Diagnose „Gesundheit“

In the early days of psychotherapy diagnoses were seen as unnecessary and even not helpful. After psychotherapy has become a method of medical treatment diagnoses are necessary in order to justify reimbursement of treatment by health insurance. Diagnoses are also useful to guide treatment, help communication between professionals and morbidity statistics. Diagnoses can have negative effects, such as simplification of complex problems, aggravation of normal life experiences or stigmatization and labelling. Therefore, diagnoses should be made when a person is suffering from an illness in order to avoid underrecognition and undertreatment. Similarly, the diagnosis “healthy” is important when no disease is present but only a normal problem in everyday life. To say that a person is healthy is an important and difficult task in all areas in medicine. Therapists must not only know the criteria for illnesses but also those for the spectrum of healthy problems in normal life. This can be done when the psychopathological assessment is professionally precise and makes a differentiation between signs of illness and other negative feelings. Also, normal life events must not be directly translated into illness states. Furthermore, therapists must be aware of their diagnostic preferences and bias. In the training of psychotherapists recognition of healthy states should get as much attention as the diagnosis of illnesses.     

Psychisches Risiko „Großstadtleben“

The material determining factors of mental stress and diseases are comparatively rarely reflected on and analysed in depth in psychotherapy research and by psychotherapists. This article should be seen as a plea to look at these factors in more detail. When this involves the question of the influence of risk factors of city lifestyle conditions on the mental health of its inhabitants, the urban environment“city” is the melting pot for a multitude of individual factors and factor constellations the influence of which must be theoretically conceptualized and empirically collated.     

Intuition

At least since the Enlightenment Western thought has been dominated by a skeptical attitude towards intuition, although it is vital for mental and creative functions. In contrast, in recent times, a re-evaluation has emerged. Intuition is now considered by many to be of significant assistance not only in everyday life but also in making complex decisions in business, people management and psychotherapy. This article describes different dimensions of intuition ranging from unconscious intelligence in everyday life through intuitive processes with their connection to the collective unconscious up to its spiritual dimension. The question of how intuition works is extensively discussed. A distinction is made between intuitive work, resonance phenomena and gut feelings. The author concludes that it is not a question as to whether we want to use intuition as a source of knowledge for ourselves but if we recognize and appreciate that we do it constantly.     

Implizites Beziehungswissen

Implicit relational knowing is for the most part procedural implicit knowing. Implicit relational knowing operates outside verbal experience and is mostly expressed in actions and constitutes the ‘how’ of being with others. Interpersonal relationships develop step by step and even subtle behavioral means can be a step. A subsequent step documents how the person interprets the preceding behavior of the other person. According to the Boston Change Process Study Group (BCPSG), implicit relational knowing can change with increasing integration and coherence in the therapeutic process. This enables the patient to bring into the therapeutic relationship even difficult and affectively charged experiences which thus become “relationable” for the patient.     

Kognitive Verhaltenstherapie bei schizophrenen Psychosen

Cognitive behavioral therapy (CBT) can be regarded as an established intervention for the treatment of patients with schizophrenia. Based on randomized clinical trials and meta-analyses, which found evidence for the efficacy of CBT, almost all evidence-based treatment guidelines recommend CBT for routine treatment. This paper demonstrates that in psychoses CBT is a disorder-specific adaptation of general principles of CBT for the treatment of patients suffering from schizophrenia. The CBT procedure draws on cognitive models of symptoms for the identification of treatment targets and focuses on everyday problems of patients by implementing a self-management approach. Fostering motivation and the application of behavioral and cognitive treatment strategies characterize this approach. If the patients live in a family, other family members should be involved in order to improve crisis management and problem solving within the family. A major challenge for the future is to improve the availability of CBT under the German conditions of routine mental health care.     

Mentalisierungsbasierte Psychotherapie bei schizophrenen Psychosen

Recently, there has been growing interest in new methods of psychotherapeutic interventions for schizophrenic patients. Social cognition, social functioning and quality of life are central objectives. Mentalization-based therapy (MBT) is a specific psychodynamic method developed from the fundament of attachment theory and empirical psychotherapy research for the treatment of borderline personality disorder, particularly focusing on attachment relationships, mentalizing capacity and affect regulation. Studies have shown that MBT is able to ameliorate interpersonal experience and social life. The latest neuroscientific findings support this view and encourage the application of a modified form of MBT in the treatment of schizophrenic patients. The authors present a concept for disorder-specific interventions in schizophrenia, including psychoeducational aspects and mentalizing exercises which step-by-step lead to a more reflective work in mentalization-based group psychotherapy.