Associations between therapists' verbal techniques and patient-rated therapeutic alliance, insight, and problem solving.

OBJECTIVE: To investigate associations between common factors (alliance, insight, problem solving) and therapists' techniques. We expected a positive association between (1) supportive techniques and the alliance, (2) interpretative techniques and insight, and (3) a stronger association between interpretative techniques and insight for patients with more severe baseline symptoms. Other associations were analyzed in an exploratory way. METHOD: Sixty sessions from 15 adult female patients diagnosed with personality disorder were analyzed using the Psychodynamic Interventions List (verbal techniques, observer-rated transcripts), and the Session Questionnaire for General and Differential Individual Psychotherapy (common factors, patient-rated after each session). Multilevel modeling was applied. RESULTS: A greater use of supportive techniques was related to a higher therapeutic alliance (b = .28, 95% CI: .01-.55, p = .042). Neither the positive association between interpretative techniques and insight nor the moderating effect of baseline symptom severity could be confirmed. Exploratory analyses revealed associations between problem-solving and different verbal techniques. CONCLUSION: Therapists' use of supportive techniques seems to influence the therapeutic alliance positively in patients with personality disorders. The effect of interpretative techniques might depend on other factors like patient characteristics. In general, there seem to be differential and specific associations between different therapists' verbal techniques and common factors.

The East-West blood trade : How the German Democratic Republic obtained foreign currency with blood products (1983-1990).

Using the East-West blood trade of the German Democratic Republic (GDR) in the 1980s as an example, this study aims to show what kind of problems arise when trade agreements are made with authoritarian regimes, where transparency is lacking and the general public is not informed about the trading conditions. Files from the Ministry of Health and the Foreign Trade Ministry show the extent, aims, and scope of the blood exports to the West. Within the East-West trade, blood was regarded solely as a commercial good; ethical concerns played no part. The blood trade was the most important income source of unscheduled foreign currency for the GDR health sector. People were asked to donate for the wellbeing of society and without receiving remuneration. They were unaware that their blood was an object of commercial trade. Most of the revenue was put into secret accounts of the GDR Foreign Trade Ministry or went to Western intermediaries. The regulations for blood deliveries often challenged the blood donation institutes; they lacked donors, modern techniques/equipment, and personal. Buyers in the West repeatedly complained about the quality of the blood products. The Western intermediaries sold the goods to bulk-buyers, predominantly in German-speaking countries.

Testing ground GDR: Western pharmaceutical firms conducting clinical trials behind the Iron Curtain.

Western pharmaceutical companies conducted clinical trials in the Eastern Bloc during the Cold War. Recently, media reports about alleged human experimentation provoked a wave of indignation. However, a scientific and objective account of these trials is lacking. The aim of this study was to describe and evaluate the clinical trials performed in the German Democratic Republic (GDR) based on archival material from the health system and the secret service. We found documents relating to 220 trials involving more than 14,000 patients and 68 Western companies. However, no record of patient information forms or systematic documentation regarding the provision of patient consent was discovered. There was no evidence to suggest that the trials systematically and intentionally damaged patients. The trials were conducted without the knowledge of the public. GDR legislation stipulated that patients must consent to the trials, but no evidence was found to suggest that patients were systematically informed. Documents suggest that at least some of the trials were carried out without patients having a comprehensive understanding of what the trial involved. The GDR agreed to the trials due to impending bankruptcy and Western pharmaceutical companies capitalised on this situation.

[Factorial structure and psychometric criteria of the German translation of the Maslach Burnout Inventory--Student Version by Schaufeli et al. (MBI-SS)]. / Faktorstruktur und Gütekriterien der deutschen Übersetzung des Maslach-Burnout-Inventars für Studierende von Schaufeli et al. (MBI-SS).

The Maslach Burnout Inventory (MBI) is the most commonly used instrument in research on burnout. For the German translation of the MBI student version (MBI-SS), the postulated 3-factorial structure of the questionnaire could be confirmed using confirmatory analyses. The internal consistencies of the scales can be classified as good. First findings underline the construct validity of the questionnaire. As expected, burnout was associated with psychic and somatic complaints as well as with experienced social support. Couples reported higher "Efficiency" levels. Academic studies became less important with increasing duration. Time pressure during the last month was correlated with "Exhaustion". The presented findings on factorial structure and validity speak for the applicability of MBI-SS for research projects on students of German institutes of higher education.

Crisis-repair sequences - considerations on the classification and assessment of breaches in the therapeutic relationship.

BACKGROUND: Recent research indicates that temporary deteriorations of variables monitored continuously in the course of the therapeutic relationship are important characteristics of psychotherapeutic change. These so-called rupture-repair episodes were assessed by different authors using different mathematical methods. METHODS: The study deals with the criteria for identifying rupture-repair episodes that have been established in previous studies. It proposes modifications of these criteria which prospectively could make it possible to identify rupture-repair episodes more precisely and consistently. The authors developed an alternative criterion. This criterion is able to include crisis patterns which had not been considered before, as well as to characterize the length of the crises. As a sample application, the different criteria were applied to continuously measured assessments of the therapeutic interaction in psychodynamic therapy courses (ten shorter processes and one long-term therapy). RESULTS: The analysis revealed that the number of the identified rupture-repair episodes differed depending on the criterion that was used. Considerably more crises were identified with the newly developed criterion. The authors developed a classification of crisis patterns. They distinguished five patterns of crises and their resolution in therapy processes and ascertained the frequency of distribution. The most frequent pattern was the simple V-shape. The second most common pattern was a decline over more than one session with a sudden repair. The longest downward trend comprised a period of six sessions. CONCLUSIONS: The findings of the study give insight into basic mechanisms of change within the therapeutic relationship. A phenomenological discussion of how a crisis is defined is useful to create a methodological approach to the operationalization of crises, to differentiate specific characteristics and to specifically link these characteristics to the outcome in future studies. The methodological deliberations might be applyable to different research areas where the analysis of fluctuations in a variable of interest over time is relevant.

[Burnout experience and work disruptions among clients seeking counselling. An investigation of different groups of academic level]. / Burnout und Arbeitsstörungen bei Studenten. Eine abschlussspezifische Untersuchung von Klienten einer psychotherapeutischen Studentenberatung.

Due to the debate on the Bologna Process, psychic problems among students are now receiving increasing attention. In this context, differences between groups of academic level are of interest. The data of 251 students who consulted a counseling center were examined regarding the experience of burnout and work disruptions. Magister candidates experienced more doubts about their studies compared to Master's degree and state examination and less efficiency compared to state examination candidates. They showed significantly higher values regarding "writer's block" compared to Bachelor and state examination, as well as worries about the future compared to state examination candidates. The discussion on psychic strain among students should to be led in the overall context. It would be useful not to primarily focus on isolated groups of academic level. Analyses on the prevalence and typology of work disruptions among students are prerequisites for developing methods of psychological help.

[Psychological complaints by academic level among students seeking counseling]. / Macht der Bachelor wirklich krank? - Studienabschlussspezifische psychische Beschwerden bei Klienten einer psychotherapeutischen Studentenberatung.

There is a lack of detailed surveys on the mental health of students. German university counseling centers have faced increasing demand, which is primarily due to the newly introduced Bachelor/Master system. The data of 251 students who consulted the Leipzig psychotherapeutic counseling center were examined with regard to complaints, symptoms and interpersonal problems. Significant differences were observed with respect to usage of the counseling center and interpersonal problems. Master's degree and state examination candidates sought counsel most often. Bachelor's degree students were least likely to seek help. Magister and Bachelor candidates showed a higher level of symptoms and interpersonal problems. Depression and work disruptions were the concerns mentioned most frequently. The findings should be examined further using additional samples. It should be clarified whether the likelihood of usage also differs with other forms of psychological help.

The role of the State Security Service (Stasi) in the context of international clinical trials conducted by western pharmaceutical companies in Eastern Germany (1961-1990).

BACKGROUND: After the building of the Berlin Wall in the 1960s, a number of international pharmaceutical manufacturers from the West had their drugs tested in Eastern Germany (GDR). So far, the extensive collection of documents on the subject stored in the archives of the GDR State Security Service (Stasi, MfS) has not been systematically analysed. Until now, the role of the Stasi with respect to the surveillance of the trials has been unclear. METHODS: A keyword search within the database of the Stasi files was conducted. All available files were screened in order to identify institutions, companies and personnel involved in the clinical trials. On this basis, further files were requested. A total of 259 files were available for analysis. Relevant data was derived from 160 of these files. A contextualised approach was applied, which critically explored the origin, content, and impact of the data. In addition, an approach guided by the central steps of document analysis was applied. RESULTS: At least 400 clinical trials were conducted during the GDR period. The exact number remains speculative. According to references found in the Stasi files, it might have been considerably higher. Initially, the main goal of the trials was for the GDR authorities to decide whether to import certain Western drugs. By 1983, this intention had changed. Now, the primary aim of the trials was the procurement of foreign currency. The Stasi feared that the pharmaceutical companies could have a significant influence on GDR Health System. Stasi spies were holding positions in the responsible medical committees, universities, and hospitals. Constant surveillance by the Stasi served the purpose of monitoring any contact between people from the West and the East. Unknowingly, representatives of Western companies were surveilled by the Stasi. The studied documents also point to the fact that a number of clinical trials conducted during the GDR period did not comply with GDR regulations, and were therefore deemed illegal by the Stasi. The Stasi was not particularly interested in medico-ethical questions. CONCLUSIONS: Clinical trials conducted during the GDR period were surveilled by the Stasi. It was their aim to monitor all people involved in the trials, including their Western contacts. Relevant medico-ethical questions like patient consent and safety with respect to the clinical trials were not the focus. Considering the significant number of conducted trials, only limited evidence exists of doctors having discussed them critically. The public was not officially informed about the trials.