Forensische Psychotherapie

Ohne Zusammenfassung     

Ressourcenorientierte Psychotherapie

Resource orientation is a transdiagnostic and integrative approach. It is more than just a technique and corresponds closer to a therapeutic attitude. Disorder-specific models and resource orientation complement each other. Resource activation aims at the utilization of already existing resources to achieve the therapeutic targets. Resource orientation has many advantages: the working alliance is improved, the patient experiences positive emotions in therapy sessions, the expectations of self-efficacy and self-confidence are strengthened and problem solving is promoted. The article presents practically relevant tangible methods in terms of systematic resource diagnostics and helpful resource activating interventions. An appropriate balance between problem actualization and resource activation is necessary so that the patient does not get the impression that the individual suffering will be trivialized, negated or made taboo.     

Strukturbezogene Psychotherapie

Structure-oriented psychotherapy is a variant method of the psychodynamic therapeutic procedure concerned with the therapeutic encouragement of insufficiently available structural abilities of patients, in contrast to realization of conflicts. This form of psychotherapy is based on the definitions of Operationalized Psychodynamic Diagnostics (OPD) and the diagnostic and therapeutic studies carried out with this method in the comprehension of structural functions and levels. The therapeutic approach and the therapeutic attitude were formulated with respect to the developmental psychological aspects of early relationship disorders. The method is indicated where, for example in severe personality disorders the clinical picture is determined by the structural problems of self-regulation and relationship formation. In this case the patient should first be actively stabilized in order to then increasingly transfer responsibility for self-regulation and way of life and to work these out together. The individual stages of the therapeutic process and the special interventions against the background of a development promoting, parental-like therapeutic attitude will be described.     

Evidenzbasierte Psychotherapie

Zusammenfassung Seit einiger Zeit wird auch in der Psychotherapie – so wie in anderen Bereichen der Medizin – eine intensive und kontroverse Diskussion über die wissenschaftlichen Standards und deren Praxisrelevanz geführt. Dabei nehmen Fragen der Qualitätssicherung und der Entwicklung von Leitlinien einen zunehmenden Raum ein. Von besonderer Bedeutung sind in diesem Zusammenhang die Evidence Based Medicine (EbM) und ihre methodischen Standards, in deren Mittelpunkt experimentelle Therapiestudien stehen. Im Beitrag wird das Konzept der Evidence Based Medicine im Kontext der Psychotherapie (Evidence based Psychotherapy) vorgestellt und unter methodischen und inhaltlichen Gesichtspunkten diskutiert. Eine zentrale Frage ist dabei die inhaltliche Aussagekraft und die Übertragbarkeit von wissenschaftlichen Befunden auf die klinische Praxis.      

Psychotherapie auf Palliativstationen

Exemplary for psychotherapeutic activity in the ??sphere of death?? the article focuses on the present situation of psychotherapists working on palliative care units in Germany. For that a questionnaire has been developed which includes 17 items dealing with fields of concrete psychotherapeutic work, psychotherapy training, relations with teams and institutions, subjectively felt burden and contentment etc. The questionnaire was sent to most of the German palliative care infirmaries. There is a high presence of psychotherapists in these units who are well trained in different therapeutic methods, numerically led by behavior therapy and non-directive therapy. In addition most colleagues are qualified in psychooncology and specialized pain management. Surprisingly topics, such as death or spirituality are not so often found in therapeutic contacts as would be expected. Furthermore there is a rather negative outlook on the preparation for the palliative working field during psychotherapy training. This requires extensions and supplementary curricula concerning existential themes in psychotherapy. The psychotherapists feel well integrated in their therapeutic teams but many of them have a feeling of at best a mediocre appreciation in their institutions. In spite of the difficult and stressful work the general job satisfaction is stated as high to very high.     

Psychotherapie mit Migranten

After an introduction and presentation of the influence of immigration on psychological health, the present overview focuses on several models of psychological development in immigration. Cross-cultural psychodynamics and culturally conditioned transference in ethnically mixed cultural psychotherapy settings are explored. The effectiveness of Western therapy methods based on Christian – Jewish values is discussed with regard to the therapy of patients from different ethnic backgrounds, i. e. so-called traditional societies. In Western cultures, proximity in object relations is based on autonomy whereas in traditional societies proximity is based on relatedness. Knowledge of specific cultural issues are considered to be an important instrument in cross-cultural therapies. Joining, activation of ethnic resources, and culture-sensitive interventions are considered to be helpful psychotherapeutic interventions. Specialized therapy settings, e.g. integration of ethnic therapists in established institutions, mono-cultural ethnic settings and collaborative projects are described. Last but not least, the authors point out the necessity of cross-cultural therapeutic competence because of an expanding cultural heterogeneity of society.     

Menschenbild und Psychotherapie

Images of humans provide preliminary answers to the question of what essentially constitutes their situation. In psychoanalytically based procedures images have appeared from time immemorial, which especially emphasize the animal impulses, the emotions, the interpersonal situation and in contrast, the self-reflecting subject, the capabilities for speech, communication and culture. In addition to this, in this discussion special attention is paid to the changing economic and technological circumstances, which displace humans into a novel living environment and could possibly bring about new forms of personality development with respect to the biological nature and also the sociocultural possibilities. As a consequence for psychotherapy, the consideration of these anthropological aspects is recommended beyond the processing of individual mental disorders.     

Psychotherapie und Pharmakotherapie

Zusammenfassung Psychotherapie und Pharmakotherapie verk?rpern jeweils eigenst?ndige Zugangsweisen zu psychisch kranken Patienten. Eine Kombination in einem integrativen Behandlungsmodell tr?gt der multifaktoriellen ?tiopathogenese von psychischen St?rungen Rechnung. Sie verlangt eine besondere Beachtung der Psychologie der Medikamentenverschreibung und -einnahme. Bewu?te und unbewu?te Bedeutungen der Medikamente für und in der aktuellen psychotherapeutischen Beziehung sind grundlegend für eine sichere Pharmakotherapie. Sie vermitteln aber auch entscheidende übertragungs- und Gegenübertragungsmuster im psychotherapeutischen Proze?. Für diagnostisch definierte, nicht-psychotische St?rungen (depressive, Angst-, Zwangs- und Pers?nlichkeitsst?rungen) werden vorliegende empirische Studien zur Pharmako- und Psychotherapie referiert und im Hinblick auf eine Kombinationsbehandlung reflektiert.      

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.     

Psychotherapie von Suchterkrankungen

Zusammenfassung Im ersten Teil dieser übersicht wurden m?gliche Bedenken hinsichtlich der Psychotherapie Suchtkranker diskutiert. Der Weg von der Diagnostik zur Motivationstherapie wurde beschrieben. In diesem zweiten Teil werden zun?chst einige ausgew?hlte Beitr?ge verschiedener Psychotherapierichtungen zur Suchtkrankenbehandlung vorgestellt. Es wird deutlich, dass die deskriptive Diagnostik zur Interventionsplanung um eine weitergehende „Feindiagnostik” erg?nzt werden muss, die von dem gew?hlten psychotherapeutischen Ansatz abh?ngt, da es eine einheitliche Suchtpers?nlichkeit nicht gibt. Vor diesem Hintergrund werden – nach einer einführenden übersicht – die psychoanalytisch-tiefenpsychologischen Konzepte und Therapiemodelle für Suchtkranke sowie die kognitiv-verhaltenstherapeutischen Ans?tze unter Berücksichtigung spezifischer Rückfallpr?ventionstrainings vorgestellt. Abschlie?end wird auf allgemeine und spezifische Wirkfaktoren und empirische Wirksamkeitsnachweise der Psychotherapie von Suchterkrankungen eingegangen.      

Emotion und Psychotherapie

Considering the fact that all psychic disturbances are emotional disturbances as well, we develop based on our research on the modular structure of the emotional system a systematisation of the disturbance-specific concatenation of these modules within the patient’s social relationships. Subsequently, we discuss treatment possibilities and contraindications for each clinical empirically validated constellation. We describe a fundamental mechanism of affect induction keeping the disturbances alive and transporting them to the next generation. We conclude in stating that treatment recommendations focusing on a standard algorithm of handling the emotions system fail because there is no general indication for such enterprises.     

Psychotherapie und Internet

The Internet plays an important role in healthcare. Approximately two thirds of Internet users search the medium for, e.g. personal questions of health, including aspects of mental health. In countless discussion forums or blogs mentally stressed people discuss their problems and search for contact to other affected individuals but also to professional helpers. In this article an attempt is made to systematize the interface between Internet and psychotherapy in the narrower and broader sense. In particular five topics and problem areas will be dealt with: (1) as information medium Internet delivers an immense number of resources on mental disorders, which raises the problem of quality assurance. (2) As a communication medium it can provide support for therapeutic interventions. Psychological online counseling has now been proven to be effective. (3) Internet alters the traditional therapeutic relationship in one way or another. In particular e-mail communications supplement a face-to-face treatment. (4) Use of the Internet also brings along clinically relevant problems and because of this patients visit psychotherapeutic practices increasingly more often. (5) Internet can be fruitful for psychotherapy research.     

Fokusbezogene psychodynamische Psychotherapie

The OPD-based diagnostics allows to formulate the psychodynamically significant aspects of the unconscious conflict, of the structural limitations and of the dysfunctional relational dispositions. Considering the relative weight of the conflict- and the structural dynamics we are able to differentiate three types of disturbances: the conflict type, the structural type and the miscellaneous type. For these three types of disturbances the therapeutic consequences for setting and therapeutic attitude, for the hierarchy of the foci, and the working through of dysfunctional relational dispositions and at last for the conflict- vs. structure-related interventions are discussed. The Heidelberger Umstrukturierungsskala enables us to the focus-related documentation and evaluation of the progress and the result of the therapy.     

Wissenschaftlicher Beirat Psychotherapie

Ohne Zusammenfassung