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.     

Neurodynamics inside therapeutic interaction: a case study with simultaneous EEG recording / La neurodinámica en el contexto de la interacción terapéutica: un estudio de caso con una grabación simultánea de EEG

Recent research on processes of psychotherapy has focused on the study of patient-therapist regulation. Evidence concerning verbal and nonverbal coordination as predictors of therapeutic alliance and outcome in psychotherapy has been cumulating. These, along with others results in the field of social neuroscience, suggest that behavioural coordination may have neurophysiological correlates, which play a role in the regulatory process in psychotherapy. Here we introduce an observational paradigm and analytic method to assess the joint neurodynamic activity of patient and therapist. Additionally we report results from ongoing psychotherapy sessions. Our work highlights the involvement of brain activity in the psychotherapeutic process and provides novel insights on how psychotherapy works, in order to further the understanding of the embodied characteristic of the therapeutic interaction.     

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.     

Researching the “therapeutic relationship” in psychoanalysis,counselling psychology and psychotherapy—a qualitative inquiry

This paper reports the methodology of a research project based on and including a review of almost 1000 texts and more than 20 years of learning and supervised practice as clinician and supervisor in the psychotherapeutic professions on the nature of the therapeutic relationship. Following a pilot study by five years, the findings were reported in a 165,000 word document which encompasses poetry, personal experience, many textual extracts of theory or therapeutic dialogue, other research reports, theoretical considerations, clinical reflections, syllabus constructions—a postmodernist assemblage which nonetheless attempts coherence, validity and reliability. The findings have also been tested in the field for example by: (a) providing the framework for at least one four-year psychotherapy training course from which the first students have recently graduated by external assessment and (b) an independent psychotherapy accreditation process by a case study submission. It is argued that clinical practice or supervision should be inseparable from research—Particularly qualitative research in psychology.     

心理治疗的过程研究

心理治疗的过程研究是辨识心理治疗的活性成分和改变机制,是心理治疗效果研究的重要领域。心理治疗过程研究的最新进展体现在研究内容的扩展,研究方法的改进及研究结果的新发现等方面。对未来研究的几点建议：活性成分的层次性观点,改变机制的双线研究及与治疗过程模型的结合,借鉴邻近学科的研究成果,改善RCTs时间设计,关注质化研究,临床工作者与研究者的合作,以及开展本土化研究。     

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.     

Implications of the Empirically Supported Treatment Movement for Psychoanalysis

In this article, I critique the empirically supported treatment (EST) movement and discuss the limitations of traditional psychotherapy research from a psychoanalytic perspective. The EST movement is based on a medical model that assumes that a psychotherapeutic treatment can be conceptualized independent of the human relationship in which it takes place. Psychotherapy and psychoanalysis are, however, treatments only in a metaphorical sense and are more akin to educational processes than medical treatments. Every therapeutic dyad is unique, and research that treats therapy as a standardized, disembodied entity will not contribute to our understanding. Nevertheless, there is a real need for psychoanalysts to become more actively involved in psychotherapy research both for political and scientific reasons. Although I do not believe that “empirical validation” in the form envisaged by the American Psychological Association task force is a realistic goal, I do believe in the value of microscopic studies of therapeutic process, particularly in the context of research-informed case histories.     

The causality principle of psychotherapy and supportive methods in group psychotherapy--reflections on the principles of method combinations

A causality principle of psychotherapy is offered, starting from a technologically orientated concept of psychotherapy as a process. Working from target, commencement, principles, and means, psychotherapeutic methods may be characterised. From these, rules governing the therapist's mode of conduct are arrived at. The causality principle provides a theoretic and practical basis for the integration of ancillary methods into various therapeutic concepts, and for therapeutic teamwork.     

Übertragung und Gegenübertragung in Verhaltenstherapie und Psychoanalyse

Most psychotherapists and researchers agree that a good relationship essentially contributes to therapeutic change. The psychoanalytic concepts transference and countertransference which describe fundamental aspects of the psychotherapeutic relationship have now become integrated into behavior therapy. These concepts, however, are used differently in psychoanalysis as well as in behavior therapy. This makes the communication between psychotherapists coming from different orientations difficult. Therefore, a research approach which describes the important verbal and nonverbal elements of a helpful therapeutic interaction independently from therapeutic orientation could help to evaluate their effectiveness in different psychotherapeutic methods. In this way a culture of integration into psychotherapy could be encouraged.     

Integrative problem-centered metaframeworks therapy I: core concepts and hypothesizing

Over the last 20 years psychotherapy and family therapy have been inundated with a plethora of empirically validated treatments for particular disorders. That trend will increase. Psychotherapists will increasingly be exhorted and ultimately required to integrate empirical data and multicultural competence into their practice. Additionally, individual psychotherapy's default dominance of psychotherapeutic discourse needs to integrate and come to theoretical and clinical terms with the implications of the growing body of research demonstrating the validity and value of a multisystemic perspective. This article (and its companion article) presents a comprehensive, integrative, multisystemic, and empirically informed psychotherapeutic perspective to help therapists and psychotherapy trainers successfully address these challenges-Integrative Problem Centered Metaframeworks (IPCM) Therapy. This first article presents and illustrates IPCM's theoretical foundation, core concepts, and "case formulating" components. It delineates a Blueprint for the practice and teaching of 21st century psychotherapists who can meld science and art into best practice.     

Two-Track Differentiation Paradigm in Psychotherapy

This paper describes the Two-Track Differentiation Paradigm, an updated therapeutic methodology within psychotherapy. The Two-Track Differentiation Paradigm is based on the assumption that patients habitually regard their problems as one-dimensional and thus tend to become rigid in their attitudes toward these problems. The paradigm suggests a psychotherapeutic process of enriched reframing called Differentiation. This Differentiation between patients’ negative and positive narratives and perceptions offers them more options and frees them to contend with their problems more effectively. Thus, with the Two-Track Differentiation Paradigm, cases of impasse and stuck psychotherapeutic situations are turned into cases of cooperation.     

Spezifische psychoanalytische Interventionen

It is held that specific ingredients are responsible for the effectiveness of various psychotherapies and it is supposed that for this reason particular therapeutic approaches are more efficient than others. First, this article presents Bruce E. Wampold’s research on psychotherapeutic efficacy, which gives evidence that psychotherapies efficiency is due to general, not to specific factors. It is shown that in the end the common factors like alliance, compliance, empathy and the fact, that therapists generally make best use of their personality, are interpersonal factors. The impact of these empirical results on psychotherapy, on theory and practice is described in the light of two metatheories, the “medical modell”and the “contextual model”. The author delineates some consequences, for instance that in psychotherapeutic practice the diagnosis-based indication for therapy has to be replaced by fitting-indication. Regarding outcome research, the randomized goldstandard research design has to be replaced by a fitting indication concerning therapist /patient and patient/paticular treatment. Further it is shown that although specific ingredients in a strict sense are not active, therapists have to realize that they are nessessary even if active only as a component of the healing context. How specific ingredients might be realized within a healing context is shown with regard to the adaptive approach to psychoanalysis.     

Conceptualizing Genetic Counseling as Psychotherapy in the Era of Genomic Medicine

Discussions about genetic contributions to medical illness have become increasingly commonplace. Physicians and other health-care providers in all quarters of medicine, from oncology to psychiatry, routinely field questions about the genetic basis of the medical conditions they treat. Communication about genetic testing and risk also enter into these conversations, as knowledge about genetics is increasingly expected of all medical specialists. Attendant to this evolving medical landscape is some uncertainty regarding the future of the genetic counseling profession, with the potential for both increases and decreases in demand for genetic counselors being possible outcomes. This emerging uncertainty provides the opportunity to explicitly conceptualize the potentially distinct value and contributions of the genetic counselor over and above education about genetics and risk that may be provided by other health professionals. In this paper we suggest conceptualizing genetic counseling as a highly circumscribed form of psychotherapy in which effective communication of genetic information is a central therapeutic goal. While such an approach is by no means new—in 1979 Seymour Kessler explicitly described genetic counseling as a “kind of psychotherapeutic encounter,” an “interaction with a psychotherapeutic potential”—we expand on his view, and provide research evidence in support of our position. We review available evidence from process and outcome studies showing that genetic counseling is a therapeutic encounter that cannot be reduced to one where the counselor performs a simple “conduit for information” function, without losing effectiveness. We then discuss potential barriers that may have impeded greater uptake of a psychotherapeutic model of practice, and close by discussing implications for practice.