[Trauma and memory-A contribution to the current debate in law and psychotherapy]. / Trauma und Erinnerung ­ ein Beitrag zur aktuellen Debatte in Recht und Psychotherapie.

The recall of memories of past events, experiences and emotions is a complex process. When experiencing traumatic events, as is the case with sexual violence, a host of additional complexities and difficulties arise. This becomes especially important in court cases which rely mostly or exclusively on the testimony of the victim, where the problem of the fallibility of memory takes center stage. Some research studies emphasize the possibility of inducing, altering or suppressing memories, especially in the context of psychotherapy. This has led to the unfortunate reality that the testimony of victims who have undergone psychotherapy is often considered to be unreliable. This in turn can lead to the impression that a decision has to be made between treatment of the adverse effects of traumatic events and maximizing the chances for a conviction of the perpetrator in court. This article introduces some central concepts of our current understanding of memory and gives an overview of the relevant scientific literature and debate. Following this, it examines the dilemma as it pertains to the different groups of all involved parties (i.e., victims, members of the judiciary and psychotherapists). Lastly, it proposes a framework of how to approach a solution to this problem by focusing on research in critical areas, expansion of therapy guidelines and documentation procedures as well as communication of these efforts to all parties involved.

[Advance directives and mental disorders: a practice recommendation of the Commission for Ethics and Law of the German Association for Psychiatry, Psychotherapy and Psychosomatics]. / Patientenverfügungen und psychische Erkrankung ­ eine Praxisempfehlung der Kommission Ethik und Recht der DGPPN.

BACKGROUND: Since the creation of legal requirements for advance directives by the legislator in 2009, special aspects of their application in the treatment of people with mental illnesses have been discussed. GOAL OF THE PAPER: Important questions on dealing with advance directives in everyday life will be answered in a practice-oriented manner. RESULTS: Among other things, this document answers the question of the conditions under which a patient can refuse or consent to hospitalization and treatment in advance, and in particular how to deal with advance directives whose implementation would also affect the rights of third parties. The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has addressed these and other questions in the present document and added practical advice on how to formulate advance directives for people with mental illnesses and how to deal with psychiatric advance directives. DISCUSSION: The DGPPN has developed an advance directive for the area of mental health and published it on its website together with detailed explanations. With the help of this advance directive, people can decide on their treatment in phases of incapacity to consent in the context of a mental crisis or illness.

[Evaluation of injunction to care practices: A study of 119 cases]. / Évaluation des pratiques de l'injonction de soins : étude sur 119 sujets.

INTRODUCTION: The injunction to care (IC) is a new compulsory treatment created by the Act of June 17, 1998. Initially, this judicial tool concerned mainly sex offenders, but then the number of overall crimes requiring an IC began to dramatically rise. The judge can order this measure only if a psychiatric expertise has concluded to its potential opportunity. Then the convict must undergo a psychiatric follow-up after having served the sentence. The creation of a court-ordered treatment is based on the premise that many offenders are affected by psychiatric disorders. For the lawmaker, the aim is to lower the risk of recidivism. PURPOSES: The main purpose of this study is to assess the convicts concerned by the IC describing their sociodemographic characteristics, psychiatric diagnostics and criminal characteristics. The second purpose is to assess the efficiency of this measure regarding re-offending and specifically legal recidivism. METHODS: This is a retrospective and descriptive study concerning 119 subjects followed-up by two "coordinating doctors" in the department of Sarthe who could assess their psychiatric diagnostics and sociodemographic characteristics. They could also compare medical data with the judicial data for 78 of the subjects. RESULTS: The population was composed of 117 men (98.3%) aged 45 years old on average. They had a job in 37% of cases (n=44) and were single in 56.3% of cases (n=67). According to the DSM-IV-TR, only 29 subjects (24.4%) had an axis I disorder and 37.8% of the population had a pathological personality trait (non DSM-IV-TR categorized disorder). Furthermore, 51.3% (n=61) of the subjects were addicted (mainly alcohol). The medical follow-up was carried out by a psychiatrist in 83.2% of cases (n=99). The average duration of follow-up was five years. Among the 78 subjects for whom there was access to juridical data, 13 (16.7%) had committed a new offense during follow-up. Among them, seven had recidivated six of whom were initially sentenced for sexual offense. CONCLUSIONS: Most of the subjects in injunction to care had no axis I disorder but addictions and/or pathological personality traits. Nevertheless, the expert concluded the need of an IC. Personality and behavior disorders do not always require psychiatric care, and the management must be multidisciplinary. In France, the psychiatrist remains at the center of injunction to care measure. The addictology care is not developed whereas it is a population at risk and there is a lack of interactions between professionals (medical, social and judicial professionals). The IC is a measure that needs to be improved by means of better communication among the different professionals and a better global assessment of the subjects. Medical care must be a possible option but not a systematic treatment.

Untamed Jianghu or Emerging Profession: Diagnosing the Psycho-Boom amid China's Mental Health Legislation.

This article focuses on the psychotherapy debate in China that was triggered by the country's mental health legislation. Seeing the release of the draft Mental Health Law in 2011 as a "diagnostic event" (Moore in Am Ethnol 14(4):727-736, 1987), I examine the debate in order to unravel the underlying logic and ongoing dynamics of the psycho-boom that has become a conspicuous trend in urban China since the early 2000s. Drawing on my fieldwork in Beijing and Shanghai, I use the two keywords of the debate-"jianghu" (literally "rivers and lakes"), an indigenous term that evokes an untamed realm, and "profession," a foreign concept whose translation requires re-translation-to organize my delineation of its contours. I describe how anticipation of state regulation prompted fears and discontents as well as critical reflections and actions that aimed to transform the field into a profession. The efforts to mark out a professional core against the backdrop of unruly jianghu further faced the challenge of an alternative vision that saw popularization as an equally noble cause. The Mental Health Law came into effect in 2013; ultimately, however, it did not introduce substantive regulation. Finally, I discuss the implications of this debate and the prospects of the psycho-boom.

[Therapy drop-out as a predictor of re-delinquency : Legal probation of substance addicted patients according to §64 of the German Legal Code]. / Therapieabbruch als Prädiktor erneuter Straftaten : Legalbewährung von Patienten nach Unterbringungen gemäß § 64 StGB.

BACKGROUND: Recidivism rates in substance-addicted patients placed in institutions according to §64 of the German legal code are approximately 50%, 3 years after discharge from inpatient treatment. The recidivism rates of patients with premature termination of inpatient treatment who had then been referred back to prison and were finally discharged into the community are unknown. RESEARCH QUESTION: Is premature termination of treatment a risk factor for recidivism? METHODS: Patients released from forensic treatment according to § 64 of the German legal code were followed up for violent and non-violent recidivism. Full data were acquired for Baden-Württemberg patients released in 2010 and 2011 with regular vs. premature termination of treatment. RESULTS: All measures revealed highly significant group differences: 48% of the patients discharged after subsequent prison sentences recidivated within the first year and 73% within 3 years after discharge. Among recidivists, the severity of offences was much higher (odds ratio > 3.8 each). Regularly discharged patients also re-offended to a remarkable extent (50%). DISCUSSION: Patients serving prison sentences after unsuccessful forensic treatment are a high-risk group for recidivism. Alternative concepts of clinical and legal treatment of this group should be developed.

[Coercive measures in German hospitals for psychiatry and psychotherapy : A pilot study by the DGPPN to evaluate a uniform assessment instrument]. / Zwangsmaßnahmen in deutschen Kliniken für Psychiatrie und Psychotherapie : Eine Pilotstudie der DGPPN zur Erprobung eines einheitlichen Erfassungsinstrumentes.

STUDY OBJECTIVE: A simple instrument to record case-related coercive measures was tested as part of a pilot project of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). METHODS: To assess coercive measures data were collected for 3 months in 8 German hospitals for psychiatry and psychotherapy. The type of measures used, the main diagnosis and the legal basis for the coercive measures were documented. RESULTS: In the sample studied, coercive measures were applied in 8% of cases. Coercive measures were most commonly used in patients with a schizophrenic disorder. The principle of justifiable necessity according to § 34 of the German Penal Code was used particularly often as the legal basis for justifying the coercive measures. CONCLUSION: Suitable measurement instruments and reliable data that enable the learning of best practices represent the basis for a reduction of coercive measures.

[A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years]. / Evaluation von Gutachten einer Universitätsklinik für Psychosomatik und Psychotherapie für öffentliche und private Auftraggeber über einen Zeitraum von zwölf Jahren.

A retrospective study of expert opinions of a psychosomatic-psychotherapeutic university hospital for public and private customers over a period of 12 years Objectives: Both the public and the legislative have developed an increasingly critical awareness for the fact that expert witnesses need to be independent. In contrast, to date there have been few studies concerning the quantity and the results of psychosomatic-psychotherapeutic expert opinions for public and private clients. METHODS: In a retrospective study design, 285 expert opinions of a psychosomatic-psychotherapeutic university hospital stemming from consecutive, unselected random sampling over a 12-year time period (1990-2011) were analyzed using a predefined list of criteria. Besides client data, the study also noted the type and the objectives of the expertise, the sociodemographic data of the subjects, the biographic data of the subjects, the size of records, the particular psychopathological findings including conflict and structural diagnostics via the Operationalized Psychodynamic Diagnostics (OPD-2, Research Group 2006), syndromic diagnostics according to ICD-10 (WHO) including the related Impairment Scale Score (ISS, Schepank 1995), and the Global Assessment of Functioning-Scale (GAF, Heuft 2016). RESULTS: 54% of the subjects were men. All subjects were 46 years old at the time of examination; on average symptomatology had existed for 7 years, which made assessment of causality difficult. Most assignments referred to the effects of diseases or accidents in private contexts, followed by pension reports. Among the expert opinions related to possible implications of acts of violence, 95% were women. In 43.2% (n = 123) of the cases, the assessment had occurred in the context of legal action. In 65 cases at least one party had requested a supplemental written report during further procedure. In 17.8% (n = 22) of the cases sought by the courts, the expert witness was requested by at least one party to present the assessment verbally. DISCUSSION: It should be emphasized that OPD conflict and structural diagnostics appear indispensable also for assessing mental health prior to an external event (accident or assault). The use of the two severity ratings (ISS, GAF) is discussed. It is proposed that expert witnesses be requested to name all their clients fromthe last 5 years at the beginning or end of the expert opinion, so that their independence from possible conflicts of interest can be established.

[Court-ordered therapy, a measure for preventing reoffending]. / L'injonction de soins,une mesure pour éviter la récidive.

In France, court-ordered therapy is a measure applicable in the framework of socio-judicial supervision, created by the law of 17th June 1998 relating to the prevention and suppression of sex offences, as well as the protection of minors. Since its introduction, its indications have been extended to include other offences. By organising a triangulation of the relations between the legal and health care systems (doctors and psychologists) through the intermediary of the doctor-coordinator, this programme aims to prevent reoffending.

[The interaction between the judge and doctors with court-ordered therapy]. / L'interaction entre juge et médecins dans l'injonction de soins.

Faced with the increase in convictions for sex offences, legislators in the 1990s studied the possibility of monitoring these criminals and offenders, considered to be among the most dangerous, following their imprisonment. This resulted in the law of 17th June 1998, establishing socio-judicial supervision. Inspired by several high-profile cases, the resulting changes to the legislation have reinforced judicial measures aimed at preventing repeat offending with regard to the most serious crimes. Socio-judicial supervision in particular is routinely ordered as part of certain safety measures while court-ordered therapy has become a cornerstone in the management of the most dangerous prisoners. An analysis of the connection between the judge and court-ordered therapy enables its role to be better understood.

[Treating patients on the court-ordered therapy programme]. / Prendre en charge des sujets relevant de l'injonction de soins.

Psychologists and a psychiatrist testify to the clinical condition of people sentenced to socio-judicial supervision with court-ordered therapy. Despite the extension of the indication of the programme, this complex supervision often concerns the perpetrators of intra and/or extra familial sexual abuse. Preventing reoffending through the global treatment of the patient is a major concern both for the doctor-coordinators as well as the doctor and psychologists delivering the therapy.

[The risk of reoffending, a major concern of the doctor-coordinator]. / Le risque de récidive, une préoccupation majeure du médecin coordonnateur.

Doctor-coordinators are nominated by the judge for the enforcement of sentences as soon as socio-judicial supervision with court-ordered therapy is to be implemented. Their mission is to facilitate the contact between offenders and the general practitioner likely to be working with them on the therapeutic level. The experience of the doctor-coordinator in Bordeaux sheds light on the conditions in which this function is performed. Identifying elements which may be considered as indicators of the risk of reoffending is, in daily practice, a constant concern for this specialist.

[Therapeutic approaches in court-ordered therapy]. / Les approches thérapeutiques dans l'injonction de soins.

As is the case with other contexts of mental health treatments, the therapeutic approaches to court-ordered therapy are varied. They are based on the principle of their clinical indication and must be delivered by therapists trained in the specific area. The classic therapeutic approaches are used: medication, psychoanalysis and psychoanalytically inspired therapies, cognitive behavioural therapies, group therapies and body-oriented approach.

[Court-ordered therapy, the case of sex offenders in Belgium]. / Injonction de soins, le cas des délinquants sexuels en Belgique.

Following the Dutroux affair which rocked Belgium in 1996, the Belgian minister for justice signed cooperation agreements with the country's three regions (Flanders, Wallonia and Brussels-Capital), imposing on sex offenders therapy or treatment as an alternative to imprisonment. What legal programme is now in place for their management? Experience of the Brussels support centre.

[The new German drug market law AMNOG from a child and adolescent psychiatry perspective]. / Das Arzneimittelmarktneuordnungsgesetz aus kinder- und jugendpsychiatrischer Perspektive.

BACKGROUND: The European Union (EU) regulation 1901/2006 plus the implementation of pediatric investigational plans by the European Medicines Agency (EMA) have contributed to more clinical studies in pediatric psychopharmacology. A new drug market law (AMNOG) has been in force in Germany since 2011 that requires an additional process of assessment of benefits of newly authorized medications by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G­BA), which also holds for medications licensed for pediatric populations. OBJECTIVES: Summary of early assessments of benefits for newly registered compounds in the treatment of psychiatric disorders and critical discussion from the perspective of child and adolescent psychiatry. MATERIAL AND METHODS: Application and critical review of documents and written statements by various institutions and stakeholders related to assessment procedures and respective decisions by the G­BA for these medications. RESULTS AND CONCLUSION: Clearly differing requirements for study designs and outcome parameters characterize the conditions for market authorization and for the assessment of benefits. Further adjustments to the regulations in implementing the AMNOG appear to be essential, integrating agencies involved so far, complimented by expertise from regulatory agencies and medical scientific societies.

[Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders]. / Entscheidungshilfe zur Therapieplanung bei jugendlichen Flüchtlingen und Asylbewerbern mit Traumafolgestörungen in der ambulanten Praxis.

Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.

[Assessment of prescriptive therapies and remedies - Experience and results].

In the years 2005-2015, a leading assessment institute conducted numerous assessments on behalf of two major German private health insurance companies concerning the necessity of prescriptive therapies and remedies. The findings are presented in this article, and the results vary significantly, depending on the prescriptive therapy assessed.

[The changes in values and beliefs through the first 50 years of the department of Psychiatry at the University of Montreal]. / Le changement de nos valeurs et certitudes au long de ce demi-siècle.

This essay attempts to describe and discuss the major changes in values and fundamental beliefs related to clinical practice within the Département de psychiatrie de l'Université de Montréal since its creation fifty years ago.Being an essay, the methods include shared recollections, discussions with colleagues, especially between the co-authors, and the study of some documents related to the practice of psychiatry 40 to 50 years ago.Five major axes of change are proposed: 1- From psychoanalysis to brain diseases, 2- From "Can a non-physician practice psychoanalysis?" to "Can a psychiatrist still perform psychotherapy?" 3- From continuity of care to episodes of treatment, 4- From treatment first to repeated assessments of patients, 5- From love that can heal and repair to a taboo of love.Finally it is suggested that the increasing emphasis on psychopharmacology and on DSM classifications has contributed to a shift from attempts to understand the intimate nature of symptoms and suffering to a priority given to rather mechanical clinical assessments in search of "objective" criteria.

[Psychotherapeutically Competent Child Guidance-General Framework and Legal Foundations]. / Psychotherapeutisch kompetente Erziehungsberatung - ihre Rahmenbedingungen und rechtlichen Grundlagen.

Assistances in education are pedagogical and therapeutic benefits connected with it. For child guidance as an assistance in education therefore psychotherapeutic competence is constitutive. The article describes the professional and legal framework of a psychotherapy in child guidance. It specifies on the one hand the composition of the multi disciplinary team (including child and youth psychotherapists and psychological psychotherapists) and the additional therapeutic qualifications acquired by the skilled employees. On the other hand it traces the judicial border between a medical psychotherapy with its scientifically recognised psychotherapy procedures and methods and a psychotherapy in child guidance. The applicability of the new law on the rights of patients with its requirements on a contract governing medical treatment (standards of medical specialists, duty to provide information, information provided for self-determination as well as documentation) on child guidance is discussed as well. The author argues for the preservation of psychotherapeutic competence in child guidance as a benefit sui generis and sees precisely in its therapeutic competence its specific contribution to the advancement of the assistances in education.