ABSTRACT
Why the concept of distinct psychotherapeutic approaches is indispensable - and why the tool box concept of psychotherapy cannot work Background: In Germany, the official psychotherapy guidelines are oriented towards the model of distinct psychotherapeutic approaches. Within the German health care system this also applies to the training in psychotherapy. Some critics, however, are presently pleading in favour of abolishing the model of distinct psychotherapeutic approaches, which also implies to abolish the concept of the so called "Richtlinienverfahren" in Germany - approaches of psychotherapy which proved to be efficacious and whose costs are reimbursed by the insurance companies. Objective: The arguments put forward such as the heterogeneity of the approaches as well as the proposed alternatives, for example, an "integrative" model of both mental disorders and psychotherapeutic treatment are critically discussed. Results: Both the arguments and proposed alternatives are found to be not convincing, neither from a scientific nor from a psychotherapeutic perspective. From a scientific perspective, there is no evidence for efficacy of a "general" or "integrative" model of psychotherapy - which is in contrast to the Richtlinienverfahren for which evidence for efficacy exists. From a psychotherapeutic perspective psychotherapy cannot be taught, learnt and applied by use of tools or modules without a theoretical orientation. Conclusions: The concept of distinct psychotherapeutic approaches proves to be an in dispensable principal for orientation in psychotherapy, for both therapists and patients.
Subject(s)
Psychotherapy/methods , Germany , Humans , Mental Disorders/therapyABSTRACT
OBJECTIVE: While several studies have shown that cognitive-behavioral therapy (CBT) is an efficacious treatment for generalized anxiety disorder, few studies have addressed the outcome of short-term psychodynamic psychotherapy, even though this treatment is widely used. The aim of this study was to compare short-term psychodynamic psychotherapy and CBT with regard to treatment outcome in generalized anxiety disorder. METHOD: Patients with generalized anxiety disorder according to DSM-IV were randomly assigned to receive either CBT (N=29) or short-term psychodynamic psychotherapy (N=28). Treatments were carried out according to treatment manuals and included up to 30 weekly sessions. The primary outcome measure was the Hamilton Anxiety Rating Scale, which was applied by trained raters blind to the treatment conditions. Assessments were carried out at the completion of treatment and 6 months afterward. RESULTS: Both CBT and short-term psychodynamic psychotherapy yielded significant, large, and stable improvements with regard to symptoms of anxiety and depression. No significant differences in outcome were found between treatments in regard to the primary outcome measure. These results were corroborated by two self-report measures of anxiety. In measures of trait anxiety, worry, and depression, however, CBT was found to be superior. CONCLUSIONS: The results suggest that CBT and short-term psychodynamic psychotherapy are beneficial for patients with generalized anxiety disorder. In future research, large-scale multicenter studies should examine more subtle differences between treatments, including differences in the patients who benefit most from each form of therapy.
Subject(s)
Anxiety Disorders/therapy , Cognitive Behavioral Therapy/methods , Psychotherapy, Brief , Psychotherapy/methods , Adult , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Depressive Disorder/therapy , Female , Humans , Male , Outcome Assessment, Health Care , Patient Dropouts/statistics & numerical data , Personality Inventory , Psychiatric Status Rating Scales , Treatment OutcomeABSTRACT
On the basis of a case study the conciliar physician procedure in Germany is described in the context of psychotherapy for problematic constellations during severe physical diseases. Changes and modifications are suggested.
Subject(s)
Colitis, Ulcerative/psychology , Depressive Disorder/psychology , Patient Care Team/legislation & jurisprudence , Psychophysiologic Disorders/therapy , Psychotherapy/legislation & jurisprudence , Referral and Consultation/legislation & jurisprudence , Sick Role , Adult , Colitis, Ulcerative/therapy , Depressive Disorder/therapy , Expert Testimony/legislation & jurisprudence , Female , Germany , Humans , Treatment Refusal/psychologyABSTRACT
OBJECTIVES: In the areas of psychosomatic medicine and psychotherapy, the relative proportion of female physicians is above average compared with other medical specialty areas. Is there a gender-specific affinity for the subject even among medical students and if so, how does it affect the students' choice of their subsequent specialty and their further professional career? METHODS: Gender proportions were studied in a) students of elective courses in psychosomatics and psychotherapy at the University of Goettingen, b) graduate students of German medical faculties between 1993 and 2004 and c) advanced ranks of medical career. RESULTS: Female preponderance in psychosomatics and psychotherapy is already to be found among students and extends to the rank of specialists. However--as in other medical specialties--women are not adequately represented in managerial positions. CONCLUSIONS: The relatively high proportion of female physicians might be the result of women's special disposition for the field. While an adequate representation of both sexes among medical psychotherapists is desirable for clinical practice, an increase of female physicians in management and research positions would be expedient in order to direct more attention to gender-specific questions in psychosomatics and psychotherapy.
Subject(s)
Career Choice , Physicians, Women/supply & distribution , Psychosomatic Medicine/education , Psychotherapy/education , Sex Ratio , Students, Medical/statistics & numerical data , Female , Germany , Health Workforce , Humans , Male , SpecializationABSTRACT
The present critical commentary deals with the 2006 study by R. Sachsse. This study examines the influence of psychotherapy on chronic inflammatory intestinal disorders (in German: chronisch entzündliche Darmerkrankungen-CEDE) using a "disorder-specific psychotherapeutic approach". However, the study totally excluded the investigation of any relevant, disease-specific physical parameters. Therefore, conclusions on the effectiveness of the psychological psychotherapy applied in this study on the course of chronic inflammatory intestinal disorders are not possible.
Subject(s)
Inflammatory Bowel Diseases/psychology , Inflammatory Bowel Diseases/therapy , Psychophysiologic Disorders/therapy , Psychotherapy , Adaptation, Psychological , Humans , Inflammatory Bowel Diseases/diagnosis , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Treatment OutcomeABSTRACT
AIM: We investigate which articles out of the entire fifty volumes of the Zeitschrift fur Psychosomatische Medizin und Psychotherapie (Journal of Psychosomatic Medicine and Psychotherapy (Psychoanalysis) have been most frequently cited. These articles are analysed according to the groups of authors and topics. METHODS: The citation frequency was determined in the source journals listed by the ISI and contained in the SCI and SSCI data banks. RESULTS: 58 articles were cited at least ten times, and five of these articles were cited at least twenty times. One article was cited 45 times and thus was the top runner. The authors who are particularly important in their specialized areas dominated, and the most frequently cited articles were distributed quite evenly in both psychosomatic and psychotherapeutic topics. DISCUSSIONS: A relatively large number of articles in this journal have a sustained influence among experts in the field. Since there are not many of German journal listed in the ISI data banks or have only recently been included by them, the number of citations is most likely considerably higher.
Subject(s)
Periodicals as Topic/statistics & numerical data , Psychosomatic Medicine , Psychotherapy , Publishing/statistics & numerical data , Authorship , Databases, Bibliographic/statistics & numerical data , Germany , Humans , Manuscripts as TopicABSTRACT
The directives for psychotherapy, which were established in 1967 for the compulsory national health insurance system, had a strong influence on the subsequent development of psychotherapy in Germany. This article depicts the historic conditions and the general framework of the directives for psychotherapy as well as their development in the decades following. Finally, possible future perspectives and risks are discussed.
Subject(s)
National Health Programs , Psychoanalytic Therapy , Psychotherapy/history , Psychotherapy/statistics & numerical data , Germany , History, 20th Century , Humans , Primary Health Care/history , Primary Health Care/statistics & numerical data , Psychoanalytic Therapy/statistics & numerical data , Psychotherapy/standardsABSTRACT
OBJECTIVES: The present article deals with the question as to which kind of evidence is necessary to demonstrate the effectiveness of a psychotherapeutic method. RESULTS: The authors point out that randomized controlled studies (RCTs) are carried out in standardized laboratory contexts, whereas naturalistic studies are based on conditions in the psychotherapeutic practice. Accordingly, RCTs and naturalistic studies address different questions of research (laboratory vs. field). CONCLUSIONS: This view has several important implications: (1.) RCTs and naturalistic studies do not differ concerning their internal and external validity. (2.) In principal, naturalistic studies do not provide lower level evidence than RCTs. (3.) Evidence from RCTs cannot be transferred to psychotherapeutic practice in the field: If a therapy has worked in an RCT, this does not necessarily imply that it will work in the field as well. (4.) Naturalistic studies provide important evidence for determining the effectiveness of a therapy in practice. (5.) The proposed catalogues for levels of evidence focus on RCTs. Thus, they cannot be applied to hypotheses on the effectiveness of a therapy in the field (naturalistic studies). (6.) It is necessary to define separate criteria for levels of evidence of naturalistic studies. In this article, criteria and levels of evidence of naturalistic studies are defined. The implications of the differentiation of randomized controlled vs. naturalistic studies is discussed.
Subject(s)
Evidence-Based Medicine , Psychotherapy , Randomized Controlled Trials as Topic , Humans , Observation , Reproducibility of Results , Treatment OutcomeABSTRACT
This article is a review of the historical development of this journal from its establishment in 1954 to the present. The history of its founding will first be briefly outlined and illustrated with some facsimile prints from that time. The thematic focuses as they evolved over the last five decades will then be reviewed. In a further chapter individuals will be presented who have contributed significantly to the journal and made it what it is today.
Subject(s)
Periodicals as Topic/history , Psychosomatic Medicine/history , Psychotherapy/history , Publishing/history , Germany , History, 20th Century , HumansABSTRACT
OBJECTIVES AND METHODS: In a cognitive framework appraisal and coping are seen as major factors in the adaptation of chronic pain patients. This study evaluates the differences between rheumatoid arthritis (N = 70) and fibromyalgia (N = 74) outpatients in regard to coping and appraisal, and the relationship between appraisal, coping and adaptation in general. RESULTS: In rheumatoid arthritis patients acceptance of illness and cognitive-reappraising coping prevails. In fibromyalgia patients, however, passive, emotion-focused coping and the judgement of illness as a "threat" or "punishment" (Lipowsky) was pronounced. A connection between individual appraisal of the illness and means of coping was observed. There was also a strong relationship between coping and adaptation, with one third of the variance of the mood variables explained by appraisal and coping. The presence of a psychic disorders played only a minor role. CONCLUSIONS: A detailed understanding of the relationship between appraisal, coping, and adaptation may contribute to improved treatment concepts in pain patients. One aim of psychotherapy in chronic pain patients should be to reduce passive, emotion-focused coping and to change maladaptative concepts of illness.
Subject(s)
Adaptation, Psychological , Anxiety/psychology , Arthritis, Rheumatoid/psychology , Depression/psychology , Fibromyalgia/psychology , Sick Role , Adult , Aged , Anxiety/diagnosis , Defense Mechanisms , Depression/diagnosis , Female , Humans , Male , Middle Aged , Personality Inventory/statistics & numerical data , PsychometricsABSTRACT
Depth psychologically founded psychotherapy is a treatment based on psychoanalysis. This article describes the treatment method. The following aspects are emphasized: Terminology definitions, historical development, specific differences between depth psychologically founded and analytic psychotherapy as well as the treatment practice with the focus on current psychosocial conflicts and their implications. Indication, counter-indication and differential indication are also discussed, and the status of empirical evaluation is described. Finally, the therapist's qualifications for this treatment method are elucidated.
Subject(s)
Psychoanalytic Therapy/methods , Conflict, Psychological , Humans , Interpersonal Relations , Outcome and Process Assessment, Health Care , Personality Development , Psychoanalytic TheoryABSTRACT
Depth psychologically founded psychotherapy is a treatment based an psychoanalysis. This article describes the treatment method. The following aspects are especially emphasized: Terminology definitions, historical development, specific differences between depth psychologically founded and analytic psychotherapy, and the treatment practice with the focus an current psychosocial conflicts and the implications connected with these. Then indication, counter-indications and differential indication are discussed, and the status of empirical evaluation is described. Finally the therapist's qualification requirements necessary for this treatment method are explained.
Subject(s)
Child Behavior Disorders/therapy , Neurotic Disorders/therapy , Psychoanalytic Therapy/methods , Adolescent , Child , Child Behavior Disorders/psychology , Humans , Neurotic Disorders/psychology , Object Attachment , Professional-Patient Relations , Psychoanalytic TheoryABSTRACT
Patients with fibromyalgia are compared with rheumatoid arthritis and coxarthrosis patients respecting biographic risk factors and comorbidity (mental disorders). As expected, in fibromyalgia there are higher biographic risk factors and more mental disorders than in the other groups. Moreover, there is a positive relation between mental disorders and biographic risk factors in fibromyalgia. Therefore patients with fibromyalgia are no uniform group, but can be divided in at least two subgroups: One subgroup with high biographic risk factors and mental disorders and another subgroup without increased biographic risk factors and without comorbidity (mental disorders). Consequences for psychosomatic theories are discussed.
