Intelligenzgeminderte Rechtsbrecher im Maßregelvollzug

Forensic patients with intellectual disabilities have so far received little attention which is reflected in the comparatively briefly written chapters in the standard textbooks and also the low scientific interest in this patient group. There are only few therapeutic concepts and even less information on their effectiveness. This article presents the Christophorus Clinic in Münster which was the first forensic institution in Germany to specialize in these patients. The institution incorporates 54 treatment places and started operating on 3 June 2011. In addition to the known fact that a therapy concept must (further) develop over the years, during the first year of operation some aspects have arisen which have cristallized as problem areas specific for this patient group, which are discussed.     

Die Durchführung antiandrogener Behandlung von Sexualstraftätern im Berliner Maßregelvollzug

In 2002, the Forensic Psychiatric Hospital in Berlin started a pilot project for combined treatment of sex-offenders with anti-androgenic LH-RH agonists and psychotherapy. On the basis of experience-based knowledge transfer and with almost six years of practical experience, this article reports results of this new approach of combined psychotherapy and drug treatment from medical and psychological viewpoints. First, a short history and general information about the combined treatment are provided. Secondly, its effects on patients’ sexual self-perception, personality disorders and aspects of prognosis are explored. Thirdly, a medical therapy scheme, possible side effects, as well as issues of patients’ rights and approvals are discussed.     

Autonomie und Fürsorge im Ma?regelvollzug

In the debate on compulsory treatment of psychiatric patients (Zwangsbehandlung), an excessive emphasis has recently been placed on patient??s rights to self-determination, leading to a series of verdicts which have progressively restricted this type of intervention. Rulings by the Federal Constitutional Court of Germany (Bundesverfassungsgericht) during the previous year have now caught up with involuntary treatment (Ma?regelvollzug). In this paper, an analysis is given of the ethical consequences arising from the conflict between the right to self-determination and medical care at psychiatric clinics. Categorically ruling out compulsory treatment on the basis of the right to self-determination becomes ethically questionable if, due to a misunderstanding of this right, patients are not given appropriate medical care and are thus at risk of neglect, social decline and delinquency, possibly even of endangering third parties.     

Kritische Anmerkungen zur Einweisung von Jugendlichen und Heranwachsenden in den Maßregelvollzug

In this paper the preconditions for placing adolescents and young adults in forensic psychiatric institutions are analyzed. According to the law such placements are only justifiable in exceptional cases. Even from a psychiatric point of view it is difficult to delineate a severe and most notably lasting mental disorder at a young age and distinguish it from a lack of maturity, although only the first would justify an indefinite placement in an institution. Nevertheless both broadly pathologizing certain behaviors and loosely interpreting preconditions for placements in institutions encourage commitment to institutions.     

Zur Differenzierung zwischen unsicheren und aggressiven Teilnehmern beim Gruppentraining Sozialer Kompetenzen (GSK) im Straf- und Maßregelvollzug

The cognitive-behavioural group training for social competence “GSK” [16] has proven to also be effective in the penal system [28]. The present study examines if a targeted differentiating assessment prior to the intervention and a thereon based homogeneous group composition with regard to insecure and aggressive behaviour patterns can enhance the effectiveness of the “GSK” in the penal system and in a forensic hospital unit. Altogether 48 male delinquents across both settings were therefore divided into a “homogeneous insecure” group, a “homogeneous aggressive” group and a “heterogeneous” group. Pre-post-comparisons show that the intervention is effective for all three groups and also in both settings, the penal system and the forensic hospital unit. The “homogeneous aggressive” group revealed the strongest intervention effects.     

Transparenz und Fairness in der Therapie von Sexualstraftätern in Haft und Maßregelvollzug

It makes sense to treat sexual offenders in prison. Treatment can be successful even if coerced. However, particular difficulties arise due to the great power disparity between therapist and patient and the latter’s remoteness from normal living conditions. This report will describe the current status of treatment techniques/approaches for sexual offenders in prison (with particular regard to social therapy) and special forensic hospitals as viewed by an external reviewer judging the process, methods and success of treatment for preventing relapse and estimating criminal prognosis. We mention standards for a respectful and positive approach towards the patient client. With regard to the Good Lives Model, it is supportive to develop positive resources in the perpetrator. This also requires a heightened readiness from therapist and team for transparency (instead of confidentiality) towards the perpetrator as to the assessment of progress and status of therapy. We criticize tendencies for a confrontative, if not humiliating approach, which undermines the self-esteem of the client and exploits the power disparity between therapist and perpetrator.     

Drogenabhängige Patienten im Maßregelvollzug gemäß § 64 StGB: Verbesserung der Quote erfolgreicher Behandlung durch suchtspezifische Medikation?

In Germany, addicted offenders can be sentenced to compulsory addiction treatment in forensic mental hospital departments (Art. 64 of the penal code). A presupposition to such a sentence is a fair chance of successful treatment and rehabilitation. Commonly, an expert witness is asked by the court to assess this point in the trial. To date, the treatment in forensic mental hospitals aims at total abstinence from any kind of drugs. But in at least half of the cases, a fair chance of successful treatment is no longer seen after a period of therapy. In most cases, these patients are returned to prison. The paper pleads that in offenders addicted to illegal drugs, a drug specific medication – in particular methadone maintenance treatment or naltrexone medication – might be a useful option. The rate of “treatment failure” might be reduced slightly by using this option with some of the patients.     

Patientenpfade im psychiatrischen Ma?regelvollzug �C Intensivere Behandlung, k��rzerer Freiheitsentzug?

This article reports on the results of two workshops which attempted to register and characterize clinical pathways in special hospitals for schizophrenic offenders. The starting point for both workshops was the analysis of the stages and elements which naturally constitute long-term therapy in schizophrenic patients. Based on this analysis it was aimed to develop standardized operating procedures: which mode of action is most sensible in which phase of treatment? How to respond to the different problems arising during therapy? How to prevent therapeutic stagnation? How to retain up-to-date knowledge on the patient? How to manage a faster and more effective transfer into outpatient care? This article focuses particularly on the course of patientsduring the process of in-patient care in special hospitals for schizophrenic offenders.     

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.     

Wo steht der Jugendmaßregelvollzug in Deutschland aktuell?

With up to 67% of all young offenders suffering from mental illnesses, the question of how professional care should be arranged for them arises. The ability to detain a young offender for an indefinite period of time in a forensic psychiatric institution represents the final solution in juvenile law. This currently affects approximately 300 patients nationwide, of which there is precise data available only for patients who were detained before the age of 18. This is due to the differing nationwide organisational structures within specific forensic psychiatric institutions for adolescents. There is currently a lack of forensic psychiatric units in several federal states providing treatment for adolescents. When examining under what basis, and when the relocation of a person from a young forensic psychiatric institution into the corresponding adult one occurred, and how long specific pedagogic facilities were provided to these individuals, the differences between various adolescent forensic psychiatric institutions become apparent. This especially concerns young adolescent offenders suffering from delayed mental development.     

Prozeß-Erlebnisorientierte Psychotherapie – Ein Überblick: Teil 2

Zusammenfassung Die Proze?-erlebnisorientierte Psychotherapie ist eine neohumanistische Behandlungsform, in der versucht wird, eine kreative Verbindung zwischen einer eher klientzentrierten, echten, wertsch?tzenden und empathischen Beziehung und einem eher aktiven, aufgabenorientierten und proze?-direktiven Stil der Gestalt-Psychotherapie herzustellen. Diese Therapieform ist wissenschaftlich fundiert (im Sinne von Grawe 1997). Ihre Krankheitslehre wurde durch Beitr?ge aus der modernen psychologischen Theorie erg?nzt. Die Behandlung umfa?t eine Reihe wesentlicher therapeutischer Aufgaben, die charakterisiert sind durch spezifische Hinweise oder Zeichen auf Klientenseite, L?sungsstufen, verschiedene Schritte, die ein Klient auf dem Weg zur L?sung der Aufgaben durchl?uft und therapeutische Interventionen, die den Klienten auf diesem Weg unterstützen. In diesem zweiten Teil der übersicht werden spezifische therapeutische Aufgaben beschrieben. Schlie?lich werden praktische Implikationen diskutiert und Ergebnisse zum Therapieeffekt berichtet.      

Prozeß-Erlebnisorientierte Psychotherapie – Ein Überblick: Teil 1

Zusammenfassung Die Proze?-erlebnisorientierte Psychotherapie ist eine neohumanistische Behandlungsform, in der versucht wird, eine kreative Verbindung zwischen einer eher klientzentrierten, echten, wertsch?tzenden und empathischen Beziehung und einem eher aktiven, aufgabenorientierten und proze?-direktiven Stil der Gestalt-Psychotherapie herzustellen. Diese Therapieform ist wissenschaftlich fundiert (im Sinne von Grawe 1997). Ihre Krankheitslehre wurde durch Beitr?ge aus der modernen psychologischen Theorie erg?nzt. Die Behandlung umfa?t eine Reihe wesentlicher therapeutischer Aufgaben, die charakterisiert sind durch spezifische Hinweise oder Zeichen auf Klientenseite, L?sungsstufen, verschiedene Schritte, die ein Klient auf dem Weg zur L?sung der Aufgaben durchl?uft und therapeutische Interventionen, die den Klienten auf diesem Weg unterstützen. Dieser Beitrag gibt im ersten Teil einen überblick über die proze?-erlebnisorientierte Therapie einschlie?lich ihrer theoretischen Grundlagen, i.e. der Emotionstheorie, des dialektischen Konstruktivismus und der Proze?orientierung sowie über die Grundprinzipien des Behandlungsmodells.