[Evaluating the reform of the psychotherapy guideline using a mixed-methods approach: a study protocol]. / Mixed-Methods-Ansatz zur Evaluation der Reform der Psychotherapie-Richtlinie: ein Studienprotokoll.

INTRODUCTION: In Germany, psychotherapy in outpatient statutory health care is regulated by the Psychotherapy Guideline (PT-GL). A discussion on waiting times and inadequate care for patients resulted in a structural reform of the PT-GL in 2017. The reform aims to improve access to psychotherapy and the entire course of care and treatment. The purpose of the present study was the evaluation of the new elements and identification of obstacles and barriers in their implementation. METHODS: Quantitative and qualitative methods were used to evaluate the reform of the PT-GL. In a retrospective cohort-based analysis of anonymized administrative claim data from the statutory health insurances BARMER and AOK, the health care situation before and after the reform were compared. In addition, a cross-sectional questionnaire survey evaluated the implementation of the new care elements from the perspective of psychotherapists, general practitioners and patients. The questionnaires were developed based on focus groups with stakeholders and a literature search. The survey results provided the data basis for the cross-sectional analysis together with the routine data on the care situation after the reform of the PT-GL as well as aggregated, anonymized data from the National Association of Statutory Health Insurance Physicians on statutory health insurance care and on the use of the appointment service centers. CONCLUSION: By combining quantitative and qualitative data, the effects of the structural reform of the PT-GL of 2016 can be analyzed at the individual and structural level as well as in relation to the entire care and treatment process. Based on this, proposals for a needs-oriented further development of the PT-GL will be prepared, considering the perspectives of various interest groups.

[Evidence for Psychodynamic Therapy for Children and Adolescents]. / Evidenz für psychoanalytisch begründete Verfahren für Kinder und Jugendliche.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

Psychoanalytic psychotherapy for children and adolescents with severe depressive psychopathology: preliminary results of an effectiveness trial.

This waitlist-controlled field study aimed to evaluate the effectiveness of psychoanalytic short- and long-term psychotherapy for children and adolescents by using a prospective design. The presented analyses focus on the self- and parent-reported levels of depression and the therapists' ratings of the patients' level of functioning. Thirty-five children and adolescents (aged 4-21 years) and their parents who entered psychoanalytic therapy in private practices in northern Germany participated in this ongoing study. At the time of data analysis, the wait-list control group comprised 17 patients. Data were collected from therapists, parents, and from the patients themselves. Questionnaires were administered at the beginning and the end of treatment, as well as up to 5 points in time during therapy. Follow-up took place at 6 and 12 months after therapy. Depression levels were measured with the self- and parent-reported screening questionnaire Child Depression Inventory, and quality of life with the KIDSCREEN. Patients received, on average, 97 sessions of therapy (range: 25-205). Overall, patients showed pronounced impairments at the commencement of outpatient therapy. At the end of therapy, there was a significant reduction in depression in the treatment group (parent report: d = 0.88, p < .001; patient report d = 0.68, p ≤ .003). The wait-list control group, which received minimal treatment, displayed a slight, but not statistically significant, symptom improvement in the patient report (d = 0.07, p ≤ .503), but a significant improvement in the parent report (d = 0.49, p ≤ .008). The results suggest that psychoanalytic therapy is successful in alleviating depressive pathology and improving quality of life for a significant number of depressed children and adolescents.

[Two or three of us? Case study of a psychoanalytic therapy of a girl between the oedipal phase and the latency period]. / Zu zweit oder zu dritt?--Fallbericht der psychoanalytischen Therapie eines Mädchens zwischen ödipaler Phase und Latenzalter.

This article presents a case study of a psychoanalytic psychotherapy of a girl at the age of five to eight years with a predisposition to somatization and anxious-compulsive symptoms in the transition from the oedipal phase to the latency period. In the diagnostic phase, the concept of scenic understanding is used. In the representation of treatment, the process of transference and countertransference in the relationship between the therapist and the patient has been placed in the foreground. The therapeutic process is understood as a general movement in which patient and therapist are performing together towards the treatment goals. Basics of this are both, the working alliance and the therapeutic dialogue, which is based on an interactive feedback system which serves the uncovering of blocked development efforts. The treatment technique is also oriented in terms of linguistic expression, abstinence, and interventions to the needs of the development phase of the patient. In the meetings with the parents will be referred to the process of change in the parent-child relationship through the psychotherapy of the child and to the topic of transgenerational transfers of anxieties and emotional blocks.