Scham und Schuld – Sein und Tun

Shame and guilt are affective experiential dimensions regulating the different forms of being and behaving in a social context. Constructive or even pathologic feelings of guilt are to be distinguished from real guilt. Shame refers to the judgment of ?So-sein” even if being often manifests itself in action. Shame is generated by the ideal ego. Guilt and feelings of guilt are dimensions of acting, real guilt requires the recognition of guilt, guilt is generated by the superego (conscience). The implications of familiar as well as extreme traumatisation for shame and feelings of guilt are discussed. The most frequent wish for a therapy nowadays that offers perspectives of changes by action can be considered as a defence against processing of the being in psychoanalytical therapy.     

Angststörungen und Phobien im Kindes- und Jugendalter

Anxiety disorders belong to the most frequent mental disorders in childhood and adolescence. They cause severe impairment, show poor long-term outcome and they are often not recognized as a mental disorder. For a reliable and valid diagnosis and treatment outcome evaluation a multi-informant approach is essential including information from the child and the parents. Methods of choice are structured clinical interviews and questionnaires filled out by the child and the parents. Meta-analyses showed that only cognitive-behavioral treatment can be considered as a sufficiently evidence-based treatment. No differences in outcome were found between individual and group treatments or child and family focused treatments. Medication treatment with selective serotonin reuptake inhibitor (SSRI) showed short-term efficacy. Major evidence-based interventions are psycho-education, exposure techniques and cognitive restructuring strategies.     

Übertragung und Gegenübertragung in Verhaltenstherapie und Psychoanalyse

Most psychotherapists and researchers agree that a good relationship essentially contributes to therapeutic change. The psychoanalytic concepts transference and countertransference which describe fundamental aspects of the psychotherapeutic relationship have now become integrated into behavior therapy. These concepts, however, are used differently in psychoanalysis as well as in behavior therapy. This makes the communication between psychotherapists coming from different orientations difficult. Therefore, a research approach which describes the important verbal and nonverbal elements of a helpful therapeutic interaction independently from therapeutic orientation could help to evaluate their effectiveness in different psychotherapeutic methods. In this way a culture of integration into psychotherapy could be encouraged.     

Ökonomisierung und Psychotherapie

Former fundamental social structures are disappearing and, especially by the economization and industrialization of medicine, the self-understanding of patients, doctors and hospitals has changed. From these developments psychotherapy gets into a strange area of tension, not only in the society as a whole, but also within medicine: on the one hand psychotherapy is needed more than ever, but on the other hand it finds itself in an outsider position. Thereby, the reality constructions of patients and psychotherapists are affected as well, mostly gradually, so that the consequences for the relationship between psychotherapists and patients escape attention. Dealing with these problems in a considered and transparent manner can avoid damaging the therapeutic work.     

Freud und die pränatale und perinatale Dimension des seelischen Erlebens

The tradition of psychoanalysis is burdened with fractures and splitting, the consequences of which have not yet, in my opinion, been adequately reflected. This concerns in particular the time-relatedness of some psychoanalytical concepts and the experiential importance of earliest experiences with the mother before and during birth. A fundamental reason for the incomplete apprehension of the reality of prenatal and perinatal experiences lies in the era-dependent and personally related limitations of Freud’s possibilities of insight, which were not adequately reflected in consideration of his great discoveries and from loyalty. The fractures mentioned were often compromise-like “solutions” relating to differing perceptions but also meant, more than had been realized, a loss of substantial insights. The consequence of this situation is that nowadays we have a variety of schools and groups with partial insights, which are, however, often arbitrarily generalized for the sake of group identity. This article is an attempt at a reflection of this situation and its background.     

Wirkung vorgeburtlicher und früh-nachgeburtlicher Umwelteinflüsse auf Gehirn und Psyche

The psyche of a human being is formed in strict correlation with the development of the brain. Genetic, epigenetic regulatory and prenatal influences through the brain of the mother as well as postnatal influences, predominantly as early childhood attachment experiences are all intertwined with each other. This takes place at three “limbic levels”: a lower level at which the infantile temperament resides, a middle level of early childhood impressioning experiences and an upper limbic level of socialization. The cognitive language level develops in a relatively independent manner. At the three limbic levels six psychoneural systems are operative, namely the stress processing, the self-calming, the impulse inhibiting, the motivation, the attachment and the reality and risk perception systems. Mental disorders are characterized throughout by disorders of the first two systems, predominantly in the form of greatly increased cortisol levels and greatly reduced serotinin levels. These then induce deficits in other systems; however, in less severe cases compensatory processes can occur via an attachment-related increased release of oxytocin. Similar processes also occur within the “therapeutic alliance” in the patient-therapist relationship.     

Ästhetische Befriedigung und Unbestimmtheitsreduktion

Zusammenfassung Vpn mußten unter standardisierten Bedingungen zweidimensionale Farbmuster herstellen, die ihrer Meinung nach ästhetisch maximal befriedigend, bzw. maximal unbefriedigend waren. Die beiden Gruppen von Bildern wurden untersucht, wobei sich eine Gruppe von ästhetisch befriedigenden und zwei Gruppen von ästhetisch unbefriedigenden Bildern zeigten. Eine weitere Analyse ergab, daß sich die ästhetisch befriedigenden Bilder von den ästhetisch unbefriedigenden statistisch darin unterscheiden, daß bei den ästhetisch befriedigenden Bildern die Farbelemente in hohem Maße zum Aufbau komplizierter und tiefer Hierarchien von Zeichen höherer Ordnung verwendet wurden, wohingegen bei den ästhetisch unbefriedigenden Mustern übergeordnete Konfigurationen entweder nur in einfacher Form und flachen Hierarchien auftreten (1. Gruppe) oder Zeichen höherer Ordnung gar nicht vorhanden sind (2. Gruppe). Aufgrund der empirischen Ergebnisse wird die Hypothese aufgestellt, daß ästhetische Befriedigung auf Unbestimmtheitsreduktion gegen Widerstand zurückgeführt werden kann. In einem nachfolgenden Experiment wurde diese Hypothese geprüft und bestätigt.

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Aesthetical appreciation and the reduction of uncertainty

Summary Subjects were asked to construct colored pictures which they considered to be aesthetically maximally pleasing or unpleasing. These two groups of pictures were analyzed and it was found that the aesthetically pleasing pictures showed a statistically significant increase in the number of higher order configurations of color elements and a greater hierarchical organization of such configurations. Furthermore, the higher order configurations of the aesthetically pleasing pictures were of a more complicated structure than the higher order configurations of the aesthetically unpleasing pictures. Considering these results, the hypothesis was raised that aesthetical appreciation may be based on the reduction of uncertainty against the resistance of a complicated system of ordering relations within a stimulus. This hypothesis was tested and verified in a subsequent experiment.

     

Alkoholismus und Selbstzerstörung

First, the development of addiction theory in psychoanalysis is recapitulated on the basis of the works of W.D. Rost and A. Heigl-Evers. For the understanding of alcoholism two concepts are fundamental. The ego-psychological concept postulates addiction as an attempt of a weak ego to help itself, while the object-psychological concept of Rost considers some forms of alcoholism as an expression of unconscious self-destruction.The author of the present article examines on the basis of a case study of autodestructive alcoholism the strength and weak points of the approach of Rost and proposes certain expansions of the model regarding first the object relations of the addict and the counter-transference, where a strong entanglement of the therapist with the destructivity of the patient is obvious. In addition, further considerations about the role of the superego are necessary, which faces the ego with hostility. Finally, the nature of the primary object of the addict person and the nature of the substance as transferential object should be examined. In the case of these inner objects there is a strange mixture of positive and negative aspects having in their consequence a great destructive potential for the person. This constellation bears resemblance to the pathological personality organisation as understood in Kleinian literature.     

Sexualität und Gewalt

Sexual assault as defined by law, psychiatry and sociological research is contrasted to the everyday definition of rape. Official figures on the frequency of sexual assaults as communicated in annual reports by the police differ greatly from figures found by research on sexual victimization or representative studies using different definitions of violence and abuse in sexual relations. Overpowering and violence is not a rare phenomenon in sexual relations – nearly every second woman and 10% of men are familiar with such situations. There are not only biological conditions (individual variance in neurophysiological parameters) but also psychological conditions favoring the use of power and threat instead of courting in sexual partnerships. External conditions are certain popular opinions in parts of society and certain subcultures which may also be more or less in favor of male superiority, thus helping the perpetrator to justify his assault or on the contrary helping the victim to find support in court procedures and therapy if necessary. Prevention therefore has two targets: a general one by changing popular opinions which are in favor of the use of power in sexual relations and informing persons in danger of becoming victims about the risks and the possibilities to protect themselves and an individual one by treating victims to overcome their psychological injuries and to treat perpetrators inside and outside the judicial system. The current discussion on increased availability of pornography in the internet shows both aspects: a general target to reduce negative influences of pornography which produces devaluating views on sexuality and women and the more individual task of tackling new forms of pathology created by the media at least for some of the consumers.     

Arbeitsstörungen und Prokrastination

Work disruption and procrastination include dysfunctional behavior in the context of completion of tasks in occupational and personal fields as well as in school and professional training. A psychological model for the explanation of work disruption and procrastination is presented. Based on this model dysfunctional behavior occurs when individual skills and personality factors do not fit with the demands and conditions of the task. Especially when depression, some anxiety disorders, test anxiety as well as adjustment disorders and personality traits related to personality disorders are present, work disruption and procrastination can play an important role as additional problems. A modularized intervention program is presented which can serve as a support for self-help, counseling as well as professional psychotherapy. It includes the analysis of dysfunctional behavior and cognition, improvement of work-related techniques, time-management and work conditions and reduction of distraction from work as well as improvement of work-life balance.