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Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), This article investigates distances between therapists and their clients in their experience of the therapeutic alliance across the duration of the psychotherapeutic treatments in a naturalistic study. We looked at the working alliances from different vantage points—rupture, repair of ruptures, distances in the alliance impressions of both clients and therapists—and their correlation with treatment outcome. The only predictive variable of alliance ruptures was the inability of therapists to bond sufficiently with their clients regarding a sustainable working atmosphere, which could be identified through a continuous distant alliance rating by the therapists. Alliance ruptures in turn significantly predicted premature termination of treatments, whereas alliance ruptures per se did not necessarily predict treatment outcome. The paper discusses the possible role of the quality of therapists’ attachment styles as a potentially crucial variable in an effective working alliance in psychotherapy.

How effective are Balint group leaders? Objectives Balint leadership until today is based on views of experts. Empirical research is still lacking. This paper reports about leadership effects in Balint groups measured by the newly developed Balint Group Questionnaire (BGSQ). The questionnaire comprises three scales: Scale 1 - Reflection of Transference Dynamics in the Doctor-Patient Relationship, Scale 2 - Emotional and Cognitive Learning, Scale 3 - Case Mirroring in the Group Dynamic. Results 87 out of 107 cooperating Balint group leaders had six or more participants who filled out the questionnaire after a Balint session. Based on the scale scores of the BGSQ from 1459 medical participants we found three clusters of differentially effective leadership. 52 leaders (59.8 %) belonged to the most effective cluster in scale 1, 11 leaders (12.6 %) were particularly effective in scale 2, and 21 leaders (24.1 %) in scale 3. Five out of 87 leaders were found most effective for all three scales. No other influencing factors predicted leadership effectiveness. Conclusions This is the first quantitative study to differentiate leadership effects on learning processes of participants of Balint groups. The importance for training of Balint group leaders is discussed. More research regarding predictive variables and helpful leadership interventions is needed.

Objective Although effective Balint leadership is viewed as essential for good Balint practice, nearly no quantitative research is available regarding the importance of the person of the group leader in Balint group outcome. This study aims to identify Balint group leaders’ impact on “typical Balint” learning processes in Balint groups. Method A total of 1460 medical doctors in 352 Balint groups in Germany, Austria, and Switzerland were investigated. Based on the three learning dimensions of the Balint Group Session Questionnaire, statistical analyses were conducted to identify differential effectiveness in Balint leadership. Results On the basis of the mean scores of the Balint Group Session Questionnaire items across all group participants of each group leader, the 80 certified Balint group leaders were clustered into two groups of more and less effective leaders by a hierarchichal cluster analysis. Mixed model analyses revealed that the effectiveness of the person of the Balint group leader was the most predictive factor for learning effects. Conclusions Training for Balint group leaders should take into account that effective learning processes in Balint groups are strongly related not only to the method itself but also to the person of the group leader.

This article reports about the role of psychotherapists in creating a good enough therapeutic alliance as the basic task for other therapeutic factors come into play. Data from a naturalistic study involving 237 patients treated by 68 psychotherapists using 10 different psychotherapy approaches were analyzed in a process-outcome research design. The results show that therapists had to adapt their alliance perspectives to patients' level of alliance ratings as treatments progressed. Treatment concepts did not play a role in outcome. The view of a similar quality of the therapeutic alliance seems to be an indispensable precondition for favorable treatment outcomes. Successful treatments were conducted more often by therapists who showed significant convergence of alliance ratings over time, whereas discrepant alliance ratings correlated significantly with unsuccessful treatments.

Designing the doctor-patient relationship: How beneficial are Balint groups and for whom? Objectives Participation in Balint groups is obligatory for some medical specialist trainings. Yet there is a substantial lack of empirical evidence for Balint group effects. Methods 1,460 medical specialists who participated in 352 different Balint groups were investigated using the Balint Group Questionnaire (BG-F) at the end of a Balint group session. Using mixed-model analyses, we examined the predictive value of the independent variables Experience in Balint Groups (in years), Clinical Experience in General (in years), Case Presentation vs. Nonpresentation, Facultative vs. Obligatory Participation (status) with regard to scale characteristics of the BG-F: Scale 1: Reflection of Transference Dynamics in the Doctor-Patient Relationship, Scale 2: Emotional and Cognitive Learning, Scale 3: Case Mirroring in the Group Dynamic. Mixed-model analyses were calculated separately for the subgroups Balint Experience 1 year) and for Balint Experience 2 years). Results Complete data were available for 1,400 participants. On Scale 1, "somatic" doctors scored significantly higher than "psyche" doctors. Case presenters scored significantly higher than nonpresenters. On Scale 2, "somatic" doctors showed highly significantly higher scores than "psyche" doctors. Case presenters also scored highly significantly higher than nonpresenters. Doctors with 2 years. On Scale 3, case presenters scored highly significantly higher than nonpresenters. Group participants with less Balint group experience ( 1 year). Conclusions Participation in Balint groups generates important effects on doctors' knowledge regarding the doctor-patient relationship, both privately as well as professionally. These results confirm scientifically specific effects of Balint groups, providing empirical evidence for the importance of Balint group experiences for professionals in the medical field.

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch), Previous results have demonstrated that psychotherapists working in a practice setting have a relatively low treatment adherence, regardless of the therapy school to which they were affiliated. The objective of this study was to investigate whether the therapist’s attitudes in therapeutic matters are a better predictor of interventions employed than the therapeutic method in which the therapist was trained. The relationships between various types of psychotherapeutic intervention and both predictors were tested by means of Markov Chain Monte Carlo simulations. A total of 162 therapy sessions conducted by 18 therapists affiliated to 6 different therapeutic methods were analyzed. The interventions were classified according to the criteria of essentiality and commonality. The analysis showed that 40% of the examined intervention types were significantly associated with at least one of the nine attitude scales considered, whereas only 14% exhibited a significant association with the completed type of therapy training. The latter predictor was only associated with interventions of the kind essential/not common, whereas the attitude scales were related with both essential and common interventions. The rather weak association between the type of completed training and preferred therapeutic intervention types means that many essential intervention techniques acquired during training assume a subordinate role in a practice setting. Choice of therapeutic action is conditioned to a greater extent by nuances in individual attitudes, which may change throughout a professional career. The reciprocal influence of a psychotherapist’s attitude and his or her professional development is discussed.

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.

Zusammenfassung In einem Ubersichtsartikel werden das derzeit vorherrschende Forschungsparadigma der evidenzbasierten Medizin (EBM) und seine Auswirkungen in Psychologie und Psychotherapie (Stichwort empirically-supported treatments, EST) vor dem Hintergrund politisch-okonomischer und ideologischer Stromungen problematisiert und in seinen Auswirkungen diskutiert. Das Dodo Bird-Urteil eines Aquivalenzparadoxons vergleichbarer Effektivitat unterschiedlicher Behandlungskonzepte hat weiterhin Bestand, wie samtliche grose Metaanalysen zeigen. Das medizinische Modell mit seinem randomisiert-kontrollierten Forschungsparadigma (RCT-Studien) ist fur die Psychotherapie unangemessen, weil nur sehr eingeschrankt durchfuhrbar, ist unterkomplex und tragt nicht zur Kenntnis uber die wahren veranderungsrelevanten Wirkfaktoren bei. Stattdessen wird eine aufwendige Prozess-Ergebnisforschung als sinnvoller und gangbarerWeg vorgeschlagen (kontextuellesModell), der die hohe Komplexitat des therapeutischen Veranderungsprozesse...

Zusammenfassung Fragestellung: Diese Studie untersucht die Beziehungen zwischen Achtsamkeit, Depression und Lebensqualitat bei Krebspatienten. Methode: Insgesamt wurden 51 Krebspatienten mithilfe des Freiburger Fragebogens zur Achtsamkeit (FFA;Walach et al. 2004), derHospital Anxiety and Depression Scale (HADS-D;Herrmann et al. 1994) und des Schedule for the Evaluation of Individual Quality of Life - DW(SEI QoL-DW; Browne et al. 1997) untersucht. Die Beziehungen zwischenAchtsamkeit, Depression und Lebensqualitat wurde mithilfe der "instantaneous indirect effect procedure" von Hayes und Preacher (2010) analysiert. Ergebnisse: Der Einfluss von Achtsamkeit auf Lebensqualitat wird durch Depression mediiert. Der Zusammenhang zwischen Achtsamkeit und Depression ist quadratisch. Insgesamt ist daher der totale Effekt von Achtsamkeit auf Lebensqualitat nicht gleich bleibend.Mit zunehmender Achtsamkeit sinkt der Einfluss auf die Lebensqualitat von Krebspatienten. Diskussion: Krebspatienten profitieren bis zu einer ...

In this naturalistic study, 262 audiotaped psychotherapy sessions--randomly drawn from 81 individual therapies from eight different psychotherapy approaches--were rated completely on treatment adherence using a newly developed rating manual. In the therapy sessions, a relatively low percentage of treatment specific interventions (ranging from 4.2% to 27.8%) was found for all eight approaches, 50% to 73% of the interventions were nonspecific or common, and approximately 18% to 27% were intervention techniques from other approaches. Different types of psychotherapy differed highly significantly in levels of treatment adherence. There was no statistically significant association between the type of psychotherapy and its outcome, or between the degree of therapists' treatment fidelity and the treatment outcome. However, there were significant associations between therapists' degree of professional experience, clients' initial psychological burden, and treatment response. Clients' severity of psychological problems prior to treatment predicted quality of therapeutic alliance while therapists' treatment adherence was predicted by therapists' professional experience and by the quality of the therapeutic alliance. We discuss the seemingly indirect importance of treatment adherence for psychotherapy outcome that we found in this study in relation to findings from other studies and in the context of the role of schools within psychotherapy.

Die Arbeit uberpruft die Psychological Mindedness Assessment Procedure (PMAP) bezuglich ihrer pradiktiven Potenz im Hinblick auf das differenzielle Therapie-Outcome in ambulanten Gruppentherapien mit Patienten mit somatoformen Storungsbildern. Im Kontext des Mentalisierungskonzepts werden Uberlegungen zur pradiktiven Aussagekraft des PMAP im Vorfeld der Therapieindikationen angestellt. Wie die Ergebnisse von 50 Patienten aus 6 verschiedenen Therapiegruppen zeigen, sagen hohe PMAP-Einschatzungen vor Behandlungsbeginn offenbar die Gruppenfahigkeit von Patienten voraus. Diese ist fur die emotionale Bindungsfahigkeit wahrend des gruppentherapeutischen Prozesses pradiktiv, was wiederum Voraussetzung fur eine Involviertheit in den gruppeninteraktiven Prozess und somit prognostisch hoch relevant ist. Im umgekehrten Fall eines niedrigeren PMAP-Ratings wurde dies als Konsequenz bedeuten, bei Patienten das „psychische Funktionsniveau“ (Mentalisierungsfahigkeit) unbedingt im Rahmen der Gruppenzusammensetzungen zu berucksichtigen und speziell bei Kurzzeitgruppentherapien (z. B. im stationaren Raum) gruppentherapeutische Konzepte und in technischer Hinsicht Leitungshaltungen zu realisieren, die dem psychischen Funktionsniveau der Patienten vor Behandlungsbeginn entsprechen.

Summary Effectiveness of Outpatient Group Psychotherapy in Germany – Results of the PAGE-Study The PAGE study underlines the effectiveness of long-term psychodynamic and psychodra matic outpatient group therapies in a naturalistic setting. 40 experienced group therapists cooperated, and complete outcome data of 244 patients from psychodynamic groups and of 91 patients from psychodramatic groups (pre-post) were obtained. The effect sizes are consi derably high (ES PA = 1.33 and ES PD = 1.01) compared to internationally reported effect sizes of psychotherapeutic treatments. They highlight the importance of long-term therapeutic treatments with a severely and chronically disturbed clientele. A direct comparison between both approaches – psychodynamic and psychodramatic group therapy – is not possible due to significant differences in treatment lengths and patient demands. Approximately 2.000 treatment goals were obtained from all participating patients and provide information regarding the relationship between intrapsychic and interpersonal treatment goals of patients undergoing group psychotherapy.

This article reports on one of the largest outpatient group psychotherapy studies which investigated long-term psychodynamic groups in a naturalistic setting, i.e. the PAGE (Projekt für ambulante Gruppentherapie-Evaluation)-Study. More than 450 patients of 28 group analysts in private practices were included in the Study. The analytic and psychodynamically oriented long-term outpatient groups were accompanied by a university based research team without impacting the normal patient-therapist contact, treatment contract, and treatment itself, therefore all treatments took place in a naturalistic setting with very experienced group analysts (effectiveness-study). Results of this large study clearly demonstrate that the longer psychotherapeutic treatments take place the better the outcomes are. The average effect sizes are beyond 1.30. Statistical as well as clinical significance was reached on all levels of investigation: symptoms, interpersonal problems, treatment goals, and overall psychiatric functioning.

Objective: This paper addresses the results of two samples of a large naturalistic (effectiveness study) outpatient process outcome study in Switzerland (Practice-Oriented Outpatient Psychotherapy Study). Ten different types of psychotherapy were investigated by looking at the role of the sex or gender of therapists and patients with regard to treatment outcome by including several nonspecific therapeutic factors. Method: Ten different types of psychotherapy, 237 patients, and 68 therapists were included in the study. A subsample of 116 cases was analyzed with regard to therapists’ technical interventions. Results: Sex and gender issues of both therapists and patients did not play a crucial role in any type of psychotherapy investigated. Gender issues appeared to play an indirect role. Female therapists intervene more empathically, whereas male therapists tend to use more confrontational techniques. Conclusions: Since the results show that therapists differ substantially with regard to their intervention techniques due to their sex, they should become more conscious of their interventions by considering patients’ severity of psychological problems and patients’ level of psychological functioning so as to not over or underchallenge them.

Two long-term analytic inpatient psychotherapy groups, comprised of severely disturbed neurotic and personality disordered patients, were intensively investigated using process ratings and therapist and patient reports to examine the contribution of interpersonal feedback to treatment outcome. We found that feedback was important throughout the course of therapy, and that patients who derived the most benefit from the groups were those who experienced a greater level of group cohesiveness and were most active in terms of self-disclosure, receipt of feedback, and making significant behavioral modifications within treatment. These successful patients received both positive and negative feedback, primarily from other group members, and worked effectively toward the goals that brought them to treatment.

Two long-term analytic inpatient groups comprised of severely disturbed neurotic and personality disordered patients were intensively investigated through process ratings and therapist and patient reports with regard to five therapeutic factors: cohesiveness, self-disclosure, feedback, interpersonal learning-output, and family re-enactment. The process variables were correlated with outcome assessments at 12 and 18 months following treatment. The study applied a single case (group) approach with replication to cross-validate the findings from one group to the next. Results demonstrated that all five therapeutic factors were meaningfully associated with clinical improvement. Although different treatment groups may generate unique psychological climates for producing change, the findings suggest that group cohesiveness is an important ingredient for effective group process to occur. The multimethod, multiperspective nature of this study lends considerable credence to the findings, despite the small sample size.

Two inpatient psychoanalytic therapy groups were investigated by sequential applications of repertory grid technique (Kelly, 1955) and a method for rating interactive behaviour in groups (Orlik, 1986). Results concerning characteristics of construing at the beginning of therapy, and the process of change during therapy, discriminating successful patients from unsuccessful ones, are presented. Therapy process factors contributing to change of construing of the self in relation to significant others are suggested and the contribution of interactional behaviour in the group to the development of therapy process as well as to treatment outcome is considered.

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.

This field study represents the continuing effort to identify the determinants of learning within experiential small study groups. Thirty-seven training groups from the 1996 Institute of the American Group Psychotherapy Association were studied. Three process measures (Group Relationship Questionnaire [GRQ], Leader Adjective Measure [LAM], and Group Climate Questionnaire [GCQ]) were administered to 434 group members after the first two of four group sessions. Process variables were used to predict learning (measured by the Learning Evaluation Form [LEF]) at the end of the training groups. The factors derived from each of the measures showed good to excellent correspondence with previous studies employing the same instruments. Results suggest that perceptions of the leader and the group, rather than perceptions of one's own relationship to other group members, are more robust predictors of learning in these short-term training groups. Specifically, perceptions of an emotionally engaged group willing to confront conflict, and perceptions of a skillful leader, proved to be significant predictors of learning. Implications for the training of group therapists and group therapy research are discussed.

Selected sessions of two long-term psychotherapy groups were rated using the Gottschalk-Gleser anxiety and hostility verbal content analysis scales. O-factor analytic techniques were used to identify sessions with similar interactional climates. The group judged clinically to be more successful demonstrated prolonged periods spent in various states. The affect dimensions of these states were consistent with the predictions of the group developmental stage hypothesis. The less successful group did not show these phenomena.

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.