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At least 19 recordsLinked to original sources
PubMed2006

[Psychodynamic therapy foci in inpatient psychotherapy--relations to self-assessment scales and individual therapeutic goals].

OBJECTIVES: How do the OPD-based psychotherapy foci formulated by the therapeutic team at the patient's admission develop and how do they relate to change in symptoms and to the patient's individual therapeutic goals? METHOD: After Operationalized Psychodynamic Diagnostics (OPD) in 188 psychotherapy inpatients, 2-3 clinically relevant OPD foci were chosen in joint team sessions after admission and assessed by the Heidelberg Structural Change Scale (HSCS) at the beginning and the end of inpatient psychotherapy. Patients formulated their individual therapy goals at the beginning and assessed their achievement at the end of inpatient psychotherapy and filled in self-assessment scales. RESULTS: At the end of therapy there was a significant mean improvement of one step on the Heidelberg Restructuring Scale for all three foci (0.9-1.2) in the sample as a whole. In approximately one-fourth of the patients we observed no change in the HSCS (25.5-27.7 %), approximately 70 % improved one to four steps towards higher awareness of, coping with or restructuring of the focus. The hypothesis of high correlations between the different measures of change could be supported only in part. DISCUSSION: The clinical implications and the implications for quality management are discussed.

Adolescent↗
PubMed2004

[Relationship experiences and therapeutic outcome in inpatient psychotherapy].

OBJECTIVES: Inpatient psychotherapy includes the patient's manifold contacts with different therapists, nurses and fellow patients. The present study investigated the association between these multiple relationships and therapy outcome. METHODS: Pre-post measures of symptom load (Brief Symptom Inventory), interpersonal problems (IIP) and self-efficacy (SEB) were used to define three groups with positive (N=129), unchanged (N=44) or negative (N=40) outcome. These groups were compared 1) by their alliance with an individual therapist, their relationship to the therapeutic team, their experience of cohesion and climate concerning fellow patients in the ward (measured weekly by the "Stationserfahrungsbogen" SEB), and 2) by their differences in mean correlations between the courses of relationship experiences and symptom load. RESULTS AND CONCLUSIONS: Cohesion and relationship to the therapeutic team were not associated with therapy outcome. Therapeutic alliance with the individual therapist and climate among fellow patients turned out to be moderate indicators of the therapeutic outcome. It is recommended to include these process parameters systematically into the process diagnostics of inpatient psychotherapy.

Adult↗
PubMed2006

The cortisol awakening response is blunted in psychotherapy inpatients suffering from depression.

Determining the salivary awakening cortisol response (ACR) is a non-invasive, reliable method to detect changes in the hypothalamus-hypopituitary-adrenal (HPA) axis. Although a role of the HPA axis in depression is widely recognized, data on the ACR in depressive patients are still scarce and inconsistent. The present study assessed the ACR in depressed patients admitted for inpatient psychotherapy and a comparison group of other psychiatric diagnoses under the same conditions. The ACR was found to be attenuated in depressed as compared to non-depressed patients. This finding is in contrast to previous studies in healthy subjects or depressed outpatients and suggests a blunted rather than an exacerbated HPA reactivity. Further studies will be needed to disentangle the complex relationship between depression and the ACR.

Adult↗
PubMedDate not supplied

[Therapeutic factors of inpatient psychotherapy--the patients' view].

Inpatient psychotherapy as a complex treatment program coordinates a multitude of specific, possibly therapeutic helpful components. At least in departments of about 20 or more beds the available therapeutic components are composed or dosed in a different kind for certain groups of patients (indication). In the Psychosomatic Clinic with a ward of 22 beds patients with certain psychoneurotic symptoms, bodily dysfunction or psychosomatic illnesses take part in different inpatient psychotherapy programs for 3 months. This very intensive treatment phase is regularly followed by an outpatient psychoanalytic oriented individual or group-psychotherapy for 1 or more years. For the inpatient treatment phase we differentiate 18 possibly therapeutic helpful factors. Preparing systematic studies we asked the patients at the end of their inpatient treatment phase to judge: to what extent the 18 single factors were helpful. Furthermore a personality questionnaire (Giessen-Test) and a checklist of complaints (Giessen Checklist of Complaints) were routinely filled out by the patients pre and post their inpatient time. From this data we derive independent success-scores which enables us to investigate the association between the subjective assessment of the helpfulness of certain therapeutic factors and somewhat independent criterions. The given data of n = 291 patients allow a empirically based discussion of the question: "What relevance do certain components of inpatient psychotherapy alone or together with other components have for certain groups of patients or specific settings?

Adaptation, Psychological↗
PubMed1995

[Which factors modify the duration of inpatient psychotherapy?].

The indication for differential duration of inpatient psychotherapy is a difficult question to answer, especially when the possible outcome-success of more severely disturbed patients (e.g. with borderline-personality disorder) is considered. Our own results showed no relevant correlation between the degree of patients' disturbance and treatment duration, neither any relevant correlation between treatment duration and therapists' evaluation of symptomatic or ego-structural improvement. The only marked effect on treatment duration was found for the patients' evaluation of their therapeutic relationship: the better they judged this relationship, the more their therapists tended to elongate inpatient psychotherapy. This finding supports a paradigm, which has been already well confirmed for outpatient psychotherapy: the specific importance of the therapeutic relationship for the therapeutic process even within the scope of inpatient psychotherapy. Another finding of our study indicates that more severely disturbed patients probably need a modified setting of inpatient psychotherapy: favorably a focus oriented interval treatment with short duration periods and alternating focus if necessary.

Adult↗
PubMed2003

[Individualized therapy goals and treatment efficacy--a follow-up study one year after inpatient psychotherapy].

Quality management of inpatient psychotherapy must integrate the different aspects of process-quality management as well as the evaluation of treatment outcome. The aim of our study was to investigate the association of the achievement of individually arranged and continuously re-evaluated therapy goals with symptomatic measures of treatment outcome (SCL-90-R, Giessener Beschwerde Bogen). 51 inpatient subjects were assessed directly before and after treatment and again at approximately 1 year after treatment (mean range 14.7 months). Therapy goal achievement was assessed on a weekly basis and, in addition, globally at the end of treatment. Pre/post-treatment results remained stabile at the follow-up assessment (SCL-90-R GSI effect size: 1.2). No significant association was found between therapy goal achievement and the degree of improvement of symptoms. This result leads us to the conclusion that the continuous evaluation of therapy goals during treatment seems to be a good instrument for quality management, but it is not suitable for the evaluation of treatment outcome.

Adaptation, Psychological↗
PubMed2005

[Does improvement of symptoms four weeks after the begin of psychodynamic inpatient psychotherapy correspond to long term outcome?].

OBJECTIVES: This study was conducted to explore differentiated aspects of outcome throughout and one year after psychodynamic inpatient psychotherapy with special regard to symptomatic distress and interpersonal behaviour. METHODS: Sixty-four patients of the Department of Psychotherapeutic Medicine of the Jerichow Hospital (Saxonia-Anhaltina) were investigated with the SCL-90-R and the IIP-D four times: at the beginning of inpatient psychotherapy (t0), four weeks after (t1), at the end (t2), and one year after discharge (t3). RESULTS: The improvement of symptoms four weeks after the beginning of psychodynamic inpatient psychotherapy is equivalent with long term outcome. The Global Severity Index of SCL-90-R demonstrated a statistically significant change from markedly psychological distress to lack of distress after four weeks psychodynamic inpatient psychotherapy (effect-size d(GSI) = 0.82). At the end of psychotherapy, three weeks later, the effect-size was d = 1.11, and one year after discharge the effect-size decreased again to d = 0.85. Major improvements demonstrated the SCL-90-R subscales Depression, Anxiety, and Obsessive/Compulsive. Regarding interpersonal problems, the subscales Dominance, and Competitive demonstrated statistically significant changes from low Stanine-scores at t0 to higher scores one year after discharge. The subscales Socially avoidant, Nonassertive, and Exploitable demonstrated statistical significant changes from high levels at t0 to lower scores after one year. DISCUSSION: In conclusion the first four weeks of psychodynamic psychotherapy are not sufficient to demonstrate an optimum level of low psychological distress as well as an optimum change in interpersonal problems. Regarding stability of the effects of psychodynamic inpatient psychotherapy it was demonstrated that the first four weeks initiated changes which improved at the end of psychotherapy until one year after discharge.

Adaptation, Psychological↗
PubMed1994

[Inpatient psychotherapy of anxiety disorders--a comparison of therapeutic effectiveness in patients with generalized anxiety disorder, agoraphobia and panic disorder].

We investigated the effect of psychoanalytically oriented inpatient psychotherapy on three essential forms of anxiety disorders (classified according ICD-10): 1. generalized anxiety disorder (n = 23), agoraphobia (n = 38) and panic disorder (n = 24). Examinations with psychometric test instruments were performed at beginning of inpatient psychotherapy, at dismissal and 6 weeks after dismissal. At the end of inpatient psychotherapy we judged four clinically relevant criteria of therapy success: at the one side the therapist's judgement of symptomatic and structural improvement of the patients, at the other side the patients' judgement of anxiety and depression diminuation. The results demonstrate that summing up these four success criteria 1.) 40.0% of the patients with anxiety disorders improved, 21.2% failed; 2.) 61.4% of the patients with agoraphobia improved, 6.3% failed and 3.) 52.5% of the patients with panic disorder improved, 6.5% failed. An additional analysis of these results showed that the patients with generalized anxiety disorder were significantly (p < 0.01) more disturbed (according clinical assessment) compared to the other two diagnostic groups. About 60% of these patients exhibited increased anxiety symptoms during the course of inpatients psychotherapy, nevertheless relative to the other success criteria these patients achieved satisfactory outcome results. In the paper the consequences of these findings are discussed especially for inpatient psychotherapy of severely disturbed patients with anxiety disorders.

Adult↗
PubMed1989

The current literature on inpatient psychotherapy.

In a review of the current literature on inpatient psychotherapy, the authors discuss shortened length of stay and the interdisciplinary team approach as factors affecting psychotherapy in the inpatient setting. They examine the literature in the frameworks of long-term intensive and short-term focused psychotherapy, including arguments presented in favor of each. Much of the current literature focuses on special problems posed by patients who have severe personality disorders and are treated by long-term inpatient care with intensive psychotherapy.

Combined Modality Therapy↗
PubMed2000

[Work profile of social work in inpatient psychotherapy. Clinical fields and social rights implications].

OBJECTIVES: The task profile of social work in (acute) inpatient psychotherapy--unlike psychiatric inpatient treatment--is only fragmentarily described by the so-called Psychiatrie-Personalverordnung (Psych-PV). The aim of the present investigation was, therefore, to provide valid and representative data to define its respective scope of duties. METHODS: During a prospective one-year assessment at the Department of Psychotherapy and Behavioral Medicine at the Philipps-University of Marburg/Germany, we recorded corresponding data of social work referring to three areas of interest, i.e., "education and occupation", "housing and family", and "psychotherapy support". RESULTS: Our data suggest a broad overlap with the corresponding task profile of social work at psychiatric hospitals, which clearly differs, however, from the more therapeutical approach in social work as practiced in Anglo-American countries. CONCLUSIONS: Our findings stress the need for a re-evaluation of social work in inpatient psychotherapy concerning its specific task profile and the respective time values.

Adolescent↗
PubMed2004

[Predictors of resource use in inpatient psychotherapy: development of a German case group concept for patients with mental disorders].

OBJECTIVE: Recent research on predictors of resource use in inpatient psychotherapy indicates that various patient characteristics as well as therapeutic factors may influence resource use. The aim of our study was to examine the relationship between patient attributes and psychotherapeutic costs in German inpatient psychotherapy. The amount of variance explained in resource use was calculated. METHOD: The existing sample used in this study consists of sociodemographic and clinical variables of 2375 patients treated in various inpatient psychosomatic clinics. Resource use was measured on the basis of clinical staff activities (Klassifikation Therapeutischer Leistungen, KTL, BfA 2000). Regression Tree Analysis was performed to classify patient attributes based on resource use. RESULTS: The model assigns patients to 20 classes, accounting for 17.5 % of variance. Those patients with single status and personality or eating disorder consume more resources than those patients with non-single status, low motivation for psychotherapy, comorbidity of physical illness and lower levels on symptom severity. CONCLUSIONS: Implications of the results for the development of a patient classification system in inpatient psychotherapy will be discussed.

Aged↗
PubMedDate not supplied

[E-mail in psychotherapy--an aftercare model via electronic mail for psychotherapy inpatients].

We introduce an aftercare program for psychotherapy inpatients, which is based on regular communication via E-mail. The organizational and operational structure of the program are described within the context of computer mediated communication. First results on utilization and acceptance are reported. In comparison to patients who did not participate in either aftercare program of the clinic, the E-mail participants are younger and higher educated. Inpatient treatment of the participants was three days shorter in duration than that of non participants. Both groups were similar with regard to symptom distress at discharge from hospital. A low dropout rate of 8%, the high activity and satisfaction emphasize the positive acceptance of the program. Therapists' E-mail activity turned out to be important for the participants. Neither age, internet experience or symptom related variables nor the own E-mail activity were associated with participants' evaluation of the new service. Based on these first positive experiences the perspectives of using E-mail in psychotherapy will be discussed.

Adult↗
PubMed1996

[Evaluation of the therapeutic process in inpatient psychotherapy with the Repertory Grid technique].

With a sample of 155 patients undergoing psychoanalytic inpatient psychotherapy, the clinical relevance of nomethetic measures derived from Repertory Grids (Role Construct Repertory Test; Kelly 1955) shall be demonstrated. Results lead to the conclusion that valuable findings concerning the psychotherapeutic process can be obtained from the grid without necessarily recurring to the framework of Personal Construct Psychology. In general, cognitive differentiation seems to diminish as therapy goes on. Successful patients start to deal with their parental imagines earlier in the therapeutic process than less successful ones. Moreover, they adapt the construction of their Self to the one of their Ideal Self, just as they construe the treating therapist increasingly similar to their Ideal Self. This points to the eminence of the therapeutic relationship for successful therapy outcome. Finally, the paper presents some possibilities to demonstrate transference processes within the scope of inpatient psychotherapy by means of grid measures. All in all, we consider the repertory grid technique as a promising tool for the evaluation of therapeutic processes, but it requires considerable expenditure to fit into clinical routine.

Adolescent↗
PubMedDate not supplied

[Inpatient psychotherapy with chronic psychogenic pain patients].

The efficacy of inpatient psychosomatic psychotherapy was proved by a naturalistic prospective study with 50 psychogenic pain patients over an average time period of 12 weeks. At the end of inpatient psychotherapy about 60% of all patients achieved pain mitigation. According to the aim of our therapeutic concept to specially improve the perception and verbalization of their own conflicts or affects about 86% of all patients judged to have an enhanced competence in problem solving. The hypothesis that depression may often occur as a consequence of several years lasting chronic pain, could not be confirmed in our study. In contrast no remarkable correlation was found between symptom duration and depressive or anxious mood respectively. Concerning prognosis it seems to be significant that an increased tendency for rationalization or intellectualization diminished clinical outcome success as well as it occurred with enhanced acute pain sensation.

Adult↗
PubMedDate not supplied

[The therapeutic relationship within the scope of inpatient psychotherapy].

Within psychotherapy-research a kind of paradigm has almost established itself, maintaining that--with high probability--a positive therapeutic relationship early on permits to expect a favourable therapeutic outcome. These conclusions were mainly derived from an outpatient psychotherapy setting of under 30 hours. In our own study we wanted to examine whether an early prognosis of success under such conditions was also possible for psychoanalytically oriented inpatient psychotherapy. We examined a sample--representative by age, sex and diagnosis--of 76 patients with an average duration of treatment of 12 weeks. For the patients' self-rating of therapeutic alliance we translated a questionnaire from Luborsky (1984) into German, whereas for the therapists' rating we conceived our own questionnaire. Contrary to our expectations, we were not able to demonstrate clinically significant correlations between the initial quality of the therapeutic relationship and therapy success later on (patients' rating: r = 0.28, p < 0.01, therapists' rating: r = 0.09, p > 0.10). One hypothesis on this surprising finding seems to be especially plausible: In our opinion a substantial strength of inpatient psychotherapy (regardless of it being shaped more by psychoanalytic or behavioral orientation) is the following: it offers less motivated patients of lower social status and level of education an opportunity to experience essential processes of communicative learning and motivation especially within the first weeks of treatment.

Adult↗
PubMed1994

[The Repertory Grid as a research instrument in inpatient psychotherapy. Possibilities of semantic construct analysis in patients with psychogenic pain].

The Repertory Grid Technique provides a differential analysis of individual constructs ("hypotheses"), by which we structure the perception of our environment. In our study we investigated 35 psychogenic chronic pain patients at beginning and end of inpatient psychotherapy, whether semantic changes occurred in their construct system. We analysed these semantic changes using a categorial system, which was developed by Landfield (1971). This categorial system consists of 22 different categories, at which a rating system (by use of a manual) evaluates the appropriate semantic attachment of constructs of an individual repertory grid to these categories. Our study shows that contrary to our expectation psychogenic pain patients comparatively often described themselves with constructs, which expressed direct social interactions or emotions. However, this finding must be interpreted with some reservation, as our patient group probably is not representative for most of the chronic pain patients, which usually are hardly to motivate for inpatient (respectively outpatient) psychotherapy. Finally we investigated the semantic changes of the construct system during the course of inpatient psychotherapy--here we assume that the conceptualization of own theory guided categories will provide more clinically relevant or perspective results compared to the original category system of Landfield.

Adult↗
PubMed1999

[Individually arranged and continuously reevaluated treatment goals as an instrument for improving inpatient psychotherapy]

An agreement about individual therapy goals at the beginning of inpatient psychotherapy improves motivation and engagement of patients, and makes orientation about the planned therapy easier. Furthermore, therapy goals are an effective tool in the quality-assurance of the therapeutic process. On our ward, therapy goals are negotiated individually between patient and therapist some time before admission. The therapy goals of our inpatients are documented and concretized weekly. First empiric results showed, that individual therapy goals are an interesting instrument not only for the evaluation of the therapeutic process, but also for the evaluation of outcome. The introduction of individualized treatment goals in the treatment setting was well accepted by patients and team members.

Journal Article↗
PubMed2001

[Course of symptom severity and prediction of outcome in inpatient psychotherapy].

OBJECTIVES: The study looks for typical curves of symptom development in inpatients and investigates the influence of initial remoralisation and terminal improvement on the global therapy outcome. METHODS: 71 psychotherapy inpatients (affective, anxiety, eating and personality disorders; average treatment duration 11.9 weeks) gave weekly self-reports on symptom severity (BSI, Derogatis, 1983) and had a complete outcome evaluation. Regression parameters of the symptom curves were taken for correlational and path analytic calculations. RESULTS: Initial symptom alleviation is able to predict better global outcome. However there is a relevant subgroup of patients which has a good outcome despite an initial deterioration. CONCLUSIONS: Initial remoralisation predicts better outcome but is not a necessary condition. The results partly call into question the group statistical "dose-response-curves". Further studies should test the influence of other process parameters (group cohesion, therapeutic alliance etc.) on the course of treatment.

Adolescent↗