Psychotherapie in der neurologischen Rehabilitation

Zusammenfassung

Dem Bedarf angepasste psychotherapeutische Maßnahmen gehören zum unverzichtbaren Behandlungsspektrum der Neurorehabilitation. Allein schon angesichts der großen Häufigkeit komorbider psychischer Störungen, die freilich nicht immer erkannt und angemessen behandelt werden. Die aktuelle Lage ist außerdem gekennzeichnet von einer großen Vielfalt angewendeter Verfahren und einem Mangel an Therapiestudien und gesicherter Evidenz. In diesem Stand der Dinge kommt freilich auch die Vielfalt und Komplexität neurologischer Erkrankungen zum Ausdruck. Zumal bei Vorliegen begleitender psychischer Störungen ist mit von mal zu mal anders akzentuierten Behandlungserfordernissen zu rechnen. Zugleich ist die bei einer Schädigung des ZNS besonders enge Verschränkung leiblicher und seelischer Funktionen zu beachten. Das alles macht eine gleichsam neurologische fundierte, multimodale Psychotherapie erforderlich, die unter Berücksichtigung der unterschiedlichen Behandlungsansätze und Verfahren in eine in sich stimmige, direkt in die weiteren neurorehabilitativen Maßnahmen integrierte Behandlung mündet. Vor diesem Hintergrund soll der Artikel für den nicht tagtäglich psychotherapeutisch arbeitenden Neurologen das Problembewusstsein dafür schärfen, dass psychische Komorbiditäten in der neurologischen Rehabilitation regelhaft vorkommen, entsprechende Behandlungsbedürfnisse aber häufig nicht erfüllt werden – verknüpft mit einem orientierenden Überblick über psychotherapeutische Aufgaben, Verfahren, Entwicklungserfordernisse und Perspektiven.

Abstract

The range of treatments available for neurorehabilitation must include appropriate psychotherapeutic approaches, if only because of the frequent occurrence of psychological co-morbidities, not always diagnosed and appropriately treated. The current situation is characterized by a large variety of available treatments, dearth of treatment studies and proven evidence. This state of affairs emphasizes the diversity and complexity of neurological disease. The presence of collateral psychological problems in particular requires individually tailored treatments. Damage to the CNS requires that particular attention be paid to the closely interwoven functions of the body and mind. What follows is the need for multimodal psychotherapy, grounded in neurology. Taking into account the various treatment approaches and regimens, therapy needs to be directly integrated in a meaningful, coherent way into other measures of neurological rehabilitation. Against this background, the paper gives an overview on clinical needs and therapeutic procedures as well as on the requirements and perspectives in the further development of psychotherapy in neurorehabilitation.

Schlüsselwörter

Komorbidität - Psychotherapieverfahren - multimodale Psychotherapie - bio-psychosoziales Modell - interdisziplinär

Key words

comorbidity - psychotherapeutic approaches - multimodal psychotherapy - bio-psychosocial approach - interdisciplinary

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