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Zusammenfassung Vorlesung C1 Klinische Diagnostik und Psychotherapie
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InhaltCharakteristiken von Psychotherapie ............................................................................................ 7
Charakteristika psychologischer Interventionen................................................................................. 7
Rechtliche Rahmenbedingungen ................................................................................................... 8
Was ist Psychotherapie nach Psychotherapeutengesetz (2019/2020)? ............................................. 8
Psychotherapie-Richtlinie (vom GBA veröffentlicht, aktualisiert 2021) ............................................. 8
§5 Psychotherapieverfahren ........................................................................................................... 8
§6 Psychotherapiemethode ............................................................................................................ 9
§7 Definition psychotherapeutische Technik .................................................................................. 9
Berufsrechtliche Grundlagen............................................................................................................... 9
Psychotherapeutengesetzt (PsychThG), 1999 & 2019/2020 .......................................................... 9
Wissenschaftlicher Beirat Psychotherapie nach §8 PsychThG ........................................................ 9
Psychotherapeutenkammern: Berufsordnung ................................................................................ 9
Sozialrechtliche Grundlagen (v.a. SGB-V) .......................................................................................... 11
Sozialgesetzbuch V (SGB-V) ........................................................................................................... 11
Psychotherapie-Richtlinien............................................................................................................ 12
Psychotherapie-Vereinbarung (KBV Kassenärztliche Bundesvereinigung und GKV Spitzenverband
Bund der Krankenkassen) .............................................................................................................. 13
Psychotherapieausbildung ............................................................................................................ 14
Beratung vs. Psychotherapie ......................................................................................................... 15
Psychotherapeutische Versorgung .............................................................................................. 15
VT I: Diagnostik und Problemanalyse .......................................................................................... 16
Diagnostik .......................................................................................................................................... 16
Verhaltenstherapie............................................................................................................................ 18
Psychotherapie Richtlinie .............................................................................................................. 19
Grundprinzipien der Verhaltenstherapie ...................................................................................... 19
Methodologisches Grundverständnis des Behaviorismus ............................................................ 19
Störungsmodelle ............................................................................................................................... 20
Problem- und Verhaltensanalyse ...................................................................................................... 20
Mikroanalyse: horizontale Verhaltensanalyse (SORKC) ................................................................ 20
Makroanalyse (vertikale Verhaltensanalyse, Plananalyse) ........................................................... 22
VT II: Standardtechniken ............................................................................................................ 24
Operante Verfahren .......................................................................................................................... 25
Verhaltensaufbau .......................................................................................................................... 25
Bestrafung ..................................................................................................................................... 26
1
, Löschung (time-out) ...................................................................................................................... 26
Münzverstärker / Token Economy ................................................................................................ 26
Kontingenzverträge ....................................................................................................................... 27
Stimuluskontrolle .......................................................................................................................... 27
Konfrontationsverfahren ................................................................................................................... 28
Exposition ...................................................................................................................................... 29
Systematische Desensibilisierung.................................................................................................. 30
Wirksamkeit von Konfrontationsverfahren................................................................................... 31
Vorbehalte ..................................................................................................................................... 31
Exkurs PTBS ................................................................................................................................... 31
Entspannungsverfahren .................................................................................................................... 33
Methoden ...................................................................................................................................... 33
Aktivitätsaufbau ................................................................................................................................ 34
Verstärkung und Selbstverstärkung .................................................................................................. 34
Euthyme Behandlungsstrategien ...................................................................................................... 35
Modelllernen: Rollenspiel ................................................................................................................. 35
Training der sozialen Kompetenz ...................................................................................................... 35
Gruppentraining sozialer Kompetenzen (Hinsch & Pfingsten) ...................................................... 35
VT: Kognitive Ansätze ................................................................................................................. 36
Albert Ellis: rational-emotiver Ansatz................................................................................................ 36
ABC Modell .................................................................................................................................... 36
Störungstheorie ............................................................................................................................. 36
Aaron Beck......................................................................................................................................... 37
Kognitives Modell nach Judith S. Beck (1999) ............................................................................... 38
Ziel der kognitiven Therapie .......................................................................................................... 39
Gegenüberstellung ........................................................................................................................ 39
Intervention ................................................................................................................................... 39
Identifikation automatischer (dysfunktionaler) Kognitionen ........................................................ 39
Pfeil-abwärts-Technik .................................................................................................................... 40
Techniken der Disputation ................................................................................................................ 41
Hedonistische Disputation ............................................................................................................ 41
Empirische Disputation ................................................................................................................. 41
Empirische Disputation: Verhaltensexperimente ......................................................................... 42
Sokratischer Dialog ........................................................................................................................ 43
Logische Disputation ..................................................................................................................... 44
2
, funktionale Kognitionen ................................................................................................................ 44
Dritte Welle der Verhaltenstherapie ................................................................................................. 44
Gesprächspsychotherapie ........................................................................................................... 45
Merkmale des Klientzentrierten Konzepts ........................................................................................ 45
Klientzentrierte Persönlichkeitstheorie ............................................................................................ 45
Selbstkonzept ................................................................................................................................ 47
Diagnostik: Strukturmerkmale des Selbst ......................................................................................... 47
Therapeutische Grundbedingungen.................................................................................................. 48
Therapeutenmerkmale...................................................................................................................... 48
Indikationskriterien ........................................................................................................................... 48
Therapeutisches Handeln .................................................................................................................. 49
zahlreiche Weiterentwicklungen....................................................................................................... 49
Focusing Therapie nach Gendlin (1981) ............................................................................................ 50
Schritte des Focusing ..................................................................................................................... 50
Prozess-/Erlebnisorientierte Therapie nach Greenberg ................................................................... 50
Klärungsorientierte Psychotherapie nach Sachse (2003).................................................................. 50
Motivebene ................................................................................................................................... 51
Ebene der Annahmen und Schemata ............................................................................................ 51
„Spielebene" oder Kontrollebene ................................................................................................. 52
Therapeutische Prinzipien bei Klienten mit Persönlichkeitsstörungen............................................. 52
Empirische Absicherung .................................................................................................................... 53
Psychodynamische Verfahren (Tiefenpsychologie) ...................................................................... 53
Allgemeine Infos ................................................................................................................................ 53
Theorien ............................................................................................................................................ 54
Diagnostik .......................................................................................................................................... 55
Projektive Verfahren ..................................................................................................................... 55
Operationalisierte Psychodynamische Diagnostik ........................................................................ 55
Aufstellen von Hypothesen/ Psychodynamik.................................................................................... 56
Konfliktmodell ............................................................................................................................... 56
Psychotherapieforschung und Wirkfaktoren in der Psychotherapie ............................................. 57
Psychotherapieforschung .................................................................................................................. 57
Ziele der Therapieforschung.......................................................................................................... 57
Ergebnisforschung ............................................................................................................................. 58
Wirksamkeitsstudien ......................................................................................................................... 60
Prozessforschung............................................................................................................................... 61
3
, Leitlinien für die Psychotherapie....................................................................................................... 62
Psychotherapie bei Depression I ................................................................................................. 63
Symptome und Diagnostik ................................................................................................................ 63
F32 Depressive Episode ................................................................................................................. 63
Schweregrad einschätzen .............................................................................................................. 64
Störungsmodelle (KVT) ...................................................................................................................... 64
Verstärkerverlust Modell (Lewinsohn) .......................................................................................... 64
Erlernte Hilflosigkeit ...................................................................................................................... 65
Erlernte Hilflosigkeit und Kausalattribution .................................................................................. 65
Attributionstheoretisches Modell ................................................................................................. 65
Kognitives Modell .......................................................................................................................... 66
KVT bei Depression............................................................................................................................ 67
Anfangsphase ................................................................................................................................ 67
Psychoedukation ........................................................................................................................... 67
Aktivitätsaufbau ............................................................................................................................ 69
Aufbau sozialer Kompetenz........................................................................................................... 70
Kognitive Therapie......................................................................................................................... 70
Biologische Behandlungsmethoden .................................................................................................. 72
Psychotherapie bei Panikstörung und Agoraphobie ..................................................................... 73
Panikattacken .................................................................................................................................... 73
Symptome einer Panikattacke (ICD-10) ........................................................................................ 73
Diagnostische Kriterien: Panikstörung (F41.0) .............................................................................. 74
Agoraphobie ...................................................................................................................................... 74
Diagnostische Kriterien: Agoraphobie........................................................................................... 75
Diagnostik .......................................................................................................................................... 75
Epidemiologie .................................................................................................................................... 76
Ätiologie: Lerntheorie........................................................................................................................ 76
Intervention ....................................................................................................................................... 77
Psychoedukation: Paniksymptome ............................................................................................... 77
Kognitive Arbeit an Fehlinterpretationen - Vorgehen .................................................................. 79
Verhaltensexperimente bei Angststörungen ................................................................................ 80
Exposition – generelles Vorgehen ................................................................................................. 81
Exposition – konkretes Vorgehen.................................................................................................. 81
Exposition bei Agoraphobie – Therapieplanung ........................................................................... 82
Therapeutenverhalten in Exposition ............................................................................................. 82
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