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Abstract: This dissertation shows empirically that held opinions, clichés, and preconceptions about psychotherapy significantly influence the process and outcome of psychotherapy. Up to date, there has been an emphasis upon therapy-internal effect sizes (as motivation, readiness to change, intelligence, therapeutic relationship, …). However, the results of this study suggest the existence of a therapy-external effect size, which exerts an essential influence on the therapy-internal effect sizes: “The image of psychotherapy”. First, a pre-version of the instrument ACP-a (Acceptance of Psychotherapy) was designed from surveys and expert reviews to examine the main hypothesis, that “Acceptance of Psychotherapy is an effect size for the process of therapy”. This process developed into the final test-version ACP-a, which served to measure the “Image of Psychotherapy” of 342 out-patients of the “Norddeutschen Institut für Verhaltenstherapie” (Northern German Institute for Behaviour Therapy) in Bremen (NIVT)and was correlated with the therapeutic process and outcome. The therapeutic process was documented through a Therapist- and Patient questionnaire (ACP-P), which was specifically designed for this purpose, and handed out at each therapy session. The therapeutic outcome was assessed as measurement of change at two different measuring times (t1 = after the initial interview; t2 = after 20 therapy sessions) through a combination of questionnaires (SCL-90, SASB, IIP, …). This study demonstrates, that patients with low acceptance of psychotherapy have a more difficult/ intricate therapeutic process and a lower therapeutic outcome, than patients with high acceptance of psychotherapy. According to the results, more attention needs to be paid to the “public image of psychotherapy”, in order to change the public opinions and preconceptions about psychotherapy into a more positive direction, and therefore to support the effectiveness of therapies. Key Words: Acceptance of Psychotherapy, effect size, quality management, research on therapy process, questionnaire construction, consciousness research.
ACP Inhaltsverzeichnis 9 / 369 Inhaltsverzeichnis 1 Einleitung ......................................................................................................................... 21 1.1 Phase I – ‚Legitimationsphase’ ................................................................................................ 22 1.1.1 Studien zu Phase I................................................................................................................................ 23 1.2 Phase II – ‚Konkurrenzphase’ .................................................................................................. 24 1.2.1 Studien zu Phase II - Therapievergleichsstudien ................................................................................. 25 1.3 Phase III – ‚Prozessforschung’................................................................................................. 33 1.3.1 Generic Model of Psychotherapy......................................................................................................... 34 1.3.2 Das Wirkfaktorenmodell von Grawe.................................................................................................... 34 1.3.3 Weitere Erklärungsmodelle.................................................................................................................. 35 1.3.4 Praxisrelevantes Set von Prozessvariablen nach Sulz ......................................................................... 36 1.4 Interaktionistische Modelle ...................................................................................................... 38 1.4.1 Patient (A)............................................................................................................................................ 38 1.4.2 Therapeutenvariablen (B) .................................................................................................................... 42 1.5 CRN-Studie (zu 2 ).................................................................................................................. 50 1.6 Zusammenfassung der wesentlichen Erkenntnisse................................................................... 51 1.7 Forschungsfragestellung und zentrale Aussage........................................................................ 53 1.7.1 Einordnung der internen und externen Wirkfaktoren in das Mehrebenenmodell (MEM) von Belschner & Kaiser (1995) ................................................................................................................................... 53 2 Explikation der Darstellung der Forschungssituation................................................. 55 2.1 Theoretische Vorüberlegungen................................................................................................. 56 2.2 Einordnung des Themas in den Kontext der Therapieforschung ............................................. 60 2.3 Stand der Forschung zum ‚Image der Psychotherapie’ ............................................................ 60 2.4 Ähnliche Konstrukte................................................................................................................. 66 2.5 Fragestellung ............................................................................................................................ 68 2.6 Methode/ Design ...................................................................................................................... 68 2.7 Vorarbeiten............................................................................................................................... 70 2.8 Erwartete Ergebnisse................................................................................................................ 71 3 Empirie ............................................................................................................................. 73 3.1 Empirisches Modell.................................................................................................................. 73 3.2 Hypothesen............................................................................................................................... 79 3.3 Skalenkonstruktion ACP-a (Konstruktionsstichprobe) ............................................................ 79 3.4 Geplante Stichprobe ................................................................................................................. 85 3.5 Ablaufplan der Datengewinnung.............................................................................................. 85 3.6 Beschreibung des QS-Ablaufes................................................................................................ 88 3.7 Untersuchungsplan ................................................................................................................... 90 3.8 Gültigkeit des Untersuchungsplanes ........................................................................................ 92 4 Ergebnisse......................................................................................................................... 93 4.1 Deskriptive Analyse der Gesamtstichprobe ............................................................................. 93 4.1.1 Allgemeine Beschreibung..................................................................................................................... 93 4.1.2 Geschlechtsspezifische Unterschiede................................................................................................... 99 4.1.3 Altersspezifische Unterschiede (am Median gesplittet; Median = 38 J.)........................................... 100 4.1.4 Motivationsbedingte Unterschiede..................................................................................................... 102 4.1.5 Medikationsbedingte Unterschiede.................................................................................................... 103 4.1.6 Unterschiede in Abhängigkeit von der Veränderungssensitivität ...................................................... 104 4.1.7 Meinungsbedingte Unterschiede (VT = Psychotherapie?) ................................................................ 105 4.1.8 Therapievorwissenbedingte Unterschiede ......................................................................................... 105 4.1.9 Häufigkeitsverteilung für die Hauptstörungsgruppen der Gesamtstichprobe (ICD-10).................... 106 4.2 Itemanalyse der neu konstruierten Fragebögen ...................................................................... 109 4.2.1 Endorsementfrequenzen des ACP-a (t 1 = Therapiebeginn)................................................................ 109 4.2.2 Dimensionalität des ACP-a (t 1 = Therapiebeginn) ............................................................................ 109 4.2.3 Korrelationen der ACP-a-Skalen und Skalenreaktionszeiten ............................................................ 115 4.2.4 Skalenkorrelationen zwischen Erstgespräch (ACP-a) und Zwischenmessung (ACP-z).................... 118 4.2.5 Interkorrelationen und Reliabilität der ACP-Skalen zum Erstgespräch und Zwischenmessung mit Effektstärken....................................................................................................................................... 119
- Seite 1 und 2: Das Image der Psychotherapie Eine S
- Seite 3 und 4: Danksagung In erster Linie möchte
- Seite 5 und 6: Inge Schmidt-Hollmann (P), Dipl.-Ps
- Seite 7: Zusammenfassung: In dieser Disserta
- Seite 11 und 12: ACP Inhaltsverzeichnis 11 / 369 10.
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Abstract:<br />
This dissertation shows empirically that held opinions, clichés, and preconceptions about psychotherapy<br />
significantly influence the process and outcome of psychotherapy. Up to date,<br />
there has been an emphasis upon therapy-internal effect sizes (as motivation, readiness to<br />
change, intelligence, therapeutic relationship, …). However, the results of this study suggest<br />
the existence of a therapy-external effect size, which exerts an essential influence on the therapy-internal<br />
effect sizes: “The image of psychotherapy”. First, a pre-version of the instrument<br />
ACP-a (Acceptance of Psychotherapy) was designed from surveys and expert reviews to examine<br />
the main hypothesis, that “Acceptance of Psychotherapy is an effect size for the process<br />
of therapy”. This process developed into the final test-version ACP-a, which served to<br />
measure the “Image of Psychotherapy” of 342 out-patients of the “Norddeutschen Institut für<br />
Verhaltenstherapie” (Northern German Institute for Behaviour Therapy) in Bremen<br />
(NIVT)and was correlated with the therapeutic process and outcome. The therapeutic process<br />
was documented through a Therapist- and Patient questionnaire (ACP-P), which was specifically<br />
designed for this purpose, and handed out at each therapy session. The therapeutic outcome<br />
was assessed as measurement of change at two different measuring times (t1 = after the<br />
initial interview; t2 = after 20 therapy sessions) through a combination of questionnaires<br />
(SCL-90, SASB, IIP, …). This study demonstrates, that patients with low acceptance of psychotherapy<br />
have a more difficult/ intricate therapeutic process and a lower therapeutic outcome,<br />
than patients with high acceptance of psychotherapy. According to the results, more<br />
attention needs to be paid to the “public image of psychotherapy”, in order to change the public<br />
opinions and preconceptions about psychotherapy into a more positive direction, and<br />
therefore to support the effectiveness of therapies.<br />
Key Words:<br />
Acceptance of Psychotherapy, effect size, quality management, research<br />
on therapy process, questionnaire construction, consciousness<br />
research.
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