SANP Swiss Archives of Neurology, Psychiatry and Psychotherapy 2297-7007 2297-6981 EMH Schweizerischer Ärzteverlag AG Farnsburgerstrasse 8 CH-4132 Muttenz 03121 10.4414/sanp.2020.03121 Original article Social psychiatry Uferlose ambulante Therapien - eine Studie zur Dynmaik von langen Therapieverläufen, sozialer Entwicklung und Scheitern Cahn Theodor thcahn@hin.ch Basel | 4053 | SWITZERLAND Argast Urs Baer Niklas Glauser Christine Leonhardt Dieter Waldvogel Ruth Widmer Heinz 25 09 2020 171 05 0 0 Copyright: EMH Schweizerischer Ärzteverlag AG 2020 EMH Schweizerischer Ärzteverlag AG "Swiss Archives of Neurology, Psychiatry and Psychotherapy" is an open access publication of EMH published in accordance with the terms of the Creative Commons licence attribution - NonCommercial - NoDerivatives 4.0 International. You are free to share, copy and redistribute the material in any medium or format under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial — You may not use the material for commercial purposes. NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material. "Non-commercial" means not primarily intended for or directed towards commercial advantage or monetary compensation. The incorporation of publications in commercial products, the use of publications to advertise for commercial products or services and any other usage that directly or indirectly pursues commercial interests is subject to the express previous consent of the publishing house as part of a written agreement. Please send us your request in writing. Exact indication of the publication from which you would like to reproduce material and detailed information about its intended use help to facilitate and expedite request processing. <p>Based on experiences with long-lasting therapies with outpatients suffering both from chronical mental disorders and social disintegration, a group of professionals in the field (psychiatrists, psychologists and social workers) undertook this study. With the barely researched question of the interactions between therapeutic process and social development in the long-term course, we used a mixed-methods-design (qualitative-inductive analysis of own cases, followed by a quantitative survey). In the majority of our own cases a combination of rather vague therapeutic method, lacking patients’ or therapists’ detachment as well as patients’ social failure became apparent. It was possible to put forward some theses, which we tried to confirm with an online-survey amongst psychiatrists and psychologists in northwestern Switzerland. The response rate was unfortunately too low for an in-depth statistical evaluation, but available answers are within the range of our theses and correspond to available evidence: Socially disintegreted patients with long-term treatment seem to repeat their failure over their live course. Social failure gets the status of a symptom and is also acted out in therapy. Behind the current symptomatic, often a personality problem is decisive. The patients’ social situation requires the therapist to intervene outside of the psychotherapeutic setting. That triggers a difficult dynamic, especially the competence of the therapist is also at the mercy of failure. This ends with the therapy itself being chronical. The study shows critical aspects in the treatment of patients with severe clinical patterns, which can’t be eliminated easily. This requires further professional discussion.</p>