Klaus Grawe

Research-Informed Psychotherapy

Psychodynamic psychotherapy is effective as an approach to understanding the psychological conflicts and the psychiatric symptoms of cancer patients as well as to planning useful psychological interventions. The author recommends that the psychotherapist who treats cancer patients be familiar with the following: 1) the natural course and treatment of the illness, 2) a flexible approach in accord with the medical status of the patient, 3) a common sense approach to defenses, 4) a concern with quality-of-life issues, and 5) counter-transference issues as they relate to the treatment of very sick patients. Case reports illustrate the unique problems facing psychotherapists who are treating cancer patients. Further, these cases show the effective use of psychodynamic principles to inform the therapist of successful psychotherapeutic interventions.

BERN INVENTORY OF TREATMENT GOALS: PART 1. Development and First Application of a Taxonomy of Treatment Goal Themes.

The taxonomy of treatment goal themes of the Bern Inventory of Treatment Goals (BIT-T) is presented. The taxonomy was developed using 1,031 treatment goals of 298 outpatients at a university clinic. A first version of the taxonomy was constructed by cluster-analyzing eo-occurrence values computed from categorizations made by 22 therapists. Iterative revisions after several rating trials resulted in BIT-T Version 3.1. Categories at the highest of three levels of abstraction are coping with specific problems and symptoms (P), interpersonal goals (I), well-being and functioning (W), existential issues (E), and personal growth (G). In (re-)coding an extended sample of outpatient treatment goals, the BIT-T proved to have a good interrater reliability, identified differences between diagnostic groups, and showed meaningful relations to standardized intake measures. Applications of the taxonomy for research and practice purposes as well as possible consequences of the obtained first results are discussed.

Empirically and clinically useful decision making in psychotherapy: Differential predictions with treatment response models

In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patients response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research networks. This article presents a strategy to disaggregate patients into homogeneous subgroups to generate optimal expected treatment response profiles, which can be used to predict and track the progress of patients in different treatment modalities. The study was based on data from 618 diagnostically diverse patients treated with either a cognitive-behavioral treatment protocol (n = 262) or an integrative cognitive-behavioral and interpersonal treatment protocol (n = 356). The validity of expected treatment response models to predict treatment in those 2 protocols for individual patients was evaluated. The ways such a procedure might be used in outpatient centers to learn more about patients, predict treatment response, and improve clinical practice are discussed.

Der Inkongruenzfragebogen (INK)

Zusammenfassung. Theoretischer Hintergrund: Menschen streben nach Bedurfnisbefriedigung durch die Umsetzung ihrer Ziele. Motivationale Inkongruenz bezeichnet die unzureichende Umsetzung motivationaler Ziele. Fragestellung: Konstruktion, teststatistische und Validitatsprufung der Inkongruenzfragebogen (INK und K-INK). Methode: Der INK wurde unter Verwendung der Iteminhalte des FAMOS (Grosse Holtforth & Grawe, 2000) konstruiert und in verschiedenen Stichproben (N = 1077) zusammen mit anderen Fragebogenmasen vorgegeben. Eine Kurzversion (K-INK) wurde aus den trennscharfsten Items konstruiert. Ergebnisse: Hauptachsenanalysen reproduzieren die Skalenstruktur des FAMOS grostenteils und trennen Annaherungs- und Vermeidungszielskalen. Reliabilitatswerte fur INK und K-INK sind grostenteils befriedigend. Inkongruenzwerte sind bei Patienten starker ausgepragt als bei Kontrollpersonen und korrelieren hoch mit Symptombelastung, Depressivitat, Lebenszufriedenheit, Wohlbefinden und Neurotizismus, hingegen gering mit FAM...

Temporal interaction of process variables in psychotherapy

A sample of 91 courses of dyadic psychotherapy using different treatment modalities was analyzed in order to study session-by-session dynamics. The process data consisted of therapist and patient session reports and therapy outcome was evaluated by pre-post questionnaires and direct measures of change. After data reduction by principal component analysis, linear time series models of the resulting factors were computed to describe the prototypical dynamical patterns of the sample and of the modality subsamples (cognitive-behavioral, client-centered, schema-theoretical psychotherapy). It was found that the factor of Patients Sense of Self-Efficacy/Morale governed the observed dynamics of the sample, whereas the therapeutic bond factors did have less impact on the dynamics. The dynamical patterns of client-centered therapies differed from other modalities. The dynamics-outcome findings showed that direct measures of change were associated with a specific process pattern in which the patients sense of self-efficacy was supported by other process variables.

Reducing the dreaded: change of avoidance motivation in psychotherapy

Abstract All humans avoid aversive experiences. Avoidance motivational goals are defined as ontogenetically developed mental representations of avoided transactions, and avoidance motivation as the totality of an individuals avoidance motivational goals. Based on previous research, avoidance motivation is hypothesized to contribute to the development and maintenance of psychopathology. The authors tested the hypotheses that the intensity of avoidance motivation is reduced by outpatient psychotherapy, that the intensity of avoidance motivation after therapy approaches normality, and that change in avoidance motivation is related to other kinds of therapy outcomes. Seventy-six outpatients completed a self-report measure of avoidance motivational goals before and after therapy. All hypotheses were confirmed. Explorative analyses found differential patterns of change of avoidance motivational goals as well as relationships with psychotherapy outcomes. The authors discuss the role of avoidance motivation in psychotherapy practice and research and outline areas for future research.

The value of treatment-goal themes for treatment planning and outcome evaluation of psychiatric inpatients

Background: The taxonomy of treatment-goal themes of the Bern Inventory of Treatment Goals (BIT-T) has shown to be a comprehensive coding system for outpatient use. Aim: The current study examines the value of the BIT-T for treatment planning and outcome evaluation of psychiatric inpatients. Method: The 1991 treatment goals of 675 predominantly non-psychotic psychiatric inpatients were coded using the BIT-T. Ratings of goal-related changes by patients and length of stay were used as outcome criteria. Results: The BIT-T showed to be reliable and exhaustive. Distributions of goal themes are partially associated with diagnoses. Goal-related improvements as well as length of hospital stay differed depending on the themes of patients’ treatment goals. Conclusions: Coding of treatment-goal themes with the BIT-T provides researchers as well as practitioners with valuable information that goes beyond psychopathological diagnoses. This information can be used clinically for treatment planning as well as outcome evaluation.

Psychotherapie unter gesundheitsökonomischem Aspekt

Zusammenfassung.Theoretischer Hintergrund: Patienten mit psychischen Storungen werden in unserem Gesundheitswesen haufig gar nicht oder zu lange inadaquat behandelt. Ein vermehrter Einsatz indizierter Psychotherapie konnte die unzureichende Versorgungslage im Bereich der psychischen Storungen erheblich verbessern, aber in Zeiten der Kostenexplosion im Gesundheitswesen wird kurzfristige Wirtschaftlichkeit hoher gewertet als Wirksamkeit. Fragestellung: Kosten-Nutzen-Analyse des Einsatzes von Psychotherapie im Vergleich zu medizinischen Masnahmen. Methode: Sekundaranalyse von 124 Kosten-Nutzen-Studien. Ergebnisse: Die Studien zeigen, dass Psychotherapie im Vergleich zu routinemasig eingesetzten medizinischen Behandlungsmassnahmen nicht nur wirksamer, sondern auch kostengunstiger ist. Die zu erzielenden medizinischen und volkswirtschaftlichen Einsparungen ubersteigen die Kosten fur einen vermehrten Einsatz von Psychotherapie bei weitem. Schlusfolgerung: Die Ergebnisse werden bezuglich Fehlversorgung, Chronifi...

Structure and Change of the IIP-D Pre- and Postpsychotherapy

The structure and change of the Inventory of Interpersonal Problems in the German Circumplex version (IIP-D; Horowitz, Strauss, & Kordy, 2000) were examined in a study of 393 Swiss psychotherapy outpatients. Replicating results by Vittengl, Clark, and Jarret (2003), interpersonal problems showed a three-factor structure (Interpersonal Distress, Love, and Dominance), with the latter two factors approximating a circumplex, both before and after therapy. Interpersonal Distress, Love, and Dominance changed with therapy. Structural stability, patterns of change, as well as intercultural generalizability of IIP assessments are discussed.

Der Ordnungseffekt im Psychotherapieprozess: Replikation einer systemtheoretischen Vorhersage und Zusammenhang mit dem Therapieerfolg

Zusammenfassung. Theoretischer Hintergrund: Selbstorganisation und Musterbildung sind zentrale Konzepte der Systemtheorie. Fur Therapiesysteme wurde Musterbildung im Sinne eines Ordnungseffektes theoriegeleitet vorhergesagt. Fragestellung: Die vorliegende Studie pruft das Phanomen und die Validitat der Ordnungszunahme an 30 Therapien und untersucht Zusammenhange mit dem Therapieerfolg. Methode: Die Ordnungsmessung basiert auf Patienten- und Therapeutenstundenbogen. Als Ordnungsmase wurden faktorenanalytische Verfahren und das Ordnungsmas Ω nach Landsberg eingesetzt. Ergebnisse: Eine signifikante Ordnungszunahme in den Therapiesystemen ergibt sich mit allen verwendeten Verfahren. Dieser Ordnungseffekt geht nicht auf stereotype Antwortmuster zuruck und hangt besonders mit interaktionellen Variablen zusammen. Schlussfolgerungen: Der Ordnungseffekt in Therapiesystemen erweist sich als replizierbarer und valider Befund, der mit der Qualitat der Therapiebeziehung und dem Therapieoutcome verknupft ist. Dies unte...