Benefits and challenges in practice-oriented psychotherapy research in Germany: the TK and the QS-PSY-BAY projects of quality assurance in outpatient psychotherapy.

OBJECTIVE: Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study ("Quality Assurance in Outpatient Psychotherapy in Bavaria"; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. METHOD: Both projects and their results indicating high effect sizes are briefly described. RESULTS: From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. CONCLUSIONS: Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system.

Changes in implicit and explicit self-esteem following cognitive and psychodynamic therapy in social anxiety disorder.

The present investigation is the first to analyse changes in implicit and explicit self-esteem following cognitive therapy (CT) and psychodynamic therapy (PDT) in social anxiety disorder (SAD). We assessed a sub-sample of patients with SAD (n=27 per treatment group, n=12 waitlist condition) in the course of a randomized controlled trial prior to and following individual treatment or wait assessment with an Implicit Association Test and the Rosenberg Self-Esteem Scale. Both CT and PDT consisted of 25 sessions. Treatments were effective in enhancing implicit and explicit self-esteem. In CT and PDT, changes in explicit self-esteem were associated with SAD symptom change. No such relationships were found in implicit self-esteem. The results seem to indicate that both CT and PDT are effective in establishing a positive implicit and explicit self-esteem in SAD. The differential relationships of changes in implicit and explicit self-esteem to treatment effects on social phobic symptoms are discussed.

Motivational determinants of interpersonal distress: how interpersonal goals are related to interpersonal problems.

This study aimed to link interpersonal goals with interpersonal problems and psychological distress and to investigate changes in these variables during an inpatient psychotherapeutic treatment. Two hundred and fifty-eight patients treated in a psychosomatic hospital completed the German versions of the circumplex scales of interpersonal values, the inventory of interpersonal problems, and the outcome questionnaire before and at the end of their treatment. Patients initially reported a strong need for bonding in the CSIV. Especially interpersonal goals related to avoidant, submissive, and altruistic behavior were associated with a wide range of different interpersonal problems, and were associated with more psychological distress. At the end of treatment, patients showed no substantial changes in their predominant communal goals, but significantly reduced submissive goals. Additionally, changes of these goals were associated with changes of various interpersonal problems and psychological distress. Focusing the value patients place on submissive experiences could help to improve interpersonal problems.