Explizite und implizite psychoanalytische Behandlungspraxis

Zusammenfassung  Die Psychoanalyse wurde mit dem Ziel konzipiert, Verdrängungen dem Bewusstsein zugänglich zu machen und dadurch die Kindheitsamnesie aufzuheben (Freud 1937). Mit der Ausweitung des psychoanalytischen Behandlungsspektrums auf präödipale Störungen und Verbreitung der Objektbeziehungstheorie entwickelte sich allerdings eine alternative Behandlungsstrategie, die Therapie der emotionalen Erfahrung. Der damit verknüpfte Dualismus führte lange zu einer Kontroverse über eine einheitliche psychoanalytische Behandlungstechnik. Nur langsam setzte sich die Erkenntnis durch, dass angemessene Deutungen und ein entwicklungsfördernder Umgang mit der Übertragung zwei therapeutische Ansätze darstellen, die nicht voneinander zu trennen sind.Vor dem Hintergrund der neueren Gedächtnisforschung zeigt sich, dass beide Ansätze sich einerseits ergänzen, andererseits aber auch gegensätzliche Pole im Indikationsspektrum der psychoanalytischen Praxis repräsentieren. Die Einsichtstherapie der klassischen Analyse hat das episodische, explizite Gedächtnis als Bezugspunkt und in dieser Weise auch weiterhin Gültigkeit. Demgegenüber bezieht sich die Therapie der emotionalen Erfahrung auf implizites Erfahrungswissen, das den Kern der Patienten mit einer Entwicklungspathologie ausmacht.In dieser Arbeit wird die implizite psychoanalytische Behandlungspraxis im Umgang mit archaischen Ich-Zuständen erläutert. Dabei wird die Bedeutung der bekannten Behandlungskonzepte Objektverwendung, Metabolisierung und containment hervorgehoben.

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Explicit and implicit psychoanalytical practice

Psychoanalysis was conceived with the aim of making suppressed experiences available to the consciousness and by means of this, reversing childhood amnesia. In the course of the extension of the psychoanalytical treatment spectrum to pre-oedipal disturbances and the increasing influence of the object relation theory an alternative therapeutic strategy, the therapy of emotional experience, was developed. The related dualism led to a long-lasting controversy about a uniform psychoanalytical technique. The insight that adequate interpretations and beneficial handling of the relationship are two therapeutical approaches which have not to be separated from each other, has been accepted slowly.Against the background of recent memory research it turns out that on the one hand both approaches supplement each other, but on the other hand they are contrasting poles in the indication spectrum of psychoanalytical practice. The therapy of insight of classical psychoanalysis has the explicit memory as a reference point and is therefore still valid. On the contrary, the therapy of emotional experience refers to implicit experience which is the core of developmental pathology.In this paper the implicit psychoanalytical practice, dealing with archaic ego states, is discussed, referring to such well-known concepts as object use, metabolization and containment.

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Nach einem Vortrag zum 50-jährigen Bestehen des Lou Andreas-Salomé Instituts in Göttingen am 30.10.04.

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Psychotherapeutische Kurzintervention bei somatisierenden Patienten im Krankenhaus

The manual describes the psychotherapeutic procedure for somatizing patients who are admitted to hospital for diagnostics and therapy of unclear physical complaints. An essential goal of the psychotherapeutic interventions is to achieve an understanding for the disease, in which body, psyche and social relationships are experienced as interrelated. By addressing the health fears and subjective concepts about the onset and maintenance of his physical complaints, the patient feels that he is being taken seriously and understood. Connections between physical symptoms and the suppression of undesirable affects like anger, rage and disappointment are verbalized and understood in greater depth, based on body perception exercises and a symptom diary. The positive experience of understanding and symptom relief obtained in the psychotherapeutic sessions is used for the main goal of the intervention: to motivate the (out- and in-)patient for a regular psychotherapy. Experience up to now has shown that three to five sequential sessions of about 45–60 minutes suffice to attain this therapy goal. Implementation is most successful within an established consultant or liaison service in close cooperation with the ward doctors.     

Tinnitus als soziale Infektion?

Background

11 out of 35 male employees of a central alert team with rescue coordination function developed a tinnitus disorder. This clinical case-study highlights the psychodynamic background of this accumulation.

Methods

Employees were investigated by psychometric questionnaires and semistructured psychodynamic biografical interviews. Additionally aspects of group dynamics and organisational structure were assessed.

Results

All staff members reported adverse work conditions. Medical and psychometric examination of the tinnitus patients did not reveal severe pathological findings. The interviews identified psychodynamic conflicts dealing with autonomy and regulation of self-esteem. All tinnitus patients reported a very adverse or punitive father relation and difficulties in performing a stabile male role and self-image. Group dynamics was dominated by paranoid and regressive tendencies complicated by maladaptive coping, crude perception of external facts and a pronounced experience of aggressive impulses.

Conclusion

The remobilisation of infantile powerlessness, ineffectiveness and helplessness triggered by adverse work conditions and the introduction of a new culture of personal responsibility within the work organisation together with an impaired coping of separation conflicts enforced by traumatic aspects of the relation with the father may have promoted the tinnitus symptomatology. Additionally, due to the missing awareness of the importance of such group dynamical processes the employers contributed to an increasing psychosocial distress, which promoted the accumulated manifestation of tinnitus as a conflict expressive symptom.     

Rationale and development of a general population well-being measure: Psychometric status of the GP-CORE in a student sample

This paper presents the rationale, development, and psychometric status of a non-clinical self-report measure for the general population (GP) - including students - derived from the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and hence termed the GP-CORE. In contrast to the CORE-OM, the GP-CORE does not comprise items denoting high-intensity of presenting problems or risk and thereby increases its acceptability in a non-clinical population. Uniquely, over half the items in the GP-CORE are positively keyed. Analyses showed the GP-CORE to have good reliability, to distinguish between clinical and non-clinical populations, and have convergent validity against the full version. Norms for student populations are presented. It is suggested that the GP-CORE has considerable utility as a means of tapping the psychological well being of students and can then interface with counselling and mental health services using the CORE-OM.     

Protecting confidentiality rights: the need for an ethical practice model

All psychologists must uphold the same ethical standards about confidentiality even though each state imposes different legal limits on their ability to protect clients' confidences. The resulting ethical-legal confusion is exacerbated by legally based confidentiality training that treats legal exceptions as if they were the rule and fosters the impression that attorneys are now the only real experts about this aspect of practice. This article provides an ethics-based confidentiality practice model that clarifies the ethical rule and puts its legal exceptions into ethical perspective. Like the Confidentiality section of the American Psychological Association's (2002) Ethical Principles of Psychologists and Code of Conduct, this outline would apply to all psychologists regardless of state laws, but the details of its implementation would vary according to role and setting. It can be used as a universal training outline, a consultation and supervision tool, a guide to professional practice, and a basis for clearer ongoing conversation about the ethics of "conditional confidentiality." Psychologists can use this practice model to regain their status as experts about the confidentiality ethics of their own profession.     

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.     

Von anderen Patienten lernen

Today, internet-based technologies are used at all levels of psychosocial services. Current psychotherapeutic applications concentrate on the implementation of traditional approaches in the internet. Self-help programs are posted onto the net, therapies are conducted via e-mail and groups meet in virtual chat rooms. If one looks at the development of the web over the last 2 years, it becomes clear that the substantial growth and popularity of this medium is due to internet platforms where contents and knowledge can be developed in collaborative environments and experiences can be shared with other users. The present paper addresses this development. On the basis of our example it is discussed how collaborative elements can be integrated into a psychotherapeutic application.     

Psychosoziale Versorgungsforschung

Health is of high value. Therefore, an effective and efficient care is a widely accepted societal objective. Correspondingly, health service research in general and for the psychosocial area in particular receives increasing attention from politics, health and pension insurance companies and professional organisations. These stakeholders promote health service research with considerable financial means. The various promotional programs are described and their implications are discussed. The relationship between content, purposes and methodology for the definition of research in health care is clarified. Finally, current research questions are exemplified by five key topics.     

Glaubhaftigkeitsbegutachtung – mehr als Merkmalsorientierte Inhaltsanalyse

The diagnostic value of criteria-based content analyses (CBCA) for assessing statement credibility has been widely acknowledged. However, theoretical considerations and empirical results show that CBCA is basically appropriate for discrimination between fabricated and truthful accounts. CBCA does not differentiate between truthful and suggested statements and can therefore not help to decide upon a suggestion hypothesis. Moreover truthful accounts do not always contain many CBCA criteria. It is argued that CBCA is for these reasons not a method for substantiating a truthful statement, but a method for rejecting a fabrication hypothesis As a whole Statement validity analysis is the process of systematically generating and evaluating hypotheses about potential origins of the given statement. Only in a subgroup of cases CBCA constitutes the major part of this diagnostic procedure.