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Aim: In this paper we review the current literature on the clinical problem that some patients do not achieve response after adequately conducted psychotherapy. We explicate our understanding of nonresponse and treatment resistance including the operational definitions, summarize the theoretical explanations and empirical studies and put forward possible study designs and treatment options. Methods: Literature search using PubMed and Web of Science. Results: For the domain of psychotherapy, the term treatment resistance does not seem appropriate; instead, we use the more descriptive terms nonresponse and recurrent nonresponse. Generally, this topic is far less represented in psychotherapy than in pharmacotherapy. Controlled switching studies with a switch from pharmacotherapy to psychotherapy are rare and those switching from one psychotherapeutic approach to another are nearly nonexistent. Building on clinical considerations, we propose a flow-chart for clinical decision making after nonresponse in psychotherapy. Discussion: Learning from errors is highly beneficial. This principle should be more consistently followed up in psychotherapy research as well as in supervision and training. Guidelines should include consensual and evidence-based advice on how to deal with nonresponse and recurring nonresponse. [ABSTRACT FROM AUTHOR]

The «Recommendations for the Diagnosis and Treatment of Behavioral and Psychological Symptoms of Dementia (BPSD)» were developed in parallel with the Swiss National Dementia Strategy 2014-2019 under the auspices of the Swiss Society for Geriatric Psychiatry and Psychotherapy (SGAP) and mark the beginning of a series of recommendations for geriatric psychiatric disorders. They depict the evidence-based state of knowledge about diagnostics and therapy, based on the clinical experience of the experts, and are designed for interprofessional and interdisciplinary use. The non-pharmacological intervention options and pharmacotherapy are discussed in detail. This paper is the revised version of the 2014 publication and compiles the development in this area for everyday clinical practice. [ABSTRACT FROM AUTHOR]

The new psychotherapists' law in Germany requires that future studies in psychotherapy enable students to evaluate the evidence base of psychotherapeutic methods based on established criteria. This article summarizes and applies the most important national and international criteria for evaluating the evidence base of psychodynamic psychotherapy including the criteria detailed in the Methods Paper of the Scientific Advisory Board Psychotherapy in Germany, the internationally influential criteria by Chambless et al. (1998) as well as the most recent criteria by Tolin et al. (2015). Criticism of the criteria for evidence assessment (e.g., the disorder-specific approach), current controversies (e.g., concerning the evidence base of long-term psychodynamic therapy and analytic psychotherapy, integrative psychotherapy frameworks versus specific treatment approaches), and the relevance of the participation of practicing psychodynamic psychotherapists in research projects are addressed. For the adequate assessment of the efficacy/effectiveness of psychodynamic psychotherapy, especially long-term psychodynamic therapy and analytic psychotherapy, it is necessary to include longer follow-up periods and also to assess changes in accordance with psychodynamic assumptions about therapeutic change processes. [ABSTRACT FROM AUTHOR]

In psychotherapy and in social work, especially in the context of involuntary treatment, powerand the forces set up to counteract power play an important role. Above all in the work withthose who have a legal guardian as well as, for example, in psychotherapy with addicts that is carried out according to a court order, what counts is that the person can have an inner sense of power over his or her own actions which is greater or at least equal to the power from without. In the following paper, case studies are presented that show this more or less clearly. [ABSTRACT FROM AUTHOR]

Sophocles' »Antigone« is a tragedy that can have different readings. However, some themes (forexample, inferiority and compensation, powerlessness and omnipotence), remain basic. At the23rd Congress of the Italian Association for Individual Psychology (Turin, 26th–29th September2005) I gave a talk entitled »Antigone is alive«. At that time, I followed the most usual line ofinterpreting this myth, namely Antigone's powerlessness and her rebellion against state power(Creon). In the present paper, I have chosen a different analysis, namely the conflict between Antigone's omnipotence opposed to the powerlessness of Ismene, her sister, focusing particularlyon the feeling of repudiation. We can find that feeling both in our psychotherapeutic work, as well as in many social conflicts. Sophocles' »Antigone« turns out to be a most pertinent classical drama to analyze the various dynamics of power and powerlessness in an Adlerian sense. [ABSTRACT FROM AUTHOR]

Background: Guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with obsessive-compulsive disorder (OCD) is an important part of the care available for these patients. It may not be adequately reflected in the current personnel resources available according to the German psychiatry personnel regulation (Psych-PV). Objectives: The goal of this work was to assess the personnel resources necessary for a guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with OCD and compare the necessary resources with the resources available according to Psych-PV. Methods: Based on the German national guidelines for OCD and a meta-analysis on treatment intensity, we formulated a normative weekly treatment plan. Based on this plan we calculated the necessary personnel resources and compared these with the resources available according to Psych-PV category A1 (standard care). Results: The weekly treatment time for a guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with OCD is 23.5 h per week. This corresponds to a weekly personnel requirement of 20.9 h. This requirement is only partly reflected in the Psych-PV (17.3 h, 82.8 %). The coverage of personnel resources by Psych-PV is even lower for psychotherapy provided by psychiatrist and psychologists (38.3 %, i. e. 183 min in the normative plan versus 70 min in Psych-PV). Conclusions: The current paper shows that the personal resources required for a guideline-oriented inpatient psychiatric and psychotherapeutic treatment of patients with OCD is not adequately reflected in the German psychiatry personnel regulation (Psych-PV). The actual shortage may be underestimated in our paper. [ABSTRACT FROM AUTHOR]

Given the epidemiological relevance and the growing insights into biopsychosocial mechanisms and etiological pathways, this paper describes the current practice in psychotherapy as treatment of choice for patients with personality disorders. The main focus is on borderline, antisocial, narcissistic and avoidant personality disorders. Borderline personality disorder (BPD) is clinically the most relevant, i. e. the most prevalent and most disabling condition, for which several transtheoretical psychotherapeutic approaches have been developed. Their effectiveness has empirically been validated with encouraging results. These evidence-based psychotherapies are dialectical behaviour therapy (DBT), mentalization-based treatment (MBT), transference-focused psychotherapy (TFP), and schema therapy (ST). All of them converge in general principles necessary for a successful treatment. Likewise, general guidelines can be established for antisocial, narcissistic and avoidant personality disorders taking into account their specific features. However, there is less evidence for the effectiveness of psychotherapy for these disorders than for BPD. Finally, future challenges with regard to psychotherapy research, clinical management and implementation of evidence-based treatments in everyday practice are discussed. [ABSTRACT FROM AUTHOR]

In the light of historical and modern criticism of the discipline of psychiatry and psychotherapy as a medical subspecialty, this paper deals with aspects of the theory of medicine as postulated by the physician and philosopher Wolfgang Wieland. According to his contributions medicine is a practical science aiming at establishing rational action. Central to this model is a diagnosis, which helps to subsume individual cases under general principles from which essential therapeutic options can be derived. Hence, psychiatry and psychotherapy become a medical subspecialty by adopting the basic model of medical reasoning and action as described by Wieland. Nevertheless, the limits of such an approach must be taken into consideration. Especially in a psychiatric and psychotherapeutic context it is of particular importance that even when being guided by general principles the responsibility for the personality of each individual patient should be adequately met. Furthermore, attention should be paid to the limits of the subspecialty of psychiatry and psychotherapy as a medical discipline, which also requires a critical analysis of the concept of psychiatric illness. [ABSTRACT FROM AUTHOR]

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore the nature of the delusional construction so as to render it susceptible to a therapeutic approach. Particular attention is devoted to the nature and structure of delusion and its relation to the healthy part of the personality. In the author's view, delusion is a psychopathological construction that makes it impossible for the patient to understand his own experience. The delusional construction is similar to a dream-like sensorial production but, unlike a real dream, it remains in the waking memory and creates characters which live independently of the 'dreamer's' awareness. It is a dream that never ends. The delusional imagination is so deeply rooted in the patient's mental functioning that, even after systematic analysis, the delusional world, which had seemed to disappear, re-emerges under new configurations. This paper particularly deals with the difficulty in working through the psychotic episode and in 'deconstructing' the delusional experience because of the terror connected with it. [ABSTRACT FROM AUTHOR]

The reflections on supervision presented in this paper were written against the background of a psychoanalytic training. The paper describes what – in the author's view – characterizes a patient in psychoanalytic psychotherapy, a psychoanalytic therapist, and a supervisor. In addition, the author reports on his personal experiences which he has made with supervision in the course of his activity as a psychoanalyst in the roles of supervised and supervisor. In this context, he presents some actual memories from supervisory experiences with M. Balint, H. Argelander and F. Morgenthaler. [ABSTRACT FROM AUTHOR]

Communicating from multiple perspectives is an integral part of psychodynamic group therapy and thus an ideal tool for enhancing mentalising and mentalising ability. However, in the case of people lacking in stable mentalising skills, the intensity, complexity and unpredictability of the group situation can spark severe reactions of fear and stress which counteract the developmental goal of mentalisation enhancement. For this reason, specific modifications of group treatment have been developed for patients with mentalisation deficits. One of the best described modifications is Mentalisation Based Group Therapy as part of Mentalisation Based Treatment. This paper describes the theory, the therapeutic stance and the technique of mentalisation based group therapy. Focussing on mentalising is not only suitable for patients with structural deficits and complex traumatic stress disorders but also for neuroses and patients showing acute symptoms of stress. [ABSTRACT FROM AUTHOR]

This paper wants to reflect the actual transformations of modern medicine. The implementation of the market into medicine is only possible by presupposing at least three implications: a. the patient as consumer, b. medical care as commodity, c. competitiveness as criteria for good medicine. All three implications seem to be inadequate if the core identity of medicine is considered. If medicine is regarded as a human service for suffering people it becomes clear that what medicine has to offer must be more than mere commodity. It is suggested to see medicine as a social institution which is linked to the obligation of the whole society to give medicine the possibility and the economic independence to in order to remain an institution of caritas which assures help for every man in need and which cannot be reduced to a mere enterprise. [ABSTRACT FROM AUTHOR]

In the study »Psychotherapy in older age« (PSYTIA) we examine barriers and opportunities for access to psychotherapy of elderly people with depression. In the present paper we explore the relevance of images of aging of physicians, psychotherapists and elderly people for the access to psychotherapy. We first give an overview on the study PSYTIA. In the following we describe the state of research on images of aging of general practitioners, psychotherapists and elderly people. We stress on the importance to consider images of aging in their relatedness with facts and ideas of socio-economic inequality, gender issues and also health, illness and psychotherapy to gain a comprehensive understanding of the meaning of images of aging for the access to psychotherapy. [ABSTRACT FROM AUTHOR]

This paper confirms a marked change in developmental context and serious delays in identity development in all age groups, which have consequences for relationships in general and therapeutic relationships in particular. These changes in identity development have led to a depathologization of the prolonged transition to adulthood. In addition, it became obvious how much parents may hinder identity development. Recent societal changes leading to a more precarious life are responsible for an increase in reactive identity disturbances. In psychotherapy the endless search for identity, a difficulty to balance individuality and attachment and, considering transference, a too supportive relationship are important issues. Furthermore, it might be useful to discriminate between identity crisis, identity conflict and identity diffusion. [ABSTRACT FROM AUTHOR]

Psychiatric care for severe and persistent mentally ill individuals has considerably changed over the last three decades. Striving for improvement in services provision for these patients has led to the emergence of various specialized community services, suited housing and supported work offers. Moreover, community-based treatment is also offered during acute episodes of mental illness. At the same time a range of evidence-based psychotherapeutic approaches targeting treatment needs of people with severe mental illness were developed in a process independent of the rise of community psychiatry. At present, however, a sufficient level of coordination of psychiatric services and integration of evidence-based psychological treatment into psychiatric care has not been achieved. Thus, these issues represent important steps in the further development. This paper discusses recent developments in psychiatric care of people with severe mental illness and reviews the evidence-based psychotherapy approaches suited to fit the needs of patient-centered integrated care. [ABSTRACT FROM AUTHOR]

This paper summarizes the results of a systematic literature search on three widely used psychosocial interventions for people with severe mental illness: psychoeducation for patients and relatives, social skill training and physical exercise. Based on this evidence, recommendations given in the S3 guidelines on psychosocial therapies in severe mental illness of the German Society for Psychiatry, Psychotherapy and Neurology (DGPPN) will be reported. Areas of future research are identified. [ABSTRACT FROM AUTHOR]

People with severe mental disorders are often without work, although work may have a positive effect on their health. The paper presents some results in this field from the German S3 guidelines on psychosocial therapies. In terms of evidence-based medicine supported employment (SE - first place then train) has proven to be most effective. Nevertheless, SE is still rare in Germany. Pre-vocational training, however, follows the concept first train then place and is offered in rehabilitation of the mentally ill (RPK) centres in Germany. There is some evidence that the programs are beneficial for users. The UN Convention for the Rights of Persons with Disabilities outlines an obligation for work on an equal basis with others and for vocational training. So far, the German mental health system only partly meets these requirements. [ABSTRACT FROM AUTHOR]

Due to a presently growing demand for evidence-based medicine different psychotherapeutic methods are facing increasing political pressure to demonstrate their efficacy. The realization of evaluative projects is not only in need of study patients but also of study therapists. Although many psychoanalysts support the general need for research the number of actual participants is rather low. In this paper the motives of psychoanalysts to decide for or against participation in evaluative research were investigated. Guided interviews were conducted with six psychoanalysts working in outpatient practice. The results support the hypothesis that in particular the need for security and protection influence a psychoanalyst willingness by causing either a driving or inhibition force. Both the intraindividual and interindividual areas of the interviews displayed unresolved ambivalences towards participation in psychotherapy research. It was concluded that changes in psychoanalytic training could have the most profound influence on the personal motivation to participate. [ABSTRACT FROM AUTHOR]

The practice guidelines of the German Society of Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) include systematically developed and evidence-based treatment recommendations which assist clinicians and patients in making decisions about appropriate treatment for specific conditions. The intentions of practice guidelines are to improve the quality of care and the outcome of mental diseases. This paper describes the methodology behind the development of the guidelines and lists the already existing practice guidelines as well as the guidelines actually being developed. In addition, it is outlined how quality indicators may be derived from guidelines. A major aim of the German Society of Psychiatry, Psychotherapy and Nervous Diseases (DGPPN) is to assure the quality of inpatient and outpatient care of the mentally ill by developing evidence-based consensus guidelines. [ABSTRACT FROM AUTHOR]

In successful psychotherapy pathogenic psychological contents (e.g. thoughts, dreams, emotions, perceptions of the body, etc.) are subject to an emotional process of transformation. This process can be observed, described and conceptualized independently of the contents at work in the particular case. Interestingly, several non-linear properties of this process of self-organization become apparent by clinical observation. Typical patterns can be discerned in the interplay of the various levels of representation (physical, emotional, cognitive), in the regulation of emotional intensity, and in the alternating prominence of negative and positive emotional material (bipolar pattern). The transformation process has rhythmic, almost musical, qualities. This paper describes this processual pattern, discusses various psychoanalytical process models, and proposes a process-oriented therapeutic method. In this type of process-oriented therapy, to the traditional interpretation of contents interpretations of the process are added, whenever necessary. [ABSTRACT FROM AUTHOR]