ABSTRACT
RESEARCH QUESTION: The study investigates the factors that have a bearing on the development of a chief expert opinion in standardized German psychotherapy (psychodynamic therapies). METHODOLOGY: As part of the MARS project a documentation system was developed to record the sociodemographic, clinical and biographical data of the patients as well as data relating to the therapists and the evaluation of the experts, all of which are contained in the therapist's reports. In a comparison of n = 153 chief expert opinions with n = 291 opinions relating to the control group under the normal process, differences occurred between the two groups with respect to the data on both patients and therapists. Moreover, the system records the frequency with which the individual experts contribute to the initiation of a chief expert opinion over a period of 3 years. RESULTS: Proceedings based on chief expert opinions are initiated with patients who have severe psychopathologies and marginal prognostic prospects. Reservations expressed by the experts refer in particular to the psychodynamics described and the foreseen treatment planning. The qualification and gender of the therapists are certainly an issue for chief expert opinions. The experts themselves contribute with varying degrees to the initiation of an expert opinion. DISCUSSION: While the role of patients and therapists in the realization of a chief expert opinion comes as no surprise and is in fact testimony to the quality assurance function of the process, considerable differences have emerged in the handling and approach adopted by the experts themselves. Calls for a better coordination process on the part of the experts should not go unheeded.
Subject(s)
Expert Testimony/legislation & jurisprudence , Guideline Adherence/legislation & jurisprudence , Guideline Adherence/standards , Mental Disorders/psychology , Mental Disorders/therapy , Psychoanalytic Therapy/legislation & jurisprudence , Psychoanalytic Therapy/standards , Quality Assurance, Health Care/legislation & jurisprudence , Adolescent , Adult , Aged , Aged, 80 and over , Cooperative Behavior , Female , Germany , Humans , Interdisciplinary Communication , Male , Middle Aged , Outcome Assessment, Health Care/standards , Outcome Assessment, Health Care/statistics & numerical data , Prognosis , Young AdultABSTRACT
RESEARCH QUESTION: According to the German Guidelines for Psychotherapy, psychotherapists need the consent of the respective insurance company to commence outpatient therapy. They have two options: (1) To begin a so-called short-term therapy (KZT) for up to 25 sessions--a quick and easy procedure requiring few formal expenses. Afterwards the therapist must provide the reasons for extending the therapy in a formal expert assessment request (extension request). (2) It is also possible to obtain the consent of the insurance company at the beginning of therapy (initial request) for up to 50 sessions (psychodynamic long-term therapy) or even for up to 160 sessions (analytical psychotherapy), both of which require the same expert assessment to be filled out beforehand (LZT). This study examines the initial and extension requests submitted for evaluation for psychodynamic therapies according to the German Guidelines for Psychotherapy. The question is posed as to what influences are important in the selection of therapists for these two types of request. METHODOLOGY: In the context of the MARS study, we evaluated a total of 362 randomly chosen requests submitted between May 2007 and June 2008, 128 of which were initial requests and 234 of which were requests for an extension. The evaluation of the reports proceeded on the basis of a previously developed documentation system with various modules comprising information on the sociodemographics and morbidity of the patients as well as information on the therapists themselves. Further modules are assessed in this review. RESULTS: There were many more requests for an extension submitted than initial requests. Initial requests were preferably made when planning analytical psychotherapy. Patients for whom initial requests were submitted were also distinctly younger. The morbidity of the patients had no noticeable influence on the choice of procedure. In particular, diagnoses that could require crisis intervention were not more common in the requests for an extension than in the initial requests. Variables among the therapists had no influence on the form of procedure. These results were confirmed by a multivariate statistical analysis. DISCUSSION: The inconsistencies found in the reported and encoded morbidity of the patients confirm earlier results. Basic conditions, like the guidelines themselves or the payment of trial treatment, seem to determine therapists' behaviour. We also discuss whether or not the advantages of the current procedures to both the patient and the therapist outweigh the possible disadvantages..
Subject(s)
Insurance Coverage/legislation & jurisprudence , Long-Term Care/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Psychoanalytic Therapy/legislation & jurisprudence , Psychotherapy, Brief/legislation & jurisprudence , Adult , Aged , Aged, 80 and over , Expert Testimony/legislation & jurisprudence , Female , Germany , Guidelines as Topic , Humans , Male , Middle Aged , Young AdultABSTRACT
OBJECTIVES: This paper focuses on the relationship between childhood experiences in wartime Germany and mental well-being in adulthood. METHODS: An analysis of data from the Mannheim Cohort Study is done on a sample of 50 elderly people born between1935 and 1945. Overall development and World War II experiences in particular are correlated with later psychosomatic disturbances recorded over a period of 25 years. RESULTS: Individuals suffering from psychosocially influenced disorders were exposed to a significantly higher level of psychosocial stress during childhood than mentally healthy participants. Psychosomatic illness in adult life is, however, not related to the number of war experiences. The absence of one's father during childhood due to the war is not a predictor of long-term psychosomatic impairment. CONCLUSIONS: The results are discussed against the background of most participants coping with life's challenges and preserving their mental health for decades despite painful experiences and various hardships as a result of wartime experiences.
Subject(s)
Adjustment Disorders/psychology , Mental Recall , Personality Disorders/psychology , Psychophysiologic Disorders/psychology , Stress Disorders, Traumatic/psychology , World War II , Adaptation, Psychological , Adjustment Disorders/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Cohort Studies , Cross-Sectional Studies , Female , Follow-Up Studies , Germany , Humans , Infant , Interview, Psychological , Life Change Events , Male , Middle Aged , Personality Disorders/diagnosis , Personality Disorders/epidemiology , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/epidemiology , Stress Disorders, Traumatic/diagnosis , Stress Disorders, Traumatic/epidemiology , Young AdultABSTRACT
Based on the results of the Mannheim Cohort Study, a possible causal relationship between childhood experiences and the long-term course of predominantly psychosocially influenced disorders was examined, focussing on global development terms and war experiences. A sample of 26 individuals born in 1935 was investigated over a period of approximately 25 years. Psychosomatic impairment was assessed using a standardized expert rating (BSS impairment score) with high reliability. We found strong evidence that global development terms make an impact on mental health in advanced age. The amount of war experiences was not correlated with psychosomatic impairment in later life. Furthermore, war-determined fathers' absence during childhood was not a predictor of psychosomatic impairment in later life. Methodical problems and consequences of these findings are discussed.
