Biomedical subjects
M von Rad
Publications and source records attributed to M von Rad.
[DKPM basic documentation. A uniform basic documentation for inpatient psychosomatic treatment and psychotherapy].
The Arbeitsgemeinschaft Basisdokumentation presents the DKPM-Basisdokumentation, which is conceptualized as a uniform modul of a documentation system for the routine-like use in the in-patient psychosomatic and psychotherapy. We outline possibilities of use, aspects of the data security and the data access as well as some practical presuppositions.
["Quality of life" in the former and new Germany].
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[Predisposition and environment. Remarks on W. Bräutigam's "Causality in neurotic and psychosomatic diseases"].
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Empirical hypotheses on the psychotherapeutic treatment of psychosomatic patients in short and long-term time-unlimited psychotherapy.
In the Heidelberg Follow-Up Project, the results of psychoanalytically oriented treatment in a practice-oriented design are investigated. The patient sample is not homogeneous with regard to the diagnosis; the sample (n = 209) comprised primarily psychoneurotic and psychosomatic patients. All treatments were intended as long-term psychotherapies. The duration of therapy as well as the number of sessions actually realized may be regarded as one result of therapy. This situation, which is not quite ideal in the classical clinical experiment, allows us to develop the following empirical hypotheses: (1) The relationship between the therapeutic effort (e.g. treatment duration and number of sessions) and the results of psychotherapy can be mapped by a dose-effect model. The formal characteristics, especially the shape of the corresponding graphs, are similar for four different evaluation levels. Within the context of a dose-effect model, a treatment duration of about 2.5 years or respectively a number of sessions of about 160 seem to be most beneficial. (2) If we split up the total sample of patients into two subgroups (group 1: patients with psychoneurotic symptoms or non-chronified bodily dysfunctions; group 2: patients with psychosomatic illnesses or chronified bodily dysfunctions) and repeat the analysis, we obtain similar results for both groups of patients. The dose-effect graphs are of similar shape but differ in height. There is a slight tendency in patient group 2 that a treatment duration of up to 3.5 years may be associated with increased success rates.
Time and its relevance for a successful psychotherapy.
Time and the distribution of time have hardly been taken notice of up to the present although they are of great importance when considering the economic perspective. The present study reports on the results found between certain time parameters (e.g. total duration, total number of sessions, number of sessions per week, longer interruptions) and the outcome of psychoanalytic psychotherapies. The sample consists of 76 patients with neurotic, functional or psychosomatic diagnoses. The results support the thesis that not only the quantity of time (number of sessions, duration of therapy), but also the distribution throughout the therapy is associated with the success of therapy.
[Psychosomatic aspects of sudden deafness].
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The integrated psychosomatic inpatient unit. A new approach to hospital medical care.
In contrast to the liaison psychiatry model, various types of psychosomatic inpatient units have been established successfully especially in Europe. Since Simmel's first attempt, they all use the unique possibility to create a special milieu of psychosomatic understanding and treatment of patients with all kinds of illnesses and somatic diseases. To fulfill this goal, the psychosomatic unit has to rely on three conditions: it must (1) be institution-independent as well as integrated within a large hospital system; (2) provide psychotherapeutic and somatic care of equally high standard, and (3) have the possibility to keep the patient sometimes for a longer duration than in other (e.g. internal) medical inpatient units. Principles, experiences and results of a psychosomatic unit with 60 beds integrated in a large municipal hospital are presented as an example for this promising approach to modern medicine.
[Current problems of psychoanalytic psychosomatics].
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Indication in psychotherapy on the basis of a follow-up study.
The problem of indication is a central one of psychotherapy research. Unfortunately up to now only few scientific results contribute to a therapist's decision in selecting patients for a specific therapeutic setting. Thus, indication and outcome research should be combined. A critical view on traditional research strategies demonstrates that psychotherapy research should replace the ideal of normative and general rules by the rational investigation of one's own therapeutic practice. From this point of view some results of the Heidelberg Follow-Up Project of 110 psychotherapies which were started on an inpatient and continued on an outpatient basis are presented. Based on the therapeutic changes of these 110 patients the question is investigated whether the decisions of the indications correspond with the therapeutic goals of the treatment models. Moreover, the question is discussed what kind of success a specific treatment model offers for 'problem patients'.
Alexithymia and symptom formation.
In regard to its clinical descriptive aspects the concept of alexithymia is based on a broad consensus of the investigators. However, with respect to its etiopathogenesis (hereditary, neurophysiological, sociogenic, psychogenic) and its relevance for the formation and maintenance of psychosomatic symptoms, this concept is controversial and unclear. In this context the psychodynamic aspects which are under discussion for the development and maintenance of alexithymic behavior are reported particularly from an object relations point of view. Some resulting principles for a possible psychotherapy of these patients are finally presented.
Prevalence and incidence of psychic disorders and the provision of psychotherapeutic care: an epidemiological field study in the Andorran Lake District 1950-1980.
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Success and failure in psychotherapy: hypotheses and results from the Heidelberg Follow-Up Project.
Within the Heidelberg Follow-Up Project all treatments of the clinic regardless of the type of psychodynamic technique used are investigated. The outlet is both prospective and retrospective. There are four points of investigation: (1) immediately after the first contact with the hospital (2) at the beginning; (3) at the end of therapy, and (4) after a 2-year follow-up period. Immediately after the first contact with the patient a test battery (Giessen Test, Holzman Inkblot Technique, Gottschalk-Gleser Method, symptom checklist) is administered. This is repeated after a waiting period at the beginning of therapy, where in addition the therapist formulates a psychodynamic hypothesis and defines 3-5 individual treatment goals in connection with the individual pathology of the patient. At the end of the therapy the tests are repeated and the therapist assesses the success or failure of the therapy with regard to symptoms, object relations and psychodynamic change, while the patient fills out a special questionnaire dealing with his personal view of the therapy, the therapist and his own treatment experiences. The first results of about 100 combined inpatient and outpatient psychotherapies are presented (third test-round at the end of treatment). The results are discussed on the basis of the involved tests and ratings with respect to success and failure in the view of patients, therapists and independent clinical experts. Since the study is still under way, reports of the follow-up data are not yet evaluated.
Content analysis of verbal behaviour in psychotherapy research: a comparison between two methods.
Verbal behaviour of a mixed patient population during psychotherapeutic interviews was analysed for affective content by means of two content analytic techniques, the Gottschalk-Gleser method and the 'anxiety topics dictionary' developed at the University of Ulm. Both methods share basic theoretical assumptions regarding affect definition and strive for pragmatic relevance in their meaning categories. They differ with respect to the analysis program they employ, the main difference being the coding unit and the extent to which they take into account contextual information. Correlational data presented shows a significant positive relationship between scores for shame and separation anxiety from both methods. A somewhat weaker correlation was found for guilt anxiety. These results suggest a formal similarity between these constructs as operationalized by both methods and call for further research on the comparability of meaning categories in studies of verbal behaviour.
Empirical evidence of alexithymia.
In spite of the wide discussion on alexithymia for the last years, empirical research aimed at its testing or validation has been remarkably scarce. Two basic approaches can be distinguished: psychometric investigations (for instance, using questionnaires) based upon previous operationalization of 'alexithymic' behavior and direct observation of behavioral patterns in different types of individuals. This second approach entails the relating of these behavioral features to alexithymia. As an example, our research results from these situations will be presented and discussed. The emphasis will be placed upon psychodynamic models. It is shown that the conditions under which the exploration is carried out are particularly important for the manifestation of 'alexithymic' characteristics in speech.
Situational influences on verbal affective expression of psychosomatic and psychoneurotic patients.
Group comparisons between psychosomatic and psychoneurotic patients using the Gottschalk-Gleser method of speech content analysis are presented. Two matched patient groups (N = 40 each) were discriminated on the basis of anxiety and hostility scores derived from verbal samples collected during psychoanalytically conducted first interviews. A concordance with clinical classification was reached in 79.75 per cent of cases, with psychosomatic patients exhibiting lower affect scores. These results could not be replicated in a comparison between 92 psychoneurotic and 56 psychosomatic patients based upon verbal samples produced in responses to a request to narrate a dramatic life episode (standard instruction). Percentage of correctly classified cases was 62.84 in the second study. Factor structures derived from affective variables showed more similarity between independent samples of psychoneurotic than between samples of psychosomatic patients across both exploration situations (interview and standard instruction). A major factor exhibiting high loadings from guilt anxiety and ambivalent hostility was evinced, being more important in psychoneurotics. These results are discussed against the background of the alexithymia notion. Methodological considerations pertaining to diagnostic applications of the Gottschalk-Gleser content analysis are presented.
[Psychoanalytic concepts of psychosomatic symptom-formation (author's transl)].
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Alexithymia: anxiety and hostility in psychosomatic and psychoneurotic patients.
Verbal samples obtained from 40 psychoneurotic and 40 psychosomatic patients, matched with respect to age, sex, intelligence and some social indicators, were examined using different methods of content analysis. According to the concept of 'alexithymia' it was postulated that the restricted fantasy life and difficulty in expressing feelings attributed to psychosomatic patients would be reflected at the speech level (psycho-analytic interviews). The measurement of anxiety and hostility using the Gottschalk-Gleser scales gave the following results: with total anxiety in particular, and its subscales guilt, shame, separation and diffuse anxiety, and with hostility, the psychosomatic patients showed lower values than the neurotic patients, which were in part highly significant. The results confirm the existence of the 'psychosomatic phenomenon' but they do not permit statements concerning its etiology.