Antje Gumz

Corresponding instability of patient and therapist process ratings in psychodynamic psychotherapies

Abstract The transference relationship within the psychodynamic process was conceived of as a self-organizing system under the assumption that patient and therapist instability trajectories prove similar. Nine patients and therapists each rated their experience of the therapeutic interaction (Intrex, SASB) over the course of therapy (29 to 35 sessions). A measure of instability was calculated for these ratings across the resulting time series. The degree of synchronicity (correlation) and the correspondence of instability levels (measure of difference) were calculated for each patient-therapist dyad. Destabilization of ratings was highly synchronous and the level of destabilization corresponded highly in successful therapies. Destabilization in non-successful cases showed low synchronicity and/or therapist ratings proved more instable. The results suggest that systematically including a measure of instability and associations between patient and therapist ratings may prove fruitful in process research.

Vom Chaos zur Einsicht – Die Charakterisierung der Dynamik therapeutischer Veränderungsprozesse mittels textanalytischer Untersuchung von Verbatimprotokollen

The objective of this study is to determine and to analyze so-called key sessions in the frameworks of Therapeutic Cycles Model introduced by Mergenthaler and the Energy Model proposed by Caspar. For this purpose, different measures for key session identification are used based on linguistic text variables. The investigation is done for 10 high-frequency, psychodynamic, inpatient, individual therapies consisting of overall 206 therapeutic sessions, all of which were completely videotaped and transcribed. The text analysis was performed using the automated text analysis tool provided by Mergenthaler, which measures the construct of Emotional Tone as a linguistic manifestation of the emotional event and the construct of Abstraction as a linguistic manifestation of cognitive-reflective processes in speech and texts. Feeding these variables into both models, results reveal their coherence: Therapeutic change may occur, whenever an emotional and cognitive-reflective processing of the internal conflicts begins after destabilisation of coherent patterns of behaviour and experiencing. The discussion suggests a more detailed specification of the definition of key sessions in the Therapeutic Cycles Model by Mergenthaler.

Crisis-repair sequences - considerations on the classification and assessment of breaches in the therapeutic relationship

BackgroundRecent research indicates that temporary deteriorations of variables monitored continuously in the course of the therapeutic relationship are important characteristics of psychotherapeutic change. These so-called rupture-repair episodes were assessed by different authors using different mathematical methods.MethodsThe study deals with the criteria for identifying rupture-repair episodes that have been established in previous studies. It proposes modifications of these criteria which prospectively could make it possible to identify rupture-repair episodes more precisely and consistently. The authors developed an alternative criterion. This criterion is able to include crisis patterns which had not been considered before, as well as to characterize the length of the crises. As a sample application, the different criteria were applied to continuously measured assessments of the therapeutic interaction in psychodynamic therapy courses (ten shorter processes and one long-term therapy).ResultsThe analysis revealed that the number of the identified rupture-repair episodes differed depending on the criterion that was used. Considerably more crises were identified with the newly developed criterion. The authors developed a classification of crisis patterns. They distinguished five patterns of crises and their resolution in therapy processes and ascertained the frequency of distribution. The most frequent pattern was the simple V-shape. The second most common pattern was a decline over more than one session with a sudden repair. The longest downward trend comprised a period of six sessions.ConclusionsThe findings of the study give insight into basic mechanisms of change within the therapeutic relationship. A phenomenological discussion of how a crisis is defined is useful to create a methodological approach to the operationalization of crises, to differentiate specific characteristics and to specifically link these characteristics to the outcome in future studies. The methodological deliberations might be applyable to different research areas where the analysis of fluctuations in a variable of interest over time is relevant.

Faktorstruktur und Gütekriterien der deutschen Übersetzung des Maslach-Burnout-Inventars für Studierende von Schaufeli et al. (MBI-SS)

The Maslach Burnout Inventory (MBI) is the most commonly used instrument in research on burnout. For the German translation of the MBI student version (MBI-SS), the postulated 3-factorial structure of the questionnaire could be confirmed using confirmatory analyses. The internal consistencies of the scales can be classified as good. First findings underline the construct validity of the questionnaire. As expected, burnout was associated with psychic and somatic complaints as well as with experienced social support. Couples reported higher Efficiency levels. Academic studies became less important with increasing duration. Time pressure during the last month was correlated with Exhaustion. The presented findings on factorial structure and validity speak for the applicability of MBI-SS for research projects on students of German institutes of higher education.

Burnout und Arbeitsstörungen bei Studenten

Due to the debate on the Bologna Process, psychic problems among students are now receiving increasing attention. In this context, differences between groups of academic level are of interest. The data of 251 students who consulted a counseling center were examined regarding the experience of burnout and work disruptions. Magister candidates experienced more doubts about their studies compared to Masters degree and state examination and less efficiency compared to state examination candidates. They showed significantly higher values regarding writers block compared to Bachelor and state examination, as well as worries about the future compared to state examination candidates. The discussion on psychic strain among students should to be led in the overall context. It would be useful not to primarily focus on isolated groups of academic level. Analyses on the prevalence and typology of work disruptions among students are prerequisites for developing methods of psychological help.

Strafbare Bestechlichkeit von Vertragsärzten und Ethik

ZusammenfassungFragen der Korruption von Vertragsärzten sind seit längerer Zeit höchst umstritten: Nach dem so genannten „Herzklappenskandal“ sind in den vergangenen Jahren wiederholt Pharma-Konzerne mit dem Vorwurf der Bestechung von Ärzten in die Schlagzeilen geraten. Das Thema wirft nicht nur juristische oder sozialpolitische, sondern auch ethische Fragen auf. Bislang gab es dazu in Deutschland jedoch nur wenig Reflexion. Bewertungen wurden von der Ärzteschaft vor allem Politikern und Juristen überlassen. Dabei bleibt die Frage der strafbaren Bestechlichkeit im Kern ein Problem, das Ärzteschaft und Medizinethik betrifft. Im Alltag ist es oft schwer zu entscheiden, wann es sich bei Zuwendungen um mögliche Bestechung handelt. Die Übergänge zwischen dem unproblematischen Annehmen kleiner Geschenke und Korruption sind fließend. Es bleibt fast ausschließlich dem moralischen Empfinden der Ärzte überlassen, die Grenze zwischen Kooperation und Korruption im Umgang mit Pharmaunternehmen zu ziehen: Unausweichlich vorhandene Konflikte zwischen privaten und berufsethischen Interessen müssen von den Ärzten angesichts unzureichender allgemeingültiger Richtlinien für angemessenes Verhalten individuell gelöst werden. Das Bewusstsein für die sozialpolitische und berufsethische Bedeutung von Interessenkonflikten unter Ärzten und Studierenden sollte erhöht werden. Eine offensivere Auseinandersetzung mit der Frage der Bestechlichkeit in der Medizin ist wünschenswert und erforderlich.AbstractDefinition of the problem The potential corruptibility of contracted medical practioners has been controversially discussed for a long time: following the so-called “heart valve scandal”, numerous other pharmaceutical companies have also made the headlines when being accused of trying to bribe medical practioners. The issue not only raises judicial and sociopolitical questions, but also ethical questions. Thus far, only few reflections have been made on the matter. The medical profession has preferred to let politicians and legal professionals assess these aspects.Arguments The question of criminal bribery remains in its core a problem for the medical profession and medical ethics. In daily life, it is often difficult to recognize compensations as bribery. The border between harmless acceptance of gifts and possible corruption is often not very clear. It mostly remains in the moral perception of the doctors themselves to recognize the border between cooperation and corruption when dealing with a pharmaceutical company. Inevitably there will be conflicts between private and ethical interest of the medical professionals. Since the official ruling on the matter is insufficient, doctors are forced to decide individually what behavior is appropriate in each case.Conclusion Awareness of sociopolitical and professional-ethical conflicts of interest among doctors should be improved. It is desirable to establish a more agressive dialogue on the question of bribery of doctors.

Verbal expression of emotions in the stage-wise progress of a case of long-term psychodynamic therapy

Abstract Background: An important focus of current psychotherapy research is to explore how change occurs in the psychotherapeutic processes. There is a lack of studies that track the process of emotional change throughout therapy. Aim: Analysis of a single case is used to examine transformations of emotional functions during the course of psychodynamic long-term therapy. Method: A rating instrument was used to assess three aspects of emotional expression over 120 hours of therapy. Results: The number of verbalised emotions and the variability of the emotional profile increased during the course of the therapy. These developments occured in three distinct phases. The proportion of positive emotions varied across each stage although there was no linear increase across the case as a whole. Modifications of the rating scale were made, in relation to its applicability to the analysis of therapeutic dialogue. Conclusions: The findings of this study suggest that discontinuous transitions can be regarded as refl...

Macht der Bachelor wirklich krank? – Studienabschlussspezifische psychische Beschwerden bei Klienten einer psychotherapeutischen Studentenberatung

There is a lack of detailed surveys on the mental health of students. German university counseling centers have faced increasing demand, which is primarily due to the newly introduced Bachelor/Master system. The data of 251 students who consulted the Leipzig psychotherapeutic counseling center were examined with regard to complaints, symptoms and interpersonal problems. Significant differences were observed with respect to usage of the counseling center and interpersonal problems. Masters degree and state examination candidates sought counsel most often. Bachelors degree students were least likely to seek help. Magister and Bachelor candidates showed a higher level of symptoms and interpersonal problems. Depression and work disruptions were the concerns mentioned most frequently. The findings should be examined further using additional samples. It should be clarified whether the likelihood of usage also differs with other forms of psychological help.

Testing ground GDR: Western pharmaceutical firms conducting clinical trials behind the Iron Curtain

Western pharmaceutical companies conducted clinical trials in the Eastern Bloc during the Cold War. Recently, media reports about alleged human experimentation provoked a wave of indignation. However, a scientific and objective account of these trials is lacking. The aim of this study was to describe and evaluate the clinical trials performed in the German Democratic Republic (GDR) based on archival material from the health system and the secret service. We found documents relating to 220 trials involving more than 14u2005000 patients and 68 Western companies. However, no record of patient information forms or systematic documentation regarding the provision of patient consent was discovered. There was no evidence to suggest that the trials systematically and intentionally damaged patients. The trials were conducted without the knowledge of the public. GDR legislation stipulated that patients must consent to the trials, but no evidence was found to suggest that patients were systematically informed. Documents suggest that at least some of the trials were carried out without patients having a comprehensive understanding of what the trial involved. The GDR agreed to the trials due to impending bankruptcy and Western pharmaceutical companies capitalised on this situation.

Kritische Instabilitäten im Therapieprozess

Anhand einer Zeitreihe von 580 Tagen wurde eine 80-stundige ambulante tiefenpsychologisch fundierte Einzeltherapie eines Patienten mit einer Panikstorung charakterisiert. Die Zeitreihenanalyse umfasste folgende, taglich erhobene Parameter: Intrex-Fragebogen (SASB, Bezug „Wie gehe ich mit mir selber um?“), Polaritatenprofil nach Feldes (Selbst- und Wunschbild Potenz und Valenz), Teile des Prozessdokumentationsbogens von Schiepeck und Emotionalitateninventar (EMI) von Ullrich & Ullrich de Muynck. Die Therapie wurde dabei als dynamisches System betrachtet. Die entsprechende Zeitreihe wurde mit Methoden der statistischen Physik untersucht, um kritische Instabilitaten zu definieren, die Hinweis auf kritische Therapieereignisse sein konnen. Als Beschreibungsparameter zur Zeitreihenanalyse dienten u.a. Komplexitatsindex, Phasensprunge und Drift-Prozesse. Die gefundenen kritischen Instabilitaten wurden in Beziehung gesetzt mit den klinisch zu beobachtenden Veranderungen. Literatur: Caspar, F.: A connectionist view of psychotherapy. In: Stein, D.,J.: Neural Networks and Psychopathology. Cambridge: University Press 1998. Feldes, D.: Standardisierung von Schatzskalen fur den sozialen Raum und ihre Anwendung als soziometrisches Verfahren bei Gruppenstrukturanalysen in psychiatrischen krankenhausern. In: Bach, O., Feldes, D., Thom, A., Weise, K. (Hrsg.): Sozialpsychiatrische Forschung und Praxis. Thieme-Verlag Leipzig. 1976 Haken, H. und Schiepek, G.: Synergetik in der Psychologie. Gottingen, Bern, Wien, Hogrefe Verlag 2006. Tress , W.: SASB. Die Strukturale Analyse Sozialen Verhaltens. Asanger Verlag, Heidelberg 1993. Ullrich, R., Ullrich de Muynck, R.: Das Emotionalitateninventar (EMI). Diagnostica 21, 84. 1975.