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[Conflict-centered individual therapy or integration of psychotherapy methods. Process of change in client-centered psychotherapy with and without behavioral exposure therapy in agoraphobia with panic disorder].

The mechanisms of change due to different psychotherapeutic treatments of anxiety disorders are the subject of the present study. Sixty-eight patients with agoraphobia and panic (DSM III R No. 300.21, ICD 10 No. F 40.01) were included, exclusively treated with client-centered treatment (n = 28) or with additional behavioral exposure treatment (n = 40) in an inpatient setting. The patients were examined on admission, at discharge, and at 6 and 12 months follow-ups with the Structured Clinical Interview for DSM III R (SKID), the Freiburg Personality Inventory (FPI R), and the Giessen Test (GIESS). Both treatment modalities significantly reduced panic and avoidance. Differences were found in personality scales. The support of autonomy was superior by client-centered treatment alone: client-centered treated (CCT) patients felt less dependent on the expectations of others, less under stress, and had fewer psychosomatic complaints. Patients with additional exposure treatment feel accepted by their social environment earlier. The results are discussed with regard to open questions of therapy integration and different mechanisms of change.

Adult↗

Health care policy, psychotherapy research, and the future of psychotherapy.

In a quest for accountability in the delivery of health services, health care policymakers in both government and private sectors are creating clinical practice guidelines, many of which heavily emphasize medical and pharmacological approaches. Yet, there are now sufficient data to support the efficacy of psychotherapeutic procedures for a wide variety of specific disorders, and it seems now is the appropriate time to communicate these findings to health care policymakers and the public at large. At the same time, data must be developed on the delivery of these interventions by frontline clinicians in the settings where they practice. The emergence of practice research networks may accomplish this latter goal.

Delivery of Health Care↗

Relations of the alliance with psychotherapy outcome: findings in the Second Sheffield Psychotherapy Project.

Clients (n = 79) and therapists (n = 5) rated their alliance using parallel forms of the Agnew Relationship Measure (ARM) after every session of their time-limited psychodynamic-interpersonal or cognitive-behavioral treatments for depression. The ARM assesses 5 dimensions of the alliance: Bond, Partnership, Confidence, Openness, and Client Initiative. Treatment outcome was assessed as residual gain from pretreatment assessment to end of treatment, 3-month follow-up, and 1-year follow-up on 6 standard measures. Some aspects of the alliance as measured by the ARM were correlated with clients' gains in treatment. The strength of the association varied across assessment measures, occasions of outcome assessment, ARM scales, and the session number when the alliance was measured.

Adult↗

Positive psychotherapy: a transcultural and interdisciplinary approach to psychotherapy.

The development of society may be described in terms of the following structural changes: (a) increased population, which requires other rules of contact for adequate forms of social relationships; (b) urbanization, with people living together in clusters, which, on the one hand, intensifies social relationships, but, on the other, reduces possibilities for real friendship; (c) differentiation, which rests on increasing technological development and requires specialization in partial functions; (d) transcultural problems. With people in the industrialized countries, this somatic-psychosocial relationship finds expression in the famous deadly sins of civilization, the risk factors. The following five factors are responsible for the origin and development of psychosocial and psychosomatic diseases, especially the so-called diseases of civilization: alcohol; intoxicants and drugs; smoking, overweight, sedentary life; and emotional stress (anxiety and inner tension).

Conflict, Psychological↗