Ambulante Psychotherapie bei Kindern und Jugendlichen

This paper presents the results of a study of the state of outpatient psychotherapy of children and juveniles in Germany after the PTG came into force. A total of 180 psychotherapists were questioned on certain issues. One result was that patients have to wait 4.5 months for psychotherapy and that every second patient asking for a diagnostic interview and possible treatment was refused.Of those who were given a diagnostic interview 43% were not taken into treatment, although disturbances were diagnosed such as addiction, bodily disabilities with psychic complications, enuresis/encopresis, anorexia nervosa, psychosomatic illnesses, developmental arrests which would normally demand psychotherapeutic treatment. Furthermore only 25% of those children and juveniles who Löcherbach et al. (2000, S.59 f.) considered needing and wanting psychotherapeutic treatment were actually in a G IV psychotherapy.Apart from this the possibility of getting psychotherapy as well as the kind of psychotherapy proved to be dependent on the kind of medical insurance. Differing payments by the insurance companies caused longer waiting times for patients and determined the choice of psychotherapy by the psychotherapists.     

Psychotherapeutische Behandlung von depressiven Kindern und Jugendlichen

Background

Depression is a psychiatric disorder with debilitating symptoms (e.g. suicidal behavior) with a high prevalence rate even in children and adolescents and the disorder shows a chronic course in many cases. According to psychiatric guidelines, cognitive behavioral therapy and interpersonal therapy are the psychotherapeutic methods of choice.

Aim

This article gives an overview of the current studies on cognitive behavioral and interpersonal group therapy programs for the treatment of depression in children and adolescents as well as a short illustration of the most prevalent therapy programs.

Material and methods

A literature research (PsycInfo, Psyndex, Pubmed) revealed 280 hits. After a review of all titles and abstracts 25 studies were included in this study.

Results

Efficacy studies mainly exist for cognitive behavioral group therapy programs (effect sizes ranged from 0.02 to 1.34) from English-speaking countries. There are only a few German programs available. With respect to interpersonal group therapies there are only few articles published in English and to the best of our knowledge none in German.

Conclusion

There is a great need for further studies that investigate the efficacy of group therapies for the treatment of depression in children and adolescents especially in German-speaking countries.     

Die Entwicklung des moralischen und rechtlichen Bewusstseins von Kindern und Jugendlichen.

First, Piaget’s and Kohlberg’s models of moral development are briefly sketched and some objections rose. Then the cognitive dimension of the development of moral and legal understanding in childhood and adolescence is described. This involves knowledge of moral rules, an understanding of the categorical ought, cognizance of the prima facie validity of moral rules and specific knowlegde systems guiding contextualized rule applications. Data show that all children quite early acquire an adequate basic understanding of moral rules and legal concepts. Several learning mechanisms are at work – sociocognitive development, processes of implicit rule reconstruction, acquisition of knowlegde systems. The following part focusses on moral motivation - its strength and the types of concerns motivating conformity. Moral motivation develops in a second, delayed, differential learning process which only on average shows a steady continuous increase. Individual trajectories often display losses attributable to sociocultural influences.     

Systemische Therapien bei Menschen mit psychotischen Verhaltens- und Erlebnisweisen

Systemic therapy for persons who have been diagnosed as having schizophrenic or schizoaffective psychosis has been practiced since the 1950s, not everywhere and routinely but in many psychiatric hospitals and outpatient clinics with a strong psychosocial orientation. Evidence of the effectiveness is well documented in randomized controlled studies. This article describes three systemic approaches in which the authors are actively involved: (1) systemic constructivist family therapy developed in Heidelberg for outpatient contexts, (2) need-adapted treatment and open dialogue developed in northern Europe that has gained access to psychiatric clinics through regional training within integrated care projects and (3) the concept of systemic therapeutic methods of acute psychiatric treatment (SYMPA) a systemic family-oriented inpatient treatment.     

Systemische Familien- und Spieltherapie im Krankenhaus

Studies on children after pediatric liver transplantation have shown that patients are confronted with various psychosocial problems due to the illness and long hospitalization. They do not have suitable coping strategies available to handle this situation. A concept of systemic family therapy and play therapy for children in hospital was thus developed. The patients and their families are accompanied during hospitalization, are supported preventively and are helped in developing suitable strategies for coping with the psychosocial stress.     

Cannabiskonsum und -missbrauch bei Jugendlichen und jungen Erwachsenen

After a long time of growth current studies on representative samples of adolescents indicate that the number of adolescent cannabis users in Germany is possibly decreasing. However, it may be presumptuous to expect a similar trend concerning the number of clients with cannabis-related disorders. Even if there is in fact a downward trend which is not yet proven, the rapidly growing number of clients presenting with these disorders in recent years cannot be explained by a similar growth in the number of regular cannabis users. Treatment centres should therefore expect a further inreasing number of especially male adolescents and young adults seeking help for problems related to cannabis use. The development, evaluation and implementation of specific treatment options concerning cannabis use disorders will be increasingly needed in the future. Cognitive-behavioral and motivational interventions have been shown to be evidence-based treatments. The paper describes some promising or already successful treatment approaches and related research projects in Germany.     

Therapie und Theater

Theatre experience serve in drama therapies only as a background for a better understanding of the patients problems, whereas the dialogue between therapy and theatre contributes to the understanding of the process of therapy itself and the secrets of it’s effect. As the actor creates an “empty space” to express himself, so tries a therapist to eliminate all obstructions of understanding. Both dedicate their whole personality to the author respectively to the patient, which requires an enormous amount of humility and responsibility and can be achieved only by a continuous argument with himself. The closeness of profession and personal life is therefore unavoidable, which means various possibilities and impulses but great dangers as well. Therapy and theatre are not to compare with any other interpersonal relationship, for they are trying to achieve changes in the way of feeling, thinking and acting. Whether, on this way, the therapist’s and actor’s real emotional expression is more important than the rational analysis of all emotions or not, is a question often discussed controversially. Just like in a child’s play, it is always about the argument between fantasy and reality and, therefore, about the stimulation and development of the audience’s and the patient’s creativity. Therefore it is of greatest importance for the therapy as for the theatre that the process is immediate, vivid and unforeseen. They are paths towards life, experiencing their purpose and limits through this task.     

Die Krankheitslehre der Psychoanalyse. Allgemeine und spezielle psychoanalytische Theorie der Neurosen, Psychosen und psychosomatischen Erkrankungen bei Erwachsenen, Kindern und Jugendlichen, 6. Aufl. Herausgegeben von Helmut Hinz

Ohne Zusammenfassung     

Ein Kontrollzwang und seine Therapie

Das folgende nachempfundene Erlebnisprotokoll zeigt einen kurzen Ausschnitt aus dem Leidensweg einer Patientin mit Kontrollzw?ngen. Es handelt sich dabei um eine schwere St?rung, welche die Lebensqualit?t der Betroffenen stark beeintr?chtigen kann. In einem solchen Fall ist eine Psychotherapie unerl?sslich. Die Methode der Wahl ist dabei die Verhaltenstherapie.