Well-Being as a Precursor and Consequence of Micro-Processes in a Group Psychotherapy With Forensic Patients.

Psychotherapy is an important approach for the treatment of psychiatric disorders. Apart from treating disorders as such, psychotherapy aims at increasing patients' well-being. The Therapeutic Cycles Model (TCM) is a process-oriented theoretical model that makes predictions about the psychotherapeutic progress based on verbatim content. The model helps to identify therapeutic factors on a language level. The present study aims at analyzing transcripts of group therapy sessions with forensic psychiatric patients using the rationale of the TCM. Furthermore, the relationship between linguistic features of psychotherapy sessions and patients' well-being before and after therapy are investigated. In order to identify therapeutic factors, a group psychotherapy with nine drug addicted forensic psychiatric patients was videotaped and transcripts of N = 16 sessions were analyzed. Process-oriented measures were rated by the patients, their therapists, and an external observer. Patients' self-reported well-being before therapy was negatively related to Connecting (indicating emotional insight), and the frequency of therapeutic cycles, which are both thought of as key moments in therapy. Well-being of forensic patients is not necessarily a helpful precursor for insightful and productive events in therapy to occur. The findings help to better understand psychotherapeutic micro-processes throughout forensic therapies, and their relationship with patients' well-being. Implications for research and the forensic practice are discussed.

Traumatic events, PTSD, and psychiatric comorbidity in forensic patients--assessed by questionnaires and diagnostic interview.

BACKGROUND: Relationships between posttraumatic stress disorder (PTSD), comorbid illness and experiences of traumatic stressors have been reported for large and different groups. The present study investigated this relationship specifically for patients with psychiatric disorders admitted to a forensic ward because of criminal behavior. METHODS: In sixteen German and fifteen Sudanese forensic patients the prevalence of PTSD and comorbid symptoms of anxiety and depression were assessed and related to traumatic experiences, emotional distress, and stressful life events over four developmental periods. RESULTS: In the total sample, subjects had experienced an average of five traumatic events, the first one occurring early in childhood, and 39% met criteria of current, 55% of lifetime PTSD, the diagnosis being more likely in patients with a greater number of reported traumatic experiences. Neglect and emotional abuse in childhood were associated with current PTSD diagnosis. As reported for other populations, comorbid symptoms were frequent with 60% of the sample displaying comorbid anxiety symptoms and 64% comorbid depression. PTSD and comorbidity did not differ between cultures. CONCLUSION: Results suggest that forensic patients experience multiple traumatic events, usually beginning early in development, so that the assessment of PTSD and comorbid anxiety and depression is recommended for the clinical evaluation. Further studies have to substantiate, whether traumatic stress during developmental stages interact with other factors leading to routes of forensic psychopathology.