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Background Balint groups aim to reflect doctor-patient relationships on the basis of personal cases. This study reports the validation of a questionnaire aimed at the identification of learning processes among Balint group participants in China. Methods This multicenter cross-sectional study was conducted during Balint group sessions in Beijing, Guangzhou and Shanghai. A heterogeneous sample of different professional groups was intended to adequately capture the reality of Balint work in China. After a Balint group session, the participants were asked to complete the Mandarin version of the Balint group session questionnaire (BGQ-C) and the group questionnaire (GQ), an internationally validated instrument to assess central dimensions of therapeutic relationships during group processes. Results Questionnaires from n = 806 participants from 55 Chinese Balint groups, predominantly comprising individuals with a medical background, were analyzed. Most participants were female (74.6%), and the average age was 34.2 years old (SD = 9.4). The results indicated good to very good reliability (Cronbach’s α = .70 to .86; retest rs = .430 to .697). The verification of the construct validity of the BGQ-C showed satisfying convergent (rs = .465 to .574) and discriminant validity (rs = -.117 to -.209). The model was tested with a confirmatory factor analysis of a three-factor model (standardized root mean square residual = .025; comparative fit index = .977; Tucker-Lewis index = .971). The 3 empirically identified scales resulted in good model fit with the theoretical dimensions of Balint work postulated in the literature: “reflection of transference dynamics in the doctor-patient relationship”, “emotional and cognitive learning” and “case mirroring in the dynamic of the group”. Due to the high correlations between the factors, a single-factor model was possible. A group comparison between the German and Chinese samples showed different loadings across cultures. Conclusions The BGQ-C is a quick-to-complete, item-based measuring instrument that allows the relevant dimensions of Balint group work to be recorded. This study suggests good psychometric properties of the Chinese version. Nevertheless, it must be assumed that the composition of constructs in the two countries is different.

Die Praxisstudie ambulante Psychotherapie Schweiz (PAP-S) bot mit dem Sample von 362 Patient_innen und Tonaufnahmen von über der Hälfte der Therapien eine ausgezeichnete Basis, den Therapieprozess zu untersuchen. An dieser Stelle werden sog. Gendereffekte vorgestellt. Während der letzten rund 50 Jahre hat die Psychotherapieforschung keine konsistenten Forschungsergebnisse zu Gendereffekten für Patientinnen im Vergleich zu Patienten wie auch für Therapeutinnen gegenüber von Therapeuten gezeigt. Allerdings stützten sich die meisten Studien auf Fragebogenerhebungen. Untersuchungen, die Gendereffekte anhand von Tonbandaufnahmen untersuchen, sind eher selten und oft auf kleine Stichproben beschränkt. In zwei Teilstudien der PAP‑S zeigen wir, dass die am meisten sich unterscheidenden Interventionen der Therapeutinnen und Therapeuten den Geschlechtsrollenstereotypen entsprechen: Therapeutinnen intervenieren unterstützender und haltgebender, Therapeuten intervenieren konfrontativer und analytischer. Gendereffekte konnten somit auf der Ebene des Prozesses nachgewiesen werden, allerdings fanden sich keine Unterschiede zwischen dem Geschlecht von Therapeut_innen und Patient_innen hinsichtlich Outcome. With a sample of 362 patients and audio recordings of more than one half of the therapies, the Practice Study Outpatient Psychotherapy Switzerland (PAP-S) provided an excellent basis for investigating the psychotherapeutic process. Here, effects of gender are presented. In the last 50 years, psychotherapy research has produced no consistent research findings on gender effects for female patients compared to male patients or for female therapists compared to male therapists. However, most of the studies have been based on questionnaire surveys. Studies that examine gender effects based on audio recordings of therapy sessions are rather rare and are often restricted to small samples. Two substudies of the PAP‑S revealed that the therapist interventions that differed the most corresponded to gender role stereotypes: Female therapists’ interventions were more supportive and stabilizing; male therapists’ interventions were more analytical. Although this demonstrated gender effects at the process level, no differences in psychotherapy outcome were found between male and female therapists or patients.

ZusammenfassungAls positive Effekte der Balintgruppenarbeit finden sich in Studien patientenbezogene Aspekte wie Empathie und verbessertes Zuhören, aber auch arztbezogene Verbesserungen des Selbstvertrauens und der Arbeitszufriedenheit. Mit der Entwicklung des Balintgruppen-Fragebogens BG-F konnten in einer aktuellen Studie 1460 ärztliche Teilnehmer in 352 unterschiedlichen Balintgruppen untersucht werden und eine differenzielle Wirksamkeit der Balintgruppenarbeit auf den 3 Skalen des BG-F nachgewiesen werden. Insbesondere somatisch tätige Ärzte und fallvorstellende Ärzte zeigen signifikante Effekte für eine verbesserte Reflexion der Übertragungsdynamiken sowie emotionales und kognitives Lernen. Teilnehmer mit längerer Balintgruppenerfahrung zeigen sich mehr geübt im Erkennen von Beziehungsdynamiken und Spiegelungseffekten in der Balintgruppenarbeit. Die Ergebnisse der Studie bestätigen wichtige Zielsetzungen der Balintgruppenarbeit zur Verbesserung der kommunikativen ärztlichen Kompetenz.

Self-report questionnaires are economical instruments for routine outcome assessment. In this study, the performance of the German version of the Outcome Questionnaire-45 (OQ-45) and the Brief Symptom Inventory (BSI) was evaluated when applied in analysis of the outcome quality of psychiatric and psychotherapeutic interventions. Pre-post data from two inpatient samples (N=5711) and one outpatient sample (N=239) were analyzed. Critical differences (reliable change index) and cut-off points between functional and dysfunctional populations were calculated using the Jacobson and Truax method of calculating clinical significance. Overall, the results indicated that the BSI was more accurate than the OQ-45 in correctly classifying patients as clinical subjects. Nonetheless, even with the BSI, about 25% of inpatients with schizophrenia attained a score at admission below the clinical cut-off. Both questionnaires exhibited the highest sensitivity to psychopathology with patients with personality disorders. When considering the differences in the prescores, both questionnaires showed the same sensitivity to change. The advantage of using these self-report measures is observed primarily in assessing outpatient psychotherapy outcome. In an inpatient setting two main problems—namely, the low response rate and the scarce sensitivity to psychopathology with severely ill patients—limit the usability of self-report questionnaires.

Die Arbeit setzt sich mit der derzeitig kontrovers geführten Debatte um angemessene und notwendige Forschungsdesigns in der Psychotherapie auseinander und bezieht eindeutige Position für einen naturalistischen, prozess-outcome-orientierten Forschungsansatz (practice-based evidence). Am Beispiel des Designs und erster Ergebnisse der PAP-S-Studie der Schweizer Charta für Psychotherapie wird aufgezeigt, wie sinnvolle empirische Forschung in der Psychotherapie erfolgen kann. The paper addresses the currently heated debate of appropriate empirical research in psychotherapy. The contribution is in favor of so-called naturalistic approaches to the field of psychotherapy (effectiveness studies) which includes the objective evaluation of process-outcome relationships (practice-based evidence) instead of laboratory studies (efficacy studies). Very first preliminary data of the project provide the reader with ideas regarding meaningful research approaches to the complex field of psychotherapeutic change.

The paper deals with a comparison between verbal affective interventions by the same psychoanalyst in different therapeutic settings, individual and group therapy. Since the same therapist is involved, an exploration of interactional aspects of his therapeutic style becomes possible, taking into consideration his theoretical allegiance and his hypotheses about the structure and development of the psychotherapeutic milieu. The conformation of therapist-group and therapist-individual dyads shows a high thematic concordance across both settings, particularly with regard to separation anxiety, but also to a significant degree in relation to other verbally expressed affects. However similar the correlations do appear, there remain certain differences in the affective interactions between group or individual patient and the therapist that are due to developmental aspects of the therapeutic relationship in either setting.

To study empirically some psychoanalytic assumptions concerning aspects of the oral character and manifestations of fixation and regression, 61 neurotic inpatients at a psychotherapeutic clinic were investigated using a semantic differential technique (Ertel). Each patient was judged by the differential technique on the basis of 12 object representations which, in respect to the psychoanalytic theory of development, are postulated to have connections with the oral stage. A connotative proximity in the semantic space was postulated for several 'oral connotations'. For these relevant connotations the theoretical assumptions were proved empirically. However, there were no statistical differences between several groups of patients (those with an oral fixation and those with later fixations). Furthermore single dimensions of the semantic differential technique used, in contrast to the three-dimensional analysis, allowed the differentiation of patients with oral fixations from the others simply by using object representations that ought to be relevant for the oral stage of psychosexual development.