Obergutachten bei den psychodynamischen Verfahren - ein Beitrag zur Qualitätssicherung in der Richtlinien- Psychotherapie. Ergebnisse aus dem MARS1-Projekt

Abstract

The study investigates the factors that have a bearing on the development of a chief expert opinion in standardized German psychotherapy (psychodynamic therapies). As part of the MARS project a documentation system was developed to record the sociodemographic, clinical and biographical data of the patients as well as data relating to the therapists and the evaluation of the experts, all of which are contained in the therapist's reports. In a comparison of n = 153 chief expert opinions with n = 291 opinions relating to the control group under the normal process, differences occurred between the two groups with respect to the data on both patients and therapists. Moreover, the system records the frequency with which the individual experts contribute to the initiation of a chief expert opinion over a period of 3 years. Proceedings based on chief expert opinions are initiated with patients who have severe psychopathologies and marginal prognostic prospects. Reservations expressed by the experts refer in particular to the psychodynamics described and the foreseen treatment planning. The qualification and gender of the therapists are certainly an issue for chief expert opinions. The experts themselves contribute with varying degrees to the initiation of an expert opinion. While the role of patients and therapists in the realization of a chief expert opinion comes as no surprise and is in fact testimony to the quality assurance function of the process, considerable differences have emerged in the handling and approach adopted by the experts themselves. Calls for a better coordination process on the part of the experts should not go unheeded.