Stationäre oder teilstationäre Psychotherapie?

In a pilot study we compared two groups, one of inpatients and one of day clinic patients who were treated between January 1999 and December 2001 at the Department of Psychosomatics and Psychotherapeutic Medicine in Freiburg/Germany. Both settings offer a similar, multimodal and intensive psychotherapy program on a psychodynamic background. In a first explorative data analysis (sociodemographic data, SCL-90-R, IIP-C) we studied differences in severity of initial symptomatology and differences in outcome (prae/post). Patients with anorexia nervosa and a very low weight were preferentially treated in the inpatient setting. In addition the inpatient group of patients with a somatoform disorder showed higher degrees of somatization, as compared to patients with a somatoform disorder in the day clinic. Therapeutic change with respect to psychopathology however did not differ between the two settings: both groups showed a significant improvement during the course of therapy.     

Stationäre körperbezogene Psychotherapie bei Anorexia und Bulimia nervosa

Disturbances of body-images in women with anorexia and bulimia nervosa are described at the behavioral, perceptional and affective-cognitive level. The disturbances of body image, which are often accompanied by personality-structural deficits and have a decisive influence on the course of disease, can be reached only in part by verbal forms of therapy. Considering these facts, we present an integrative clinical procedure in which the application of body-related therapy modules play a central role in supplement to cognitive-behavioral and psychodynamic forms of therapy. Process-oriented body-perception therapy in an individual setting and a communicative movement group therapy are used and their relevance to the in-patient therapy process examined from the patient’s point of view. The study reveals a high value of body-psychotherapy, wherebydifferences were observed between anorexia (15) and bulimia (27) patients in the course of the process. The results suggest an indication for the application of combined individual and group body-psychotherapy for hospitalized anorexia patients. A communicative body therapy in group form is also very important in the in-patient treatment of bulimia patients, but there is a differential indication with regard to individual body therapy.     

Stationäre Kinder- und Jugendpsychiatrie sowie Psychotherapie bei substanzabhängigen Jungen und Mädchen

This study examines post-treatment outcomes (6 and 12 months post-release) of a multimodal child and adolescent psychiatric and psychotherapeutic inpatient treatment program for boys and girls diagnosed with substance use disorders (n=71) in 2 centres. Up to now there has been a lack of outcome research in this field in Germany. Outcome measures included drug use patterns and psychopathology. The greatest reductions in prevalence at 1 year follow-up occurred for cannabis, methamphetamine, cocaine and heroin use. Additionally the patients and their parents also reported significant improvements in adolescent’s psychopathology at the 1 year follow-up. The results underline the importance of disorder-specific, multimodal inpatient programs for the treatment of children and adolescents with substance use disorders.     

Station?re Psychotherapie und Medien

Background

According to several studies the application of different media in inpatient psychotherapy and psychiatry has proven to be a useful and effective addition to conventional methods of intervention. This study is the first to catalogue the current spread of media in inpatient treatment as well as the evaluations of media-supported interventions by therapists and patients.

Sample and method

In a representative survey conducted in all psychiatric and psychosomatic clinics in North-Rhine/Westphalia (response: 40 psychologists/doctors and 289 patients from 39 clinics) media equipment, usage of media in different areas, evaluation of and satisfaction with the media usage were measured by a questionnaire which was constructed especially for this purpose.

Results

A widespread usage and acceptance of media could only be found in some areas. The study identified large differences in equipment standards and media usage depending on the type of media, the area of usage and the specific clinic.

Conclusion

Recommendations for the further development and optimization of media usage in inpatient psychotherapy are derived from the results of this study.     

Teilstationäre Psychotherapie

Psychotherapeutic day clinics increasingly take over responsibility for the treatment of patients who cannot be cared for satisfactorily, respectively, at all in an inpatient setting. Psychotherapy in a day clinic setting is a treatment in its own right which has progressively established itself between inpatient and outpatient treatment. Empirically raised up to date data prove the efficacy and the efficiency of psychotherapeutic treatment in day clinics. Accordingly, the goal of the present study is to investigate the outcomes of psychotherapeutic treatment in a day clinic with a psychodynamic concept. Since 1996 the psychotherapeutic day clinic Basel empirically assesses the treatment course of all admitted patients. Patients and therapists fill in questionnaires upon admittance, two months into the course of treatment and upon discharge (SCL-90-R, PSKB-Se-R, OPD etc.) Our results indicate that significant improvements of symptoms as well as of socio-communicative competency can be achieved during treatment which remain stable even after discharge (first follow-up three months after discharge). Comparing outcome data of patients treated in full-time inpatient setting and of patients who undergo partial hospitalization we found that outcome was at least equivalent. Additionally we found that the diagnosis of a personality disorder influenced treatment results significantly in some symptom specific spheres.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.     

Stationäre Psychotherapie in der Kinder- und Jugendpsychiatrie: “Die Kunst des Unmöglichen?”

Inpatient psychotherapy of children and adolescents occurs in a tangle of reciprocal psychodynamic effects. It comprises the individual level of each patient, the dynamics within the group of the patients and within the staff on the ward and as well the influence of the institution and its structure. The psychopathology of the patients will be coloured by these interactions. They have to be cared for and analysed to prevent the repetition of patients' traumatic experiences and the failing of the goals of the treatment directed on autonomous functioning of the patients outside of the hospital. The statements are illustrated by case vignettes.