[Target dimensions of psychosomatic-psychotherapeutic care]

In 1965, the effectiveness of psychoanalytic therapy was demonstrated, which was then included in the reimbursement schemes of the statutory health insurance. In 1987, epidemiologic evidence was provided for the high prevalence of psychosomatic diseases, often associated with a high risk load. Later a phase model described the effects of psychotherapy by the successive levels of remoralisation, symptom and functional improvement. On the basis of health insurance data Felliti (2002) provided plausible evidence for the psychosocial aetiology of most chronic somatic diseases. These data correspond to a dramatically reduced life expectancy. Thus, a causal bio-psycho-social chain exists between adverse childhood events (ACE), unspecific bodily tensions, dysfunctional health-related coping behavioural strategies (risk load), serious chronic diseases and premature death. In summary, psychosomatic medicine and psychotherapy is a field of health care with a variety of target dimensions which can be brought together in an appropriate model.