How nice is good for patients and for therapy outcome? The role of confrontation in the process of psychotherapy

It is well established that the therapeutic relationship contributes about as much to therapy outcome as 'technical' intervention. Furthermore, it follows clear prescriptive concepts in the same manner as technical interventions do. 'Motive Oriented Therapeutic Relationship' is such a concept for establishing a solid basis for whatever therapeutic work the patients' problems require (Grawe, 1980, 1992; Caspar, 1996). Yet, the therapeutic relationship doesn't explain everything because other factors play a significant role too. Previous studies showed that outcome is clearly better when therapists achieved a generally high quality of a therapeutic relationship when they did not shy away from possibly threatening interventions such as confrontations. This ratio of a fruitful alliance and marginally present confrontations in the same session also showed significant correlations with patient's assessment of alliance and progress in therapy (Figlioli et al., 2009).Aim: The current state of research in the field does not give any answers to questions like how good and bad confrontations can be characterized or what role does the intensity, respectively frequency of confrontations play in the process of psychotherapy. Methods: A sample of 80 therapies of 3 sessions each representing either good or bad outcome was judged moment by moment by independent raters if and how therapists used confrontative interventions. Results: Preliminary analyses show that successful confrontations are explicitly uttered, short but intense, related to important patients goals in therapy and embedded in prior complementarity. Discussion: The results will be discussed in terms of their implications for the clinical daily work.

How nice is good for patients and for therapy outcome? The role of confrontation in the process of psychotherapy

It is well established that the therapeutic relationship contributes about as much to therapy outcome as ‘technical’ intervention. Furthermore, it follows clear prescriptive concepts in the same manner as technical interventions do. ‘Motive Oriented Therapeutic Relationship’ is such a concept for establishing a solid basis for whatever therapeutic work the patients’ problems require (Grawe, 1980, 1992; Caspar, 1996). Yet, the therapeutic relationship doesn’t explain everything because other factors play a significant role too. Previous studies showed that outcome is clearly better when therapists achieved a generally high quality of a therapeutic relationship when they did not shy away from possibly threatening interventions such as confrontations. This ratio of a fruitful alliance and marginally present confrontations in the same session also showed significant correlations with patient’s assessment of alliance and progress in therapy (Figlioli et al., 2009). These findings are also very much in line with Sachse’s metaphor of accumulating, but then also using ‘relationship credits’ and Farrelly’s ‘Provocative Therapy’ (1986), as well as the ‘Intensive Short-Term Dynamic Psychotherapy’ by Davanloo (1980).Aim: The current state of research in the field does not give any answers to questions like how good and bad confrontations can be characterized or what role does the intensity, respectively frequency of confrontations play in the process of psychotherapy.Methods: A sample of 80 therapies of 3 sessions each representing either good or bad outcome was judged moment by moment by independent raters if and how therapists used confrontative interventions. Results / Discussion: The results will be discussed in terms of their implications for the clinical daily work. Preliminary analyses show that successful confrontations are explicitly uttered, short but intense, related to important patients goals in therapy and embedded in prior complementarity.

The biomechanics of the hip joint using new diagnostic aspects in the field of hip joint dysplasia. Constructive criticism of hip dysplasia diagnosis and present marketable breeding methods with an outlook on future perspectives and possibilities. Part I

In absence of basic canine hip biomechanics, a specific, consequent three dimensional concept to evaluate the coxofemoral joint was developed for the dog. With the help of a new method to radiologically demonstrate the hip in a physiological standing position several new clinically relevant aspects could be further investigated. For example the breed specific anatomical differences in the hip, and dynamics and the background on "iatrogenic luxations" in HD diagnostics could be shown. The caudal luxation and the growth abnormalities of the hip and their consequences on the whole leg (antetorsion syndrome) as a consequence of inadequate breeding could be demonstrated.

Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study

Motive-oriented therapeutic relationship (MOTHER), a prescriptive concept based on an integrative form of case formulation, the Plan Analysis (PA) method (Caspar, in: Eells (ed.), Handbook of psychotherapy case formulations, 2007), has shown to be of particular relevance for the treatment of patients presenting with personality disorders, in particular contributing to better therapeutic outcome and to a more constructive development of the therapeutic alliance over time (Kramer et al., J Nerv Ment Dis 199:244–250, 2011). Several therapy models refer to MOTHER as intervention principle with regard to borderline and Narcissistic Personality Disorder (NPD) (Sachse et al., Clarification-oriented psychotherapy of narcissistic personality disorder, 2011; Caspar and Berger, in: Dulz et al. (eds.), Handbuch der Borderline-Störungen, 2011). The present case study discusses the case of Mark, a 40-year-old patient presenting with NPD, along with anxious, depressive and anger problems. This patient underwent a seven-session long pre-therapy process, based on psychiatric and psychotherapeutic principles complemented with PA and MOTHER, in preparation for further treatment. MOTHER will be illustrated with patient–therapist verbatim from session 4 and the links between MOTHER and confrontation techniques will be discussed in the context of process-outcome hypotheses, in particular the effect of MOTHER on symptom reduction.

Eine Confrontation zwischen Glückel Hameln's Memoiren und den alten Hamburger Grabbüchern

David Jakob Simonsen

Rammed earth walls in Serón de Nágima castle (Soria, Spain): Constructive lecture

The Raya or frontier between the kingdoms of Castile and Aragón was fortified with a system of castles and walled-cities that were useful during the several conflicts that took place in the Late Medieval Age. The Serón de Nágima castle defended the communication road between the axis of the Jalón river valley, which flows into the Ebro, and Duero valley. Its uniqueness stems from the fact that it is one of the few fortifications in the area where rammed earth is the only building system used. In this paper, the castle building fundaments are exposed mainly focusing on the techniques and building processes developed from the interpretation of the legible constructive signs in its walls.

New Constructive Solutions to Improve Energy Efficiency in Existing Buildings and their Economic Viability

The improvement of energy efficiency in existing buildings is always a challenge due to their particular, and sometimes protected, constructive solutions. New constructive regulations in Spain leave a big undefined gap when a restoration is considered because they were developed for new buildings. However, rehabilitation is considered as an opportunity for many properties because it allows owners to obtain benefits from the use of the buildings. The current financial and housing crisis has turned society point of view to existing buildings and making them more efficient is one of the Spanish government’s aims. The economic viability of a rehabilitation action should take all factors into account: both construction costs and the future operative costs of the building must be considered. Nevertheless, the application of these regulations in Spain is left to the designer’s opinion and always under a subjective point of view. With the research work described in this paper and with the help of some case-studies, the cost of adapting an existing building to the new constructive regulations will be studied and Energetic Efficiency will be evaluated depending on how the investment is recovered. The interest of the research is based on showing how new constructive solutions can achieve higher levels of efficiency in terms of energy, construction and economy and it will demonstrate that Life Cycle Costing analysis can be a mechanism to find the advantages and disadvantages of using these new constructive solutions. Therefore, this paper has the following objectives: analysing constructive solutions in existing buildings - to establish a process for assessing total life cycle costs (LCC) during the planning stages with consideration of future operating costs - to select the most advantageous operating system – To determine the return on investment in terms of construction costs based on new techniques, the achieved energy savings and investment payback periods.

Hacia una taxonomía constructiva de las tapias de tierra y fábricas encofradas históricas = Towards a constructive taxonomy of the historical rammed-earth and formwork masonry

El objetivo fundamental de la investigación es el estudio de los fundamentos constructivos de las fábricas históricas de tapia de tierra y mampostería encofrada de las fortificaciones bajomedievales. Ante las incertidumbres detectadas en la datación de estas estructuras y frente al excesivo número de excepciones que quedan fuera de las clasificaciones tradicionalmente empleadas para estudiar este tipo de técnicas, el artículo desarrolla una propuesta de tipología o taxonomía constructiva basada en un sistema abierto. Este sistema nace del análisis de un número significativo de fábricas y atiende a diversos parámetros de control para la completa caracterización de cada fábrica: material, grado de compactación, función constructiva, encofrado, acabado superficial, combinación de materiales y situación, profundidad, formación y sección de los agujales. Cada fábrica se clasifica mediante una etiqueta alfanumérica. El sistema permite establecer tipos constructivos con los que se genera una clasificación cronotipológica constructiva. ABSTRACT The principal aim of the research is the study of the constructive reasons of the historical masonries built with rammed earth and formwork masonry, belonging to late medieval fortifications. Uncertainties have been warned about dating the historical masonries and there are excessive exceptions that do not fall in the rankings traditionally employed to study these techniques. Due to these reasons, the article develops a proposal of constructive typology or taxonomy based in an open system that comes from the analysis of a representative number of masonries and that attends to several control parameters tor the complete characterization of each masonry: material, compaction degree, constructive function, formwork, rendering, combination of materials and, last, the situation, deepness, formation and section of the putlogholes. Each masonry is classified through an alphanumeric label. The system allows establishing several constructive types which it is possible to do a cronotypological and constructive classification.

Sense-Making Bodies: Feminist Materiality and Phenomenology in Constructive Body Theologies

Constructive body theology provides an ethical commitment to and a set of analytical principles for understanding bodily experience. If we insist upon the theological value of embodied experience, how can we give an adequate account of it? Are feminist appeals to the senses useful in developing theological truth claims based in embodied experiences? Feminist theologies which explicitly seek to overcome body/mind dualisms often reinscribe them when they neglect to attend to perception as a critical element of bodily experience. Phenomenological analyses of perception (such as suggested by Merleau-Ponty) strengthen and refine our conception of embodiment. Grounding constructive theology in experience requires understanding experience as bodily perceptual orientation, as perceptual bodily and cultural acts involved in socially and historically situated contextual meaning-making processes. This shift expands phenomenological concepts such as intentionality and habit, and allows for a comparative investigation of historical and cultural differences in embodied experiences through examples found in sensory anthropology. Body theology, framed as principles, strengthens theological projects (such as those by Carter Heyward and Marcella Althaus-Reid, as well as new constructive possibilities) through opening dialogical avenues of exploration into embodied being in the world. Body theology principles help us conceive of and address how our bodily experiencing--our feeling, tasting, hearing, imaging, remembering and other sensory knowledge --comes to matter in our lives, especially where oppressive forces viscerally affect embodied life.

Way of scoring by Spanish First Division volleyball teams in relation to winning/losing, home/away, final classification, and type of confrontation

The aim of this study was to assess the way volleyball teams score with regard to: whether or not they won the game, whether they were the home or away team, the level of the opposing teams, and the type of confrontation. The sample was composed of 118,083 plays from 794 men’s volleyball matches and 125,751 plays from 719 women’s matches of Spain’s first division clubs (from the 2002-2003 season to the 2006-2007 season). The variables studied were: the way points were obtained in each play, being the home or away team, the level of the teams, the result of the match, and the type of confrontation between the teams with regard to their level. The results demonstrate that for both men’s and women’s teams, the majority of the points were obtained in attack and by opponent errors. Differences were found with regard to the way points were obtained when winning or losing the match was taken into account as well as when considering the level of the teams. This paper discusses the differences found with regard to whether the team is home or visiting and the type of confrontation.

Excavated housing in Crevillente (Spain). Constructive and typologycal study

Underground architecture has sheltered man for many centuries, but the current need to emphasize the bioclimatic approach makes the study of excavated housing essential. This traditional construction is a part of the collective human living experience but also a reference in using the natural conditions of each region through simple proposals based on ground thermal inertia. The aim of this paper is to show the typological evolution of the excavated dwelling in Crevillente, in southeast Spain, compared to other worldwide architectural proposals or urban solutions. To show their adaptation to the regional geography and to comprehend both formal and material characteristics of these simple typologies, which do not need extra energy contribution for interior conditioning. This work is part of the doctoral thesis of the author.