Psychotherapie zwischen Narrativ und Qualit?tssicherung

Two important books and a psychotherapeutic quality study published in 2011 serve as background for the examination of the polar conditions that determine psychotherapeutic work: the laws of the narrative, i.e. of relating, which provides the contents of the psychotherapeutic work and quality assurance as the canon of the scientific, politically correct and governmental controls of psychotherapeutic practice. The narrative is a composition formally characterized by a course scheme and in terms of contents as an enactment of the first person narrator and a narrated first person. Different from daydreams it seeks public attention and the listener in order to evoke concern and identification. It transports wishes, anxiety, fulfillment and catastrophes. The narrative is the phenomenology of speech logic and interpersonal coherence and can be linked to different theories, above all psychoanalytical ones. For psychotherapy it opens the world of the ??I??, with its conflicts, assessments and stabilizing efforts in the interpersonal context. Quality control is also a scientifically based steering of practical work which is increasingly being manifested in psychotherapy as well as in medicine and other areas of life. A study of the Techniker Krankenkasse (Technical Health Insurance) concluded in May 2011, confirms the uselessness of time-consuming and costly control procedures in psychotherapy and emphasizes the importance of good training and further education, for which the study has attested a high quality for Germany.     

Psychoanalytisch begründete Ans?tze in der forensischen Psychiatrie und Psychotherapie

After many years where manualized mainly behaviour treatments dominated in forensic settings, psychodynamic therapies are gaining acceptance and are performed and evaluated more and more in forensic hospitals and in prisons. This encompasses individual, couple, family and group therapies. Individual and group analysts are starting to perform these tasks again, mostly as workers in forensic settings but also as external therapists and supervisors. All staff members are important in creating a therapeutic community based on group analytic principles. They are therefore required to build up a therapeutic attitude supported by regular external case and team supervision. Delictogenic situations occur in everyday life as well as in professional settings and are analysed mainly in group therapies, considering situations of the past and the effect on other people. Modern manualized analytical concepts, such as transference-focussed psychotherapy (TFP) and mentalization-based therapy (MBT) depthen the quality of therapeutic work of all professionals in forensic settings. The multimorbid and sometimes dangerous patients require good ethical and professional attitudes. The psychoanalytic concepts of defence and resistance, transference and countertransference are essential parts of changing internalization and corrective emotional experience, important parts of useful forensic treatments.     

Patientensicht zur Qualität in der Psychotherapie

Concerning the discussion about the quality of psychotherapy, the different perspectives in the definition of quality are rarely considered. Especially the patients’ perspective is barely respected although quality assurance of psychotherapy should be for their benefit. Patients were interviewed (n=8) to answer the question which criteria of quality are relevant in their view. Using the grounded theory a variety of quality criteria was found. The interviewees emphasized the relationship between therapist and patient, the empathy of the therapist, the scheduling of appointments and the progress in therapy. The results suggest that when judging the quality of psychotherapy clients do not only focus on the outcome of psychotherapy, as presumed by some experts, but also on the dimensions structure and process. Professionals have to consider this fact when designing and applying methods of quality assurance.     

Zur Qualitätssicherung zivilrechtlicher Begutachtungen

Quality assurance in forensic psychiatry must take into account the different requirements for assessment in criminal, civil and social law. For civil law assessments the following measures are recommended: a reading list of articles reflecting the expert consensus, guidelines, a list of approved expert supervisors, an exemplary curriculum, modification of the present certificatation by the German Society for Psychiatry and Psychotherapy, Psychosomatic and Neurology (DGPPN) with more emphasis on civil law and a continuous process of education and recertification. Besides an interdisciplinary statement defining minimum requirements for civil law assessments, measures for continuous quality improvement should also be established in cooperation with representatives of the judicature.     

Qualifizierung und Qualit?tskontrolle in der forensischen Psychiatrie

At the end of the last decade severely violent and sexual crimes by previously convicted persistent offenders initiated a discussion about the necessity of quality control in the forensic psychiatric practice in Switzerland. Subsequently, measures similar to those in Germany were adopted, e.g. the implementation of a specialisation in forensic psychiatry. In addition, they included the creation of commissions with the duty of evaluating the dangerousness of serious offenders, the implementation of a standardized and certificated postgraduate training in forensic psychiatry and guidelines for the qualification of forensic assessment experts and the quality of reports. The following article presents the implemented measures and discusses their possible consequences for the quality of forensic psychiatric work.     

Dokumentation auf einer Station für psychosomatische Medizin und Psychotherapie

The documentation system for a psychosomatic-psychotherapeutic ward must integrate and process medical and psychotherapeutic treatment in a way that allows, over and above transparence and completeness, the constructive use of the collected information. But how to describe the increasingly complex picture of the patient during a stay on the ward, and how to utilize it effectively for his treatment? The search for satisfying answers has led the Department of Psychosomatics and Psychotherapy of the Clinic of the University of Münster to develop a new documentation system that will meet such demands. The system is innovative in visualizing and using the progression of the different therapeutic offers, in addition to introducing a “synopsis” of the dysfunctional relationship patterns and the individual psychodynamic background, which permits a swift overview of a patient’s treatment during his whole stay. This allows optimization of the multimodal treatment concept.     

Qualitätssicherung bei der betreuungsrechtlichen Begutachtung

Quality assurance in the field of medico-legal assessment for civil courts has not developed as far as in other legal fields, especially in criminal law. This also applies to assessments in cases of guardianship and custody even though assessments for these cases are much more frequent than in other areas of law. Efforts to achieve quality assurance should rely on quality standards which have been developed both in criminal law and in social law. A large proportion of these standards are suitable for all expert assessments. In addition to the specific statutory requirements in the law on the procedure in family cases and in matters of voluntary jurisdiction (FamFG), the specifications of the particular jurisdiction and especially the needs of those assessed and the courts concerned with them have to be observed. Building on the already published proposals this article attempts to systematize procedures, drafting of the assessment and the written report so that the quality of the work of the expert can be checked by those concerned.     

Qualitätssicherung von Gerichtsgutachten im Familienrecht

In recent years many controversial verdicts and studies have brought discussions about the quality of expert opinions in family law into the focus of the media, political and expert public spheres. With the coalition contract, the ruling parties agreed on improving the quality of expert opinions, especially in the sector of family law, in collaboration with professional institutions. Representatives of the legal, psychological and medical associations, the Federal Bar Association and the Federal Chamber of Psychotherapists worked out guidelines for expert opinions in family law in cooperation with the Federal Ministry of Justice and Consumer Protection. The three main quality assurance aspects are scientifically founded procedures, transparency and traceability. These requirements are concretely illustrated in this article with recommendations concerning the procedure and composition of expert opinions.     

Qualifizierung und Qualitätskontrolle in der forensischen Psychiatrie – die aktuelle Situation in der Schweiz

The practice of civil expert opinions in Switzerland is in a period of upheaval due to fundamental alterations regarding the legal foundations which were implemented on 1 January 2013. The new civil code displaces the authority to order measures which restrict people’s liberty based on an endangerment to themselves or third parties from a lay institution to a newly created expert committee. Moreover, patient’s rights are greatly enhanced. The subsequent consequences for expert opinion activities are not yet appraisable. The development in the practice of insurance legal expert opinion is influenced by new legal measures which aim at reducing the growing number of new disability retirements most notably due to psychiatric disorders. In contrast to the civil area there are already clearly defined standards for the insurance legal area which were established by the Swiss Society of Psychiatry and Psychotherapy in 2012. The legal foundations as well as the practice of expert opinions in the context of the Swiss civil and insurance law are comparable with the German situation but there are still some important differences related to the content and terminology. This paper outlines the current situation and recent developments in Switzerland as well as pointing out differences in comparison to Germany.     

Qualit?tssicherung in der Glaubhaftigkeitsbeurteilung

This article analyzes various levels of the quality discussion that are relevant for credibility assessment. On the highest level, the German Federal Supreme Court's (BGH) leading decision on scientific standards for psychological credibility assessment in 1999 has been exceptionally influential. The particular impact of this decision is that it does not just list general demands or name which topics need to be addressed, but lays down specific methodological standards. This has countered a frequent error in the past: namely, that of treating probabilistic indicators as if they were nomological laws. On the concrete level, the instrument known as the critical appraisal of methods (methodenkritische Stellungnahme) has frequently been used to uncover the quality deficits in existing expert's reports. The article points out that although a critical appraisal of methods is also a scientific instrument that has to meet minimum quality standards, these standards have not always been met in practice. Nonetheless, the best outcome of a specification of quality standards is the application in practice of the current state of knowledge in a discipline. Therefore, it has to be stressed that a viable quality discussion depends crucially on the allocation of sufficient research resources to engage in the evaluation and further development of diagnostic strategies for single-case assessments.     

DRG-Vergütung und Kosten stationärer integrierter psychosomatischer Behandlung

Ohne ZusammenfassungDie Autoren M. Rose und R. Lohmann zeichnen für den Beitrag als gleichberechtigte Erstautoren.