Beurteilerübereinstimmung von Psychotherapie-Gutachtern

The access to outpatient psychotherapy in Germany is regulated by an application and expert opinion procedure in a peer-review system. In an external assessment procedure, the application of each patient is considered concerning the existence of a mental disorder, a positive prognosis as well as the adequacy of the chosen therapy rationale. The present paper examines the reliability of this procedure by reanalysing the data from three studies on interrater agreement in the expert opinions about psychoanalytic/psychodynamic therapy, behaviour therapy or child and youth behaviour therapy. In the study of Rudolf et al. (2002) 48 experts re-examined two already assessed cases, in the studies of Sulz et al. (2003) as well as Sulz and Peterander (2004) each of 30 and respectively 7 experts had judged five non selected or seven selected applications. The interrater agreement was calculated using the kappa coefficient by Fleiss for the agreement among many raters, which tests the observed agreement probability against the expected agreement probability that would occur by chance. The level of agreement among the experts differs between 46% and 70%. With the chosen method it is mostly not possible to show that there is a significant higher agreement than by chance. The generalizability of the results to the usual assessment procedure is discussed as well as their potential for the advancement of the application procedure and expert peer-review system.     

Rehabilitation von Straftätern

The German correctional treatment in prison, social therapeutic units and social therapy capitalizes on therapeutic interventions developed in English-speaking countries, which are based on the risk-need-responsivity model (RNR). However, this approach is rarely discussed in the German literature. The present article aims at filling this gap by illustrating the basic assumptions, strengths and limitations of the RNR model. Moreover, this presentation highlights the usefulness of the RNR model for the treatment of offenders.     

Additivitätseffekte von Konfliktalternativen

Zusammenfassung Ausgehend von einem Modell von Feger u. Sorembe (1972) über Zusammenhänge zwischen Reaktionsvariablen bei Entscheidungen wurden nach dem von Bechtel (1971) vorgelegten Skaliermodell additive Effekte von Konfliktalternativen bei erlebnisdeskriptiven Variablen und bei der Entscheidungszeit überprüft. Insgesamt 140 Vpn wurden acht Alternativen in Zweierkombinationen vorgelegt. Dabei sollte die bevorzugte Alternative angegeben werden und danach mit Hilfe von Ratingskalen die Wichtigkeit, Konfidenz, Konfliktstärke und der Wunsch nach weiterer Information eingestuft werden. Die Entscheidungszeit wurde von den Vpn unbemerkt gemessen.Für die Variablen Entscheidungszeit, Konfliktstärke und Konfidenz konnte die Hypothese beibehalten werden, daß sich die mittleren Zeiten bzw. Ratings für einen Konflikt additiv zusammensetzen aus der Kombination je eines Wertes pro Alternative. Aus den hohen Interkorrelationen zwischen den Skalenwerten der Alternativen für Entscheidungszeit, Konfliktstärke und Konfidenz wurde geschlossen, daß die Anzahl der Folgeantizipationen das diese Variablen gemeinsam beeinflussende Prozeßcharakteristikum ist.

---

Additivity effects of conflicting alternatives

Summary In a model of conflict behavior Feger and Sorembe (1972) recently explained the relationships found between dependent variables in decision-making situations by assuming an underlying anticipation process. The model implied for example that the decision time is a function of an additive combination of the time spent anticipating the consequences for each of the alternatives in conflict. By applying Bechtels (1971) scaling model it was tested whether the assumption of additive effects of the alternatives was correct. 140 majors in psychology acted as Ss in real conflicts, the alternatives of which were related to a new examination regulation.It was not possible to reject the additivity hypothesis for the variables decision time, rated conflict strength and rated confidence. It is doubtful for our data whether Bechtel's scaling model is really applicable to rated subjective importance of the decision and rated desire for further information on the alternatives. The scale values of the conflict alternatives were intercorrelated for all variables. The high correlations between the scale values for decision time, rated conflict strength and confidence were explained by assuming the number of anticipations to be the common process characteristic of these variables.

---

---

Die Arbeit wurde mit Unterstützung der DFG durchgeführt. Das Bechtel-Programm wurde von Herrn Dipl.-Psych. E. D. Lantermann zur Verfügung gestellt.     

Psychotherapie von Anpassungsstörungen

In this study we examined the effectiveness of an outpatient client-centered psychotherapy of patients with adjustment disorders (ICD-10 F43.2) limited to twelve sessions in comparison to an untreated control group. The patients of each group (n_treatment= 31 and n_control= 19) had been diagnosed with an adjustment disorder in response to one of the following stressful events: either the loss of an important person or performance deficits at work or university. Compared with the untreated control group the immediate therapy group improved significantly on rating scales and questionnaires. These positive treatment effects proved stable at a 3 months follow-up. Individual treatment gains were also analyzed for clinical and statistical significance. The improvements of the treatment group were significantly greater in all used measures than those of the control group. These improvements were interpreted as an effect of the client-centered treatment which resulted in high individual overall treatment gains and in high effectsizes.     

Partnerschaften von Sexualstraftätern

Intimate relationships of convicted and released sexual offenders have hardly been the topic of systematic research. This article presents a systematic review of this topic. Only nine articles were found in a systematic literature search which investigated this topic with qualitative and quantitative methods. These studies were dominated by the determination of multiple deficits in the sexual offenders, such as intimacy and empathy problems, high frequencies of conflicts and aggression in the relationships as well as social isolation of the female partners. The female partners of sexual offenders also showed a high tendency to denial and minimization similar to the offenders and blamed the victims for the offence. The women seemed to like their status as a “martyred wife” and gave their husbands a “second chance in life”. However, the currently available studies have barely investigated the “sexual offender couple” and the dynamics of their relationship to elucidate stabilizing factors. In a pilot study on the topic of “partnerships of sexual offenders” 17 “sex offender couples” were questioned by interviews and questionnaires to collate the dynamics of the partnership, which was published in the Journal of Sex and Marital Therapy. In the quantitative results it was found that the female partners of sex offenders predominantly demonstrated an insecure preoccupied attachment style and this influence on the relationship stability is discussed. Further studies are needed in this field of research to gain detailed data of “sex offender couples” for relapse prevention and therapeutic implications.     

Die Rehabilitation von Straftätern

The rehabilitation of offenders in English-speaking countries is primarily guided by a risk management framework (the risk-need-responsivity principles: RNR model), which aims at reducing the possibility of harm to the community rather than improving offenders’ quality of life. In the last decade Tony Ward and his colleagues have developed the good lives model of offender rehabilitation (GLM) as an alternative to the RNR model. The GLM incorporates the RNR principles of risk, need and responsivity into its theoretical structure while aiming to provide a more constructive and comprehensive approach to correctional practice. More specifically, it aims to both reduce risk while enhancing the quality of offenders’ lives. The present article aims at outlining the general, etiological assumptions and practice implications of the GLM. In addition, its strengths and limitations and evidence base are reported. These illustrations highlight the usefulness of the GLM for the treatment of offenders and sex offenders in particular.     

Begutachtung von somatoformen Störungen

As a result of their prevalence somatoform disorders represent a substantial burden not only for health care systems but also for social security and pension programs around the world. In fact, in recent years there has been a steady increase in the number of applicants filing for disability pensions due to such disorders. Recent studies focus on the relationship between biological, psychological and social factors and the subjective experience of somatoform symptoms and their concomitant impairments. Despite this progress, diagnostic work in general remains a challenge. The purpose of this paper is first to discuss a dimensional diagnostic system for somatoform disorders. Secondly based on the dimensions of this diagnostic system, considerations regarding the differentiation of the diagnosis “pain disorder” will be made. Furthermore, considerations concerning the severity and prognosis of somatoform disorders are presented. These considerations should help to assess vocational disability.     

Ambulante Behandlung von Sexualstraftätern

Treatment of sexual offenders is still a controversial issue for both forensic clinical practice and research. The methods to evaluate efficacy and effectiveness in the field of forensic psychiatry and psychotherapy show many distinctive characteristics. Especially outpatient treatment of sexual offenders takes place in a conflict of interest. This article aims to illustrate several potentials and difficulties in the field of sexual offender treatment using the example of the Hamburg Institute for Sex Research and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf (UKE).     

Carl Friedrich von Weizsäcker

Ohne Zusammenfassung

---

Einsatz von Bupropion bei älteren Patienten

Die chronische bipolare Depression bei ?lteren Menschen ist eine klinische Herausforderung und erfordert unter Umst?nden, wie der vorliegende Fallbericht zeigt, Behandlungswege, die von Leitlinien nicht unbedingt abgedeckt werden.     

Qualitätssicherung von Gerichtsgutachten im Familienrecht

In recent years many controversial verdicts and studies have brought discussions about the quality of expert opinions in family law into the focus of the media, political and expert public spheres. With the coalition contract, the ruling parties agreed on improving the quality of expert opinions, especially in the sector of family law, in collaboration with professional institutions. Representatives of the legal, psychological and medical associations, the Federal Bar Association and the Federal Chamber of Psychotherapists worked out guidelines for expert opinions in family law in cooperation with the Federal Ministry of Justice and Consumer Protection. The three main quality assurance aspects are scientifically founded procedures, transparency and traceability. These requirements are concretely illustrated in this article with recommendations concerning the procedure and composition of expert opinions.     

Diagnostik von Persönlichkeitsstörungen

Diagnosing and classifying personality disorders is complex and difficult from both the scientific and clinical perspectives. Dimensional and categorical models and assessment instruments of personality disorders, and different (behavioral and psychodynamic orientated) clinical procedures are described. Furthermore, an integrative view on clinical practice is presented.