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The human factor on the Couch

this is how It is: Some people can do certain things better than others. This applies to the sprinters at the Olympic games, the not run all at the same time over the finish line. But this is also true for Doctors, some of whom make more than others the correct diagnosis. And this is also true for psychotherapists. Some therapists heal the Suffering of their patients more effectively than their colleagues. In the past few years, researchers have discovered increasingly the characteristics that make a good therapist.

for a Long time, these characteristics remained, however, unexplored. Because, in contrast to Olympians of the therapists don't compare yourself so much with each other. There are no Doctors-Super-League, and in hospitals, no psychiatrists of the month. Tables on the number of symptoms before and after treatment, the Severity and course of a disease or as is often the Treated suffer relapses result in the fewest therapists. In short: data is missing.

for Decades, it seemed impossible, therefore, to find out what is the influence of the therapist and not the treatment or the disease on a successful therapy. Still in 1977, the American psychologist Donald Fiske wrote: "What the therapist contributes to the effectiveness of psychotherapy? This question is not to explore."

Nevertheless, at that time there were already clues that the therapist has an important role in the treatment process. In 1974 the American psychology Professor David Ricks published one of the first studies on the topic. Ricks looked for 121 young offenders with mental disorders, and observed that 61 developed them later in life schizophrenia.

Then he identified the therapists who had treated you once. Ricks was fascinated in particular by two of them, in which a total of 28 of the young people were in therapy, because their results were so different. Of 15 patients of the therapist A 4 developed schizophrenia. This accounts for about 27 percent. If therapist B 11 of 13 Treated schizophrenic – i.e. 85 percent were not. A huge difference, especially since Ricks had not previously looked to see that the young people in characteristics, such as age or gender differences between the two therapists. Even if nothing was proved, was an obvious choice for Ricks, the presumption is that therapist A was simply better.

"Alliance" with the patient is very important

in fact, this conclusion is vulnerable. Nevertheless, the study showed, for the first time, how big is the difference between the two therapists can be – even if Ricks couldn't even tell what it was. Unfortunately, that didn't seem to be interested in the psychological research community in the following decades, and it lasted until after the turn of the Millennium, to individual groups of researchers turned to the subject of increasingly.

In 2004, then managed a Team led by psychologist Larry Beutler, to show at least what it seems to have no influence. The researchers analyzed a number of earlier published studies on whether, for example, the age, the gender, the ethnicity, cultural Background, professional training or professional experience of the therapist influence the well-being of the patients have to go. The result: you Have not.

Furthermore, the researchers noted in their study: "In the last two decades the interest in research areas that are not connected with the specific effects of the treatment and its implementation has dropped significantly." To compare different therapies, was, therefore, interesting to compare the therapist is more likely to work.

It took again a few years – until 2013, as the American psychologist Scott Baldwin and Zac Imel rallied together finally, in a further review of all previously published studies on the topic and analyzed again whether or not the characteristics of a good therapist could make. 29 studies were included in their analysis, and this Time they were successful.

So, you observed that the influence of the therapist on the outcome of a therapy of between three and seven percent. In the past year, published a Meta-analysis that considered all of the since then, published studies, confirmed this number – here the researchers were on average five percent. The like little blades, the influence is even similar, such as the selection of therapy.

"About 15 to 16 percent of the therapists are significantly better than the average."Wolfgang Lutz, a psychotherapist

"This information is valid but for an average-loaded patients," says Wolfgang Lutz, a Professor at the University of Trier and head of the Department of clinical psychology and psychotherapy, and has researched a lot myself to a therapist effect. "For heavily loaded patients, you can increase more than Double." What does this mean for the practice? "About 15 to 16 percent of the therapists are significantly better than the average, about as many of them are significantly worse, and the more the patients are charged, the more important the competence of the therapist is." But what makes the Better ones better?

A couple of factors can account for the researchers in the meantime. Very important seems to be how well the therapist with the patient may be able to forge an "Alliance". This means three things: the connection between the Patient and the therapist, voting a unanimous view on the objectives of the therapy, and a same arrangement of the tasks of psychotherapy.

In addition, interpersonal skills are important. So that a therapist can Express themselves with language and emotions well, he is convincing and empathetic, he radiates hope and warmth, yet is always on, the problems will stay in focus. A good therapist is also not fully of his mastery, but have doubts on yourself and is formed in addition to the day to day practice. Ultimately, it is important that the therapist has a high level of everyday resilience and non-Burn-out-is at risk.

still Unclear is whether some therapists with some patients better than others. So, there is evidence that some therapists work more successfully with men, or women, or their intercultural competence better effects in patients to achieve, depending on what cultural Background they have. On the other hand, there are studies that show that the better therapists are generally better, regardless of the patients or their diseases.

A traffic light shows whether everything is according to Plan

runs Even if scientists have now found some of the factors that make a good therapist, and the research in this field has come after decades of infirmity is now more in the focus, it will need a few more studies until the effect is completely explained. To do this, it needs data. It seems that the researchers could get in the future. In more and more large projects are collected together information about patients and therapists – for example, in the Kodap-project, in which all the psycho to carry therapeutic outpatient clinics of German universities, these data together to create an unprecedented data set on mental diseases and their treatment.

Even now, but it is already clear that there are better and worse therapists. This raises the question of how to deal with it naturally. "Would be helpful", says Wolfgang Lutz, "is that therapists learn during their training, dealing with Feedback." So you could use it later, in the course of a treatment, such as appropriate progress documentation, in order to check whether your therapy is working.

such An approach of the questionnaire, OQ-45 – kind of an alarm system for therapists to offer about. Session for session control. For example, the Patient must fill out a questionnaire about depression symptoms, and the therapist can detect whether he is on the target line. A traffic light in the System indicates, if everything goes according to Plan (green) or whether there are large steps backwards (red). This is of course a certain amount of effort, to the therapists, but with a Feedback, which allows him to tailor the treatment.

For patients who are looking for the right therapist, recommends Lutz: "At best, you make sure that you have an early positive feeling toward the therapist." If the early progress or positive experiences would have to be the good characters. Nevertheless, one should not feel discouraged if progress is the absence of first. Because, according to Lutz: "of Course, there are also therapies that have only in the course of positive changes, and improving jumps."


This Text is from the current issue. Now all of the articles in the E-Paper of the Sunday newspaper, read: App for iOS App for Android – Web-App (Sunday newspaper)

Created: 18.05.2019, at 18:16

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