Psychopathologie und Behandlung der Borderline-Persönlichkeitsstörung

Zusammenfassung Das Wissen über Psychopathologie, Ätiopathogenese und Behandlungsmöglichkeiten der Borderline-Persönlichkeitsstörung (BPS) hat sich in den letzten Jahren deutlich verbessert. Heute sehen die meisten Wissenschaftler eine generalisierte Störung der Affektregulation im Zentrum der BPS, deren Ursachen in Wechselwirkungen zwischen genetischen Faktoren, traumatischen biographischen Erfahrungen und dysfunktionalen Verhaltensmustern liegen. Störungsspezifische Therapieverfahren, insbesondere die Dialektisch Behaviorale Therapie (DBT) nach Linehan, flankiert von psychopharmakologischer Behandlung, zeigen gute Behandlungsergebnisse sowohl im stationären als auch im ambulanten Bereich. In jüngster Zeit wurden viel versprechende Konzepte zur Behandlung schwerer komorbider Störungen [Alkohol und Drogenabhängigkeit, Posttraumatische Belastungsstörung (PTBS)] entwickelt.     

Langzeitwirkungen psychoanalytischer und verhaltenstherapeutischer Langzeitpsychotherapien

The prospective study compares 31 patients in long-term behavior therapy with 31 patients in psychoanalytically oriented long-term therapy. A naturalistic design was applied within the German health system. All patients underwent a diagnostic interview (SCID) by an external interviewer. Only patients who fulfilled the DSM III-R criteria for a depression or an anxiety disorder were included in the study. Although the diagnoses of the patients undergoing long-term behaviour therapy and long-term psychoanalytical psychotherapy were comparable, we found that they differed in various ways. The differences arose in a number of characteristics, such as education, access to psychotherapy (recommended by professionals versus patients introducing themselves), usage of psychotropic medication, and the strain of symptoms. The average duration of long-term behavior therapy was 2.4 years and 64 sessions. The average duration of psychoanalytically oriented long-term therapy was 3.6 years and 209 sessions. Symptoms (SCL-90-R) and interpersonal problems (IIP) were examined at the beginning, after 1 year, 2.5 years, 3.5 years and after 7 years. Both groups showed significant degrees of improvement within the first 3.5 years and remained stabilized in the following 3.5 years regarding the symptomatic aspects. Focussing on the interpersonal problems, group PA showed further improvement after the 3.5-year period. The BT group however, showed no further improvement after 3.5 years but stabilized. The evaluated phase-model of psychotherapeutic change for short-term therapy was confirmed more clearly for long-term therapies of psychoanalytical orientation than for long-term therapies of behavioral orientation.     

Subjektive Einschätzung der eigenen Gesundheit und gesundheitsrelevantes Verhalten bei niedergelassenen Psychologischen Psychotherapeuten

From June until August 2004 we asked 488 established psychological psychotherapists in selected German federal states for a subjective evaluation of their own health, their utilization of the health care system and their health-related behavior. It turned out that the psychotherapists mainly reported a good state of health although their reported state of health was more negative than in the general population with equal age and level of education. This finding is surely connected with specific mental, physical and existential burdens of their profession as well as with specifics of the “psychotherapist personality”. The psychotherapists’ evaluations highly depend on age, but not significantly on sociodemographical criteria like gender and place of establishment (East/West Germany). Also the affiliation to a therapy school (psychoanalysis, depth psychological funded psychotherapy, behavior therapy) is irrelevant for the subjective evaluation of one’s own health. Concerning the annual number of consultations and disability days the psychotherapists are clearly below average. They report a lot of attentiveness about their health and practice a health-benefical behavior. In this case they make higher demands on themselves than the general population.     

Researching psychotherapy integration: A heuristic approach

Moustakas argues that questions and methodology in heuristic research flow out of inner awareness, meaning and inspiration. The approach might arguably embrace a combination of qualitative research methods, and constitute a kind of bricolage. This paper describes a heuristic enquiry into psychotherapy integration that used such a combination of methods – an interpretative phenomenological approach, case studies, reflexive action, and writing. It demonstrates how each of these methods contributed to the six phases of heuristic enquiry, from the initial engagement with psychotherapy as a trainee to the creative synthesis of published works and a PhD thesis, together with some reflection on the enquiry's limitations and rigour. Published texts, training, clinical practice and reflexivity constituted the material from which a new organizing framework for understanding psychotherapy integration was formulated. The author reflects on how the research design allowed deep engagement with this material, and changed his perspective of psychotherapy integration. In conclusion, this paper suggests that both psychotherapy integration and heuristic enquiry can only be conducted on an individual and personal basis, and that it is the quality of the relationship, with the client, or the research material, that produces results.     

New job market entrants' future work self,career adaptability and job search outcomes: Examining mediating and moderating models

Based on career construction theory and the model of proactive motivation, the current research examined the mediating and moderating models for the relations among future work self, career adaptability, job search self-efficacy and employment status. A survey study was conducted among Chinese university graduates (N = 270). The results showed that future work self (measured at wave 1) had positive effect on employment status (measured at wave 3), with this relationship partially mediated by career adaptability (measured at wave 1) and job search self-efficacy (measured at wave 2). In addition, the results further revealed that the positive effect of future work self on job search self-efficacy was stronger among the graduates who had a higher level of career adaptability. In support of the hypothesized moderated mediation model, for individuals with a higher level of career adaptability, the indirect effect of future work self on employment status through job search self-efficacy was stronger. These findings carry implications for research on job search behavior, career education and career counseling.     

The Role of Irrelevant,Class-Consistent,and Class-Inconsistent Intraverbal Training on the Establishment of Equivalence Classes

The Psychological Record - The current study evaluated whether college students’ performance on visual–visual matching-to-sample (MTS) tasks were differentially affected by learning to...     

Die verwundbare Analytikerin

The withdrawal of acceptance lies at the centre of the traumatic experience and the disastrous consequences are overwhelming feelings of anxiety and shame relating to the individual’s own existence. Intense feelings in traumatised individuals are accompanied by fundamental shame as they fear once again being inundated by their own emotions and thus yet again becoming helpless and defenceless. Further, the emergence of emotions inevitably demonstrates their roots in the individual personality and it is precisely the withdrawal of recognition as a separate, autonomous being which these individuals have experienced. “When I experience myself as an individual with feelings, then I am but I am not allowed to be” seems to be what these people are unconsciously thinking. Recognition, in the true sense of the word, can only be achieved by the performative act of recognition both of the subjectivity and of the trauma. Such acts of recognition can be performed in the psychoanalytical process when the analyst shows herself as being involuntarily vulnerable and at the same time as a survivor of that vulnerability. This means, however, that the dialectic tension must not only be endured but under certain circumstances also admitted; the tension between the wish to keep all emotions within oneself and the simultaneous unavoidable failure to do so. Only an analyst who is actively alive can, in the last resort, help the traumatised to establish contact with the world of living objects and to feel themselves as being alive.     

Gender Role Beliefs and Attitudes toward Lesbians and Gay Men in Chile and the U.S.

We compared the relationship between gender role beliefs and antigay prejudice in Chile and the United States. Participants were Chilean and American university students. In Study 1, Chileans were more prejudiced than Americans, and men were more prejudiced than women. In Study 2, gender role beliefs mediated cultural and sex differences in prejudice. Chileans held more traditional gender role beliefs and were more antigay than Americans. Men were more prejudiced than women, particularly in their attitudes toward gay men. Further, sex differences in attitudes toward lesbians and gay men were completely mediated by gender role beliefs. Nationality differences in attitudes toward lesbians were completely mediated, and nationality differences in attitudes toward gay men were partially mediated, by gender role beliefs.