pre-print from Märtens & Petzold (1999, Vol. I)
Rudolf Sponsel (GIPT), Erlangen Joint Practice for General and Integrative Psychotherapy and Psychotherapy Research translated by Agnes Mehl
List of Contents - Summary
the Concept of Cures and especially the Criterion-Valid Cure
within the GIPT
Tree of psychotherapy
Criterion valid cures
Axiom of cures XV
3. Digression: On the History of the Concept of Cures (Concept of Curative Effects)
4. Practical Examples for a Better Understanding of the Idea of Cures
Historical case no. 1
Historical case no. 2
Historical case no. 3
Historical case no. 4
5. From the Research on GIPT Therapy
5.1 Construction and Description of Different Specific and Gobal Measures of
Criteria-system of CST, aims and background
Afterwards it is shown, how psychotherapy research is seen, applied and judged within the framework of evaluation and quality management of the General and Integrative Psychological Psychotherapy (GIPT). Among others the following proposition is justified:
Any reflected-differentiated and documented practice of psychotherapy is at the same time genuine psychotherapy research. Thus any only nomothetic oriented research is to be rejected as biased, reduced and irrelevant. The third part introduces a practically-empirically tested and substantial manual for a criterion-oriented therapy planning and estimation of therapy success, which is also suitable to control intra- and interpsychical dispacements of symptoms.
A short outline of the history of GIPT and of the concept of cures is given including case examples and also the model of illness and the problem of causality with respect to etiology is explained. It is shown, that there is no scientific alternative to the general and integrative psychotherapy. Dogmatism of schools is a professional error and according to Mallach et. al. (1993) it is said: "If a medical professional overlooks new methods of treatment and sticks to out-dated methods this is contrary to duty". This of course is also true for psychotherapists.
In March 1994 the section of clinical psychology of the American Psychological Association (APA) has given a report of the "team for promoting and spreading psychological methods (see Hahlweg 1995) which tries to solve the problem of quality management as follows. First three quality classes are differentiated:
(1) therapies of well verified effectiveness
(2) probably effective therapies
(3) experimental therapies
It is important to note that according to this team the evaluation can and should be tested with respect to a specific problem. For the integrative ideographic approach this still doesn't go far enough, but the tendency is getting close (loc cit. table 1:277, table 2:278).
I. At least two sound group studies carried out by different research
groups prove the
effectiveness of the therapy by at least one of the following conditions:
A. The therapy is better than another treatment or a placebo treatment (using pills or caring).
B. It is comparable to an already proven form of therapy in studies
of adequate statistical
II. A large number of case studies proves the effectiveness of the therapy.
A. have an experimental design
B. compare the effectiveness of the interventions in question to another form of treatment (see I.A).
Further criteria for I and II:
III. The examined therapies have to be based on manuals of treatment.
IV. The characteristics of the respective sample have to be clearly specified.
I. Two studies prove that the therapy is more effective than a waiting
list control group.
II. Two studies, which meet the criteria I, III and IV for sufficiently proven forms of therapy in another way, but are carried out by the same research group, or a sound study proving the effectiveness of the therapy on the basis of these criteria.
III. At least two sound studies prove the effectiveness of the therapy
but are limited in
their significance by the heterogenity of the examined samples.
IV. A smaller number of case studies meeting the criteria of well proven forms of therapy."
There is a predominance of behavioral therapy(3) on the part of references. To ask for an "experimental design" for the individual case is extremely impractical and eccentric, especially as it is not even explicit what is meant exactly. It would be much more important to ask for a comprehensible documentation to check what really was done. The work concept has a pragmatic orientation and doesn't seem to know critical problems. It is positive that the research on individual cases is not misunderstood as the starting point of a supposedly "true research", but it is accepted as being equal.
Description of the problem: The treatment process (counselling, therapy) is influenced by many factors. Even if only few are differentiated, the explosion ob combinations is obvious even with simple configurations. These facts are the basis for Kieslern (German 1977) still valid and important criticism of the myth of uniformity within psychotherapy research. So far the traditional psychotherapy research was not able to draw the only correct conclusion from this that only an ideographic evaluation concept of the individual case could lead the way out of the dilemma. At least the following relevant classes of variables have to be considered for a therapy result TR:
(1) Environments, situations,
contexts of the clients/patients E1, E2, ...
Ei ... En. En and the influences
of these environments including the two main environments: personal relations
(partnership, familiy, friends, acquaintances, neighbours) and work environment
(work and profession, position, colleagues, business partners). An other
perspective looks at the individual framework of reality and at specific
Looking at a group of only four persons, like a family, with four basically possible affective relations results in more than for billion possible combinations (Sponsel, 1995).
(2) Persons having problems, disorders, illnesses - P1, P2, ... Pi ... Pn, e.g. individuals (children, youngsters, adults, old people) couples, families, groups, teams, organisations (systems) with their specific personality, genetic disposition and current life situation including the specific individual background.
(4) Applied methods M1, M2, ... Mi ... Mn to solve the problems, disorders and illnesses e.g. autogenic training, prescription of sports and play, practising the progressive muscle relaxation for disorders of the type "lack of relaxation". On the concepts of the methods within the GIPT see Sponsel (1995, 103): "Method indicates the fundamental path to seek for a goal."
(5) Technical realization of the methods T1 , T2 , ... Ti ... Tn. Technique in GIPT means the specific form of a methodical realization (organization, presentation, the way and the application mode of the method). The technical realization often is not sufficiently recognized - especially among therapists who are critical of techniques. Often, however, the wrapping and the "how" are very important.
(7) Criteria C1, C2,
... Ci ... Cn, of changes, success or failure
of therapy, e.g. measures of symptoms (scaling of the severity of the symptoms,
e.g. according to the quality of symptoms, intensity, frequence, degree
of harm), global health measures (like the trias by Freud, satisfaction
within the norm, well being - not valid for manic processes or for a obsessive-compulsive
isolation of symptoms - satisfaction in life within the norm), measures
of criteria e.g. reducing sick-leave days, goal <partner found> or <separation
managed> or <dis-loving successful>, reducing the use of pills by half,
no stationary treatment for x time units, symptoms improved, <attitude
Important addition: This is the place for the intra- and interpsychic problem of displacement of symptoms. It is not enough to only find a reduction of symptoms, although this often is a necessary and criterion-valid reflection of the cures. On the problem of measuring in the brief and hazy within the ideographic see Sponsel (in preparation).
(8) Sources of judges J1, J2, ... Ji ... Jn, , e.g. self informations of clients, reports of relatives or colleagues, impressions of therapists, impressions of independent judges on the basis of data.
(9) Methods of evaluation EMT1, EMT2, ... EMTi ... EMTn of the results of judgement, e.g. how good and reliable are the applied methods (objectivity, validity, reliability, stability, fairness, usefulness). T=type. At least three levels have to be distinguished for the evaluation: (T=1) individual case, (T=2) forming a group from individual cases (group study), (T=3) forming meta-analysis from group studies (quality and quantity). On the problem of evaluation especially qualitataive evaluation see Sponsel (in preparation).
(10) Other influencies Xi
Quality management and assessment of psychotherapy results according to this is a ten digit relation: TR = f (E_nvironment, P_erson, S_ymptoms, M_ethod, T_echnique, U_ser, C_riteria, J_udges, E_valuation M_ethod, X_rest and rescue category).
For any disorder Si there is a client/patient Pi
having it, living in a specific environment Ei .
A therapy method Mi is applied by a user Ui in a certain technical realization Ti with this or that result according to the criteria Ci as seen by the judges Ji , ascertained by the evaluation method EMi .
It can be seen easily that the combinations of variables exceed the
trillions without problem. To be able to research in the traditional way
one has to simplify to the extreme and to abstract and thus ends up with
the myth of uniformity by Kiesler and thus with very questionable results.
On the other side the attempt of Kiesler to handle the astronomic combinations
of variables in a grid model (1969) also has to fail, as Grawe (1988, 2)
It is asking too much of the traditional research on psychotherapy and so far it cannot solve the problem of the individual case in a way to satisfy the practicioner. The main reasons are:
(1) most researchers have little or no therapeutic experience and don't know what is really going on; (2) most of them have a questionable education in statistics-methodology and know little ideographically, because most courses have no concept for this; (3) it lacks creative ideas. This, however, doesn't prevent many "scientists" to feel superiour to ideagraphically experienced practicioners. In fact all psychotherapists conceptualizing and using therapy in a differentiating-reflecting (metatherapeutic) way are genuine researchers of psychotherapy. This can be controlled the better, the better they document their therapeutic work. The elementary problem of any research not starting off ideographically with the individual case is the basic "aporie" of the transfer of the results, i.e. when and under which conditions may a conclusion be drawn from the evaluation to the application in a new case and vice versa when may a conclusion be drawn from an individual case result to a general application. According to the strictly traditional theory of science both cases - deductive and inductive - are logically not proven arguments by analogy. Already this consideration shows, that the traditional theory of science generally is not helpful. On the critique of the traditional theory of science see Sponsel (1995, 328-352), especially on the liberal concept of a theory of science of GIPT (loc cit. 335).
The extreme astronomical possibilities, which lie in only one psychotherapy,
are also the scientific reason why the traditional schools of therapy with
their narrow dogmatic concepts represent rather a confession than a profession
and don½t stand up to the variability and complexity of realtity.
Therefore there exists no scientific alternative to the general and integrative
psychotherapy. Dogmatism of schools is a professional error and Mallach
(1993,2) says on this:
"If a medical professional overlooks new methods of treatment and sticks to out-dated methods this is contrary to duty (BGH* NJW 1978 587, OLG Bamberg VerR 1977 436)." This of course is also true for psychotherapists.
Before Freud almost all of psychiatry and the included psychotherapy
of the time was
G_eneral, D_ifferential, E_clectical, I_ntegrative, S_chools and methodes integrating ("GDEIS") - ignored(6) and suppressed by Freud and his successors. This is documented by many psychological-psychopathological journals(7) since 1780. Then the empirical psychology started to develop. The first measures on after-sensations were reported by Nikolaus Tetus (around 1770). And C.C.E. Schmidt(9) recognized already in 1791 - almost 200 years before a systematic movement - that the human body is e.g. an organized and a self organizing being. And already in 1751 Johann Christian Bolten, physician in Halle realized that the basis of any psychotherapy is a sound knowledge of psychology. The first large and systematic publication on general and integrative psychotherapy was written by Johann Christian Reil in 1803 (see Ernest Harms (1960). American Psychiatric Association Journal (66, 1037-1039)
J.A.C. Heinroth (1773-1843), who in 1811 got the first chair of psychic therapy(10), recognized in his textbook of psychic disorders the great significance of heuristics for skilled treatment. According to Heinroth therapy is a heuristic "business". Even Wilhelm Griesinger (1817-1868), who is said to be the founder of scientific psychiatry, wrote in "Pathologie und Therapie der psychischen Krankheiten" (pathology and therapy of psychic illnesses) in 1861 (§205, p. 471): "Zunächst auch von der Thatsache des empirisch constatirten Erfolges ist auszugehen, indem für die psychische und somatische Heilmethode eine absolut gleiche Berechtigung in Anspruch genemmen wir(first one has to start off with the fact of empirically proven success by making psychic and somatic cures absolutely equally available)". Griessinger didn't shy away from using the term Eclecticism and advocated an "ecclectische Concession beider Partheien" (eclectic concession on both sides) (p.471), like before Leupoldt in Erlangen in his textbook from 1837 (p.27). In 1897 Leopold Löwenfeld, who in the 1870s spent a few years in the USA, published his textbook on the complete psychotherapy. He was followed by no one less than Hugo Münsterberg in 1909 with his Psychotherapy and in 1914 with a corresponding section in "Grundzüge der Psychotechnik" (essential features of psychotechnique). Also Dornblüth, founder of the clinical dictionary, today known as Pschyrembel, wrote a general psychotherapy in 1911.
In 1936 the work by Saul Rosenzweig `Some Implicit Common Factors` was published including the famous statement: "At last the Dodi said, 'Everybody has won, and all must have prices'". Already in 1940(11) there were first efforts to bring different schools of therapy round the conference table (for reference see a reader by Sponsel 1995, p.587) including Carl Rogers - completely unknown at the time, today well-known - and Saul Rosenzweig, a psychotherapy researcher being close to psychoanalysis, who was snubbed so nastily and unadequately by Freud.
Still much further back to the year 1910 reaches the branch of psychosynthesis(12), which Roberto Assagnoli first outlines in his critical dissertation on Freud.
early approaches (in the 20th century). In 1950 the famous publication Personality and Psychotherapy: An Analysis in Terms of Learning, Thinking and Culture by Dollard and Miller comes out. Also around this time Thorne starts publishing.
J.D. Frank publishes his pioneering book on general curing factors from schamanism to modern psychotherapy in 1961 (German 1981).
Lazarus says to have started developing the technical eclecticism and the multimodal therapy around 1967.
From the humanist psychotherapy Hilarion Petzold develops his large and still continuing work in Germany starting in the 70s: from 1975 the magazine "Integrative Therapie" comes out - the same year Bastine publishes an important article in Psychologie Heute; in 1993 his main publication in three volumes comes out.
In 1967 the book by Neisser comes out indicating the famous cognitive swing, which in psychotherapeutic circles had been already anticipated by Ellis in 1956 (published in 1962). In the same year Systems of psychotherapy: A comparative study by Ford and Urban comes out. In 1977 the book by P. Wachtel "Psychoanalyse und Verhaltenstherapie. Ein Plädoyer für ihre Integration (psychoanalysis and behavioural therapy: a summation to favour their integration) comes out.
A particular year became 1979, when Renaud van Quekelberghe presents the first modern and fundamental publication on general and integrative psychotherapy (written in 1977): "Systematik der Psychotherapie (systematology of psychotherapy) forming the basis for the qualification of the schools and methods integrating clinical psychologist BDP(13)
The concept of schools and methods integrating psychotherapy plays and important and central role(14) in the certification of clinical psychologists by the professional association.
In 1980 (German 1982) appears Garfield`s psychotherapy - an eclectic
From this all goes very rapidly and in the 70s and 80s the first international "GDEIS" organizations develop. The International Academy of Eclectic Psychotherapists (IAEP)(15) , which e.g. Ellis is member of, was founded in 1982 and organizes trainings and congresses (also on an international scale) and publishes a magazine (JIEP).
The Society for Exploration of Psychotherapy Integration (SEPI) was founded in 1983 and since then trainings are carried out regularly in many countries around the world and are documented in the magazine "Journal of Psychotherapy Integration". At the moment it has around 900 members, among them also many famous psychotherapists and psychotherapy researchers (e.g. Lazarus, Beck, Mahoney, Wachtel, Garfiled). The SEPI sees itself as institution to promote the contact between schools and the school integrating development. Homepage SEPI
In association with SEPI and the Academy many articles and books on general, differential, eclectic, integrative and schools and methods integrating psychotherapy come out (e.g. Norcross 1986, 1987; Norcross & Garfield 1992; Stricker & Gold 1993), but they all don't really reach up to the fundamental and general approach by van Quekelberghe.
On November,11.,1993 the DGGK (Deutsche Gesellschaft für Gestalttherapie und Kreativitätsförderung, German association for integrative Gestalttherapy and promoting creativity) was renamed after 20 years to DGIK (Deutsche gesellschaft für Integrative Therapie, Gestalttherapie und Kreativitätsförderung, German association for integrative therapy, Gestalttherapy and promoting creativity) (around 700 members). Numerous publications on the theory and practice of psychotherapy have been published not only with the associated publishing company, Jungfermann Verlag.
Since 1992 the chair of Grawe in Bern provides on a general training
of psychotherapy, which now is started once a year. In his infamous book
"Psychotherapie im Wandel" (changing psychotherapy)(16)
it says on page 787:
"We are convinced, that it is possible, even today, to realize an approximation towards such a general psychotherapy within trainings of psychotherapy and the practice of psychotherapy. We don't have to wait for a better formulated or better empirically tested concept." (emphasizing by R. Sponsel).
In the meantime two originally behavioural therapeutic training institutes (Munich and Bamberg) have been renamed as CIP (center of integrative therapy) and now train also "integratively", but with a behavioral therapeutic main focus and corresponding restriction.
In 1992, after 8 years of work, the Swiss group Blaser, Heim, Ringer and Thommen presented an eclectic-integrative publication on effective short-term therapy, which was developed at the psychiatric university hospital of Bern. There also trainings are taking place.
In Freiburg (Germany) the colleague Schramm trains IPT under Prof. Berger (Klerman & Weissman) and Berger also trains integrative, inclusive psychoanalysis and behavioural therapy. The medical profession generally tends to get trained very much integratively and get double qualifications (psychoanalysis and behavioural therapy).
I investigated and documented around 800 publications (of an estimated 1000) in my book on general and integrative therapy. And already in 1984 I carried out an extensive control study on the success of intergrative psychotherapy on a sample of N=1091.
1. The proceeding of the GIPT. It is summarized on the back of our application foms for psychotherapy - comprehensible for agencies bearing financial responsibility and patients.
I) Scientific basis of the GIPT For abbreviations and quotations see Sponsel 1995 (17)
Historically the general and integrative psychotherapy is based on the
psychological, psychiatric and psychotherapeutic works by Johann Christian
Reil (1803, 1805, 1808, 1812) and later for example on the works by Otto
Binswanger (1896), Leopold Löwenfeld (1897), Otto Dornblüth (1911)
and Hugo Münsterberg (1909, 1914), (Sponsel 1997).
The newer development of the general and integrative psychological psychotherapy (GIPT) scientifically is based on the fundamental principles of psychology, the processing by the international schools and methods integrating development of psychotherapy (18) and evaluation (Van Quekelberghe 1979 (19), Garfield German 1982, Petzold 1993, the DGIK (since 1993), EAG (since 1989) IAEP (since 1982, SEPI (since 1983), SEPI Germany (since 1995), Glatzel (1995) and Grawe et.al. (1994), Grawe 1995, Hummitzsch 1995, Sponsel 1995 etc. and the practical work proven for decades by the "schulen- und methoden übergreifenden Klinischen Psychologischen PsychotherapeutInnen des Berufsverbandes Deutscher Psychologinnen und Psycholgen ("KLIPS") (schools and methods integrating clinical psychological psychotherapists (qualification by the association of German psychologists) like it is described e.g. by Blaser et.el. 1992, Rahm et.al. 1992 or Sponsel 1995.
1) Working relation and assessment. First it is part of probatory sessions to find out whether a successful working relation can be expected, whether the patient has got trust in the competence of the GIPT therapist and the therapist feels qualified for the problem und thinks to be successful. From the beginning the eco-social environment of the patient is taken into consideration and possible inclusions are checked.
2) Case history, specific analysis of symptoms, causal (ethiological) diagnosis. (a) A detailed and comprehensive general case history (AAA) justifies that no relevant factors for the disorder are neglected, the optimal treatment is choosen (e.g. heart neurosis; Sponsel 1995 p. 461-463) and the positive ressources are included. (b) Afterwards it is soundly and specifically examined, how the disorders could have been developed, triggered, caused and maintained. (c) The causal development has to be examined better and more profoundly in cases, where a therapy without causal understanding doesn't appear to be successful.
3) Plan of treatment. On the basis of etiological knowledge a heursitic plan (heuristic being the science of problem solving) of treatment is developed according to curing experience, thinking and intuition, how this disorder(s) or illness should and can be treated under these conditions for this patient with this eco-social environment in a way that essential improvement, curing or a better coping is probable. The corresponding cures, methods and techniques are named, if they are familiar, or described. If methods are imported from schools of therapy, it is explained, how they are adapted.
4) Control and evaluation. The plan of treatment is documented in written form for control and evaluation purposes and is supplemented, modified and adapted for the current situation by records.
5) Quality management. The GIPT therapist is qualified
as clinical psychologist - in the school and methods integrating way -
by the association of German psychologists (BDP) and is subject to the
professional ethical obligations and the obligations for supervision and
training by the professional association.
In the GIPT the same ideas are valid on therapy evaluation as are developed by Kanfer, Reinecker & Schmelzer (1991) in "Selbstmanagementtherapie" (selfmanagementntherapy) (phase 6 and 7). Diagnostics and therapy according to ourmideas are mutually dependent and permanent. Thus diagnostics is part of any therapy and has to take place constantly.
The general model is based on a model of system disorders distinguishing the following phases of development: 1) Causes, conditions and evoking factors of the disorder. 2) The valuation of the disorder as illness. For the character of an illness reasonably an - important - disorder of function is defined (according to Gustav von Bergmann (1878-1955). 3) Different consequences (local, central, general, specific) of the disorder. 4) Raising and processing of information on the disorder and 5) The recovering procedures: the conflict between the forces of the disorder and the cure. Disorders can be exogenous (outside of the system) and endegenous (inside the system). Disorders generally have causes, which are dealt with in etiology within a general theory of illness . If a disorder, as mostly, is developed during time, this process is called pathology. Often the concept of symptom is not clear, as it may have a threefold meaning according to the model theory: 1) it is a sign of the disorder (e.g. certain antigenes in the body; anxiety); 2) it is a sign of the spontanous reaction to the disorder (e.g. certain anti-bodies against the antigenes; avoiding); 3) it is a sign of the recovering procedure, thus expressing the "struggle" between illness and curing processes (e.g. high temperature; conflict of ambivalence between avoiding and confronting).
The problem of causes is difficult according to the theory of science
for two principal and one avoidable reason: (1) Strictly speaking there
is only one tree with many branches according to the concept of causality.
Every identified cause can be traced back to other causes or at least can
be thought to be traced back to another. Which of these many causes can
be choosen to be the specific one? In reality it is mostly a complex of
causes, a network of conditions. (2) One has to differentiate between conditions
(framework or side conditions), occasions or triggers, and side and associating
effects, which often ist very difficult. (3) The psychic events can be
seen from several perspectives: e.g. physical, biological, chemical, physiological,
neurological, internistical, psycho-pharmacological, immunological, cybernetic,
psychological, socio-economical, social psychological, social-permissible
in law and communicative. Additionally, in the metapher of a computer the
hardware being physical and the software being psychic, both are multiply
joined and interrelated for the realization of the operating system of
man. It is not necessarily observable whether the bio-cybernetic events
of the body represent the "hardware" or the "software". Thus in many articles
and books three levels are confused: a) perspective (e.g. physical, chemical,
biological, medical, psychological, social), b) representation of hardware
or software, c) causes, side and associated effects or results. Independent
of the problems, the conceptual idea of one or more causes (trees or braches)
naturally is meaningful and reasonable. The tendency of some systematists
and popular constructionists to play down the problem of causes or even
declair it for completely superfluous, cannot be shared nor accepted by
the general and integrative psychotherapy.
Microconcepts on the process of therapy lead to the basic concept of
cures. By a cure we mean facts, the occuring of which potentielly. i.e.
relative to specific conditions has a positive, negative, neutral or ambivalent
effect completely or partially with a certain probability.
to establish or evoke them, are called methods and the specific way, how
it is done, is called technique. Different methods are summarized in the concept of procedures. (20)
Autogenic Training e.g. thus is a method to evoke the cure (curative factor) of relaxation. The specific application and wrapping: individually or in a group, in sections or in one stretch, lying or in cabman's position, are questions of the technique. The different methods of relaxation form the class of relaxation procedures e.g. autogenic training; progressive muscle relaxation; functional relaxation; hypnosis; meditation; natural methods like sports, playing, arts and culture; sleeping, lazing about and relaxing. Well known and effective cures (curative factors) naturally cannot belong to a school of therapy, even if they have been found or invented by it, but they are part of the general theory of cures and belong to everyone.
Positive cures improve, negative ones worsen a state of disorder or
illness, neutral ones have no and ambivalent ones have positive as well
as negative effects. Important general cures are for example activity,
giving up (letting go), consciousness, thinking, working through, attitude,
being aware / experiencing, feeling, sensing, assigning or giving energy
to ..., experience, knowing (ability, competence), cognitive schemes (concepts),
guiding, learning, confronting, doing, overcoming, avoiding, preparing,
rating/judging - primarily, rating/judging.
Cures can also be organized according to the perspective of important life themes, which at the same time is creating a therapy relevant checklist for case histories, e.g.: competition, rivalry, treating competitors, performance, effort, knowing, ability, competence, learning, talent, aptitude; coping, standing, tolerating, coping with, accepting; counting, position, rank, status; having e.g. work, flat, money, social security, partner, lover; goals in life, joie de vivre, respect, recognition; communication, clarity, sincerety, expressiveness; interests, inclination, preferences, dislikes; relation, distance, closeness, intimity, trust, bonding, love, hatred, partner, lover, relatives, aquaintances, contact; fighting, victory, defeat, winning, loosing, confronting, escaping; asserting, achieving, arguing, insisting; relaxation, calm, recreation, sleep; balancing/compensation: leisure, play, free time, pleasure; health, intactness.
Theoretically there is an infinite number of cures; those being practically relevant can be reduced to a few dozens (Survey see Sponsel 1995, 193-200). It looks like there are completely elementary and no further reducable cures, which we call atomic cures because they cannot be further taken apart on the level of psychic experiencing and consciousness. Experiencing_feeling_sensing doesn't seem to be taken further apart, whereas the process of remembering at least can be supported by different activities and thus represents rather a molecular or more complex cure. At the moment we cannot estimate the significance of the difference. However we want to warn to overestimate these differences. Learning and guiding definitely are no atomic, but very general cures, programs or because of their very general importance something like meta-cures (e.g. APLS in Sponsel 1995, 293). The following remarks, however, we think of being very important. It could be true, that these ideas contain the solution to some fundamental problems of therapy research.
The most important schools of psychotherapy and main classes of cures can be illustrated in a tree of psychotherapy:
The class of cures (curative factors) experiencing_feeling_sensing e.g. play an important part with the client-centered psychotherapy, with focusing, with body therapies, with Gestalt and with all relaxation therapies. The cure (curative factor) relaxing thus is a very important species of this class of cures (curative factors). Alexithmias, lack of orientation, psychosomatic masks of symptoms, stress and burn-out symptoms very often have to do with disturbences of experiencing_feeling-sensing. It is hard to overestimate the class of cures (curative factors) of experiencing_feeling_sensing; by the way it also supplies the psychological basis of the important class of cures (curative factors) of judging.
Understanding, consciousness and catharsis are the main cures (main curative factors) of psychoanalysis, but also of Gestalt and client-centered psychotherapy.
Learning and behaviour are the fundamental classes of behavioural therapeutic cures (curative factors).
Working through and clarifying are important species of the class of cures (curative factors)of communication playing a central part in all psychotherapies.
Rules - guiding, shaping and changing relationships - are important cures (curative factors) of interpersonal therapies, the transaction analysis, the system, strategic and communication therapy, especially of the application in group and familiy therapy.
Confronting are species of various classes of cures (curative factors), especially of doing which play a central part in behavioural and system therapy.
Guiding probably is the most important cure (curative factor) of all. It plays an obvious part treating compulsion, impulse neurosis, addictions and dependencies, avoiding behaviour and all the disorders of the type self-control on one side and overcoming passivity, lack of interest and lethargy on the other.
Criterion valid cures. Depending on the goals of therapy respectively the classes of goals looked at, a cure can become a necessary, adequate or necessary or adequate (equivalent) cure. Cures having such qualities in relation to classes of therapeutic goals, we call criterion-valid cures. Thus they are criterion for evaluation. This is of more importance, as thus the evaluation of a method is determined or at least very much delimited.
Confronting definitely is a necessary cure for all disorders and problems of the type avoiding, getting out of something, shirking, circumventing unpleasant matters, thus it is necessary for the evaluation of all phobias.
Learning and exercising are criterion-vald cures for all disorders and problems of the type lack of ability and competence assuming a certain level of intelligence.
The abilities experiencing_feeling_sensing and pay attention are probably necessary and adequate cures to avoid or reduce all psychically based disorders and problems of the type expecting too much and stress, but also to recognize values, wishes, goals.
Abreacting (catharsis) is probably a necessary cure for all disorders and problems of the type "affective accumulation". In order not to produce such an affective accumulation again and again, further considerations are necessary to prevent such an affective accumulation to happen.
I think, that the research of criterion valid cures in relation with certain classes of disorders, problems and thus therapeutic goals will help to bring the psychotherapy research much further.
Axiom of cures XV. Within the GIPT the significance of cures is put down in the axiom XV (Sponsel 1995, 140): Preliminary remark: This axiom is very radical, but represents in its radicalism the extreme complexity, difficulty and relativity of reality. And it represents the real experiences of any therapists and patients. It also has its good sides: it prevents from inadmissible, simplifying and wrong generalizations and repectively questionable schemes of diagnosis and therapy: it keeps awake, open, critical and makes us flexible. The idea of the relativity of all cures is an old one, basically it is found with Hippokrates, with Moritz (1783-1793) and with the early history of psychotherapy of Reil (1803; Sponsel 1997). Also in recent years this idea has been taken up several times: Wyss (1982, 87f) has introduced explicitely a "general principle of relativity" in his anthropological-integrative psychotherapy, even if it is not as specifically differentiated as ours. The idea of a relativity of cures can be found with many psychotherapists and researchers, the double character came up again only recently with Kriz (1994, 236).
(1) Principle of the double character: A curing effect can derive from the presence or absence (negation) of a cure or from a quantum of it.
(2) Fundamental relativity of effects: cures and quantities of it are only potential cures and principally can have four effects: positive, negative, neutral, ambivalent, i.e. positive as well as negative.
(3) Principle of individual relativity: whether a cure or a quantum of it is effective as such, can vary from individual to individual.
(4) Principle of situative relativity: whether a cure or a quatum of it is effective for one individual, can depend a lot on the situation, i.e. one and the same cure or a quantum of it, can have positive effects in one situation, negative ones in another, no effects or ambivalent ones in a third.
From A-XV, (1) to (4) follows a strict checking of the individual case as well with respect to the individual person as to the respective situation. This axiom includes lots of potential professional errors (Sponsel 1997).
In the early psychiatriy and history of psychotherapy research of the 19th century the term and concept of psychic cures (curative factors) were very common (Sponsel 1977). Even proper monopraghs came out on the issue: Thus Dr. F.G. Bräunlich (? - 1875), director of the private hospital Wackerbarthsruhe near Dresden, published a book of 352 paragraphs on 240 pages with the significant title "Psychische Heilmittellehre für Ärzte und Psychologen" (Psychic theory of cures for medicals and psychologists). He starts his book in the first chapter with the subtitle "Geschichte dre psychischen Heilmittel" (history of psychic cures), which is subdivided as follows: first period until 600 B.C. (21), second period until Christ, thirs perioad until the Reformation and the fourth period until present times. Still earlier is the work by Schneider, P.J. (1824)(22).
A complete history was provided by Friedreich (1830). One of the first large and fundamental works still dates back before BrŠunlich and was published by Johann Christian Reil (1759-1813),the father of the general and integrative psychiatry (23) and psychological psychotherapy.
In his main publication (Rhapsodien...§3) he developed a general theory of cures appearing quite modern (chemical, physical, psychic), which then anticipated three fundamental principles:
(1) the only potential nature of all cures (curative factors),
(2) the potentially infinite variety of cures (curative factors),
(3) the ideographic principle of relativity (Reil 1803; Löwenfeld 1897, Wyss 1982; Sponsel 1995). Reil (24) knew clearly already in 1803, that all materials can be looked at from several perspectives for different purposes, even have to, and that the curative perspective is only one of them. As this cognition is of greatest significance for practical psychotherapy I want to present the two main propositions here again:
(1) Almost all matters can be seen from acurative perspective, but naturally
also from other perspectives (first main proposition).
(2.1) All cures (curative factors) are only potential cures (curative factors).
(2.2) There is a potentially infinite varieta of cures (curative factors).
(2.3) The ideographic principle of relativity, i.e. whether a matter or material works as cure (curative factor) depends completely on the framework of reality and of the situation, on aims and purposes, abilities and possibilities of all who are engaged in the therapeutic process.
We express this extraordinarily significant fact in the general emblem / logo of psychological cures (curative factors):(25) may have the effect of cures (curative factors). The switching image in the form of an arrow expresses that the cures (curative factors) may work completely differently depending on the case and the situation.
Only with the development of the so-called "modern" psychotherapy and
the psychoanalysis, the valuable term of cures disappeared, to reappear
some 75 years later as curative factor respectively effecting factor in
the newer psychotherapy research (26). The
reception of the history of psychotherapy is partly extremely biased, superficial
and often wrong, unfortunately even within the academic clinical psychtherapeutic
literature. Although I generally very much appreciate the SEPI authors,
the title of the book by Freedheim (1992, Ed.) - History of Psychotherapy
- starting only with Freud seems rather astonishing; a better title would
have been History of Psychotherapy in the 20th Century.
Let's start with a classical example in various ways (history case no. 1): Describing flooding experiences of Goethe climbing the summit of a cathedral tower (Link "Straßburger Münster") to overcome his fear of heights (Quotation from Goethe 1770, from Gerlach, H.E. et.al. 1966, p.49p). As we can see here, Goethe like many others discovered for himself the cure (curative factor) of confronting, standing and training, which today is called confronting, flooding and exposing.
And some 150 years later we read with Ferenczi (2,1984, vol.II, 1927, orig. 1919, p.59-60):
History case no. 2
for confrontation therapy
"We, three friends from high school, went to university to study natural sciences. We started to integrate the infinite facts of chemestry, botany etc. in our store of knowledge and thus developed the basis for independent working. While two of us got along, the third started to get deeper into a sad mood finally leading to a deep melancholia and tried to commit suicide a few times. Already at grammar school our friend had a particular interest in history and liked written papers about causes and effects of differen historical events the most. His melancholia could only be cured as we, his friends, used tender strictness to take him to lectures of jurisprudence. After a few such lectures his mood improved constantly until he was completely healthy again. After this he enroled with the faculty of jurisprudence, finished his studies extraordinarily successfully and stayed normal throughout his life..."
Portrait: Iwan P. Pawlow (left), brother Dimitri (right)
The reporter is a well-known personality of the theory of cures, being
Pawlow (1849-1936) (27), getting the nobel
prize in 1904. It is remarkable with this case that the etiological concept
of a reactive melancholia is given and that the complete curing takes place
without any therapeutic help. It may be asked at this point, what Freud
or Rogers could have helped?
What are the cures (curative factors) here? Obviously a drastic directive treatment by the friends opposing the parental directive and supporting professional self-realization. The significance of this was already known by Reil. In the "Magazin für psychische Heilkunde (journal of psychic theory of cures) edited by Reil (portrait of Reil) and the philosopher Kayßler in 1805, Reil develops in his only essay "Medicin und Pädagogik" (medicine and pedagogics) the concept of self-development by Jung and the humanist concept of self-realization:
"... education cannot be "co-curing", but only reason for self-realization of what already is given by the predisposition" (p.418). And on p. 422: "The true method of educating and teaching is to activate and bring to life all the inner of a person."
Belief, illusion (28) and trust e.g. are important general psychic cures (curative factors) and the fundament of the placebo-effect being so important for the theory of cures. The following example taken from real life demonstrates impressively how Reil's brillant idea of a theatrical therapy could be used.
The important cure (curative factor) of the period of Janet (1859 - 1947), Breuer and Freud around the turn of the last century was called catharsis. If it succeeds to make repressed traumas conscious again thus removing dissociations of the emotion and the cognitive matter according to the psychoanalytic hypothesis, we don't believe it so generally and think it is true only sometimes. Combination theory of cures and methods
Example: Working through of the childhood.
Let's assume relatively independent methods i.e. those in which the sequence doesn't matter. Given e.g. the segment of therapy "working through the childhood" then it includes different standard treatings, like the following: (1) experiences and relation with the mother, (2) experiences and relation with the father, (3) experiences and relations with sisters and brothers, (4) significant experiences, (5) psychical working over these experiences, (6) relations today, (7) possible therapeutic goals with respect to the cognitive affective scheme of childhood. Spontanuously most will aggree that the segmental parts (1) to (4) can be organized quite independently, wheras for (7) it would be good to know (1) to (6) already.
The sequence being important, which definitely often is true in psychotherapy, the possibilities can be calculated according to a simple permutation formula N = faculty (n) with n being the number of combinating segments or methods. For n=10 results N= 4.037.932, thus around four millions. The sequence not mattering there is a simplified formula for the possibilities of combinations 2n-1. With 10 cures or combining methods result still 210-1 = 1024-1=1023 integration tasks, 100 different methods demand around
CST system. Between 1980 and 1985 I developed and empirically-practically
evaluated a number of methods being summed up in the term CST-system-diagnosis.
Aims & background. The method should be suitable for a better understanding of human beings, for therapy planning and particularly to control the success of psychotherapy (analysis of the existential orientation) in the established private practice (quick, simple, tough).
test theory: criterion oriented, i.e. all methods can be interpreted with regard to content and meaning even without statistical norms. For all methods - exception so far: family image scale (FBS) - norms on percent rank were drawn up usually for three comparing groups (cases, norm group, ideal group of those being relatively healthy and satisfied). For numerous single case studies a special measurement of reliability was developed not having the faults and weak points of the correlation coefficient (Sponsel 1994, I, 24-33). For all metods exists a Computer evaluation and scientific service. At the moment 6000 tests are included. The tests 01 to 08 are described and documented in the CST-system-handbook (2 vol., around 1400 pages). For the FBS scale there exists a manual. Methods 10 and 11 are only available through the evaluation service so far.
01 Statistical Header Card
It serves the research intending to study e.g. the character structure of all eldest sisters woith secondary school certificate, the life satisfaction of unemployed, the personality structure and first diagnosis of therapy drop-outs or of asthmatics then the statistical Header Card allows the specific search by computer coding.
CST - character-structure-test (according to Fritz Riemann)
The test is constructed according to the works by Fritz Riemann ("Grundformen der Angst") four basic structres Z (obsessive-compulsive), H (hysteroid), S (schizoid), D (depressive) are ascertained in their personality typical, not their clinical meaning by 20 items each. The four structures were translated into 17 groups of motives and were examined in pairs with respect to their amicability and influence (reinforcement, hindrance, relief or favouring, colouring) in 136 comparing analyses. From a mutual hinderance a measurement of the personality structure was developed, which also proved to be clinically valid. The measurement of tension has got two main meanings: (1) rich, multiple motivation full of tension with the integration being successful (type Goethe) or (2) rich and multiple motivation full of tension but the integration not being successful and symptoms being produced. The differential diagnosis: successful - not successful is operationalized according to the measures of the analysis of existential orientation (BA)), the measures of therapy control along the simple rule: BA scores o.k., tension o.k., BA scores not o.k. tension measures producing symptoms.
Character structures which are not clinically interpreted, but along general motivation psychology, are "translated" into the following groups of motives: Z (obsessive-compulsive): Z-perfection, Z-performance, Z-control, Z-security. H (hysteroid): H-demanding attitude, H-freedom. H-hunger for adventure, H-vividness, H-impressiveness. S (schizoid): S-distance, S-control (measuring somthing different from obsessive-compulsive control), S-aggression (indirect), S-identity (wholeness, homogenity), D (depressive): D-security, D-conformity, D-harmony, D-devotion.
energy-scale ("ego strength")
There are two variants here: one is built into the CST consisting of 20 items and one is built into the analysis of existential orientation consisting of 22 items. Psychodynamically the VS can be interpreted as estimation of ego strength as 20 life items are asked which usually are successful if a person possesses sufficient ego strength. Additionally this gives an operational definition of ego strength: life satisfaction; self-confidence; resistance; independence (2 items); confidence; self-esteem; confidence in one's own abilities; getting love, recognition and understanding; having true contacts; efficiency; ability to relax; vitality (3 items); ability to assert oneself; certainty of goals; job satisfaction; joie de vivre; knowing one's limits. The BA version also includes: ability to enjoy; ability to tackle problems, The statistical limit of being relatively satisfied and healthy turned out to be 14/20. The VS is suitable for therapy planning as well as validly esimating success control. On the sum-score-function (cardinal scale) of the VS see Sponsel (in preparation a).
04 PSBS- scale
of psychosomatic stress
Here 29 items are ascertained according to their frequencies (never, seldom, sometimes, often) with assigned raw scores 0, 2, 5, 10 (Sponsel, in preparation b). It is not rare that psychic-mental conflicts are expressed in psychosomatic symptoms. It is included: trembling, blushing, diarrhoe, constipation, sweating, stomach trouble, palpitaions, stabbing pain in the chest, back aches, circulation problems, breathing problems, asthma, exhaustion, tension, sleeplessness, tiredness, colds, seizure, restlessness, infects along with high temperature, night mares, skin disease, allergies, sexual problems. The scale is suitable for therapy planning as well as for the control of therapeutic success, especially og psychosomatic strain.
05 GVS - scale
of ratio of emotions
Here 13 positive and 13 negative emotions and moods were choosen representatively for all emotions and moods and calculated according to the categories (never, seldom, sometimes, often) with the raw scores 0, 2, 5, 10 (Sponsel, in preparation b). Then the relative share of positive emotions (G+%) on all emotions were determined with a criterion-oriented expected norm interval of scores between 60 and 80%. Higher scores express an exceptionally happy period of life, expansive syndromes or an exceptionally strong denial of negative emotions. The positive emotions and moods being joy, feeling of well-being, good mood, love, strength, trust, happy, confidence, vibrant, affection, recognition, power. The negtive ones being anxiety, annoyance, inhibition, anger, distrust, sad, depression, envy, disappointment, tension, hatred rejection, feeling of being ill. The scale is suitable for therapy planning as well as for the control of therapeutic success, especially for the condition regardring emotions and moods. The idea was promoted by studying the works by Flugel (1925) and the Polish School of Emotions of Reykowski (German 1973).
06 SKS - scale of
The SKS is asking for traditionally general human faults and weak points. Someone is self-critical, if she/he is able to perceive and admit general human weaknesses. A pilot study was validated on 100 cases. The item-matter being assessed were: admitting annoyance; having secrets; admitting faults; delaying; having antipathies; white lies; envy for others; bad moods; occasionally lazy; sometimes irrationality; malicious joy; uncomfortable with criticism; sometimes diplomacy. Findings: of 11 items the norm group reaches a percent rank of 81, the case group (without expansive syndromes) reaches PR 63. Psychotherapy patients tend so be often more scroupulous, more self-critical, more strained by conscience (dominant on superego).
07 LZS - scale
of satisfaction in life
The concept is based on the homostatic model of motivation by Toman (1968, 1978). The simple idea of curing is: relatively healthy and satisfied people produce no or less symptoms. Thus: the score for satisfaction is a indirect sign of a probable or real production of symptoms. Thus a normal score should be determined being suitable as global measurement for health and for estimating the risk for a displacement of symptoms. Evaluating different areas the mechanisms of compensation and exchange can be studied. This procedure is examined, documented and evaluated carefully and in detail under 08 (SZS --scale of self-satisfaction) as part of my dissertation. Additioanlly to the real satisfaction also the level of demands is ascertained making it possible to get interesting information. 17 areas of life are examined on a natural percentage-scale of seven verbal estimations of markedness: work & job; friendships; recognition; money & possession; relaxation; realization of interests; influence and prestige; Health; giving love; receiving love; sexual fulfillment; familiy climate; living situation; neighbourhood; self-realization; quality of life; fellow men. The scale is suitable for therapy planning as well as for the control of therapeutic success, and especially to control inter-psychic displacement of symptoms: within eco-social systems, within families and with couples it can be worked at by several persons, but the increase of satisfaction for one person mustn't be at the expense of another.
08 SZS - scale
Whereas the LZS includes more components, which life offers (or not), the SZS is mainly related to the self. Usually the SZS scores are higher than the LZS scores. This makes sense: usually we are more satisfied with ourselves than with the the world and life. Sometimes this ratio is inverted and indicate a specific problem of self-criticism and over-criticism of the patient. 20 important dimensions of real self-satisfaction and the level of demands are ascertained: outer appearance; ability to enjoy sensuously; expressing positive emotions; expressing negative emotions; articulating wishes; expressing honestly ons's opinion; intelligence; knwoledge & education; professional knowledge; dealing with money; talents; openness; self-confidence; trust; activity; tolerance; sense of tact; love of mankind; readiness for responsibility; sexual lust.
09 FBS - scale of familiy
The FBS - scale of family image was developed in 1980 by a so-called scaling of competent judges (qualified clinical psychologists). It allows to judge the quality of an image as well as it is possible to determine the similarities or identifications, the contrasts and the differences when comparing two images. Thus also questions like the following can be examined, e.g.: identification who with whom, choice of partner in accordance or contrast with the mother, image of the father problematic or not, is the therapist/counsellor identified with a parent (analysis of trasnference), is the image of the partner positive, how well does A know B, etc.?
The quality of an image: The most important score regarding quality is the P%=positive percenatge. It is calculated as follows: 100 * (raw score positive : (raw score positive + raw score negative)); P% thus gives the positive percentage of the whole image. Images of a percentage less than 60 are to be calssified as significant and potential problematic. Experience proved "ambivalent qualities" (40-59) to be difficult. Sometimes it is easier to come to terms with a negative image than with a "half and half image". Extreme scores, extremes at the edges and medium choice were additionally ascertained. In any case a positive self-image (at least >= 60% positive share) should go along with therapeutic success. The standard survey is based on self image, image of the partner, image of father, image of mother. Thus in the therapy of couples there are 8 images allowing 28 comparisons. From comparing the self- and partner images result the 6 combinations by Harris (German 1975) (A: I'm (not) o.k., you are (not o.k. crossed over by B: I'm (not) o.k., you are (not) o.k.) operationally determined.
LGWS - life principles and value system. LG: life principles.
The scale of life principles is supposed to estimate the self-healing powers interpreted as ability to solve problems and cleverness of life. The model assumes that a good coping of life and ego-strength results, if a number of life principles which are partly or in detaim contradictory are available simultanuosly in the repertory of action of a person and can be used depending on the situation according to given aims and purposes. Thus: sometimes it is good to be real, but sometimes this is what is wrong and it would have been better to be cautious. Often it is good to stand up, but sometimes avoiding would have been better, etc. Relatively healthy and satisfied people heed such relativity principles of cures intuitively without consciously being aware of them. They are real and tactful, they assert themselves and adapt, they are realistic and they dream. The variety of principles, their appropriateness and their balance thus characterize a person relatively able to cope with life. In detail the LG ascertains 5 vital ego-functions (authenticity, decision, problem solving, doing without rationalizations, self-responsability) and 5 social ego-functions (adaptation, differentiation, cleverness of life, realism, social understanding). The LC score is the better, the higher the balanced scores are on the 10 sub-scales. Each sub-scale is signed in a compressed way fromm +++ to ---, so that it can be seen at a glance, where the problematic areas are.
WS: value system. The items of the valus system ascertain the personal rating (order of rank) and the image of man (order of rank of projections) and are evaluated in relation to each other. 6 value classes are determined: SKGM: senses, body, pleasure, leisure). GLKO: emotion, love, contact. K…BI: ability and education. LEAK: performance, success, activity. SICH: security (material and immaterial). WEIS: wisdom.
(1) The global measures of satisfaction. As part of my dissertation (Sponsel 1984) I created a terminological basis and important parts of technical instruments to control the success of psychotherapy particularly in the private psychotherapeutic practice and integrated it into the CST system. In the technical part of my dissertation two gobal measures were developed - the estimation of life satisfaction (LZS, 17 items, 34 including aspiration level) and of self-satisfaction (SZS, 20 items, 40 including aspiration level) - and evaluated (strictly symptom- and criterion-oriented according to the integrative psychological psychotherapy). Especially the scale level of estimation of satisfaction was examined. Also it was shown, that the mean is independent of the weight of the areas of features. The evaluation was based on N= 1091 surveys alltogether and the following treatment and control groups wre built:
norm- and control groups all N=403....................
(563 including repetitions for reliability & control)
all conspicuous (with symptoms) N=72 (loc cit. 313)
.. LSZ=53,0 %
conspicious (with symptoms) without specification .... LSZ=53,4 %
N=44 (loc cit. 317)
conspicuous (with symptoms) without treatment ........
N=28 (loc cit. 321)
inconspicuous (ideal norm group of those relatively
healthy and satisfied N=46 (loc cit. 325) ............ LSZ=66,9 %
beginning phase N=52 (loc cit. 329)..................
in between phase up to 1 year N=33 (loc cit. 333).... LSZ=50,0 %
in between phase longer than 1 year N=24 (loc cit. 337)LSZ=54,9 %
treatment groups all up to 1 year N=69 (loc cit. 341) LSZ=48,7 %
check-up group more than one year after finishing
treatment N=27 (loc cit. 345) ........................ LSZ=64,1 %
evaluation group according to criterion orientation
i.e. on a wide range the disorders had disappeared
respctively were significantly reduced
drop-out study up to 1 year after drop-out N=14 ...... LZS=48,1 %
drop-out study 1 to 2 years after drop-out N=16 ...... LZS=57,0 %
drop-out study without specification N=28 ............ LZS=57,0 %
drop-out without further treatment N=19 .............. LZS=54,5 %
Weights of the areas of life:
main proposition: der mean of the life satisfaction is arithmetically independent
of the personal evaluation, i.e. its importance is already considered by
the clients when marking with a cross (loc cit. 132; the correlation between
evaluated and unevaluated means of life satisfaction is r=.96 for N=30
(measure of similarity=95%). In detail the
following order of ranks resulted (orientation: higher figure=higher rank, R-rank, results ranks loc cit. 126):
receiving love .......... R10 giving love
............. R9 self-realization .........
R8 health .................. R8
friendships .............. R8 family climate .......... R8
sexual fullfilment ....... R8 work & profession ....... R7
recognition .............. R7 relationship of interests R7
relaxing ................. R5 living .................. R5
quality of life .......... R5 fellow men .............. R5
money & possession ....... R4 influence & reputation .. R4
neighbourhood ............ R3
Additionally a number of special studies were carried through, which are mentioned for information:
The significance of worksatisfaction (loc cit. 157)
The significance of satisfaction in love (loc cit. 203)
Connection trust and love (loc cit. 194)
The significance od self-realization (loc cit. 172; 262)
The significance of self-esteem (loc cit. 192)
The significance of life quality (loc cit. 174)
Analysis of breakthrough and authenticity (loc cit. 264)
Remark: For all groups also the level of aspiration of the satisfactions
Norms: percent rank, with respect to three levels of education, five age cycles and gender. Reliability: a reliability measure was developed and evaluated for the individual case, not having the weak points of the correlation coefficient (Sponsel 1994, 24-33), and for process and longterm analyses (LZS=94.4% similarity and r=.934; SZS=95.5% similarity and r=.89). Selectivity and analyses of regression and corelation were carried through.
For the markedness of syndromes we choose S and then we get:
markedness of syndromes
global measures Send < Sbeg Send = Sbeg Send > Sbeg
11 Markedness of syndromes is smaller after therapy than before, but also the gobal measure is smaller. Thus: strong susoicion of displacement of symptoms. The patient doesn't suffer from pest anymore, but only of cholera.
12 The situation has worsened.
13 The situation has worsened dramatically: as well on the level of syndromes as on the level of global measure.
21 Situation has improved on the level of syndromes, but this doesn't effect the global measure. Suspicion of displacement of syndromes.
22 Situation not changed.
23 Worsening: production of symptoms has increased, while the global measure stays equal.
31 Ideal success of therapy: the syndromes receded and also an improvement of the global measure resulted.
32 Although the sybdromes show no change, the global measure indicates improvement. The patient can get along better with the syndrome or she/he has settled down. Typical results of earlier psychoanalyses.
33 Paradoxical result: although the symptomes increase, the global measure also increases. This case should be examined carefully.
For all investigations we recommend the general GIPT-validity-meta-rule: the scores have to fit with the situation and the criteria of comparison. If thy don't, special security measures, interpretation efforts and considerations are necessary. Thus we found e.g. that the global measures we developed have to be particularily carefully controlled with expansive processes, with obsessive-compulsive isolations of symptoms and for specifical interest-oriented situation (desire for pension, question of compensation, selection, expert witnesses).
(2) Empirical investigation on the trias hypothesis of Freud
The trias hypothesis by Freud, saying that somone is healthy, who can
work, love and relax, was examined by me empirically via items of the vitality
scale (scale of ego-strength) and was confirmed (Sponsel 1982-1984, 1.
supplement 08AV:02, 3,4,5-UV; V8, V11, V15-01 to 10). Under the condition
that three items are approved, the conditioned propability to confirm criterion
14 or more items of vitality is p= 0.88, to exceed the pathological
limit of the production of psychosomatics decreases by factor 9 from
p=.16 with the conspicuous to .018. Also the conditioned probalility to
reach a positive ratio of emotions of >=60% is 2,5 times higher under the
trias condition by Freud than with the conspicuous. The score of conflict
and tension for PR=50 (Median) is with the trias condition fulfilled only
400 (N=228) in the personality structure, 690 (N=635) with the norm group
and even 1030 (N=187) with the conspicuous, thus it si extraordinarily
valid. Besides the validation and evaluation of the measure of tension
constructed in CST results in a clear argument supporting
the utility of methods justified regards content as opposed to artifically formal methods, like e.g. factor analyses.
6. Summary of the Pratical Procedure on Evaluation and Success Control: 12 Points Manual
(1) Case history of criterion-valid cures, case histories
and changes within the lebensraum
and life quality:
(2) Relatedness (partner, friend, family, neighbour, acquaintance)
(3) World of performance (work, profession, education, learning, performance, career)
(4) Recreation, leisure, pleasure & fun
CST system scales
(6) Personality structure within the CST, particularly scores of tension
(7) Vitality or ego-strength
(8) Ratio of positive emotions and moods
(9) Psychosomatic stress
(10) Life- and self-satisfaction
(11) Family image, particularly self-image
(12) Other individual pecularities
In future much attention within the GIPT will be given to the development of criterion-valid cures and their constant diagnostic application within the therapy process and to a methodology, which are consideres to be really scientific - beyond to the scientistical mythology of numbers, which is handed down so wrongly at the universities. (Sponsel 1994, in preparation a and b).
(1) GIPT= the international abbreviation of General and Integrative Psychotherapy. GIPT substitutes the precious IPPT
(2) GDEIS = for G_eneral, D_ifferential, E_clectical, I_ntegrative, S_chools and methodes integrating psychotherapy
(3) The juggling with names as it is practiced e.g. with the so-called "guide-line" therapies in Germany is not at all questioned. For the behavioural therapy Wittchen (1996, 165) is quoted: "Despite of thousands of practing psychotherapists calling themselves behavioural therapists it is almost impossible to find colleagues who practice an anxiety therapy according to the rules using cognitive or exposure techniques. Margraf is said to have found similar results in a representative survey.
(4) GDEIS= G_eneral, D_ifferential, E_clectical, I_ntegrative, S_chools and methodes integrating psychotherapy. Necessarily the selection is shortened and subjective. I do apologize to all who are not mentioned.
(5) Please see also the digression on the history of the concept of cures.
(6) Exceptions: Ellenberger and Hart brothers, who particularly appreciate the work of Janet.
(7) The first interdisciplinary, general and integrative journal was published by Karl Philipp Moritz 1783 to 1793 with the title "Erkenne dich selbst - Magazin der Erfahrungs-Seelenkunde" (recognize yourself - journal on experiential psychology), which in the first volume contains a clearly general and integrative conception of psychotherapy which is supposed to go back to the physician Marcus Herz. The journal is structured in five main categories: (1) psychopathology, (2) psychology, (3) diagnostics, (4) prophylaxis, (5) psychiatry and psychotherapy. Psychiatry as well as psychology and psychotherapy refer rightly to this first empirically interdisciplinary journal. It says in the preface that the journal is not about "moral prattle" but about "facts" (I, p.8)
(8) Here we follow the historian of psychology Max Dessoir (1902, p.367), contradicting the opinion that there was no "mathematical" - meaning measuring - psychology before Herbart. He thinks of the empirical measuring of time periods of after sensations, which Tetens (1777, p.32-33) mentions in his publication. Choosing systematic measuring and experimentizing for the birthday of empirical psychology, it doesn't start with the physician, philosopher and psychologist Wilhelm Wundt, but with the psychology of capacity by Nikolaus Tetens (1777, p.32-33) who says about measuring after sensations: Even the length of the duration of after sensations can be determined. Taking those which disappear the quickest, but are strong enough to be perceived, the shortest duration of this visual sensation is 6 to 7 thirds, with audial sensations it's only 5 thirds and still less with after sensations of feelings." And in footnote number 1 (p.33) he points out: "the impressions of feelings are only half as long as audial impressions, as I know from experiments, which I carried out, but this is not the place to describe them."
(9) It can be read in the empirical psychology by C.C.E. Schmidt (Jena 1791, p.425), that the human body e.g. is a orgaized ans self-organizing being.
(10) Heinroth talks of Hevrisitcs. I thank the Germanist Prof. Dr. Naumann, Univerity of Erlangen for explaining and proving that the term by Heinroth is equivalent to the term Heuristics.
(11) For comparison: The birthday of the general and integrative psychotherapy starts in 1803 when Reil published his elementary work of 500 pages. Before Freud everyone was working generally and integratively.
(12) Psychosynthesis. The positive ressources oriented and integrative psychotherapy approach by the Italien psychiatrist and psychotherapist Roberto Assagioli (1888-1974) was first outlined in 1910 in his critical dissertation on the psychoanalysis of Freud. At an international philosophical conference in 1911 in Bologna Assagnoli pointed out his ideas about the unconscious. In 1926 the Instituto di Psicosintesi was founded in Rome and was closed in 1938 by the faschists (re-opening in 1944 in Florence). In 1927 the article "A New Method of Healing - Psychosynthesis" was published. In 1965 the first main publication came out: "Psychosynthesis: A Manual of Principles and Techniques" and in 1973 the second main publication "The act of will". In 1957 the Psychosynthesis Research Foundation was founded in New York. The basis of this approach is the importance which is given to the healthy and positive and an open and un-dogmatic attitude towards the variety of procedures, methods and techniques developed internationally and on the basis of everyday life. (Survey of around 40 "techniques" (in our terminology "methods") German 1993, p.63-65). Illness is only one - mostly contemporary - aspect, one feature, one part of the complete human being having also many healthy aspects and sources. As a hypothesis for research symptoms are seen as blockades which have to be explored with regard to their meaning and function. According to psychosynthesis the release of constructive sources often makes the symptoms disappear. Psychosynthesis corresponds very strongly with the class of cures 'activation of ressources' of the research group Grawe et.al. (1994). Assagioli also deserves the merit to again have developed and made useable for psychotherapy the old psychic elementary category of will. After all he is the only more famous representative of a model of psychotherapy who has developed an explicit and practical psychology of will. Also the basic significance of values and purposes is emphasized correctly. In contradiction to Freud - in accordance with humanistic Ego-psychoanalysis and the humanistic psychotherapy - Assagnoli emphasizes 1) the significance of the conscious, 2) the significance of positive ressources and 3) the significance of present and future. The scientific importance which is given to parapsychology is critically seen from the GIPT perspective. Lit.: Assagioli, R. (German 1993, original 1965; German 1982, orig. 1973); Crampten M., in Corsins, R.J. (German 1983, 1052-1073).
(13) BDP = professional association of German psychologists.
(14) From 1971 to now. Here it is often not recognized both by officals and by chair holders of a certain school orientation, how this concept had been developed and spread already in the early psychiatry and psychotherapy of the 19th century (Reil 1803) and reached a second peak around the turn of the century (Löwenfeld, Münsterberg, Dornblüth) and made an extremely rapid development in the 70s of the 20th century. The publications by Van Quekelberghe, Garfield and Petzold already have built an extensive fundement since 1980.
(15) The communication with the IEAP according to my experience is not easy.
(16) The publication is to be evaluated in a differentiated way. It consists of three parts: 1) metaanalysis without studies controlling the strength of effects; 2) prove of effectiveness in favour of behavioural therapy (this has evoked a lot of trouble and criticism) and 3) the development of the general psycotherapy - also based on research results. The metaanalyses are naturally problematic with respect to methodology as well as the scientistic concept of controlled studies. Therefore I mainly refer to part 3)
(17) Presentation according to Sponsel (1995, 289-290)
(18) With respect to the authors we refer mainly to German publications.
(19) The Systematology of Psychotherapy is the first large modern fundamental publication on general and integrative psychotherapy. It was already written in 1977 and published in 1979.
(20) For more details please see Sponsel (1995, p.102-107), Sponsel 1997.
(21) For this period he names as most important cures (curative factors): arts, culture, music and the placebos: curious expecation, hope, belief, trust.
(22) Contains on page XIV the neologism "psychological-therapeutic". It is organized in three sections: "Materia medica", "Materia diaetica", "Materia psychica".
(23) From Reil also originates the term "Psychiatrie" in: †ber den Begriff der Medizin und ihre Verzweigungen (On the term of medicine and its branches"..(p.161), compare also Mechler, A. (1966).
(24) in ¤3 (p.23p): "Cures are matters, which we apply to animal bodies to try to make their illness disappear. These matters can be of physical or non-physical nature, substances from the world or etherical substances belonging to the cosmos, they can work through mechanic, chemical or other forces. Thus their reality is based on the relation between them and the purpose which they should reach. Thus in the world existing as diversity according to the laws of causality there are no matters having only the purpose to cure illnesses. Their effectiveness is limited and as diverse as the objects theyare applied to. The same matter which a medical professional uses to cure illnesses, can also be used for other purposes, e.g. for destroying the organization and thus in this other relation is a poison. The theory of cures thus has no specific area (dominium) in the series of natural matters, which it possesses, but chooses those matters being useful for the purpose of curing the human body. Thus it is only allowed a whereabouts (domicilium), which is not absolutely limited but changes, gets smaller and broader according to the progress of skills. The same matter is food, if it is substituting the loss of substance in a healthy body; it is medicine, if it reestablishes lost health; and it is poison, if it destroys. With all this it always stays the same matter. Therefore all efforts have to fail trying to draw a line within the realm of nature by diatetics, pharmacology, toxicology etc. and thus to seperate certain areas.
(25) In accord with the classical logic we distinguish here between contradictory (white - not white; feeling - not feeling, for instance desired with pain) and contrary (black - white), sometimes contradictory and contrary coincide, e.g. with the cure (curative factor) guiding the contradictory is not guiding and the contrary is letting (Sponsel 1995, p.188).
(26) Mertens (1993, vol. 3, p. 1929, however, has to admit 100 years (!) after the "preliminary statements" (Freud 11.1.1893), that there exists no elaborate theory on this important issue" (curative factors within psychoanalysis). Nevertheless they want to be a "guide-line" method.
(27) Quoted according to Schipkowensky (1966, p. 236)
(28) Reil's suggestions appearing phantastical, like e.g. a perfect theatrical illusion therapy are all based on empirical reports and case reports, all these bold and creatice ideas start from the observation e.g. sometimes delusion can be cured presenting the illusion of fulfilling the delusional idea like on a perfect Hollywood screene to the patient, e.g. seemingly, but convincingly giving birth of someone delusional pregnant.
(29) On the sudden cures see > Corsini`s "Konfrontative Therapie" Corsini R.J. (1983) vol. 1, p.555pp.