Lachen, um nicht zu weinen …

In this article the prevalent concepts on crying will first be described, especially concepts on occasions and various functions of crying. Subsequently, some very preliminary results of an ongoing study are presented including assumptions about the reasons why crying is mostly experienced as being difficult and aversive and is therefore often suppressed or controlled by laughter. Examples from diagnostic interviews will illustrate the interplay of laughter or smiling and crying. At the end a hypothesis on the basic function of crying and on the connection between crying and laughter will be presented.     

Familienfunktionalität und Therapieerfolg

Background

Even though it is a treatment standard of child psychotherapy to involve the parents, hardly any research has been carried out about the impact of family functioning on treatment outcome. Aims of the present study were to investigate the change in and the prognostic power of family functioning on treatment outcome of short-term psychodynamic psychotherapy in children and adolescents.

Patients and methods

The sample consisted of 54 children and adolescents undergoing outpatient short-term psychodynamic psychotherapy. To assess family functioning, their parents were asked to complete the Family Assessment Measure (FAM).

Results

Patients from families with high levels of functioning in task accomplishment, communication and affective expression were more often treated successfully. Improvement in levels of functioning in role performance, emotionality and control were only found in the group of successfully treated patients.

Conclusion

Family functioning is a decisive factor in the differential indication of psychotherapeutic treatment in children and adolescents.     

Hausaufgaben in der Psychotherapie

Homework assignments represent a standard intervention in psychotherapy. Homework provides the unique opportunity to emphasize patients’ responsibility for therapeutic change and to intensify the therapeutic process. Despite these high potentials systematic homework assignment is still rare in practice. Psychotherapy research has just recently focused its attention on homework as an effective therapeutic method. Meanwhile the positive effects of homework use on therapeutic outcome have been demonstrated but little is known about therapeutic strategies to enhance these effects. The present article highlights the functions of homework within the therapeutic process and discusses its theoretical mechanisms of action. The article concludes with suggestions from both an empirical and practical point of view to further assist practitioners’ use of homework assignments.     

Körperbeschwerden bei niedergelassenen Psychologischen Psychotherapeuten

From June until August 2004 we asked 488 freely practising psychological psychotherapists in selected German federal states for the frequency of somatic complaints using the short version of the Gießener Beschwerdebogen (GBB-)24. It turned out that the psychotherapists suffered most from exhaustion and pain. Their somatic complaints were remarkably less influenced by sociodemographic characteristics like age, gender and location of practising (East/West). In comparison to the overall population the psychotherapists in total reported quantitatively the same frequencies of somatic complaints. Qualitatively the psychotherapists reported less problems concerning gastric and heart complaints but more problems concerning exhaustion than the overall population. Compared with a sample of saxonian general practitioners, the psychotherapists suffered from slightly less somatic complaints.     

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.     

Dissoziative Störungen (Konversionsstörungen)

The ICD-10 diagnostic category of dissociative disorders encompasses very different clinical pictures. The so called dissociative disorders of consciousness are characterized by functional disturbances to the psychic domains of consciousness, identity, autobiographic memory and experience of self and the world. The core features of conversion disorders are functional alterations in the sensorimotor systems. The phenomenological heterogeneity is reflected by prevalence rates ranging from very rare to 30% in clinical populations. Traumatic experiences play a crucial role in the etiology and pathogenesis of these disorders. High rates of comorbid disorders, a tendency to a chronic course and a somatic illness concept in patients with conversion disorders complicate the psychotherapeutic approach. Depending on the therapeutic goals, both psychodynamic and cognitive-behavioral treatment forms are suitable.     

Psychologische Mess- und Testverfahren

The use of psychological assessment methods is flawed by incorrect assumptions of their capacity. Some of these assumptions are discussed. It is argued that psychological tests are necessary to expand the database for expert reports about the impact of mental disorders on work and different levels of functioning. Tests help to protect psychological assessments against errors and chance bias. With respect to levels of functioning, examples of German tests and questionnaires are given. Test-based information requires objective validation methods and should not be subordinated to an intuitive assessment strategy.     

Die Sachverständigenexpertise im Spannungsfeld zwischen Justiz und Psychiatrie am Beispiel des Hangbegriffes des § 66 StGB (Sicherungsverwahrung)

Using the example of psychiatric expert opinions in trials leading to preventive detention, we analysed how far the corresponding orders by the courts were suited to guide the psychiatric experts and restrict them to their area of expertise. Furthermore we concentrated on the question, what reasons were given for preventive detention on both psychiatric and judicial side and how psychiatric arguments were adopted by the judges. Our results show clearly, that placing an order with the psychiatric expert as well as adopting the psychiatric arguments for preventive detention occur mainly in a stereotypic way. Psychiatric and judicial arguments for preventive detention refer both to previous delinquency. Aspects concerning the offenders personality appear to be secondary, although they play a major role in the decision for preventive detention. The article shows the controversy associated with forensic-psychiatric expertise in the courtroom and the need for communication and clarification between psychiatry and law.