological persuasion that may or may not be personally therapeutic. As in other ethically implicated issues in the psychotherapies, the question becomes one of treatment versus exploitation, or therapy for the individual versus recruitment on behalf of a cause.     

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.     

7. Guided Group Interaction in a Correctional Setting

Review of the origins of group psychotherapy reveals concerns with social as well as with personal “psychopathology.” Thus, group processes have been mobilized for curative or change purposes for ideological as well as individual therapeutic goals. Psychopolitical as well as personal change are the goals for some groups. The ethical problem stems from a persistent assumption that the group's processes are inherently benign and curative and beneficial to individual participants. A more sophisticated understanding takes into account their essential neutrality and their potential use (or abuse) for purposes of ideological persuasion that may or may not be personally therapeutic. As in other ethically implicated issues in the psychotherapies, the question becomes one of treatment versus exploitation, or therapy for the individual versus recruitment on behalf of a cause.     

Psychoanalysis in Psychiatric Institutions - Theoretical and Clinical Approaches

The paper presents historical remarks about psychoanalysis in institutions with a special focus on the contributions of nurses working in psychoanalytic settings. A case report of the forensic psychotherapy ward in Reichenau Mental Hospital, which is organised as a therapeutic community, shows how individual psychotherapy, group psychotherapy and special nursing care contribute to significant progress in the treatment of a severely narcissistic arsonist.     

Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice.     

Psychologists versus psychologists: evaluating the claims of psychologists who publicly criticize their profession

Since the 1990s, 7 psychologists have written books for a public audience expressing great dissatisfaction with mental health practitioners. These critics represent 4 English-speaking countries: Australia, Canada, the United Kingdom, and the United States. Those psychologists make 3 basic arguments: (a) any improvements attributed to psychotherapy are due to placebo effect, (b) psychological assessments have little value, and (c) clinicians do not meet the legal standards to qualify as experts in a court of law. The present author examines these arguments and concludes that these concerns are unfounded. The exception is that several forensic psychologists had been using tests that were invalid for legal purposes, but this situation has shown gradual improvement in the past 15 years.     

Is a science of psychotherapy possible? Subjectivity problems

Two sorts of subjectivity problems are discussed. The 1st concerns the characterization of psychotherapy as an attempt to alter clients' meanings. The 2nd concerns the seemingly subjective nature of value judgments about psychotherapy outcomes. It is argued that despite initial appearances, neither of these problems poses an insuperable difficulty for transforming the discipline of psychotherapy into a genuine science.     

Existential issues in group psychotherapy

Existential issues in group psychotherapy derive from existential thought both as a philosophy and as a value system. Its origins derive from the weakening of traditional values and the growing alienation of man from himself. The unique features of existentialism can be applied to all forms of therapy. These features are universal to humankind. They are finiteness, aloneness, guilt, responsibility, and freedom. In including existential concerns as part of group psychotherapy, therapist and patients move more closely to bilateral relationships and subjective interactions.     

Shame and violence in ‘Starred Up’

Shame plays a powerful role in triggering violence, sometimes with fatal consequences. It is fundamentally important to understand and treat the roots of this aggression and its links to an internal sense of shame. In this paper, I will discuss the contribution of forensic psychotherapy to this project and link it to the excellent depiction of violence, shame and the development of insight and impulse control through psychotherapeutic work in the powerful film, ‘Starred Up’, written by Jonathan Asser and directed by David Mackenzie. At the 2015 Birkbeck summer conference, I was asked to speak to the themes of the film and relate them to my work with violent male offenders and their psychotherapeutic treatment. As a clinical and forensic psychologist and forensic psychotherapist, I have been heavily involved in assessing and treating men and women with violent histories in prisons, mental health services and community settings over the past 25 years. I see the film through the lens of forensic psychotherapy, filtered by my own clinical encounters. I discuss its main themes in relation to the challenges and possibilities of the therapists who work with men with entrenched violence and the underlying issues at stake for the men themselves.     

Secular Psychotherapists and Religious Clients: Professional Considerations and Recommendations

Traditional psychotherapy has often failed to meet the needs of religiously committed clients. Because many potential clients have religious as well as secular concerns, secular psychotherapists must become more empathic and competent in treating religious individuals. In this article the author argues that efforts toward consciousness raising as well as fundamental changes in professional training programs are necessary to accomplish this goal. Recommendations are offered for counselor educators and mental health service providers.     

积极心理治疗思想概要

积极心理治疗虽然是以积极心理学作为自己的理论基础,但积极心理治疗的实践却早已有之。积极心理治疗作为心理治疗中的一个新生事物．它以反传统医学式心理治疗的面貌出现,运用故事作为治疗者与病人之间的媒介,充分发挥病人的直觉和想象,在与病人的观念不发生直接冲突的情况下提出改变病人观点的建议,这一较符合人性特点的心理疗法正越来越多地受到社会的广泛关注。     

The practice of psychotherapy and spiritual direction

The author compares and contrasts insight-oriented psychotherapy, supportive psychotherapy, and spiritual direction in relation to goals and methods; management of resistance, transference, and countertransference; and selection criteria. The enhancement of spiritual formation through insight-oriented psychotherapy and supportive psychotherapy is also discussed.     

Women, money, and psychodynamic group psychotherapy.

Developmental concerns and sociocultural expectations may keep female patients and therapists from addressing financial issues openly in group psychotherapy. Interpersonal theory provides a different view of nurturing that may help women leaders deal better with financial discussions in group. This paper includes a review of the literature on group psychotherapy and fees; feminist literature relevant to leadership; money management in group therapy; countertransference; and case examples.     

Psychodynamische Psychotherapie bei antisozialen und psychopathischen Störungen der Persönlichkeit

Important theoretical basic principles of the psychodynamic treatment of patients with antisocial and psychopathic personality disorders are presented. Focusing on delinquency and general orientation to the structural level of the personality organization should be integrated. Indications of treatment difficulties, countertransference problems and technical principles are given. Skepticism of the treatment is poorly evidence-based and forensic psychotherapy of these patient groups should be intensified.     

Forensic follow-up care for outpatients in Germany

Legislation has revived forensic psychotherapy for outpatients in Germany. Since 2007, in almost all 16 federal states of Germany forensic outpatient clinics have been and are being established for criminal and sex offenders who have been released from prison or secure detention under conditions imposed by the court. This paper reviews the consequences of this legislation for forensic outpatients, and will focus on some of the central organisational, institutional and social aspects that stem from the experience of the author. Although the conclusions may not be new, they require repeated reflection and well-considered political commitment.     

Special perspective: An immodest proposal: should treating mental health professionals be barred from testifying about their patients?

Notwithstanding ethical rules that address therapeutic and forensic role conflicts for psychologists and psychiatrists, overzealous patient advocacy by therapists, tightened reimbursement for therapy, and a growth market for forensic psychology and psychiatry, have led many therapists to appear willingly as forensic experts on behalf of their patients. Existing ethical rules, as well as other proposed approaches to address this problem, assume that it can be resolved by modest changes in existing practice that permit therapists to testify as long as their testimony avoids psycholegal opinions. This essay questions whether these modest changes can adequately address this problem and advances consideration of a more radical proposal to address this problem, prohibiting therapists from testifying about their patients. © 1998 John Wiley & Sons, Ltd.