Table Of ContentW
Heinrich Bartuska, Manfred Buchsbaumer,
Gerda Mehta, Gerhard Pawlowsky,
Stefan Wiesnagrotzki (eds.)
Psychotherapeutic Diagnostics
Guidelines for the New Standard
SpringerWienNewYork
Dr. Heinrich Bartuska
PD Manfred Buchsbaumer
Dr. Gerda Mehta
Dr. Gerhard Pawlowsky
Ass.-Prof. Dr. Stefan Wiesnagrotzki
Vienna, Austria
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Forewords from Various Perspectives
Translated from the German by Luna Gertrud Steiner
World Council for Psychotherapy
This book contributes to the clarifi cation of two fundamental questions of
psychotherapy:
1) how can we describe diagnostic processes in psychotherapy? and
2) can we solve the problem that there are different ways of diagnosing in
different psychotherapeutic schools, and will our answers transcend the
idiosyncratic1 self-conceptions of the pertaining theories and set the stage
for a conjoint diagnostic practice?
A study group within the Advisory Board of the Austrian Ministry of Health
and Women’s Issues concerned itself with these fundamental questions, thus
preparing the ground for the book you are holding in your hands.
Historically, the specifi c psychotherapeutic way of diagnosing has often
been experienced as insuffi cient, particularly when compared to medical
diagnostics. Treatment without accurate diagnoses to start from seems im-
practicable to most medical professionals. Psychotherapeutic diagnoses pur-
sue an entirely different way, in that it is embedded in the process or occur-
rence of people interacting, and we might term it ’thera-gnostics’, thus denot-
ing diagnoses that emerge in the course of therapy. Psychotherapy addresses
the subjectivity of a patient or a client, and not objectifi able biochemical
parameters. Nevertheless, we need to bear in mind that a patient’s subjectiv-
ity does not stand by itself but meets with the psychotherapist’s perspectives,
which also constitute subjectivity, however screened they may appear by
experience and knowledge. Hence, an interactive process of jointly elaborat-
ing diagnostic aspects of the patient’s personality is facilitated, including the
awareness of oneself and others, action competence, and emotional dimen-
sions. The diagnostic proceeding of psychotherapy is, therefore, a multi-
layered one which, apart from the individual dimension, is determined by
cultural and sociological parameters and traditions, which have to be taken
1 Structural or characteristic behavioral peculiarity of an individual or a group
VIII Foreword
into account in particular respect of an intercultural and increasingly glo-
balized world. For what is experienced as painful, deviant, or troublesome is
not only subject to individual perception but also to collective states of un-
consciousness.
The diagnostic process may be understood as a form of translation in so
far as a patient’s utterances, be they verbal or nonverbal, are transferred to a
new code of understanding, a process every communicator is involved in
because, as we all know, there is no such thing as non-communication. If in
an empathic relational fi eld we manage to decode a patient’s subjective lan-
guage including that of her symptoms and distress, a new language will crop
up which will fi nally explain the text the patient originally came up with. Dif-
ferent visions entail different actions. At best, translating widens the scope of
options of the affected individual and, precedingly, her scope of decision-
making.
Just as translating from other languages is judged successful only if the
hermeneutic depth dimension of a notion has been embraced and con-
veyed, the psychotherapeutic process calls for the same prudence: only if we
have grasped most of the meaning and the content may we adequately inter-
pret psychological occurrences and bestow meaning to them.
The present volume approaches the problem from two different angles:
on the one hand, it is in search of a language that lies ‘underneath’ the par-
lance of the psychotherapeutic schools, so to speak, and on the other, of one
that lies ‘between’ them.
‘Underneath’ the schools means fi nding a language that is comprehen-
sible to everyone, an Esperanto of psychotherapy, as it were. It is this lan-
guage’s most delicate duty to fi nd general acceptance – otherwise it would
not deserve the name ‘universal’ – by leaving the usual space of interaction
behind and by defi ning a new one. Its benefi t will be a common understand-
ing of basic diagnostic criteria.
The language ‘between’ psychotherapeutic schools will facilitate a learn-
ing process in reference to differing perspectives and traditions which, for
one part, promotes diversity of descriptions of various diagnostic phenome-
na, thus enriching the other viewpoints, and which, for the other, is apt to
identify the sameness of features which appear different at fi rst sight.
From this perspective, the book on hand provides the basis for psycho-
therapeutic diagnostics to rise from the Procrustean bed2 of an all too narrow
view, yet without abandoning the essence, the specifi city, and the vantage
points each individual school has to offer.
Alfred Pritz
President of the World Council for Psychotherapy
2 From the ancient Greek myth, denoting a situation that tends to produce conformity
by violent or arbitrary means (Random House Webster’s Unabridged Dictionary)
European Certifi cate for Psychotherapy
On a fi ne evening in June 1995, at the annual conference of the European
Association for Psychotherapy in Zurich, Heiner Bartuska convinced Digby
Tantam and myself that it would be a good idea to create a European Cer-
tifi cate for Psychotherapy.
It was his vision to have wide ranging discussions with all the national
representatives in the Association in order to arrive at a jointly agreed mini-
mum standard for European Psychotherapy training. Digby and I agreed to
co-chair the committee that was established as a result. Its task was to
come up with the European Certifi cate of Psychotherapy over the next
years and in the summer of 1997, in Rome, the fi rst draft was agreed by all.
In 1998 in Paris the Certifi cate was launched and awarded for the fi rst time.
The European Commission commended the ECP as an example of a profes-
sional qualifi cation, capable of recognizing equivalence of standards across
Europe.
The work that went into achieving this agreement was a marvellous,
though also arduous process of collaborative work. It required that each of
the country representatives on the committee, as well as each of the repre-
sentatives of the different modalities of psychotherapy learnt to listen to each
other. We all had to become masterful at compromise and negotiation until
we fi nally arrived at a jointly agreed document. It was a good example of the
spirit of the European Association for Psychotherapy, which has always stood
for inclusiveness, openness and tolerance on the one hand, and high profes-
sional standards on the other. The common objective was to defi ne, develop
and protect a European wide profession of psychotherapy. This objective
continues to be valid.
It is very telling that after the ECP process was completed Heiner Bartuska
should have gone on to write this book, since this represents the follow-up
to the process of the creation of the European Certifi cate. Here is a book,
which sets out the fundamental principles of psychotherapy in a systematic
fashion. It fl eshes out the standards agreed in ECP with the concrete realities
of psychotherapy training and practice. It aims to remind psychotherapists of
X Foreword
the need to consider the basic parameters of their trade and formulate these
clearly and explicitly from a trans-theoretical position.
Like with the European Certifi cate for Psychotherapy: once such a text is
written it seems obvious, but the writing of it can be extremely complex and
problematic. This book should provide an excellent complement to the bare
bones of the ECP. May many generations of trainee therapists benefi t from
these structures, which give them access to the profession of psychotherapy,
which we still had to defi ne and consolidate. To have such an edifi ce to
dwell in should in time allow trainees to feel secure enough within the pro-
fession to dare and be able to challenge it. In that sense it is my hope that
this book will stimulate the generation of new ideas, which in turn will affect
and alter the world of psychotherapy, keeping it in continuous movement.
Emmy van Deurzen
Austrian Federal Association for Psychotherapy
By 1990, psychotherapy had been established as an independent scientifi c
discipline and treatment modality, regulated by law through the Austrian
Psychotherapy Act (PthG). The defi nition and the circumscription of psycho-
therapy tie psychotherapeutic practice to a comprehensive, conscious and
planned treatment (§1 PthG). The formulation implied that psychotherapists
were obliged as well as authorized to set up diagnoses and indications self-
reliantly and autonomously. The explicit defi nition refl ected an understand-
ing of the psychotherapeutic profession which, by then, the accredited and
old-established schools had partly been implementing for years. They had,
moreover, advanced their lore continuously and taught it in their school-spe-
cifi c ways.
The discussion and the recurrent controversy as to whether psychothera-
py was an independent science or not, necessitated the elaboration of those
superordinate components which are inherent in all psychotherapeutic mo-
dalities and orientations. The challenge was to fi nd those intermodal and
interdisciplinary factors which could be considered as the core of a specifi c
psychotherapeutic, science-based form of diagnostics and thus of this par-
ticular profession altogether.
The Research Committee of the Advisory Board for Psychotherapy of the
Federal Ministry of Health and Women’s Affairs concerned itself with this
delicate task of elaborating the present Guideline for Psychotherapeutic Dia-
gnostics; it is closely linked to the psychotherapeutic practice and thus ori-
ented towards the Austrian Psychotherapy Act. Clearly and distinctly differ-
ent from the medical-psychiatric and clinical-psychological diagnoses, the
psychotherapeutic ones are described as process-oriented, intrinsic to the
psychotherapeutic procedure and as comprehension- and approximation
processes; these are thought to constantly accompany the therapeutic course
and to appraise the clinical pictures, conditions, or statuses within the frame-
work of psychotherapeutic treatment, as opposed to a diagnostic mode that
classifi es and is status-oriented. The Guideline describes the three crucial
pillars on which diagnostic cognition characteristically rests: (1) the ‘Symp-
