Die Destruktivität in der psychoanalytischen Ausbildung

In this study, a survey of all criticism of psychoanalytic training and of the from its beginnings formulated problems is given. Doing so, the presented literature covering the issue is discussed from four perspectives: the candidate’s perspective, the socio-political perspective, the perspective of power and the perspective of professionalization. The latter perspective involves historical aspects too and thus shows the resistance towards change, proposes solutions and therefore may be deemed to be especially relevant. In order to summarize the criticism regarding psychoanalytic training, a systemic model was developed including its systemic structure, organizational aspects and its content. Furthermore, ten hypotheses are developed as to why psychoanalytic training proves to be to a large extent resistant to change. Against the background of the existing situation in training, current job-political conditions and changes for present trainees are presented and existing exacerbations are pointed out. Ignoring these aggravated conditions and simultaneously tightening and regimenting training guidelines are understood as a destructive process for psychoanalysis and its training by the author. At the same time it is pointed out that the presented problems are not related to one single psychoanalytic society, but have been developed over decades throughout different psychoanalytic societies and countries and therefore seems to be an international problem of psychoanalytic organizations. Finally, preexisting propositions for changes are discussed, and fourteen solutions, which could help to renew future psychoanalytic training, are shown; this may also serve as a plea for a basic reform in training and organization. Regarding a reform of the training, the author deems all three issues to be relevant: the systemic-structural aspect, the content and the organizational aspect.     

Destruktivität in Paarbeziehungen

Quarreling couples caught in destructive patterns of communication often cause difficult situations during couple therapy. Such communication patterns range from pure verbal humiliation and insults up to outbursts of violence. In order to remain capable of therapy, psychotherapists must know the underlying mechanisms that provoke and maintain the destructive viscious circles. Moreover, they must have at their disposal the required explanatory ideas and practical intervention strategies for de-escalation and interruption of these destructive patterns.     

Umgang mit gefährlichen Straftätern in England und Wales

Forensic psychiatric institutions exist in all western European countries. Their organisation depends on a number of factors including the legal framework and societal attitudes towards mentally disordered offenders. This article describes and critically comments on the forensic psychiatric system in England and Wales, its legal framework and approaches to dealing with dangerous offenders. England and Wales have a long forensic psychiatric tradition with the first high security hospital, Broadmoor hospital, having been established in 1863. Evidence-based treatment approaches in forensic hospitals as well as in prisons, training of forensic psychiatrists and research in the field of forensic psychiatry have gained international recognition. However, there are some worrying aspects in the system of forensic psychiatric care and the criminal justice system more generally, in particular the high and still increasing number of prisoners in comparison with other European countries, the low age of criminal responsibility, long sentences, increasing length of stay in forensic care and the increasingly risk averse culture. A number of differences to the German system can be found; one such difference relates to the role of criminal responsibility which is irrelevant for decisions regarding commitment in England and Wales. Only the mental state and need for treatment at the time of trial (or later assessment in prison) determine whether an offender is admitted to psychiatric care or receives a prison sentence. A number of new initiatives have been launched in recent years resulting in an increasing number of individuals being detained in forensic psychiatric and criminal justice institutions, in particular the initiative for the detention and treatment of individuals with so-called dangerous and severe personality disorders, the sexual offenders register and the new sentence of indeterminate imprisonment for public protection. These initiatives have been the subject of a number of complaints to the European Court of Human Rights. Nevertheless, the trend towards a more and more risk averse culture continues.     

Intensität und Qualität in der Geruchswahrnehmung

Zusammenfassung Vier unterschiedliche Geruchsstoffe in je 4 Konzentrationen wurden von 23 Versuchspersonen nach Intensität beurteilt und paarweise auf ihre relative Ähnlichkeit hin verglichen. Eine Systematik der Versuchspersonenvarianz konnte weder in den Intensitäts- noch in den Ähnlichkeitsurteilen mit dem Tucker-Messick-Verfahren nachgewiesen werden. Mit den Medianwerten der Ähnlichkeitsurteile wurde das Skalierungsverfahren von Kruskal durchgeführt. Unter 25 Lösungen wurde diejenige mit einem Exponenten (Minkowski-Metrik) von r=2,5 und 5 Dimensionen als optimal ausgewählt und zur Grundlage der Interpretation genommen. Als wichtigstes Ergebnis erhielten wir eine unabhängige Intensitätsdimension mit Ursprung außerhalb der Reizkonfiguration, die eine hohe Übereinstimmung zur Intensitätsskalierung aufwies. Weiter konnte ein Qualitätswechsel jeweils innerhalb eines Stoffes zwischen den Konzentrationen festgestellt werden. Dieser Qualitätswechsel ist bei den einzelnen Stoffen unterschiedlich stark ausgeprägt.

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Quality and intensity in olfactory perception

Summary In an experiment on olfaction 23 subjects judged 16 odors (four chemicals each in four concentrations) with respect to intensity and with respect to similarity for each pair of stimuli. Systematic interindividual variation can he found neither in the intensity nor in the similarity data. Multidimensional scaling according to Kruskal's procedure reveals a configuration in 5 dimensions, the exponent of the optimal Minkowski-metric (out of 25 alternative solutions) is r=2.5. This scaling is based on the medians of similarity judgments. One of the dimensions corresponds to a subjective scale of intensity, with a zero-point lying outside of the configuration. The quality of the stimuli depends on their concentrations. The perceived quality-changes differ in amount and directions for each of the chemicals.

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Von der Philosophischen Fakultät der Universität des Saarlandes auf Antrag von Prof. Dr. K. Eyferth angenommene Dissertation.     

Religiosität und Spiritualität in der Psychotherapie

For many years religious and spiritual issues have been avoided in psychotherapy. In the face of social changes a more culturally sensitive psychotherapy is needed to professionally deal with religious backgrounds, spiritual needs and spiritual resources. A remarkable spiritual turn has recently been observed particularly in psychoanalysis, which was originally very antireligious. Health research studies are exploring the healing craft of religious virtues and values. It is important to discern between an empirically proven healing method and an ideologically founded promise of salvation. It is the task of the therapist to find out whether the patient's religiosity or spirituality is part of the problem or part of the solution.     

Dynamische Komplexität in der Therapeut-Klient-Interaktion

The importance of client-therapist-relationship in psychotherapy has often been stressed. On the one hand, the quality of this relationship has proved to be an important predictor of therapy outcome, on the other hand the relationship itself is realized as a complex dynamic pattern of interpersonal interaction. It seems appropriate to investigate this dynamics by a microprocess analysis with high resolution. Interactive plans (idiographic self-presentation unities) of client and therapist were coded by a sampling frequency of 10 seconds. The coding system of plan activation follows the idea of synchronous musical score notation of different orchestra instruments. It allows for the representation of contextualized interactive behaviors. The context is introduced by the consideration of synchronous and diachronous plan-activation patterns of the interaction partners. The observed dynamic patterns are fulfilling the prerequisites of usual definitions of “chaos”: irregularity of the process, restricted prediction horizon, and still some global order of the dynamic process. Based on nominal data (on-off-patterns), a method for the identification of order within irregular patterns of plan activations is presented. The frequency distributions of plans realize the shape of 1/f^α-noise, indicating features of self-organized criticality within the dynamic system of client-therapist-interaction.     

Die Komplementarität in der Sowjetphilosophie

Ohne ZusammenfassungGekürzte Fassung eines Vortrages an der Universität Bonn am 19.XI.1963.     

Patientensicht zur Qualität in der Psychotherapie

Concerning the discussion about the quality of psychotherapy, the different perspectives in the definition of quality are rarely considered. Especially the patients’ perspective is barely respected although quality assurance of psychotherapy should be for their benefit. Patients were interviewed (n=8) to answer the question which criteria of quality are relevant in their view. Using the grounded theory a variety of quality criteria was found. The interviewees emphasized the relationship between therapist and patient, the empathy of the therapist, the scheduling of appointments and the progress in therapy. The results suggest that when judging the quality of psychotherapy clients do not only focus on the outcome of psychotherapy, as presumed by some experts, but also on the dimensions structure and process. Professionals have to consider this fact when designing and applying methods of quality assurance.     

Zum gegenwärtigen Stand der psychoanalytischen Selbstpsychologie

Zusammenfassung Die psychoanalytische Selbstpsychologie wird dargestellt als postmodernes Paradigma zur Analyse des postpatriarchalen Selbst mit dem methodischen Zugang über Introspektion und Empathie. Die eingeschr?nkten Behandlungsm?glichkeiten vor allem bei narzi?tisch gest?rten Patienten führte Heinz Kohut zur Annahme einer eigenen Entwicklungslinie des Narzi?mus und eines Motivationsprimats des Selbst, welches er bipolar konzipierte. Sexuelles und aggressives Verhalten werden in der Folge nur dann als prim?r angesehen, wenn ein koh?rentes, vitales, nicht fragmentiertes Selbst vorliegt. Wesentliche Bedingungen für Selbstkoh?renz sind die Selbstobjekterfahrungen, die in ihrer Vielfalt ebenso wie Selbstst?rungen dargestellt werden. Aus den Selbstobjekterfahrungen leiten sich die Hauptübertragungsformen in der psychoanalytischen Selbstpsychologie ab. Ein kurzer Abri?über den therapeutischen Proze? sowie über die Integration der S?uglings- und Kleinkindforschung in die Selbstpsychologie und eine andere Sicht des ?dipuskomplexes vervollst?ndigen die hier gegebene übersicht und werden abschlie?end durch einige Neukonzeptionen der psychoanalytischen Selbstpsychologie erg?nzt.      

„Intention to treat“ oder „treatment as received“ – Umgang mit Abbrechern in der Forschung zur Straftäterbehandlung

Lack of internal validity is a frequent problem in evaluation studies of offender treatment, as randomized controlled trials are difficult to implement and comparison groups in quasi-experimental studies are often not completely equivalent. Special matching procedures or statistical control of selection bias by using potentially interfering variables as covariates can provide a solution to some of these problems; however, a high dropout rate from offender treatment programs presents another problem, as the variables that cause attrition are often risk factors for reoffending. It is argued that a treatment-as-received (TR) approach which compares treatment completers with the comparison group may confound genuine treatment effects with selection effects. Particularly high recidivism rates in dropouts may be due to negative effects of attrition (e.g. stigmatization) but may more likely reflect a higher a priori risk for reoffending. Using data from some recent treatment studies, the authors show that alleged positive effects often disappear when a more adequate intention-to-treat (ITT) approach is used in which dropouts are retained in the treatment sample.     

Pluralität der Wissenschaften

In September 2002 the international conference on "Pluralism of sciences: the psychoanalytic method between clinical, empirical and conceptual research" took place in Frankfurt am Main. One of the purposes was to discuss a research methodology, which is adequate in psychoanalysis. The major points were clinical research as process-outcome research and experimental research on psychoanalytic paradigms with current methods of the so-called "life sciences". A critical discussion of these research strategies appeared difficult and did not reach a satisfying conclusion.     

Strukturen der Alterskriminalität

The group of the over 60-years-old does only contribute a relatively small part to the registered crime – compared to their continuously growing percentage in the population. Crimes committed by elderly persons are predominantly property offences with shoplifting playing an outstanding role. Elderly persons are also overrepresented concerning offences of insult, (negligent) arson and environmental offences whereas violent crimes are rare. Elderly men are also slightly overrepresented concerning sexual abuse of children, but this is very rare, too. As a whole, the fear that Germany will be overrun by a wave of old-age crime does not seem to be confirmed. Elderly offenders are still very rare and the offences committed are significantly less heavy than those committed by younger offenders.     

Die Effektivität der Hypnose

From 193 studies published until 1998 that investigated the efficacy of hypnosis 43 randomized clinical studies were selected that compared a patient group treated exclusively by hypnosis with an untreated control group (or with a group of patients treated by conventional medical procedures). The 43 studies were integrated into a meta-analysis that yielded a weighted average post-treatment effect size of d=.60 (medium effect size) for hypnotic treatment of ICD-10 coded disorders (24 studies; average treatment period: 5.1 weeks) and d=.38 (small effect) for hypnosis as an adjunct for supporting medical procedures (19 studies). These estimates are conservative since all variables of a given study were used. Most of the studies employed methods of the classical approach to hypnosis. In order to obtain an estimate to which extent non-clinical factors (design-quality, way of comparison of dependent variables) have an influence on the effect sizes, effect sizes were computed for all studies of the original 193 studies that reported the necessary statistical information (N=89). For those studies with an average effect size of d=.80 a massive influence of non-clinical factors was demonstrated with a range from d=.51 for randomized studies with group comparisons to d=2.0 for non-randomized studies using pre-post-comparisons.