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At the inaugural meeting, key questions on all clinically relevant themes were formulated and divided up between nine working groups. Building on the S2e guideline, a seven-member steering group eBox 1 carried out a systematic literature search of publications dating from 1 January to 1 January for search terms see eBox 2 , which was added to and brought up to date by the working groups up to May 3.

After assessment of inclusion and exclusion criteria eBox 3 and the quality and relevance of the studies e1 eTable 1 , publications were included for the guideline Figure 1. The working groups analyzed the literature, evaluated the evidence levels ELs e2 eTable 2 , and developed recommendations, statements, and source texts. For the most important forms of therapy, examples of numbers needed to treat NNTs were calculated as a statistical measure of efficacy Table 1. The guideline was modified in two online Delphi procedures and three consensus conferences, and finalized by consensus, in most cases strong consensus e3 eTable 3.

The corresponding recommendation grades RGs were based on the evidence levels, but could be raised or lowered during the consensus procedure e4 eFigure. The guideline version passed by consensus was posted on the Internet in February for 4 weeks for public comment. It was reviewed by three external experts eBox 1 , approved by the participating medical societies and associations, and adopted by the AWMF on 15 April register no.

It is valid for 5 years. Systematic literature search and selection of relevant publications. FSS, functional somatic syndrome. A half standard deviation was chosen as the minimally important difference MID e Association between evidence level EL and recommendation grade RG from e4 ;. The plethora of terminology e6 is a hindrance to care and to research e7.

The guideline is concerned with what these disorders of adults have in common 5 , 6 , e8 , e9. Its aim is to provide practical, interdisciplinary recommendations for all levels of care, to promote a biopsychosocial understanding of health and illness, to optimize early diagnosis, prevention, and treatment, to improve the quality of life and ability to function of those affected, and to reduce undertreatment and erroneous treatment.

These are often accompanied by illness anxiety. If this anxiety dominates, a hypochondriac disorder is present e Current etiopathogenetic models assume complex interactions between psychosocial factors, biological factors, iatrogenic factors or factors related to the medical system, and sociocultural factors, which can lead to neurobiological changes, and act together in disposition, triggering and maintenance of the complaints 7 , 8 , e A health system that focuses more on repair and care than on self-responsibility and prevention, and provides counterproductive financial incentives to illness-related behavior and technical measures rather than to healthy behavior, achievement through talking to the patient, and the avoidance of unnecessary treatment, has the effect of maintaining complaints 7 , e11 — e The iatrogenic chronification factors to be avoided e14 — e21 CCP are shown in Box 1.

In both clinical and population-based samples, NFS show a co-morbidity that increases with the severity of the NFS, including depressive, anxiety 11 , e27 , e28 , and post-traumatic stress disorders e29 as well as addiction disorders medications, alcohol e30 , e In severe cases full-blown somatization disorder F A majority show high, dysfunctional use of the health care system, especially in cases of psychological co-morbidity 9 , e34 EL 2b.

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The result is high direct multiple diagnoses, overdiagnosis, inappropriate treatment and indirect health costs loss of productivity, long-term inability to work, early retirement 13 , e Also in older patients, NFS parts of the complaints should be considered, even if the differential diagnosis is more complex and uncertain because of multimorbidity and multimedication. Life expectancy for patients with NFS is presumably normal e37 , e38 , but quality of life is more impaired than with somatic diseases e39 EL 2b.

Suicide risk, especially among those in chronic pain, is greater than in the general population e40 , e In patients with fibromyalgia, the standardized mortality ratio for suicide was between 3. Since the physician—patient relationship is often felt to be difficult on both sides e42 — e45 , building up a sound working alliance on a partnership basis is of central importance 7 , e46 — e Psychosocial themes should be handled casually and indirectly rather than by confronting them, e.

Clues to psychosocial problems and needs shall be picked up empathetically and spoken of as meaningful e54 EL 1b, RG A. For early diagnosis of NFS, stepped simultaneous diagnostic assessment of both somatic and psychosocial conditioning factors should be carried out. For patients with a chronic course, the first thing is to take stock of the results of previous diagnostic and therapeutic procedures EL 5, RG 0. Waiting for the exclusion of somatic disease despite the presence of psychosocial stressors is contraindicated. Diagnostic algorithm: Stepped simultaneous diagnostic assessment depending on symptom severity modified from 2 , 4 ; PTSD, post-traumatic stress disorder.

First, the bodily complaints should be recorded precisely nature, location, number, frequency, duration, intensity e53 EL 3b, RG B. Because accompanying complaints are often not reported spontaneously, history taking should be extended beyond the main symptoms, e. The number of symptoms is an important predictor of the presence of NFS and of an unfavorable course 15 EL 1b.

For all bodily complaints, everyday functioning and psychological state should be assessed even at the first consultation e59 EL 2b, RG B. Basic organic diagnostic investigation including physical examination is always necessary. Depending on the pattern of symptoms, specialist diagnostic procedures may also be required e58 EL 5, RG B. A reasonable endpoint for the somatic diagnostic pathway should be agreed and adhered to EL 1b, RG A. Treatment should adhere to a severity-staged, collaborative and coordinated model of care 7 , 16 , 17 , e65 RG A Box 2 , Figure 3.

Stepped, collaborative, and coordinated care model according to severity level modified from 2 , 4. Both complaints and findings should be explained clearly and reassuringly, and psychophysiological relationships should be explained psychoeducation: e. The physician should offer a positive description of the complaints e. Medication e. Physicians should not be too quick to certify patients as unable to work, and should weigh the advantages rest, relief from stress against the disadvantages avoidance, increased weakness due to rest, loss of participatory activity early on e83 EL 4—5.

Psychotherapy may be considered, e. Even in severe courses, care at the primary level and specialist somatic medical level is at the center of management. Within the framework of a clear treatment plan, there should be a stronger structuring of the framework and content of treatment e71 EL 2a, RG B.

Essential elements are regular appointments that are time-limited and are not complaint-led e48 , e71 EL 2b along with treatment of comorbid disorders in accordance with guidelines RG B. Specific, realistic therapy goals should be developed with the patient 18 , e72 EL 2b, RG A , in the process of which the importance of self-responsibility and collaboration should be conveyed EL 4. Physical activation especially aerobic exercise [endurance training] and strength training of low to moderate intensity should be carried out in stages, with slowly increasing work alternating with rest 7 , e73 — e76 EL 2b, RG A Table 2 and should be accompanied by sustained encouragement.

Similarly, the patient should be encouraged towards social activation 7 , e69 , e Some body-centered or nonverbal therapy elements and relaxation techniques e. In severe cases where pain predominates, low-dose, short-term antidepressant treatment should be given 7 , 19 , e80 — e82 EL 1a, RG A Table 1. In severe courses where pain does not dominate, treatment with antidepressants according to guidelines should be given only where there is relevant psychological co-morbidity e5 EL 2a, RG B.

Referrals, especially psychosocial referrals, should be well organized and carefully discussed both before and after they take place CCP. Requesting a specialist psychosocial assessment will reduce health service utilization 20 EL 1a, RG A. Follow-up studies showing positive effects are available for psychotherapy and physical activation, but not for medications e74 , e75 , e81 , e In particularly severe and chronic cases, multimodal treatment should already be initiated at the primary care and specialist somatic medical level Box 2.

Multimodal treatment has been shown to be effective especially for chronic pain syndrome e90 EL 1b, CCP. Rehabilitation should also follow a multimodal approach e The main goals are improvement in ability to function and to work, and to prevent further chronification. The sociomedical baseline situation e. In suitable facilities e.

To prevent cases become dangerous or chronic when this could have been prevented, complaints, diagnostic categorization, and the severity of illness and the outcome of treatment should be reassessed after 3 months at the latest e56 , e95 EL 2b, RG B. If appropriate, and in agreement with the patient and collaborating physicians and therapists, both somatic and psychosocial diagnostic investigations and treatment should be adjusted.

Basic medical diagnostic investigations including physical examination should be regularly repeated, especially where complaints persist. In this way, changes in symptoms will be recognized, organic disease will be identified, the patient will be given a feeling of being looked after and taken seriously, and unnecessary tests will be avoided EL 5, RG B.

After 6 months, if treatment on an outpatient basis fails, treatment on an inpatient or day clinic basis should be considered Box 3. The innovations are summarized in Box 4. To date, randomized controlled studies, reviews, and meta-analyses are available on only a few aspects Figure 1 , so that in places the present guideline has to rely on weaker evidence or clinical consensus. Overall, a very strong need is evident for fundamental research as well as research in treatment and health services.

Guideline texts and practice materials may be downloaded from the AWMF website www. This is primarily aimed at psychotherapists as an aid to choosing effective psychotherapeutic interventions. The authors are grateful to the AWMF, and to all colleagues, professional societies, and patient representatives eBox 1 who contributed to the development of this guideline. Special thanks are due to Dipl. Heribert Sattel as a member of the steering and editorial group. Conflict of interest statement. Schaefert, C. Hausteiner-Wiehle, M. Herrmann und J. Ronel declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

Europe PMC requires Javascript to function effectively. Recent Activity. They can be made worse by inappropriate behavior on the physician's part. RESULTS: Because of the breadth of the topic, the available evidence varied in quality depending on the particular subject addressed and was often only of moderate quality. Effective treatment requires the patient's active cooperation and the collaboration of all treating health professionals under the overall management of the patient's primary-care physician.

The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Dtsch Arztebl Int. Published online Nov PMID: Rainer Schaefert , Dr. Received Aug 2; Accepted Sep Copyright notice. This article has been cited by other articles in PMC. Methods The new S3 guideline was formulated by representatives of 29 medical and psychological specialty societies and one patient representative. Results Because of the breadth of the topic, the available evidence varied in quality depending on the particular subject addressed and was often only of moderate quality.

Conclusion A thorough, simultaneous biopsychosocial diagnostic assessment enables the early recognition of non-specific, functional, and somatoform bodily complaints. Markus Herrmann, MPH. Winfried Rief. Volker Arolt. Alexandra Martin. Marcus Schiltenwolf. Caroline Herr. Dennis Nowak. Friederike Siedentopf. Astrid Marek.

Wolfgang Eich. Anne Wolowski. Karl-Heinz Ladwig. Marianne Dieterich. Uwe Gieler. Gerd Rudolf. Ulrich Schultz-Venrath. Wolfgang Deetjen. Heide Glaesmer. Method The guideline group included members from all areas of care and was balanced in terms of gender and seniority. Open in a separate window. Figure 1. Table 1 Effectiveness of selected therapies in comparison to control groups at the end of therapy in patients with non-specific, functional, and somatoform bodily complaints; based on systematic review articles with meta-analyses of randomized controlled studies 2 , 4.

NFS Therapy form No. Study of a non-specific, functional, or somatoform bodily complaint including a defined diagnostic description. Studies of treatment procedures: randomized studies with a control group, controlled studies without randomization, or case—control studies. Etiological and pathophysiological studies: prospective cohort studies or systematic reviews of cross-sectional studies level 3 case—control studies, ecological studies, case series.

Study of a non-specific, functional, or somatoform bodily complaint without a defined diagnostic description or with a diagnosis described as a sequela of a defined organ pathology. Assessment Methodological quality Influence on validity of study results Most relevant Bias can be largely ruled out or cannot be identified Low risk of bias; any bias will have at most a small effect on study results Relevant Bias can be largely ruled out, slight errors may exist in some areas or cannot be assessed Low risk of bias; any bias will have at most a small effect on study results Fairly relevant Identifiable but not serious bias present in some areas Uncertain risk of bias; study results may be affected Relevance doubtful Slight bias identified in several areas, or some areas cannot be assessed with sufficient certainty because of inadequate description Risk of bias; study results probably affected Not relevant More than slight bias identified in several areas, or such bias cannot be ruled out with sufficient certainty because of inadequate description High risk of bias; an effect on study results must be assumed.

Terms and objectives The plethora of terminology e6 is a hindrance to care and to research e7. If any physical disorders are present, they do not explain the nature and extent of the symptoms or the distress and preoccupation of the patient. Band 1: Grundlagen und Konzepte Klinische Kinderpsychologie, Band 5. Grundlagen, Diagnostik und Interventionen 2. Die Jugendlichen werden in das Elterntraining einbezogen.

Brunstein Hrsg. Fallanalysen aus der Lerntherapie Kinder psychisch kranker Eltern stellen eine besondere psychiatrische Risikogruppe dar. Der Leitfaden zeigt die Schwerpunkte und Besonderheiten des diagnostischen und therapeutischen Vorgehens bei dieser speziellen Patientengruppe auf. Entwicklungspsychopathologie der ersten Lebensjahre Klinische Kinderpsychologie, Band 9.

Leitfaden Kinder- und Jugendpsychotherapie, Band 3. Altersspezifische Verfahren zur Diagnostik emotionaler Kompetenz bei Kleinkindern, Vorschulund Schulkindern werden vorgestellt. In die 3. Training mit Jugendlichen Aufbau von Arbeits- und Sozialverhalten Ziel ist es, sowohl aggressiv-dissoziales als auch initiativloses und sozial unsicheres Verhalten abzubauen.

Altersspezifische Verfahren zur Diagnostik emotionaler Kompetenz bei Kleinkindern, Vorschul- und Schulkindern werden vorgestellt. Klinische Kinderpsychologie, Band 7. Leitfaden Kinder- und Jugendpsychotherapie, Band 5. Praxis der Paar- und Familientherapie, Band 5. Praxisorientiert wird das therapeutische Vorgehen beschrieben. Ein besonderes Augenmerk liegt dabei auf dem Selbstmanagement der Angst.

Anorexia nervosa Leitfaden Kinder- und Jugendpsychotherapie, Band 7. Autismus bei Kindern Ursachen, Erscheinungsformen und Behandlung Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie. Der Schwerpunkt liegt dabei auf den Schwierigkeiten des Patienten, sich selbst und zwischenmenschliche Beziehungen zu regulieren.

Empirische Befunde aus einer randomisiert-kontrollierten Studie belegen die Wirksamkeit der vorgestellten Therapie. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band Die multimodale Therapie umfasst patientenzentrierte sowie familien- und umfeldzentrierte Interventionen. Es wird auf die kognitive, die emotional-physiologische und die be-. Leitfaden Kinder- und Jugendpsychotherapie, Band 6.

Jugendlichen anzupassen. Klinische Kinderpsychologie, Band 2. The focus of the book is a highly practical guide to implementing treatment, packed with helpful clinical pearls, therapist-patient dialogues, illustrative case vignettes, and sample forms and handouts. Readers are equipped with skills for engaging reluctant patients in treatment and tailoring educational, cognitive, and behavioral techniques for healthrelated anxiety.

State-of-the-art strategies for enhancing exposure therapy using inhibitory learning, ACT, and couples-based approaches are described. A Biopsychosocial Approach Cognitive-behavioral therapy using the techniques of exposure and response prevention has helped countless individuals with obsessive-compulsive disorder OCD overcome debilitating symptoms. This volume opens with an overview of the diagnosis and assessment of OCD in adults and delineates an evidence-based conceptual framework for understanding the development, maintenance, and treatment of obsessions and compulsions.

This is followed by a highly practical treatment manual, based on decades of scientific research and clinical refinement,. Fortschritte der Psychotherapie, Band Babor, T. Forschung und Alkoholpolitik Prinzipien dieser manualisierten Kurzzeittherapie sind u. Dazu werden u. Anhand zahl-. Es stellt dazu auch die grundlegenden Theorien und den aktuellen Forschungsstand zu den einzelnen Aspekten der Positiven Psychologie vor.

Tools for Stabilization and Recovery Trauma Practice, now in its 3rd edition, is back by popular demand! Filled with new resources, this book based on the tri-phasic trauma treatment model is a guide for both seasoned trauma therapists and newer mental health professionals seeking practical approaches that work. Clearly written and detailed, Trauma Practice provides the reader with an array of techniques, protocols and interventions for effectively helping trauma survivors.

Deutsche Ausgabe herausgegeben von Franz Caspar. Das Therapeutenmanual liefert eine praktische Anleitung dazu. From Research to Practice Culturally sensitive practice is a vital component of effective mental health care in our increasingly diverse societies. The important implications of this interplay between culture and psychopathology for diagnosis and treatment are scrutinized and elucidated in this comprehensive and well-organized book, which uniquely looks at a range of practical examples involving various ethnic minority populations in North America and Europe.

Leading experts from around the world have integrated di-. Dieser Band stellt ein manualisiertes Behandlungskonzept vor, das zur psychotherapeutischen Behandlung von Krebspatienten mit einer depressiven Erkrankung entwickelt wurde. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie Band 7 herausgegeben von Manfred E.

Das in diesem Band beschriebene Behandlungskonzept orientiert sich an dem supportiv-expressiven Ansatz von Luborsky. Die Behandlung ist als Kurzzeittherapie mit einer Behandlungsdauer von 25 Sitzungen konzipiert, und ihre Wirksamkeit konnte in einer empirischen Studie nachgewiesen werden.

Beutel, M. Manfred E. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band 7. Grundlage menschlichen Bewegungsverhaltens 2. Wie gehen moderne Verhaltenstherapeuten vor, wenn Paare mit ihren Schwierigkeiten zu ihnen kommen? CHF Die Therapie erweitert die kognitive Verhaltenstherapie um interpersonelle und emotionale Behandlungsstrategien. Beispiele und Transkripte runden diesen praxisorientierten Band ab. Anwendungen in Psychotherapie, Beratung, Supervision und Selbsthilfe 2.

Cohen Karestan C. Das Manual beschreibt ein zweiphasiges Therapieprogramm zur Behandlung von Erwachsenen, die an den Folgen von sexuellem Missbrauch und Misshandlung in der Kindheit leiden. Wochenbettdepression Erkennen — Behandeln — Vorbeugen Daly Elizabeth Nicholls Ronald T.

In der ressourcenorientierten Therapie lernen Patienten, einen Zugang zu ihren Ressourcen wieder- zu erlangen. Es werden u. ADHD is a neurodevelopmental disorder that emerges during childhood. However, it is now well recognized that ADHD frequently persists over the lifespan and the presentation of symptoms may differ considerably between adults and children. Without appropriate symptom management, ADHD can significantly interfere with academic, emotional, social, and work functioning. However, outcomes in adults with ADHD who receive appropriate treatment are encouraging. This book is a compact guide covering all aspects of practice that are relevant in real life in the assessment and management of ADHD in adults.

The authors describe, step by step, what happens to people after the sudden death of a family member or close friend, the difficulties they face in coping, and how professionals and volunteers can help. With their wide experience, both personally and as internationally renowned authorities, they have written a book for professionals and volunteers who deal with bereavement in language that is accessible to all, so it will also help those who have suffered a traumatic loss themselves to understand what to expect and how to get help.

Helping the Survivors This book speaks about the consequences of traumatic deaths in a wonderfully simple and straight-. Ressourcenaktivierung wirkt sich positiv auf das Therapiegeschehen aus! Quellen und Prozesse seelischer Gesundheit The literature on diagnosis and treatment of drug and substance abuse is filled with successful, empirically based approaches, but also with controversy and hearsay. Health professionals in a range of settings are bound to meet clients with troubles related to drugs — and this text helps them separate the myths from the facts.

It provides trainees and professionals with a handy, concise guide for helping problem drug users build enjoyable, multifaceted lives using approaches based on decades of research. Readers will improve their intuitions and clinical skills by adding an overarching understanding of drug use and the development of problems that translates into appropriate techniques for encouraging clients to change behavior themselves. Ebert, D. Diagnostik und Indikation zur Psychotherapie Wann ist welche Psychotherapie indiziert? Fortschritte der Psychotherapie, Band 8.

Das therapeutische Vorgehen hat sich insbesondere auch beim Einsatz bei schwierigen und therapieresistenten Patienten als erfolgreich erwiesen. Written in an easy and relaxed style, using everyday language, it also contains sample worksheets for practice use and suggestions for further reading. Anthropologische Grundlagen der Psychotherapie 3. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band 5.

Sportpsychologie, Band 6. Ein Integraler Gestalt-Ansatz Fokale psychodynamische Psychotherapie Der Band stellt ein manualisiertes psychodynamisches Behandlungskonzept zur ambulanten Behandlung der Anorexia nervosa vor. Der Behandlungsfokus wird zum einen auf beziehungsdynamische Aspekte und damit verbundene zentrale Konfliktthemen gelegt. Tinnitus und Hyperakusis Fortschritte der Psychotherapie, Band Diagnostik, Therapie, Forschung Von der Konfession zur Profession 5. Systemische Praxis, Band 3. Traumatisierte Menschen brauchen unmittelbar nach dem Ereignis Betreuung.

Formen und Folgen psychischer Traumatisierung werden beschrieben, ebenso Risiken und Chancen der Therapie. Gunderson, J. Ein handlungstheoretischer Ansatz zur Nachsorge Praxis der Paar- und Familientherapie, Band 7. Fortschritte der Psychotherapie, Band 2. Psychotherapie, dyadische und Gruppeninteraktion bis hin zu Management und Organisationsentwicklung. The Shape of Couple Therapy to Come Selbstorganisation verstehen und gestalten Das Buch bietet eine umfassende Darstellung der Synergetik in der Psychologie.

Akute Depression Fortschritte der Psychotherapie, Band Fortschritte der Psychotherapie, Band 4. Die theoretischen Annahmen, die Erfassung der Konstrukte und die sich daraus ergebenden verschiedenen Interventionen werden in diesem Band vorgestellt. Standards der Psychotherapie, Band 1. Die Module umfassen u. Evidenzbasierte Leitlinien Psychotherapie, Band 2. Evidenzbasierte Leitlinien Psychotherapie, Band 3. Ein Arbeitsbuch Therapeutische Praxis, Band Biologische und psychosoziale Aspekte.

Depression und Trauer. Die Neuauflage des Manuals liefert eine anwenderorientierte Beschreibung der Behandlung von Prokrastination. Die umfassenden Arbeitsmaterialien zur Diagnostik und Therapie erleichtern die Umsetzung in der Praxis. Therapeutische Praxis, Band 2. In Studien hat sich insbesondere die Arbeit mit dem Schemamodus-Ansatz als hoch wirksam erwiesen.

Ein neuropsychotherapeutisches Behandlungsprogramm Therapeutische Praxis, Band Evidenzbasierte Leitlinien Psychotherapie, Band 1. This book is a straightforward yet authoritative guide to eff ective diagnosis and empirically supported treatments for autism spectrum disorder ASD. It then provides clear guidance on evaluation of ASD and comorbidities, with practical outlines and examples to guide practice. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band 6.

An Integrative View of HumanAnimal Relationships with Implications for Therapeutic Practice In recent years, the ancient symbiosis between humans and their pets has entered a new phase, marked by the burgeoning clinical specialty of human-animal therapy.

This approach uses the relationship between humans and their mainly mammalian pets to support the growth of emotion regulation, social. Anhand zahlreicher Fallbeispiele wird der Umgang mit schwierigen Therapiesituationen vermittelt. Ein Buch, das ein neues Licht auf viele Konzepte von Freud und Lacan wirft, die klar und verstehbar dargestellt und diskutiert werden. Weg-Erfahrungen in der Imagination Nonsuicidal self-injury NSSI is a baffling, troubling, and hard to treat phenomenon. Key issues in diagnosing and treating NSSI adequately include differentiating it from attempted suicide and other mental disorders.

This accessible and practical book provides therapists and students with a clear understanding of these key issues, as well as of suitable assessment techniques. Ein Trainingsprogramm Therapeutische Praxis, Band Dieser Band stellt dar, wie chronischer beruflicher Stress in der Therapie systematisch aufgegriffen und gezielt bearbeitet. Fortschritte der Psychotherapie, Band 9.

Das Internet als Kommunikationsmedium hat sich in den letzten Jahren als wirksame therapeutische Alternative erwiesen. Es werden die therapeutischen Voraussetzungen auf inhaltlicher, struktureller, organisatorischer und kommunikativer Ebene dargestellt, welche die Grundlage des therapeutischen Begegnungsmodells bilden. Systemische Praxis, Band 5. Ein Gruppenprogramm nach R. Therapeutische Praxis, Band 5. Psychodynamische Therapie Der vorliegende Band stellt ein Behandlungsmanual zur psychodynamischen Kurzzeittherapie bei Sozialer Phobie vor.

Das Vorgehen basiert auf der supportiv-expressiven Therapie von Luborsky. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band 8. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band 4. When Psychopharmacology Is Not Enough Using Cognitive Behavioral Therapy Techniques for Persons with Persistent Psychosis This book provides a practically oriented and clear overview of how to use CBT techniques in mental health services that have traditionally emphasized medication management.

At the same time as respecting the important role of drug treatment, it shows clinicians how to achieve better outcomes with schizophrenia and other psychosis patients using CBT techniques. Es wird deutlich gemacht, welchen Stellenwert der Faktor Kultur in der Behandlung haben kann und wie darauf konstruktiv, d.

Ein individuenzentrierter Ansatz Das Manual stellt anhand zahlreicher Beispiele kognitiv-verhaltenstherapeutische Interventionen zur Behandlung schizophrener Patienten dar. Das klassische Lehrbuch der Imaginationsverfahren 4. Hierzu wird u. Ziel ist es, Therapeuten Mut zu machen, sich an die ambulante Behandlung von Psychosen heranzuwagen. Praxisorientiert werden u. Fortschritte der Psychotherapie, Band 6. Das Lehrbuch stellt die Grundlagen, Formen und Basisorientierungen klinisch-psychologischer Interventionen dar.

Generalized Anxiety Disorder Generalized anxiety disorder GAD is a debilitating disorder that has often proved difficult to treat. This clear and concise book presents an integrative, up-to-date treatment protocol for GAD. Suitable both for practitioners and for students, it guides readers through assessment and differential diagnosis, etiological models and treatment techniques.

The therapeutic approach described here integrates techniques from CBT, mindfulness- and acceptance-based therapy, as well as motivational interviewing. Evidenzbasierte Leitlinien Psychotherapie, Band 4. Fortschritte der Psychotherapie. Dabei geht es u. This book is a concise yet detailed clinical guide to the treatment of sexual difficulties in women. Written with the general psychologist and therapist in mind, it takes the novel position that most clinicians interested and willing to help female clients with sexual concerns can do so effectively. It empowers general psychologists, therapists, and other practitioners to actively engage in the multidisciplinary treatment of sexual disorders.

Systemische Praxis, Band 4. The Evolution of a New Treatment Approach Die Wider-. The Attempted. Suicide Short Intervention Program ASSIP described in this manual is an innovative brief therapy that has proven in published clinical trials to be highly effective in reducing the risk of further attempts.

The emphasis is on the therapeutic alliance with the suicidal patient, based on an initial patient-oriented narrative interview. The four therapy sessions are followed by continuing contact with patients by means of regular letters. This clearly structured manual starts with an overview of suicide and suicide prevention, followed by a practical, step-by-step description of this highly structured treatment.

Also available as eBook Moggi, F. Wege zu psychodynamisch wirksamen Dialogen Der vorwiegend stabilisierende und ressourcenorientierte Ansatz besteht aus kognitiven, verhaltensbezogenen und interpersonalen Interventionen. Das Buch stellt ein innovatives Supervisionskonzept vor: Das schematherapeutische Modusmodell und der Moduszirkel werden zur Analyse dysfunktionaler Therapeut-Patient-Interaktionen in der verhaltenstherapeutischen Supervision verwendet. Anhand zahlreicher Fallbeispiele zum Therapeutenverhalten und zu schwierigen Therapiesituationen wird das Vorgehen veranschaulicht.

Seligman, The founder of positive psychology. For educators, researchers, and anyone striving for personal growth and a fulfilling life! This completely revised edition of the popular Positive Psychology at the Movies provides a unique way to learn and appreciate what is right and best about human beings. Now with discussions of nearly 1, movies, dozens of evocative movie images, and much more! Erkenntnisse, Theorien, Behandlungsmethoden 3. The definitive, practical handbook on positive psychology and character strengths for practitioners working in coaching, psychology, education, and business — put the science of well-being into action!

The 24 summary sheets spotlighting each of the universal character strengths are an indispensable resource for client sessions and the 70 evidence-based step-by-step activity handouts can. Die renommierten Autoren vernetzen die Klinische Psychologie konsequent mit den psychologischen Grundlagen und den fachlichen Nachbargebieten. Bachelorstudium Psychologie, Band 5. Das diagnostische und therapeutische Vorgehen wird anhand zahlreicher Falldarstellungen veranschaulicht. Entstehung, Diagnostik und Behandlung Fortschritte der Psychotherapie, Band 5.

Handbuch der Psychologie, Band 1. Zahlreiche Fallbeispiele veranschaulichen das Vorgehen. Adipositas Fortschritte der Psychotherapie, Band Humanistische Psychologie Psychologie, Philosophie, Organisationspsychologie 3. Grundlagen, Diagnostik und verkehrspsychologische Therapie Praxis der Paar- und Familientherapie, Band 1. Agoraphobien, soziale und spezifische Phobien The completely revised edition of this popular text on bipolar disorder, with new, extensive information on medication management and incorporating the latest findings of evidencebased treatment methods.

Verhaltensanalyse Ein Praxisleitfaden Die funktionale Verhaltens- und Problemanalyse ist ein wichtiges diagnostisches Verfahren der Verhaltenstherapie. Grundlagen der Psychotraumatologie Gruppentherapie nach dem supportiv-expressiven Ansatz Psychische Belastungen bei Krebserkrankungen. Das Buch beschreibt praxisorientiert die schematherapeutische Arbeit mit Patienten mit aggressiven Verhal-. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band 9. Grundlagen, Techniken und Anwendungsgebiete Integrated Psychological Therapy IPT for the Treatment of Neurocognition, Social Cognition, and Social Competency in Schizophrenia Patients A practical, comprehensive guide to using Integrated Psychological Therapy IPT for Schizophrenia Patients — the highly successful empirically supported approach that has fast become a standard treatment in many psychiatric clinics around the world.

Fortschritte der Psychotherapie, Band 1. This book provides general therapists with practical, yet succinct evidence-based guidance on the diagnosis and treatment of the most common male sexual disorders encountered in clinical practice. It assumes that mental health professionals and other clinicians without expertise in the field of sex therapy have much to offer these men by combining a multidisciplinary understanding of issues surrounding sexual problems with their general clinical knowledge and expertise. Therapeuten finden in diesem Buch zahlreiche konkrete Beispiele und Informationen zu den besonderen Problemen der Paartherapie.

This edition of the clearly structured and easy-to-follow NET manual includes the latest insights and new treatments for dissociation and social pain. Seminarkonzepte und Materialien 2. A Feedback-Driven Dynamic Systems Approach Existing schools of psychotherapy all have limitations and shortcomings and there is increasing empirical evidence that it is the factors they have in common which contribute most to their efficacy.

Systemische Praxis, Band 1. Verhaltenstherapeutische Supervision Theorie und Praxis Ein Schwerpunkt des therapeutischen Vorgehens liegt auf Methoden des Selbstmanagements. Neben kognitiven und konfrontativen Vorgehensweisen werden auch Techniken zur Beeinflussung der physiologischen und motorischen Ebene der Angst beschrieben. Therapeutische Praxis, Band 1. Hinweise zum Umgang mit schwierigen Situationen sowie zahlreiche Beispiele zum konkreten Vorgehen bei den einzelnen Therapieschritten machen das Buch zu einer wertvollen Hilfe bei der Behandlung dieser Patientengruppe.

Fortschritte der Psychotherapie, Band 3. Die Therapieziele bestehen u. Der Band stellt ein umfassendes Modell der Therapiemotivation vor. Therapieplanung 2. An overview of relevant psychological factors and the behavioral conceptualization of headache is followed by a step-by-step, manual-type guide to implementing behavioral interventions within clinical practice settings. Fortschritte der Psychotherapie, Band 7. Praxis der Paar- und Familientherapie, Band 3. The new edition of this highly acclaimed, compact text provides a fully updated account of the psychopathology, clinical assessment, and treatment of schizophrenia spectrum disorders.

It provides both experienced practitioners and students with an evidence-based guide incorporating the major developments of the last decade: the DSM-5 new diagnostic criteria, recovery as central to treatment and rehabilitation,. Das Vorgehen bei den zentralen Elementen der Therapie wird mithilfe von Fallbeispielen veranschaulicht.

Psychologische Grundlagen, Diagnostik und Therapie Band Systemische Praxis, Band 2. Anhand zahlreicher Beispieldialoge wird das therapeutische Vorgehen in den einzelnen Sitzungen detailliert beschrieben und auf schwierige Therapiesituationen eingegangen. Praxis der psychodynamischen Psychotherapie — analytische und tiefenpsychologisch fundierte Psychotherapie, Band 3.

Praxis der Paar- und Familientherapie, Band 8. Formen — Wirkung — Interventionen Pro Jahr sterben in Deutschland etwa Der Band liefert epidemiolo-. Das therapeutische Vorgehen wird anhand zahlreicher Fallbeispiele veranschaulicht. Die Exposition bzw. Standards der Psychotherapie, Band 3. This book provides therapists and students with practical and evidence-based guidance on diagnosis and treatment of anorexia nervosa AN , bulimia nervosa BN , eating disorders not otherwise specified EDNOS , and binge eating disorder BED. Es werden hilfreiche therapeutische Strategien aus den Bereichen der Psychotherapie, Psychoonkologie, Palliative Care, Philosophie und Ethik beschrieben.

Alle Schritte dieses Weges werden anhand von Beispielen und Abbildungen veranschaulicht. Standards der Psychotherapie, Band 2. Ein Behandlungsprogramm Therapeutische Praxis, Band A variety of brief motivational behavioral interventions developed for nonpregnant women of childbearing age can effectively prevent alcohol-exposed pregnancies AEP. The information presented will help practitioners in diverse settings deliver interventions targeting behavior change. Ein kognitiv-verhaltenstherapeutisches Behandlungsprogramm Therapeutische Praxis, Band Movies and Mental Illness, written by experienced clinicians and teachers who are themselves movie aficionados, has established a great reputation as a uniquely enjoyable and highly memorable text for learning about psychopathology.

The core clinical chapters each use a fabricated case history and Mini-Mental State Examination along with synopses and discussions about specific movies to explain, teach, and encourage discussion about all the most important mental health disorders. Ein Behandlungsleitfaden This innovative book will help both mental health and medical professionals empower patients or clients to live well with multiple sclerosis MS.

It is a practical, culturally relevant guide to the most effective current medical, psychological, and neuropsychological diagnostic methods and interventions. The book describes a biopsychosocial, multidiscip-. Dieser Band zeigt Grundhaltungen, diagnostische Strategien und Therapiemethoden zur Ressourcenaktivierung auf. Seine jahrelange Erfahrung spiegelt sich in den reichhaltigen Tipps und der Weisheit, die dieses Buch auszeichnen.

Though some young drinkers are able to consume alcohol without incident, many face significant negative fallout from their excessive consumption. This volume describes the nature of alcohol misuse, its epidemiology, its causes, and methods for treatment, specifically as they pertain to college students and other young adults. It provides practitioners and trainees with a range of evidence-based treatment approaches to help clients change their alcohol use habits.

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Behandlung mit Psychopharmaka Aktuell und massgeschneidert 3. Das Tele. Die einzelnen Bausteine behandeln u. Leading experts describe the concepts and roots of mindfulness, as well as examining the science that has led to this extraordinarily rich and ancient practice becoming a foundation to many contemporary, evidenced-based approaches in psychotherapy. Der Autor gibt in diesem umfassend. Der Band zeigt praxisorientiert auf, wie die Behandlung von begleitenden Symptomen individuell angepasst und die Verarbeitung des schweren Verlustes erfolgen kann.

Die Neuauflage des Bandes greift u. Ein kaleidoskopischer Blick auf die Psychotherapie Es bietet. Fallbeispiele und einfacher Techniken, wie Sie Ihre Symptome besser beherrschen lernen. Warum es menschliche Grausamkeit gibt Sehen andere Menschen die Welt genau so wie wir oder stellt sie sich aus ihrer Perspektive ganz anders dar? Das Subjekt vor dem Objektiv Sie ermutigt, Belastungen zu ertragen sowie letzte Dinge zu regeln und Abschied zu nehmen.

Sie hilft Eltern, sich auf die Endlichkeit des Le-. Einblicke in ein faszinierendes Fachgebiet 2. Wege zu prosozialem Verhalten Gibt es den idealen Beruf? Den Traumberuf? Dann liegt in der Regel eine Hypochondrie vor. Trage ich eine Mitschuld an seiner Erkrankung? Was kann ich tun, um ihm zu helfen? Ratgeber Kinder- und Jugendpsychotherapie, Band Wie das Kind sprechen lernt 2. Christine Bryden zeigt, wie sie mit der Demenz tanzt, ohne sich aus dem Rhythmus und dem Takt des Lebens bringen zu lassen.

Die Folgen betreffen nicht nur die Spielerinnen und Spieler selbst, sondern auch das Umfeld. Freude am Denksport Aufgaben, um das geistige Potenzial zu testen und zu trainieren Die Denkfehler unseres Gehirns Der Marketingexperte und Sozialpsychologe Robert B. Dinner, P. Anhand von bekannten Konzepten aus der Psychologie, wie z. Das Buch. Was will das Kind mir sagen? Wertvolles Wissen und praktische Tipps von renommierten Schlafexperten. Digitale Medien haben in der Lebenswelt von Heranwachsenden eine hohe Bedeutung. Internetsucht und Cybermobbing.

Lebenskrisen neigen viele Menschen zu Essattacken. Dieses Selbsthilfeprogramm hat das Ziel, krankhafte Essattacken zu erkennen, zu stoppen und dauerhaft abzuwehren. Gefangen im Netz? Onlinesucht: Chats, Onlinespiele, Cybersex Die Triebfeder der Wissenschaft Architektur — psychologisch betrachtet Wohnen psychologisch betrachtet 2. Viktor E. Beispiele, Folgen, Alternativen In der vierten Auflage werden neu u. Was man gibt, verliert man nicht Oft ist uns dabei nicht klar, was uns und unsere Familie wirklich bewegt.

Das zu erreichen, ist Ziel dieses Buches. Was Eltern und Familien stark macht Auflage Ein Bildband zum Liebhaben und Verschenken! Dieser Ratgeber wendet sich an Eltern, Lehrer sowie Erzieher. Er beschreibt, was sexueller Missbrauch genau ist und welche. Whether the problem is soiling with or without constipation, toilet refusal, or soiling with wetting, this clearly written book provides step-by-step instructions and concrete ideas to help children and adolescents achieve continence. Useful charts and questionnaires help identify the exact problem, track progress on a daily basis, and increase motivation.

This practical guide is ideal for parents as well as for teachers, educators, and caregivers. Whether the problem is daytime wetting, bedwetting, or wetting with soiling, this clearly written book provides step-by-step instructions and concrete ideas to help children and adolescents achieve dryness. Praktische Hilfe gegen Depressionen Rat und Hilfe Das vorliegende Buch strebt, jenseits der ver-. Oder sind Sie nicht sicher, ob Sie die richtigen Lerntechniken anwenden? Doch leidet unter den resultierenden Normen nicht die Klugheit des einzelnen?

Alter ist keine Krankheit. Wird sie noch einmal besser? Und wer zahlt das alles? Diese und andere Fragen beantwortet das Buch. Jeder schiebt dann und wann einmal etwas Unangenehmes auf. Aber ab wann wird das Aufschieben zum Pro-. Dieser Ratgeber hilft Betroffenen, Aufschiebeverhalten und Prokrastination besser zu verstehen.

Ideal Type B "Hurt": There is often an aggressive entanglement between the patient and the therapist, in which the patient, anticipating rejection, is passively or actively aggressive. Aggressive emotions predominate in the counter-transference. Similarly, suicidal dynamics are characterised by real experiences of loss, which mobilise aggression, and simultaneously temporary unbearable feelings of emptiness, immediate need for another person to be here and the awareness of having failed in important relationship goals in life.

Real trauma occurs frequently in biographies, and triangulation experiences are absent. In childhood, these patients experienced themselves as self-object 2 of the mother, whereas the father was mostly experienced as absent. Often a significant woman mother, girlfriend, female therapist recommended treatment.

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Both hospitalized and out-patient psychiatric-psychotherapeutic treatments are frequent. This ideal type shows evidence of chronic suicidality although perhaps not so much as in "Stormy" and "Object Dependent" ideal types , and patients are more likely to come for treatment shortly before than after a planned or threatened suicide attempt. The men are often strongly built, sporty and well-dressed, but exude a sense of great tension.

The need to conceal some physical defect, weakness, hypochondriac anxieties or insecurities is frequent. Ideal type C "Stormy": A stormy transference e. This is a reproduction of the comfort-searching side of a late adolescent separation-dependency conflict. Suicidal feelings are, therefore, connected with separation experiences, as well as with the development of a fixation on a certain psycho-social development level. Very intensive, ambivalent bonds to the mother appear in the biographies. Patients often report destructive parental relationships, that is, of fathers physically threatening the mother, as if the patients feel they had to protect their mother and her life.

At the same time, identification with the violent father is highly ambivalent. Emotions are inadequately controlled. Their outward appearance is based on one-dimensional, aggressive male concepts, e. They have a tendency to have strong outbursts of emotion. Ideal type D "Object dependent ": In the transference relationship, there must be no "third" element, not even as an explanation for the current experience.

Therefore, only concrete matters can be queried and dealt with. Accordingly, these men want the women who have turned away from them to return. The biography seems simplistic and conceals a lack of emotional experience. One has the impression that an experience of chronic emotional neglect is warded off by idealising and identifying with family norms e. Patients report supposedly pleasant childhoods, although the description seems evasive. In connection with a specific counter-transference experience under pressure and having to make "sense" of everything alone the impression is formed that they were emotionally neglected in childhood.

Stable psycho-social arrangements can support for a long time defence against feelings and conflicts associated with the neglect. Patients only become suicidal when these relationship constellations and their inherent defence mechanisms are threatened. If alcohol is consumed in the framework of a suicidal experience, it is an unconscious cry for help to an inanimate object, which, however, provides no protection. In the sample, there is one special case Case U of an abused and abusing man who has little similarity with all other cases, and is marked by a specifically highly aversive counter-transference reaction.

Also, another two prototypical constellations were heuristically developed that were not in the sample, which are rarely seen at the Therapy Centre: older men and patients with acute psychiatric illnesses, such as seriously depressive episodes or chronic schizophrenic psychoses. The special case and the heuristically "composed" constellations point out that there are probably further types of suicidal men who, within other cultural paradigms, and also in other clinical settings, e.

Concreteness 3 leads to distress in therapist. Table 1: Results from the first discussion: There are four ideal types with the cases assigned to them, the prototypical cases are indicated. Case U is indicated as a special case, which could not be assigned to any ideal type. The second process undertaken by the Tavistock group—blind to the findings of the TZS group—led to the formation of three ideal types: [ 48 ]. These men present a "thin-skinned narcissism" BRITTON, that causes every approach from the outside to be experienced as an attack.

The resulting aggression must be projected into the outer world again. These men still fight, because they come into treatment in contrast to some homeless suicidal people but in the transference relationship they unconsciously, and thus actively destroy all therapeutic attempts to come into a contact with them. So the transference situation is characterised by withdrawal. The main biographical aspect is that of a loner. Ideal type B "Sado-masochistic enmeshed" : These men create unpleasant relationships; in current relationships with partners or past relationships with parents they cannot separate but cannot live together either.

In this ideal type there are only a few suicide attempts. It was hard for the members of the discussion group to "stay in the room" with these patients, meaning that they expressed the wish not to discuss these cases any longer. In biographies there are lots of controlling and enmeshed relations with suicidal parents with mental illnesses as well as absent fathers and frightening and controlling mothers.

Ideal type C "Psychotic—unrealistic" : These patients resorted to "psychotic" solutions, in psychoanalytic terms: they would fall in love in order not to experience their anxiety and separateness. The lack of anxiety is the result of the defence of splitting relatedness to "good" and "bad" so that the anxiety is projected into the "bad" object and thus is experienced as not belonging to the self.

The transference situation is characterised by a tendency to merge or fuse with the therapist. The biographies often reveal intense and idealised relations. Table 2: Results from the second expert discussion: There are three ideal types with the cases assigned to them; the prototypical case is indicated. Illustration 2: The ideal types of the second formation process are projected on the ideal types of the first formation process. Red: Ideal type "Withdrawn", yellow: "Psychotic-unrealistic", blue: "Sadomasochistic-enmeshed".

Initial observations appear to show that the TZS and Tavistock groups developed different sets of ideal types, which are identified through both the different groupings of cases and the different language used to describe ideal type. The two groups were using different criteria—especially theoretical—to assess the cases, which resulted in different classifications as ideal types. This is evidenced by the fact that all three ideal types of the Tavistock group spread over three of the four ideal types of the first group.

On the other hand, there are some similarities between the two research groups, which can be discerned through closer examination. Moreover, no patient from the ideal type "Withdrawn" London group was placed in the ideal type "Stormy" Hamburg group ; no patient from the type "sado-masochistic enmeshed" came from the ideal type "disconnected" and no patient from "psychotic-unrealistic" came from "object dependant".

This analysis leads to the hypothesis that the diagnostic assessment criteria, which generated most similarities stems from experience-based criteria, that is, from the counter transference aspect. Psychotherapists can "feel" one patient to be similar to another, but how they explain this phenomenon may be very different due to the use of different theoretical approaches.

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Both groups of therapists were quite similar in their assessments of aspects they could feel and experience in the therapeutic relationship out of a common clinical experience. These are experiences about the quality of the therapeutic contact, whether the patient and the therapist is remote and distant or whether there is an intensive, aggressive, manipulative or idealising transference situation. Another similarity in both groups seems to be the assessment of aspects of the transference relationship, for example, the discussion of illusory or unrealistic relationships or relationships in which no inner meaning can be found.

It seems very likely that similarities found by both groups arise from clinical experiences of the quality of the therapeutic relationship. On the other hand, differences seem to stem from the two quite distinct theoretical approaches used by the two groups to understand the interactional patterns within the cases. It is important, therefore, and consistent with our methodological approach, to explore the nature of these differences. The TZS group of German psychoanalytic psychotherapists had their theoretical background in the work of the psychoanalyst Heinz HENSELER who influenced the psychoanalytic understanding of suicide in German psychiatry for decades with a self-psychological understanding of suicidality as a narcissistic crisis.

This framework emphasises the elemental conflict between life and destructive forces, the projection of destructive elements into others and the impact of these on the therapeutic relationship, generating re-enactments of sado-masochistic relatedness. We embarked on this study with the hope and expectation that some forms of similarities across the two groups would be found, and that these would provide evidence for the transferability of findings beyond the immediate context of the study.

At the same time, we were aware of the potential differences between the two groups of researchers, who had different national and historical backgrounds and, following from this, different heritages in terms of psychoanalytic theory and practice. The two groups also differed in their knowledge of the cases. Given these differences we expected that the study would provide both differences and similarities that we could find and account for. Our findings show that the groups differed in the way they developed ideal types, the descriptions for these and the theoretical frameworks that drove the conceptions that formed our clustering, as described above, into different ideal types.

We found that similarities existed at the level of the clinical experience. This analysis suggests some ways of analysing the data, comparing these through the clustering of similar cases and the similarities of descriptors within ideal type categories provide a starting point for developing transferability. Qualitative research does not usually focus on transferability and generalisability of results, except in the demand to work thoroughly, to give a clear description of the material, patients or persons who are investigated, and to present the material and the methodical steps so that anyone can follow the heuristic steps from the material to the concluding results.

Rather, some qualitative researchers such as MAYRING claim that generalisability is very important for qualitative research to come to results that can lead to political, medical or psychotherapeutic action. In psychoanalytical discussions the question of the frame and limits of general statements are not very often discussed; theoretical considerations stemming from very different cultural and theoretical backgrounds are often presented without mentioning these limitations.

Therefore it is of value to show on which level the same material can lead to different but also, on another level, similar results when examined by different experts. In a quasi experimental setting it can be shown that speaking about patients may on the one hand lead to totally different interpretations and on the other lead to similar results. From a methodological perspective, the possibility to find common interpretations can be defined as a form of "moderatum" or mid-range generalisations as defined by WILLIAMS , p.

Moderatum generalizations I advocate are, then, the bridge between the ideographic and nomothetic. They can provide testable evidence of structure and outcomes of structure. Their limits lie in the logical problem of inductive inference and in the ontological problems of categorial equivalence". These results lead to the suggestion to present the clinical material in a way that the therapeutic relationship can be understood easily, that the reader is able to remember own experiences with similar patients and through this may connect with the clinical knowledge.

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This can be achieved by presenting the case without theoretical metapsychological considerations by just "telling the story" as DENEKE advocates. Inter- subjectivity is and should not be ruled out in finding an understanding of another person's inner world because the process of understanding is only possibly done through the researcher's personal and partly unconscious inner relations to the material.

This being said, the finding that a thorough use of transference and counter-transference analysis produces some similarities between the two groups of researchers provides evidence for the credibility of this instrument, without stretching its meaning to the domain of impersonal "truth". Future development of the method would focus on the meaning of differences in order to both appreciate the different approaches within different national and theoretical backgrounds and to get beneath these distinctions to appreciate the clinical phenomena.

As a continuative research a case report can be used to interpret an ongoing process between two groups , which always share not only their interpretations of the material but also the theoretical, personal and cultural reasons for them. This may lead to more scientific consistency in an interpretive science like psychoanalysis.

This case report is a translation from one of the Hamburg case reports as an example of the 20 reports. The initial material stems from session protocols. The case reports were written by the therapists. Each participant in both groups had to read the case reports in advance before the case-contrasting discussions.

At the time of his first appointment Mr. At the first appointment I greet a very tall, lanky year-old man, visibly worn out by his ill physical condition. He attempts to be relaxed when greeting me. His depressed and resigned state of mind beneath the surface can be sensed at once. During our talks, he keeps staring into the distance. He remarks that since his suicide attempt his situation has not changed. For him the kind of life he is leading makes no sense.

The acute reason for this is the separation from his girlfriend he was with for many years. She has decided to live with another man. For over six years there have been continual see-saw changes. He finds it difficult to have a close relationship with somebody, but he does long for one. In fact, his girlfriend stuck with him for quite a while.

He prefers living with his half-blind sheep dog, which he "needs". In contrast, he defines his attachment to his girlfriend as a "desire" for her. It is terrible for him to realize that when he had opened up to her more than ever before, she chose another man she had known for some time already. She still takes care of his dog, and they are still in touch. He only feels fine when he is busy doing something he likes to do. Then he feels easy, acting out his abilities.

He always needs a certain atmosphere, for example when he makes music, or when he thinks of the time he worked for an artist in P. He then used to work with pleasure and loved what he did. He also liked living in a motor home with his dog.

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On my inquiry he tells me about some events from the past years, especially about his father's death, as well as the deaths of several friends. During our talks I have the impression that Mr. It becomes clear to me that the attention he received when he was under watch is exactly what he needs. Obviously he has a talent for mobilising doctors, nurses and orderlies; even the cleaning woman and surrounding patients seemed to attend to him in a touching way, as well as a woman from the social services at the University Hospital Hamburg-Eppendorf, Mrs.

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At the same time he conveys the impression that all this does not have an effect upon him; as soon as he is alone the inner emptiness comes back immediately. Soon after our first appointment Mr. Since it is impossible for me, we meet again only one week later at the fixed date. Right from the beginning he says he regrets he did not have the opportunity to talk to me earlier. My first impression is that as soon as he feels lonely and needy he wants to talk to somebody. Then he tells me he has checked out of the in-patient clinic and has found accommodation in a hostel of the Salvation Army.

The previous weekend he felt very lonely there, although the director took care of him very much. He tried to hang himself with a cable but did not succeed. He explains that he was missing the warming atmosphere of the ward. The following three conversations are underpinned by an event that is still disturbing Mr. He tells me that his ex-girlfriend offered to cook for him at her house on his birthday. He went to her house at the time agreed upon, but she did not open the door.

He called her from a public phone. She answered the phone and told him she was still in bed. It was clear to him that she was in bed with her current boyfriend. He felt like being kicked onto the street. After his initial fury he felt "like in a film", so humiliated. She apparently showed no empathy at all. He felt so unprotected having disclosed his wishes to her so sincerely that now he could only "completely shut himself down" again. All he is now seeking is calm, he says, and finally the inner film will stop. What he finds particularly bad is that now he has nobody to take care of his dog, because he has become so dependent on his girlfriend.

Every time he has to go to her house to fetch the dog, he feels extremely mortified and humiliated. His dog symbolizes the part of himself not being currently attended to. As a consequence, he has fallen into a state of inner unrest, and he describes this as an undifferentiated physical condition. He has started drinking more and more beer in the evenings to calm himself, at least a little. At the end of the fifth session, I mention the possibility of a medical treatment, as I could see no way of easing the effects of the conflict with his girlfriend.

This he felt as a rejection, and it must have reminded him of an earlier, similar experience. I suspect these "on and off" - changes with his girlfriend are something he initially experienced with his mother. I also think the separation from a woman unconsciously means death for Mr. After the separation from his girlfriend Mr. He then fell asleep.

However, he had not switched off the radio so that the taxi centre noticed he did not react and tried to track him down. Somehow he got into the clinic. He could not stand being rejected so massively, having disclosed his innermost feelings to his girlfriend so sincerely. He felt he had no place in this world any more. He has always experienced a longing for death, always being beneath the surface.

The experience that nothing good or nice is permanent for him and that in the end he is always left alone is not bearable for him any longer. He remembers his youth in this small town mainly as a time when he was part of a music scene with friends, a phase symbolising for him an independent way of life he now misses.

The family lived in large premises where his mother's parents also stayed in a house. His father ran a photo shop on the premises. The grandmother dominated the clan, whereas the father spent much time in his shop, using it as a place to retire to. He was always in a state of slight inebriation, apparently feeling constantly under pressure to be successful in his job. As a child Mr.

The atmosphere in his family was stamped by his "rustic father" and his beautiful mother, who came from a civil servant's household. During his last years at home the relationship between his parents continued to deteriorate. Finally his mother divorced his father, whom she eventually came to despise. After the divorce his father was in a very bad state of mind. When he the patient once went home for a visit he worked for the alternative civilian service in Husum at the rescue service 5 , he found his father dead. He had apparently "croaked", as the patient said, from too much alcohol.

After his civilian service his mother obtained an apprenticeship as a TV-technician for him, which he finished. Later he worked in this profession at the Federal Post for 7 years until he had problems with his back, which made it impossible for him to work in that job any longer. That friend was a heroin addict and is now dead. Other friends of his died of AIDS.

He feels he has experienced so many separations and deaths that he has lost all hope that anything good can last. In Hamburg he worked as a free-lancer for an artist for some time, living on his premises in a mobile home with his dog. When that artist could not pay him any longer, he started working as a taxi-driver. He has known his ex- girlfriend for six years. She is a very active woman who sometimes reminds him of his mother. They he and his mother understand each other very well. His relationship with his girlfriend, however, is characterised by ups and downs.

She often finds he is lacking initiative and sometimes completely spoils the atmosphere by her reproaches and bossy behaviour. On the other hand, he appreciates her domestic abilities. She has a nice flat and he very much enjoys having meals with her. But he does not feel he can really relax there as it is not his flat.

Wir waren also in einem genuinen therapeutischen Bereich. Bei G erfolgte der Verlust mit 7 Jahren. R und K, beide sehr unter Druck, machten hier "viel Wind". Eine zweite, sich evtl. So ist der Suizidversuch stark im Zusammenhang damit, Hilfe zu mobilisieren. Vorherrschend ist eher eine anale Struktur. Am Nachmittag wurde es dann sehr anstrengend.

Es ist also offen, ob die Aspekte der Biografie notwendig oder nur hinreichend sind. Hierzu fanden sich dann F, O, Q und etwas auch H. Hierzu fanden sich dann L, D, U und S. Nicht zuzuordnen waren M und T. Als Sonderfall entpuppte sich immer wieder H. Dann aber ist die Diskussion sehr stockend. Die Gruppe setzt sich also aus Therapeuten, Diskutanten, des jetzt mitdiskutierenden Therapeuten, aber auch zwei Teilnehmern zusammen, die keine Therapeuten waren, wobei einer OF nicht am gesamten Diskussionsprozess des Marathons beteiligt ist. OF, der nochmals deutlich macht, wie die aktuelle Sicht auf die Biografie zu verstehen ist, bringt das Bild eines Schwimmenden, in Not geratenen, der von einem Boot aufgenommen wird und zum Hergang eines Schiffsuntergangs befragt wird.

Beziehungen hat er eigentlich als Versorgungsinstanzen erlebt, die Geborgenheit vermitteln sollen, als Tankstellen. Die Freundin ist nicht so dumm, wie er dachte. Offenbar war seine Verfassung schon regressiv labilisiert durch die Geburt des Kindes. OF macht deutlich, dass er 1.

Aus Angst, dass "sie" sich trennt, muss er der Trennung zuvorkommen. Auch bei der Freundin ist eher eine ferne Beziehung vorliegend. Er "hat einfach jemanden", aber er hat sie nicht wirklich. Er hat eine ungeheure Angst vor dem Alleinsein, weil er nicht ausreichende Objekte internalisiert hat. Andere Abstraktionen:. B ist ein Zwilling mit einer sehr ambivalenten Vaterbindung, hat etwas sehr "borderline" Adoleszentes.

Er organisiert aber sein Leben adoleszent, er kommt immer irgendwo dann doch unter. N ist ein Riesenbaby. Seine Aggressionen kann er nur schwer kontrollieren. Er selbst nimmt aber auch aggressiv seine Behinderung nicht wahr. LQ meint, dass die Abstraktionsniveaus nicht ausreichen und immer wieder unterschiedliche Ebenen der Abstraktion gewonnen wurden. Kurzbericht zur Fallkontrastierung Dabei gehen die einzelnen Teilnehmer sehr unterschiedlich vor.

Bei einigen Prototypen z. So scheint jetzt das Votum des Therapeuten etwas gewichtiger zu sein als am Ende des Marathons. Appendix 3: London Research: Notes f rom the Process These process notes are the protocol of the discussion process on the case material of 20 suicidal men, taking place at the Tavistock Clinic, London. The participants were blind to the results of the other case discussion group in Hamburg.

The protocol will be compared with the research protocol from the Hamburg group to see the differences and similarities in the discussion process. Discussion began about the material and time table for the day. Everyone from the discussion group had read the case notes. The group felt that all the cases merged into one and that the translation from the German original stood out in the material. They asked what the aims of the session were. One member was unclear about the aim of the exercise, another commented on the similarity of the method to Interpretive Phenomenological Analysis.

The group plumped to begin with Case C. One member, BL, had made notes on the cases and his method was adopted. The method was to have three sections—biography, transference and suicidality. The group began with the transference, then followed with biography and lastly turned to suicidality with all the cases. The question arose as to whether the therapist was male. One member thought that the gender of the therapist would likely make a difference in the transference.

The group discussed how to start with the case and decided to brainstorm. The group went through what BL had written for the case. Discussion about under which heading some items should go—e. They decided that things that are self-destructive go under suicidality, along with factors that appeared to precipitate suicidal acts.

It was noted there are numerous variations on the theme of separation. The question arose as to whether the group should continue discussing until they run out of ideas. Like IPA, the idea is to unpack every aspect of the materials. Like IPA too, it is better to be over-inclusive than to leave elements out.

A discussion followed about German culture and how the meetings might be perceived as more formal i. Mr C than in England. The following excerpts will cite direct quotations from the original discussions:. Does not provoke care or love, but anxiety; actually controls objects. Does being off-sick have a self-destructive element? It was actually self-abuse. Finds it hard to communicate; primitive,physical inside-the-body experiences. He doesn't tell the therapist what he has but describes the symptoms.

It is like a baby—cannot put into words what is wrong—lacks symbolism. The therapist cannot quite articulate it, stops thinking and goes into action. It is interesting how the therapy ends with the therapist saying 'no' 'provokes enactment of rejection' goes onto the board. It links in with 'lacks symbolism. Maybe very intolerant of loneliness. He feels that the object isn't there for him and he's got to do something but does it in a nasty way.

Do you have that down?