Zwei Wege am Ödipuskomplex vorbei

Two pathological constellations are presented that prevent from resolving the Oedipal complex. Both have in common the poor resilience of the negative Oedipal constellation. In the first version, a rivalry with the father is avoided, acknowledgement and idealization do not take place, but the father’s position is taken over in a regressive surreptitious way. The second way to avoid resolving the Oedipal constellation is based on narcissistic omnipotence. During Oedipal development the child – owing to the behaviour of the parent of the other sex – becomes convinced to be himself the preferred partner of father or mother. This development is illustrated by a case study.     

Die Bindungstheorie als Basis psychotherapeutischer Interventionen in der Terminalphase

Recent attachment research has shown that every person develops, already in early childhood, special attachment strategies activated in cases whenever the person cannot cope on his own with dangers. These strategies are classified into four categories: “secure”, “insecure-avoidant”, “insecure-ambivalent/enmasked” and “disoriented/disorganized” attachment patterns. The death of a next person represents a situation of a unique and final separation causing psychical disturbances for the patient himself and his relatives. It is, therefore, an especially effective trigger for the activation of the attachment system. This article aims on relating attachment theory to an attachment-oriented therapy, that would open, particularly in the field of palliative medicine, possibilities of application which have been neglected. Case studies illustrate how these insights may be applied during the psychotheraputic care for patients and their relatives. As dying patients generally are brought by their family to the clinic, physicians have a particularly favourable situation to observe the attachment patterns in the family and integrate these informations into their treatment strategy: for example in case of “avoidant” attachment patterns, to bring cautiously the denied emotions into the communication and to support hopes for the fulfilment of needs for affection and protection; or in case of so-called “ambivalent/entangled” attachment patterns to help to disentangle too close relationships; or in case of “disorganized” attachment patterns to support emotional regulation and help to clear the relationships. It is obvious that this approach based on attachment theory and offering alleviations during the process of dying, is not only on a palliative board relevant, but may be applied with success in the medical care of dying patients and their relatives.     

Matching therapeutic interventions to drug and alcohol abusers’ stage of motivation: The clients’ perspective

The present study aims to explore the issue of matching the appropriate therapeutic intervention according to the stage of readiness for change in addictive clients, following the model proposed by Prochaska and DiClemente in the 1980s. The study focuses solely on the perspectives of people with drug and alcohol problems, in contrast to previous ones which have been concerned with the researchers’ understandings and postulations of the issue under exploration. One of the most important findings of this study is that participants in the “early” stages of their readiness to change their addictive behaviour, irrespective of their gender or whether they had seen a therapist significantly prefer non-action-oriented therapeutic interventions than action-oriented interventions. Similarly, participants in the “later” stages, showed a significant preference to action-oriented than non-action interventions, irrespective of their gender or previous experience of counselling. It is suggested then that careful assessment of the stage of motivation and individual-tailored intervention should be an essential element of any treatment program for drug and alcohol addicted clients.     

Counselling values and their relationships with self-efficacy among Chinese secondary school teachers in Hong Kong

Two-hundred-and-ninety-nine Chinese secondary school teachers in Hong Kong were assessed on their endorsement of counselling values using a 19-item self-report checklist, and on their perceived self-efficacy towards helping using the 10-item Schwarzer-Wegner scale. These teachers were found to share the same counselling values as counselling psychologists. They prized most highly the humanistic counsellor qualities, followed by counselling practice with a preventive, developmental and holistic perspective. Their relative endorsement of scientific values suggested that they were not resistant to the promotion of empirically supported and evidence-based treatment approaches. Teachers’ self-efficacy towards helping was also predictable from endorsing values related to interpersonal relationships and diversity in counselling practice. Implications of the findings for improved counselling training for teachers are discussed.     

Telefonische Nachuntersuchungen bei postpartaler Depression

Interviews over the telephone with mothers with and without postnatal depressive symptoms are reported. Advantages and disadvantages of interviews by telephone are discussed. Especially in cases of long distance to the home of a client, telephone interviews have economic and logistic advantages. If there are special questions (e.g. depression), telephone interviews seem to be widely accepted by the people.     

Indikation zur ambulanten Nachsorge (Curriculum Hannover) in der Psychosomatischen Rehabilitation

Outpatient psychosomatic aftercare (Curriculum Hannover) was introduced nationwide in 2000 by the pension scheme. The effectiveness and efficacy of outpatient psychosomatic aftercare has been widely researched. This publication presents an indication-model based on four levels (capacity, participation, activity and impairment) whereas empirical results and clinical experience concerning participation in psychosomatic outpatient aftercare following an in-patient rehabilitation are considered in accordance with the international classification of functioning, disability and health.     

Vom Labor ins Feld

The mainstream of psychotherapy evaluation had moved away from naturalistic studies like catamnestic ones because their internal validity had to be questioned. The kind of studies which predominated after that have also been criticised in the last few years due to their lack of external and ecological validity. The new approach nowadays is to use controlled field studies which manage to combine the advantages of both previously mentioned evaluation methods. The possibilities with regard to contents and methodological requirements of such studies are described. However, this approach is only possible if it is firmly supported by psychotherapists in the field.     

Trauma und Traumafolgen aus psychodynamischer Sicht

Zusammenfassung Posttraumatische Störungen sind psychogene Erkrankungen, die durch Traumatisierungen bewirkt werden. Das sind seelische Verletzungen, die schwer oder gar nicht bewältigt werden können. Die Störungen beruhen auf unterschiedlichen Arten von katastrophalen Erlebnissen und können mit zeitlicher Verzögerung, unabhängig von einer spezifischen Disposition, also auch bei bis dahin völlig gesunden Menschen, zu einer vorübergehenden, länger andauernden oder lang anhaltenden Störung im seelischen und körperlichen Bereich und zu einer Veränderung der Persönlichkeit führen. Diese Störungen sind außerordentlich häufig und haben eine große Vielfalt in Hinblick auf ihre Entstehung und ihre Krankheitserscheinungen. Dynamik und Folgen traumatischer seelischer Verletzungen werden in diesem Beitrag systematisch aus psychoanalytisch orientierter Perspektive untersucht und dargestellt.     

Psychotherapie bei lebensbedrohlich Erkrankten

In den letzten 20 Jahren ist die begleitende psychotherapeutische Behandlung bei körperlich Schwerkranken fester Bestandteil der Tätigkeit von psychosomatischen Konsiliar- und Liaisondiensten im Krankenhaus geworden. Eine Konzeptualisierung dieser Tätigkeit auf psychodynamischer Basis wird beschrieben. Ziele der psychotherapeutischen Interventionen sind die Stabilisierung der Abwehr des Patienten und die Rückgewinnung eines strukturierten Umgangs mit der Krankheit, mit den Behandlern und den nahen Bezugspersonen. Therapiebausteine sind eine narrative Gesprächsstruktur, ein psychodynamisches Verständnis der aktuellen Krankheitssituation auf dem Hintergrund der Lebensgeschichte, aktives Zuhören, Fokusformulierung und systemische Sichtweise. Wichtige Wirkfaktoren sind eine empathische Beziehung, Verbalisierung von belastenden, negativen Gefühlen, Fokussieren auf aktuelle Probleme und Ressourcenorientierung. Probleme entstehen durch negative Gegenübertragung des Psychotherapeuten und ausgeprägte Verleugnungsvorgänge auf Patientenseite. Die Umsetzung erfordert vom Psychotherapeuten kontinuierliche Präsenz und regelmäßige Rücksprachen und Konsultationen mit dem behandelnden Team.     

Two ways of being a Christian in the Muslim context of the Middle East

This article identifies two fundamental outlooks and basic orientations of Christians living among Muslims in the context of the Middle East that result in two ways of being a Christian in that region. The origin of the two types, labelled the ‘Arab Christian’ and the ‘Eastern Christian’, is traced back to early Christian contacts with Islam, and the content of those two ways is explicated in their political, cultural and religious implications by briefly elaborating two contemporary Lebanese Christian conceptualizations of the two ways. It is argued that these two types provide a hermeneutical key not only for understanding the behaviour, actions and thought of Christians of the Middle East, but also for understanding and evaluating the perceptions of non-Middle Eastern writers and historians about the topic of Christians in that region.