Ökonomisierung und Psychotherapie

Former fundamental social structures are disappearing and, especially by the economization and industrialization of medicine, the self-understanding of patients, doctors and hospitals has changed. From these developments psychotherapy gets into a strange area of tension, not only in the society as a whole, but also within medicine: on the one hand psychotherapy is needed more than ever, but on the other hand it finds itself in an outsider position. Thereby, the reality constructions of patients and psychotherapists are affected as well, mostly gradually, so that the consequences for the relationship between psychotherapists and patients escape attention. Dealing with these problems in a considered and transparent manner can avoid damaging the therapeutic work.     

Psychodynamische Kurzzeittherapie mit erlebnisaktivierenden Interventionen

This short-term therapy model with experiential interventions is based on the basic assumptions of psychodynamic psychotherapy. The focus of treatment is the current psychosocial situation, in which dysfunctional emotional patterns are elicited by specific triggers. These emotional patterns are evidence of anconscious intrapsychic conflict, which has biographically relevant precursors. This conflict and the associated dysfunctional relationships are explored in a supportive therapeutic relationship, formulated in cooperation with the patient and then made accessible in an experience-activating process in the present. The effect is, in addition to the reduction of clinical symptoms, the improvement in managing relationships and improved social competence. The transference is noticed, but it is only addressed if it has a lasting compromising effect on the therapeutic relationship. This therapy model is especially suitable for psychotherapy with time limits of 25–40 hours.     

Psychopathologie und Behandlung der Borderline-Persönlichkeitsstörung

Zusammenfassung Das Wissen über Psychopathologie, Ätiopathogenese und Behandlungsmöglichkeiten der Borderline-Persönlichkeitsstörung (BPS) hat sich in den letzten Jahren deutlich verbessert. Heute sehen die meisten Wissenschaftler eine generalisierte Störung der Affektregulation im Zentrum der BPS, deren Ursachen in Wechselwirkungen zwischen genetischen Faktoren, traumatischen biographischen Erfahrungen und dysfunktionalen Verhaltensmustern liegen. Störungsspezifische Therapieverfahren, insbesondere die Dialektisch Behaviorale Therapie (DBT) nach Linehan, flankiert von psychopharmakologischer Behandlung, zeigen gute Behandlungsergebnisse sowohl im stationären als auch im ambulanten Bereich. In jüngster Zeit wurden viel versprechende Konzepte zur Behandlung schwerer komorbider Störungen [Alkohol und Drogenabhängigkeit, Posttraumatische Belastungsstörung (PTBS)] entwickelt.     

Langzeitwirkungen psychoanalytischer und verhaltenstherapeutischer Langzeitpsychotherapien

The prospective study compares 31 patients in long-term behavior therapy with 31 patients in psychoanalytically oriented long-term therapy. A naturalistic design was applied within the German health system. All patients underwent a diagnostic interview (SCID) by an external interviewer. Only patients who fulfilled the DSM III-R criteria for a depression or an anxiety disorder were included in the study. Although the diagnoses of the patients undergoing long-term behaviour therapy and long-term psychoanalytical psychotherapy were comparable, we found that they differed in various ways. The differences arose in a number of characteristics, such as education, access to psychotherapy (recommended by professionals versus patients introducing themselves), usage of psychotropic medication, and the strain of symptoms. The average duration of long-term behavior therapy was 2.4 years and 64 sessions. The average duration of psychoanalytically oriented long-term therapy was 3.6 years and 209 sessions. Symptoms (SCL-90-R) and interpersonal problems (IIP) were examined at the beginning, after 1 year, 2.5 years, 3.5 years and after 7 years. Both groups showed significant degrees of improvement within the first 3.5 years and remained stabilized in the following 3.5 years regarding the symptomatic aspects. Focussing on the interpersonal problems, group PA showed further improvement after the 3.5-year period. The BT group however, showed no further improvement after 3.5 years but stabilized. The evaluated phase-model of psychotherapeutic change for short-term therapy was confirmed more clearly for long-term therapies of psychoanalytical orientation than for long-term therapies of behavioral orientation.     

Meaning-Preserving Translations of Non-classical Logics into Classical Logic: Between Pluralism and Monism

Journal of Philosophical Logic - In order to prove the validity of logical rules, one has to assume these rules in the metalogic. However, rule-circular ‘justifications’ are...     

Zur Dynamik der Interaktion in der Supervision

The manifold functions of a supervisor in following the course of complex processes together with the trainee, are: ? to keep the goals of the supervision in view, ? to establish a teaching alliance and to support the wish and ambitions of the candidate to learn, ? to build a platform for the complex interactions with the trainee with regard to the dynamics of the training situation and keeping in mind the institutional influences, ? to lay down the setting for the work, ? to explore and to reflect how transference and counter-transference influence the interaction between patient and analyst as well as between trainee and supervisor, ? to examine these interactions together focussing continuously on the interaction between candidate and patient, and to encourage the candidate to do the same on his own, ? to continuously formulate hypotheses about the core conflict, the transference phenomena and resistance of the patient, ? to explore and reflect on the cooperative work.     

Stalking

An anti-stalking law, now common in many western countries, took effect in Germany in November 2006 (§238 Criminal Code; see Infobox). Stalking occurs when a stalker follows a victim for weeks or months and shows molesting, threatening or attacking behavior. Through the continual pursuit, the victims feel at the least extremely insecure and at times afraid; in extreme cases, stalking can lead to psychological disturbances. Our investigations have shown that about 10–15% of males and 15–20% of females are stalking victims at some stage of their lives. This contribution describes the different forms of stalking and discusses the various motives for this behavior, as well as the psychological problems of the victim. It also provides some first thoughts on the psychotherapy of both stalkers and victims.     

Leitlinie für die Begutachtung von Schmerzen

The present guidelines for expert testimony have been elaborated for the first time in 2004 by medico-legal representatives from several German professional academic societies (neurology, orthopedic surgery, psychiatry, psychosomatic medicine, psychotherapy). Their aim is to standardize the course and the content of expert testimony in subjects, who complain about chronic pain as the leading symptom for seeking pension or other compensation. In 2006, the guidelines have been revised and completed by adding detailed data about classification and prognosis of chronic pain, about causality questions, and about estimation of functional impairment in different legal areas.     

Fibromyalgie und Leistungseinschränkung

Interdisciplinary guidelines allowed for new quality standards in pain appraisal. Simultaneously, the scientific notion of fibromyalgia changed from a subjectively overvalued malaise to a central disturbance of coping with stress, which is neurobiologically determined. Therefore, in this article a psychosomatics-based guide is given for the socio-medical appraisal of fibromyalgia with reference to the new International Classification for Functioning and Disability (ICF) of the World Health Organization (WHO). As illustration a case study is presented.