Gewaltprävention statt Präventivschlag

Die Psychotherapie -     

Therapieverläufe von Sexualstraftätern

Throughout the past decades evaluation studies on sexual offender treatment have led to controversies. While numerous studies examined the effectiveness of different interventions, the possible underlying mediating mechanisms have largely been neglected. This study took a multimethod approach to investigate the measurability of change processes in sexual offenders serving a sentence in the social therapeutic institution (SothA) of the detention center in Tegel, Germany (n?=?105). A longitudinal design with three groups (i.e. waiting group, treatment group and day release group) from four perspectives on change processes (i.e. external criminal prognostic assessment, therapists’ view, staff observation and clients’ perspective) was employed. Most criminal prognostic risk and protective factors improved over the course of treatment and this effect was smallest in the waiting group. While therapists reported increased therapeutic constraints in the course of treatment, they were more favorable in the criminal prognosis and detected more differentiated patterns of needs and resources of clients as conceptualized by the primary and secondary assets of the good lives model (GLM). In contrast, during the course of treatment the sexual offenders showed an increased awareness of the criminogenically relevant problems in the sexual domain. Nonetheless, the overall number of problems they identified as criminogenically relevant decreased. The internal problem attribution in the sense of internal causes (“It is my fault”) and capability of change (“Only I can solve the problem”) was increased. The stronger the clients’ perception of own problems in the sexual context increased over the course of treatment, the more positive the change in the staff’s view of their behavior became and the more their dynamic risk factors improved. Overall, this study found strong evidence that change processes in SothA might already be detectable during ongoing social treatment. It is currently uncertain whether these changes influence future recidivism. A comparison with recidivism data is necessary and in planning.     

Zur Phänomenologie islamistisch-terroristischer Straftäter

Very little reliable information is currently known about the individual background of terrorist offences. The few empirical studies available are as a rule based on a consideration of the social statistical characteristics without reference to personality or psychopathological diagnostic findings. The present article is based on 40 expert opinions which were given by the author on a total of 29 subjects in the years 2000–2013. All subjects had committed crimes motivated by Islamic beliefs of which 23 could be explored and investigated in detail. Although the offenders included in this study consisted mainly of immigrants to Germany, in recent years a group of young offenders has crystallized, even in this sample of subjects, who were born and grew up in Germany. In the “immigrant” group (n?=?19) no psychopathological traits were detected and also only few ego-syntonic offenders who acted on convictions. In fact, these subjects were more a series of primarily conspicuously dissocial offenders and subjects who had failed to cope with their way of life or with their aims in life. Of the young Moslems who grew up in Germany (n?=?10) three subjects suffered from a schizophrenic psychosis and two had a primarily dissocial psychosis. Among the other subjects there were some special features in the developmental background, especially in the area of identity crises but without any noticeable uniform background pattern for a personality development to an Islamic offender.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.     

Zur Häufigkeit der Schuldfähigkeitsbegutachtung von Sexualstraftätern im Erkenntnisverfahren

This study investigated how often and depending on which factors sexual offenders are examined by mental health experts regarding their criminal responsibility. Out of a total of 306 legal charges against sex offenders accused of child sexual abuse (CSA: n?=?145), rape or sexual assault (n?=?89), exhibitionism (n?=?39), sexual abuse of adolescents, mentally defective, physically helpless or warded persons (n?=?18) that were admitted by a criminal court in 2001 in the German federal state of Schleswig-Holstein, 209 (95.6 %) were analyzed regarding the following questions: how often was the accused examined by a mental health professional regarding mental responsibility? Was the chance of being examined systematically related to certain factors (e.g., personality of the accused)? Expert advice regarding the mental responsibility of the accused was obtained by the court in only 34 cases (11.7 %). No systematic relationships of personal variables as well as the modus operandi and the chance of commissioning a mental health expert were found. The main reason for assigning a forensic expert opinion was the vague impression of a psychic disorder. Re-offending increased the rate of a mental health examination only in CSA (34.6 % of re-offenders were examined compared to 9.2 % of first-time offenders), but not in rape or sexual assault. Also age does not predict the commissioning of an expert opinion. Only one fifth of all accused below the age of 21 were investigated by a mental health professional. Results are discussed in terms of legal background, consequences for risk assessment and relapse prevention.     

Rökavvänjning genom självterapi

Sammanfallning : I artikeln presenteras kortfattat ett program för rökawanjning, vilket utvärderats på experimentell basis. Programmet, som består av olika självterapeutiska tekniker, föreligger i bokform och omfattar 5 veckor. Under derma period instruerades fpp att observera sig själva på olika sätt för att bli medvetna om sitt rökbe—teende. Därefter gavs de uppgifter som gradvis fick dem att minska sin cigarrettkonsumtion. Slutligen fick de lära sig nya beteendemönster som ersättning för den avlagda rökvanan. 150 personer del tog i försoket, indelade i 3 olika be—handlingsgrupper. Dessutom fanns en kontrollgrupp     

Ost-West-Verhältnis

The first question a psychoanalyst has to examine in connection with this topic is, whether psychoanalytical concepts apply to sociological and political developments (problems) at all, and which ones, if they do. The most adequate theories seem to be the psychoanalytical developmental and the object relation theories, the regression model, first of all in its group dynamical version as described by Bion and later on by Heigl-Evers, and the psychoanalytic-anthropological socialization model of Erich Fromm. Following the way of the author’s work in Balint groups, he examined the conscious and unconscious interactions between East- and West-Germany’s societies. Moreover, the consequences of the unresolved humiliation because of the lost war (denazification in West-Germany) and the comparison of the post-communist development of Czechia with that of East-Germany served me as further background screens.     

Eltern-Säuglings-Psychotherapie

In this article the treatment of a 1-year-old girl with eating disorder and of her mother is presented. First, the theory of the disturbance constituting the basis for the work of the psychological counseling service named ?Vom Säugling zum Kleinkind“ (From infancy to early childhood) at the Potsdam College is presented as well as the treatment technique of parent-infant psychotherapy. The focus of the article is the case study. Its particular characteristic is the non-interpretative handling of the transference. The connection between the specific transferential disposition of the parents and the operating factors of the parent-infant therapy is described. The author distinguishes three levels of parental transference which are used in parent-infant psychotherapy. She reflects about the psychodynamics of the infantile pathology and discusses the factors which in this case have allowed a positive development.     

Prävention

Ohne Zusammenfassung     

Indeterminiertheit,Iterabilität und Intentionalität

In his recent paper Indeterminacy, empiricism, and the first person John R. Searle tries to refute Willard V. O. Quine's famous indeterminacy of translation thesis by arguing that this thesis is in fact areductio ad absurdum of Quine's own linguistic behaviorism. Searle accuses Quine of being (irrationally) antimentalistic and suggests that the absurdity of Quine's thesis might be avoided if a full-fledged intentionality were tolerated in the debate on meaning. — This anti-Quinean approach in some respects reminds of the improbable debate between Searle and Jacques Derrida ten years ago, when Derrida had split and deferred intentionality by showing that the essential iterability of signs inevitably infects every intentional act with an unremovable non-presence.In this paper it is argued that Searle's attacks on Quine and Derrida have both failed — and that there are structural similarities between these two failures which reveal some interesting parallels between Quine's and Derrida's philosophy.     

Primärprävention bei Essstörungen

Zusammenfassung Essstörungen gelten als schwer therapierbar. Mit einer Mortalitätsrate von 5–16% ist Magersucht die schwerste psychosomatische Erkrankung bei Mädchen und jungen Frauen. In den letzten Jahren wurde daher verstärkt versucht, der Entstehung von Essstörungen durch präventive Maßnahmen entgegenzuwirken. Der Schwerpunkt liegt hierbei auf der Primärprävention im Rahmen von Schulprojekten. Hierfür liegen bereits ermutigende Wirkungs- und Qualitätsnachweise vor. Entsprechende Projekte stehen im Zentrum der vorliegenden Übersichtsarbeit. Diese stellt keinen Anspruch auf vollständige Darstellung, sondern ist ein Versuch der Systematisierung unterschiedlicher Herangehensweisen und soll durch die kurze Beschreibung möglichst prototypischer und evaluierter Beispiele einen Einblick in die derzeitige Praxis der Primärprävention von Essstörungen geben. Quellen der Übersicht sind die Datenbank der Bundeszentrale für gesundheitliche Aufklärung (BZgA), Veröffentlichungen in Fachzeitschriften sowie Internetauftritte. Da Art, Umfang und Umsetzung der Präventionsprogramme sehr von politischen Bedingungen und Voraussetzungen innerhalb des Gesundheits- und Bildungssystems abhängen, bleibt die Übersicht auf Programme aus dem deutschen Sprachraum beschränkt.     

Angstbewältigung

In the psychiatric outpatient clinic of the University Hospital Tulln, the Canadian Occupational Performance Measure (COPM) – an occupational therapy, evidence-based, and diagnosis-independent assessment – is used to collect and assess performance problems in everyday life. Subjectively perceived everyday problems are assessed with regard to performance and satisfaction on a scale from 1–10 at the start and upon completion of treatment. The particular focus is on the impact and relevance of anxiety symptoms. Using the example of a 35-year-old woman with obsessive-compulsive disorder and anxiety, the possibilities of diagnosis, treatment planning, and quality assurance are shown and the relevance for the treatment process is illustrated.     

Sind Exhibitionisten gefährliche Straftäter?

Exhibitionists are generally considered to be repeated but otherwise inoffensive delinquents. In contrast to this position in the past politicians repeatedly declared acting exhibitionistically to be the starting point of a development leading to sexual assaults. The following analysis is based on conviction records for the years 1998 to 2000. Out of 1979 Federal Registry records a total of 34 showed a development toward sexual assault. A far greater number of delinquents were convicted for property crime or common crime like assault or libel. This could has been confirmed for the time before they have committed exhibitionistic acts in public as well as after that. Convictions for similar offenses like indecent behaviour or sexual acts in front of children are common as well. More than one fifth of all offenders committed such an offence over the evaluated period of about 5 years after the reference crime. A much more decisive fact is that absolutely as well as relatively more offenders had been convicted of sexual assault before they were convicted of exhibitionistic acts in public. So from a statistical point of view a correlation between acting exhibitionistically and sexual assaults is not obvious. The ongoing dissection of files gives reason to classify the above mentioned 34 offenders to be a atypical type of exhibitionist, what means that their behavior is dominated by a antisocial personality and not by exhibitionism in psychiatric terms.     

Transsexualität

Transsexuality is a process with biological, psychological and social aspects. It makes the person concerned feel subjectively appendant to the other gender. The own gender is objectively sensed but it is experienced as foreign. Because of this deep internal certainty, transsexual persons change into their inner chosen gender. This change goes along with a psychosocial alteration of role and in most cases with a hormonal and surgical conversion. Psychotherapy with transsexual persons is known to be difficult and disappointing. The aim of this review is to invalidate these prejudices and to encourage psychotherapeutic treatment of transsexual persons. It also will give all necessary information for this kind of psychotherapy. Generally the psychotherapeutic accompaniment of transsexuals is definitely a meaningful experience for a psychotherapist, in which basic issues of human existence are being touched.     

Stationäre oder teilstationäre Psychotherapie?

In a pilot study we compared two groups, one of inpatients and one of day clinic patients who were treated between January 1999 and December 2001 at the Department of Psychosomatics and Psychotherapeutic Medicine in Freiburg/Germany. Both settings offer a similar, multimodal and intensive psychotherapy program on a psychodynamic background. In a first explorative data analysis (sociodemographic data, SCL-90-R, IIP-C) we studied differences in severity of initial symptomatology and differences in outcome (prae/post). Patients with anorexia nervosa and a very low weight were preferentially treated in the inpatient setting. In addition the inpatient group of patients with a somatoform disorder showed higher degrees of somatization, as compared to patients with a somatoform disorder in the day clinic. Therapeutic change with respect to psychopathology however did not differ between the two settings: both groups showed a significant improvement during the course of therapy.