Diagnostik in der Psychotherapie

The present paper gives an overview of criteria and methods of diagnostics and assessment in psychotherapy from an orientation-unspecific point of view. First, some general remarks on the aims and strategies of psychotherapeutic assessment are made as well as specific functions during the different phases of a treatment are explicated. Because of its many functions diagnostics in psychotherapy has to take into consideration psychiatric, psychological and orientation-specific models and methods of assessment. At the beginning of a treatment problem-analysis and therapy-planning are needed, during its course the processes and changes are to be studied and at the end of the treatment its outcomes are to be evaluated. Diagnostic assessments are also important for monitoring and controlling the quality of the process and the outcome of a psychotherapy. At the end of the paper some general criteria for the application of assessment in psychotherapy are formulated.     

Themen der Ausbildungsforschung in der Psychotherapie

This review is based upon an appraisal of training research in psychotherapy showing that many questions are still unanswered. By means of a schema for the organization of research results that differentiates input, process and output variables, unselected results are summarized relating to issues such as the choice of the psychotherapeutic profession, pre-experiences of candidates, the selection of an orientation, personality factors, characteristics of training institutes, quality standards, as well as the organisation and structure of training programs. Process oriented studies mainly focus on the operationalisation and development of skills, the significance, the effects of and the satisfaction with training components. Finally, the output category comprises results related to graduation, to professional development during and following training and to the development of competence and its prediction.     

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.     

Professionalisierung der Supervision

Supervision is a central domain of professional education and clinical practice. Supervisors features for qualification as well as formal training standards have been largely neglected. In this article the proposals of different psychotherapeutic societies concerning the features for qualification are discussed. Additionally, some training concepts are presented. Suggestions for future development in this area are addressed including the need to refine further operationalized competence, develop conditions for accreditation and certification regarding supervision competencies.     

?ISPS-Germany“

The authors describe the development from a study group on group psychotherapy for patients with schizophrenia, started in 1975, to the foundation of the German branch of the International Society for the Psychological Treatments of Schizophrenias and Other Psychoses (ISPS) in 2011. The history of this study group confirms the continuity of a sometimes hidden psychotherapeutic culture in German psychiatry and underlines the growing importance of psychological and psychosocial interventions in the current treatments of psychoses.     

Die DPG-Praxis-Studie

All psychotherapeutic methods must be scientifically evaluated. Empirical evaluation of evidence is a prerequisite for acceptance as scientific psychotherapy as well as for payment by health insurance. Currently the psychotherapy methods accepted within the German health system (behavioural therapy, psychodynamic psychotherapy, and analytic psychotherapy) are reviewed by a governmental evaluation committee concerning evidence, necessity and cost-effectiveness. The DPG practice study has basically two aims: 1) to conduct a large naturalistic study to investigate effectiveness, sustainability and economic aspects of psychodynamic and analytic psychotherapy and 2) to offer a framework for psychoanalytic institutes, members, candidates or groups to realize own research ideas by collecting additional data within the study. The present article describes the background, main research questions, structure and design of the DPG practice study with regard to the evaluation questions.     

Some ethical aspects of psychotherapeutic work

A few thoughts are presented regarding the current discussion concerning ethical aspects of psychotherapy in socialist society. The author states his opinion regarding such problems as the obligation to take maximum care, the obligation to be constantly on call, professional discretion, the obligation to give treatment, cooperation with colleagues and the necessity of self-experience for the psychotherapeutic on the basis of experience gained in psychotherapeutic practice.     

On the nature and standing of psychoanalytic psychotherapy

In this paper, I offer some reflections on the standing of psychoanalytic psychotherapy in the National Health Service (NHS), with special reference to contemporary forms of evidence-based thinking. I consider what may follow when a narrow view of science or psychotherapeutic practice becomes conventional wisdom and assumes dominance. I place stress on the potential loss to NHS psychology and psychiatry if psychoanalytic psychotherapy becomes increasingly marginalized on the one hand, or overly standardized on the other.     

Ambulante Psychotherapie in Deutschland aus Sicht der Patienten

This study analyzed the provision of outpatient psychotherapy services in Germany in typical practice settings. In a representative survey (from June 2008 to September 2009) 1,212 subjects who received outpatient psychotherapy during the past 6 years were questioned about their experiences with outpatient psychotherapy via telephone interviews. Socio-economic data, reasons for seeking treatment, access paths, financial resources and psychosocial support data were collected. Therapeutic settings and modalities and concomitant medication treatment are described. The findings illustrate the problem of multiple psychiatric morbidity in the clinical practice and confirm the urgent need for patient access to professional psychotherapeutic services. Improving access to these services requires close cooperation between care providers.     

Psychotherapie und die Anerkennung des Fremden

The aim of the present paper is three-fold: it reveals the inherent limitations of the concept of disorder in psychopathology and psychotherapy. It argues that characteristics of the person such as individuality, subjectivity and identity, have to be considered in psychiatric and psychotherapeutic concepts. And it shows that psychotherapy is dependent on cultural, social and socio-economic factors that are neglected in many theories. The paper uses clinical and epistemological arguments. It arrives at the conclusion that the above mentioned limitations have a common ground. They could be overcome, if psychiatry and psychotherapy were self-reflective and self-critical in respect to the inherent limitations of theory and practice and if they integrated concepts of being different in their basic theories so that symptoms, persons and cultural or societal peculiarities could be recognised and acknowledged.—The paper has been written as a comment to D. Orlinsky's statements considering disorder-specific psychotherapies from the viewpoint of psychotherapy research.     

Single session and walk‐in psychotherapy: A descriptive account of the literature

Over the last several decades single session psychotherapy has become a mainstream psychotherapeutic approach. A steadily increasing demand for psychotherapeutic services and a continuous reduction in mental health care resources worldwide are both largely responsible for this development. This paper describes single session psychotherapy and provides a brief review of the relevant literature. Single session psychotherapy delivered in walk‐in settings is also discussed. Therapists who are unfamiliar with single session psychotherapy will find that this paper provides a concise introduction to the essential processes and outcomes of this psychotherapeutic approach.     

Inanspruchnahme, Verlauf und Ergebnis ambulanter Psychotherapie

This paper summarizes the major results of the study ?Optimizing psychotherapy service provision via transparency and outcome orientation: evaluating outpatient psychotherapy“ (TRANS-OP). Between September 1998 and February 2000, all insured persons of a major German health insurance company (?Deutsche Krankenversicherung“) who requested reimbursement of outpatient psychotherapy were asked to participate in the study. Comprehensive data concerning structural, process and outcome criteria of outpatient psychotherapy were collected from 714 participants and from the majority of their psychotherapists during a 2-year observation period. Participants applied for the following treatments eligible for reimbursement in the German health insurance system: psychodynamically oriented psychotherapy (52%), cognitive behavioral therapy (31%), and psychoanalytic psychotherapy (17%). The amounts of sessions claimed for reimbursement were approved almost without exception. Participants in the three treatment modalities did not differ in socio-demographic characteristics, or in initial symptom severity as assessed by standardized measures. Even though courses of improvement of the symptoms varied, therapy outcome after 2 years was similar in the three forms of treatment. In addition, a cost offset was found, i.e. medical costs, especially for hospital days, substantially decreased during the course of psychotherapy. These findings support the effectiveness as well as the economic significance of outpatient psychotherapy across different treatment modalities in routine care. However, allocation of psychotherapeutic resources should be more considerate of individual patient needs and treatment outcome.     

Onkologisch Kranke als Patienten der psychotherapeutischen Praxis

Background

The high prevalence of cancer and the considerable psychological comorbidity is a challenge for psychotherapists. There are, however, relatively few patients in outpatient psychotherapy. Aim of the study was to survey outpatient psychotherapists concerning this issue and their attitudes towards the treatment of cancer patients.

Methods

All outpatient psychotherapists of an East-German city were surveyed using semi-structured interviews.

Methods

There are various reasons for the relatively rare visits of cancer patients in psychotherapeutic practices: For instance the subjective lack of specific competence, the fear of many psychotherapists to treat physically ill people, insufficient fitting of the relatively inflexible organization structure of psychotherapeutic settings with the vicissitudes of life among physically ill people, e.g. long waiting periods until the begin of treatment, furthermore the psychotherapeutic training focuses on psychosomatic and not so much on somatopsychic perspectives. A further problem is the widespread attitude about psychic causation of cancer, which is contradictory to scientific evidence.

Conclusions

Psychotherapists who want to treat cancer patients need specific and in-depth training in psychooncology.     

The Future of Psychotherapy and the Expanding Universe or Michael J. Mahoney

Human Change Processes (Mahoney, 1991) is an attempt to set experiential psychotherapy on a scientific basis. The first tow-thirds of the book, based on an extensive survey of diverse scientific and scholarly literatures, argues fairly convincingly for a conception of human beings in which attachment, subjectivity, emergent and unconscious mental processes-especially regarding the self-and emotionality are central to human development and psychotherapeutic change. The book's last part, a discussion of experiential psychotherapy, based largely on clinical experience and intuition, is vague on important points of psychotherapeutic procedure ad process and is less convincing. The disjunction between the scientific discussion of psychology and the non-scientific discussion of psychotherapy is the book's major flaw. Nevertheless, the book is important as an attempt to synthesize a psychotherapy that is at once humanistic and scientifically informed.     

Standards der sozialmedizinischen Leistungsbegutachtung in der Psychosomatischen Medizin und Psychotherapie

Sociomedical problems are playing an increasingly important role in both psychosomatic medicine and psychotherapy and in psychiatry. The present article examines the standards relating to content and method in sociomedical assessments, primarily in the discipline of psychosomatic medicine and psychotherapy. The focus is on the assessment of performance, highlighting the fact that performance and performance deficits cannot primarily be derived from the medical diagnosis; instead, psychosocial variables that influence the processes of dealing with disease in particular affect the actual performance status. The article pays particular attention to aspects that aggravate or dissimulate performance competence. Finally, the principles of integrating the various findings and results that are incorporated into the assessment report are outlined.     

In Treatment

This article deals with current representations of psychotherapy in movies and television and focuses on the recent TV series In Treatment. It is discussed if and how this and other TV series might contribute to a change in the public image of psychotherapy. This discussion is based on studies investigating the public image of psychotherapy and its image within the media as well as the potential to use movies and TV as a stage for psychotherapeutic processes. Among several TV series dealing with psychotherapy, In Treatment plays a special role because of its conception as an intimate play. The series is described and discussed in relation to the question how realistic psychotherapy is staged and whether the hero of the series ??Dr. Paul Weston?? can be used as a model in psychotherapeutic training.     

Neurodynamics inside therapeutic interaction: a case study with simultaneous EEG recording / La neurodinámica en el contexto de la interacción terapéutica: un estudio de caso con una grabación simultánea de EEG

Recent research on processes of psychotherapy has focused on the study of patient-therapist regulation. Evidence concerning verbal and nonverbal coordination as predictors of therapeutic alliance and outcome in psychotherapy has been cumulating. These, along with others results in the field of social neuroscience, suggest that behavioural coordination may have neurophysiological correlates, which play a role in the regulatory process in psychotherapy. Here we introduce an observational paradigm and analytic method to assess the joint neurodynamic activity of patient and therapist. Additionally we report results from ongoing psychotherapy sessions. Our work highlights the involvement of brain activity in the psychotherapeutic process and provides novel insights on how psychotherapy works, in order to further the understanding of the embodied characteristic of the therapeutic interaction.