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.     

Kombination von Settings und Verfahren in der Psychotherapie

Literature research and own clinical experiences confirm the significance of a combined use of settings and methods in the area of inpatient and outpatient psychotherapy. For inpatient treatment, the combined use of methods, such as individual psychotherapy, group therapy, creative therapies, and sport, are an essential part of the treatment. In outpatient treatment, the regulations of the German insurance do not permit such combinations. Nevertheless, they occur and are often proactively initiated by the patients. The various combined use of psychotherapy and psychotropics is very well studied, but also the combination of settings, i.e. supplementary inpatient treatment, day treatment, and outpatient treatment have to be considered. While administering their therapies, psychotherapists should keep in mind possibly concurrently ongoing treatments as well as former therapies and their effects on the patients. With the exception of combinations with psychotropic treatment, there exist almost no empirical data in this important field.     

Psychotherapie von Suchterkrankungen

Zusammenfassung Im ersten Teil dieser übersicht wurden m?gliche Bedenken hinsichtlich der Psychotherapie Suchtkranker diskutiert. Der Weg von der Diagnostik zur Motivationstherapie wurde beschrieben. In diesem zweiten Teil werden zun?chst einige ausgew?hlte Beitr?ge verschiedener Psychotherapierichtungen zur Suchtkrankenbehandlung vorgestellt. Es wird deutlich, dass die deskriptive Diagnostik zur Interventionsplanung um eine weitergehende „Feindiagnostik” erg?nzt werden muss, die von dem gew?hlten psychotherapeutischen Ansatz abh?ngt, da es eine einheitliche Suchtpers?nlichkeit nicht gibt. Vor diesem Hintergrund werden – nach einer einführenden übersicht – die psychoanalytisch-tiefenpsychologischen Konzepte und Therapiemodelle für Suchtkranke sowie die kognitiv-verhaltenstherapeutischen Ans?tze unter Berücksichtigung spezifischer Rückfallpr?ventionstrainings vorgestellt. Abschlie?end wird auf allgemeine und spezifische Wirkfaktoren und empirische Wirksamkeitsnachweise der Psychotherapie von Suchterkrankungen eingegangen.      

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.      

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 und Internet

Zusammenfassung  Die Außendarstellung im Internet ist wichtig und in der Zukunft unverzichtbar. Jedoch hat die Liberalisierung des Werberechts der freien Berufe keineswegs zur absoluten Schrankenlosigkeit geführt. Vielmehr sind die zu beachtenden Regeln auf verschiedene Gesetze und Rechtsgebiete verstreut, so dass ohne fachkundige Hilfe—etwa durch die Kammern oder durch juristische Beratung—die Selbstdarstellung im Internet schnell zu einem bösen Erwachen führen kann.

Emotion und Psychotherapie

Considering the fact that all psychic disturbances are emotional disturbances as well, we develop based on our research on the modular structure of the emotional system a systematisation of the disturbance-specific concatenation of these modules within the patient’s social relationships. Subsequently, we discuss treatment possibilities and contraindications for each clinical empirically validated constellation. We describe a fundamental mechanism of affect induction keeping the disturbances alive and transporting them to the next generation. We conclude in stating that treatment recommendations focusing on a standard algorithm of handling the emotions system fail because there is no general indication for such enterprises.     

Psychotherapie und Internet

The Internet plays an important role in healthcare. Approximately two thirds of Internet users search the medium for, e.g. personal questions of health, including aspects of mental health. In countless discussion forums or blogs mentally stressed people discuss their problems and search for contact to other affected individuals but also to professional helpers. In this article an attempt is made to systematize the interface between Internet and psychotherapy in the narrower and broader sense. In particular five topics and problem areas will be dealt with: (1) as information medium Internet delivers an immense number of resources on mental disorders, which raises the problem of quality assurance. (2) As a communication medium it can provide support for therapeutic interventions. Psychological online counseling has now been proven to be effective. (3) Internet alters the traditional therapeutic relationship in one way or another. In particular e-mail communications supplement a face-to-face treatment. (4) Use of the Internet also brings along clinically relevant problems and because of this patients visit psychotherapeutic practices increasingly more often. (5) Internet can be fruitful for psychotherapy research.     

Supervision von Psychotherapie

Zusammenfassung Modelle, Varianten und Methoden der Supervision von Psychotherapie werden vor dem Hintergrund eines sich ?ndernden Supervisionsverst?ndnisses dargestellt. Es wird aufgezeigt, worin diese Ver?nderungen bestehen, auf welche empirische Basis sich die Behauptung von der qualit?tssichernden Funktion der Supervision stützt, und was unternommen wird, um die Qualit?t der Supervision selbst zu sichern.      

Neurowissenschaften und Psychotherapie

The rapid development of the cognitive neurosciences is based on interdisciplinary efforts and on a broad repertoire of research methods ranging from molecular biological to functional neuroimaging procedures suitable for the study of complex, ongoing intrapsychic processes. Selected recent results that are relevant for psychotherapy are discussed. They are based on genetics, on animal studies about the impact of early relational experience on brain development, further on memory research, on functional neuroimaging (PET, fMRI), and on first studies about the impact of psychotherapy on the brain. Neuroscience studies confirm some major psychoanalytic hypotheses (crucial role of early experience, unconscious processing) and question others (e. g. structural models). They help to overcome the split between “somatic” and “psychological” theories and treatments and open new, interdisciplinary research perspectives for psychotherapy.     

Onlineberatung und internetbasierte Psychotherapie

The internet has established itself as an everyday medium of communication, whereby patterns for the use of information and services relevant to health can be documented. Therefore also allowing questions regarding the possibilities and limit limitations of internet intervention in clinical psychology and psychotherapy to be also posed. Although specialist discourse is limited to conceptional analysis due to the lack of theoretical concepts and weak empirical data, there is a basis for the realization of a system of net-supported psychological advice and psychotherapy. Our present contribution has the goal of introducing some current exemplary concepts.Furthermore, effects on the therapeutic process and setting will be described and necessary quality criteria clarified.Finally, perspectives on counseling and therapy through the internet will be formulated.The authors conclude that online, counseling will take on an important function in the exchange of information and although useful in the initiation of therapy, will have to be considered separately from online therapy.Both methods – although instrumental in closing gaps within the socio-psychological care-system – can not substitute classical psychotherapy.