Psychotherapie als evidenzbasiertes Prozessmanagement

Zusammenfassung

Der vorliegende Beitrag entwickelt ein auf der Theorie selbstorganisierender Systeme beruhendes Verständnis von Interventionen in der Psychotherapie. Zunächst werden einige Anomalien des bisherigen Standardmodells, welches Effekte im Wesentlichen Interventionswirkungen zuschreibt, aufgelistet. Die weiterführenden Überlegungen gehen davon aus, dass Interventionswirkungen als Resonanzeffekte zwischen Systemzuständen des Patienten und Angeboten der Behandler zustande kommen. Um Therapie in diesem Sinne eines permanenten Erzeugens von Bedingungen für klienteneigene Selbstorganisationsprozesse sinnvoll gestalten zu können, bedarf es eines Feedback- Systems zum Monitoring der aktuellen Dynamik und Systemzustände. Beschrieben wird, welchen Nutzen ein solches internetbasiertes System für Therapeuten und Patienten haben könnte. Psychotherapie wird unter Einsatz dieser Technologie zu einem theoretisch fundierten und evidenzbasierten (das heißt, auf konkreten Prozessdaten beruhenden) Prozessmanagement. Diskutiert werden einige Konsequenzen für ein verändertes Verständnis von Interventionen sowie für die Professionalisierung der Psychotherapie.

Summary

This contribution gives an interpretation of therapeutic interventions which is based on the principles of complex selforganizing systems. Usually the standard model of how psychotherapy creates its effects is focusing on specific factors contained within specific interventions. Decades of psychotherapy research, however, have produced an amount of empirical anomalies to this model. An alternative understanding consists in the idea that interventions produce their potential outcome by resonance effects between the dynamics of the intervened system (i. e. the client) and the perceived events of the treatment or other meaningful environments of the client. By this, therapy is the continuous realization of the boundary conditions for self-organizing processes of the client’s mental and neural systems. Actually, this understanding is not metaphorical but has a very concrete meaning since internet-based feedback systems are available to measure and analyze the present states of self-organizing processes (Synergetic Navigation System). This technology will have specific benefits for the client as well as for the therapist. Psychotherapy becomes an evidence based and theoretically founded management process of the client’s systems dynamics. The base of the data driven evidence is the actual change process, not only the results of controlled outcome studies. Finally, the consequences for the role of interventions as well as for the profession of psychotherapy are discussed.

Schlüsselwörter

Intervention - Real-time-Monitoring - Evidenzbasierung

Keywords

Interventions - real-time monitoring - change process - evidence- based practice

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