Background: Despite a long tradition of discussions on the evaluation of psychotherapy, there is still a lack of agreement for measuring change after psychological treatment. In this paper we describe the concept of statistical and clinical significance of change. We use the Symptom Checklist 90 R as a commonly administered instrument to propose conventions and cutoff points for psychological symptoms and their change after therapy. Method: A German norm population and several psychotherapy samples have been aggregated to calculate cutoffs and confidence intervals (reliable change indices) for statistically and clinically significant changes after psychotherapy. Results: The cutoff point between a ‘functional’ and a ‘dysfunctional’ population was calculated as C = 0.57 (Global Severity Index, GSI). Patients above this score need a change of at least RCI = 0.43 (GSI difference) for a statististically significant change. Below this score the RCI = 0.16. The use of multiple clinical groups (e.g. inpatients and outpatients) for a more realistic determination of a ‘stepwise’ clinically significant change, as proposed by Tingey et al. in the USA, is not possible in the German samples collected so far. Initial SCL 90-R scores in these groups do not show enough differences to call a move from one group to the other a clinically significant change. Conclusion: In the German samples investigated the move from a ‘functional’ to a ‘dysfunctional’ population and vice versa has to be taken as the criterion for a clinically significant change up to now.

The Adult Attachment Interview (AAI) was used to study 31 psychotherapists who treated 1,381 patients in intensive multimodal inpatient psychotherapy. AAI dimensional ratings of security versus insecurity and dismissiveness versus preoccupation were used to predict alliance and outcome via multilevel regression techniques (hierarchical linear modeling). There were no main effects of therapists' attachment dimensions. However, higher attachment security of the therapist was associated with both better alliance and outcome in more severely impaired patients. Implications of the findings as well as limitations of the study are discussed.

Urbanization by densification is globally increasing and endangers maintenance of urban green and associated social-ecological systems. Cultural ecosystem services play a crucial role in human well-being, especially in urban areas. We analyzed perceived importance of cultural ecosystem services provided by green space in Berlin along an urban-periurban gradient. Based on extensive pretests, we designed a standardized questionnaire and conducted 558 face-to-face interviews. B using multiple regressions and principal component analysis, we show that perceived importance of cultural ecosystem services and patterns of urban green use are affected by an urbanization gradient and associated changes in population density. Important cultural ecosystem services decreases in urban core areas with higher population density, whereas people in periurban areas with more available green spaces exhibit a greater valuation of nature. In contrast, social relations and cultural diversity had the highest importance in the urban core, while cultural heritage, education, natural awareness, recreation, and aesthetical appreciation were higher valued in the less populated periurban areas, suggesting two bundles of cultural ecosystem services.