Norbert Hartkamp

The Symptom Check-List-90-R (SCL-90-R): A German validation study

The Symptom Check-List-90-R (SCL-90-R) is a widely used psychological status symptom inventory. The properties of the German SCL-90-R version were studied in two clinical samples: psychosomatic outpatients and primary care patients. The data were compared with a German community sample. The internal consistency, measured by Cronbachs α coefficients, was found to be high, for the global scale and all original subscales. Mokken scale analysis indicated hierarchical structure for most of the subscales. Concurrent validity, evaluated by studying the relationship between the SCL-90-R subscales and the Inventory of Interpersonal Problems (IIP-C) and the General Health Questionnaire (GHQ-12) was also high. On the basis of receiver operating characteristic (ROC) analyses, it was found that the SCL-90-R was able to differentiate between subjects known to have a given psychological disorder and those who do not. Results of exploratory and confirmatory factor analysis failed to support the original nine factor model and two subsequent factor models. The strong interdependence of the original subscales and the strong first unrotated factor of the exploratory factor analyses raised concern regarding the multi-dimensionality of the SCL-90-R subscales. We concluded that the SCL-90-R is a useful tool for measuring psychological status, measuring change in outcome studies, or screening for mental disorders.

Assessing clinically significant change: application to the SCL-90-R.

A Symptom Checklist (SCL-90–R) is a potentially useful measure of psychological distress; it is frequently used in psychotherapy research and clinical practice. The purpose of this study was to illustrate the use of the SCL-90–R for determining statistically reliable change and clinical significance outlined by Jacobson and Truax in 1991. This paper describes the concepts of statistical and clinical significance of change. A proposal for obtaining and characterizing samples is made. Then a clinicians perspective is taken. Reliable change estimates and cut-off scores are chosen based on outcome data. Selected data from a single psychotherapeutic process and outcome study then were used to test the estimates of change and cut-off scores.

Effects of Short-Term Dynamic Psychotherapy for Neurotic, Somatoform, and Personality Disorders: a Prospective 1-Year Follow-Up Study

Time-limited psychodynamic therapies in an outpatient setting are offered for a broad spectrum of psychogenic disorders. Chiefly, meta-analyses have proved their effectiveness where neurotic disorders have been concerned. The Cyclic Maladaptive Pattern/Structural Analysis of Social Behavior (CMP/SASB) model (Tress et al., 1996) of short-term dynamic psychotherapy (STDP) in this study was applied to patients with somatoform and personality disorders. Using a naturalistic design, 41 therapists treated 75 patients with personality (n = 24), somatoform (n = 24), and neurotic (n = 27) disorders. Relevant research instruments were Beeinträchtigungsschwere Score (BSS; an impairment score), Global Assessment of Functioning Scale (GAF), CMP, Symptom Checklist (SCL-90-R), and Intrex Introject Questionnaire based on the SASB. The treatments lasted for 25 sessions, and follow-up examinations were performed after 6 months and 1, 2, and 5 years. Effect sizes for the entire sample by BSS and GAF are reported. Somatoform patients benefited the most, but those with personality disorders also profited. Effect sizes of self-ratings (SCL-90-R and Intrex) were not as high. Thus, the CMP/SASB model of STDP is suited not only for neuroses but is especially appropriate for somatoform disorders as well.

Comparison of the standard and the computerized versions of the Symptom Check List (SCL‐90‐R): a randomized trial

Objective: The purpose of this study was to examine whether computer administration of the Symptom Check List (SCL‐90‐R) is equivalent to paper‐and‐pencil originals.

Psychometric properties of the German version of the NEO-FFI in psychosomatic outpatients

Abstract The five factor model of personality has received widespread attention during the last years. The NEO-Five-Factor Inventory (NEO-FFI) is one of the most widely used instruments to assess the dimensions of the five-factor model. The psychometric properties of the German version of the NEO-FFI were studied on a large sample of psychosomatic outpatients ( n =950). Internal consistencies and intercorrelations were in line with results reported in other studies. Concurrent validity, evaluated by studying the relationship between NEO-FFI dimensions and Symptom Check List (SCL-90-R) and Inventory of Interpersonal Problems (IIP-C) subscales, was high. Confirmatory factor analysis failed to support the original five-factor model and two subsequent models. Logistic regression analysis showed that the dimensions Neuroticism and Conscientiousness discriminated between patients with personality disorders and those with other mental disorders.

Computerized administration of the Symptom Checklist (SCL-90-R) and the Inventory of Interpersonal Problems (IIP-C) in psychosomatic outpatients

This study investigated whether the method of administration (computer vs. paper-and-pencil) influenced mean scores on the Symptom-Checklist (SCL-90-R) and the Inventory of Interpersonal Problems (IIP-C). The performance of 32 psychosomatic outpatients on the computerized version was compared with the performance of a matched control group on the paper-and-pencil version. No systematic differences were observed in group means.

Stationäre tiefenpsychologisch orientierte Psychotherapie bei depressiven Störungen (STOP-D) - Erste Befunde einer naturalistischen, multizentrischen Wirksamkeitsstudie

OBJECTIVES While the general effectiveness of psychodynamic psychotherapy in both outpatient and inpatient treatment has been proven, few studies document the effectiveness of clinical inpatient treatment of depression through psychodynamic psychotherapy. METHODS This paper presents first results of a naturalistic multicenter intervention study. Included were female inpatients suffering from depressive symptoms who had been admitted to 15 psychodynamically oriented psychosomatic hospital units (N = 487). The mean duration of treatment was 61.8 days. Data were acquired at admission (T1) and discharge (T2). RESULTS Our findings support previous evidence and show that psychodynamically oriented inpatient psychotherapy of depressive disorders is efficient. High pre-post effect sizes were documented in all psychometric instruments used (BDI, HAM-D, SCL-90-R, BSS, GAF). Initial subgroup comparisons reveal that the benefits for patients with comorbid personality disorder are significantly lower than for depressed patients without comorbid personality disorder. CONCLUSION Psychodynamic inpatient psychotherapy, as practiced under naturalistic conditions, is an effective treatment of depression. Predictors of therapeutic effects within different therapeutic settings, however, remain unclear. The sustainability of the therapeutic effects found and their impact on psychodynamic relevant constructs have still to be proven.

Spezifisches Gegenübertragungserleben und interpersonelle Problembeschreibung in psychodynamischer Psychotherapie

ZusammenfassungDie Gegenübertragung und ihr professioneller Gebrauch gilt in der psychodynamischen Psychotherapie als ein wichtiges Werkzeug, um zentrale Schwierigkeiten von Patienten zu erfassen. Die vorliegende Studie untersucht den Zusammenhang von Gegenübertragung und interpersonellen Schwierigkeiten an 30 Therapeut-Patient-Paaren in tagesklinischer psychodynamischer Psychotherapie. Zur Erfassung der interpersonellen Problemschilderungen diente das Inventar Interpersoneller Probleme (IIP), die Gegenübertragung wurde mit dem Impact Message Inventory (IMI) erfasst. Die Bestimmung der Zusammenhangs erfolgt durch Korrelation der IIP-Daten der Patienten mit den IMI-Daten der Therapeuten. Die Messung erfolgte zu Beginn der Behandlung, nach 4-wöchiger Behandlung und zum Therapieende. Über den Therapieverlauf kam es zu einem Anstieg der Korrespondenz von interpersonellen Schwierigkeiten und Gegenübertragung von anfänglich im Mittel r=0,22, über r=0,47 (nach 4 Wochen) bis r=0,58 zum Therapieende. Damit lag die Korrespondenz etwas über dem Wert einer Kontrollgruppe (n=20) von nichtklinischen Paaren aus Alltagsbeziehungen von mindestens 6 Monaten Dauer.SummaryIn psychodynamic psychotherapy, countertransference and its professional use is seen as an important means to identify central difficulties of patients. The present study examines the correspondence of countertransference and interpersonal difficulties in 30 therapist-patient couples in day hospital psychodynamic psychotherapy. Interpersonal problems were recorded using the inventory of interpersonal problems (IIP) and countertransference was measured using the impact message inventory (IMI). Correspondence was measured as the correlation of IIP data from the patients and IMI data from the therapists. Data were collected at the start of therapy, after 4 weeks of treatment, and at the end of treatment. Over the course of the therapy, an increase in the correspondence of interpersonal problems as reported by patients and countertransference could be observed, starting with r=0.22 at the beginning of therapy and continuing through r=0.47 after 4 weeks to r=0.58 at the end of therapy. The mean correlation was slightly above that of a control group of 20 nonclinical couples associated for at least 6 months.

Structures of Introject and Therapist–Patient Interaction in a Single Case Study of Inpatient Psychotherapy

This case study in inpatient psychotherapy attempts to identify characteristic patterns of interactions between therapists and their patients. To this end, we make use of the nonlinear analysis of dominance of interactions, a method of analyzing complex dynamic systems with regard to dominant influences and critical and stable variables. The method is based on Intrex questionnaire data giving evidence of self-directed behavior and therapeutic interactions in relation to the model of the Structural Analysis of Social Behavior (SASB). This empirical study endeavors to explain why certain introjective and interpersonal kinds of a patient behaviors seem to be dominant, thus influencing other behavior, whereas other kinds seem to be critical, unstable, and likely to be influenced. We get an impression of what might be termed the patients intrapersonal and interpersonal psychodynamics. Diese Einzelfallstudie aus dem Bereich dre stationaren Psychotherapie versucht, charakteristische Muster der Interaktion zwisc...

Krankheitstypische Gegenbertragungsreaktionen@@@Countertransference reactions as specific for the different psychic illnesses

ZusammenfassungTypische Gegenübertragungen der wichtigsten, psychotherapeutisch bedeutsamen Krankheitsgruppen (Neurosen, psychosomatische Erkrankungen, somatopsychische Störungen, Persönlichkeitsstörungen, Sucht und Traumata) werden beschrieben. Die hier vorgenommene Auswahl stützt sich zum einen auf die lange Tradition klinischer Beschreibungen und zum anderen auf die zunehmende empirische Sicherung des Phänomens. Auch wenn es aufgrund der unterschiedlichen Krankheitsebenen zu Mischungen im Gegenübertragungserleben kommen kann, plädiert der Beitrag für die Wichtigkeit der umfassenden Analyse der Gegenübertragung. Hierdurch wird dem Therapeuten der Umgang mit den vielfältigen Gegenübertragungsgefühlen erleichtert, und diese werden zu einem wichtigen differenzialdiagnostischen Werkzeug für die tägliche Praxis.AbstractCharacteristic countertransferences of the most important groups of psychotherapeutically relevant diseases (neurotic, psychosomatic, somato-psychic disorders, personality disorders and traumas) are presented. The choice made is derived from the long tradition of clinical description and the increasing amount of empirical evidence about the phenomenon. Even if due to the different levels on which a disease may function a mixing of different countertransferences may occur, it is suggested that a precise analysis facilitates a therapist’s dealing with the various countertransference feelings and makes countertransference an important differential diagnostic tool for the daily practice.