Psychotherapy, seen as a drug to treat, has positive main effects in treating psychosomatic disorders, personality disorders, phobic or depressive disorders, but there are also possible side effects like chronification of symptoms, dependency of the therapist, flight in drug abuse, conflicts in partnership, family and social environment, undesired changes in behavior or character. To avoid such side effects and to have the best possible results, specific quality assured methods are necessary, adapted to the patients need in the way of an integrative psychotherapy.
But mainly, capacities and characters of the therapist influence the quality of psychotherapy, such as flexibility and self reflection of emotion, relation or conflict contents.
My thesis is, that a palette of different patterns of behavior in psychotherapy is necessary: i. e. the supporting aid in a deeply depressive patient, the structuring in affective disorders, the freedom of association after telling a story or metaphor, surprising, or postponing subjects. Not a single pattern of behavior like it is teached in psychotherapeutic schools of Rogers, Freud, Jung, or systemic therapy, is ideal, but a whole variation of accepting, supporting, surprising, complementary and contrary behavior, rationally and emotionally.
Meta-studies of Grawe1 1 Grawe K, R. Donati, F. Bernauer: Psychotherapie im Wandel - von der Konfession zur Profession, 2. Aufl. Hogrefe, Gцttingen 1994 and investigations of others 2 2 Federschmidt H, Wirksamkeit und Nutzen von psychotherapeutischen Behandlungsansдtzen, Deutsches Дrzteblatt 93, Kцln, Jan. 1996 3 3 Senf W., Broda, M., Hrsg.: Praxis der Psychotherapie, Thieme, Stuttgart 1996 showed the effectiveness in psychotherapy of the following factors: Aid in conflict solving, understanding and clearing, quality of the therapeutic relation, optimism to find and to give help on the outcome on psychotherapy, personality and maturity of the therapist independent of the method he uses.
Differentiating the necessary capabilities of the therapist, concerning the different steps, methods and needs in therapy, the following are to find:
You can ask Yourself as a therapist, which of the different abilities is developed and which can be more developed, while reading or listening.
The first basic capacity of the psychotherapist is...
... to listen with patience, empathy and to add different points of view: This means the conditions of Rogers: empathy, authenticity, acceptance, also the transcultural and positive change of view after N. Peseschkian. - This includes the ability to register sensitively the therapist’s own emotions - .
This is a step of attachement, acceptance, creating trust and hope.
Concerning this capacity, we can find the following in literature.
After Federschmidt4 4 Federschmidt H 1996 the empirically best proved efficiency factor in psychotherapy the quality of the therapeutic relation. Frank (1982) sees in the foreground „the emotional involving, confident relation“, Karasu (1986) „affective sensitivity., cognitive mastering, behavior regulation“ (after StrauЯ and Wittmann5 5 in Senf, Broda: Praxis der Psychotherapie, G. Thieme 1996, S. 530 )
Krause: „...as showed in our investigations, the good psychotherapists at least in affective expression behavior do not react at all spontaneously, but well-considered complementary. ...that is what one in past times understood as tact, politeness, education of the heart or maybe as general education. ...I prophecy a rehabilitation of this script of feelings and a later condemnation of the narcissistic „culture of authenticy... I may be very angry as a therapist or even may feel contempt, but I will not give it back directly affective, rather as a „container“ take the projections, convert them and use them in my interventions in a curative way.“6 6 Krause R: Gefьhle in der Psychotherapie, in: Zsch. psychosom. Med. 42, 195-204, ISSN 0340-5613, Vandenhoeck & Ruprecht 1996 (translated by AR)
This is everyday practicing in Peseschkians work, fully accepting the patient without prejudices, but to surprise him with an unexpected point of view, with metaphors, stories, transcultural examples or the patient’s own words in a new meaning. In comparison to Krause there is Peseschkian’s opinion, that without laughing at least five times in a session you may not call it a psychotherapeutic one.
The second capacity is...
... to ask exactly, to define contents, history, dynamics and possibilities: To distinguish psychogenesis, somatogenesis and sociogenesis and to give a full understanding of the situation to the patient is based on systematic first interview and therapy structure.
- It contains the capacity to translate the emotional feelings of transference and counter-transference into conflict contents, capacities and relation patterns - .
This differentiating step is characterized by several secondary capacities like justice, exactness, order, openness, and uses mainly the analytic-logical ressources. Clear communication with the patient gives himself an understanding of his symptom as a step within his development and of the difference between conflict contents and ressources.
The third capacity is...
... to accompany the patient and to encourage his self help: The step to self help means to trust in the patient’s discovered resources, to know ways to support also by involving the social groups. - This means also to develop the deficit in emotions and feelings in the patient by moderating the own emotional behavior - .
This is the classical behavior in medicine: to support by advise, to see the resources, to use drugs, relaxation techniques, group therapy or sports. In psychotherapy it means to combine all necessary treatment, not to avoid antidepressive or antipsychotic drugs or the body check, for instance making tests concerning hyperthyreosis, drug side effects or tumors as possible reasons for psychic disorders.
The forth capacity is...
... to focus on conflicts by consultation and to mediate responsibility for the consequences of changes: To practice openness and honesty as well as patience and politeness in solving conflicts (coping, family consultation, changing). - Included is the training of affective-emotional possibilities of changes, for instance by training of openness and showing emotion, and to find out the responsibility for emotional reactions. Specific difficulties from transference and contents need supervision or intervision - and the readiness of the therapist have it.
The fifth capacity is...
... to see the future after conflict solving in the center: To widen the goals to the future meanings in life plans is not only work with hope as a treating drug, but also concerning the surroundings and relations of the patient.
This means detachment, to see problems and therapy as a chance for a new beginning, and selfhelp
The situation of pneumonia, treated with antibiotic may be compared with the psychotherapeutic situation: effective treatment will be quit shortly after healing the pneumonia, even if the result is very good. The same is valid for our own narcissism as therapists: already in beginning a therapy one of the most important questions is to ask, which signals would show us the end of the therapeutic situation, when will it be enough for the patient? Can I prepare the patient within the first interview to see mainly the future after therapy, not only the attractive atmosphere of the therapists cabinet?
Education in Positive Psychotherapy means to experience in self experience, in supervision and intervision these capacities and to discuss them also in the extended Balint-group concerning the relations of the therapist with the patient, but also with his colleagues and other methods, his family, his view of mankind.
A questionnaire for the above mentioned capacities is available in German.
Federschmidt H, Wirksamkeit und Nutzen von psychotherapeutischen Behandlungsansдtzen, Deutsches Дrzteblatt 93, Kцln, Jan. 1996
Grawe K, R. Donati, F. Bernauer: Psychotherapie im Wandel - von der Konfession zur Profession, 2. Aufl. Hogrefe, Gцttingen 1994
Peseschkian, Nossrat: "Positive Psychotherapy", Springer-Verlag, Berlin Heidelberg 1987
Peseschkian, Nossrat: "Psychosomatik und positive Psychotherapie", Springer-Verlag, Berlin 1991
Peseschkian, Nossrat: "Psychotherapy of Everyday Life", Springer-Verlag, Berlin Heidelberg 1986
Reimer Ch: Ьber MiЯbrauch von Abhдngigkeit in der Psychotherapie, in: Lindauer Texte, Springer Berlin 1991, S. 212ff.
Remmers A, Kriterien des Ausbildungsganges und berufsbegleitender Qualitдtssicherung in der Ausbildung von Дrzten und medizinischen Psychologen zu Psychotherapeuten, Zschr. „Positum“ der Gesellschaft fьr Positive Psychotherapie Bulgariens, Varna 1994 (bulgarisch, deutsche Version als Arbeitspapier b. Verf.)
Senf W., Broda, M., Hrsg.: Praxis der Psychotherapie, Thieme, Stuttgart 1996