Die Psychotherapieausbildung aus Sicht der Lehrkräfte

Background

A survey was carried out to ask the trainers and supervisors about their appraisal of the quality of the psychotherapy training and about ways to improve it 10 years after the inception of the “German psychotherapy law”.

Methods

Training institutes provided e-mail addresses and other contact information from over 5,000 trainers. The questioning was carried out mainly by on-line questionnaires and 2,196 data sets were used for analysis.

Results

Trainers showed overall satisfaction with the components of psychotherapy training and the skills of the training candidates. More knowledge transfer in the fields of therapy techniques and case studies and more cooperation with other professional groups were suggested. Trainers acknowledged redundancies between professional training and university studies and observed a heterogeneity of trainees, however, these were mostly considered helpful. Only half of the trainers were subject to evaluation of their work.

Conclusions

The quality of psychotherapy training could be improved by stronger emphasis on practical knowledge. Structural changes should be made to take the problem of redundancies and heterogeneities into account. Regular and continuous evaluation of the training should become an integral part of professional training and the results should have consequences.     

Frühe Störungen aus der Sicht zunehmender Mentalisierung

The term “mentalization” describes the capacity to judge other humans in terms of their mental activities such as wishes, hopes, beliefs and intentions, as well as the ability to think about one’s own thinking. Mentalization and reflective function are equivalent to each other. They play an important role in selforganization, impulse control, and affect regulation. Mentalization develops during approximately the first five years of life on the basis of attachment in Bowlby’s sense. Around the 9th month of life the child begins to understand her mother as an intentional agent. Mirroring by the mother, in a way of reproducing the child’s state of mind but in a slightly different “marked” manner, enables the child to establish a second “objectified” representation of her condition besides her primary unreflected one. Consequences of lacking, unmarked, or distorted mirroring for later narcissistic or borderline personality are discussed. The child begins now thinking, i.e. playing with representations, but the state of brain development allows to conceive of only one reality. Internal world and external reality appear undistinguishably identical. This is called the “equivalence mode” of psychic functioning. As-if-games open, in a further developmental step, the possibility of including a second reality, namely a pretended one. This is called the “pretend mode” of psychic functioning. At age four to five the child has reached the capacity to take multiple realities into consideration, to take the perspective of an other and to decentrate. She now has a “theory of mind”. Patients with early disturbances have reached this stage only partially. They may also regress to one of the earlier modes of psychic functioning as a consequence of stress or trauma. The knowledge of these early mechanisms helps to identify and understand them when they appear in our clinical practice.     

Ost-West-Verhältnis

The first question a psychoanalyst has to examine in connection with this topic is, whether psychoanalytical concepts apply to sociological and political developments (problems) at all, and which ones, if they do. The most adequate theories seem to be the psychoanalytical developmental and the object relation theories, the regression model, first of all in its group dynamical version as described by Bion and later on by Heigl-Evers, and the psychoanalytic-anthropological socialization model of Erich Fromm. Following the way of the author’s work in Balint groups, he examined the conscious and unconscious interactions between East- and West-Germany’s societies. Moreover, the consequences of the unresolved humiliation because of the lost war (denazification in West-Germany) and the comparison of the post-communist development of Czechia with that of East-Germany served me as further background screens.     

Über das Spannungsverhältnis von Psychoanalyse und Berufspolitik

Taking the inherently conflicting relationship between psychoanalysis as a science of the unconscious and reality as her starting point the author describes the historically developed need of an extensive political commitment as a genuine task of the psychoanalyst to ensure the own group’s survival within health system in the long run. The author illustrates her argument by the numerous changes, which have been introduced into the field of professional and social law within in the last 12 years and affected clinical practice within the legal health insurance system as well as psychoanalytic training. She describes the area of tension in which politically committed psychoanalysts find themselves. These tensions are produced by a frequently met defence fuelled by anxieties and denial of the own colleagues against professional politics within psychoanalytic organisations and by various defences in extraanalytical professional politics. The author discusses ways of an individual, intrapsychical mastering both on part of colleagues committed to professional politics and of members of analytic organisations and describes ways of institutional dealing with these conflicts in psychoanalytic organisations and in the extraanalytical field of professional politics as a precondition of a more successful representation of the own group’s political interests. Finally she considers structural changes which are necessary if psychoanalysis is to succeed not only in the struggle about distribution of resources but also in the interdisciplinary scientific debate.     

Psychische Beschwerden und Störungen von Studierenden

Background

Psychological distress among students is receiving growing attention in the scientific community as well as in the general public. There are counseling services available in student societies and universities which address psychological distress among students but scientific research in this area is rudimentary and poorly represented.

Problem in question

In order to present the prevalence, extent and type of psychological disorders in students and the alterations over time, an investigation was carried out to show which psychological complaints and disorders were present in students who consulted a psychotherapeutic counseling center. These data were compared with the psychological complaints of a student field study population. Furthermore, alterations in the psychological complaints and disorders of students over periods of 10 and 15 years will be presented.

Methods

The prevalence and change over time of psychological syndromes in students were identified by a comparison between an unselected sample of counseling center clients and several student field samples from the previous 15 years. The type of distress and severity of symptoms were measured with a Symptom Checklist (SCL-90-R), the Psychosocial Complaints List (PSB), the Satisfaction With Life And Studies Scale (LSZ), the diagnostic assessment according to International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), the Complaints Severity Score (BSS) and Global Assessment of Functioning (GAF).

Results

Previous results of investigations which showed that 20–25% of students suffer from psychological disorders could be confirmed in this study. However, 60–65% of the clients of a counseling center suffered from clinically relevant psychological disorders, which is significantly higher. The most common disorders were depressive moods, lack of self-confidence and exam anxiety, which can mostly be diagnostically assigned to adjustment, depression and anxiety disorders. The comparison with previous studies showed that the types and severity of psychological distress among students have remained stable over the last 15 years, with the exception of test anxiety which increased by 51% from 1993 to 2008. With respect to alcohol abuse, considerably less impairments were found than had been assumed based on the earlier investigations.

Conclusions

Psychological complaints and disorders are frequently found among students and they cause individual suffering as well as economic expenses. Noticeable was the obvious increase in clinically relevant exam anxiety. Psychological-psychotherapeutic counseling centers make an important contribution to screening, clinical assessment, primary health care and prevention of severe mental disorders among students and have shown a continuously increasing number of cases in recent years. Further studies especially in a process-outcome design of the mostly eclectic counseling centers are needed and possibilities will be presented.     

Kindesmisshandlung – eine Übersicht aus rechtsmedizinischer Sicht

Medicolegal criteria have increasingly become the focus of attention in the assessment of child abuse cases. The principle of assessment is often to prove the plausibility of whether, for instance, the ascertained injuries are in accordance with the reported background information. A further aspect is to aid in clarifying differential diagnoses (e.g. skin diseases or congenital metabolic bone diseases). In cases of suspected sexual abuse a professional strategy is required with a suitable examination process and appropriate scrutiny of the results. Flawed or incorrect diagnoses (i.e. false positive or negative) in cases of suspected child abuse could have dramatic consequences for parents or guardians and the children; therefore, in the interests of the children it is absolutely necessary to have a good collaboration between all disciplines involved, including those inside and outside medical specialties.     

Das Leibgedächtnis. Ein Beitrag aus der Phänomenologie Husserls

Die Unterscheidung von verschiedenen Ged?chtnisformen und -systemen sowie die Beziehung zwischen Ged?chtnis und Leiblichkeit stehen sowohl im Fokus der kognitionswissenschaftlichen, als auch der ph?nomenologischen Debatte. In diesem Artikel wird versucht, beide Ans?tze zum Thema in einen Dialog zu bringen. Das Leibged?chtnis wird hier zun?chst ph?nomenologisch als der konkreteste Ausdruck des impliziten Ged?chtnisses bestimmt. Basierend auf Edmund Husserls Analysen zum Zeitbewusstsein und zur leiblichen Erfahrung werden folglich die Strukturen und die Dynamik des Leibged?chtnisses hervorgehoben. Dabei wird gezeigt, dass das Leibged?chtnis sowohl in den Wahrnehmungsprozessen als auch in der Gestaltung des pr?reflektiven leiblichen Selbstbewusstseins eine unentbehrliche Rolle spielt. Schlie?lich wird die Relevanz der durchgeführten ph?nomenologischen Analysen im Rahmen der aktuellen Debatte über Ged?chtnissysteme in den Kognitionswissenschaften diskutiert.     

Zur Qualit?t forensischer Gutachten aus strafrechtlicher Sicht

The paper describes the requirements, both regulatory and developed by court decisions that have to be fulfilled by expert witnesses in criminal cases. It emphasizes the borderline between (psycho) science and law, names sources of mistakes made by experts and the reasons and shows some results caused by bad expertise. A much better basic and advanced training of experts is demanded for experts as well as for judges, prosecutors and prison officers and calls for a new culture for a mutual exchange of dialogue.     

Zur Problematik der Suchtgefährdung von berufstätigen Medizinern

Two samples of working physicians have been compared in a cross-sectional study – one representative sample of addicted physicians with a substance abuse problem (n=142) and one representative sample (n=275) of physicians in general; the objective was to develop preventive strategies. As a measuring instrument a specific questionnaire on quality of life of physicians (Reimer and Jurkat) has been used. Generally, quality of life is lower in the substance abuse sample in comparison to the control group. It can be concluded that the variables concerning the areas life satisfaction/-dissatisfaction and health differentiate even more between the groups than the areas work satisfaction/-dissatisfaction and choice of occupation. Whereas quality of life of female physicians was on the average somewhat higher than that of their male colleagues in the control group, this could not be confirmed in the sample of impaired physicians. Especially the ability to relax seems to be essential as a preventive measure, and apparently it is of high importance for working physicians to care for an adequate and satisfying private life to balance their stressful working life.     

Zu den Voraussetzungen des § 3 JGG aus jugendpsychiatrischer Sicht

The capability to recognize illegality depends on developmental steps in the field of biological as well as psychological processes and, as far as the juridical text is concerned, bond to the notions as morality and intellectuality, judgement and the way of right acting. The awareness of being or becoming unlawful is depending on punishable offences as well as physiological and psychological developmental steps. The notions “sittliche und geistige Reife” and the overlapping field of responsibility and culpability are discussed.     

Individuelle Lernstrategien von Totenkopfäffchen bei der Diskriminierung von visuellen Sequenzen

Zusammenfassung Durch 5 Lehrprogramme wurden Totenkopfäffchen in einer instrumentellen Verhaltenssituation darauf trainiert, Sequenzen von zwei Lichtern (weiß und blau; A und B) voneinander zu unterscheiden. In Programm 5 wurden alle 4 Permutationen der Elemente A und B, also AB, BA, AA und BB als Lichtreize verwendet. Die Beantwortung von B in AB wurde belohnt.Die Analyse der Strategien der Tiere in Programm 5 ergab verschiedene Strategien für verschiedene Tiere bei der Konfrontation mit den verschiedenen Sequenzen trotz des gleichen Vortrainings der Tiere: Zufallsbeantwortung, Beantwortung des zweiten Lichtes der Sequenzen, Beantwortung von B in 2. Position, Beantwortung nach jedem Stimulus A und jedes Stimulus A in 1. Position.Von 7 Tieren erreichten 4 die für diese Diskriminierung notwendige Strategie Beantwortung von B nach Stimulus A.3 Tiere verbliehen bis zum Schluß in der Strategie Beantwortung nach einem Stimulus A in 1. Position, die eine Vorstufe der Sequenzendiskriminierung darstellt.Durch die durchgeführte Analyse ist auch eine Beurteilung von Beantwortungsschemata möglich, die noch keine Diskriminierung von Sequenzen darstellen und damit eine Beurteilung dessen ermöglicht, was einem Versuchttier von der dargebotenen Information relevant geworden ist. Das Verhaltensmodell ist entwickelt zur Verwendung bei verschiedenen Manipulationen im Zentralnervensystem (Ausschaltungen, Psychopharmaka), bei den Effekten in den zeitlichen Parametern des Lernprozesses zu erwarten sind oder beurteilt werden sollen.

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Individual learning strategies for discrimination between visual sequences in squirrel monkeys

Summary Squirrel monkeys were trained to discriminate between the four permutations of a two-element sequence of colored lights (white and blue, A-B). Five teaching programs were developed to direct the animals' activity in an instrumental behavioral situation. In Program 5 the animals were confronted with all possible sequences in randomized order and were only rewarded if they pressed a lever in the B-part of sequence AB.Analysis of the animals' strategies revealed different strategies in different animals when exposed to program 5, although the animals had undergone the same training previously: Random responding, responding to the second part of each sequence, responding to B in the second position of a sequence, responding after each stimulus A, and responding after each stimulus A in the first position of a sequence.Four out of 7 animals reached the necessary strategy for real discrimination of sequences, namely responding to B after a stimulus A.Three animals faited to advance beyond the strategy responding after a stimulus A in the first position of a sequence, which represents the closest strategy before real discrimination of the sequences.The analysis performed makes it possible to find out which cues the animals use in the performance of the task, even if the animal has not yet reached true discrimination between sequences.The experimental model has been developed for use as a sensitive instrument for the detection or assessment of changes in the temporal parameters of the learning process in experiments where manipulations of the central nervous system (lesions, drug) make such changes likely.

     

Empathie und Persönlichkeitsstörungen aus neurobiologischer Sicht

In contrast to the vague application of the term empathy in general usage, the neurobiological literature differentiates between cognitive empathy and emotional empathy. The former includes cognitive recognition of the mental state of someone else due to reflexive acquisition of perspectives and theory of mind functions, the latter includes the reflexive intuitive sympathy and sharing the emotions of others. Both independent from each other and interindividual differently expressed facets can be assigned to different brain networks which process these events. Early evolutionary processes of emotional empathy are already developed in infants by mirror image imitation of mimicry and gestures of the primary contact person. They involve premotor regions, areas of the sensomotor cortex, the inferior parietal lobule and the anterior insular regions. Phylogenetically younger processes of cognitive empathy are represented in particular in midline structures, such as the medial prefrontal cortex, superior temporal sulcus, posterior cingulum or precuneus as well as in the temporoparietal junction. They have their beginning in shared attention processes in early dyadic processes. Both facets of empathy are involved in moral decision-making processes. In this context, neurobiological studies show that psychopaths have undisturbed cognitive empathic capabilities and are principally able to recognize and apply moral values but confer little attentional importance to them when they compete with own targets. Individuals with borderline personality disorders in contrast to psychopaths show impairments in cognitive empathy. The deficits affect mentalization functions, which involve the understanding of the mental state of others and oneself and are also the starting point for many misunderstandings in an interpersonal context. Additionally, individuals with borderline personality disorder have a tendency to share emotions with other people. They therefore succeed in showing sympathy and compassion although associated with the danger of diffusion of self and third party borders.     

Zur Häufigkeit der Schuldfähigkeitsbegutachtung von Sexualstraftätern im Erkenntnisverfahren

This study investigated how often and depending on which factors sexual offenders are examined by mental health experts regarding their criminal responsibility. Out of a total of 306 legal charges against sex offenders accused of child sexual abuse (CSA: n?=?145), rape or sexual assault (n?=?89), exhibitionism (n?=?39), sexual abuse of adolescents, mentally defective, physically helpless or warded persons (n?=?18) that were admitted by a criminal court in 2001 in the German federal state of Schleswig-Holstein, 209 (95.6 %) were analyzed regarding the following questions: how often was the accused examined by a mental health professional regarding mental responsibility? Was the chance of being examined systematically related to certain factors (e.g., personality of the accused)? Expert advice regarding the mental responsibility of the accused was obtained by the court in only 34 cases (11.7 %). No systematic relationships of personal variables as well as the modus operandi and the chance of commissioning a mental health expert were found. The main reason for assigning a forensic expert opinion was the vague impression of a psychic disorder. Re-offending increased the rate of a mental health examination only in CSA (34.6 % of re-offenders were examined compared to 9.2 % of first-time offenders), but not in rape or sexual assault. Also age does not predict the commissioning of an expert opinion. Only one fifth of all accused below the age of 21 were investigated by a mental health professional. Results are discussed in terms of legal background, consequences for risk assessment and relapse prevention.     

„Krise der Medizin“ – Modelle der Reform

In the 1920s and early 1930s there was a heated debate about the importance of the natural sciences for medicine. Prominent physicians, such as Ferdinand Sauerbruch and Wilhelm His in Germany or Richard Cabot and Charles-Edward Amory Winslow in the USA criticized clinical practices, medical education and research for placing too much focus on the natural sciences and the somatic correlates of human disease and for neglecting the psychological and social dimensions. In spite of a similar diagnosis of the problem, the consequences drawn differed considerably between the German and US contexts: in Germany first steps towards the institutionalization of the new field of psychotherapy and psychosomatic medicine and, in parallel, a consolidation of previously existing approaches of complementary medicine were developed, whereas in the USA the discussions led to the introduction and strengthening of social sciences in medicine, particularly in the field of public health. This article reconstructs the historical debate as well as the proposed models of reform and discusses potential implications for present-day medicine.     

Eine informationstheoretische Methode zur Bestimmung der ästhetischen Wirkung von Flächenmustern

Zusammenfassung In dieser Arbeit entwickeln wir eine Form der informationsanalytischen Charakterisierung von Flächenmustern, welche es ermöglicht, schön wirkende von häßlich wirkenden Mustern zu trennen. Wir betrachten ein Flächenmuster als eine Menge von Rasterpunkten. Jeder Rasterpunkt kann hinsichtlich der drei Variablen horizontale Lage, vertikale Lage und Farbton kategorisiert werden. Wir charakterisieren durch eine multivariate Informationsanalyse die statistischen Beziehungen zwischen den genannten Variablen mit zwei Kennwerten. Diese Kennwerte sind die Interaktion zwischen den drei Variablen und ein Balancekoeffizient für die Variablen horizontale und vertikale Lage. Hinsichtlich dieser beiden Kennwerte unterscheiden sich Muster, die von Vpn als schön empfunden werden von solchen, die als häßlich empfunden werden. Schöne Muster haben signifikant höhere Interaktionen und signifikant niedrigere Balancekoeffizienten als häßliche. Hinsichtlich beider Parameter streuen schöne Muster signifikant weniger als häßliche.

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An information analytic method to estimate the esthetical effect of pictures

Summary In this paper we show, that multivariate information analysis can be used to separate pictures regarded as nice from pictures regarded as ugly. A picture may be considered as a set of pictureelements. Each pictureelement can be classified with regard to three variables, namely vertical position, horizontal position and colour tone. We characterize the statistical relations between these variables by multivariate information analysis which results in two parameters. These parameters are the interaction between the variables and a balance coefficient for the variables vertical- und horizontal-position. In respect of these parameters pictures, which are regarded as nice by human subjects are separable from ugly pictures. Nice pictures show significantly higher interactions and lower balance coefficients than ugly ones. The dispersion of interactions and balance coefficients is lower at nice pictures.