Primär- und Sekundärprozess bei Angst und Depressivität im psychoanalytischen Erstinterview

Zusammenfassung Vorgestellt wird eine quantitative inhaltsanalytische Untersuchung an 46 psychoanalytischen Erstinterviews, die mit Angstpatienten und depressiven Patienten in Düsseldorf und Magdeburg geführt wurden. Im Mittelpunkt der Methodik steht das Regressive Imagery Dictionary (RID), ein computergestütztes Verfahren mit 43 Einzelkategorien, die zu den drei Indikatoren primärprozesshafter Inhalt, sekundärprozesshafter Inhalt und Emotionalität zusammengefasst werden. Die durchgeführten Subgruppenvergleiche beziehen sich auf Unterschiede zwischen Angstpatienten und depressiven Patienten sowie ostdeutschen (Magdeburg) und westdeutschen (Düsseldorf) Patienten. Die Ergebnisse zeigen in den Texten der ostdeutschen Patienten ein höheres Maß an primärprozesshaften Inhalten, insbesondere in den Kategorien Passivität und regressive Kognition. Bezüglich der Diagnosegruppen zeigen die Angstpatienten gegenüber den depressiven Patienten ein höheres Maß an primärprozesshaften Inhalten in der Subkategorie Oralität. Es zeigt sich, dass in psychoanalytischen Interviews nicht nur diagnosespezifische Inhalte thematisiert werden, sondern auch kultureller Hintergrund, Geschlecht und Bildung von Bedeutung sind. Die Studie leistet einen Beitrag zur Identifizierung automatisch erfassbarer Textmerkmale, die charakteristisch für die in einer qualitativen Studie gefundenen idealtypischen nosologischen Konstrukte der neurotischen Depression und der phobisch-angstneurotischen Erkrankung sind. Hierbei ist der depressive Idealtypus durch eine Überidentifikation mit Werten, durch das Gefühl der Abhängigkeit von einer schädigenden Person, durch Selbstwertprobleme, Hemmung und den unerfüllten Wunsch, geliebt zu werden, gekennzeichnet. Der Angsttypus zeichnet sich durch ein klischeehaft positives Bild der eigenen Persönlichkeit aus sowie durch die Gefühle, falsch verstanden, ausgenutzt, nicht ernst genommen und zum Außenseiter gemacht zu werden, sodass er bei nachlassenden Kräften im Kampf um Leistung nicht mehr mithalten kann.

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Primary and secondary processes in psychoanalytic first interviews with patients suffering from anxiety and depressionA regressive imagery dictionary content analysis study in West and East German patients

The present paper describes a study on the intake interview narratives of psychotherapy patients with computer assisted content analysis methods. 46 psychoanalytic first interviews of patients suffering from depression or anxiety disorders were analysed with the Regressive Imagery Dictionary (RID), a computer assisted content analysis method with 43 subcategories, which were sumed up to three main categories: Primary Process, Secondary Process, and Emotion. Comparisons between different subgroups of this sample were made: Anxiety vs. depressive patients, and East Germans (Magdeburg) vs. West Germans (Düsseldorf). Significant correlations were found between the Primary Process subcategories Passivity and Regressive Cognition, and East German patients, as well as correlations between the Primary Process subcategory Orality, and anxiety patients. The results confirm our hypothesis, that the psychotherapist-patient-interaction sequences, which are the basis of diagnostic categorization, enclose as well elements which are specific for the disorders under study as elements which are specific for sex and culture (east vs. west). The study contributes to the identification of specific text markers, which can be found in the narratives of patients suffering from neurotic depression vs. patients with phobia and panic disorders. The results of the study are compared with a previous qualitative study. Using the ideal-type concept, our qualitative content analysis study showed as characteristic features of depressed patients overidentification with social roles and norms, feeling of being dependent and injured by another person, problems of self-esteem, shyness, and unfulfilled wishes to be loved and accepted. In contrast, phobic patients characterized the own personality as normal and without any problems in a stereotype way, at the same time feeling misunderstood and exploited by other persons, feeling as an outsider and left alone, and being no more able to compete with others.

     

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.     

Familienfunktionalität und Therapieerfolg

Background

Even though it is a treatment standard of child psychotherapy to involve the parents, hardly any research has been carried out about the impact of family functioning on treatment outcome. Aims of the present study were to investigate the change in and the prognostic power of family functioning on treatment outcome of short-term psychodynamic psychotherapy in children and adolescents.

Patients and methods

The sample consisted of 54 children and adolescents undergoing outpatient short-term psychodynamic psychotherapy. To assess family functioning, their parents were asked to complete the Family Assessment Measure (FAM).

Results

Patients from families with high levels of functioning in task accomplishment, communication and affective expression were more often treated successfully. Improvement in levels of functioning in role performance, emotionality and control were only found in the group of successfully treated patients.

Conclusion

Family functioning is a decisive factor in the differential indication of psychotherapeutic treatment in children and adolescents.     

Interdisziplinarität und Wissensentwicklung

Interdisciplinarity and the Development of Knowledge. The author is engaged in the question how to explain the development of scientific meanings of facts which does not coincide with producing them rather with processes of the scientists' public communication. So long as the facts are adjustable to the conventional theories of those discipline which the researcher belongs to this connection does not reveal perfectly clear. More instructive is a consideration of so-called anomalies. The author demonstrates with an example of the history of science that researchers in case of new phenomena use to borrow concepts from other disciplines for resolving the interpretative problems. It emerges a loose net-work of concepts. In this way the researchers are producing a disciplinary mixed public at the same time. This process is seen as an important phase of the development of new theories and, complementary, new disciplines.     

Stationäre Kinder- und Jugendpsychiatrie sowie Psychotherapie bei substanzabhängigen Jungen und Mädchen

This study examines post-treatment outcomes (6 and 12 months post-release) of a multimodal child and adolescent psychiatric and psychotherapeutic inpatient treatment program for boys and girls diagnosed with substance use disorders (n=71) in 2 centres. Up to now there has been a lack of outcome research in this field in Germany. Outcome measures included drug use patterns and psychopathology. The greatest reductions in prevalence at 1 year follow-up occurred for cannabis, methamphetamine, cocaine and heroin use. Additionally the patients and their parents also reported significant improvements in adolescent’s psychopathology at the 1 year follow-up. The results underline the importance of disorder-specific, multimodal inpatient programs for the treatment of children and adolescents with substance use disorders.     

Fibromyalgie und Leistungseinschränkung

Interdisciplinary guidelines allowed for new quality standards in pain appraisal. Simultaneously, the scientific notion of fibromyalgia changed from a subjectively overvalued malaise to a central disturbance of coping with stress, which is neurobiologically determined. Therefore, in this article a psychosomatics-based guide is given for the socio-medical appraisal of fibromyalgia with reference to the new International Classification for Functioning and Disability (ICF) of the World Health Organization (WHO). As illustration a case study is presented.     

Indeterminiertheit,Iterabilität und Intentionalität

In his recent paper Indeterminacy, empiricism, and the first person John R. Searle tries to refute Willard V. O. Quine's famous indeterminacy of translation thesis by arguing that this thesis is in fact areductio ad absurdum of Quine's own linguistic behaviorism. Searle accuses Quine of being (irrationally) antimentalistic and suggests that the absurdity of Quine's thesis might be avoided if a full-fledged intentionality were tolerated in the debate on meaning. — This anti-Quinean approach in some respects reminds of the improbable debate between Searle and Jacques Derrida ten years ago, when Derrida had split and deferred intentionality by showing that the essential iterability of signs inevitably infects every intentional act with an unremovable non-presence.In this paper it is argued that Searle's attacks on Quine and Derrida have both failed — and that there are structural similarities between these two failures which reveal some interesting parallels between Quine's and Derrida's philosophy.     

Veränderungen kriminogener Faktoren bei Sexual- und Gewaltstraftätern in Sozialtherapie und Regelvollzug

In the evaluation of offender treatment programmes, recidivism is still the most common measure of success. However, positive effects concerning future delinquent behaviour do not prove that treatment led to changes in the targeted criminogenic risk factors. Furthermore, little is known about whether such changes differ among the various offender types. This study investigated changes in self-reported criminogenic personality patterns and cognitions in a sample of treated and untreated sexual and violent offenders. Specific prosocial changes in treatment targets, such as self-control, excitability and neuroticism were found but similar improvements were also found in untreated offenders. In addition, changes in measured risk factors did not differ between offender types, although self-control, aggressiveness and neuroticism showed significant interactions between offence type and treatment delivery. Whereas treated violent offenders exhibited more positive changes than untreated violent offenders, an inverse pattern was observed in the case of sex offenders. Minor specific treatment effects as well as the limitations of the administered psychometric instruments are discussed as possible explanations for these results.     

Lebensqualität von ärztlichen und psychologischen Psychotherapeuten

In a large empirical cross-sectional study the quality of life of medical and psychological psychotherapists ( n =71, respectively n =103) was examined as well as the influence of the different therapeutic methods used. Instruments used were the Questionnaire on Quality of Life of Physicians (Reimer and Jurkat 2003) respectively the Questionnaire on Quality of Life of Psychologists (Jurkat and Reimer 2003) as well as the SF-36 Health Survey (Bullinger and Kirchberger 1998). The majority of participants in both samples are satisfied with their life. Psychological psychotherapists are comparatively more content with their work situation and judge their own health more positively than their medical colleagues do. Both groups feel their income situation to be a loss in quality of life. A common fear is an even greater bureaucratic burden and financial deterioration. Thus it seems that psychohygienic measures and secure job perspectives may contribute to raising the quality of life of psychotherapists.     

Sexueller Sadismus und Sexualkriminalität

The categorization of sadism has turned out to be a versatile phenomenon, which covers a spectrum from harmless symbolic rituals to extremely violent acts where strong impulses or prolonged fantasies and rituals are involved. As the phenomenon is versatile its causes and appearances vary as well, although so-called BDSM (bondage & discipline & dominance & submission & sadism & masochism) practitioners and persons with severe sadism in a forensic context share only few common preferences. Based on own clinical experiences with sadism in forensic patients the authors support the proposed revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) especially the diagnostic disjuncture of sadism and masochism. Sexual sadism appears more frequently in forensic contexts in combination with sadistic, antisocial and borderline personality disorders but rarely with masochism. Masochism is otherwise reported to be more prevalent in patients of general psychiatry, however, combined with depression or dependent personality traits rather than with sadism. Moreover, the authors believe that if use of the diagnostic term sadism is perpetuated the establishment of the proposed new diagnosis “paraphilic coercive disorder” is unnecessary. The diagnostic term is also important for treatment and assessment. Despite the lack of reliable long-term studies with larger samples, it is reasonable to assume that medication, sometimes even anti-androgenic treatment, can be indicated in patients with severe sadism.     

Ausbildungs- und Berufserfahrungen älterer Psychoanalytiker

Based on the discussion about the crisis of psychoanalysis and in particular of psychoanalytic training, 145 (female and male) analysts older than 70 years of age were interviewed about their training and professional experiences as well as about their attitudes towards psychoanalysis. This older generation is of great interest because their training generally took place prior to 1967 and preceded the introduction of guideline therapy (cost coverage by the general health insurance) and under much less formalized conditions, which can be seen almost as a contrast to the current circumstances and conditions. This research has shown that especially personal or content and value-based motivations (personal problems, therapeutic experience, interest in the subject, the desire for depth, self-realization and expansion of the situation perceived as restrictive of their former profession) were the main determining factors for the choice of career. The training analyses were, despite some exceptions, of substantial length even then (an average of 544 h), but often had a lower frequency (30% had less than 3 h per week). Since the age limitation for running a psychoanalytic practice within the general health services (formerly 68 years) is no longer compulsory, the results of this study regarding the professional life of older psychoanalysts are of special interest. Of the respondents 45% are still running their own practice and 22% are working as training analysts.     

Gesundheitsverhalten und präventive Interventionen

In the following article selected psychological concepts that proved to be important or the topic of health and health prevention are taken up, and the attempt is made to discuss their explanatory power and their applicability for preventive approaches, even if without the claim of an exhaustive or comprehensive argument. Because of the complexity and manifold manifestations of the topic, this is only possible in a restricted measure. In the focus of the discussion are questions of the connection between personality and health, models of health behavior and concepts of health and illness in the system of laymen. But we intend to discuss them also under methodical and application-oriented aspects. Moreover, the attempt is made, to determine the position of psychosocial concepts of reflexion and action, to be able to sound on this basis for the profession of psychotherapists, to what extent the field of prevention could be interesting for psychotherapy for scientific, social political and practical reasons.     

Protophysik und Spezielle Relativitätstheorie

Protophysics and Special Theory of Relativity. First, a proposal for a constructive foundation of the Special Theory of Relativity by M. Buth is criticized and confronted with an alternative proposal by the author. The main idea is to solve the problem of transforming coordinates between inertial systems in terms of the General Theory of Measurement. Regarding transformations of co-ordinates as transformations of thecorresponding “functions of measurement” these functions have to meet two demands. 1. To identify measured values which are related to different inertial systems and measuring procedures as the same magnitude, the ratio scale of length and duration has to be defined with respect to the whole class of inertial systems. 2. Using the concept of a certain physical magnitude, propositions about measuring devices are made which are invariant with respect to measuring procedures. As aconsequence every transformation between functions of measurement has to be an equivalence relation. The first demand leads to linearity, the second one reduces the set of permissible transformations between inertial systems to the alternative of Galilei- and Lorentz-transformation. The (im)possibility of putting an absolute simultaneity into practice decides between these transformations. This revised version was published online in August 2006 with corrections to the Cover Date.     

Somatische und psychische Komorbidität

Studies indicate that chronic somatic diseases are often associated with psychological burden and manifest mental disorders. The interaction may be a complex one rather than a mere reaction to severe somatic illness. Early recognition of psychosomatic comorbidities has important implications for adequate diagnostic classification, therapy, and the course of the whole disease pattern. The timely treatment of depression in somatic illnesses can for example not only alleviate depressive symptoms but also raise quality of life and reduce the consequences concerning the course of the somatic disease. However, many questions still need to be answered relating to the concrete influence of a therapy of the mental disorder on the somatic prognosis.     

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.     

Träume erzählen und die Übertragung

Zusammenfassung. Der Umgang mit Tr?umen in der psychoanalytischen Behandlung ist seit Freuds fundamentalen theoretischen und technischen Schriften zur Traumdeutung weitgehend unver?ndert geblieben. Er ist durch traumzentrierte Assoziationen und ihre Deutung in Hinblick auf Trauminhalt und übertragung gepr?gt. Im Kontext der heutigen, beziehungsorientierten Behandlungstechnik wirkt dieses Vorgehen wie ein Fremdk?rper, der eine zus?tzliche Integrationsaufgabe schafft und zum Kristallisationspunkt von Widerst?nden werden kann. Diese Arbeit betont die Bedeutung, die das Erz?hlen von Tr?umen als Geschehen in der aktuellen analytischen Beziehung hat, und gelangt zu der Konsequenz, Tr?ume im Rahmen der interaktionellen gegenw?rtigen Behandlungstechnik gleichartig wie alle anderen Einf?lle in der Behandlungsstunde zu handhaben, d. h. ihre Bedeutung als unbewu?te Aussagen im Proze? der analytischen Beziehung in das Zentrum der Aufmerksamkeit zu rücken. Die leitenden Fragen der Beziehungsanalyse von Tr?umen sind: Warum erz?hlt der Analysand an dieser Stelle der Begegnung gerade einen Traum, und warum erz?hlt er diesen Traum und nicht einen anderen?

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Telling dreams and the transference. The interactional function of dream reports as free associations

Summary. Since Freud's Dream Interpretation and his additional writings on the analysis of dreams, technique of handling a dream report within the analytic session has nearly been unchanged. It is characterized by dream centered associations and their interpretation in regard to dream contents and to transference. This approach constitutes an alien element within contemporary interactional psychoanalytic technique and tends to provoke resistances in the analytic dialogue. This article stresses the function of reporting of dreams during the session in respect to the interactional process. It comes to the conclusion that sufficient attention should be drawn to interactional analysis of dream reporting following the questions: Why does the patient at this point of the process tell a dream, and why does he tell this very dream instead of another?