The Multidisciplinary Guideline for Depression: a commentary

The multidisciplinary guideline for the treatment of depression has come to be regarded as an important summary of the currently available information about the treatment of depression. We are critical of several of the views expressed in this guideline--first of all, the guideline opts for the selective uptake inhibitors fluvoxamine, paroxetine and sertraline rather than for citalopram, and secondly, the guideline rates antidepressants more highly than psychotherapy or a combination of antidepressants and psychotherapy. There is a lack of cohesion between the various aspects of treatment and little attention is given to the problems of treating depression in everyday practice. In our view this restricts the applicability of the guideline.     

The demand for integrative approaches in psychotherapy research demonstrated in an bibliometrical and speech statistic analysis of the PPMP

Based upon the recent discussion on integrative approaches in psychotherapy research, the last two volumes of the PPmP were bibliometrically analyzed. The articles of authors which belong to different disciplines like psychosomatic or medical psychology were compared with respect to the word and speech statistic, leading representatives and the reception of the international state of research. The interdisciplinary standard of the PPmP has proven successful in view of the impact of the journal within the Scientific Community and among the flagship journals of the field. The study shows that the plurality of methodological approaches and interdisciplinarity provides an important criterion for the quality of psychotherapy research and for the corresponding publication institutions. Related to scientific quality standard the PPmP has found good impact in the scientific community but there are points to be changed.     

Resource oriented counseling--conceptual and methodological considerations

In the last years resources have become one of the most discussed topics, nearly a magic word, in psychotherapy and in psychosocial practice. The orientation towards human strength and potentials can be considered as a central dimension within the reflections about an independent psychosocial understand of counselling apart the field of psychotherapy. The point of view connected therewith is not only fixed on personal resources as it mostly the case within the methods of psychotherapy but also on the interaction between the individual strength and abilities and the resources regarding the context which is mainly arranged by the social network. In order to realize this interactive view counselling makes use of different methods and strategies according to schools of psychotherapy, especially narrative psychology and community psychology. The perspective of empowerment gives direction of the development of an integrative concept.     

Known object loss,disturbance in reality testing,and “ee-grief work” as a method of brief psychotherapy

Summary Traditionally psychiatry and its teaching regarding psychotherapeutic technique have centered around the classical aspects of psychoanalysis and psychoanalytically oriented long-term psychotherapy. The authors' observation of hospitalized patients has led them to believe that there is a definite need for the development of short-term techniques in psychotherapy. In the particular therapeutic technique discussed in this paper an effort is made to consider the need for short-term techniques predicated upon psychoanalytic hypothesis, although differing widely from the practice of long-term psychoanalytically oriented psychotherapy.The method described in this paper utilizes as its cornerstone focalization upon a specific aspect of the patient's history, namely the loss of an object to which the patient had developed significant libidinal and aggressive attachments. The paper develops a concept of re-grief work, which is a method of short-term psychotherapy in which a patient suffering from a delayed or pathological grief reaction may be assisted in experiencing a satisfactory grief reaction somewhat later in time than would be expected in the normal course of grief work.The authors' investigations in this area are only beginning but it was felt that reporting of this initial work might stimulate the interest of other investigators in this area, aid in the elucidation of all the forces that may be at work in this particular type of therapeutic endeavor, and finally result in the refinement of the therapeutic technique herein described.     

Psychoanalytically based and psychoanalysis in children and adolescents from the viewpoint of a child and adolescent psychotherapist

The author, practitioner of psychoanalytic psychotherapy with children and adolescents, explains her point of view regarding psychotherapy versus psychoanalysis. Verbatim process notes illustrate the work and are used to plan the therapeutic method.     

Adolescents' dropout from individual psychotherapy--is it true?

Although adolescent patients are said to have a propensity to drop out from psychotherapy, and clinical experiences seem to support this view, few studies have systematically examined this issue. However, a review of researches on adults' dropout shows that dropout is a serious problem for psychotherapy with adult patients. Moreover, available evidence on adolescents' dropout suggests that there is no significant difference in the rates of dropout from psychotherapy between adolescent patients and adult ones. In order to understand the specific quality of adolescents' dropout, the termination of psychotherapy with an adolescent patient is described and discussed. The view is put forward that it is because of the strong counter-transference feelings evoked in the therapist, when his adolescent patient leaves him prematurely, tends to maintain the impression of adolescents' proclivity to drop out from psychotherapy.     

Rituals in therapy, rituals in our lives

The authors review the history of rituals and their healing and preventive role within the community in a comprehensive study. They illustrate with examples the rituals employed in therapy and discuss their classification. They also touch upon the different methods used in family psychotherapy and the function of rituals. In our modern society, there is a lack of rituals at each transition from one life cycle to another, but there is a particular scarcity of coming of age rituals in adolescence. In the authors' view therapists should not only become familiar with rituals but should also be able to use the healing power of rituals occasionally in the treatment of psychiatric illnesses and crises.     

The care and feeding of a psychotherapy research team.

Although psychotherapy research teams have been in existence since the 1940s, one of the reasons they are not more popular is the absence of literature on how they operate. There is essentially no literature on the organization and administration of psychotherapy research teams, on the management of their everyday practical issues, decisions, and problems. In order to open the way for a dialogue on these matters, an inside view is provided of one relatively productive psychotherapy research team. The topics include the mission and goal, nature and size of the team, administrative locale, team contract, meetings and homework, leadership and decision-making, the research tape library, and what team members get from participation on the team.     

Imaginal desensitization: a cost-effective treatment in two shop-lifters and a binge-eater resistant to previous therapy

Case reports are given of three patients, two suffering from compulsive shop-lifting and one from binge-eating, who responded to a week's treatment with imaginal desensitization after having failed to respond to prolonged interpretative psychotherapy. Expectancy of improvement did not appear to play a major role in their response, but it appears impossible to disprove that expectancy determines the response to this or any form of psychotherapy. Whether or not imaginal desensitization acted specifically in the present study, in view of its cost-efficacy it is suggested it is worthy of trial in impulse disorders which have persisted despite treatment.     

The transference in psychotherapy: the old vs. the new, analytic vs. dynamic

This article takes a look at the concept of transference from several contemporary perspectives. It compares the traditional (or classical) view of transference with a more contemporary view based on the joint creation of the transference. It then discusses the relevance of transference to the dynamically based psychotherapies. From this perspective analytically oriented psychotherapy is contrasted to dynamically oriented psychotherapy.     

Die Meta-Analyse zur Psychodrama-Psychotherapie in "Psychotherapie im Wandel" von Grawe, Donati und Bernauer

This article presents Klaus Grawe and co-workers' assessment of the scientific standing of psychodrama psychotherapy within the broader context of psychotherapy and examines it critically from a methodological as well as a substance point of view. Further research is suggested in order to enhance the independence of psychodrama psychotherapy as an approach in its own right.     

A systems approach to behavioral neurobiology: integrating psychodynamics and neuroscience in a psychiatric curriculum

In the practice of medicine, an understanding of the biological functioning of organs and organ systems is the basis for theories of pathology and clinical practice. If psychoanalysis is to be accepted by the medical and psychiatric community, it must be based on a sophisticated understanding of the organ from which mental and emotional experiences emanate and use scientifically acceptable language. Each approach to psychotherapy has its own vocabulary for describing neuropsychological processes. Neurobiological vocabulary provides the various factions "neutral ground" upon which to carry on a multidisciplinary integrative dialogue. An understanding of behavioral neuroscience allows the therapist to look beyond the labels that spawn division and identify unifying biological principles that are described in a variety of ways in a multitude of theories. We contend that the neural network/representational approach to neurobiology views human mental experience as the result of multiple complex integrated systems, and is therefore holistic and antireductionistic in its perspective. Such a biologically informed psychotherapy facilitates integration of skill sets and flexibility in technique. With these principles in mind, the therapist can base his or her approach to the patient based on these principles rather than on devotion to one particular "school" or another. Because behavioral neuroscience supports many of the basic tenets of psychoanalytic theory, such an integrative psychotherapy would be psychodynamically informed. In this paper, we outline some of the ideas we present in our neuroscience course and how we relate biological concepts with some core principles of psychodynamics and psychotherapy.     

The demographics of American Psychotherapists: a pilot study

Of the professional groups from which data are available, psychiatrists, psychologists and social workers do approximately 30 percent of the total number of hours of self-defined psychotherapy while primary care physicians report doing 10 percent. These figures are not truly representative of the actual percentage of psychotherapy being performed by these groups, since at least three other professions (ministry, psychiatric nursing and the counseling profession) are also significantly involved in the delivery of such services. The expansion of psychotherapeutic practice has been accompanied by an increasing ambiguity in the definition of psychotherapy, to the point that the definition appears solely dependent upon the judgement of the participants. The Commission on Psychiatric Therapies of the American Psychiatric Association is attempting to clarify psychotherapeutic practice in regard to decision trees applied to specific diagnostic categories. In order to lead the way to its utilization by all psychotherapists, two further problems need attention: (1) the demography of American psychotherapists and (2) a definition of the basic elements of psychotherapy.     

Kinder- und Jugendpsychiatrie und Psychotherapie – Ein Rundblick

The child- and adolescent psychiatry has emancipated itself 10 years ago from an additional specialist physician’s area to a separate specialist medical domain with a specific curriculum. Associated with this is an irreconcilable interlacing with the psychotherapy of childhood and adolescence. Even if childhood and juvenile psychiatry is always settled within the framework of a biopsychosocial model, psychotherapy is of particular importance. In the following, the psychotherapeutic requirements and ethical issues of the human being are to be formulated according to a view on the new morbidity and the Zeitgeist in which we are working. A scientific legitimation leads to the demarcation of esoteric endeavors and the view into practice leads us from nosology to functionality in the consideration of mental disorders in children and adolescents.     

A symposium on psychotherapy in the age of managed care

This article is based upon a symposium presented at Vanderbilt University Medical Center on the Department of Psychiatry's 50th anniversary (September 20, 1997). The panel of psychotherapy scholar-clinicians discusses issues including: whether or not managed care and psychotherapy are compatible; the relevance of the Consumer Reports' psychotherapy study to MCOs' emphasis on brief therapy; how MCOs impact upon the therapist-patient relationship; the effects of MCOs on the psychotherapist's personal and professional identity; and training psychotherapists in the era of managed care. The paper is dedicated to Pietro Castelnuovo-Tedesco, M.D., Vanderbilt's Blakemore Professor of Psychiatry, who died on January 24, 1998.     

Psychiatry residents and dynamic psychiatry: two narratives, a survey, and some ideas to enhance recruitment

Psychiatric residency has undergone a major shift over the past 50 years with increasing emphasis on psychopharmacology evidence-based treatments, and competency-based requirements which has led to concerns that psychodynamic knowledge and skills are in jeopardy. Narratives of two residents who developed strong interest in psychodynamic psychotherapy and psychoanalytic training are presented to illustrate the important influences on their identities as psychodynamically oriented psychiatrists. Results from a recent survey of U.S. residents regarding psychodynamic psychiatry indicate that they value psychodynamic psychotherapy, want to incorporate psychotherapy into their careers as psychiatrists, and strongly endorse personal psychotherapy but view their psychodynamic skills as weak. Recommendations about how to enhance education and interest include (1) building or strengthening relationships with mentors, supervisors, and teachers, (2) emphasizing the importance of psychodynamic understanding of patients whether or not the resident is functioning as a therapist, (3) using psychopharmacology to engage residents in thinking psychodynamically, (4) encouraging personal psychotherapy for residents and helping find ways to make it affordable, (5) utilizing awards, visiting scholars, specialized programs, and distance learning, especially for programs without adequate resources, and (6) encouraging clinicians to become familiar with the research base in psychodynamic psychotherapy to correct biases and misperceptions.     

Psychotherapy: the treatment of choice for neurotic/reactive depression?

A recently published paper by Prioleau and colleagues has questioned whether the benefits of psychotherapy exceed those of placebo in real patients. A critique of that paper is presented drawing attention to key methodological weaknesses, to the subjective interpretation of the meta-analysis data, and to the selective and tendentious presentation of the authors' conclusions. Arguing that psychotherapy is best evaluated in relation to a limited group of conditions, and to disorders in which high efficacy is claimed, controlled studies of psychotherapy for neurotic and reactive depressive disorders are reviewed. The view that psychotherapy may have a key effect in influencing the natural history of these depressive disorders is explored.