Psychotherapeutenausbildung aus Sicht der Absolventen

Background

A survey was performed to assess the current situation in education and to identify critical issues 10 years after the inception of the psychotherapy act in Germany.

Methods

In August 2008 all non-medical psychotherapists who had graduated since 2002 according the psychotherapy act were invited to take part in the survey and a total of 863 persons participated. The answers from 666 could be evaluated corresponding to a participation rate of 20%.

Results

A total of 57.6% of the graduates had completed a full-time training and approximately 50% of the graduates had completed the training within the allotted time. In the majority of cases evaluation occurred only for the theoretical courses. During the practical work (PT I) 36.8% of the graduates did not receive any salary or remuneration, 82% had their own field of activity and of these 38% treated patients without the presence of qualified tutor.

Conclusions

The training often lasts longer than intended, the financial situation in the PT I is exceptionally critical and in clear contrast to the field of activity in this section of training. Further detailed results will be presented and discussed.     

Die Psychotherapeutenausbildung aus Sicht der Teilnehmer

Background

A survey was performed to assess the current situation in education and to identify critical issues 10 years after the inception of the German law regulating the education of psychological psychotherapists and child and adolescent psychotherapists. The study reports the results of a nationwide survey of German psychological psychotherapists and child and adolescent psychotherapists currently in training. The aim of the survey was to evaluate the individual sections of training, desired alterations and structural and financial conditions.

Methods

All trainees were contacted via the training institutes and the umbrella organizations. A total of 3,223 trainees participated and answered questions mainly using an online questionnaire.

Results

Most respondents practiced their training part-time and in most cases the trainees thought that the training would last longer than initially expected. The practical training was rated most poorly, whereas practical education and individual supervision were rated as most useful. The survey revealed deficits concerning the evaluation of the quality of several components of the training.

Conclusions

From the perspective of the trainees there is a necessity to modify the financial conditions of the training. This result has been considered in the recommendations of a research expertise on psychotherapy training and should stimulate further research.     

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.     

Ambulante Psychotherapie in Deutschland aus Sicht der Patienten

This study analyzed the provision of outpatient psychotherapy services in Germany in standard practice settings. A total of 1,212 subjects who received or were still receiving outpatient psychotherapy during the past 6 years provided information about their experiences via a telephone survey. Outpatient psychotherapy was sought for many different conditions and was rated as highly effective. The improvement rates for all complaints were higher than 50%, except for obesity (37%) and sexual dysfunctions (44%). Patient ratings of worsening were less than 8% throughout. Treatment had very positive results not only for target symptoms but also for other aspects of patients?? lives. Almost 90% of those questioned stated that they were satisfied with their therapist. High agreement ratings were reported specifically with respect to positive therapeutic relationship, stable working alliance, experience of autonomy during therapy and therapists?? competency and ethical conduct. Patients gave their psychotherapists excellent evaluations and were highly satisfied with the changes achieved through treatment.     

Erste Erfahrungen mit der operativen Fallanalyse aus der Sicht des Revisionsrichters

Criminal investigative case analysis is a method for identifying the perpetrator of a crime based on an analysis of the nature of the offence and the manner in which it was committed. Various aspects of the criminal’s personality makeup are determined from the choices before, during and after the crime. In German criminal procedural law it is a new investigative tool in preliminary proceedings to give the prosecutor extensive assistance to the police to profile unknown criminal subjects or offenders and to supply more evidence. The Federal High Court has decided that police officers who use this method are not expert witnesses whose evidence can be challenged in the main proceedings by the state attorney.     

Trauma und Traumafolgen aus psychodynamischer Sicht

Zusammenfassung Posttraumatische Störungen sind psychogene Erkrankungen, die durch Traumatisierungen bewirkt werden. Das sind seelische Verletzungen, die schwer oder gar nicht bewältigt werden können. Die Störungen beruhen auf unterschiedlichen Arten von katastrophalen Erlebnissen und können mit zeitlicher Verzögerung, unabhängig von einer spezifischen Disposition, also auch bei bis dahin völlig gesunden Menschen, zu einer vorübergehenden, länger andauernden oder lang anhaltenden Störung im seelischen und körperlichen Bereich und zu einer Veränderung der Persönlichkeit führen. Diese Störungen sind außerordentlich häufig und haben eine große Vielfalt in Hinblick auf ihre Entstehung und ihre Krankheitserscheinungen. Dynamik und Folgen traumatischer seelischer Verletzungen werden in diesem Beitrag systematisch aus psychoanalytisch orientierter Perspektive untersucht und dargestellt.     

Erwachsenenschutz bei dementen Patienten aus rechtlicher Sicht

Das 2. Erwachsenenschutz-Gesetz brachte 2017 eine gewisse Neupositionierung in Bezug auf nicht entscheidungsfähige Patienten. Im neuen Recht liegt es wie bisher am Arzt selbst, die Entscheidungsfähigkeit zu beurteilen. Vor Einschalten eines Vertreters greift eine spezielle Unterstützungspflicht (Beiziehung einer Vertrauensperson), um eine Entscheidungsfähigkeit doch noch zu erlangen. Ansonsten erfolgt – abgesehen von Fällen einer Gefahr in Verzug – die Aufklärung gegenüber dem Vertreter des Patienten, der eine allfällige Einwilligung zu erteilen hat. Eine gerichtliche Zustimmung ist grundsätzlich nicht mehr einzuholen.     

Szientifik, Hermeneutik, Ideologie-Kritik: Entwurf einer Wissenschaftslehre in erkenntnisanthropologischer Sicht

Ohne Zusammenfassung     

Erscheinungsformen und Ursachen von Amoktaten aus kriminologischer,forensisch-psychiatrischer und forensisch-psychologischer Sicht

Cases of running amok are intentional, accomplished and attempted multiple homicides by which mass murder is generally carried out by a single offender, motivated by anger, hate and revenge, attacking defined or randomly selected victims. The offender intends to become famous and in many cases commits suicide after the attack. Young offenders up to the age of 24 years old differ from the heterogeneous group of adults. Within a core group of young offenders personality disorders and behavioral problems are the main cause of the attacks. A quiet, reclusive and always somewhat strange loner has a deep feeling of alienation, feels offended and disregarded, identifies with perpetrators and stages the crime as revenge for subjectively experienced insults. Schizotypal, paranoid and narcissistic aspects dominate. The offenders are not characterized by patterns of impulsive, aggressive or dissocial behavior.     

Deuten aus der Perspektive der strukturalen Psychoanalyse Lacans

“Beware of understanding!” Lacan’s structural analysis: theory and practice of interpretation. This paper investigates the relationship of understanding and countertransference analysis in the process of analytical interpretation. Here self-image of the analyst is crucial concerning the direction of the analysis. As field and function of speech are pivotal, they will be briefly sketched to clarify the structural-analytic starting point of the following arguments. The basis of the ideas is a definition of the unconscious as what is not conscious available. Should the analyst see himself as the “knowing” one, as his patient also assumes, a false assurance will result and the analysis will lead nowhere. This is typical of a “forced” transference analysis in the here and now. The alternative is a strategy of hints, whose premise is, that we do not know. This assumption makes it unnecessary to rely on countertransference analysis. Instead, the spoken word and its contradictions are in the focus. This analytical attitude makes listening to the “subject of the unconscious” possible by means of the analyst and his hints.     

Analytische und tiefenpsychologisch fundierte Psychotherapien im Gutachterverfahren

Zusammenfassung. Ein Vergleich von 94 Erstberichten der analytischen Psychotherapie und 339 Erstberichten zur tiefenpsychologisch fundierten Psychotherapie im Rahmen der Richtlinienpsychotherapie mit Hilfe der Gutachtenkriterienliste (Rudolf et al. 2002) zeigt in beiden Verfahren sehr ?hnliche Quoten der gutachterlichen Befürwortung oder Nichtbefürwortung. Vergleichbares gilt für eine Gegenüberstellung von 61 analytischen und 147 tiefenpsychologisch fundierten Fortführungsberichten. Zweifel und Bedenken der Gutachter, die sich jedoch nicht auf die Entscheidung von Befürwortung/Nichtbefürwortung der Kostenübernahme auswirken, betreffen in der tiefenpsychologisch fundierten Psychotherapie Merkmale der prognostischen Einsch?tzung bezüglich des gew?hlten Verfahrens und der erkrankten Pers?nlichkeit sowie das Thema der Differentialindikation; bei Fortführungsberichten gelten die Zweifel der bearbeiteten Konfliktdynamik und prognostischen Einsch?tzung. Eine Ungleichbehandlung der beiden Verfahren durch die Gutachter kann aus diesen Daten nicht abgeleitet werden. In der Richtlinienpsychotherapie begründen die Therapeuten den Antrag der Patienten auf Psychotherapie durch einen ausführlichen anonymisierten Bericht über die Erkrankung der Patienten und die geplante Behandlung.

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Comparison of psychoanalytic and psychodynamic expertizes

Summary. On the basis of the criteria for expertizes (Rudof et al. 2002) we compared 94 therapy recommendations after the first assessment for psychoanalytic and 339 first recommendations for psychodynamic therapy, corresponding the psychotherapy guidelines. We found very similar proportions of approving and disapproving psychotherapy. The same result was found when comparing 61 psychoanalytic and 147 psychodynamic reports in the course of the therapies. Doubts and reservations of experts in the case of psychodynamic psychotherapy are first of all related to prognostic assessment of the chosen method and of the disturbed personality including the topic of differential indication. Expertizes about the course of therapies include first of all results about the dynamics of the conflict and prognostics. Our results do not support the opinion, that experts would make a difference along the two methods.

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Anschrift: Prof. Dr. med. G. Rudolf, Psychosomatische Universit?tsklinik, Thibautstra?e 2, 69115 Heidelberg, E-Mail: gerd_rudolf@med.uni-heidelberg.de