[Conceptual development of partial inpatient psychosomatic rehabilitation]. / Konzeptionelle Entwicklung der teilstationären psychosomatischen Rehabilitation.

The conceptual development of partial hospitalization treatment is a present-day task for psychosomatic rehabilitation. For this task the general regulations of the pension insurance agencies as well as the conceptions existing in the field of psychosomatics and psychotherapy can serve as a sufficient basis for the conceptual development of partial hospitalization psychosomatic rehabilitation inspite of several differences between them. The elaboration of concrete outlines of this kind of psychosomatic rehabilitation takes place within a framework of structural models which encompasses different variants of institutional, organizational, functional and content forms of partial hospitalization rehabilitation. Moreover, the conceptual development of day treatment in rehabilitation raises several questions of the overall system of psychosomatic rehabilitation and offers possible solutions of general problems in psychosomatic rehabilitation. On this conceptual basis, in the further construction of partial hospitalization in psychosomatic rehabilitation concrete models should be designed and tested in clinical practice along with scientific evaluation.

[Partial inpatient treatment as a responsibility in psychosomatic rehabilitation]. / Teilstationäre Behandlung als Aufgabe der psychosomatischen Rehabilitation.

Day clinic rehabilitation is part of the development of the medical rehabilitation system. Psychosomatic rehabilitation faces the task of developing a concept of day treatment and of collecting experiences with such models in clinical practice. The basis of this task consists in regulations laid down by the social security insurance authorities which serve as a frame for the development. The main points of these regulations are presented and their relevance for psychosomatic rehabilitation is outlined. The institutional and conceptual establishment of day treatment presents psychosomatic rehabilitation with a number of problems that are particular in this area and which are discussed in detail. Besides that, consequent elaboration of day treatment could stimulate further development of psychosomatic rehabilitation in general and help to overcome prevailing shortcomings of this part of the rehabilitation system.

[Functions of the social worker in a multi-professional team in inpatient psychosomatic rehabilitation]. / Funktionen des Sozialarbeiters im multiprofessionellen Team der stationären psychosomatischen Rehabilitation.

The task of rehabilitation as defined by law and the concept of psychosomatic-psychotherapeutic treatment require cooperation of different professions in a clinical team. This approach implies a concept of interdisciplinary cooperation in which the contributions towards treatment to be made by the individual members of the multiprofessional team are defined by means of functions and tasks. Participation of the social worker is an integral element of psychosomatic teamwork. The social worker makes an important contribution towards the interdisciplinary arrangement of psychosomatic rehabilitation treatment by taking over functions for maintaining the ward setting, for the psychotherapy process and the rehabilitation task as well as for the working of the team. On the basis of his specific competence he provides independent knowledge, particular ways of interaction, and singular methods of intervention of social work for the psychosomatic treatment carried out by the multiprofessional team.

[Aspects of process quality in quality assurance regarding inpatient psychosomatic rehabilitation]. / Aspekte der Prozessqualität in der Qualitätssicherung der stationären psychosomatischen Rehabilitation.

Quality assurance in in-patient psychosomatic rehabilitation is performed basically by an external, general, structure-oriented and outcome-oriented programme of quality assurance conducted by statutory insurance bodies. In contrast, the differentiation of quality assurance in special fields of rehabilitation as well as the elaboration of the dimension of process in quality assurance have been neglected. Particular conditions of treatment in in-patient psychosomatic rehabilitation highlight the importance of the quality of procedure. Among these are the relatively longer duration of treatment, the particular dynamics and liability to disturbances of psychotherapeutic interaction, the cooperation of different therapeutic fields within a comprehensive plan of treatment and the specificity of treatment goals for each individual patient. Such a kind of quality assurance relating to procedure is made feasible by two types of structural elements of quality of procedure in in-patient psychosomatic-psychotherapeutic treatment. Iterative structural elements of procedure (e.g. team conferences, supervision) serve to control the cooperation of the team by means of a random sample of patients. Sequential structural elements (e.g. admission conference, intermediate review conference, discharge conference) help in monitoring systematically the course of treatment in relation to each individual patient. As for the obtaining of information, sequential structural elements of assurance of quality of procedure make routine monitoring possible, whereas iterative elements create space for spontaneous notification of disturbances.

[Patient satisfaction as a criterion of quality assurance in inpatient psychosomatic rehabilitation]. / Die Patientenzufriedenheit als Kriterium der Qualitätssicherung in der stationären psychosomatischen Rehabilitation.

The investigation of patient satisfaction with treatment by means of simple standardised self-rating instruments is a focal point of monitoring and improvement of treatment quality in the programme of quality assurance of rehabilitation within the statutory social insurance system. In the field of psychosomatic rehabilitation this criterion contains a number of problems due to the individual traits of patients, the treatment institutions, and the rehabilitation process. A structural discrepancy between the patients' attitudes and the requirements of the rehabilitation measure causes a systematic potential of dissatisfaction of the patients throughout the whole rehabilitation procedure. The specific quality of psychosomatic rehabilitation requires differentiation in the assessment and interpretation of patient satisfaction as a criterion of quality assurance as well as in the deduction of subsequent measures for improvement. Doubts are also raised as to the usefulness of a simple and global reference to patient satisfaction as a criterion of quality assurance even beyond the field of psychosomatic rehabilitation.

[Patient cooperation as a problem in inpatient psychosomatic rehabilitation]. / Die Mitwirkung des Patienten als Problem der stationären psychosomatischen Rehabilitation.

Patients insured under the pension insurance scheme are subject to a statutory obligation to cooperate in their remedial treatment. In in-patient psychosomatic rehabilitation, a number of problems arise in view of this cooperation, as the patients are hampered in their potential for compliance with this demanded cooperation due to the specific nature of their psychosomatic condition, their personality structure as well as their previous disease history. Moreover, cooperation in psychosomatic rehabilitation involves special requirements in terms of active participation, inner openness and readiness for psychosocial change. In psychosomatic rehabilitation, the patient's cooperation cannot be assumed as a matter of course, rather, it is a task of the treatment process itself, which by appropriate therapeutic means seeks to achieve the patient's motivation and a working alliance, hence to create the prerequisites for cooperation.

[The contribution of social work to psychosomatic rehabilitation in social insurance]. / Der Beitrag der Sozialarbeit zur psychosomatischen Rehabilitation in der Rentenversicherung.

Psychosomatic rehabilitation conducted by the social insurance system aims at improvement or restitution of the patient's impaired competence of leading a regular social life and in particular of taking part in the working process. Psychoanalytically based in-patient psychotherapy is focussed on the patient's psychosocial conflict constellations and tries to enable him to cope with his daily social tasks in a satisfying and self-reliant way. In the process of psychosomatic treatment the social worker has an important function in the comprehensive treatment plan due to his expert knowledge and counselling competence. In coordination with the treatment team the social worker makes a genuine contribution in examining and diagnosing the patient, motivating him/her, working out a treatment scheme, realising the treatment process, completing the treatment and arranging for further social and psychotherapeutic care.

[Handling indications for an initial psychotherapy interview]. / Der Umgang mit der Indikation in der psychotherapeutischen Erstuntersuchung.

The treatment of indication in the psychoanalytically oriented psychotherapeutic initial interview has been neglected by research on the initial interview as well as on indication. The indication discourse is a genuine part of the psychotherapeutic initial examination which is of great importance for the acceptance of the indication by the patient. The indication discourse has its own tasks, roles, and contents. In the treatment of indication in the interview phases of preparation, information, and working with the patient's reactions can be differentiated, each of which contains further elements. Further research in this field should be guided by an interest in the role of the patient in the reception of indication.

[Contributions of psychotherapy research to theory and practice in interconceptional differential indications]. / Beiträge der Psychotherapieforschung zur Theorie und Praxis der interkonzeptionellen differentiellen Indikation.

Several changes in the social conditions of psychotherapeutic care in the public health service call for the development of a theory and practice of differential treatment selection for heterogeneous schools of psychotherapy, e.g. psychoanalysis and behaviour therapy. To do this, first some basic problems of interconceptional differential indication have to be solved. Furthermore, findings of the empirical psychotherapy research should be used for working out such a theory. Results of two important fields of psychotherapy research are presented and discussed with respect to their relevance to differential treatment selection. Conclusions are drawn for a theory of interconceptional differential indication and some principles of differential treatment selection pertaining to heterogeneous treatments are formulated.

[Psychotherapeutic treatment of patients with functional voice disorders]. / Psychotherapeutische Behandlung von Patienten mit funktionellen Stimmstörungen.

Psychic factors in the development and maintenance of functional voice disorders call for a psychotherapeutic treatment of dysphonic patients. The voice symptom is considered as a creative achievement of the patient to cope with an internal conflict using the ego function of speaking in the social context. A large number of dysphonic patients require an orientation of psychotherapy towards their symptoms. Symptom-centered short-term psychotherapy on a psychoanalytic basis concentrates on a symptom focus which, being a generalized description of cognitive, affective and behavioural elements of speech-conflict situations, structures the psychotherapeutic work with the material of the manifestations of voice complaints in the psychosocial context. Working out the psychodynamic conflict constellation underlying the voice symptomatics enables the patients to develop alternatives of coping with the internal affective conflict and of arranging interaction patterns with emotionally significant persons.

[Indications for psychotherapeutic treatment of functional dysphonias]. / Indikationen zur psychotherapeutischen Behandlung bei funktionellen Dysphonien.

Functional voice disorders require adequate psychiatric screening and treatment due to the complex etiologies of the psychic elements involved. While the diagnosis of dysphonia increasingly takes into account various emotional factors, considerations of indications for psychotherapy and for differing forms of psychotherapy are missing in the literature. To fill this gap, the aims and principles of a number of psychoanalytically based therapeutic methods are presented. Criteria for general indications for treatment and with respect to patients with functional voice disorders are outlined. Case reports of patients with functional voice disorders illustrate individual methods for diagnosis and treatment. Finally, the necessity, for the development of general criteria for differential indications for psychotherapy in functional voice disorders is pointed out.

[Personality markers of patients with vocal cord granuloma]. / Persönlichkeitsmerkmale von Patienten mit Kontaktgranulom.

Particular features of the personality of patients with vocal cord granuloma have been reported in the literature based on intuitive observation of individual cases in clinical examination. The present study was designed to examine systematically a larger number of patients with vocal cord granuloma by means of a psychosomatic interview and with objective standardised personality inventories. The aim was to investigate characteristics of personality structure, the extent and form of psychosomatic complaints, and the psychosocial self-image of these patients. 33 patients with the diagnosis of vocal cord granuloma participated in the study. They underwent a psychodynamic psychosomatic interview and filled in the Giessen test, a standardized personality inventory, the Giessener Beschwerdebogen, a somatic complaints list, and a social questionnaire. Descriptive statistics were computed. Psychodynamic diagnostics revealed two types of the functional level of personality: narcissistic and psychosomatic structures were almost equally represented. With respect to the drive organisation of personality structure, mainly compulsive and to a lesser extent depressive dominant features were found. The structure of somatic complaints in our patient group with vocal cord granuloma was different from that of the norm population as well as that of a group of psychosomatic-psychoneurotic outpatients. With regard to the extent of somatic complaints, the scores of our patients were in the middle between the norm values and those of psychosomatic patients. In the self-image of their personality and their psychosocial relations, patients with vocal cord granuloma deviated from the values of the norm population in all scales into the direction of the scores of psychosomatic-psychoneurotic outpatients.(ABSTRACT TRUNCATED AT 250 WORDS)

[The psychosomatic interview in diagnosis of functional voice disorders]. / Das psychosomatische Interview in der Diagnostik funktioneller Stimmstörungen.

For the psychosomatic diagnosis of functional voice disorders, the concept of a semistructured psychosomatic interview is presented which follows the principles of psychoanalytic interviewing and of deep-psychological biographical anamnesis. It also takes into account the special features of dysphonic patients as psychosomatic patients, the characteristics of functional voice disorders, and the interrelationship of voice and psychosocial biography. The psychosomatic interview consists of the components interviewing situation, voice symptomatology and voice genesis, psychosocial biographical anamnesis and indication to psychotherapy. Beginning and end of the interview are fixed, whereas in the further course the selection of elements is fitted to the conflict constellations of the patient.

[Symptom-centered psychotherapy in patients with functional voice disorders]. / Symptom-zentrierte Psychotherapie bei Patienten mit funktionellen Stimmstörungen.

As a disorder of an ego-function, functional voice disorders display a remarkable sensitivity and variability towards psychosocial factors and an often immediate connection with the underlying psychic conflict constellation. Being concentrated on their symptomatics, patients with functional voice disorders command a good capacity of observing their complaints and factors affecting them. Symptom-centered short-term psychotherapy makes use of the particular character of the voice symptom and of the patient's capacity in a focal treatment of the symptom. First, a symptom-focus is established on the basis of an analysis of speech conflict situations which contains essential psychosocial factors and is structured by a psychic conflict constellation. In the further course of psychotherapy, the symptom focus is used as a heuristic device in the treatment of material of the voice symptomatics. In working through present and past speech conflict constellations patients reach an understanding of the psychosocial conflict contained in the voice symptomatics and are enabled to develop alternatives for changing the maladaptive speech interaction patterns.

Cortisone image and emotional support by key figures in patients with bronchial asthma. An empirical study.

In a subgroup of patients with bronchial asthma, irrational fears of steroid medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone often underlies non-compliant illness behaviour. In the present study, cortisone image and the relationship with a key figure was investigated in 62 patients with bronchial asthma, all of whom had participated in a structured asthma treatment and teaching programme (ATTP). The data show that (1) perceiving cortisone as threatening predicts poor adherence to ATTP guidelines how to manage severe attacks, and (2) patients having a supportive relationship with their key figure are less likely to experience threatening aspects of cortisone.

[Psychosomatic findings in patients with contact granuloma--initial results]. / Psychosomatischer Befund bei Patienten mit Kontaktgranulom--erste Ergebnisse.

In a prospective study, 33 patients with vocal cord granulomas were seen in a psychosomatic interview and given questionnaires. Results showed the significance of psychosomatic factors in the occurrence of vocal cord granulomas. Psycho-social stress situations, particularly in private lives, and losses of emotionally significant persons were of prime importance. Two types of personalities--a narcissistic and a psychosomatic type--were represented about equally. In the personality structure of the patients, compulsive behavior was diagnosed most frequently while depressive features occurred to a lesser degree. Supportive and expressive psychotherapy was indicated in two thirds of the cases.