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.     

Integrative Therapie von narzisstisch gestörten Patienten

The psychotherapy of patients with a narcissistic personality disorder continues to be a psychotherapeutic challenge. There is still no psychotherapeutic program for the treatment of these patients which integrates different psychotherapeutic methods and strategies. Therefore the therapy of narcissistic patients remains difficult and only few psychotherapists voluntarily meet the challenge of treating such patients. In this article an integrative psychotherapeutic concept for the treatment of narcissistic patients using psychotherapeutic methods of different psychotherapeutic schools is presented. This integrative concept includes basic strategies such as working with the therapeutic alliance, schema work and activation of resources. On the other hand specific modules for different core symptoms of these patients are proposed. With this article the authors hope to contribute to a new conceptualization of the psychotherapy of narcissistic patients.     

Opfer-überzeugungen

The public interest in ??new?? clinical symptoms is described exemplified by burnout, mobbing and trauma. In the background self-explanations by patients as well as interests of therapists can be recognized. Both can be understood as an expression of subconsciously reflected contemporary convictions. Post-traumatic stress syndrome and the sequelae of abuse, which are probably diagnosed too often in guideline correct psychotherapy, throw up questions on the appropriate therapy and possible injurious side effects. The social background to the psychotherapeutic fascination with trauma will be discussed.     

Die Therapie-Vorbereitungsgruppe

There are different kinds of pretraining for psychotherapeutic treatment. They have two objectives: to get future patients in the right frame of mind for the imminent psychotherapy by informing them about the treatment, and to support therapists while clarifying the indication and selecting patients. Pretherapy training for group psychotherapy is frequently offered in Anglo-American countries. So far empirical studies have only partly been able to prove the supposed positive effects of pretraining on process and outcome of psychotherapy treatment, particularly as the studies showed profound flaws with regard to methods and pretraining concepts. The “Therapie-Vorbereitungsgruppe” presented here is a pretherapy training group in the run-up to inpatient group psychotherapy at a German university clinic. In Germany, such groups are rarely offered. The “Therapie-Vorbereitungsgruppe” consists of weekly meetings of therapists of a psychotherapeutic ward and applicants for inpatient treatment. Ward members introduce the applicants into the concept of treatment and the treatment setting and they explore the psychological background of each of the applicants. Besides economical the concept has clinical and therapeutic advantages. Future inpatients get a realistic view of the treatment, they can build up a relationship to other inpatients and to therapists, and besides waiting for the admission to the clinic is made more bearable. Therapists are helped with their decision on the admission. The concept has proved itself in clinical practice for many years. The empirical proof of its effectiveness and a comparison with other, similar concepts fall due.     

The Effectiveness of Brief Versus Intermediate Duration Psychodynamic Psychotherapy in the Treatment of Adjustment Disorder

Treatment studies and particularly psychotherapeutic treatment studies of patients suffering from an adjustment disorder are very scarce, leading to insufficient evidence regarding the efficacy of treatment in this population. Whereas timely psychotherapy is known to be of benefit in the treatment of adjustment disorders, the ideal duration of psychotherapeutic interventions is not known. This study examined whether a brief 12-session focused psychodynamic psychotherapy may be as efficient as a longer intermediate-term (1?year) psychodynamic psychotherapy in treating patients suffering from an adjustment disorder. Subjects (n?=?66) were randomly assigned to either brief or intermediate psychotherapy. They were assessed by self-report measures and clinician’s evaluation at baseline, end of therapy, and 9?months after therapy was terminated. The results showed a good overall improvement in the whole group. Furthermore, brief psychotherapy was found to be as good as intermediate psychotherapy both at the end of treatment and at follow-up. Although our study was not designed to confirm the efficacy of dynamic psychotherapy in the treatment of adjustment disorders, our results suggest that brief interventions may be good enough in adjustment disorder, thus allowing treatment of a greater number of patients without compromising for the quality and suitability of treatment.     

Value for money?: Issues of fees in counselling and psychotherapy

Drawing on literature from different psychotherapeutic traditions, the meaning of money is reviewed, and the psychological and practical issues which arise from the setting, changing and payment of fees in counselling and psychotherapy are discussed. A person-centred approach is offered as a framework for the counsellor's understanding of fees in the therapeutic relationship.     

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.     

Direktausbildung Psychotherapie an der medizinischen Fakultät

Background

There is ongoing political discussion at the Federal Ministry of Health that a university entrance diploma should allow psychotherapy to be studied directly: Graduation leads to a licensure that qualifies for further specialization, e.g. in cognitive behavioral therapy (CBT) or psychodynamic psychotherapy analog to medical specialization. As psychotherapy has its roots in both psychology and in medicine, the question is raised which faculty should be the future home of direct psychotherapy schools.

Material and methods

A theoretical model curriculum of psychosomatic psychotherapy is proposed. Its structure which is oriented to the established structure of medical training and its contents are described. It is argued that the proposed model in the tradition of psychosomatic medicine is suitable to meet ongoing changes in the structure of psychotherapeutic care due to new challenges in the field of public health.

Conclusion

The study of psychotherapy should be associated with chairs in clinical psychology and psychosomatic medicine in order to maintain and further develop the variety and quality which psychotherapy has gained in Germany.     

Kunsttherapie

Art therapy uses all kinds of art media for psychotherapeutic purposes, such as painting, drawing, moulding, constructing, sculpturing and building. Therapeutically driven art therapies are aimed at the enhancement of personal resources, motivational and intentional improvement, coping and more adaptive interpersonal functioning. Every psychotherapeutic and psychiatric setting can integrate art therapy, and its use in different types of mental disorder has been extensively described. Neurobiological aspects of creativity and effects of the therapeutic relationship are discussed as being involved in the effectiveness of art therapy. There is growing evidence for its effectiveness. Art therapy can contribute to diagnostic and therapeutic procedures. A comprehensive table of art therapy interventions which can be applied within a psychotherapeutic setting is presented.     

Single session and walk‐in psychotherapy: A descriptive account of the literature

Over the last several decades single session psychotherapy has become a mainstream psychotherapeutic approach. A steadily increasing demand for psychotherapeutic services and a continuous reduction in mental health care resources worldwide are both largely responsible for this development. This paper describes single session psychotherapy and provides a brief review of the relevant literature. Single session psychotherapy delivered in walk‐in settings is also discussed. Therapists who are unfamiliar with single session psychotherapy will find that this paper provides a concise introduction to the essential processes and outcomes of this psychotherapeutic approach.     

Musiktherapie bei Kindern mit Migräne

Migraine in childhood is a serious health problem with a tendency for chronification. According to the bio-psycho-social model migraine is considered as a disorder generated by multiple factors and requiring an interdisciplinary treatment concept consisting of both medical and psychotherapeutic interventions. Music therapy as a nonverbal, creative arts therapy is especially apt for the treatment of children. A specific treatment concept in music therapy for children with migraine, to be applied within a multidisciplinary framework, and its theoretical background are presented in this article. Music therapy is firmly established within the context of stationary infant psychiatric care. Also, it is presently used as a method of outpatient psychotherapy mainly for children and adolescents. Additionally, music therapy finds frequent use in medical care, special needs education and curative education for children. This article will be limited to the presentation of music therapy as artistic psychotherapy.     

The Future of Psychotherapy and the Expanding Universe or Michael J. Mahoney

Human Change Processes (Mahoney, 1991) is an attempt to set experiential psychotherapy on a scientific basis. The first tow-thirds of the book, based on an extensive survey of diverse scientific and scholarly literatures, argues fairly convincingly for a conception of human beings in which attachment, subjectivity, emergent and unconscious mental processes-especially regarding the self-and emotionality are central to human development and psychotherapeutic change. The book's last part, a discussion of experiential psychotherapy, based largely on clinical experience and intuition, is vague on important points of psychotherapeutic procedure ad process and is less convincing. The disjunction between the scientific discussion of psychology and the non-scientific discussion of psychotherapy is the book's major flaw. Nevertheless, the book is important as an attempt to synthesize a psychotherapy that is at once humanistic and scientifically informed.     

Development of anxiety arousal in group psychotherapy

37 patients taken from three psychotherapy groups had completed a course of communication training as preparation for dynamic group psychotherapy. Two anxiety tests were performed at different times before, during and after the therapy. After completion of the communication training, the anxiety diminished as a result of general factors that had come into effect. After completion of the dynamic group psychotherapy they diminished owing to a genuine improvement in social competence. The different modes of action of two psychotherapeutic methods are clearly shown.     

Halachic Judaism's Influence on the Practice of Psychotherapy

This paper enumerates and discusses some halachic principles and values which are exerting increasing influence on the practice of psychotherapy. This trend is linked to the resurgence of spiritual values and content in mainstream psychology and therapy, and to the changing concepts of the philosophy of science. The cultural roots of psychotherapy, specifically the contrast between the Greek and Jewish approaches to freedom are also briefly analyzed. The Jewish stand is viewed as imposing a set of values which has as its core enormous respect for the person and his/her ability to choose. Another factor regarded as pivotal is that Jewish teachings foster esteem for objectivity as opposed to the rampant subjectivity seen in some contemporary psychotherapeutic methods. An additional factor discussed is the relation of character traits to therapy. Finally, some facets of the unconscious are analyzed as to their relation to psychotherapy and Judaism.     

Die DPG-Praxis-Studie

All psychotherapeutic methods must be scientifically evaluated. Empirical evaluation of evidence is a prerequisite for acceptance as scientific psychotherapy as well as for payment by health insurance. Currently the psychotherapy methods accepted within the German health system (behavioural therapy, psychodynamic psychotherapy, and analytic psychotherapy) are reviewed by a governmental evaluation committee concerning evidence, necessity and cost-effectiveness. The DPG practice study has basically two aims: 1) to conduct a large naturalistic study to investigate effectiveness, sustainability and economic aspects of psychodynamic and analytic psychotherapy and 2) to offer a framework for psychoanalytic institutes, members, candidates or groups to realize own research ideas by collecting additional data within the study. The present article describes the background, main research questions, structure and design of the DPG practice study with regard to the evaluation questions.     

Effectiveness of Psychodynamic Treatment in Patients with Borderline Personality Disorder

There is some evidence that the efficacy of four types of psychotherapeutic psychotherapy (mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy), is superior to treatment-as-usual. More controlled and randomized studies are needed in order a) to confirm the results of the relatively few investigations that were available, b) to examine the therapeutic relevance and usefulness of correlates and predictors of improvement and remission in borderline patients, and c) to examine possible fruitful combinations with other types of treatment.     

Die Bindungstheorie und ihre Relevanz für die Psychotherapie

Ten years ago, two reviews of clinical attachment research were published in this journal (Schmidt and Strauß 1996; Strauß and Schmidt 1997) dealing with the question whether this theory might be of relevance for psychotherapy. Since that time, numerous theoretical and empirical papers related to this issue have been published, thus, justifying an update. The prediction that attachment theory would gain importance within psychotherapy and psychosomatics has been clearly confirmed. Elements of attachment theory have been incorporated into non-specific and specific psychotherapeutic approaches. Recently, also including neurobiological evidence, clinical attachment research continues to deal with the question whether clinical diagnoses or constructs can be differentiated on the basis of attachment characteristics. Related to this question, problems in assessing attachment characteristics are still of relevance. Within psychotherapy research, attachment-related characteristics are primarily investigated in relation to a) their value to predict treatment outcome, b) their significance for the psychotherapeutic process and c) their change during treatment.     

Entwicklungstendenzen psychotherapeutischer Praxis und Forschung

This review presents an analysis of articles in the journal “Psychotherapeut” during the years 2000 and 2001 with the focus on new efforts in the field of psychotherapeutic practice and research. The main topics of the journal are the presentation of new therapeutic approaches, some of them integrating different theoretical orientations, and the emphasis on the therapeutic relationship as a specific contribution to the process and the results of psychotherapy. In addition, this article presents a survey of the various subjects in psychotherapeutic research including a) the application and testing of new questionnaires to measure the effectiveness and the process of psychotherapy and b) research in the epidemiology of selected forms of stress, their consequences and lasting effects.