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Psychotherapeutischer Prozess und Persönlichkeitsstörungen

Zunehmende Evidenz für psychodynamische Perspektiven aus der Prozess-Outcome-Forschung

Psychotherapeutic process and personality disorders

Growing evidence to support psychodynamic views from process outcome research

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Zusammenfassung

Es wird zunächst ein kursorischer Überblick über die Outcome-Forschung im Bereich der Psychotherapie von Persönlichkeitsstörungen gegeben. Dagegen gibt es relativ wenig Wissen und Studien über Prozessforschung und Prozess-Outcome-Beziehungen. Es wird dann auf relevante Patienten- und Therapeutenvariabeln eingegangen, und wichtige Kontroversen in der Behandlungstechnik von Persönlichkeitsstörungen werden beleuchtet. Während anfangs Studien dafür zu sprechen schienen, dass Übertragungsdeutungen generell mit schlechterem Therapieerfolg verbunden sein könnten, finden sich in neueren Studien Hinweise auf differenziertere Zusammenhänge. Es gibt zunehmend Evidenz, dass insbesondere bei schwereren Persönlichkeitsstörungen vom B-Cluster gerade eine moderate Zahl von Übertragungsdeutungen und vielleicht sogar ein nicht zu gutes therapeutisches Bündnis, das ein Indikator für eine innere Auseinandersetzung auf der Beziehungsebene mit dem Therapeuten sein könnte, sich als günstig erweisen könnten. Ein Zusammenhang, der bei Cluster-C-Persönlichkeitsstörungen so möglicherweise nicht besteht. Ein Problem der Studienlage liegt allerdings darin, dass oft klare Definitionen fehlen, was die Vergleichbarkeit der Studien erschwert, und der Einfluss anderer Mediatorvariabeln unklar bleibt.

Abstract

This paper begins with a cursory overview of psychotherapy outcome research for personality disorders; however, relatively little is known about process research or process outcome relationships. It then focuses on relevant patient and therapist variables. Significant controversies in personality disorder treatment techniques are examined. Initially, studies generally associated transference interpretation with less favorable therapy outcomes. Recent work supports the possibility of differentiated correlations. There is increasing evidence that a moderate amount of transference interpretation and perhaps even a therapeutic alliance that is not so good, maybe indicative of an inner conflict with the therapist relationship, could ultimately be beneficial. This association most probably does not exist in cluster C personality disorders. A problem with this type of research is that clear definitions are often lacking. This complicates comparisons between studies and the influence of other mediating variables remains vague.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Gerhard Dammann gibt an, dass kein Interessenkonflikt besteht. Das vorliegende Manuskript enthält keine Studien an Menschen oder Tieren.

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  1. Psychiatrische Klinik Münsterlingen, Psychiatrische Dienste Thurgau, Spital Thurgau AG, 154, 8596, Münsterlingen, Schweiz

    Gerhard Dammann MBA

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  1. Gerhard Dammann MBA
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Correspondence to Gerhard Dammann MBA.

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Dammann, G. Psychotherapeutischer Prozess und Persönlichkeitsstörungen. Psychotherapeut 59, 119–129 (2014). https://doi.org/10.1007/s00278-013-1020-6

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