Replacement of the IPG requires careful follow-up of patients with DBS to ensure stable symptom control.
Studies on the dimensionality of the therapeutic alliance had been conducted by Hatcher et al. factor-analyzing three widely used alliance measures (Helping Alliance Questionnaire, Working Alliance Inventory, California Psychotherapy Alliance Scales) and proposing two additional dimensions (on affects and interpersonal aspects). The present study intended to construct an economic German patient questionnaire on the basis of this preliminary work, which represents relevant dimensions of the therapeutic alliance in an economic way. 36 items, purposed by Hatcher et al. were translated into German. They have been examined by confirmative factor analysis (sample 1: N=301 psychotherapy patients). As a result of further factor analysis, the "Skala Therapeutische Allianz - Revised STA-R" was developed. The 17-items questionnaire has 4 scales: "Confident Collaboration", "Bond", "Patient Fear" and "Therapist Interference", which correspond to Hatcher et al. The latter scales have not yet been considered in German questionnaires. A confirmatory factor analysis with sample 2 (N=427 patients) showed a good model fit with these factors, too. Correlations of the therapeutic alliance at the end of the treatment with change in symptom load (SCL-90-R) proved to be significant (rSTA-R, GSI=0.43**).
Design: The effects of two types of interventions were investigated in an explorative single-case study of three patients with chronic depression and/or borderline personality disorder over 20 therapy sessions (sessions 2-11 and sessions 51-60). The ratings of therapeutic interventions that promoted mentalization were based on the concept of mentalization (Bateman & Fonagy), and the ratings of those disconfirming pathogenic beliefs were based on Control Mastery Theory (Weiss & Sampson). The effect of therapeutic interventions (mentalization vs. pathogenic beliefs) was assessed by measuring the level of reflective self-awareness, which was rated using the Experiencing Scale. The therapeutic alliance relationship was examined each session by a questionnaire. Therapy sessions were analysed with two different time series analyses. Each session was rated in five-minute sections. Results: In the time-series analysis, therapeutic interventions promoting mentalization and those disconfirming pathogenic beliefs correlated significantly with reflective self-awareness for two of the three patients. For one patient, there was no correlation. However, the results in the trend were different. For all patients, reflective self-awareness decreased or remained stable, and therapeutic alliance improved. This needs to be explained. ABOUT THE AUTHORSThe authors have been working together in this single-case research project for 10 years. This article shows a main result of this project. All authors are psychodynamically oriented psychotherapists with experience in clinical practice and training. J. Brockmann and H. Kirsch are experienced in psychotherapy research for many years. G. Silberschatz has supervised the project since its beginning. He is a well-known psychotherapy researcher of the San Francisco Psychotherapy Research Group (SFPRG) and was president of the Society for Psychotherapy Research (SPR). The authors published another part of the project "Mr K -A successful case of analytic oriented therapy documented empirically: The role of the therapeutic relationship and reflexive self-awareness" in Psychoanalytic Psychotherapy (2017).
Further DBS and medication adjustments play an important role for hospital rehabilitation of PD patients after initial DBS programming in DBS centers.
In view of the inceasing number of implanted defibrillators in all industrial nations, the number of people who have suffered so-called multiple shocks (electrical storm, ES) also increases. Common complaints are severe and continuously recurrent massive anxiety, panic attacks, fear of death, helplessness and hopelessness, depression, nervosity and irritability as well as reclusive and uncontrollable avoidance behaviour, intrusions, nightmares, flashbacks, sleeplessness and the inability to show feelings and limitation of future perspectives. Because people with an ICD are often physically (very) ill and after multiple ICD shocks are additionally very insecure, it would seem logical if the inpatient treatment would be carried out in an institution which has close connections and is also spatially close to a cardiology department. The basis of the diagnostics is the clinical anamnesis and a systematic exploration of the trauma situation and the resulting complaints. As an additional diagnostic element psychological test procedures should be implemented to determine the core symptomatic (anxiety, depression, trauma symptoms). Psychological test procedures should be included in the diagnostics so that at the end of treatment it is obvious even to the patient which alterations have occurred. The core element of inpatient treatment is daily intensive psychotherapy and includes deep psychologically well-founded psychotherapy and behavioral therapeutic-oriented anxiety therapy as well as cognitive restructuring and elements of eye movement desensitization and reprocessing (EMDR). A follow-up examination within 4 months of the multiple shocks episode is recommended because symptoms of posttraumatic stress disorder often occur after a long latent time period.
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