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H Kächele

Publications and source records attributed to H Kächele.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Identification of repetitive relationship patterns using the FRAMES METHOD].

Frames is a method to identify Fundamental Repetitive And Maladaptive Emotion Structures in verbatim transcribed psychotherapy sessions. The 5 steps leading to Frames consist of 1. criteria to select sessions or other material apt to identifying Frames; 2. coding of emotions according to Dahls and Stengels (1978) category system; 3. the construction of an Object Map in which each person or object is located where he/she was referred to in the dialogue; 4. the identification of the narrative structure, i.e. the logical plot structure of the stories that are told about these objects; and 5. the construction of Frames as generalised patterns of behaviour. These 5 steps are demonstrated by means of material from a specimen (hour 290) from a psychoanalytical treatment.

Emotions↗
PubMed1998

[Psychotherapy research--how it should (not) be done. An expert reanalysis of comparative studies by Grawe et al. (1994)].

22 psychotherapy outcome studies used in the Bernese meta-analysis by Grawe, Donati and Bernauer (1994) for a treatment comparison between behavioural and psychoanalytic-psychodynamic treatment concepts were reanalysed by 12 expert psychotherapy researchers independent of each other. Three clinical criteria served as basic criteria for the assessment of the methodological quality of the 22 comparative studies: treatment dosage, therapists' competence or expertise, and an adequate realisation of the intended treatment concept. The expert ratings were then compared with an evaluation of an assessment of a research team from the University of Ulm and with the one from the Bernese research team. Contrary to the Bernese meta-analysis, both the experts and the Ulm research group conclude that only 5 or 8 of the 22 studies, respectively, could be accepted for a relatively fair comparison between the treatments under study. Out of the 5/8 studies, none could be considered fully suitable for a treatment comparison, at the most only moderately suitable. These remaining 5 or 8 studies, respectively, do not prove superiority of one treatment over the other. Hence, the "Dodo Bird Verdict" stands up under scrutiny.

Behavior Therapy↗
PubMed1995

[Education in psychosomatic medicine/psychotherapy at German universities: a critical evaluation of the current status].

The integration of psychosomatics/psychotherapy into the medical curriculum has not yet resolved the majority of problems in conveying a bio-psycho-social perspective to medical students. A survey, conducted 1992/93 at the university departments of psychosomatics-psychotherapy in Germany yielded that there is no true integration of a bio-psycho-social perspective into the curriculum up until now. A second investigation with students of the university of Ulm in 1993 revealed that there is substantial variety in the quality of teaching and that improvement is possible with resources already available. Consequences with regard to changes to be expected by the 8th renewal of the present teaching regulations ("Approbationsordnung") are discussed. A pilot project aiming at the integration of preclinical and clinical aspects of the psychosocial aspects of medicine is outlined.

Curriculum↗
PubMed1995

[Klaus Grawe's confession and the psychoanalytic profession].

1994 saw the publication of the volume Psychotherapie im Wandel. Von der Konfession zur Profession ("Psychotherapy in Transition. From Confession to Profession") by K. Grawe et al. This book did much to fuel the professional policy debate on the purpose and efficiency of long-term and high-frequency analytic psychotherapies. The author examines Grawe's book, comparing its methodological approach with other (largely US-American) studies on psychotherapeutic research, and concludes that the studies analysed by Grawe do not do justice to the realities of psychoanalytic therapy. He advocates more naturalist designs reflecting the change from controlled therapies in institutions to clinical treatment in private practices. Finally he criticises psychoanalysts for having failed to provide evaluation of long-term and high-frequency analysis.

Humans↗
PubMed1995

[Expert assessment within the scope of legal social determination of the extent of economic responsibility of insurance for analytic psychotherapy].

Expert Opinions and Social Insurance Tribunal Rulings on the Scope of Medical Insurance Cover for Analytic Psychotherapy.--In Germany at present medical insurance cover is more or less automatic for a bone-marrow transplant costing anything up to 100,000 dollars--an operation where the death of the patients is by no means infrequent. In view of this state of affairs it is hard to comprehend the refusal on the part of insurance cover reviewers to approve ongoing cover for analytic psychotherapy beyond the 240-hour limit. In the case presented here, privately financed continuation by some 180 hours demonstrated that this prolongation and intensification of therapy was in fact essential to ensure the success of the treatment.

Expert Testimony↗
PubMed1994

The clinician's illusion and the psychotherapy practice: an application of stochastic modeling.

The caseload of practicing clinicians tends to be unrepresentative of the population of psychotherapy patients. This results from the fact that, although the majority of patients use relatively few treatment sessions, the majority of a clinician's time is spent with longer term cases--a minority of patients consume the majority of services. Here, a stochastic model is used to describe the development of caseloads under 4 different treatment regimens. It is shown that a psychotherapy practice will reach a steady state (a stable case mix) in relatively short time and at that this will limit the open appointment slots available each week to serve new patients. Implications for training and clinic staffing are discussed.

Humans↗
PubMed1994

[Effect of the setting on therapeutic verbalization of affects].

In psychotherapy research vocabulary measures are still an exception, although clinically relevant hypotheses might well be investigated by means of those measures. The affective vocabulary seems to be particularly apt to serve as an indicator of psychotherapeutic processes, since the "processing of emotions" can be regarded as a crucial part of any kind of psychotherapy. The emotion theory of Dahl and a classification schema derived from DeRivera will be explained in the text. The development of the Affective Dictionary Ulm (ADU), a computer measure for evaluation of affective vocabulary was based on this classification system. The distinction between two important categories of emotions, it-emotions (like anger) referring to wishes about objects, and me-emotions (like depression) reflecting self states, i.e. beliefs about the status of wish fulfillment, will be explained. The study described focuses on the affective vocabulary of one psychotherapist in three different settings: initial interviews, short term therapy and psychoanalysis. It can be demonstrated, that the "intensity" of the setting significantly positively correlates with the use of words indicating object (or it-) emotions. According to the transference paradigm, these results suggest, that the intensification of psychodynamic settings lead to an increasing work on help to regulate object relationships.

Adolescent↗
PubMed1994

[The Ulm databank].

Since 1968 one of our major research efforts consists in establishing a methodology for performing psychoanalytic process research. Within this frame tape-recording of psychoanalytic long-term treatments constituted an essential methodical step inevitably leading to the production of a large collection of verbatim transcripts. We gradually and inadvertently realized the need for a major computerized databank to assist our own research. With support of the German Research Foundation we started in 1980 with the development of the Ulm Textbank Management System. While realizing the system it became obvious that such a databank would serve as well other researchers involved in process research when analyzing verbatim material. The final shape of the systems thus was strongly influenced by the orientation towards a variety of users and methodological approaches. Meanwhile this task is completed and the Ulm Textbank, as it is known, is available as a new unique tool for psychotherapy research.

Database Management Systems↗
PubMed1993

[Application of the Relationship Episodes Interview].

The Core Conflictual Relationship Theme (CCRT) is a content analytic assessment developed by Luborsky that uses narratives about relationship episodes with significant others as data base to identify repetitive relationship patterns that appear in individual behavior. Luborsky's Relationship Anecdotes Paradigm (RAP) Interview for which we introduced the German expression Relationship Episodes-Interview (RE-Interview) is a method for eliciting relationship episodes independently from therapy. In this paper we give an introduction into the practice and into the possible applications of this interview form according to the experiences the Ulm CCRT-group made with the instructions of Luborsky. The bases of our experience are 40 audio-visual recorded RE-Interviews. An example shows how to attain to the CCRT-formulation from the interview.

Adolescent↗
PubMed1992

[Psychotherapy research and therapeutic management].

The history of psychotherapy research has been closely allied with the development of clinical practice, as this review demonstrates. Empirical psychotherapy research aims at the scientific evaluation of existing practice and at the discovery of new fields of application. The early phases of psychotherapy research were concerned with scientific justification and societal legitimation. These questions changed with the extension of possible indications, the growing differentiation of treatment procedures and the progressive implementation of psychotherapy within the health-care system. The early issue "does psychotherapy work at all?" has been replaced by the questions "to whom is psychotherapy helpful?" and "how does psychotherapy work?". As an established part of the health-care system, psychotherapy is now faced with the same urgent problems as other medical specialties: therapeutic goals and economic conditions have to be brought in balance. Thus the perspectives of psychotherapy research have to encompass the individual patient as well as the system of care. These demands create new questions which enlarge the approaches of traditional psychotherapy research; new structural and logistic methodologies are asked for. We conclude by referring to a multicenter study on the psychodynamic treatment of eating disorders that has been initiated by the Center for Psychotherapy Research in Stuttgart as a prototype form of the new look in psychotherapy research.

Anorexia Nervosa↗
PubMed1992

[Phases in the rehabilitation of male and female bone marrow transplant patients].

Teamwork is essential when investigating the long-term adoption of such medical intervention that are highly demanding on patients, physicians and nursing staff. Bone marrow transplantation represent such an intervention for a series of well defined hematological diseases. The contribution demonstrates the multiple perspective approach of the Ulm team. A case report illustrates the multiplicity of clinical issues. The state of research allows the sketching of a process model on rehabilitation.

Adaptation, Psychological↗
PubMed1992

Defense mechanisms in patients with bone marrow transplantation: a retrospective study.

The impact of defense processes on coping with threatening life diseases has been shown in many studies. Systematic studies focusing on defense mechanisms in these conditions are still rare, however. We report here on the results of a retrospective study on patients after bone marrow transplantation. Thirty four transcripts of patients interviewed at various time spans from treatment were analyzed for the presence or absence of an inventory of defense mechanisms. Cluster-analytic analysis revealed 2 clinically meaningful factors, described in detail.

Adaptation, Psychological↗
PubMed1992

[The personality of the psychotherapist and its contribution to the treatment process].

The therapist's activity is a highly personalized form of medical action. However, it is still unclear to which extent the personality of the therapist or his acquired technical skill bear the responsibility for his contribution to the treatment process. The present state of process-outcome research contributes a host of results which may stimulate further clinical considerations. Especially the distinction of private features and personalized handling of the therapeutic process is relevant. The importance of self analysis or training therapy in this respect is controversial; the discrepancy between results of formal research and prevailing clinical notions is breathtaking.

Adaptation, Psychological↗
PubMed1992

[Research in psychoanalytic therapy 1930-1990].

The author provides a survey of three phases of psychoanalytic therapy research, each one is being characterized by its most important representatives and their contributions. The first phase (1930-1970) sought in essence to justify, i.e. to prove, that analytical therapies are useful. The second phase (1960-1980) was dedicated to a deeper understanding of the relationship between the course of therapy and its results. The third phase, finally, can be identified as a thorough and detailed inquiry into the analytical process.

History, 20th Century↗
PubMed1990

[How long does psychotherapy last?].

In West Germany, the sickness insurance companies pay for a psychotherapy treatment course for a certain length of time may or may not be sufficient for achieving a successful treatment result. We made a statistical analysis of a large sample of patients (n = 1,689) treated in the outpatient department of a psychotherapeutic hospital of the University of Ulm. It was found that the longer the treatment period covered by the study, the lower the proportion of successfully completed courses. These results are discussed with reference to the long-term treatment ("dose")/effect relationship.

Follow-Up Studies↗