Diagnostische Methoden in der Gesprächspsychotherapie

As in other scientifically recognized psychotherapy procedures diagnostic methods are highly valued in modern client-centered psychotherapy. On the one hand diagnostics provide the necessary documentation of the effects of therapy (as legally prescribed), on the other hand they enable the indications for psychotherapy and monitoring of the therapy process. Besides theory-overlapping instruments (especially for comparing the effects with those of other therapies) there is a respectable repertoire of client-centered theory-oriented diagnostic methods, primarily for the diagnostics of essential process variables. For the three domains of diagnosis, pretesting, process diagnosis and post-testing, the methods used by client-centered therapists are introduced and theory-oriented methods are delineated with recommendations for acquisition. Moreover, the use of other procedures is also suggested.     

Zur Problematik der Suchtgefährdung von berufstätigen Medizinern

Two samples of working physicians have been compared in a cross-sectional study – one representative sample of addicted physicians with a substance abuse problem (n=142) and one representative sample (n=275) of physicians in general; the objective was to develop preventive strategies. As a measuring instrument a specific questionnaire on quality of life of physicians (Reimer and Jurkat) has been used. Generally, quality of life is lower in the substance abuse sample in comparison to the control group. It can be concluded that the variables concerning the areas life satisfaction/-dissatisfaction and health differentiate even more between the groups than the areas work satisfaction/-dissatisfaction and choice of occupation. Whereas quality of life of female physicians was on the average somewhat higher than that of their male colleagues in the control group, this could not be confirmed in the sample of impaired physicians. Especially the ability to relax seems to be essential as a preventive measure, and apparently it is of high importance for working physicians to care for an adequate and satisfying private life to balance their stressful working life.     

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.     

Zur Entwicklung von Konzepten und Methoden der Prävention

Zusammenfassung  Die Verstärkung von Primärprävention als Senkung der Eintrittswahrscheinlichkeit von Krankheiten ist angesichts der Dominanz chronisch-degenerativer Erkrankungen und der wachsenden Ungleichheit von Gesundheitschancen in reichen Industrieländern eine zentrale Herausforderung zeitgemäßer Gesundheitspolitik. Die heute dabei verwendeten Konzepte und Methoden haben historische Wurzeln, deren Kenntnis Anregungen für ihre Verbesserung und weitere Entwicklung liefern kann. Moderne Primärprävention senkt Gesundheitsbelastungen und fördert gesundheitsdienliche Ressourcen, sie arbeitet mit spezifischen und unspezifischen Interventionen, gibt der Veränderung der Kontexte von Krankheitsentstehung und belastendem Verhalten Priorität und ist partizipativ angelegt. Das gilt für Interventionen auf der Ebene des Individuums ebenso wie für solche in settings/Lebenswelten und für bevölkerungsweite bzw. zielgruppenspezifische Kampagnen. Eine Verbesserung der Qualitätssicherung ist notwendig. Das im Jahr 2005 gescheiterte Präventionsgesetz sollte zwar lediglich den Beitrag der Sozialversicherungsträger zu dieser anspruchsvollen, gesamtgesellschaftlichen Strategie regeln, enthielt aber Festlegungen im Hinblick auf Ziele, Instrumente, Zuständigkeiten und Ressourcen, die auch für den nächsten Anlauf der Gesetzgebung richtungweisend sein sollten.

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.     

Zur Bedeutung von kurzzeitigen Gedächtnisleistungen für das langzeitige Behalten

Zusammenfassung Die vorliegende Arbeit ist auf die Untersuchung funktionaler Beziehungen zwischen kurz- und langzeitigen Gedächtnisleistungen gerichtet. Ausgehend von der allen zur Zeit diskutierten gedächtnistheoretischen Ansätzen gemeinsamen Annahme, daß jeder permanenten Veränderung im zentralnervösen Bereich (als neuronales Substrat dauerhafter Gedächtniseindrücke) ein dynamisches Erregungsgeschehen vorangeht, welches die Grundlage für kurzzeitige Gedächtnisleistungen bildet, wurde die Bedeutung kurzzeitiger Gedächtnisleistungen für das langzeitige Behalten zu ermitteln versucht.Nach einmaliger Präsentation einer Anzahl von Konsonanten-Trigrammen wurde sowohl die unmittelbare Behaltensleistung 0, 6 bzw. 12 sec nach Darbietung derselben als auch — im Anschluß an eine 5 min dauernde Konzentrationsaufgabe — die Leistung im freien Reproduzieren bzw. Wiedererkennen festgestellt, wobei ein aktives Memorieren der Trigramme während der Einprägungsphase nicht möglich war. Ein Vergleich der mittleren Langzeitleistungen je nach Leistung im unmittelbaren Behalten (KZ-Gedächtnisleistung) ließ keine entsprechenden Unterschiede derselben in Abhängigkeit von den verschiedenen Behaltensintervallen (0, 6, 12 sec) erkennen. Dies wird als ein Beleg dafür aufgefaßt, daß die Übertragung von Information in einen Langzeitspeicher nicht ausschließlich über den Kurzzeitspeicher erfolgt. Ein Modell wird vorgeschlagen, das die verschiedenen theoretischen Ansätze integriert und neue Möglichkeiten der Interpretation von Ergebnissen der experimentellen und klinischen Gedächtnisforschung, die mit den zur Zeit diskutierten Theorien nicht vereinbar sind, eröffnet.

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The effect of short-term memory performance on long-term memory

Summary A functional aspect of the relation between short- and long-term storage systems in human memory was investigated, i.e. the assumption that transfer of information to a long-term store depends on the processing of information by means of a short-term storage system. The testing of this hypothesis involves a within-Ss comparison of long-term recognition performance as a function of short-term recall in a modified Peterson paradigm. In spite of different scores in short-term recall as a consequence of various short-term retention intervals (0, 6 and 12 sec) during which rehearsal was prevented by making the Ss count backwards, there were no differences in long-term performance. This was interpreted as evidence against the common assumption that information is transferred into the long-term store through the short-term store.An alternative model is proposed which integrates different theoretical positions on the flow of information within the human organism. This model seems to allow the interpretation of some experimental and clinical data that are incompatible with existing theories.

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Erste Ergebnisse dieser Untersuchung wurden auf der XV. Tagung experimentell arbeitender Psychologen im April 1973 in Erlangen referiert.Der Verfasser dankt Frl. G. Gletthofer und Fr. I. Hausmann für die Mitarbeit bei der Abfassung des Manuskriptes sowie Herrn J. Egger für die überaus sorgfältige Durchführung der Versuche.     

Zur Phänomenologie des Wärmeschmerzes

Ohne Zusammenfassung Mit 35 Textabbildungen. Dissertation der Philosophischen Fakult?t Greifswald.     

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.     

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 Qualitätssicherung zivilrechtlicher Begutachtungen

Quality assurance in forensic psychiatry must take into account the different requirements for assessment in criminal, civil and social law. For civil law assessments the following measures are recommended: a reading list of articles reflecting the expert consensus, guidelines, a list of approved expert supervisors, an exemplary curriculum, modification of the present certificatation by the German Society for Psychiatry and Psychotherapy, Psychosomatic and Neurology (DGPPN) with more emphasis on civil law and a continuous process of education and recertification. Besides an interdisciplinary statement defining minimum requirements for civil law assessments, measures for continuous quality improvement should also be established in cooperation with representatives of the judicature.     

Zur Frage des Pihl-Froehlich-Phänomens

Ohne Zusammenfassung