[Backache from the psychosomatic viewpoint].
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Biomedical subjects
Publications and source records attributed to K Höck.
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The future activities of the physician specialised in psychotherapy undergoes essential changes requiring also a new orientation with regard to the self-identification of the psychotherapist. In addition to the acquisition of comprehensive theoretical knowledge and methodical abilities, also the development and formation of his personality will have to find our decisive attention in the training of the future specialised psychotherapist. Partnership relations between physician and patient presupposes that the physician not only possess the professional but also the necessary personal-human competence.
The progress of a group under intended dynamic direction was recorded over a period of 65 hours on the basis of interaction frequencies and directions as well as interaction contents and styles. It could be demonstrated that by means of this relatively simple or global approach an adequate and sufficiently sensitive picture of the therapist/patient activities and their phase-specific change could be reflected. On the basis of an example of a cohesive group, the change in significance of the therapist postulated in our conception and the interaction process between group, therapist and patient could be confirmed. The data obtained for the individual hours have been condensed for a demonstration of the phase-typical course.
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The scientific basis of psychotherapeutic findings involves a number of difficulties which are above all connected with the insufficient state of basic research in this field. In this situation, significant advances can only be expected on the basis of a systematic long-term investigation and research programme. This applies in particular to the problems of personality and efficiency diagnostics and to group process research. On the basis of some intermediate results, it is shown that by the combined and systematic use of procedures a number of possibilities for the differentiated recording of the complex processes in therapeutic groups can be obtained.
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The content of the concept of neurosis has been subject to repeated change in the course of scientific development, the collective term being still used to describe etiopathogenetically different disease pictures. Leading G.D.R. psychotherapists, in the interest of mutual understanding, have decided to narrow down the term "neurosis" and use it only to describe biographically derivable and psychoreactively produced and sustained disorders of the person-environment relation, thus acting in conformity with the present state of knowledge and following a recent international trend. Neuroses may, in principle, be classified according to different aspects. For the classification of individual forms of neurosis the author and his associates decided to select, as primary criteria, the main etiological factors believed to be chiefly responsible for the actual disease picture, and this was done under etiopathogenetic and at the same time diagnostic and therapeutic aspects. Accordingly, a distinction is drawn between the following four forms, of which two are in group 1 and two in group 2. 1. Neurotic reactions in the two subforms; affective reactions producing enduring effects; functionally fixed reactions; and 2. Neurotic developments in the form of primary and secondary maldevelopments. The above four forms of neurosis were exactly defined operationally, and they are, in general, easily distinguishable diagnostically, differ to a large extent in both course and prognosis, and require different therapeutic approaches.
On account of the scope and significance of functional neurotic disturbances in the modern development of morbidity results that only by a continuous collaboration between the in-patient and out-patient psychotherapeutic special departments and the other physicians working in out-patient care, above all the family dcotors and factory physicians as well as internists, with different tasks a decisive improvement of the care of these patients is to be expected.
The trend toward integration of psychotherapy into general medical practice has, especially in inpatient treatment of neurotic diseases, led to the development of psychotherapeutic systems, the differences of which are largely dependent upon both clinical conditions and therapeutical objectives. The author, in the light of ten years of practical experience with group psychotherapy of patients living in a hospital, gives a schematic outline of the Berlin system of integration of methods, discussing the system with reference to Kabanov's four basic principles, namely, the principle of the partnership of doctor and patient, the principle of the differences in efforts and effects, the principle of the unity of efficacy of methods, and the principle of the gradual transitions between methods and procedures. A detailed discussion is given of the gradual transition principle by reference to the phase-specific procedure of group psychotherapy and the methods of treatment coordinated therewith.
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