Forensische Psychiatrie zwischen Therapie und Sicherung

The therapeutic tasks of forensic psychiatry range between the field of tension of “improvement” and “security” of entrusted persons. With respect to these aspects a paradoxical position of politics and society can be seen: whereas, regulatory security aspects are emphasized and detention measures are required with respect to the treatment measures according to §63 and §64 of the penal code (StGB) and any relaxation of rules is critically viewed, under pressure from the European jurisprudence preventive detention has been declared as a therapeutic measure. The superordinate priority of these measures is to prevent recidivism. This article firstly summarizes the empirical evidence concerning the efficacy of forensic psychiatric treatment of relevant disorders. From this it becomes obvious that the data are unreliable due to relevant risk aspects; therefore, the comparison of safety and therapeutic interests remains a challenging undertaking. A working approach that can successfully encompass both aspects is long-term case management, which is in a position to do justice to both the inpatient interaction and dynamic aspects of the treatment process beyond detention. Because the effectiveness of aftercare has been confirmed, we propose the implementation of forensic outpatient treatment as an alternative to forensic inpatient treatment.     

Die Psychotherapieausbildung aus Sicht der Lehrkräfte

Background

A survey was carried out to ask the trainers and supervisors about their appraisal of the quality of the psychotherapy training and about ways to improve it 10 years after the inception of the “German psychotherapy law”.

Methods

Training institutes provided e-mail addresses and other contact information from over 5,000 trainers. The questioning was carried out mainly by on-line questionnaires and 2,196 data sets were used for analysis.

Results

Trainers showed overall satisfaction with the components of psychotherapy training and the skills of the training candidates. More knowledge transfer in the fields of therapy techniques and case studies and more cooperation with other professional groups were suggested. Trainers acknowledged redundancies between professional training and university studies and observed a heterogeneity of trainees, however, these were mostly considered helpful. Only half of the trainers were subject to evaluation of their work.

Conclusions

The quality of psychotherapy training could be improved by stronger emphasis on practical knowledge. Structural changes should be made to take the problem of redundancies and heterogeneities into account. Regular and continuous evaluation of the training should become an integral part of professional training and the results should have consequences.     

Familienplanung junger onkologischer Patienten

Cancer patients in young adulthood are affected by the cancer diagnosis in a period of life where future parenthood or fulfilling of a potential wish to have children plays an important role. To perform fertility preserving treatment, patients should be fully informed before any treatment is carried out. The following review broaches the issue of whether and how fertility concerns are discussed in the medical consultation. Therefore, relevant papers were identified by a database search between the years 2000 and 2010. A total of 21 studies were included which focussed on physician-patient communication from the point of view of the patients or healthcare professionals. Oncologists do not routinely speak to patients about fertility issues. Both oncologists and patients expressed communication difficulties. An improvement of the medical interview concerning family planning could be achieved by provision of guidelines, training for healthcare professionals, cooperation between oncologists and reproductive medicine and the provision of educational patient material.     

Innerdeutsche Migration und psychisches Befinden

In a representative study German migrants within Germany were assigned to two different groups depending on their answers to the following two questions (?Where did you mainly grow up – Eastern Germany or Western Germany?“ and ?Where do you live now?“). The migrants (54 West-East and 68 East-West migrants) were compared with non-migrants (1,136 Western and 294 Eastern Germans) concerning different variables of their psychic condition. Migrants suffered from higher stress, less bodily well-being and more somatic symptoms than non-migrants. Probands migrating from Western to Eastern Germany reported the lowest levels of quality of life.     

Ambulante Psychotherapie in Deutschland aus Sicht der Patienten

This study analyzed the provision of outpatient psychotherapy services in Germany in standard practice settings. A total of 1,212 subjects who received or were still receiving outpatient psychotherapy during the past 6 years provided information about their experiences via a telephone survey. Outpatient psychotherapy was sought for many different conditions and was rated as highly effective. The improvement rates for all complaints were higher than 50%, except for obesity (37%) and sexual dysfunctions (44%). Patient ratings of worsening were less than 8% throughout. Treatment had very positive results not only for target symptoms but also for other aspects of patients?? lives. Almost 90% of those questioned stated that they were satisfied with their therapist. High agreement ratings were reported specifically with respect to positive therapeutic relationship, stable working alliance, experience of autonomy during therapy and therapists?? competency and ethical conduct. Patients gave their psychotherapists excellent evaluations and were highly satisfied with the changes achieved through treatment.