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Due to the treatment costs, extensions of the standard therapy duration are a matter of critical examination. This study investigates which factors characterize patients with treatment extensions in the German health system and how effective these extensions are for a reduction of the patients' symptoms. We analysed a disorder heterogeneous sample of 810 patients. We found that therapy extensions are more common among with more severe mental disorders, when the therapeutic relationship is positive, and little therapy success has been achieved during the standard duration. Overall, the findings suggest that outpatient psychotherapy is mainly extended for patients with a low symptom reduction after the standard therapy duration and that therapy extension allows a symptom reduction that could not have been achieved otherwise.

Der vorliegende Kommentar stellt nochmals die Sicht des wissenschaftlichen Evaluationsteams auf das Modellprojekt „Qualitatsmonitoring in der ambulanten Psychotherapie“ (TK-Studie) dar. Es werden Aspekte der Reprasentativitat der Stichprobe sowie Designprobleme, welche die statistische Kontrolle der bewilligten Sitzungen bei der Analyse der Behandlungsdauer notwendig machten, erortert. Die positive Einschatzung der psychometrischen Ruckmeldungen sowie des Qualitatssicherungskonzeptes auf Patientenseite, die hohere Patientenzufriedenheit in der Ruckmeldegruppe und die Nutzung der Ruckmeldungen fur Behandlungsentscheidungen durch die Therapeuten werden als wichtige Befunde der Studie betrachtet. Die Studie wird abschliesend als Pilotstudie im Kontext eines notwendigen Ausbaus der Psychotherapieforschung unter Anwendungsbedingungen in Deutschland diskutiert.

Als erste Studie dieser Art in Deutschland zielt das Modellprojekt Qualitatsmonitoring in der ambulanten Psychotherapie darauf ab, ein Qualitatssicherungs- und Ruckmeldeverfahren hinsichtlich seiner Einsetzbarkeit in der Routineversorgung zu untersuchen. Im vorliegenden Beitrag werden Aspekte der Reprasentativitat der Stichprobe, des Einflusses des Modellprojektes auf die Behandlungsdauer und die Basisannahmen und Konzepte des Modells aus der Sicht des Evaluationsteams dargestellt. Es handelt sich um einen Kommentar zum Beitrag: Das Modellprojekt der Techniker-Krankenkasse. Eine Kommentierung der Ergebnisse aus der Sicht des wissenschaftlichen Projektbeirates.

This article reports on a questionnaire concerning individual problems in psychosomatic rehabilitation. A sample of 858 patients answered the questions at the beginning and on a one year catamnestic measurement. First, the frequency of occurrence of several symptoms was asked. Second, the rehabilitants were asked to indicate for each symptom if it was an important problem before treatment. This procedure of identifying problems was done at the beginning (prospective marking) and also at the one year followup (retrospective marking). The questionnaire allows to compute eight subscales and one global scale regarding all items (classical approach). Frequency of occurrence decreased with an average effect size (ES) of 0.56 on the global scale. In the next step, measurement was individualized by regarding only items which were marked as relevant problem. By prospective marking, effect size was 1.32. By retrospective marking, no growth of effect size in comparison to the classical approach was found (ES = 0.56). The results indicate that the prospective approach of identifying problems is the better way of individualizing measurements. Moreover, the impact of individual problem definition on outcome was demonstrated.

Objective: Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study (“Quality Assurance in Outpatient Psychotherapy in Bavaria”; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. Method: Both projects and their results indicating high effect sizes are briefly described. Results: From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. Conclusions: Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system