Clinical, scientific and stakeholders' caring about identity perturbations.

In this editorial we comment on the article by Zhang et al published in the recent issue of the World Journal of Psychiatry. We focus on identity diffusion, identity perturbations, their origin and developmental pathways. This is an upcoming problem in the society as not only school children are affected. Adolescents and young people suffer from uncertainty in gender identity, in self-image, migration effects due to chronic crises caused by war, pandemic disruptions or climate change. We show how such chronic uncertainty can be cared for, treated, and contained. The key is affective holding, reflection and to provide adequate affective mentalizing in a close concomitant way. These key features also depend on ambient conditions, such as psychotherapeutic care. In a qualitative interview study carried out in a cyclical research design with a comparative analysis on the basis of thematic coding using Grounded Theory Methodology we found institutionalized defenses in health policies. Professionals request better training and adequat academic knowledge as well as research into unresolved areas for improvement of the ambient conditions for adequat development of the self. Practice points for further clinical and scientific development are given and discussed.

Investigating the network ties between affect, attachment, and psychopathology.

OBJECTIVES: Recent years have seen an increased interest regarding theoretical and empirical associations of adult attachment security and primary affective traits concerning psychiatric disorders. In this study, network analysis technique is applied to dissect the links between both psychodynamic personality constructs and an array of psychopathological symptoms. METHODS: A total sample of 921 (69.9 % female) participants from the general population was investigated. A regularized cross-sectional partial correlation network between attachment (Experiences in Close Relationships-Revised [ECR-RD8]), primary affective traits (Brief Affective Neuroscience Personality Scales [BANPS-GL]) and psychopathological symptoms (ICD-10-Symptom-Rating Questionnaire [ISR]) was estimated via the EBICglasso algorithm. Node centrality, predictability and bridge centrality were analyzed. To evaluate the stability of the network and evaluate the significance of differences, we employed bootstrap techniques. RESULTS: The network was found to be stable, allowing reliable interpretations. We observed SADNESS, as well as depressive, PTSD and anxiety symptoms as the most influential nodes within the investigated network. Attachment AV and SADNESS were observed as nodes with the highest bridge centrality. CONCLUSIONS: The results provide a data-driven in-depth look into the complex dynamics between psychopathological symptoms, attachment security and basic affective traits. Results underscore the critical interconnections between affect, attachment, and psychopathology, advocating for a psychodynamically informed systems approach in psychological research that considers the affective dimensions underlying human mental health.

Cognitive dissonance and mindset perturbations during crisis: "eco-socio-psycho-somatic" perspectives.

Mandatory and restrictive health regulations during the corona pandemic caused psychic disorders in many people, which even led to clinically relevant mental disorders. At the same time, there was gradually a polarization of opinions among the population. In order to improve future pandemic management, an integrative understanding of these psychosocial processes therefore seems useful. Here we start theoretically with the mental effects of inconsistencies of the information environment by referring to concepts such as the theory of cognitive dissonance. In a next step, we use the psychodynamic theory to understand the affective-motivational defense mechanisms underlying these cognitive states and processes. However, a broader theoretical framework of psychoanalysis seems to make sense, because self-referential processing also influences the style of thinking. For this reason, we use a more comprehensive psychological systems theoretical framework model to integrate these different perspectives. This integrative view refers in part to basic knowledge of health psychology regarding the resistance of unhealthy ways of thinking and behaviors and the possibilities for interventions for change. We then extend this model to a broader picture that also covers the relationship between men and their environment. This results in the perspective of a multidimensional socioecological theoretical framework, which as a heuristic reference model and related to other ecological approaches could also be helpful for various theoretical questions for public health, and could provide a better public understanding of health issues. In line with this perspective, we hypothesize that with regard to the coronavirus disease 2019 pandemic, the acceptance of public health narratives could be increased if a more consistent picture of the scientific descriptions and explanations of the pandemic - similar to the model proposed - could be provided, which would enable the understanding of the origin, course and countermeasures, and thus could have positive collective psycho-hygienic effects.

PSYCHIATRY IN THE BIO-PSYCHO-SOCIAL RESEARCH PARADIGM AS OPTION FOR ENDURING AND SUSTAINABLE CHANGE IN A TIME OF CHRONIC CRISIS.

BACKGROUND: The prevalence of mental disorders and global burden of disease increases and need an integrated psychiatric treatment at the best point of service. Severe mental disorders have medical consequences and solid psychiatric interventions are necessary. Research is required to be conducted along the bio-psycho-social paradigm. AIM: Based on the dynamics of memory and mentalization theory this paper presents clinical and therapeutic considerations for change. RESULTS: Mentalization is influenced by patterns of parental rearing styles, attachment, and traumatic incidents. In psychoanalytic theory, unconscious memory contents are enacted in the patient-therapist relationship. This editorial gives a review and intends to bridge the gap between psychiatry, the neurosciences, psychoanalysis and other sciences concerned with the study and processing of memory and its associated psychological, cognitive, and affective functions. The role of memory and related abilities and factors affecting psychological functioning are outlined. Research findings on memory dynamics and vulnerability as well as insights that are relevant to bridge the gap to related sciences are highlighted. CONCLUSIONS: For treatment, a dynamic view of long-term memory with a plasticity of states of memories when they are reactivated is supported. For intervention technique, affect-related therapist-centered interpretations and a sound working through of such enacted states in the interpersonal environment of the treatment is essential.

Expert Perspectives on the Effectiveness of Psychotherapy.

The effectiveness of psychotherapeutic care, as well as the implementation of adequate improvements, are in question. A qualitative interview study was carried out in a cyclical research design with a comparative analysis on the basis of thematic coding using Grounded Theory Methodology. An overview of the design, sampling procedure, and data analysis is given. A variety of critical perspectives emerged concerning the state of psychotherapeutic care in Austria. Two perspectives are presented in this paper as interim results: a health care administration perspective states a general lack of knowledge and a possible unmet need, problematizes the underutilized benefit of psychotherapists and describes a shift in regard to the issue of effectiveness of care to the topic of access to psychotherapeutic care and to a problem with the care and work ethics of professionals. In this perspective, one solution may be to implement intermediary organizations, clearinghouses with multi-professional teams, comprehensive documentation and an indication-oriented approach. The health insurance perspective also claims the organization-specific action problem and the lack of rules for clearing in such intermediary organizations, as well as the relevance of regulated, limited access to psychotherapy.

Efficacy of high-intensity versus low-intensity psychoanalytically oriented long-term treatments and determinants of outcome: individual participant data Meta-analysis of Long-term Analytic treatment Studies (MeLAS).

INTRODUCTION: Long-term psychodynamic/psychoanalytic psychotherapy (LTPP) is a prevalent treatment option for complex mental disorders. Yet, little is known about the role of treatment intensity in LTPP. We present a study protocol for a systematic review and individual participant data (IPD) meta-analysis aggregating and analysing individual data from randomised and quasi-experimental trials by meta-analysis. The purpose is to (1) determine the treatment effectiveness of LTPP with low versus high intensity (up to 2 weekly sessions vs three or more), (2) compare their joint effectiveness to shorter therapies and treatments as usual, (3) identify predictors and moderators of treatment outcomes and (4) determine reciprocal relationships between different outcome domains (symptomatic and structural/personality change) over the courses of LTPP. METHODS AND ANALYSIS: We include studies from (randomised controlled trial, RCT) and quasi-experimental trials, where at least one condition was LTPP of high or low frequency. Long-term treatment is defined as ≥1 year or ≥50 sessions. To be eligible studies must include a standardised outcome measure of symptoms (global or disorder specific) with at least one proof of reliability. The primary outcome is symptom reduction (global or specific), secondary outcome criteria are reliable change, remission, functional capacities, personality, personality functioning and interpersonal pathology. Relevant studies will mainly be identified by searching relevant databases: PubMed, PsycINFO (via EBSCO), Web of Science (via Elsevier), Chochrane's Central Register of Controlled Trials (via Wiley). Risk of bias will be evaluated in line with the Cochrane assessments tools for quasi-experimental trials and RCTs, respectively. ETHICS AND DISSEMINATION: Aggregation of data from primary trials collected based on ethics votes. Dissemination into clinical practice via open access publications of findings. PROSPERO REGISTRATION NUMBER: CRD42022304982; Pre-results.

Exploring the Synergy of Music and Medicine in Healthcare: Expert Insights into the Curative and Societal Role of the Relationship between Music and Medicine.

Our study aimed to investigate the correlation between medicine, health perception, and music as well as the role of music in the healthcare setting. To gain insights into the dynamics between these two fields, we gathered opinions from attendees and presenters at an international conference on music medicine, musicians' health, and music therapy. A team of six interviewers conducted a total of 26 semi-structured interviews. The interview guide focused on four predetermined themes: (1) "music in medicine", (2) "performing arts medicine", (3) "music for the individual", and (4) "music for society". The responses were analyzed using grounded theory methods as well as thematic and content analysis. To enhance the analytical strength, investigator triangulation was employed. Within the predefined themes, we identified several subthemes. Theme 1 encompassed topics such as "listening and performing music for treating diseases and establishing non-verbal relationships", "the value of music in specific disorders, end-of-life care, and pain management", and "the design of sound spaces". Theme 2 explored aspects including the "denial and taboo surrounding physical and mental health issues among musicians", "the importance of prevention", and an antithesis: "pain and suffering driving creativity". Theme 3 addressed the "mental role of music in ordinary and extraordinary life" as well as "music's ability to enable self-conditioning". Lastly, Theme 4 examined the role of music in "cultural self-identification" and "development and education for children". Throughout the interviews, participants expressed a lack of knowledge and awareness regarding interdisciplinary research and the fields of music and medicine. Our findings affirm the significance of music therapy and performing arts medicine as well as the broader relationship between music and medicine. They highlight the potential benefits of perception and experiential pathways for individuals and, consequently, for human society.

A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms of the acute infection phase. A patient with swollen extremities was presented to the Department of Angiology at the Medical University of Vienna with complaints of muscle and joint pain, paresthesia, and arterial hypertension with intense headache. Prior to these complaints, she had been suffering from various symptoms since November 2020, following a SARS-CoV-2 infection in the same month. These included recurrent sore throat, heartburn, dizziness, and headache. Paresthesia and muscle and joint pain started in temporal relation to a human papillomavirus (HPV) vaccination. Since the patient was suffering from severe pain, intensive pain management was performed. Skin and nerve biopsies revealed autoimmune small fiber neuropathy. The patient's condition could be related to COVID-19, as her first symptoms began in temporal relation to the SARS-CoV-2 infection. Furthermore, in the disease course, antinuclear (ANA) and anti-Ro antibodies, as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies, could be detected. Together with the symptoms of xerophthalmia and pharyngeal dryness, primary Sjögren's syndrome was diagnosed. In conclusion, though biopsy results could not distinguish a cause of the disease, SARS-CoV-2 infection can be discussed as a likely trigger for the patient's autoimmune reactions.

The Search for Meaning in Medicine When Confronted with Life-Threatening Illness - How to Include a Bio-Psycho-Social Model into Health-Care.

This paper aims to discover and discuss the place of spirituality in the meaning-making process for patients with life-threatening diseases like cancer. Does the search for meaning serve a specific role, or is it purely subjective? Finding constructive coping strategies can improve the quality of life. Meaning-making might be an essential coping strategy. Research has confirmed that spirituality is an integral part of meaning-making for many patients. To understand the findings of studies and their relevance for oncology and healthcare in general, definitions of religion, religiosity, and spirituality are presented. The main theoretical framework is shown in theories of the psychology of meaning. The search for meaning is discussed conceptually in psychoanalytic terms alongside developing a supporting super-ego. It aims to clarify the psychological effects and implications of faith, religion, religiosity, and spirituality on individual, interpersonal and social levels. The influence of illness on life and the impact of life on illness have to be considered, as cultural/societal challenges influence change processes. Internalization of a supportive super-ego, adequate self-regulation, and subjective illness perception/ "truth" influence (social) behavior (un)consciously. Therefore, a systems-theoretical view of the ability to accept boundaries should accompany the supporting super-ego in the process of the search for meaning. A bio-psycho-social model integrates all aspects of human life which are involved in dealing with a disease. The interest in the bio-psycho-social model is neither outdated nor new. The model is often supplemented by the factor of spirituality, which has been part of human experience throughout human history.

COVID-19 survivors: Multi-disciplinary efforts in psychiatry and medical humanities for long-term realignment.

The coronavirus disease 2019 pandemic represents an enduring transformation in health care and education with the advancement of smart universities, telehealth, adaptive research protocols, personalized medicine, and self-controlled or artificial intelligence-controlled learning. These changes, of course, also cover mental health and long-term realignment of coronavirus disease 2019 survivors. Fatigue or anxiety, as the most prominent psychiatric "long coronavirus disease 2019" symptoms, need a theory-based and empirically-sound procedure that would help us grasp the complexity of the condition in research and treatment. Considering the systemic character of the condition, such strategies have to take the whole individual and their sociocultural context into consideration. Still, at the moment, attempts to build an integrative framework for providing meaning and understanding for the patients of how to cope with anxiety when they are confronted with empirically reduced parameters (e.g., severe acute respiratory syndrome coronavirus type 2) or biomarkers (e.g., the FK506 binding protein 5) are rare. In this context, multidisciplinary efforts are necessary. We therefore join in a plea for an establishment of 'translational medical humanities' that would allow a more straightforward intervention of humanities (e.g., the importance of the therapist variable, continuity, the social environment, etc) into the disciplinary, medial, political, and popular cultural debates around health, health-care provision, research (e.g., computer scientists for simulation studies), and wellbeing.

Subjective well-being among psychotherapists during the coronavirus disease pandemic: A cross-cultural survey from 12 european countries.

OBJECTIVE: The aim of this study is to examine the amount of the total variance of the subjective well-being (SWB) of psychotherapists from 12 European countries explained by between-country vs. between-person differences regarding its cognitive (life satisfaction) and affective components (positive affect [PA] and negative affect [NA]). Second, we explored a link between the SWB and their personal (self-efficacy) and social resources (social support) after controlling for sociodemographics, work characteristics, and COVID-19-related distress. METHODS: In total, 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Satisfaction with Life Scale (SWLS), the International Positive and Negative Affect Schedule Short Form (I-PANAS-SF), the General Self-Efficacy Scale, and the Multidimensional Scale of Perceived Social Support. RESULTS: Cognitive well-being (CWB; satisfaction with life) was a more country-dependent component of SWB than affective well-being (AWB). Consequently, at the individual level, significant correlates were found only for AWB but not for CWB. Higher AWB was linked to being female, older age, higher weekly workload, and lower COVID-19-related distress. Self-efficacy and social support explained AWB only, including their main effects and the moderating effect of self-efficacy. CONCLUSIONS: The results highlight more individual characteristics of AWB compared to CWB, with a more critical role of low self-efficacy for the link between social support and PA rather than NA. This finding suggests the need for greater self-care among psychotherapists regarding their AWB and the more complex conditions underlying their CWB.

Burnout among psychotherapists: a cross-cultural value survey among 12 European countries during the coronavirus disease pandemic.

The aim of this study was to examine cross-cultural differences, as operationalized by Schwartz's refined theory of basic values, in burnout levels among psychotherapists from 12 European countries during the coronavirus disease (COVID-19) pandemic. We focused on the multilevel approach to investigate if individual- and country-aggregated level values could explain differences in burnout intensity after controlling for sociodemographic, work-related characteristics and COVID-19-related distress among participants. 2915 psychotherapists from 12 countries (Austria, Bulgaria, Cyprus, Finland, Great Britain, Serbia, Spain, Norway, Poland, Romania, Sweden, and Switzerland) participated in this study. The participants completed the Maslach Burnout Inventory-Human Service Survey, the revised version of the Portrait Values Questionnaire, and a survey questionnaire on sociodemographic, work-related factors and the COVID-19 related distress. In general, the lowest mean level of burnout was noted for Romania, whereas the highest mean burnout intensity was reported for Cyprus. Multilevel analysis revealed that burnout at the individual level was negatively related to self-transcendence and openness-to-change but positively related to self-enhancement and conservation values. However, no significant effects on any values were observed at the country level. Male sex, younger age, being single, and reporting higher COVID-19-related distress were significant burnout correlates. Burnout among psychotherapists may be a transcultural phenomenon, where individual differences among psychotherapists are likely to be more important than differences between the countries of their practice. This finding enriches the discussion on training in psychotherapy in an international context and draws attention to the neglected issue of mental health among psychotherapists in the context of their professional functioning.

What We Need for Encoding of Memory and Emotional Reconsolidation.

BACKGROUND: It is known that an interactive design and good participants' involvement strengthens the motivation to engage in learning processes. Previous research suggests attitude-behaviour consistency with relevance of subjective meaning and interest in learning. This observational study aims to measure the attitude of medical students. METHODS: The connotative meaning and perception of e-learning were explored. A semantic differential scale was given to all students (N=328) of a case-based blended-learning (CBBL) course, 296 medical students were included in this study. RESULTS: The online-survey completion rate was 100%. An exploratory principal components analysis with varimax rotation was performed. Five components could be extracted that explained 47.21% of the total variance. The five components are best described by the following adjectives taken from the item pool: "soft, emotional, playful", "clear and organised", "vigorous and serious", "vivid and outgoing", "economical and introverted". An additional qualitative analysis revealed relevant positive connotations ascribed to e-learning by the students: freedom in time and space for learning, interdisciplinary approach and communication, playfulness and clear, structured procedure. CONCLUSION: Our study demonstrated that a specific set of aspects is essential for students to feel comfortable and affect-cognitively engaged to learn and gain the best exam grades.

Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review.

Background: Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12-30) with psychotic disorders. Methods: A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis. Results: Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders. Conclusion: There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].

Psychotherapist Trainees' Quality of Life: Patterns and Correlates.

While psychotherapists are trained to improve their clients' quality of life, little work has examined the quality of life experienced by psychotherapist trainees themselves. Yet their life satisfactions and stresses would plausibly affect both their ability to learn new skills and conduct psychotherapy. Therefore, in the Society for Psychotherapy Research Interest Section on Psychotherapist Development and Training study, we investigated the patterns of self-reported life quality and their correlates in a multinational sample of 1,214 psychotherapist trainees. A comprehensive questionnaire was used at the outset of trainings to assess trainees' professional background, current life situation, personal characteristics, family background, and social and national origin. The findings indicated 54.3% of trainees' lives could be characterized as fortunate or happy (i.e., experiencing great life satisfaction and not much stress), whereas 14.3% could be characterized as clearly distressed or troubled (i.e., experiencing great life stress and not much satisfaction). The strongest correlates of high life stress, a contributor to poor life quality, were economic insecurity, self-protectiveness, and attachment-related anxiety in relationships, and economic or psychological hardship in childhood. In turn, greater wellbeing was most strongly associated with a warm and open interpersonal style, being married, having sufficient economic means, and material and emotional security in childhood. While the results indicate the majority of therapists experience a relatively good quality of life, the findings also suggest potential targets for increasing trainees' life quality when it may be deficient, such as those on a societal level (e.g., availability of low-cost student loans), training program level (e.g., promoting supportive supervision, positive between-trainee relationships and group collaboration), and individual level (e.g., personal therapy and learning self-care), in order to promote effective learning and therapy practice.

Personalized treatment - which interaction ingredients should be focused to capture the unconscious.

A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual's unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis's focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient's inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at supporting the internalization of the superego's functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.

Importance of communication in medical practice and medical education: An emphasis on empathy and attitudes and their possible influences.

BACKGROUND: Healthcare professionals need to be prepared to promote healthy lifestyles and care for patients. By focusing on what students should be able to perform one day as clinicians, we can bridge the gap between mere theoretical knowledge and its practical application. Gender aspects in clinical medicine also have to be considered when speaking of personalized medicine and learning curricula. AIM: To determine sets of intellectual, personal, social, and emotional abilities that comprise core qualifications in medicine for performing well in anamnesis-taking, in order to identify training needs. METHODS: An analysis of training clinicians' conceptions with respect to optimal medical history taking was performed. The chosen study design also aimed to assess gender effects. Structured interviews with supervising clinicians were carried out in a descriptive study at the Medical University of Vienna. Results were analyzed by conducting a qualitative computer-assisted content analysis of the interviews. Inductive category formation was applied. The main questions posed to the supervisors dealt with (1) Observed competencies of students in medical history taking; and (2) The supervisor's own conceptions of "ideal medical history taking". RESULTS: A total of 33 training clinicians (n = 33), engaged in supervising medical students according to the MedUni Vienna's curriculum standards, agreed to be enrolled in the study and met inclusion criteria. The qualitative content analysis revealed the following themes relevant to taking an anamnesis: (1) Knowledge; (2) Soft skills (relationship-building abilities, trust, and attitude); (3) Methodical skills (structuring, precision, and completeness of information gathering); and (4) Environmental/contextual factors (language barrier, time pressure, interruptions). Overall, health care professionals consider empathy and attitude as critical features concerning the quality of medical history taking. When looking at physicians' theoretical conceptions, more general practitioners and psychiatrists mentioned attitude and empathy in the context of "ideal medical history taking", with a higher percentage of females. With respect to observations of students' history taking, a positive impact from attitude and empathy was mainly described by male health care professionals, whereas no predominance of specialty was found. Representatives of general medicine and internal medicine, when observing medical students, more often emphasized a negative impact on history taking when students lacked attitude or showed non-empathetic behavior; no gender-specific difference was detected for this finding. CONCLUSION: The analysis reveals that for clinicians engaged in medical student education, only a combination of skills, including adequate knowledge and methodical implementations, is supposed to guarantee acceptable performance. This study's findings support the importance of concepts like relationship building, attitude, and empathy. However, there may be contextual factors in play as well, and transference of theoretical concepts into the clinical setting might prove challenging.

Individual Perception of Telehealth: Validation of a German Translation of the Telemedicine Perception Questionnaire and a Derived Short Version.

Telehealth is a growing domain with particular relevance for remote patient monitoring. With respect to the biopsychosocial model of health, it is important to evaluate perception and satisfaction with new methods in telehealth as part of an integrative approach. The Telemedicine Perception Questionnaire (TMPQ) is a 17-item questionnaire measuring patients' perception of and satisfaction with telecare. We translated this survey into German and determined its validity and reliability in 32 adolescents and adults. Furthermore, we derived a short version of the TMPQ, named Patient and Physician Satisfaction with Monitoring (PPSM), which is a 5-item questionnaire that can be administered to both patients and physicians. Validity and reliability were tested in 32 patients and 32 physicians. Crohnbach's α for the translated TMPQ was 0.76, and the German version yielded high validity (intraclass correlation coefficient (ICC) 0.995). We tested the PPSM in both patients and physicians and found acceptable values for Crohnbach's α (0.72 and 0.78) with excellent validity (ICC 0.965). We therefore concluded from this small study that both German versions of the TMPQ and PPSM can be used to investigate the acceptance of telehealth applications.

Future of processing and facilitating change and learning.

The field of the sciences of the mind is evolving fast. With the diversification of knowledge and accumulation of data, often lacking integration and reproducibility, questions arise. The role of critical thinking and research is evident. As the science of the unconscious, psychoanalysis provides a method and theory to understand human minds and mentalities, helping the patient know his mind and transform action into reflection. Mental activities, including social skills, develop in the social context, depending on the social environment's demands and resources put onto the individual. Encoding emotional signals, markers of meaning for the individual, is ontogenetically necessary and has influences on memory encoding. Beyond theoretical understanding, implicit relational knowledge is actualized in the therapeutic setting. With a strong focus on experiencing emotional reconsolidation of memories, previous relationships' repercussions are enriched with broadening viewpoints in the analytic environment. The long-term effects of psychotherapeutic treatments have been examined. A sufficient explanation of the specific factors contributing to success or an answer when an impact is lacking is still under investigation. When investigating subliminal and implicit mechanisms leading to memory reconsolidation and the formation of functional object relations and interaction patterns, the focus is set on affective interplay and processing prior/during and after social interactions. The present paper discusses which parameters might contribute to the reshaping of memories and the linkage of memory with the emotional load of experience. Providing insights into such dynamic mental phenomena could enhance process research by investigating moment by moment interactions in psychoanalysis, treatment, and learning processes. Due to the research subject's complexity, different research methods and integration of associated research fields are required.

Analysis of a dream series by the Dream Coding System developed by Ulrich Moser.

This paper serves psychotherapeutic process research and shows the process of change in a psychodynamic, individual psychological psychotherapy by means of a theory-based content analysis of the dreams reported in this therapy. The analysis of the patient's dreams is carried out according to the dream coding method by Ulrich Moser and Vera Hortig (2019). The guiding question is about changes in positioning and interactions of the dream elements, how can they be determined and how (within the framework of the underlying dream generation theory) the influence of these changes on the patient's ability to regulate affect can be assessed. Dream coding according to Moser and Hortig uses only the manifest dream and can be regarded as a research tool that rests, among other things, on psychoanalytic concepts, while at the same time taking into account more recent findings in dream and affect research. Its focus is on the coding of the present dream experience and the transformation of dream elements both within individual dreams and in the course of an entire dream series. It allows, without knowledge of the biographical anamnesis and without using psychoanalytic interpretation methods, to recognize changes in the dream structure and the affect regulation produced by it. The coding system thus also offers the possibility of making comparisons regarding the therapeutic changes achieved and thus (at least potentially) the effectiveness of different treatment methods (cf. Leuzinger-Bohleber, 2008, p. 7 f.). The coding of several dreams, i.e. the manifest dream content as a dream series highlighted the patient's inner psychic change process: while the safety principle dominated the beginning, involvement increased and the use of the elements was more flexible and the interactions more mixed, to approach the initial dream again towards the end of the dream series. The coding indicates that the patient was able to increase her self-efficacy due to better containment of the emergent (dysfunctional) affects. This coding procedure serves as a promising empirical process assessment for carrying out single case studies.