Zusammenfassung
Die Qualität der therapeutischen Beziehung ist prädiktiv für den Therapieerfolg und der größte Einflussfaktor, der diesbezüglich isoliert untersucht wurde. In der Allgemeinpsychiatrie existieren verschiedene Beziehungsmodelle, deren Operationalisierungen als Messinstrumente Verwendung finden. Aufgrund der Vorhersagekraft dieser Fragebogen für den Therapieerfolg in der allgemeinen Psychotherapie ist es sinnvoll, die therapeutische Beziehung auch in der forensischen Psychiatrie zu operationalisieren. Die vorliegende systematische Übersichtsarbeit untersuchte die Besonderheiten und Unterschiede validierter Messinstrumente zur Erfassung der therapeutischen Beziehung bei unfreiwillig behandelten psychiatrischen Patienten. Dabei zeigte sich, dass die üblichen Beziehungskonzepte im forensischen Kontext stark adaptiert werden müssen. Die wenigen vorliegenden Messinstrumente sind in der Lage, forensische von allgemeinpsychiatrischen Patienten zu unterscheiden, wenn sie die „Strenge“ des Therapeuten als zusätzliche eigene Beziehungsdimension berücksichtigen. Zudem sind diese, anders als Fragebogen der allgemeinen Psychotherapie, prädiktiv für die strafrechtliche Rückfälligkeit der Patienten. Die gemeinsame Einigung auf Therapieziele und therapeutische Aufgaben ist in der Forensik weniger relevant für eine gute Beziehungsqualität. Diese profitiert am ehesten von einem bestimmten und direktiven Stil, mit klar definierten Rollen und einem „Hart-aber-fair-Prinzip“.
Abstract
The quality of the therapeutic relationship is predictive for therapy outcome and is the most important influencing factor that has been examined in isolation in this context. There are various models of the therapeutic relationship in general psychiatry, which have been operationalized for use as a measuring instrument. As these questionnaires predict therapy outcome in general psychotherapy, operationalization of the therapeutic relationship should be applied in forensic psychiatry as well. This systematic review examined the peculiarities and differences of validated measurement instruments for documenting the therapeutic relationship in involuntarily treated psychiatric patients. It was found that the routine relationship concepts must be thoroughly adapted to be used in a forensic context. The few available measurement instruments are capable of differentiating forensic from general psychiatric patients if the “strictness” of the therapist is taken into account as an additional dimension of the relationship. Unlike the questionnaires of general psychotherapy these instruments are also predictive for recidivism. The mutual consent on therapeutic tasks and goals is less relevant for a good relationship quality in forensic psychiatry. The best relational style seems to be directive and authoritative with clearly defined roles and a firm but fair approach.
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Meyer, M., Hachtel, H. & Graf, M. Besonderheiten in der therapeutischen Beziehung bei forensisch-psychiatrischen Patienten. Forens Psychiatr Psychol Kriminol 13, 362–370 (2019). https://doi.org/10.1007/s11757-019-00559-y
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DOI: https://doi.org/10.1007/s11757-019-00559-y