Beziehungsmuster und Beziehungskonflikte

Zusammenfassung  Die Veränderung pathogenetisch bedeutsamer Beziehungsmuster gilt als wesentliches psychotherapeutisches Behandlungsziel. Um zielgerichtete Veränderungen von Beziehungsstrukturen zu erreichen, bedarf es sowohl einer Diagnostik und Beschreibung solcher Beziehungsmuster, einer darauf zielenden Behandlungstechnik als auch einer Verlaufskontrolle und Evaluation der angestrebten Veränderungen. Nach einem Überblick über verschiedene Methoden zur Erfassung von Beziehungsmustern wird die Methode des Zentralen-Beziehungskonflikt-Themas (ZBKT) von Luborsky näher beschrieben; ausgewählte Ergebnisse der ZBKT-Forschung werden dargestellt und die Methode kritisch bewertet.

Introducing ethics and engineering: the case of Delft University of Technology

This article focuses mainly on (1) the policy of Delft University of Technology since 1992 as regards the university-wide introduction of a compulsory course on ethics and engineering, and (2) the ideal structure of such a course, including the educational goals of the course. Dr. G. J. Scheurwater is Senior policy-advisor to the Board of Delft University of Technology. Prof. S. J. Doorman is Chairman of the Advisory Committee on Ethics of Delft University of Technology.     

The ‘redefinition of death’ debate: Western concepts and western bioethics

Biomedicine is a global enterprise constructed upon the belief in the universality of scientific truths. However, despite huge scientific advances over recent decades it has not been able to formulate a specific and universal definition of death: In fact, in its attempt to redefine death, the concept of death appears to have become immersed in ever increasing vagueness and ambiguity. Even more worrisome is that bioethics, in the form of principlism, is also endeavouring to become a global enterprise by claiming neutrality. It appears that the discourse within both disciplines have similarly manipulated the boundaries of death to include the “dying”. This paper argues that the redefinition of death debate in biomedicine reveals a concept of personhood which is profoundly western in origin and which is in accordance to the concept adhered to within principlism. Biomedicine and bioethics do not appear to acknowledge the limitations of their own world view and hence lack an understanding of their applicability and appropriateness in diverse social and cultural contexts; a situation which adds credence to claims as to the hegemonic and imperialistic nature of all such global enterprises. Ms. Jones is an intensive care clinical nursing specialist. Dr. Kessel is a public health physician and medical ethicist.     

A conceptual model of child psychopathology: implications for understanding attention deficit hyperactivity disorder and treatment efficacy

Highlights the desirability of using a theoretical framework for guiding the design and evaluation of therapeutic interventions for children with attention deficit hyperactivity disorder (ADHD). A general conceptual model is introduced and used to evaluate ADHD treatment outcome research. Treatments designed to target the substrate level (pharmacological interventions) result in broad, robust improvement in both core and peripheral areas of functioning. Those targeting hypothesized core features of the disorder (i.e., attention, impulsivity-hyperactivity) produce corresponding improvement in core and peripheral outcome measures with the exception of studies employing cognitive-behavior therapy. Those targeting peripheral features of the disorder effect change only in corresponding peripheral areas of functioning. Implications for clinical practice are discussed, and an alternative conceptual model of ADHD is introduced and compared with existing models.     

Fehldiagnose Aufmerksamkeitsdefizit- und Hyperaktivit?tssyndrom?

Although it is assumed both by healthcare professionals as well as by public opinion that attention deficit hyperactivity disorder (ADHD) is widely overdiagnosed, so far there is little empirical evidence to support this presumption. However, the presented study shows clear evidence for an overdiagnosis of ADHD. Furthermore, the data demonstrate that based on identical symptoms, boys more often receive a diagnosis for ADHD than girls. A false ADHD diagnosis also correlates with a recommendation for medical and psychotherapeutic treatment. One explanation for misdiagnosis is the fact that therapists in the course of diagnosis, as with other everyday decision-making processes, are influenced by heuristics. The most common heuristics that can lead to misdiagnosis are the representativeness heuristic and the availability heuristic. Such mistakes could be avoided by clearly following diagnostic criteria and the use of structural interviews.     

Relationship between reaction time variability and motor skill development in ADHD

Slower and more variable reaction times to computerized tasks have been documented in children diagnosed with attention deficit/hyperactivity disorder (ADHD). Recent research supports a role for attentional lapses in generating abnormally variable and slow responses. However, given the association between ADHD and impairments in motor control, we hypothesized that slower or more variable reaction times might also correlate with motor development. The aim of this case-control study was to explore the relationship between motor function, reaction speed and variability, and ADHD. After comprehensive educational and clinical assessments, motor skill development was evaluated in 35 children ages 9 to 14 (19 with ADHD) using the Physical and Neurological Examination for Subtle Signs (PANESS) test battery. Finger-sequencing speed and variability were quantified with goniometers. Reaction times were measured with 20 trials each of computerized simple and choice (binary) tasks. Compared to healthy controls, children with ADHD had slower and more variable reaction times, and these findings correlated with impaired motor development (PANESS) and slow and variable finger sequencing (goniometers). Further studies of motor development in ADHD may identify factors influencing speed and variability of reaction times.     

Linderung depressiver Symptomatik

Standard interventions, such as antidepressive medication or psychotherapy, show only medium effect sizes in the reduction of depressive symptomatology. In addition, medication has problematic and not well accepted side-effects therefore it seems reasonable to look for alternative, cost-effective, easily available treatments which show no side-effects. A large number of studies have demonstrated similar neurophysiological effects of sport as antidepressants or psychotherapies but the crucial question remains unanswered: does sport show antidepressive effects by alleviating depressive symptomatology? Some randomized, controlled studies and all available recent meta-analysis addressing this question are reviewed. This review concludes that randomized control trials including sport activities have similar positive effect sizes as psychotherapy or antidepressant studies. The pre-post effects are in the medium to high range. Such a conclusion is jeopardized by a limited number of methodolically sound studies. It is too early to make evidence-based recommendations about the antidepressive effect of sport. Currently, it can only be speculated about moderators and mechanisms mediating outcome.     

Psychotherapie, Globalisierung, Hartz?IV

The mental effects of globalization, the economic crisis and unemployment must not be underestimated. In general they have to be looked upon as a complex system of structural traumatization which is causing severe psychological mental disorders, such as depression. Not only that, a psychotherapist has to pay particular attention to this. More than in physical illnesses the psychotherapist has to be solidly united with the patient, which might also result in political action.     

Sexualit?t und Internet

On the discussion about sexual internet activities, the professional and public discourses have been strongly polarized for a long time. Currently the trend is that online sexuality is to be seen in a differentiated and empirical manner. Next to undesired (e.g. assault by internet platform) or indirect (e.g. due to excessive pornography use by partners) confrontations with online sexuality, there is a broad spectrum of self-initiated sexual use of the internet. These are, for example reception of information sites, exchange of experiences, utilization of online sexual consultation and romantic relationships. On the other hand clinically relevant problems could accompany sexual internet use, such as cybersex addiction. Because of the mediatization in society ambulant patients in the psychotherapeutic practice are more informed about sexual internet use. For psychotherapists it is important to know the internet-specific details and the potential risks and chances for sexual behavior in order to know how to deal with the situation and if necessary to integrate the internet into the spectrum of web-based sexual therapeutic options.