Arbeitsbelastung und Lebenszufriedenheit von Psychotherapeuten

First, different sorts of strains resulting from psychotherapeutic work are discussed and from this, consequences for psychotherapeutic work are drawn. The second part of the article refers to the personal problems of psychotherapists and illustrates to what extent these problems may interfere with the psychotherapeutic process.     

Role of countertransference in complex psychotherapy]

The psychotherapist has a key position in any psychotherapeutic situation, participating in the psychotherapeutic process with all his personality and responding both consciously and unconsciously to the patient and the entire psychotherapeutic system. Countertransference consists of those actions and emotional manifestations on the part of the psychotherapist, which originate from his unconscious strata as a reaction to the overall situation. The existence of countertransference and its possible interference with, and perhaps adverse effect on, the psychotherapeutic process require close scientific and social controls. Also, it will be necessary to make "self-experience" psychotherapy (educational analysis) a required subject. Countertransference also has important perception- and empathy-promoting functions.     

Note on optimization of individual psychotherapeutic processes

Individual psychotherapy typically involves a sequence of recurrent sessions of client-therapist interaction. Accordingly, the psychotherapeutic process can be conceived of as evolving at least at two different time scales: a fast time scale pertaining to the on-going interaction within each session and a slow time scale associated with sequential regularities occurring between consecutive sessions. It is possible to exploit the sequential regularities between sessions in order to assess and optimize an ongoing individual psychotherapeutic process in real time. In this note a computational paradigm is outlined according to which this can be implemented and applied in flexible ways. Illustrations are given with simulated data. A heuristic summary is provided in the closing section.     

Psychoanalysis and Humanism: A Review and Critical Examination of Integrationist Efforts With Some Proposed Resolutions

Psychoanalysis and psychological humanism are theories that provide ways of understanding the psychotherapeutic process. These orientations have somewhat incompatible assumptions, thereby making integration difficult. Efforts at theoretical integration of psychoanalysis and humanism are critically reviewed along the lines of F. Pine's (1990) 4 psychologies of psychoanalysis. The author concludes that psychoanalysis and humanism have certain compatible features, but that they generally represent opposing vantage points in the study of subjectivity. Each orientation is grounded in a particular epistemic value system that dictates the way knowledge about others should be acquired. Recommendations for integrating these orientations in the psychotherapeutic process are provided.     

Entwicklungstendenzen psychotherapeutischer Praxis und Forschung

This review presents an analysis of articles in the journal “Psychotherapeut” during the years 2000 and 2001 with the focus on new efforts in the field of psychotherapeutic practice and research. The main topics of the journal are the presentation of new therapeutic approaches, some of them integrating different theoretical orientations, and the emphasis on the therapeutic relationship as a specific contribution to the process and the results of psychotherapy. In addition, this article presents a survey of the various subjects in psychotherapeutic research including a) the application and testing of new questionnaires to measure the effectiveness and the process of psychotherapy and b) research in the epidemiology of selected forms of stress, their consequences and lasting effects.     

Parent – infant psychotherapy,the transition to parenthood and parental narcissism: Implications for treatment

In this article the author discusses some of the indications for short- or long-term parent?–?infant psychotherapeutic interventions in terms of what he defines as ‘problems of parenthood’ and ‘problems of parental narcissism’. Brief parent?–?infant psychotherapeutic interventions are most frequently indicated in the case of the former: more neurotic problems of parenthood where the parents present a manic or counter-depressive type of narcissism. Masochistic problems of parenthood are also susceptible to treatment through brief parent?–?infant interventions, although in such cases treatment may have to be continued in another modality of long-term psychotherapy. More dissociated problems of parental narcissism constitute a contraindication for brief psychotherapeutic parent?–?infant interventions. The persecutory narcissism of these parents contributes to a ‘negative pre-transference’ which creates a major resistance to the therapeutic process.     

Two-Track Differentiation Paradigm in Psychotherapy

This paper describes the Two-Track Differentiation Paradigm, an updated therapeutic methodology within psychotherapy. The Two-Track Differentiation Paradigm is based on the assumption that patients habitually regard their problems as one-dimensional and thus tend to become rigid in their attitudes toward these problems. The paradigm suggests a psychotherapeutic process of enriched reframing called Differentiation. This Differentiation between patients’ negative and positive narratives and perceptions offers them more options and frees them to contend with their problems more effectively. Thus, with the Two-Track Differentiation Paradigm, cases of impasse and stuck psychotherapeutic situations are turned into cases of cooperation.     

On the process of the psychoanalytic psychotherapy with the borderline depressive patient

Abstract

A certain subgroup of borderline patients often presents depressive symptomatology (either chronic or periodic) and an underlying borderline personality organization.

In this article, the effort is directed at elucidating the psychoanalytic psychotherapeutic process of these borderline depressives by presenting clinical fragments of several psychotherapeutic cases.

The process goes through periods of activation of the patient's depressive or primitive mental functioning, which also reflects on the therapist's countertransference.

The capacity of the therapist to tolerate and elaborate on his patient's projections, facilitates the development of the therapist-patient communication and plays a significant role in the therapeutic outcome itself.     

Der Arztbrief

The right of inspection in the hospital documents, the hospital discharge report for example, is often refused to patients in in-patient psychotherapeutic treatment (psychiatry, psychosomatic and psychotherapeutic medicine) with reference to the protection of the patients themselves, their doctors or relatives. Within a systemic therapy approach patients of an acute psychosomatic care unit in a hospital the patients could inspect the report of their hospital treatment including all ?objective” and ?subjective” data of their hospital stay. The conversation with patients and their relatives about this report and modifications of the details and addresses of the report in case of patients’ objections is considered as a psychotherapeutic tool (narrative of doctor and patient) in order to improve the transparency of the diagnostic and therapeutic process and the insights in the psychosomatic mechanisms of the patient’s disease. We discuss our organisation of cocreating the hospital discharge report and our experiences with this type of patient-doctor-communication.     

Sociopolitical Enactments as Arenas of Mutual Vulnerability: Psychotherapeutic Experiences During the War Between Israel and Gaza in the Summer of 2014

The understanding that sociopolitical, cultural, and socioeconomic spheres always play a part in psychotherapeutic endeavors forms a central aspect of the relational premise. Nevertheless, the literature rarely relates to psychotherapeutic interactions in which patient–therapist exchanges involve sociopolitical disputes or discussions. The main thesis of this paper suggests that the sociopolitical context in which the psychotherapeutic process takes place tend to serve as an arena of mutual vulnerability (Aron & Starr, 2013) between patient and therapist out of which Sociopolitical Enactments characterized by a curative potential tend to emerge, especially during times of war and horror. Two very different Sociopolitical Enactments that took place with patients in Tel Aviv during the war between Israel and Gaza in August 2014 are presented, followed by a literature review and conceptualization of Sociopolitical Enactments as arenas of mutual vulnerability that explicitly or implicitly facilitate working through processes of traumatic self-states, challenge binaries, and open up ways for inquiring power relations in the therapeutic alliance and beyond.     

Integrative Therapie von narzisstisch gestörten Patienten

The psychotherapy of patients with a narcissistic personality disorder continues to be a psychotherapeutic challenge. There is still no psychotherapeutic program for the treatment of these patients which integrates different psychotherapeutic methods and strategies. Therefore the therapy of narcissistic patients remains difficult and only few psychotherapists voluntarily meet the challenge of treating such patients. In this article an integrative psychotherapeutic concept for the treatment of narcissistic patients using psychotherapeutic methods of different psychotherapeutic schools is presented. This integrative concept includes basic strategies such as working with the therapeutic alliance, schema work and activation of resources. On the other hand specific modules for different core symptoms of these patients are proposed. With this article the authors hope to contribute to a new conceptualization of the psychotherapy of narcissistic patients.     

A Preliminary Study of Clinical Process in Relation to Outcome in Psychodynamic Psychotherapy for Panic Disorder

This study identified psychotherapeutic processes that relate meaningfully to psychotherapeutic outcome for patients with panic disorder undergoing Panic-Focused Psychodynamic Psychotherapy (PFPP) (Milrod et al., 1997). Subjects were 21 patients who participated in an open clinical trial of PFPP (Milrod et al., 2000; Milrod et al., 2001). The Interactive Process Assessment (IPA) (Klein, Milrod, and Busch, 1999), a process measure developed specifically to identify the process of PFPP, was used. Process-outcome relationships were calculated between process factors at early, mid, and late treatment and outcome measures at termination. Results showed that the therapist's focus on the transference late in treatment was associated with a decrease in panic symptoms. Transference focus early in the treatment, however, was correlated with an increase in related symptomatology, as measured by the HAM-A and SDS. It was unclear from the present study how focusing on panic symptomatology affected the treatment. This process might be better investigated by comparing this aspect of PFPP with alternative psychotherapies.     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.     

The ethical dimension of analytical psychology

The centrality of the ethical dimension in Carl Gustav Jung's analytical psychology is demonstrated through careful reference to fundamental moments in the Jungian text. Tracking Jung's statements about the primacy of the ‘moral function’ (or ‘moral factor’) in the cure of neurosis as well as in the process of individuation, the ethical nature of the psychotherapeutic praxis proposed by Jung is highlighted. This allows us to see the ethical aspect of psychological conflicts, and thus to understand better why individuation can be seen as a ‘moral achievement’. Finally, the intelligible ethical structure of Jungian psychotherapeutic praxis is exposed.     

Psychotherapists and the mystical process

Spirituality is an often overlooked element in the therapeutic experience. The purpose of this paper is to document a well-recognized definition and framework for the mystical process. The author suggests some similarities between the mystical and psychotherapeutic processes. He asserts that psychotherapists who can recognize elements of the mystical process among their clients can serve as spiritual guides in psychotherapy.     

„Da wirst du ja auch bekloppt bei“

Given a growing demand of psychotherapeutic care the interest of students in a psychotherapeutic occupation is gaining relevance. At the same time psychoanalytic training institutions and societies have been confronted with a continuous decrease of candidates over the last decades. Psychology students, medical students and students of educational sciences (the latter only in the child and adolescent treatment sector) are admitted for a psychotherapeutic training approved by the health care insurances in Germany and have the possibility to choose between a behavioral or a psychodynamic oriented training. In the present multimethodological cross-sectional study those student groups (N?=?679) were questioned about their interest in a psychotherapeutic training in general and, if they proved to be interested, about their specific choice of training. Amongst psychology students the largest group of those interested in a psychotherapeutic training would opt for a behavioral education. Amongst medical students and students of pedagogy and social pedagogy a psychotherapeutic training is less frequently an option for their future career plans. Amongst the students of educational sciences, for those interested in training, psychodynamic methods are more often of interest. Possible reasons for the students' decisions in the context of the specific German legal situation are discussed.     

Stochastic analysis of the duration of the speaker role in psychotherapy

An analysis has been undertaken of the stochastic behavior of the time series which defines the duration of utterances exchanged by patients and therapists in six recorded sessions of psychotherapy. Each series followed a Box-Jenkins time series model of order (1, 0, 0): that is, each behaved as a first-order autoregressive process, sensitive to the prior state of the system. The confidences associated with the parameters of the autoregressive models were very high. In addition, the histograms of length of each utterance indicated an underlying Poisson model for the emergence of speech. The parameters of the Poisson and autoregressive models varied with each patient/therapist pair. Signatures for the process dynamics of the speaker-role variable were obtained. The two analyses suggest fundamental structures within the psychotherapeutic dialogue. The Box-Jenkins results provide a global summary of the inner structure of the series and its progression, while the Poisson results describe its instantaneous behavior. This work is offered as a part of new efforts to apply scientific and mathematical methods to the psychotherapeutic domain.     

Intimacy and confidentiality in psychotherapeutic relationships

This article explores the relations among and between intimacy, psychotherapeutic relationships and moral advice. The article concludes that a psychotherapeutic relationship is not usefully explained in terms of intimacy. Instead, a psychiatric relationship is a form of moral advice, and it is this dimension of a psychotherapeutic relationship as a form of moral advice that poses a natural limit to the confidentiality necessary for engaging in psychotherapy.