Trialog und Psychosenpsychotherapie

?Trialogue in this context is defined as the equal encounter of people with experience of psychoses, relatives and therapists in the sense of reciprocal learning and mutual respect. This concept has its origins in Germany in the so-called psychosis seminars but has now become of importance for experiences with other diseases and for other levels of encounters ?C for psychiatric practice, anti-stigma work, tribunals, for psychiatry planning and quality assurance, teaching, congresses, further education and also for research. In this article the trialogue will be presented based on the targets, experiences and results of psychosis seminars and compared with the results of psychoeducation. Finally, the concept of trialogue will be placed in context with the development of the psychotherapy of psychoses: are experiences of trialogue also relevant for psychotherapy? Can not only form but also content impulses be derived? Can trialogue strengthen and support the psychotherapy of psychoses as a whole? In this context the empirical results of the trialogue research project SuSi on the subjective meaning and significance of psychoses will be presented showing a surprisingly clear case for sense orientation and for a biography-oriented psychotherapy of psychoses.     

Theorietreue und Variationen

Interventional techniques can be integrated into inpatient group psychotherapy. Our approach is not meant to be a wild eclecticism but an empirically founded interventional repertoire that contains psychoanalytical, depth psychological, behavioral and hypnotic therapeutic interventions. A “uniform solution” for an integrative therapy is not possible. A tension between theory conformity and variations remains inherent to psychotherapy for a multitude of reasons. An interventional repertoire is illustrated by case examples which use operationalized psychodynamic diagnostics (OPD). The results must be appraised within the time frame of inpatient treatment. The conception in guideline psychotherapy that the individual approaches cannot be mixed because they would lose their effectiveness, does not correspond to our experiences. The chances and risks of switching interventions must be considered.     

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.     

Werkzeugkasten des psychodynamischen Psychosetherapeuten

The authors describe the modification of the classical psychoanalytic treatment technique, which was developed in the past decades to treat people with schizophrenic psychosis. The technique which can be used in modified psychoanalytic as well as other psychodynamic settings, was adjusted to the specific problems which occur in the psychotherapy of patients with schizophrenia. This specific modified psychotherapy deals with a paradigmatic experience in the therapeutic relationship to reduce traumatic fear and to overcome interpersonal and intrapsychic dilemmas. This modification increases the possibility to reconstruct the personal history of the psychosis in a dialogical process together with the patient.     

The disintegrative factor in therapeutic groups as illuminated by kibbutz life

This article deals with the way individuals cope with the threat they experience in the framework of psychodynamic group psychotherapy. This threat, which is understood to be a disintegrative threat, is intensified in the therapeutic group. We see the therapeutic group as possessing attributes of a potential space, in which the participants are enabled to process the defense and coping mechanisms intended to preserve the sense of integration. This will be illustrated by the experiences of individuals who grew up in a kibbutz (an Israeli society in which infants were raised with their peer group) and participated in psychodynamic groups.     

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 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.     

Predicting premature termination within a randomized controlled trial for binge-eating patients

Understanding the dropout rates of efficacious forms of psychotherapy for patients with binge eating disorder (BED) is an unsolved problem within this increasing population. Up until now the role of psychotherapy process characteristics as predictors of premature termination has not been investigated in the BED literature. Within a randomized controlled trial (N=78) we investigated the degree to which early psychological process characteristics, such as components of the therapeutic relationship and the experiences of mastery and motivational clarification, predicted premature termination of treatment. We statistically controlled for the influences of covariates such as rapid response of treatment, treatment group, body mass index, Axis II disorder, and patients' preexisting generalized self-efficacy at baseline. Patients' postsession reports from Sessions 1 to 5 indicated that low self-esteem in-session experiences was a stable predictor of premature termination. Its predictive value persisted after controlling for the above-mentioned covariates. Exploratory analyses further revealed low self-esteem experiences, low global alliance, and low mastery and clarification experiences as predictors in those patients who explicitly specified discontentment with therapy as reason for premature termination. These results indicate that patients' self-esteem experiences may not be an epiphenomenon of their specific psychopathology but may represent general mechanisms on which remaining or withdrawing from psychotherapeutic treatment depends. Early psychotherapy process characteristics should therefore be considered in training and evaluation of psychotherapists carrying through BED treatments.     

Group psychotherapy as taught by the polsters and the gouldings

Psychotherapy has been viewed by many as a subtle form of interpersonal persuasion. However, persuasion, or the lack of it, in a psychotherapy relationship is not always clearly definable. Most agree that persuasion is influenced by a number of important factors, of which the personal characteristics of the therapist are generally recognized as the most significant. Experience, credibility, training, dedication, values and enthusiasm are attributes usually agreed upon as being important contributors to the therapist's power to persuade. Understandably, psychotherapy conceptualized in this manner raises significant issues of values, ethics and responsibility in treatment. While not all agree or recognize persuasive influences existing in psychotherapy, it is suggested that persuasion is a salient feature of psychotherapy, whether or not it is identified as such. It is important to remember that in all psychotherapy, trouble is apt to follow the ignorant applications of important forces. Further, it is suggested that these persuasive influences cross doctrinal differences and can be augmented by applying them with a group psychotherapy setting. In the hands of a skilled and ethical psychotherapist, these persuasive influences can be enhanced and the group can become a powerful tool in the therapeutic process. These issues are explored in this paper in relation to two different group psychotherapy training experiences with Bob and Mary Goulding and Erv and Miriam Polster.     

Working with Psychosis

This is the first of four papers about working with psychosis in a newly established post of psycho-analytic psychotherapist in an acute psychiatric unit in Australia. In this paper the author gives an account of some early impressions and experiences with staff and patients, particularly connected with an unacknowledged grief in the aftermath of psychosis. The author next discusses some of the psycho-analytic theory about psychosis which he found containing and helped make some sense of his experiences. He then introduces a case study of an exploratory psycho-analytic psychotherapy with a 40-year-old man suffering from a bi-polar disorder. The beginning of the therapy is described when this man revealed feelings of grief and despair about his illness. Being able to face and bear these feelings enabled him to begin to mourn what was irretrievably lost because of his illness and to contemplate what might still be possible. The author describes some of the early themes and one session in detail, and discusses how fluctuations in contact with the client reflect his retreat to a pathological organization in the mind. This psychic retreat was dominated by a psychotic process, and the retreat offered refuge from a dread of fragmentation and the pain of mourning and loss.     

Therapiewechsler

At least 30% of the patients, currently in psychotherapy, have been in one or more psychotherapeutic treatments before the beginnig of the actual treatment. A great number of these patients decided as a consequence of their experiences with the former therapeutic treatments to change not only the therapist but also the form of the psychotherapy. The task was to find out the reasons for this. 25 patients who had changed from one of the Guideline Therapies into a client-centred therapy (CCT) were interviewed about their reasons for this change. It was assumed, that the failing of earlier therapies was caused by a lack of matching between patient and therapist, treatment and disorder in the sense of the Generic Model of Psychotherapy (GMP) conceptualized by Orlinsky and Howard. The results support this hypotheses: For most of these patients CCT turned out to be a necessary and successful alternative to the previous treatments. Most of the patients reported that they responded better to the therapeutic offer of CCT. The reasons mentioned for choosing another form of psychotherapy support the necessity of a differential indication for psychotherapy on the basis of the GMP.     

Passt oder passt nicht?

Differential indication in psychotherapy should be a process of decision making, that takes multiple factors into account, and not just the assignment of a particular disorder to the adequate therapeutic method. Unspecific characteristics of the patient, instead of disorder-specific features, as well as personality characteristics of the therapist having therapeutic relevance are important factors either. In this way decisions for an indication then turn into the crucial question of matching between patient and therapist. The receptivity of the patient is a central component. As a result of successful maching, the therapeutic relationship will improve which has a positive influence on the outcome of psychotherapy. According to the generic model of psychotherapy 4 levels of the decision-making process are defined. They serve as orientation for a differential indication taking into account both persons and methods. The realization of this indication model in in-patient treatment has some preconditions. Obligatory is the availability of a variety of therapists differing in therapeutic methods and personal characteristics. The mostly applied principles of matching decisions are listed in tabular form and illustrated by a case report.     

Entwicklungstendenzen psychotherapeutischer Praxis und Forschung

This review presents an analysis of articles in the journal “Psychotherapeut” during the years 2000 and 2001 with the focus on new efforts in the field of psychotherapeutic practice and research. The main topics of the journal are the presentation of new therapeutic approaches, some of them integrating different theoretical orientations, and the emphasis on the therapeutic relationship as a specific contribution to the process and the results of psychotherapy. In addition, this article presents a survey of the various subjects in psychotherapeutic research including a) the application and testing of new questionnaires to measure the effectiveness and the process of psychotherapy and b) research in the epidemiology of selected forms of stress, their consequences and lasting effects.     

Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study

Extensive empirical research has established therapeutic alliance as one of the most stable predictors of psychotherapy outcomes. Nearly all the contemporary empirical literature on therapeutic alliance focuses on the therapist-client dyad without attending to the relational experiences many clients in outpatient clinics have with administrative staff. Literatures from the fields of social work, psychiatric nursing and milieu therapy suggest there are more systemic relational and environmental dynamics that impact treatment beyond the therapist-client dyad, although these issues have been considered primarily in inpatient settings. A relational ecology framework has been developed drawing upon relational psychoanalysis, attachment theory and symbolic anthropology to help conceptualise the broader relational dynamics beyond the therapist-client dyad that may impact a more systemic therapeutic alliance in certain outpatient contexts. In an initial cross-sectional pilot study with a sample of clients (N = 107) receiving psychotherapy at a community mental health clinic in the Northeastern United States, the present study found client ratings of both (a) the therapeutic alliance with their therapists and (b) their alliance with administrative staff each significantly positively predicted client ratings of treatment. Thus, ratings of administrative alliance predicted client ratings of treatment over and above the effects of the therapist-client therapeutic alliance. These findings provide preliminary support for further investigation of the relational ecology of outpatient psychotherapy and suggest that client experiences of relational and environmental dynamics with administrative staff may be important contributors to psychotherapy outcomes. Limitations of the present study and implications for future research and practice are discussed.     

The Experience of Time in Acute Psychosis and Schizophrenia

From the narrative point of view the plot of a story configures time. In psychosis, when experiences remain unnarrated, experience being-in-time is also missing. Once experiences are given narrative form, they can be left behind as a part of individual's personal history, thus enabling present experiences to be narrated. Unnarrated experiences do not accumulate. Narrative history contains, however, enough redundancy to invite you to restory your past in a new way if you need to. Hence, from the narrative point of view, early, family- and network-centered intervention is of special value in cases of acute psychosis.     

Informed love as a curative factor

Research concerning the curative factors in psychotherapy has thus far overlooked reports of religious experiences as a potential source of hypotheses. The author examines a variety of anecdotal encounters with personifications of higher power for the presence of therapeutic factors. He finds that the attitude expressed by the being, as perceived by the recipients, reflects unconditional positive regard (UCR) in the context of a thorough and intimate knowledge of the person. He thus hypothesizes that the curative factor operating in such experiences is “informed love”, defined as the twofold experience of feeling completely loved and completely known. The author discusses the differences between informed love and UCR, and the implications of informed love in modern psychotherapy practice.     

Children with Autistic Spectrum Disorders: Individual Differences,Affect, Interaction,and Outcomes

In this article, we have drawn upon the attachment motivational system (Bowlby, 1988; Lichtenberg, 1989; Shane, Shane, and Gales, 1997) as a guide to providing “positive new experience” as the cornerstone of therapeutic progress. We see positive new experience as paramount, over and above insight and/or interpretation because insight and interpretation are so varied among different theories. The common denominator that is effective in therapy, then, must be something beyond insight and interpretation. We call that therapeutic factor the positive new experience and will draw from attachment theory to understand its components. In addition, using the attachment motivation system and trauma research, we elaborate on why certain types of negative experiences in psychotherapy and psychoanalysis should be avoided. We address, in particular, harmful repetitions of traumatic relational patterns or traumatic events in the transference, overemphasis on “the empathic stance,” and the search for motivation in patients' behaviors where such a search may be based on the false assumption that all behavior is motivated. This latter category addresses aspects of behaving that may not be motivated; that is, they just “are,” and as such, the search for and attribution of meaning in such instances may lead to failed understanding and insight and to faulty correctives. We have illustrated with clinical examples both positive new experience and three types of negative experiences to be avoided in treatment.     

The Worldviews of Healing Traditions in the East and West: Implications for Psychology of Religion

This article will compare the worldviews of psychotherapy traditions in Eastern and Western culture, particularly the therapeutic factors and principles indigenous to the Chinese culture. The author will first define the meaning of culture and psychotherapy from a postmodern anthropological approach. By referring to history and literature in the study of cultural psychology, a comparison will be made between the value systems lying behind therapeutic methods used in the East and West. This includes the worldviews on the body and mind, the self, mental health, relationship, community, healing, and spirituality. Lastly, a famous Chinese legend will be used as an example to illustrate how worldview differences between the East and West determine the goals and process of psychotherapy. It is hoped that psychology of religion would be sensitive to the underlying worldviews across different cultures, without imposing its definition of “mental health” and method of “healing,” as different religions embody different cultural traditions as well. It is argued that whether spirituality or religion is helpful to the wellbeing of local people, it should be defined by the local persons and expressed in their mother tongue. Hence a psychology of religion for Chinese people should respect its customs of healing and particular set of worldviews.     

Indikation zu Psychoanalyse und analytischer Psychotherapie

Based on the diagnostic process in the initial interview, which is an intersubjective encounter, the various developmental steps for establishment of the indications for psychoanalysis are presented. Freud and his followers, who were initially oriented to the psychiatric diagnosis, were later oriented to the criteria of approachability, analysability and in particular on the aptitude for psychoanalysis. The criterion of aptitude was not only elaborated from the perspective of Ego psychology but was also relevant for all high frequency non-terminated psychoanalyses which followed the basic psychoanalytical principles of “afocality”. This has so far characterized the standard procedure of all psychoanalytic schools. Due to the experiences of psychoanalysts with early disturbed, structurally Ego-disturbed neuroses and personality disorders, the extent of lability of the mental structure and by turning to countertransference analysis, the person of the psychoanalyst become more important for the assessment of the indications. In Germany the integration of psychotherapy, which is financially supported by healthcare insurance, ultimately leads to differential indication assessments between high frequency psychoanalysis or analytical psychotherapy, modified psychoanalytical psychotherapy and less frequent psychodynamic procedures.