W. Senf

Time and Its Relevance for a Successful Psychotherapy

Time and the distribution of time have hardly been taken notice of up to the present although they are of great importance when considering the economic perspective. The present study reports on the results found between certain time parameters (e.g. total duration, total number of sessions, number of sessions per week, longer interruptions) and the outcome of psychoanalytic psychotherapies. The sample consists of 76 patients with neurotic, functional or psychosomatic diagnoses. The results support the thesis that not only the quantity of time (number of sessions, duration of therapy), but also the distribution throughout the therapy is associated with the success of therapy.

Success and Failure in Psychotherapy: Hypotheses and Results from the Heidelberg Follow-Up Project

Within the Heidelberg Follow-Up Project all treatments of the clinic regardless of the type of psychodynamic technique used are investigated. The outlet is both prospective and retrospective. There are four points of investigation: (1) immediately after the first contact with the hospital (2) at the beginning; (3) at the end of therapy, and (4) after a 2-year follow-up period. Immediately after the first contact with the patient a test battery (Giessen Test, Holzman Inkblot Technique, Gottschalk-Gleser Method, symptom checklist) is administered. This is repeated after a waiting period at the beginning of therapy, where in addition the therapist formulates a psychodynamic hypothesis and defines 3-5 individual treatment goals in connection with the individual pathology of the patient. At the end of the therapy the tests are repeated and the therapist assesses the success or failure of the therapy with regard to symptoms, object relations and psychodynamic change, while the patient fills out a special questionnaire dealing with his personal view of the therapy, the therapist and his own treatment experiences. The first results of about 100 combined inpatient and outpatient psychotherapies are presented (third test-round at the end of treatment). The results are discussed on the basis of the involved tests and ratings with respect to success and failure in the view of patients, therapists and independent clinical experts. Since the study is still under way, reports of the follow-up data are not yet evaluated.

Wirkfaktoren psychoanalytischer Therapien aus der Sicht des Heidelberger Katamneseprojektes

Wie konnen wir erkennen, was in einer erfolgreichen Psychotherapie tatsachlich wirksam war und was in einer anderen einen Erfolg vereitelte?

Empirical Hypotheses on the Psychotherapeutic Treatment of Psychosomatic Patients in Short and Long-Term Time-Unlimited Psychotherapy

In the Heidelberg Follow-Up Project, the results of psychoanalytically oriented treatment in a practice-oriented design are investigated. The patient sample is not homogeneous with regard to the diagnosis; the sample (n = 209) comprised primarily psychoneurotic and psychosomatic patients. All treatments were intended as long-term psychotherapies. The duration of therapy as well as the number of sessions actually realized may be regarded as one result of therapy. This situation, which is not quite ideal in the classical clinical experiment, allows us to develop the following empirical hypotheses: (1) The relationship between the therapeutic effort (e.g. treatment duration and number of sessions) and the results of psychotherapy can be mapped by a dose-effect model. The formal characteristics, especially the shape of the corresponding graphs, are similar for four different evaluation levels. Within the context of a dose-effect model, a treatment duration of about 2.5 years or respectively a number of sessions of about 160 seem to be most beneficial. (2) If we split up the total sample of patients into two subgroups (group 1: patients with psychoneurotic symptoms or non-chronified bodily dysfunctions; group 2: patients with psychosomatic illnesses or chronified bodily dysfunctions) and repeat the analysis, we obtain similar results for both groups of patients. The dose-effect graphs are of similar shape but differ in height. There is a slight tendency in patient group 2 that a treatment duration of up to 3.5 years may be associated with increased success rates.

Some Remarks about the College and Its Future

Some Remarks about the College and Its Future We are now 13 years old. Proverbally, we have reached our manhood and womanhood. But more likely we have only been thrown into the maelstrom of adolescence. This is our 7th congress and it seems we are in an appropriate identity crisis – who we are, where do we wish to go? We have lost our founding father. We have a membership of 400. We have wandered from Kyoto to Jerusalem. Our attendance has been as high as 1,300 and as low as the current conference. It gives us an opportunity to ask if smaller more focussed congresses are better? Will they get us beyond the platitudes and reiterations of the past toward more mature formulations of integration and synthesis? Perhaps we are establishing an identity. However, there are whole continents in which our presence and our effect is either limited or nonexistent. There is a second and a third world that we have failed to align. We have prestigious vice presidents and councillors, as well as a body of delegates whose use the Administration has tapped limitedly. We are a body without a head in the sense that we have failed in our efforts to establish a journal. The quality of our meetings has been increasingly good, as I am confident this congress will demonstrate. However, the work in their formation has been that of a few. We need to inquire of ourselves of the forwardness of our theories and of the originality of our research. How often do we confuse statistical correlations ofendless variables as proof and substantiation, independent of critical reasoning? Future administrations will need to develop communicative and directive skills in order to tap its officers, as well as its younger members at large to do the job that they have been expected to do. I believe that under the auspices of the Program Committee, with frequent communication, the officers and commitee chairpersons should be responsible for the organization of symposia in the area they share, drawing on their knowledge of the new and seminal work that is under investigation, often outside of our purview. The delegation and tendering of this responsibility will insure the quality ouf our presentations and discussions, allowing our congresses to be more scientific, more communicative, and more conceptual. Several of us believe that our congresses should return to the campus where there is a natural environment for the membership to interact and participate as scholars in a setting conducive for the intimacy of scholarship outside of, as well as within, our more formal sessions. Would this not be a more facile environment in which to bring in our students and associates from other disciplines? Within these settings, there Some Remarks about the College and Its Future 11

Opening Remarks to the 7th World Congress of the International College of Psychosomatic Medicine

Opening Remarks to the 7th World Congress of the International College of Psychosomatic Medicine Standing here, opening our 7th World Congress I am at the same time breaking a very solemn promise – practically an oath -given or sworn 24 years ago. Then – in the spring of 1959 – having been at the Hamburg Clinic for only a year, I watched Jores and Freyberger hosting and organizing the European Congress of Psychosomatic Medicine. What I perceived from my lowly position were hurt vanities of speakers or chairpersons for not having been attributed an adequate position, fights for more speaking time, and delays in the delivery of manuscripts. In my eyes – and this made the whole process simply agonizing – all these troubles seemed fully uncompensated by clear success experiences. As a consequence I gave myself the solemn promise to do anything and everything humanly possible to evade ever hosting an international congress. Having broken my oath with qualms and apprehensions, I can tell you now that the latter were completely unfounded. However, this may be a stroke of luck due to two external but mutually interacting factors. One is the cooperative dedication and zeal of the whole staff of our Psychosomatic Department. It is a very small team, but we managed with only two outside cooperations: Bernd Dahme from the Department of Medical Psychology, and – and this is the second factorthe expert help of the professionals of the Congress Center Hamburg. I am thanking them all for their work and for their dedication. Their cooperation achieved that computer outprints of plenary and symposium speakers were correct, the layout of programs attained expectations, the budget was updated regularly, and the timetable was kept throughout. Thus we have already had our success experiences and our narcissistic support, and therefore we can invite you to feel free of moral obligations and just give vent to your feelings. However, if we are quite honest, we would prefer you to enjoy the V∏th ICPM World Congress and we believe there is an objective albeit predictive reason for this. You certainly never have heard of the Meyer/Freyberger PPWC theorem, because we have only discovered it – independently but convergently – ad hoc of this world congress. PPWC stands for Progressive Pauperization of World Congresses. Its mechanism is an exceedingly simple and easy to understand economic process, one could call it the leverage depression acceleration for certain taxo-nomic subgroups of society (here scientists Opening Remarks 9

Combined Inpatient and Outpatient Psychotherapy — Theoretical Considerations and Empirical Results

Inpatient psychotherapy on a psychoanalytic basis can look back to a long tradition, since simmel formulated it comprehensively in 1928 for the first time. Today inpatient psychotherapy is considered an independent procedure alongside other forms of management. As a consequence, it is generally agreed that the psychosomatic ward is a dynamic, therapeutic unit and an instrument for treatment with defined indicators, the concept of which has found its way into a broad spectrum of publications (Beese 1978; Heigl a.; Neun 1981). The writers’ therapeutic point of departure used at their hospital makes use of a complex supply of possibilities for the treatment in which different procedures are conceived as integrated and related to each other as a whole. This is not achieved through the simple addition of different techniques, but through the integration of different procedures in a stringently coordinated and organized setting. In this way the patient, in accordance with his ability and the current condition, can be approached and reached either verbally or nonverbally, either through interpretation or reality-related intervention.