„FreiRaum“

Zusammenfassung  Ein Blick in die kunsttherapeutische Praxis und Theorie ergibt weiterhin — nach einer vieljährigen Entwicklungs- und Etablierungsgeschichte in unterschiedlichsten Praxisfeldern in Deutschland — ein sehr buntes und vielfältiges Bild. Diese Vielfalt bezieht sich auf die Vorgehensweisen, die Arbeitsfelder und die zugrunde liegenden Theorien. Sie birgt viele Chancen eines individuellen Freiraums und macht die Kunsttherapie zu einem wertvollen Teil des therapeutischen Angebots in Medizin, Psychotherapie und Pädagogik. Gleichzeitig erschwert die Vielfalt den Versuch einer systematischen Erfassung der verschiedenen Facetten. Unser Augenmerk bei der Sichtung wichtiger Grundorientierungen und Konzepte von Kunsttherapie liegt dabei besonders auf den Potentialen der bildenden Kunst in der therapeutischen Beziehung.

„Homo ambivalens“

For many individuals, under the present social conditions the processes of constituting, developing and articulating the self, i.e. a dynamic personal identity, imply experience of ambivalences. The reference to ambivalences is also an important topic in the social diagnostics of a “globalized postmodernity” and its contradictions. Psychotherapy has accumulated a rich stock of knowledge about the analysis of ambivalences and ways to deal with them. This wisdom can be used to stimulate the repeatedly claimed interdisciplinary discourses between psychotherapy and social, cultural and biological sciences. For this purpose a concept of human nature (“Menschenbild”), labelled “homo ambivalens” is proposed. This concept is to be thought of as a general heuristic orientation. It postulates not only the ability of human beings to experience and reflect ambivalences but also to judge them in an ambivalent way, namely as disturbances and burdens as well as possibilities for openness, creativity and freedom.     

Projekt „Brisant“

Die hier vorgestellte Ma?nahme versucht die Lücke zwischen station?rer Entw?hnungsbehandlung und dem beruflichen (Wieder-)Einstieg zu schlie?en. Gerade nach der Entlassung kommt es innerhalb der ersten drei Monate h?ufig zu Rückf?llen. Grund dafür ist unter anderem der Umstand, dass viele Verhaltens- und Denkweisen erstmals seit langer Zeit nüchtern und in abstinentem Zustand ausgehalten werden müssen. In dieser hoch sensiblen Phase ist es daher verst?ndlich, dass viele Patienten verunsichert und nicht ausreichend stabilisiert sind für die Herausforderungen der Arbeitswelt beziehungsweise der aktiven Jobsuche.     

Diagnose „Gesundheit“

In the early days of psychotherapy diagnoses were seen as unnecessary and even not helpful. After psychotherapy has become a method of medical treatment diagnoses are necessary in order to justify reimbursement of treatment by health insurance. Diagnoses are also useful to guide treatment, help communication between professionals and morbidity statistics. Diagnoses can have negative effects, such as simplification of complex problems, aggravation of normal life experiences or stigmatization and labelling. Therefore, diagnoses should be made when a person is suffering from an illness in order to avoid underrecognition and undertreatment. Similarly, the diagnosis “healthy” is important when no disease is present but only a normal problem in everyday life. To say that a person is healthy is an important and difficult task in all areas in medicine. Therapists must not only know the criteria for illnesses but also those for the spectrum of healthy problems in normal life. This can be done when the psychopathological assessment is professionally precise and makes a differentiation between signs of illness and other negative feelings. Also, normal life events must not be directly translated into illness states. Furthermore, therapists must be aware of their diagnostic preferences and bias. In the training of psychotherapists recognition of healthy states should get as much attention as the diagnosis of illnesses.     

„Insightfulness Assessment“

In this article a new method of Oppenheim and Koren-Karie (2002) is presented for the assessment of the insightfulness of parents regarding their children’s inner world. Parental insightfulness involves the capacity to see things from the child’s point of view, and is based on a) insight into the child’s motives, b) a complex view of the child and c) openness to new information about the child. Insightfulness is seen as the capacity underlying sensitive and positive parenting and providing the context for secure child-parent attachment. In the assessment of insightfulness parents view video segments of their interactions with their children and are subsequently interviewed regarding their children’s and their own thoughts and feelings during the segments. Interviews are transcribed, rated in 10 scales and subsequently classified into 1 of 4 groups. The first of the four groups indicates insightfulness while the remaining three indicate a lack of insightfulness.     

Die „Seelenkulturrevolution“

In this paper the work of the author as a psychoanalytic training therapist and supervisor at a counselling centre in a Chinese metropolis will be described. In the first part her experiences with adults of the age cohort 25–35 years will be described, the second generation after the Cultural Revolution. Special attention is devoted to biographically relevant life stages such as childhood, education and marriage in a transient society between a system of traditional Confucian values and that of the new capitalism. The second part of the paper focuses on culture-specific characteristics of a collectivist society from a psychoanalytic perspective, such as setting limits, saving face, empathy, transference and sexuality.     

„Peak Oil“

Scientific prognoses augur the advent of “Peak Oil”, or maximum possible global oil production, in our time. After this maximum, production rates will begin to drop due to increasing capillary pressure in rock deposits, and new discoveries will be unable to compensate for the additive drop in production rates. At the same time, a global increase in energy consumption is also predicted. It is to be expected that the discrepancy between production and demand (heat, mobility, oil-based chemicals) will lead to political destabilisation not only between the “industrial” and “developing” nations, but also in democratic systems. Like the biblical “mene tekel”, “Peak Oil” may be interpreted psychoanalytically as another ecological omen which should arouse civilization to ward off coming disaster. Up to now, psychoanalysts have dealt only sparingly with this perspective. The wake-up call of scientists and publicists in the media has prompted little reaction among consumers and decision-makers. Instead, utopian and/or apocalyptic visions of the future are the order of the day. In correspondence with the Airbus motto: “We must use the air to preserve the earth”, a project of the Max Planck Society is working on “flying automobiles”. In view of these phenomena, our paper presents for discussion the hypothesis of a collective manic denial with splitting of the ego. We try here to limit psychoanalytic speculations with a clinical vignette. It may be asked to what extent the psychoanalytic method – in matters of ecological reality – runs the risk today of entering into collusion with the above-mentioned collective denial, instead of working through it lege artis on the basis of the reality principle.     

„Pervasive refusal syndrome“

Pervasive refusal syndrome (PRS), as a new psychiatric disorder among children and adolescents, was first described 1991 by Lask et al. It is characterized by a determined refusal of the child to eat, talk, walk, care for themselves or participate in daily activities. An organic explanation for the symptoms is absent. The observed refusal of functions can be either active or passive. Children also demonstrate a clear resistance to help or treatment. This paper presents a case study that depicts PRS from the therapists’ and the patients’ viewpoint and helpful elements in therapy are evinced from both points of view.     

„Schicksalsklüfte“

The present paper deals with the derivation of the fate concept and its application in psychotherapeutic theory and practice. Conclusions for an extension of the practical therapeutic view on existential themes, such as meaning, freedom, loneliness and death are drawn and effects on the therapeutic relationship are presented.     

„Beyond efficacy“:

In this study, treatment efficacies of 30 short and long-term treatments with adolescents were presented from the perspective of the afflicted adolescent, the parents and the therapists. Assessments were made 3 times over 1.5 years after 97 therapy sessions on average. Short-term psychotherapy did not significantly contribute to symptom reduction. In the long-term treatments, therapists reported a strong reduction in symptomatology and in communicative disturbances with parents, siblings and friends over time. However, parents perceived less change in symptomatology compared to their children. The quality of the therapists' work with parents did not impact psychotherapy outcome. Tendentially, the type of treatment and the experience of the therapist were relevant for treatment efficacy.     

„Rocken statt Ritzen“

Background

Non-suicidal self-injury (NSSI) starts in adolescence and decreases during young adulthood. Despite a high prevalence among adolescents only a few therapeutic interventions directly addressing adolescents exist.

Aim

By connecting music therapy with elements from behavioral therapy an attempt was made to create a therapeutic program which is attractive to adolescents.

Material and methods

A pilot trial of the program “Stop cutting - rock!” was conducted with 12 adolescent females with a mean age of 15.15 years (standard deviation SD ±1.34). The study aimed to compare the frequency of NSSI throughout the treatment phase as well as a pre-post comparison of depression scores.

Results

The results showed a trend towards a decreasing frequency of NSSI. Depression scores decreased significantly between the assessment before therapy and at a 3-month follow-up after the end of the therapy.

Conclusion

The positive feedback concerning music therapeutic elements points to the attractiveness of the approach. By integrating multimodal therapeutic strategies it seems possible to create an individually tailored intervention for adolescents with NSSI.     

„Innerer Richter“ und „Herzenskündiger“ im Wandel der Zeit

The last few years have seen a deepening of the understanding of the role of metaphor and metaphorical processes first in the cognitive sciences, more recently also in psychoanalysis. What had for a long time been viewed as an imprecise way of understanding turned out to be central for a comprehension of how the mind functions. Most important was the step of distinguishing metaphorical processes as a fundamental way how the mind works from the linguistic form of metaphor. The essay deals with a number of core metaphors for superego conflicts and for interpersonal relations; In particular, the differentiation between people who focus more on things versus those who stress inner life and emotions.     

Autismus oder „Psychopathy“?

According to the concept of Hare autism spectrum disorders and psychopathy are associated with a strong deficit in empathy. However, empathy deficits in patients suffering from autism spectrum disorders and empathy deficits in individuals with psychopathic personality traits appear to be different. Some authors described the comorbid occurrence of psychopathic personality traits/psychopathy in individuals with autism spectrum disorders. The following article aims to approach this differential diagnostic problem by a brief review of the literature on a casuistic basis. This article reports the case of a highly remarkable 17-year-old adolescent. The case will be discussed according to the construct of psychopathy with reference to the concept of Hare.