Patientensicht zur Qualität in der Psychotherapie

Concerning the discussion about the quality of psychotherapy, the different perspectives in the definition of quality are rarely considered. Especially the patients’ perspective is barely respected although quality assurance of psychotherapy should be for their benefit. Patients were interviewed (n=8) to answer the question which criteria of quality are relevant in their view. Using the grounded theory a variety of quality criteria was found. The interviewees emphasized the relationship between therapist and patient, the empathy of the therapist, the scheduling of appointments and the progress in therapy. The results suggest that when judging the quality of psychotherapy clients do not only focus on the outcome of psychotherapy, as presumed by some experts, but also on the dimensions structure and process. Professionals have to consider this fact when designing and applying methods of quality assurance.     

Stationäre Psychotherapie in der Psychosomatischen Rehabilitation in Deutschland

Ohne Zusammenfassung     

Behandlung und Teamprozesse in der stationären Psychotherapie

Ohne Zusammenfassung     

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.     

Religiosität und Spiritualität in der Psychotherapie

For many years religious and spiritual issues have been avoided in psychotherapy. In the face of social changes a more culturally sensitive psychotherapy is needed to professionally deal with religious backgrounds, spiritual needs and spiritual resources. A remarkable spiritual turn has recently been observed particularly in psychoanalysis, which was originally very antireligious. Health research studies are exploring the healing craft of religious virtues and values. It is important to discern between an empirically proven healing method and an ideologically founded promise of salvation. It is the task of the therapist to find out whether the patient's religiosity or spirituality is part of the problem or part of the solution.     

Gegenübertragungsdiagnostik in der Psychotherapie suizidaler Männer

The diagnosis of suicidality is an important challenge in psychotherapy: The threat of life has to be determined, decisions in differential therapy must be made and the therapeutical relationship must be established. The psychoanalytical contribution to the diagnostics of suicidality is the analysis of transference and countertransference phenomena, of "scenic" actions and of enactments between patient and therapist. By a systematic qualitative research method ("forming ideal types by understanding") 5 prototypical transference-/countertransference situations at the beginning of outpatient psychodynamic psychotherapy of suicidal men are identified and out of them 3 ideal types are constructed. The object-alienated ideal type with an avoidant transference and "weak", e.g. unemotional complementary countertransference appears to be a special problem. If aggression and strong attachment wishes toward the object come into the therapeutic relationship, this often is an indicator for the contacts’strength and can lead to deactualisation of suicidality. The results are discussed with and supported by methodically different publications on object relations orientated aspects of suicidality.     

Welche Rolle spielt die Diagnostik in der systemischen Psychotherapie?

Diagnostic procedures in systemic psychotherapy are bound to raise questions: These procedures are indebted to a medical model which is pathology- and deficit-oriented and which requires that diagnosis precedes therapy. Yet diagnostic procedures in systemic psychotherapy are mainly geared to assessing the psychic and social domains rather than the domain of medicine proper. The article takes up some of the issues and problems deriving from this state of affairs.     

Bedrohungsszenarien und Gewalt gegenüber Dritten in der Psychotherapie

Aggressive behaviour, violent fantasies and potential threats against third parties are frequent topics in psychotherapy. Clinical, social and dynamic factors have to be considered for the risk assessment of aggressive behaviour. The appearance of aggressive fantasies and threats can be perceived as an indicator for potential threats. Legal aspects such as medical confidentiality, rights and duties to warn have to be kept in mind when dealing with threats against third parties. Concerning threats against children different laws have to be considered.     

Einsatz von „virtuellen Realitäten“ in der Psychotherapie

The internet, as well as various mobile media (e.g. cellular phones, handhelds, mobile paddles) have proven very useful in supporting psychotherapeutic measures in various projects. Virtual reality technologies (VR) take technical as well as intervention possibilities a step further. They enable the creation of computer-based models of the real world, with which interaction via the human-machine interface is enabled. The three-dimensional and interactively explorable environment is predominately used for exposure treatment in the behavior therapy setting. The features of VR applications are utilized as a medium between imagined and in vivo confrontation. This article illustrates various applications and compiles findings regarding effectiveness. It is concluded that the exposure treatments using this technology for various described phobias have proven effective. The use of VR for treatment of other psychological illnesses, however, for example trauma disorders, as was demonstrated in the study at hand, is viewed very critically. Finally, research necessities are indicated and psychodynamic facets of VR are discussed.