Beziehung und Exposition

In the treatment of anxiety disorders both psychodynamic and behavioral therapeutic methods have proved successful. Linking the two methods in one treatment is usually avoided by therapists, although there is evidence for using such an approach. There is a lack of a regulatory framework for the integration of the various procedures. Taking anxiety treatment as an example, a contribution to such a regulatory framework is developed: the use of exposure (as a cognitive behavioral element) and the examination of the transference aspect of the therapeutic relationship by the therapist (as a psychodynamic element) are systematically placed in relation to each other, whereby the understanding of the therapeutic process is deepened.     

Zukunftsperspektiven sexualforensischer Psychotherapie

There is a controversial discussion on to what extent sexual forensic psychotherapy has a positive influence on the legal probation of sexually delinquent people. From this the question arises on how treatment with a perspective for success could be structured. This article assumes that such a perspective can only succeed through close cooperation between science and psychotherapeutic practice. Through the analysis of a methodologically elaborate study, considerations on the motivation and the influence of empirically ascertained risk factors are developed and each placed in relation to scientific and therapeutic practice. In this way various problems are tackled, which range from insufficiently described interventions via too little therapeutic flexibility up to limitations in the scientific evaluation. Finally, possible barriers for the development of such a perspective are discussed and the connection to the so-called risk-need-responsivity (RNR) model is explored.     

Anpassungsleistung und Täuschung in der forensischen Therapie

The term adaptation is often used in forensic interventions in a negative sense to describe courses of treatment without a real modification of thinking and behavior. In many cases adaptation means only a superficial problem adaptation with a risky process. This article describes and explains that in many cases adaptation can be a fundamental performance of development in a positive sense.Finally, key questions for the assessment of different adaptations and a typology of adaptations are presented. Additionally, the difference between a positive or rather desirable adaptation and deception will be defined.     

Pathologisches Glücksspiel und Delinquenz

Pathological gambling is characterized by excessive gambling behavior which influences the life and well-being of a person in a dysfunctional way. It often leads to severe consequences in social and family life, career and material matters. This can also include illegal acts. In the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) excessive gambling was classified under impulse-control disorders but was renamed as gambling disorder (GD) and reclassified under the category “substance-related and addictive disorders” in DSM-5, due to parallels to substance use disorders in the clinical characteristics as well as genetic and neurobiological factors. In Germany, approximately 0.5?% of the adult population suffer from GD. Especially gambling machines are associated with an increased risk of gambling-related problems. Common comorbidities are substance-related and affective disorders. The most important risk factors are young age, male gender, a history of migration, gambling-related problems in the family, unemployment, a low educational level and low household income. Delinquent behavior was not considered to be a sufficiently discriminative factor for GD, although there is a correlation between delinquency and gambling behavior. In addition, those GD subjects who show delinquent behavior also show a specific risk profile. Thus, mental health professionals should be aware of possible psychosocial consequences in GD, such as illegal acts, and this should be addressed in the effective treatment strategies, such as cognitive behavioral therapy. Moreover, it is necessary to improve the access routes for affected people into healthcare system in order to ensure early detection and treatment of the disease.     

Hare Psychopathy Checklist-Revised

The Hare Psychopathy Checklist-Revised (PCL-R) is among the most frequently used instruments for the assessment of psychopathic traits. In the scope of the German adaptation of the PCL-R, normative data were collected from a sample of adult male offenders. Based on these data the factor structure and reliability of the German language version of the PCL-R are discussed in the first section of the article. The assessment of a model with four facets and two superordinate factors showed a very good agreement with the empirical data. In addition, examination of interrater agreement and internal consistency indicated that the PCL-R is a reliable measure. In the second part of the paper recommendations are provided for the correct application of the PCL-R. The focus lies on the correct performance, evaluation and interpretation of PCL-R test results with respect to key indices and the dimensional structure of the psychopathy construct.     

Sexualstrafrecht,Sexualmoral, Medienmoral

The law on sexual offences is a crystallization point of legal doctrine and criminal political dispute. It reflects in a special way the tendency and content of a “modernization”, which is characterized by an alienation of collectives and an orientation to a topus of being strictly personal and is defined as quasi-natural. The current hypertrophization of the legal protection of self-determination is closely coupled with the tendency towards socioeconomic dissolution of the western contemporary personhood. This article addresses terminological and systematic associations between “liberal” concepts of governmental restraint and “modern” concepts of a functional security strategy.     

Taking a Step Back,Moving Forward: Place and Space without Mental Representations

ABSTRACT

The publication of the revised edition of Place and Experience provides the occasion to discuss Malpas’ original account of place, and its role in a proper account of the central features of human minds. The first edition is a groundbreaking work on the embodiment and embeddedness of human minds, that prefigures more recent developments of a now established field of research on embodied minds: so-called E accounts. In this paper, I address three issues in Malpas’ book that I found problematic at times and unclear at others, and argue that E- accounts, or better, a particular rendering of them, can better dissolve. These interrelated issues are: 1. the use of the idea of mental representations to understand location and orientation; 2. the claim that non-human animals have ‘environments’ but lack ‘worlds’, 3. the use of two exclusive vocabularies, the physical and the mental, for describing cognition. I thus question such ideas, associated with traditional accounts of cognition, which not only are responsible for some of the gravest criticisms such accounts have received, but seem inadequate to Malpas’ characterization of minds as placed. My recommendation is to take a step back from the traditional framework, and allow ourselves to simply move forward.     

Wie können Langzeittherapien mit kürzeren Behandlungen verglichen werden?

Long-term psychotherapy is not recommended in the current guidelines, which are based on the criteria of evidence-based medicine, as there is a lack of confirmation for long-term psychotherapy by efficacy studies. Using the example of psychoanalytic long-term psychotherapy this article describes six dilemmas which impede the realization of efficacy studies for long-term psychotherapy. Finally, basic elements of a study design are proposed, which are considered as being adequate to compare (psychoanalytic) long-term psychotherapy with shorter treatment forms in terms of outcome and cost-effectiveness. The anxiety and personality disorders (APD) study is briefly described as an example of a study realizing the proposed design.     

Zur Therapie von ADHS bei komorbiden Autismus-Spektrum-Störungen

Until recently, research on the co-occurrence of ADHD with autism spectrum disorder (ASD) has been limited by the fact that current classification systems did not allow a dual diagnosis of these two neurodevelopmental disorders. Since the DSM-5 permits a double diagnosis of ADHD plus ASD, research on their comorbidity has substantially increased. In addition to shared and distinct etiological factors, studies have revealed a high clinical impact of the combined symptomatology on affected individuals. This article provides a selective overview of evidence-based, mainly pharmacological treatment strategies in ADHD/ASD phenotypes.     

Kinderpornografie

The quantity and distribution of child abuse material (“child pornography”) has substantially risen since the advent of the internet facilitated access. Due to the international character of the associated delinquency prosecution is confronted with several difficulties. In 2003 the European Union established a framework agreement to legally combat child pornography. The market for child abuse material is profitable, as production is comparably cheap. The number of convictions for relevant crimes varies but is generally still on a high level, even though reporting of relevant contents is decreasing. Providers and users might have switched to less controllable internet platforms. The physical and/or psychological sequelae for victims of child pornography are serious and ongoing. Studies show that compared to hands-on-offenders users of child exploitation material are generally younger, better educated and less often have a criminal record. Some of them (10–25?%) fulfill the diagnostic criteria of pedophilia. A child pornography offender’s risk of committing a hands-on-offence seems to be increasing with the diagnosis of pedophilia and antisocial personality traits. According to existing data, individuals whose only criminal record refers to illegal pornography seem to be at low risk for future offending with child abuse (0.2–6.6?%). Offenders who were already convicted for child abuse have a higher risk for re-offending when consuming (deviant) pornography. Several cognitive behavioral treatment manuals exist, however accurate diagnostic assessment and indication are required.     

In 300 Stunden um die Welt

The time frame of psychoanalytic long-term treatment depends on the therapy goals and the means by which these are expected to be reached. A core element for this is the concept of working through. In Freud’s view working through deals with resistance towards the acceptance of an interpretation regarding unconscious conflicts. Also, in classical terms there is a working through of the transference neurosis. Conceptual intertwining with the work on mourning (in terms of libidinal decathexis) brings a difficulty to light, namely the potential danger of misusing long-term treatment and the therapeutic working relationship for avoiding termination and separation. The basic concept of working through can be maintained for patients with non-neurotic disorders as well as regarding modified psychodynamic psychotherapies with fewer sessions and lower session frequency, albeit in consideration of the theory of therapeutic change for each form of treatment; however, a three-fold meaning of working through in contemporary psychoanalysis (i.e. working through of resistances, working through of transference neurosis and the structurally changing inner work of the patient) indicates the need to discuss the necessary duration of long-term treatment neither from a viewpoint of economic efficiency nor from a standpoint of mere professional policy but to base this on the logic of the dynamics of a disorder and the treatment planning.     

Epilepsie – eine potenziell chirurgisch behandelbare Erkrankung

Epilepsy is one of the most frequent neurological diseases in adults. First line therapy consists of antiepileptic drugs. However, up to 50?% of patients with focal epilepsy do not adequately respond to medical therapy. After failure of two first-line drugs, patients should be referred to a comprehensive epilepsy center for evaluation of the possibility for epilepsy surgery. The noninvasive phase 1 includes history with eye witness report, clinical examination, structural and functional imaging techniques, simultaneous video-EEG monitoring as well as a neuropsychological examination. An invasive phase 2 can be added in cases with incongruent results. Subdural strip and grid electrodes as well as stereotactically implanted depth electrodes give more detailed information on seizure origin and spread. Detailed planning of the surgical approach is of utmost importance. In patients with temporal lobe epilepsy, seizure freedom can be achieved in 60–80?% of cases after epilepsy surgery.     

Operationalisierte Basisdokumentation von Gruppenpsychotherapien

It can be assumed that group psychotherapy will play an increasingly more important role for both inpatient and outpatient basic care not only due to health economic considerations. This means that new methods of documentation, quality management and optimization of group-specific therapy processes and results have to be developed. The present system for operationalized basic documentation of group psychotherapy (OBG) is not only meant to be a starting point for research on dynamics and efficacy of group psychotherapy but could also serve as an instrument for standardized documentation of clinical progress, quality assurance and, in combination with the accompanying manual, as an aid for education and further training for psychotherapists. The contents of the documentation system are based on the current state of scientific research and, as far as possible, were implemented irrespective of specific psychotherapeutic approaches referring to particular schools of thought. Particular consideration was given to the practice guidelines for group psychotherapy of the American Group Psychotherapy Association (AGPA) published in 2007. The system structure is based on a model of anatomy and physiology of a group according to Burlingame et al., which ascertains patterns and processes within groups. In addition to general thematic and methodological aspects, several items on group dynamics are included, such as distribution of roles, formation of subgroups, development of group norms, conflict management, interpersonal feedback, self-disclosure, cohesion and other so-called therapeutic factors. Clinical testing in different settings is currently being carried out. Results and further developmental possibilities of the OBG system will be reported soon.     

LAC-Depressionsstudie

The study on long-term therapy of chronic depression (LAC depression study) is one of the first prospective studies to compare psychoanalytic with cognitive behavioral long-term treatment and also investigates the impact of patient assignment by randomization and preference. This comprehensive multicenter study combines a naturalistic and a randomized controlled approach. The long-term follow-up is based on a broad spectrum of quantitative and qualitative research methods and is expected to contribute to the further development of psychotherapeutic treatment methods in this hard to treat patient group as well as to research on the effectiveness of long-term treatment. The background, design and current state of the assessment are presented. A total of 402 patients with chronic depression were included in the trial and the 1 and 2?year follow-up results are currently being analyzed.     

Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study

Considering that programmatic data suggest a recent rise in vaccine refusal in Croatia, this study, first of its kind in Southeast Europe, aimed to estimate the prevalence, and sociodemographic, and sociocultural determinants of childhood vaccine refusal and hesitancy (CVRH) intentions among Croatian adults. Multi-stage stratified population-based survey included 1000 individuals aged 18–88 years (M_age = 47.7, SD = 17.8), of whom 51.7% were women. The outcome, a categorical indicator, distinguished among individuals who would approve vaccinating their children (vaccine accepting), those who would approve some but not all vaccines (vaccine hesitant), and those who would refuse vaccination (vaccine refusing). A sizeable minority of participants was characterized by childhood vaccine refusal (10.6%) and hesitancy intentions (19.5%). In a multivariate assessment controlling for parenthood, the odds of vaccine hesitancy were significantly increased by a younger age (AOR = 1.96–3.03, p < .01). Religiosity (AOR = 1.12, p < .05) and the use of alternative medicine (AOR = 2.85, p < .001) increased the odds of vaccine refusal. However, individual characteristics seem to be relatively poor predictors of CVRH intentions in Croatia. Following the social contagion model, future research should move beyond individual-level approach and take into account social interaction and social network effects.     

Qualitätskriterien forensischer Ambulanzen des Strafvollzugs

In 2007 the legal reform concerning the supervision of conduct established forensic aftercare as mandatory for patients released from forensic commitment hospitals and offenders released from penitentiaries. Therefore, in the past 10 years forensic outpatient departments have evolved all over Germany in a state-specific manner according to the legal mandate of treating and managing released offenders. Some of these outpatient departments were newly founded and some were long established units for treating and managing offenders that expanded their services for offenders under supervision of conduct. During the past years these heterogeneous outpatient departments have formed a federal network targeting professional exchange, commonalities, discrepancies and distinct characteristics in realizing the legal mandate. Following the debate on minimum requirements in forensic psychiatric aftercare departments of forensic commitment hospitals in 2014, this federal network developed quality criteria. Despite diverse state and trusteeship-specific conditions, these quality criteria emphasize common content and formal factors for a successful forensic outpatient treatment. This article presents the result of a discussion process along with the agreed quality criteria in the categories of the quality of structure, process and results.     

Psychoanalytische Gedanken zur europäischen Flüchtlingskrise und zum Fremden

There are many aspects – political, economic, legal, medical, cultural and religious ones – of the present refugee crisis in Europe. Difficulties in border crossing, settlement programs, life-saving issues and security measures present themselves immediately. The refugee crisis also needs to be examined from a psychological angle. In this paper I will describe psychoanalytic findings on voluntary and forced immigration and human responses to the Other. Change in the twenty-first century is occurring at an unprecedented pace and scale. Globalization, incredible advances in communication technology, fast travel, recourse limitations, and terrorist activities and now the refugee crisis in Europe make psychoanalytic investigation of the Other a major necessity.     

Esoterik und Psychose

Presuming a continuum of psychotic symptoms within the general population as well as in individuals interested in esotericism, a diagnosis is not always unambiguous. Psychotic disorders with treatment indication might be hidden under the guise of esotericism. Taking the patients’ individual concept of the development of psychiatric disorders into account is an important factor regarding treatment engagement and course.     

Psychopathie,antisoziale Persönlichkeitsstörung und Sexualdelinquenz

In today’s field of forensic psychiatry, psychopathy is seen as a subtype of antisocial personality disorder and includes manipulative behavior, egocentric and arrogant characteristics, high-risk behavior as well as a lack of empathy. Empirical data on the prevalence of psychopathy and antisocial personality disorder among offenders greatly vary depending on the study design and the composition of the sampled population. Offenders who committed both violent and sex offenses seem to have antisocial traits with a higher probability than offenders who committed only violent or only sex offenses. In the context of criminal responsibility and risk assessment for sex offenders, antisocial and psychopathic traits have a negative impact on the prediction of recidivism. Many study results, even though not all, additionally indicate that the combination of psychopathic traits and sexual deviance (i.?e. for example a paraphilic disorder such as sexual sadism) in sex offenders may be associated with a particularly high risk to reoffend. Due to the specific interpersonal characteristics (e.?g., dominant, provocative behavior, exaggerated self-esteem), therapeutic treatment of sex offenders with antisocial and psychopathic traits is often difficult. The regular supervision by the therapist is considered to be crucial to avoid harmful relationship dynamics or distorted perception of the therapist.