Psychotherapeutische Kurzintervention bei somatisierenden Patienten im Krankenhaus

The manual describes the psychotherapeutic procedure for somatizing patients who are admitted to hospital for diagnostics and therapy of unclear physical complaints. An essential goal of the psychotherapeutic interventions is to achieve an understanding for the disease, in which body, psyche and social relationships are experienced as interrelated. By addressing the health fears and subjective concepts about the onset and maintenance of his physical complaints, the patient feels that he is being taken seriously and understood. Connections between physical symptoms and the suppression of undesirable affects like anger, rage and disappointment are verbalized and understood in greater depth, based on body perception exercises and a symptom diary. The positive experience of understanding and symptom relief obtained in the psychotherapeutic sessions is used for the main goal of the intervention: to motivate the (out- and in-)patient for a regular psychotherapy. Experience up to now has shown that three to five sequential sessions of about 45–60 minutes suffice to attain this therapy goal. Implementation is most successful within an established consultant or liaison service in close cooperation with the ward doctors.     

Qualifizierung und Qualit?tskontrolle in der forensischen Psychiatrie

At the end of the last decade severely violent and sexual crimes by previously convicted persistent offenders initiated a discussion about the necessity of quality control in the forensic psychiatric practice in Switzerland. Subsequently, measures similar to those in Germany were adopted, e.g. the implementation of a specialisation in forensic psychiatry. In addition, they included the creation of commissions with the duty of evaluating the dangerousness of serious offenders, the implementation of a standardized and certificated postgraduate training in forensic psychiatry and guidelines for the qualification of forensic assessment experts and the quality of reports. The following article presents the implemented measures and discusses their possible consequences for the quality of forensic psychiatric work.     

Einige (neuere) Bemerkungen zur freien Assoziation

Three aspects of free association, namely the technical aspect, the aspect of content and the processual aspect, are examined in terms of the ideological development of this concept, which is still central for psychoanalysis. Further, it is shown that the theoretical conception of free association and of its claim and scope as well as the communication of the fundamental rule have changed in the course of time. New studies in basic research could lead to a reassessment of free association.     

Großgruppenidentität und psychosoziale Abwehr

The following considerations have their source in more than 25 years experience with intercultural contacts in teaching and research in China and with psychoanalytic therapies with patients from foreign cultures. They may broaden the inner space of the psychoanalyst by a new dimension, which is not systematically reflected due to the integration of each in the own large group identity but influences the unconscious aspects in the work with people from foreign cultures. The concepts of psychosocial defence (S. Mentzos), of large group identity (V. Volkan) and of the ethnic unconscious (G. Devereux) are helpful instruments for understanding restrictive countertransference reactions, which handicap not only the work in the psychoanalytic setting, but also all intercultural relations.     

Begutachtung der Kriminalprognose

A variety of standardized instruments allows risk assessment based upon empirical data. This paper calls attention to the pitfalls immanent to the application of popular prognostic instruments (Violence Risk Appraisal Guide, Static-99, Historical Clinical Risk Management-20, Psychopathy Checklist-Revised). Psychopathological assessment, however, has not been superseded by standardized instruments but serves as a valuable addition in terms of an integrative approach.     

Psychosomatische Aspekte des Diabetes mellitus

The term “diabetes mellitus” describes a group of endocrinological diseases characterised by hyperglycemia. The treatment is demanding for patients in terms of self-management and self-responsibility, and some patients need not only medical but psychological support as well. This article reviews essential psychological aspects of diabetes, starting with factors affecting adherence to diabetes treatment. The main part describes epidemiology and interactions between anxiety disorders, eating disorders and depression in patients with diabetes. Treatment recommendations are derived from current knowledge in accordance with evidence-based treatment guidelines.     

Subjektive Einschätzung der eigenen Gesundheit und gesundheitsrelevantes Verhalten bei niedergelassenen Psychologischen Psychotherapeuten

From June until August 2004 we asked 488 established psychological psychotherapists in selected German federal states for a subjective evaluation of their own health, their utilization of the health care system and their health-related behavior. It turned out that the psychotherapists mainly reported a good state of health although their reported state of health was more negative than in the general population with equal age and level of education. This finding is surely connected with specific mental, physical and existential burdens of their profession as well as with specifics of the “psychotherapist personality”. The psychotherapists’ evaluations highly depend on age, but not significantly on sociodemographical criteria like gender and place of establishment (East/West Germany). Also the affiliation to a therapy school (psychoanalysis, depth psychological funded psychotherapy, behavior therapy) is irrelevant for the subjective evaluation of one’s own health. Concerning the annual number of consultations and disability days the psychotherapists are clearly below average. They report a lot of attentiveness about their health and practice a health-benefical behavior. In this case they make higher demands on themselves than the general population.     

Affektverarbeitung und Beziehungsgestaltung bei somatoformen Störungen

Somatoform disorders are usually associated with disturbances in affective processing and consequently with relational disorders. The effect of psychotherapy on the emotional regulation and the relational behaviour in the course of treatment of a patient with somatoform autonomous dysfunction and dysthymia has been examined. Pre-post comparisons of inpatient treatment have been performed by means of standardized questionnaire data; the course of therapy has been evaluated by the analysis of the dependence of the leading symptom of hypogastric pain on mood parameters with the help of multivariate time-series analyses. One effect of psychotherapy was the initiation of an intrapsychic discourse, which led to an improved ability of affect regulation as well as to a better functioning in relationships. This was accompanied by a reduction of somatization. The interrelations between somatization, affect- and relationship-regulation are discussed.