Wie wirkt Psychotherapie? Einflussfaktoren auf die therapeutische Beziehung

ZUSAMMENFASSUNG

Gegenstand und Ziel Die therapeutische Beziehung stellt einen zentralen Wirkfaktor in der Psychotherapie dar. Einflussfaktoren auf die therapeutische Beziehung sowie zugrunde liegende neurobiologische Marker sind wenig untersucht.

Material und Methoden Die Übersicht basiert auf einer Recherche in den zentralen Datenbanken (Pubmed und Psycinfo) zu den verschiedenen patienten-, therapeuten- und settingbezogenen Einflussfaktoren auf die therapeutische Beziehung und den Therapieerfolg sowie deren biologische Marker.

Ergebnisse Studienergebnisse zu den Einflussfaktoren auf die therapeutische Beziehung sind heterogen. Die Erfahrung von Kindesmisshandlung sowie die Diagnose einer Persönlichkeitsstörung stellen einen patientenbezogenen Einflussfaktor auf die therapeutische Beziehung dar, wobei beide Faktoren mit einer schlechteren therapeutischen Beziehung assoziiert sind. Die Passung zwischen den Persönlichkeiten von Patienten und Therapeuten scheint für den Therapieerfolg relevant zu sein. Erste Hyperscanning-Studien zeigen einen Zusammenhang zwischen einer besseren therapeutischen Beziehung und der neuronalen Synchronisierung zwischen dem Therapeuten und dem Patienten.

Schlussfolgerungen und klinische Relevanz Physiologische und neurobiologische Daten sowie detaillierte Videoanalysen können künftig die Auswahl von psychotherapeutischen Behandlungsmethoden, die Fallkonzeption und die Anpassung des therapeutischen Vorgehens verbessern.

ABSTRACT

Object The therapeutic relationship is an effective factor in psychotherapy. However, investigations on factors influencing the therapeutic alliance and underlying neurobiological markers are scarce so far.

Methods The overview is based on a research in central databases (Pubmed and Psycinfo), requesting the various patient-, therapist- and setting-related factors influencing the therapeutic alliance and therapy outcome as well as their biological markers.

Results The results of the factors influencing the therapeutic alliance are heterogeneous. Personality disorders and experiences of childhood maltreatment are patient related factors influencing the alliance; both factors are associated with an impaired alliance. The fit between the personalities of patients and therapists also seems to be relevant for therapy outcome. Hyperscanning studies show a positive association between the alliance and the neuronal synchronization between therapist and patient.

Conclusion Physiological and neurobiological data as well as video analyses can improve the selection of psychotherapeutic treatment methods, case conception and the adaptation of the therapeutic approach in the future.

Schlüsselwörter

Therapeutische Beziehung - Therapeuteneffekte - Neurobiologische Marker

Key words

Working alliance - therapist effects - neurobiological marker - therapeutic relationship

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