Leben ohne Gewalt organisieren

Several runs of a cognitive-behavioral group-based training program for violent offenders in a youth detention center were evaluated. The training aims at reducing disposition towards violence, promoting responsibility and strengthening personal and social resources. The 49 participants were compared to 47 non-participating violent offenders. For the participants a reduction of several facets of aggression and an increase of responsibility for the offence was observed in a pre-post-comparison. However, treatment effects appear to decrease with longer observation time. Competencies such as empathy were not affected by the training. Furthermore, participants showed no difference to non-participants regarding officially recorded violent recidivism.     

Kritische Anmerkungen zur Einweisung von Jugendlichen und Heranwachsenden in den Maßregelvollzug

In this paper the preconditions for placing adolescents and young adults in forensic psychiatric institutions are analyzed. According to the law such placements are only justifiable in exceptional cases. Even from a psychiatric point of view it is difficult to delineate a severe and most notably lasting mental disorder at a young age and distinguish it from a lack of maturity, although only the first would justify an indefinite placement in an institution. Nevertheless both broadly pathologizing certain behaviors and loosely interpreting preconditions for placements in institutions encourage commitment to institutions.     

Die Entwicklung der Gesetzgebung zur Sicherungsverwahrung und die damit verbundenen Auswirkungen auf ihre Klientel

Initially, the article gives a short overview over the expansions of preventive detention the legislator has made in recent years. Secondly, prosecution statistics as well as statistics on enforcement of sentences are analyzed focusing on the effects the change in legislation has on the number and structure of preventive detainees. Hereafter, the author presents the central results of an own study titled ‘Reconviction of Dangerous Recidivists’. These results further the conclusion that there is a considerable amount of persons falsely classified as dangerous amongst today’s preventive detainees.     

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.     

Patienten mit einer wahnhaften Depression in der Maßregel nach § 63 StGB

Delinquency of depressed patients numerically plays a minor role in criminal or civil law. Compared with the high prevalence of affective disorders in the general population, the frequency of patients in forensic psychiatric hospitals with the respective disorder as a main diagnosis is low. The spectrum of possible crimes committed by depressed subjects essentially comprises disease-characteristic offences, amongst which cases of extended suicide or attempted suicide are the foremost and most tragic offences. Based on 2 case reports notions of extended suicide as well as questions of forensic assessment are discussed.     

Ost-West-Verhältnis

The first question a psychoanalyst has to examine in connection with this topic is, whether psychoanalytical concepts apply to sociological and political developments (problems) at all, and which ones, if they do. The most adequate theories seem to be the psychoanalytical developmental and the object relation theories, the regression model, first of all in its group dynamical version as described by Bion and later on by Heigl-Evers, and the psychoanalytic-anthropological socialization model of Erich Fromm. Following the way of the author’s work in Balint groups, he examined the conscious and unconscious interactions between East- and West-Germany’s societies. Moreover, the consequences of the unresolved humiliation because of the lost war (denazification in West-Germany) and the comparison of the post-communist development of Czechia with that of East-Germany served me as further background screens.     

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.