Verstehen gegen Erklären

Journal for General Philosophy of Science - Es wird versucht (hermeneutisches) Verstehen psychologisch-prozessual zu artikulieren. Welche mentalen Prozesse sind bei einem Verstehen menschlichen...     

Biofeedback bei kraniomandibulären Dysfunktionen

Temporomandibular disorders (TMD) are a painful condition present in 3% of the population. The aim of the present study was to develop a biofeedback-based cognitive-behavioral treatment for chronic TMD (BFB-KVT) and to evaluate its effectiveness compared to dental treatment. A total of 26 patients suffering from chronic TMD were randomly assigned to either BFB-KVT (n=15) or occlusal splint treatment (n=11). Preliminary data showed that both treatments reduced pain intensity and jaw disability. Greater improvement of pain-related disability was found for BFB-KVT, and its acceptance by the patients was higher. The proposed protocol appears to be an effective treatment for chronic TMD. The evaluation in a larger sample and of long-term efficacy will follow.     

Mentalisierungsdefizite bei stationären Patienten

Background

Fonagy (2009) considers the improvement of mentalization, understood as an element of structural change, as a global goal of psychotherapeutic treatment. Yet until now there is little knowledge about the mentalizing skills in clinical populations.

Material and methods

We examined the mentalizing skills in 201 patients on admission for complex psychotherapeutic inpatient treatment with the “Reading the mind in the eyes”-Test (RMET). We explored if there are diagnosis-related differences in the RMET and compared our findings to published data on the RMET in clinical and normal populations.

Results

Compared to normal populations our sample scored significantly lower in the RMET, however, no diagnosis-related differences were found.

Conclusions

Although our data are preliminary, psychotherapeutic inpatient treatment should consider the patients reduced mentalizing skills.     

Von der Triade zum triangulären Raum

The concepts of oedipal triangle and early triangulations emphasize the significance of triadic relational experiences as well as corresponding phantasies for the psycho-sexual development and for mental functioning in psycho-analytic view. The connection of these triadic concepts with a symbolic and cultural framework leads to a fourth pole. It is only through this extension of the triad by a fourth pole to which the triadic scene is relating to that we can speak of a “triangular space” (Britton). By this turn of the existing two-dimensional concepts of triangulation into a three-dimensional space of imagination the experience inside the triad is becoming connected with the outside world. Thus the familiaristic reduction of thinking in the two-dimensional triangle father-mother-child is suspended in favour of a view which makes it possible to describe aspects of therapeutic triangulation more precisely.     

Gegenübertragung im stationären Therapie-Setting

Background

Countertransference is seen as an instrument of research into a patient’s unconscious and is therapeutically useful in furthering psychodynamic work. For inpatient psychodynamic psychotherapy, where patients are treated by a team of psychotherapists, countertransference is much more complex and makes consideration and integration of different countertransference feelings necessary. Using the first German translation of the countertransference questionnaire (CTQ, Zittel Conclin and Westen, the countertransference questionnaire, 2005) an attempt was made to identify differences in countertransference phenomena in a team of psychotherapists and to show the impact countertransference has on therapy outcome.

Materials and methods

A total of t multiprofessional teams of psychotherapists (15 physicians, 5 psychologists and 9 body and art therapy psychotherapists) took part in the study and completed the CTQ for 137 patients (100 female, 37 male) at the beginning and at the end of inpatient psychotherapy. In addition, the patients completed two questionnaires, the Symptom Check List Revised 90-R (SCL-90) for the severity of symptoms and the Assessment of DSM-IV Personality Disorders Questionnaire (ADP-IV) for personality disorders.

Results

Body and art therapy psychotherapists expressed more positive, protective and involved countertransference feelings whereas psychotherapists for single and group therapy expressed more aggressive and hopeless feelings. Countertransference has an impact on therapy outcome and feelings of a lack of interest, aggression and resignation at the beginning of therapy can point to a poor outcome. Patients with personality disorders activate more negative countertransference reactions than patients without personality disorders but at the same time they may also evoke parent-like feelings of protection.

Conclusions

Using the CTQ it is possible to differentiate countertransference phenomena in a team of psychotherapists treating inpatients with psychodynamic psychotherapy. The timely perception and integration of countertransference feelings has a positive influence on the therapeutic process and therapy outcome.     

Behandlung und Teamprozesse in der stationären Psychotherapie

Ohne Zusammenfassung     

Gruppenentwicklung in zwei stationären intendiert dynamischen Gruppentherapien

Following the discussion of several methodological problems in the assessment of group development processes, a study is reported comparing the development in two inpatient groups (treated according to the intended dynamic model), measured on several levels, with a theoretical model of group development. Within the study, self experiences, group experiences and the group climate were assessed following each session. Data analysis was performed using a nonparametric procedure for the analysis of time series. The study indicated that group development can be studied economically. It further shows some indicators for differential group processes and individual reactions to the group process that can be used clinically.     

Therapieabbrüche in der stationären Psychotherapie

This article focuses on the patients’ view of the causes and consequences of premature therapy termination in inpatient psychosomatic setting. In this study, drop-out patients and non-drop-out patients were questioned in semi-structured phone interviews (n=62). The causes of early termination are seen in this study to be connected with an internal, somatic concept of disease, discontent with treatment, and social interaction problems in the hospital. In 80% of the examined cases more than two causes were reported. Consequently, early termination of treatment can be considered as an outcome of multifactorial influences. Furthermore, a group of “inner drop-outs” has been identified within the non-drop-out patients. Despite high discontent, these patients remained in treatment because they often feared possible negative consequences of early treatment termination. Both drop-outs and inner drop-outs scored lower in outcome analysis than the remaining patients. This study points to problem areas that can help identify potential drop-out patients.     

Zur Prävalenz von Depersonalisation und Derealisation in der stationären Psychotherapie

Depersonalization (DP) and derealization (DR) remain poorly recognized in clinical routine. Active exploration through structured interviews is strongly recommended, because patients rarely describe spontaneously their experiences with DP/DR. 143 psychosomatic, first-admission inpatients were interviewed about the 1-month prevalence of DP/DR using the Structured Clinical Interview for DSM-IV dissociative disorders. Additionally, the German questionnaires of the Cambridge Depersonalization Scale, the Dissociative Experiences Scale, the SCL-90-R and the Inventory of Interpersonal Problems were used. In the sample we found a prevalence of 23.1% (N=33) for depersonalization-derealization syndrom (ICD-10 F48.1) and 7% (N=10) for secondary pathological DP/DR. A total percentage of 62.9% reported DP/DR to some degree or other. There was a noticeably high co-occurrence of anxiety disorders in patients with pathological DP/DR. Patients with pathological DP/DR were generally more impaired, suffered many more interpersonal problems and were particularly characterized by introversion. Considering the high prevalence of this phenomenon, more attention should be paid to DP/DR in routine diagnostic procedures, treatment and research.     

Berufsgruppen- und methodenintegrierende Teamarbeit in der stationären psychodynamischen Psychotherapie

Zusammenfassung Die über 50-jährige Entwicklung der stationären psychodynamischen Psychotherapie ist ein Prozess von der Anwendung ambulanter psychoanalytischer Verfahren auf der Station zu einem eigenständigen multiprofessionellen, multimethodalen Therapieverfahren. Die Rahmenbedingungen der Organisation Krankenhaus und das jeweilige psychoanalytische Verständnis des Leiters der Abteilung zur Nutzung des multipersonellen Therapiefelds prägte die psychodynamischen Konzeptionen. Die Entwicklung führte zu einer Formulierung einer Komplexbehandlung für stationäre Psychotherapie im Prozedurenkatalog der DRGs. Ein Herzstück der integrativen stationären psychodynamischen Therapie ist das multiprofessionelle Team. An 2 Beispielen von therapeutischen Funktionen des multiprofessionellen Teams wird die gemeinsame Aufgabenstellung des Teams dargestellt. Darüber hinaus werden Regeln aus gruppenanalytischer Sicht für die Leitung eines solchen multiprofessionellen Teams vorgeschlagen.