Psychotherapie Psychosomatik Medizinische Psychologie最新文献

Patients with primary biliary cholangitis (PBC) suffer from a variety of physical complaints such as fatigue, itching or joint pain. Since little is known about the experience of symptoms and the corresponding coping strategies in this patient group, a qualitative study was conducted in which 15 patients with PBC were interviewed. The patients reported being burdened by numerous physical complaints, some of which require extensive coping and adaptation processes. By means of thematic analysis, two overarching themes could be generated from the data material: "Accepting limitations and shifting boundaries" describes the patients' challenge of redefining their own stress limits and adapting demands and expectations to their own capabilities. "Maintaining normality and reorienting" describes the tension between the desire to maintain normality and the challenge of integrating the symptoms as perceptible signs of their illness into their own self-image. The results illustrate the central role of physical symptoms in the everyday lives of many patients with PBC, the complexity of the experience of symptoms and the challenges of dealing with these symptoms. They also emphasize the supportive and mediating function of healthcare practitioners in individual symptom management.

Objective: Organiszed abuse (OA) is a form of long-lasting, mostly sexualized violence against children, youth, or women by networked perpetrators for financial and power-related enrichment. Individual reports and historical analyses imply this violence could have taken place in the German Democratic Republic (GDR). This study is the first to shed light on OA in the GDR from the perspective of those affected.

Methods: N=10 confidential hearings and written reports of victims of sexualized violence in childhood and adolescence in the GDR, which were made available by the Independent Inquiry into Child Sexual Abuse in Germany, were analyzed using content-structuring qualitative content analysis.

Results: OA was described with multiple forms of sexualized, physical and psychological violence. Those affected place OA in different contexts, with other categories (perpetrators, duration/frequency of violence, motives) sometimes dependent on these. The consequences for victims are both short- and long-term in nature and occur on both health (especially psychopathological) and psychosocial levels up to the present. There were no indications of further GDR-specific characteristics of OA.

Discussion: The reports of victims enable the perspective of "experienced knowledge", which has its limit where descriptions presuppose the knowledge of perpetrators (e. g., motives for violence, characteristics of violence structure). Possible political-ideological features of violence could not be discussed due to considering OA as an "ideology-free" phenomenon (in contrast to e. g. ritual abuse). In addition to definitional distinctions between different phenomena of violence, a multiperspective and multiprofessional approach is necessary to guarantee a historically sensitive continuation of research.

Body-focused repetitive behaviors (BFRBs) such as trichotillomania and skin picking are disorders at the interface of psychiatry/psychology, dermatology and dentistry. The disorders can be both either a consequence or a cause of severe somatic disorders. If BFRBs remain undetected and untreated, they tend to become chronic with at times serious somatic complications. There is currently no approved medication for BFRBs. Cognitive-behavioral therapy, especially habit reversal training, is the method of choice. The self-help technique decoupling is also effective for a subgroup of patients. In addition to behavioral change, therapy should also address precipitating factors such as poor stress and emotion regulation strategies and sensory triggers.

Objective: Therapists' interpersonal skills play a significant role in outcome differences between therapists. Similarly, the strength of the therapeutic alliance is influenced by therapist characteristics. Therefore, the aim of this study was to capture therapist differences in the alliance and to examine the effect of therapists' interpersonal skills on the therapeutic alliance.

Methods: Interpersonal skills of 99 incoming therapists were measured in a group discussion using the Therapy-Related Interpersonal Behaviors (TRIB) scale. The therapists treated n=1031 psychotherapy outpatients as part of their clinical training. The alliance was assessed at the end of therapy using the Assessment for Signal Clients (ASC). Hierarchical linear models were used to predict the alliance from interpersonal skills, controlling for other patient and therapist variables. Initial impairment was examined as a moderator of the effect.

Results: The therapist effect (TE) on the alliance was 7.3%. Interpersonal skills were a significant predictor of the alliance (b=0.104, p<0.001) and could explain 1.8% of the total variance beyond all control variables. The TE was reduced to 5.7%, meaning that 23.0% of the therapist differences in the alliance could be attributed to interpersonal skills. Although the moderation effect of initial impairment was only marginally significant (b=0.069, p=0.061), the association between interpersonal skills and alliance disappeared with low patient impairment.

Discussion: The TRIB scale can measure interpersonal skills before the start of training. The prediction should be considered in the context of the several years' temporal distance between the measurements of interpersonal skills and the alliance, applicable to the selective sample of therapists chosen for the training.

Conclusion: Interpersonal skills can predict the alliance. The influence of therapists' interpersonal skills on the alliance increases with the initial impairment of patients, while there is no significant relationship with low-impaired patients. Using video-based rating systems, interpersonal skills of individual therapists can be measured automatically, therapists with deficits can be identified, and targeted training can be provided.

Although most psychotherapists adopt an integrative and process-oriented approach, transtheoretical approaches to psychotherapy training are rare. To better prepare future therapists for the complexities of clinical practice, such an approach is needed. A promising way forward is to consider principles of change that cut across different schools of therapy. The principle of the therapeutic alliance is where different therapy schools agree most. Therefore, an alliance-focused training is presented below, where therapists learn to recognize ruptures in the therapeutic alliance and respond to them with resolution strategies. Current teaching methods like role-playing and supervision have their limitations, as they can only be applied post hoc and to a small number of cases. A new approach could be an online training that integrates principles of change, such as the alliance and markers for interventions, utilizes proven methods of deliberate practice and expert training, and makes use of the potential of technology.

Within the framework of the evidence-based practice model of the American Psychological Association (APA, 2006), psychotherapeutic core competences are mostly formulated transdiagnostically and transtheoretically, but do not exclude the systematic consideration of symptom-specific aspects. This article provides an exemplary case study of a person suffering from a generalized anxiety disorder to illustrate how evidence-based practice can be implemented. Multi-perspective competence development can be stimulated in training through the following therapeutic areas: (1) through broad assessment and psychodiagnostics, (2) through joint development of an individual explanatory model, (3) through inclusion of symptom-specific models, (4) through broad consideration of stringent interventions, (5) through application of various treatment modalities, (6) through patient-centred treatment implementation. The article concludes with a list of study examples of how psychotherapeutic competence development can be researched within the framework of the evidence-based practice model.

Objective: This study compares two types of therapeutic model videos: an ideal model and a model that shows mistakes. The idea is that the conscious perception of mistakes is more likely to help build a comprehensive understanding of clinical communication skills than an ideal model.

Methods: A total of n1=111 psychology students and n2=57 people from the general population were randomly assigned to one of two training conditions as part of an online study. While one group watched a short but competent conversation of a behavioral therapist in their training with a positive model video, the other group watched a mixed model video in their training that showed a therapist with mediocre competence. In both training videos, the positive or negative behavior was marked with written explanations. Before and after the training, the participants rated the competencies of a therapist in another interview situation using standardized scales. These competence ratings were compared with those of two clinical experts and thus provided an indicator of the participants' conceptual knowledge of competent interviewing.

Results: A series of ANCOVA models showed that the group that saw the mixed model video deviated significantly less from the experts after training than the group that saw the positive model video (ηp2=0.03-0.10). However, the group that watched the positive (vs. mixed) model video deviated more strongly from the expert judgments on two of three competence scales after the training than before (dPre-Post=0.78-0.82).

Discussion: Overall, the hypothesis that mixed models are advantageous was confirmed. The unexpected results in the group with the positive model video could be explained by the fact that they set an unrealistically high anchor to which the later behavior is compared.

Conclusion: Mixed models may offer some advantage over positive models in imparting knowledge about professional communication, especially when the model videos contain behaviorally relevant explanations.

Background: The education and training of psychotherapists is usually based on a procedure-specific theoretical orientation. However, this can have disadvantages as it hinders the utilisation of the possibilities and experiences offered by the overall field of psychotherapy. It could therefore be useful to combine different theoretical approaches and to orientate psychotherapeutic education and training in a transtheoretical and cross-procedural way.

Method: The article describes the extent to which competence-orientated psychotherapeutic training can provide a framework for interdisciplinary exchange within psychotherapy. It presents a practical example of a university-based training programme in basic psychotherapeutic skills that integrates different theoretical approaches. Transtheoretical training first requires an overarching model for case conceptualisation and a transtheoretical definition of intervention goals.

Results: Treatment methods should be classified according to their transtheoretical goals in order to better compare and combine them. Dynamic network models offer a perspective for modern transtheoretical case formulations. We present a competence-oriented approach for psychotherapeutic training in a university context and give an outlook on the barriers of competence-oriented training.

Conclusion: A competence-orientated approach in the education and training of prospective psychotherapists will help to bridge the gap between different psychotherapeutic traditions. It should be seen as a complement to existing methods, not as competition. Overall, however, there are still some barriers to overcome.

This article provides an overview of our research concepts on therapeutic competencies with regard to three main questions. The first research question deals with therapists' competencies to succesfully handle transference and countertransference in the cotext of Alliance Ruptures. Research on the Alliance-Focused Training and on subjective countertransference is presented. The second research question deals with therapists' general interpersonal skills. The research approaches outlined here concern the construct of Facilitative Interpersonal Skills (FIS) and the measurement of these skills using the FIS-task. In further studies on this topic, we are focusing on the question of which therapist characteristics are associated with higher interpersonal skills and which linguistic and phonetic features characterise therapist responses that are rated as interpersonally competent. Another study concerns the tendency of therapists to overestimate their interpersonal skills (self-assessment bias). The third main research question deals with the competence to apply therapeutic techniques and to create helpful change processes. An instrument to assess verbal techniques (Psychodynamic Intervention List) and research approaches focusing on the description and the assessment of mediators of change are presented.