Psychotherapie auf der Couch des Patienten

Abstract

Despite the high morbidity of mental disorders in old age, psychotherapy take-up, especially by multi-morbid, very old patients, is still negligible, immobility being a significant constraining factor of access. So far, variations of standard psychotherapy adapted to meet these circumstances, such as home visits providing psychotherapy are not widespread and their effectiveness unexplored. An explorative study applying the 'Grounded Theory' method examined medical letters, consultation reports and session protocols of 7 psychotherapies involving 77-89-year-old patients; it also described the setting, nature and content of the therapeutic relationship. Psychotherapy at a patient's home - compared with conventional out-patient therapy - considerably alters the therapeutic relationship in as much as an undifferentiated fullness of experience and information has to be gathered and interpreted by the therapist. Current and previous relationships, as well as the experience of disease and imminent dying are important thematic fields. Within the framework of a supportive, defence-strengthening psychodynamic psychotherapy, clarifications, interpretations, and the accompaniment of existential conflicts and developments are possible. Conflicts of identity, aggression, closeness vs. distance and power can be named. Disease, constraint, dying and death are frequent topics. The therapist is more active, enactments are possible but a reflective attitude towards the patient's inner world can be maintained. Psychodynamic psychotherapy is possible in the patient's domestic environment. Further research on indications, psychotherapeutic attitudes, strategies, techniques and effectiveness of this psychotherapy variation is necessary.

Veränderung der therapeutischen Beziehung in Folge eines coronabedingten Wechsel von Präsenz- zu Videotherapiesitzungen: Eine qualitative Analyse von Therapeut*inneninterviews

“…Dies kann eine zusätzliche Vertrautheit zwischen Therapeut*in und Patient*in schaffen. Dies postulierten auch Lindner und Sandner 20 in ihrer Studie zur aufsuchenden Psychotherapie bei älteren Patient*innen. Der direkte Einblick in das Wohnumfeld der Patient*innen hatte in deren Studie einen positiven Einfluss auf die therapeutische Beziehung.…”

Adapted psychotherapy for suicidal geriatric patients with depression

“…Lindner et al [ 26 ] report on a psychodynamic psychotherapy by which very old adults are treated in their actual residential situation. This takes into account their immobility, which restricts their access to psychotherapy as it is now being practiced.…”