Psychotherapy in consultation-liaison psychiatry

Psychotherapy in the Consultation-Liaison (C-L) setting is shaped by the realities of the patient's situation, since all patients referred are dealing with physical illness. The patient's state of physical and mental health will determine both the type of therapeutic work possible and the focus of such work. Tailoring the therapeutic intervention to the patient's specific needs and flexibility in altering and adapting therapeutic strategies over time in line with the patient's changing needs are essential. Although periods of treatment may range from single session to long term, supportive, insight oriented, group, family, cognitive and behavioral techniques have all been used successfully in a C-L setting, with measurable impact on well-being. Psychotherapeutic work in C-L is unique in that the focus of the therapist extends beyond the patient and family to include all caregivers, including other health care professionals, in line with the biopsychosocial model.     

Psychotherapy in psychiatry: the current situation and future directions in Germany

The aim of this article is to review how psychotherapy is dispensed to patients in psychiatric treatment and to render the future perspectives of psychotherapy in psychiatric outpatient and inpatient care in Germany. We demonstrate that--according to the currently available data about healthcare providers, allocation of financial resources and curricular regulations--the presently used definition of the term "psychotherapy" is ambiguous. One major problem for the application of psychotherapy in psychiatry is obviously constituted by the dominance of the major guideline therapies ("Richtlinienverfahren") within psychiatric services. Here, guideline therapies do not meet the needs of a significant proportion of acutely, severely and/or chronically ill psychiatric patients and restrain the application of scientifically approved, disorder-oriented and context compliant interventions in psychiatric practice. As a future perspective, we suggest that the training of psychiatrists should impart profound interpersonal skills and provide the competence to offer psychotherapy within a multimodal, modular, and flexible treatment plan on the background of the self-conception of psychiatry as a medical discipline. Moreover, future concepts of psychiatric psychotherapy should promote an evidence-based selection and application of scientifically approved, disorder-oriented, and integrative treatment methods, which are available in growing number.     

Psychotherapy, biological psychiatry, and the nature of matter: a view from physics

Biological psychiatry has marginalized psychotherapy, and it is difficult for psychotherapists to counter its hegemony. The reductionist/materialist position seems incontrovertible and self-evident. An important factor in maintaining this stance is the belief that the physical world is understandable, solid, unproblematic, especially when compared to the realm of the psychological. Developments in quantum and relativity theories, however, cast doubt on that belief. They show the fundamental nature of the material world to be problematic, enigmatic, paradoxical, impossible to understand or conceptualize in terms of everyday experience. This insight weakens the prima facie case for privileging the material over the psychological, and alternative (i.e., nonneurobiological) approaches to mental health matters should, therefore, be able to compete on an equal footing. However, the materialist-reductionist stance is kept in place by powerful forces and is well defended; rational arguments alone are unlikely to have an impact. This pervasive ideological resistance to rational, often well-founded critiques of physical reductionism continues to be a major impediment to changing the present materialist climate. That resistance has to be addressed before any significant shift in orientation can be expected to occur.