Gegenübertragung und Identifizierung in der kompetenten Position

The concept of the terms “competent position” and “identifying with superiority” are introduced to give a better explanation for the mental procedures occurring within the analytical therapist in cases of boundary violations during treatment. In part two attention is called to the latent preventive exculpating tendency in known theories of countertransference.     

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.     

Gegenübertragung im stationären Therapie-Setting

Background

Countertransference is seen as an instrument of research into a patient’s unconscious and is therapeutically useful in furthering psychodynamic work. For inpatient psychodynamic psychotherapy, where patients are treated by a team of psychotherapists, countertransference is much more complex and makes consideration and integration of different countertransference feelings necessary. Using the first German translation of the countertransference questionnaire (CTQ, Zittel Conclin and Westen, the countertransference questionnaire, 2005) an attempt was made to identify differences in countertransference phenomena in a team of psychotherapists and to show the impact countertransference has on therapy outcome.

Materials and methods

A total of t multiprofessional teams of psychotherapists (15 physicians, 5 psychologists and 9 body and art therapy psychotherapists) took part in the study and completed the CTQ for 137 patients (100 female, 37 male) at the beginning and at the end of inpatient psychotherapy. In addition, the patients completed two questionnaires, the Symptom Check List Revised 90-R (SCL-90) for the severity of symptoms and the Assessment of DSM-IV Personality Disorders Questionnaire (ADP-IV) for personality disorders.

Results

Body and art therapy psychotherapists expressed more positive, protective and involved countertransference feelings whereas psychotherapists for single and group therapy expressed more aggressive and hopeless feelings. Countertransference has an impact on therapy outcome and feelings of a lack of interest, aggression and resignation at the beginning of therapy can point to a poor outcome. Patients with personality disorders activate more negative countertransference reactions than patients without personality disorders but at the same time they may also evoke parent-like feelings of protection.

Conclusions

Using the CTQ it is possible to differentiate countertransference phenomena in a team of psychotherapists treating inpatients with psychodynamic psychotherapy. The timely perception and integration of countertransference feelings has a positive influence on the therapeutic process and therapy outcome.     

��bertragung und Gegen��bertragung

The article presents a modern concept of transference and countertransference in the context of psychodynamic psychotherapy. The concept of transference is contrasted with the therapeutic relationship and the work relationship. The main part of the article discusses the concept of countertransference with the typical countertransference complications and considerations about countertransference and interpretation technique. The advantages of a countertransference-focused interpretation technique, especially in the case of seriously disturbed patients, are described in detail.     

Gegenübertragungsdiagnostik in der Psychotherapie suizidaler Männer

The diagnosis of suicidality is an important challenge in psychotherapy: The threat of life has to be determined, decisions in differential therapy must be made and the therapeutical relationship must be established. The psychoanalytical contribution to the diagnostics of suicidality is the analysis of transference and countertransference phenomena, of "scenic" actions and of enactments between patient and therapist. By a systematic qualitative research method ("forming ideal types by understanding") 5 prototypical transference-/countertransference situations at the beginning of outpatient psychodynamic psychotherapy of suicidal men are identified and out of them 3 ideal types are constructed. The object-alienated ideal type with an avoidant transference and "weak", e.g. unemotional complementary countertransference appears to be a special problem. If aggression and strong attachment wishes toward the object come into the therapeutic relationship, this often is an indicator for the contacts’strength and can lead to deactualisation of suicidality. The results are discussed with and supported by methodically different publications on object relations orientated aspects of suicidality.     

Übertragung von Schweigen in der psychoanalytischen Sozialisation

This work is based on two interview studies with psychoanalysts from the German Psychoanalytic Society (DPG) and the German Society for Analytical Psychology (DGAP) belonging to the war children generation. In one study the focus was on how childhood in war can be dealt with in teaching analysis and in the other, whether experience of childhood in war had contributed to choosing psychoanalyis as a profession. A theoretical overview on questions of teaching analysis and choosing psychoanalysis as a profession is given, the results of the interview studies and detailed excerpts from an interview are presented.     

Negative Übertragung und der Respekt gegenüber dem Analytiker

The author investigates the question how treatment techniques can be used to deal with massive negative transfer. The basic principle that being open and processing the negative transfer by interpretation is very valuable for the analytical process seems to be valid for most treaments in unlimited form but not for all. This approach is particularly questioned when the patient massively devalues the analyst and loses all respect for him. In such constellations the analysis can lead to a dead end. In this article a case study of the author is discussed in which a severely disturbed narcissistic patient reacted with a high level of destructivity in the transfer. This ultimately led to the situation where the analyst became a type of whipping boy for the patient who verbally deployed aggressive actions against him. A therapeutic implementation of this dynamic force by interpretation proved to be no longer practicable so that the analyst decided to first demarcate limits on the destructive reactions of the patient during the transfer by an intervention. In this way a minimum level of respect for the analyst could be restored. Only on this basis could interpretations unfold an effect during the further course and resulted in a positive turning point in the treatment process. In the theoretical discussion the author refers in particular to the approaches of Kernberg, Ogden and Racker as well as to the term projective identification. He arrives at the consideration that the danger of a derailment of the analytical process threatens especially when projective identification unconsciously less serves communication but more the attempt to dispose of worse effects. The author finally comes to the opinion that beside especially justified interest for the negative transfer it should not be overlooked that positive transfer which includes the respect towards the analyst represents the decisive foundation for analytical treatment. To safeguard this, in some situations demarcation can be particularly useful.     

Die Handhabung der Übertragung

Zusammenfassung. Freud hat die Handhabung der übertragung als das schwierigste wie das wichtigste Stück der analytischen Technik bezeichnet. Mit Handhabung meinte er nicht den Umgang mit der übertragung im allgemeinen einschlie?lich der übertragungsdeutungen, sondern etwas Spezifischeres und Zupackendes, das sp?ter den Ruch des Nicht-Analytischen bekam. Der Autor zeigt den wichtigen Stellenwert des Terminus bei Freud und untersucht seine Entwicklung von der Ichpsychologie über Ferenczi und A. Balint bis hin zu Gill und Thom?. Er konstatiert eine erhebliche Bedeutungsverschiebung und -erweiterung. W?hrend Freud damit das energische Eingreifen des Analytikers an dramatischen Wendepunkten der Analyse gemeint hatte, schl?gt der Autor vor, die Handhabung der übertragung heute als eine ubiquit?re Dimension des analytischen Arbeitens zu betrachten. Sie bezieht sich auf den Handlungsaspekt des analytischen Tuns und nicht auf das Deuten im engeren Sinn. Damit wird der Beitrag des Analytikers zur Interaktion thematisiert. Wenn wir diesen Beitrag, d.h. alle Aspekte des Analytikerverhaltens, als Handhabung der übertragung qualifizieren, so erschlie?en wir sie als Elemente des intersubjektiven Geschehens und der übertragungsbeziehung und machen sie der Deutungsarbeit zug?nglich. Die Handhabung der übertragung ist der genuin Freud’sche Ausdruck für das, was Balint und Loch die psychoanalytische Beziehungskunst genannt haben – komplement?r zur Deutungskunst.

---

The handling of transference

Summary. In Freuds opinion the handling of transference is the most difficult and important part of psychoanalytic technique. By handling he did not mean dealing with transference and transference-interpretations in general but something more specific and grasping, that has been regarded as non-analytic later on. The author shows, how important the term was to Freud, and explores its development from ego psychology, Ferenczi and A. Balint to Gill and Thom?. He finds a lot of changes and conceptual clarification. Whereas Freud used the term for the vigorous interventions of the analyst at dramatic turning points of analysis, the author suggests to consider the handling of transference as a ubiquitous dimension of analytic work. It refers to the aspect of action in analysis, not to interpretation, and therefore means the contribution of the analyst to interaction. In qualifying this contribution, that is all aspects of the analysts be- haviour as a handling of transference, we make them accessible as elements of the intersubjective process and the transference relationship, and with that we become able to analyse them. The handling of transference is the genuine Freudian term for what Balint and Loch called the art of relating (Beziehungskunst) – complementary to the art of interpretation (Deutungskunst).

     

Scham und Berührung

The problem

Are there correlations between shame and touch in healthy persons?

Methods

Data from a questionnaire survey with the Skin Satisfaction Questionnaire (HautZuf) with 140 healthy persons were validated with TAS 26, HADS and the Adult Attachment Scale.

Results

There are significant correlations in the scale shame with all other scales of the used questionnaires TAS-26, AAS and HADS. There was a negative correlation between the scale ?physical closeness“ and ?confidence“ of the AAS, but all other scales correlated positively with the shame scale.

Conclusions

More emotions of shame seem to be present with anxiety, depression and disturbances in the sense of an alexithymia concept. Also high feelings of shame correlated with decreased confidence in the personal environment and greater intolerance for personal nearness. The significant correlations between shame affects and self-touch or touch by partner point to important factors in self-perception also for the psychotherapeutic context.     

Facetten eines „deutschen“ Gegenübertragungsproblems

Departing from two case vignettes of psychoanalytic treatments of foreign children of parents who had collaborated with the Germans during the second world war, we are pondering whether there is a specific form of German counter transference defense, making it impossible to allow destructive narcissistic transference offers full of relish through the patients out of the fear that their activation in the analyst might end up in shame and horror as in the previous generations. The nearly complete renunciation to work analytically on the Nazi and Wartime could be described as a secret agreement of the protagonists, finding its justification in keeping out this delightful destruction. The consequences of this abandonment are the disability to establish a solid oedipal position and a regression to the anal world, being characteristic for both postwar German states including much of the analytic work.     

Die Übertragung als Matrix der Traumgenerierung

Zusammenfassung  Traum und Übertragung sind die beiden Grundpfeiler der Erkenntnis in der Psychoanalyse. Sie stammen aus einer gemeinsamen Matrix und können als zwei verschiedene Ausdrucksformen des unbewussten Denkens über die analytische Beziehung beschrieben werden. Dieser Beitrag untersucht die Frage, wie die jeweils aktive Übertragungsform sich auf die Art und Weise des Träumens auswirkt. Sie stellt zwei unterschiedliche Übertragungsmodi als Pole in einem Kontinuum dar, die mit zwei unterschiedlichen Modi des Träumens einher gehen, die wiederum mit den beiden Grundformen des Gedächtnisses — explizit bzw. implizit — verknüpft sind. Wenn die Übertragung vorwiegend prozedurales Erfahrungswissen aus dem impliziten Gedächtnis aktiviert, dann enthält der Traumbericht Zeichenträume als Hinweise auf archaische Ich-Zustände. Diese sind sind der Prototyp der niederstrukturierten Träume. Wenn die Übertragung aber außerdem Erinnerungswissen aus dem deklarativen Gedächtnis aktiviert, enthält der Traumbericht Geschichten als unbewusste Kommentare über die psychoanalytische Begegnung. Solche höherstrukturierten Träume sind vor dem Hintergrund der klassischen neurotischen Übertragung zu betrachten.

---

Transference as a matrix for dream generationOn high and low structured dreams

Dream and transference are the two substantial ways in psychoanalysis towards the understanding of the unconscious. Both are rooted in a common matrix and can be regarded as two different modes of expressing unconscious thinking about the analytical relationship. This contribution studies the question of how the respectively active form of transference effects the way of dreaming. There are two different modes of transference as the poles of a continuum, which are combined with two different modes of dreaming and which in turn are connected to the two basic forms of memory — the explicit and the implicit memory. If transference mainly activates procedural information from the implicit memory, then the dream report contains sign dreams which indicate digitally computed, presymbolic archaic ego-states. Those are the prototype of lower structured dreams. If transference in addition activates information from the declarative memory, the dream report contains analogically computed, symbolic episodes as unconscious comments on the psychoanalytical encounter. Such high structured dreams are to be regarded on the background of the classical neurotic transference.

---

---

Zum 10-jährigen Bestehen des DPG-Instituts für Psychoanalyse Frankfurt am Main am 25.11.2004.

---

Husserls Evidenzbegriff in der intersubjektiven Bewährung moralischer Evidenzen

Evidence is a central theme in Husserl´s transcendental phenomenology. This article investigates not only the theoretical aspects of evidence, but also tries to develop prolegomena for a phenomenological theory of moral evidence and moral truth. Nevertheless, this endeavor is based upon the theoretical insights of Husserl: the importance of intersubjectivity and the relevance of time, which are reviewed in the first two chapters. The temporal aspect, under the title of perpetuation (Bewährung), is crucial for the understanding of the concept of evidence. But it becomes even more important when the question of moral truth is considered. Perpetuation is not only stressed in the understanding of values, but also in the unanimity (Einstimmigkeit) of the ethical and loving person. As evidence of any kind can only be falsified by a higher evidence of the same character, moral evidence cannot be understood isolated from the living process of any prefigured moral settings of a society, moral evidence can give itself only in an interpersonal community and its moral tradition and demands the community’s own readiness for a critical habituality.     

Psychotherapierichtlinien: seit 40 Jahren Bewährung in der Praxis

Looking back at 40 years application of psychotherapy guidelines, a positive balance can be drawn. Benchmarks of the guidelines are the biopsychosocial conception of psychic disturbances requiring treatment and the congruent expertise procedure. The latter is considered by many psychotherapists as unreasonable and by the health insurances as not effective enough because of a rejection quota of only 5%. Nevertheless, it proved to be useful in historical, therapeutic and textual aspects. The biopsychosocial conception of psychic disturbances according to the psychotherapy guidelines is an important counterbalance to the objectifying view and evaluation of psychic processes. This concept implies also a complementary view of the ill compared to somatic medicine which allows a better comprehension and understanding of the individual suffering. The most important modification in the psychotherapy guidelines was the inclusion of behavior therapy as the guideline therapy. It succeeded in surpassing the hallmark of (higher) effectivity by offering shorter therapies and objectifiable verification, as an important complementary object-view into psychic processes. Meanwhile, however, this object-view threatens to displace the ?subject-view“ of the psychotherapy guidelines, especially supported by new developments in evidence-based medicine.     

Glücksspielsucht in der Rechtsprechung des Bundesgerichtshofs

Among the non-substance-related addictions, pathological gambling is the only one that has gained noteworthy forensic relevance. There are numerous parallels to substance-related addictions and not only in the symptomatology. A high proportion of pathological gamblers commit criminal offences to enable them to continue gambling or to pay gambling debts. According to the jurisdiction of the Federal Court of Justice (BGH) pathological gambling in itself cannot be considered as a pathological mental disorder or other serious mental abnormality that substantially diminishes the responsibility of the offender (German Penal Code § 21 StGB); however, the BGH recognizes that in serious cases of pathological gambling mental changes and personality defects can evolve that show similar structure and severity to substance-related addictions and severe withdrawal symptoms might also develop. As with substance-related addictions a substantial diminution of the offender’s responsibility can be assumed, therefore, also with pathological gambling if it has led to most severe personality changes or if the offender suffered from severe withdrawal symptoms while committing an addiction-related crime. According to these criteria a substantial diminution of the offender’s responsibility can be stated only in very rare cases. A custodial addiction treatment order (§ 64 StGB), which is also possible for fully responsible delinquents, is not applicable to cases of mere pathological gambling because the order requires an addiction to alcohol or other drugs. A mental hospital commitment order (§ 63 StGB) can be issued by the court under the same strict conditions that are applied to cases of substance-related addictions. Based on these principles this can only be issued if the defendant is addicted to gambling due to a mental defect that can be distinguished from the addiction itself or if the dependence has already been manifested in very severe personality changes. Pathological gambling can cause a propensity to commit serious offences and therefore, under the further conditions of §§ 66, 66a StGB justify detention for the purpose of incapacitation or a deferred incapacitation order. Even during imprisonment, detainees must be offered a suitable therapy (§ 66c para 2 StGB); however, penitentiaries do not offer the best environment for the treatment of pathological gamblers. The treatment in an addiction therapeutic setting appears to be more promising. Criminal political demands to make custodial addiction treatment orders also applicable to pathological gamblers have, however, very little chance of success.