Evidenzbasierte Psychotherapie

Zusammenfassung Seit einiger Zeit wird auch in der Psychotherapie – so wie in anderen Bereichen der Medizin – eine intensive und kontroverse Diskussion über die wissenschaftlichen Standards und deren Praxisrelevanz geführt. Dabei nehmen Fragen der Qualitätssicherung und der Entwicklung von Leitlinien einen zunehmenden Raum ein. Von besonderer Bedeutung sind in diesem Zusammenhang die Evidence Based Medicine (EbM) und ihre methodischen Standards, in deren Mittelpunkt experimentelle Therapiestudien stehen. Im Beitrag wird das Konzept der Evidence Based Medicine im Kontext der Psychotherapie (Evidence based Psychotherapy) vorgestellt und unter methodischen und inhaltlichen Gesichtspunkten diskutiert. Eine zentrale Frage ist dabei die inhaltliche Aussagekraft und die Übertragbarkeit von wissenschaftlichen Befunden auf die klinische Praxis.      

Zur Psychotherapie der Depression

Ohne Zusammenfassung     

Psychotherapie bei Depression

Due to significant limitations in mental and physical being, social relationships, and working and functional abilities, prevention and treatment of depressive disorders—predicted to be the most common disorder in 2030—are of particular importance. In the S3 guideline Unipolar Depression, psychotherapy has gained in significance for the acute treatment of unipolar depression. It is noteworthy that psychotherapy is in general recommended as monotherapy or in combination in all degrees of severity of depression. The lasting effects of longer-term psychotherapies are often underestimated. A reflection of the current body of evidence based on the empirical research paradigm and its impact on clinical practice is presented.     

Psychotherapie der Psychosen

In this paper the psychotherapy of patients with schizophrenic, schizoaffective and affective psychoses is outlined. Psychoanalytic, cognitive-behavioural and systemic approaches and their theoretical concepts as well as the therapeutic techniques are de- scribed. The settings of individual, group and family therapy are also presented. A survey of the types of psychoanalytic therapy with their eldest historic roots is given with the development of the various psychodynamic concepts for schizophrenic and affective psychoses including schizoaffective psycho-ses. The different kinds of psychotherapy are compared to each other with respect to the aims. Finally this paper deals with the effectiveness of the therapies and discusses the pros and cons of relatively short randomised controlled trials compared with long term psychotherapies without control groups.     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.     

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.     

Stellenwert der Psychotherapie in der Allgemeinmedizin

Diese Arbeit befasst sich mit dem interdisziplin?ren Einsatz von Psychotherapie in der allgemeinmedizinischen Betreuung von Patienten mit psychischen Problemen oder Krisen. Bekanntlich ist es nur einem kleinen Teil der Patienten von Allgemeinmedizinern m?glich, psychotherapeutische Hilfe in Anspruch zu nehmen. Eine zus?tzliche psychotherapeutische Ausbildung des Hausarztes kann die Qualit?t der Patientenbetreuung signifikant verbessern. Zudem k?nnen nicht nur die Patienten davon profitieren; psychotherapeutische Ausbildung und Kommunikationstraining stellen eine wertvolle Bereicherung des Arztberufes und eine ernstzunehmende Burn-out-Prophylaxe dar.     

Ergebnisse der Katathymimaginativen Psychotherapie

The goal of this study was to examine the effect of guided affective imagery therapy in an outpatient setting.At first, 140 patients were recruited.Unfortunately, there were many drop-outs at the beginning of the study as well as at later assessments.The data of 66 patients could be evaluated.The patients were assessed at the beginning of the therapy, after 25 sessions, at the end of the therapy and 18 month after the end of the therapy. Because of too many drop-outs, the originally planned waiting-control-design was realized only to some extent.The diagnoses of the patients consisted mainly of neurotic disorders,many of them with a dysthymia. Data were gathered by standardized questionnaires. There were marked effects of the therapies at the end of the treatments and also at the follow-up evaluation.Effect sizes were larger than 0.8 in somatic symptoms, mood, depression and life satisfaction.On the one hand, therefore, these therapies had been very effective. On the other hand, it became obvious during the course of the study, how difficult it is to conduct such a design with many therapists in a private practice and without financial support.     

Ethik in der Psychotherapie

This contribution discusses some fundamental questions of medical ethics in psychotherapy. The problems discussed arise when ?care ethics“, which is based mainly on the Hippocratic Oath as the basis of medical ethics, is rejected. After a short overview of the relevant ethical theories, we ask for values and principles which might serve as a foundation for philosophical reasoning on the doctor-patient-relationship. In particular, we discuss the role of autonomy and informed consent in this relationship, following Beauchamp’s and Childress’ ethical principlism. We try to show the limited scope of the principle of autonomy in psychotherapy. Finally, we make a plea for a dynamic conception of patient autonomy for which we offer some pragmatic reasons. To round this conception off it is illustrated by the metaphor of the lighthouse.     

Diagnostik in der Psychotherapie

Diagnostic approaches in psychotherapy are accompanied by a continuous and unchanged discussion concerning fundamental questions. Because of its many functions diagnostics in psychotherapy has to take psychiatric, psychological, orientation-specific models and methods of assessment into consideration. Following the publication of the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-5) the increasing danger of a further increase in the number of psychiatric disorders is evident. In this article the principles of current psychiatric diagnostics and psychodynamic psychotherapy are presented and discussed. Furthermore, the dangers associated with the increased medicalization and over-diagnosis are highlighted. Against this background consideration is given to the risks for patients and societal aspects.     

Patientenziele in der Psychotherapie

Zusammenfassung  Im vorliegenden Artikel wird ein Überblick zum Stand der Forschung zu Patientenzielen in der Psychotherapie gegeben. Auf vier Aspekte wird dabei besonders eingegangen: (1) auf grundlagenwissenschaftliche Modelle und Befunde zu Lebenszielen, (2) auf allgemeine Lebensziele von Patienten und deren Zusammenhang zu ihrem psychopathologischen Zustand, (3) auf explizite Therapieziele und (4) auf zielbezogene therapeutische Interventionen. Durch diesen Überblick soll zum einen deutlich gemacht werden, wie grundlagenwissenschaftliche Forschung zu persönlichen Zielen klinische Forschung beeinflusst und bereichert hat. Zum anderen werden die therapeutischen Implikationen der Zielforschung herausgearbeitet.

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.     

Hausaufgaben in der Psychotherapie

Homework assignments represent a standard intervention in psychotherapy. Homework provides the unique opportunity to emphasize patients’ responsibility for therapeutic change and to intensify the therapeutic process. Despite these high potentials systematic homework assignment is still rare in practice. Psychotherapy research has just recently focused its attention on homework as an effective therapeutic method. Meanwhile the positive effects of homework use on therapeutic outcome have been demonstrated but little is known about therapeutic strategies to enhance these effects. The present article highlights the functions of homework within the therapeutic process and discusses its theoretical mechanisms of action. The article concludes with suggestions from both an empirical and practical point of view to further assist practitioners’ use of homework assignments.