Behandlungsmotivation und Indikation von Psychotherapie

Concepts and results of research into treatment motivation under psychotherapy are discussed with regard to the question whether decisions for indications on the basis of the motivational characteristics of patients are reasonable. Established concepts and broader theories of treatment motivation as well as diagnostic tools for the assessment are presented. Subsequently, empirical results for the effects of motivational factors on the maintenance and success of psychotherapy are briefly sketched. Approaches aimed at the enhancement of treatment motivation before and during psychotherapeutic processes are then illustrated. Finally, it is emphasized that, in turn, features of individual therapeutic processes may provide a basis for the indication of motivational enhancement interventions, thus supporting the notion of a dynamic nature of treatment motivation.     

Indikation zu Psychoanalyse und analytischer Psychotherapie

Based on the diagnostic process in the initial interview, which is an intersubjective encounter, the various developmental steps for establishment of the indications for psychoanalysis are presented. Freud and his followers, who were initially oriented to the psychiatric diagnosis, were later oriented to the criteria of approachability, analysability and in particular on the aptitude for psychoanalysis. The criterion of aptitude was not only elaborated from the perspective of Ego psychology but was also relevant for all high frequency non-terminated psychoanalyses which followed the basic psychoanalytical principles of “afocality”. This has so far characterized the standard procedure of all psychoanalytic schools. Due to the experiences of psychoanalysts with early disturbed, structurally Ego-disturbed neuroses and personality disorders, the extent of lability of the mental structure and by turning to countertransference analysis, the person of the psychoanalyst become more important for the assessment of the indications. In Germany the integration of psychotherapy, which is financially supported by healthcare insurance, ultimately leads to differential indication assessments between high frequency psychoanalysis or analytical psychotherapy, modified psychoanalytical psychotherapy and less frequent psychodynamic procedures.     

Indikation zur Gruppenpsychotherapie

Current scientific evidence on the criteria for indications for group psychotherapy is mainly based on clinical evidence or on expert assessments. Nevertheless, a wide range of inclusion and exclusion criteria have been described, which especially concern disorder and illness behavior-related features as well as emotional and interpersonal variables. The selection of patients for group treatment is just as important as their preparation with information material or pre-group training in order to reduce the comparatively high dropout rates.     

Gedanken zur Psychotherapie heute

Psychotherapie und Psychopharmakologie teilen das Anliegen, dem Menschen zu helfen und seine Integrit?t wieder herzustellen. Symptomreduktion ist die Grundlage zum Wiedererlangen einer angemessenen Lebensqualit?t, reicht aber als alleinige Ma?nahme oft nicht aus. W?hrend Psychopharmaka gezielt in der Hirntopographie und im Hirnstoffwechsel ansetzen, beeinflussen Gespr?che verschiedene Hirnregionen in integrierender Weise.     

Beratung in Abgrenzung zur Psychotherapie

There are many forms of verbal interaction between people as distinguished from professional interactions, such as patient guidance, counselling and specialized psychotherapy. Psychotherapy is the treatment of patients and illnesses which includes a special responsibility of the therapist for the well-being of the patient. Psychotherapists have to be specially licensed while counselling can be done by any person who has expert knowledge. The counsellor is only responsible for the correctness of the information provided, while the client is responsible for any consequences. There are also professional rules for good counselling in respect to the form of interaction, the clarification of goals, the method of providing information, strategy planning, clarification of options for action, support for decision making and necessary documentation. Counsellors have to be aware of possible problems, such as misunderstandings and aggravation of problems.     

Indikation zur ambulanten Nachsorge (Curriculum Hannover) in der Psychosomatischen Rehabilitation

Outpatient psychosomatic aftercare (Curriculum Hannover) was introduced nationwide in 2000 by the pension scheme. The effectiveness and efficacy of outpatient psychosomatic aftercare has been widely researched. This publication presents an indication-model based on four levels (capacity, participation, activity and impairment) whereas empirical results and clinical experience concerning participation in psychosomatic outpatient aftercare following an in-patient rehabilitation are considered in accordance with the international classification of functioning, disability and health.     

Forensische Psychotherapie

Ohne Zusammenfassung     

Ressourcenorientierte Psychotherapie

Resource orientation is a transdiagnostic and integrative approach. It is more than just a technique and corresponds closer to a therapeutic attitude. Disorder-specific models and resource orientation complement each other. Resource activation aims at the utilization of already existing resources to achieve the therapeutic targets. Resource orientation has many advantages: the working alliance is improved, the patient experiences positive emotions in therapy sessions, the expectations of self-efficacy and self-confidence are strengthened and problem solving is promoted. The article presents practically relevant tangible methods in terms of systematic resource diagnostics and helpful resource activating interventions. An appropriate balance between problem actualization and resource activation is necessary so that the patient does not get the impression that the individual suffering will be trivialized, negated or made taboo.     

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.      

Strukturbezogene Psychotherapie

Structure-oriented psychotherapy is a variant method of the psychodynamic therapeutic procedure concerned with the therapeutic encouragement of insufficiently available structural abilities of patients, in contrast to realization of conflicts. This form of psychotherapy is based on the definitions of Operationalized Psychodynamic Diagnostics (OPD) and the diagnostic and therapeutic studies carried out with this method in the comprehension of structural functions and levels. The therapeutic approach and the therapeutic attitude were formulated with respect to the developmental psychological aspects of early relationship disorders. The method is indicated where, for example in severe personality disorders the clinical picture is determined by the structural problems of self-regulation and relationship formation. In this case the patient should first be actively stabilized in order to then increasingly transfer responsibility for self-regulation and way of life and to work these out together. The individual stages of the therapeutic process and the special interventions against the background of a development promoting, parental-like therapeutic attitude will be described.     

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.     

Psychotherapie und Pharmakotherapie

Zusammenfassung Psychotherapie und Pharmakotherapie verk?rpern jeweils eigenst?ndige Zugangsweisen zu psychisch kranken Patienten. Eine Kombination in einem integrativen Behandlungsmodell tr?gt der multifaktoriellen ?tiopathogenese von psychischen St?rungen Rechnung. Sie verlangt eine besondere Beachtung der Psychologie der Medikamentenverschreibung und -einnahme. Bewu?te und unbewu?te Bedeutungen der Medikamente für und in der aktuellen psychotherapeutischen Beziehung sind grundlegend für eine sichere Pharmakotherapie. Sie vermitteln aber auch entscheidende übertragungs- und Gegenübertragungsmuster im psychotherapeutischen Proze?. Für diagnostisch definierte, nicht-psychotische St?rungen (depressive, Angst-, Zwangs- und Pers?nlichkeitsst?rungen) werden vorliegende empirische Studien zur Pharmako- und Psychotherapie referiert und im Hinblick auf eine Kombinationsbehandlung reflektiert.      

Psychotherapie auf Palliativstationen

Exemplary for psychotherapeutic activity in the ??sphere of death?? the article focuses on the present situation of psychotherapists working on palliative care units in Germany. For that a questionnaire has been developed which includes 17 items dealing with fields of concrete psychotherapeutic work, psychotherapy training, relations with teams and institutions, subjectively felt burden and contentment etc. The questionnaire was sent to most of the German palliative care infirmaries. There is a high presence of psychotherapists in these units who are well trained in different therapeutic methods, numerically led by behavior therapy and non-directive therapy. In addition most colleagues are qualified in psychooncology and specialized pain management. Surprisingly topics, such as death or spirituality are not so often found in therapeutic contacts as would be expected. Furthermore there is a rather negative outlook on the preparation for the palliative working field during psychotherapy training. This requires extensions and supplementary curricula concerning existential themes in psychotherapy. The psychotherapists feel well integrated in their therapeutic teams but many of them have a feeling of at best a mediocre appreciation in their institutions. In spite of the difficult and stressful work the general job satisfaction is stated as high to very high.     

Menschenbild und Psychotherapie

Images of humans provide preliminary answers to the question of what essentially constitutes their situation. In psychoanalytically based procedures images have appeared from time immemorial, which especially emphasize the animal impulses, the emotions, the interpersonal situation and in contrast, the self-reflecting subject, the capabilities for speech, communication and culture. In addition to this, in this discussion special attention is paid to the changing economic and technological circumstances, which displace humans into a novel living environment and could possibly bring about new forms of personality development with respect to the biological nature and also the sociocultural possibilities. As a consequence for psychotherapy, the consideration of these anthropological aspects is recommended beyond the processing of individual mental disorders.     

Psychotherapie mit Migranten

After an introduction and presentation of the influence of immigration on psychological health, the present overview focuses on several models of psychological development in immigration. Cross-cultural psychodynamics and culturally conditioned transference in ethnically mixed cultural psychotherapy settings are explored. The effectiveness of Western therapy methods based on Christian – Jewish values is discussed with regard to the therapy of patients from different ethnic backgrounds, i. e. so-called traditional societies. In Western cultures, proximity in object relations is based on autonomy whereas in traditional societies proximity is based on relatedness. Knowledge of specific cultural issues are considered to be an important instrument in cross-cultural therapies. Joining, activation of ethnic resources, and culture-sensitive interventions are considered to be helpful psychotherapeutic interventions. Specialized therapy settings, e.g. integration of ethnic therapists in established institutions, mono-cultural ethnic settings and collaborative projects are described. Last but not least, the authors point out the necessity of cross-cultural therapeutic competence because of an expanding cultural heterogeneity of society.