Imaginationen in der psychodynamischen Psychotherapie

Imaginations establish a direct access to central relational and emotional schemes. Thereby, they have considerable therapeutic potential, apt to enrich psychodynamic treatment to a high degree. In the experiential space of imaginations central wishes, anxieties and conflicts come to the fore, thus the earlier ones can be worked through and new ones may be tried. The continuous therapeutic support allows for a reasonable focussing of the imaginations by applying regression, progression, support, confrontation and stimulation. After an introduction into the therapeutic applications of imaginations the actual clinical work with imaginations as developed by the katathym-imaginative psychotherapy (KIP, guided affective imagery) is presented, exemplified by a case study. Finally, this example is discussed in the light of new theoretical and empirical findings.     

Die Wiederherstellung der Zeit in der ambulanten Psychotherapie mit Psychosekranken

In psychoanalytic psychotherapy with psychotic patients, a disturbance in time experience quite frequently turns out to be central to the psychotic experience as a whole. These patients experience disruptions in the flow of time that lead to a loss of temporal continuity. This loss of temporal structures causes damage in thinking functions: Relations like causality, finality and others which imply a temporal dimension, cannot be established any more. Parts of treatment histories serve to demonstrate the reconstruction of temporal continuity by the patient in psychotherapy. Object-relation-theory and Piaget’s experimental psychology provide the frame of reference for the understandig of the mental processes involved. At the beginning of the psychotherapy the patient experiences being together with the therapist and being separated from him as two discrete conditions of existing which have no links. The periodical reappearance of being together in combination with the awareness of the therapist’s continuous ongoing care encourages the patient to remember and to envisage the meetings with the therapist. The reliability of the alternation seems to stimulate a specific mental activity which creates connections allowing for transitions between the different conditions — in the sense of Winnicott’s transitional phenomena. Transitional phenomena which sometimes are quite concrete things bridge the gap between presence and future. Narrating serves as a link to the past. Through these creative ego-activities temporal continuity is regained providing the basis for strucured thinking and — very important — for the perception of one’s own personality and its continuity over time, thus generating a sense of identity. This process of reconstructing time is interesting in itself, because it sheds light on the psychodynamics of the restitutional processes after a psychotic illness. Moreover, it allows for hypotheses about the development of the inner time dimension in early childhood.     

Aktuelle Entwicklungen der psychodynamischen Psychotherapieforschung

The effectiveness of psychodynamic psychotherapy has been a “hot topic” in scientific and healthcare related debates in recent years. During this time a significant amount of new evidence supporting the effectiveness of psychodynamic psychotherapy has been published. The paper provides an overview on current psychodynamic psychotherapy research, with a focus on meta-analytic findings and randomized effectiveness trials. The results in the literature show robust evidence for the effectiveness of psychodynamic therapies for a wide range of psychiatric disorders. The methodological quality of current studies is good and comparative trials with other forms of psychotherapy yield mostly equivalent results. However, further studies are needed with regard to different mental disorders as well as effectiveness studies in everyday practice.     

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.     

Hausaufgaben in der Psychotherapie

Homework assignments are part of many treatment manuals for behaviour therapy. Their effectiveness for treatment success has now been shown. Far less is known about their implementation in everyday clinical practice. To offer topical data concerning the utilization of homework and the attitude towards it, we explored a sample of 140 therapists with different theoretical background and with varying degrees of therapeutic experience. Most of the participants frequently used homework assignments. Behaviour therapists use homework significantly more often than analytical therapists and have a more positive attitude towards them. Interestingly, the degree of experience had no influence on utilization of homework. Nearly all participants are familiar with the problem of unaccomplished assignments. Future directions for research und postgraduate courses are outlined.     

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.     

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.     

Exposition und Psychoedukation in der psychodynamischen Therapie

Psychotherapy is a complex process of understanding and action. In order to adequately realize this, reference to only a single therapy school or monotheoretical reference framework would be insufficient, but an appropriate reduction in complexity cannot be dispensed with. A psychotherapy process is composed of a large number of multifaceted elements: image of humanity and value orientation, personality variables of patients and therapists, relationship parameters, diagnostic categories with a spectrum of disorders and disorder symptoms, indications, approach or disorder-specific techniques and therapeutic competence. Other factors including context of life, time windows and frequency also determine the individual therapy process. The logic of the therapeutic understanding and action should be governed a far as possible by a process and patient-related and/or disorder-specific theory and should bind both together in a meaningful way.     

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.