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At least 145 records · Page 8Linked to original sources
PubMed1985

The Hannover Consultation Liaison model: some empirical findings.

Starting from the definitions concerning the concepts 'Liaison medicine' and 'Consultative Psychiatry' we begin with remarks with regard to the Consultation Liaison-Situation in West Germany on the basis of the key-words 'Brief history', 'Independent university units with regard to Psychotherapy and Psychosomatics as well as the connected organization' and 'Teaching procedures'. Following it the Hannover Consultation Liaison model is presented particularly with regard to both the psychosomatic inpatient ward including the functional organization and psychotherapeutic processes as well as the so-called 'Innere Ambulanz' which includes the consultation liaison services in the clinico-medical departments outside Psychiatry and Psychosomatics. Within the 'Innere Ambulanz', which is closely connected to our psychosomatic inpatient ward, the consultation liaison activities and the resulting supportive psychotherapeutic strategies are performed by student auxiliary therapists who are interested in completing their 4-5 months internship-time in our department. We describe both the three supportive psychotherapeutic steps, which may last months to years including subsequent dynamically psychotherapeutic strategies as well as the reactions of the auxiliary therapist function on the students. Furthermore, we may state that there exists no one more optional education procedure of graduate students than the student's confrontation with his partial self-responsibility vis-à-vis a patient who is being supportive-psychotherapeutically treated by him. Specific empirical proofs concerning our patient oriented consultation liaison activities are demonstrated on the basis of previous psychotherapeutic findings in Crohn patients. Here we are able to demonstrate the effectivity of psychotherapy in the case of the supplementarily psychotherapeutically treated patients in comparison to the patients who received medical therapy only. Finally we are able to present quantitative clinico-medical inpatient needs with regard to consultation liaison activities starting from our 'Innere Ambulanz'. On the basis of our conservative estimate, 31-42% of patients showed severe psychosomatic or psychic symptoms who should be treated by psychological means in addition to the medical treatment.

Anxiety Disorders↗
PubMed1995

Projective techniques as psychotherapy.

Projective techniques, by bypassing the conscious resistance of anxiety and defenses, elicits information about the hidden side of perception and thoughts processes, personality, emotions, and psychodynamic processes. They thus enable an assessment of ego strength and the patient's ability to face unconscious content. The aims of psychotherapy similarly disclose the psychodynamics of symptoms formation and conflicts and help the patient to face them. In some respects the test administration procedure is analogous to the psychotherapeutic process. This makes test administration useful not only for diagnosis, but also as a therapeutic tool, especially in brief psychotherapy and when sharing the results with the patient. The therapist, by translating the results, stimulates the gradual gaining of insight and self-awareness at the patient's own pace. Sharing results may allay paranoid suspicions and fears concerning the test administration and the patient-therapist relationship. The meeting with one's own deep feelings acts as a catalyst in the therapeutic process and saves valuable time. Projective results are especially useful when the interpretations are juxtaposed with content arising in the therapeutic session.

Adult↗
PubMed2003

Lessons in how to ruin a study in psychotherapy effectiveness: a critical review of the follow-up study from Chestnut Lodge.

The principal publications from the follow-up study of former patients at Chestnut Lodge are reviewed and critiqued. Originally, the follow-up study was intended as a study of the psychotherapeutic process and its outcome. While widely referred to as a follow-up study, it is not possible to make conclusions about psychotherapy from the study. Data about the psychodynamic aspects of therapy have been collected but never analyzed. Additionally, the study does not fulfill the requirements of a psychotherapeutic outcome study. The conclusion of the current review is that as the study turned out, it only allows one to draw conclusions about different kinds of illness courses and predictor factors.

Follow-Up Studies↗
PubMed2003

[Time--the 4th dimision in medicine and psychotherapy].

Time is presented as well in his historical meaning and as 4th dimension in its medical and psychotherapeutic context. In this medical and psychotherapeutic process it has an important function and is a variable of a process procedure. The difference between "kairos" = (the right point of time) and "chronos" = (the period of time) is historically meanful. The subjective experienced time is as well emphasized by the development of time in the relation to the development of the "self" as in the subjective experience of time in medical and psychotherapeutic situations. There are also changed conceptions and understandings of time running parallel to the development of nature sciences. The importance of time is explained for the medical practice and the meeting with the patient--especially for chronic diseases. The connection of confidence and time is particularly emphasized in the systemic approach.

Chronic Disease↗
PubMed2005

[Patients in group psychotherapy].

This study examines the patient in group psychotherapy, describing factors that provide changes during the process and the particularities of this therapeutic mode. Based on the available literature and the authors' systematic experience throughout thirty years of group therapeutic work, the variables that determine the commitment of the group members in a productive and well-succeeded therapeutic relation are discussed. It is emphasized how the patients assimilate the psychotherapeutic process and the way in which they participate in achieving their own improvement.

Humans↗
PubMed1985

The N of 1 Markov chain design as a means of studying the stages of psychotherapy.

Research on the process or, more specifically, the stages of psychotherapy has been difficult to carry out and can lead to spurious results. An initial step in furthering knowledge of the stages of successful therapy would be the use of an N of 1 design with Markov chain analyses. This design would allow one to incorporate the uniqueness of each therapy dyad, the interactional nature of the psychotherapeutic process, and a statistical test of the changes in the interactional behavior over time that is not often available in nonbehavioral single case designs. The purpose of this paper is to familiarize the reader with N of 1 designs and Markov chain methodologies and to propose how they could be combined in an attempt to study the stages of successful therapy. A hypothetical study is presented to exemplify the operation and value of the proposed N of 1 Markov chain design.

Dominance-Subordination↗
PubMed1996

[Remembering and acting out].

In the accompanying paper two fifteen-hour psychoanalytical therapies were investigated with regard to the temporal distribution of Luborskian relationship episodes and the facial expressions of both protagonists. The two therapies were taken from a sample of eleven treatments: one had had the most success; the other, the least. The investigation focussed on what type of interaction between the recollective narration of past relationships and the present form of relationships could be expected, and whether the relation between these two would be dependent upon the success of the therapy. The hypothesis that a parallel processing of the narrated episode and the exhibited emotion would occur within the patient could not be confirmed. The frequency of recollective narration correlated negatively--in line with a hypothesis of Freud's--with the frequency of exhibited emotions. In the successful treatment, however, the therapist exhibited the emotions which one would have expected the patient to show. The results are discussed in terms of a theory of the psychotherapeutical process and containing.

Acting Out↗
PubMed1984

Family organization as an ecology of ideas: an alternative to the reification of family systems.

The argument of this paper is that current structuralist and quasi-organismic models of family organization are descriptions masquerading as explanations. They correctly assert, but do not account for, the fact that the behavior of each member of a family is related to that of every other member. An adequate account must begin by assuming that people behave according to how they define the situations in which they are actors, and that such definitions of the situation are generalizations learned through repeated interaction with others. Family organization is regarded within this framework as the outcome of an evolutionary process by which some ideas are encouraged or confirmed and others suffer a kind of death or extinction, so that the ideas of each family member lead him or her to behave in ways that confirm or support the ideas of every other family member. That is what is meant by the slogan "family organization as an ecology of ideas." This view of family organization requires a demystified account of resistance in psychotherapy, a bare outline of which is provided in the previous section. The overall conception of the psychotherapeutic process presented here is closest to that of the Palo Alto Brief Therapy Project, though I offer as a conjecture that the effective operations of all the psychotherapies can be explained within this framework.

Communication↗
PubMed1975

[Changes in vocabulary in a psychoanalytic process].

This paper at first deals with some aspects of the relationship between psychoanalysis and linguistics. Freuds theory of parapraxis is interpreted in terms of Bühlers model of speech, whereby the entire verbal output of a speaker can be understood as an act of symptomatic behavior. The investigation of the vocabulary of nouns of a patient suffering from anxiety neurosis illustrates the fertility of this model. The frequency dispersion of all nouns taken from a specific sample of the patient's and analyst's speaking shows the stability of statistical properties of speech behavior. Following, the role of content-analytic techniques for the specific demands of research in pstchotherapy is discussed. A large part of content-analytic measures is rather far removed from the clinical description of the psychotherapeutic process, thus diminishing the validating relevance of these studies for psychoanalytic concepts. The final chapter describes the process of a psychoanalytic treatment by means of the content-analytic technique. The changes of the patient's verbal content show highly specific correlation to the clinical ratings of psychoanalytic concepts like transference and anxiety. As an initial study, these results are qualified to stimulate the development of content-analytic categories for research in psychotherapy.

Adult↗
PubMed2001

[Prospects in psychotherapy research].

The point of departure for this discussion is a critical review of the philosophy of randomized controlled trials (RCT) and their specific errors when applied to psychotherapeutic methods. There is a gap between the highly artificial settings of psychotherapy RCT and naturalistic psychotherapy procedures, which are grounded more in personality than in technique, less regulated, and mostly eclectic. Although RCT are necessary for general assessments of efficacy, they should be complemented by efficiency studies and evaluation of whole health care systems which include psychotherapy. We argue against overstretching the analogy of good clinical practice (GCP) research for the purpose of admitting new psychotropic drugs to psychotherapy research. A rational approach to psychotherapy for indication, quality ascertainment, and allocation of resources needs research which is methodologically explicable, replicable, and relevant to practice. The Cochrane Collaboration is a means of distributing such knowledge and making it work for practitioners. However, Cochrane also sheds light on psychological and practical obstacles which must be overcome before public health care systems can utilize new scientific results. The discussion of disorder-specific psychotherapy versus general psychotherapy ends by emphasizing the importance of more detailed psychopathology and pathopsychology of dysfunctions that cannot be sufficiently explained in manuals. Such dysfunctions--not necessarily specific for diagnoses or abnormality at all--can then be matched to specific psychotherapy tools. Further innovations can be expected from neurosciences, and some of the most promising paradigms are discussed. Finally, the lasting importance of hermeneutics is stressed not only with regard to the generation of new hypotheses but also to guiding the psychotherapeutic process.

Evidence-Based Medicine↗
PubMed1989

Is psychotherapy mandatory during the acute refeeding period in the treatment of anorexia nervosa?

Forty-five adolescent and preadolescent patients (42 females, three males) with anorexia nervosa (AN) were treated in a pediatric day care unit of a large urban hospital by a multidisciplinary team. In our treatment model, the pediatrician has the responsibility for the initial evaluation and physical rehabilitation while the pediatric psychiatrist does the initial evaluation of the patient and family and is available for intervention in an emergency. Parents are actively involved in the treatment program. Family psychotherapy is recommended for each patient and his or her family. Among 45 patients, 24 did not enter psychotherapy during the first 2 months of the refeeding period, while the remaining 21 patients started psychotherapy (family and/or individual) during this period. Weight gain was higher in the group without formal psychotherapy during the initial period of refeeding (7.3 +/- 3.1 kg versus 5 +/- 2.5 kg; p less than 0.01). It is suggested that the initiation of structured psychotherapy is not mandatory and does not contribute to treatment effectiveness in the acute phase when emaciation and negativism may hinder the psychotherapeutic process. We believe a multidisciplinary team, together with the parents, is the treatment of choice during the acute phase of AN.

Adolescent↗
PubMed1987

The function of food in residential treatment.

This paper describes the behaviour and backgrounds of adolescents in a therapeutic community and proposes that all experiences in the residential context need to form a single integrated psychotherapeutic process. Although reference is made to group and organizational issues, the central consideration is of the significance of food and its treatment potential in this total process.

Adolescent↗
PubMed1993

Statistical methods for analyses of incomplete clinical service records: concurrent use of longitudinal and cross-sectional data.

Statistical procedures that have become routine in other social sciences were used to analyze data from clinical service records. Despite the absence of control groups, nonrandom assignment of clients to treatment conditions, and incomplete records, effective analyses of psychotherapeutic processes were possible. Multivariate regression models, with variables that were transformed to significantly improve skewness and regression linearity, were controlled for heteroskedasticity and for end-point censoring of dependent variables. They were also used to measure the effects of a categorical variable (gender) and a scalable variable (intake distress) on a reactive outcome measure (of acute distress) and on an unreactive one (of long-term life satisfaction). Graphical methods for summarizing large data sets helped identify intake variables that could control for attrition-related sampling biases. These longitudinal covariates and corrections to adjust degrees of freedom for cases with repeated measures were then used to construct statistical models that were equivalents of pure cross-sectional designs.

Adolescent↗
PubMed2000

Getting a life: the emergence of the life story in adolescence.

In the life story, autobiographical remembering and self-understanding are combined to create a coherent account of one's past. A gap is demonstrated between developmental research on the story-organization of autobiographical remembering of events in childhood and of life narratives in adulthood. This gap is bridged by substantiating D.P. McAdams's (1985) claim that the life story develops in adolescence. Two manifestations of the life story, life narratives and autobiographical reasoning, are delineated in terms of 4 types of global coherence (temporal, biographical, causal, and thematic). A review of research shows that the cognitive tools necessary for constructing global coherence in a life story and the social-motivational demands to construct a life story develop during adolescence. The authors delineate the implications of the life story framework for other research areas such as coping, attachment, psychotherapeutic process, and the organization of autobiographical memory.

Adolescent↗
PubMed2003

[Spirituality and existential well-being as topics of research in medical psychology and psychiatry].

Spirituality is introduced as a notion referring to a personal dimension of life sense donating self-reflection and includes religious thinking in this respect but, however, is by no means limited to religiousness. Different studies point out that there may be relevant connections between aspects of subjective life sense and variables like "neuroticism" and "negative" emotionality. In the Anglo-American psychological and even psychiatric literature this spiritual dimension is a topic of empirical research; programs of psychological treatment for chronical and terminal ill patients had been created and are mainly founded on aspects of spirituality as a relevant dimension in remaining life. Referring to the presented literature the hypothesis can be formed that a sense-donating contingency is related to different psychological and psychiatric topics not limited to aged people or those suffering from severe illness. Further research is needed; culture-dependent differences in the content and expression of spiritual dimensions may exist. The question becomes actualized by migration movements (fundamentalistic philosophies), a greater proportion of patients might be influenced by other religions and life sense-donating philosophies. In the existing psychotherapy literature indications are hardly found how these patients' characteristic features can be adequately integrated in design and execution of the psychotherapeutic process.

Humans↗
PubMed1976

The secret.

The revelation of secrets lies at the core of much psychotherapeutic method and was the seed from which early psychoanalytic theory grew. The notion of "the secret" can therefore be regarded as critical to an understanding of the psychotherapeutic process. This paper puts forward a view which contrasts, in important aspects, with traditional concepts and which emphasizes the positive or creative value of certain hidden ideas and the importance of the social arena on which they are displayed.

Abreaction↗
PubMed1985

Sexual dysfunction in gay men requesting treatment.

Until recent years, homosexuality was considered to be a psychiatric disorder and no attention was given to treating same-sex sexually dysfunctional partners--either male or female. This study reports on the treatment of approximately 500 sexually dysfunctional gay men by 10 Southern California psychotherapists over a five-year period. Six aspects of sexual dysfunction in gay males are explored: the psychotherapeutic process; characteristics of men reporting homosexual dysfunction; type and incidence of dysfunction; etiology of dysfunction; treatment and recidivism; and duration and impact of dysfunction. The literature in this area is also reviewed.

Adolescent↗