Psychoonkologie

Changes in the spectrum of illnesses have led to a predominance of chronic diseases, including oncological disorders, that are connected with substantial mental health problems. The needs of people with cancer are increasingly attracting the attention of psychosocial and psychosomatic disciplines as far as patient-oriented health care research and counselling practice are concerned. Psychosocial work in oncology appears to be becoming increasingly professionalized. Theories of the psychosocial origin of cancer are gradually losing ground in the scientific community, giving way to a rational attitude towards oncological diseases that counters the stigma of cancer. At the same time, the demand for psycho-oncological services is becoming more important if we take into account the high rate of psychiatric co-morbidity and the fact that these patients are poorly diagnosed and inadequately treated. This is all the more regrettable in that a broad range of evidence-based interventions are available which are gradually being implemented in the guidelines of rehabilitation facilities and oncological centres of excellence. The transfer of knowledge in the everyday care of cancer patients, however, has yet not been accomplished.     

Erfahrungsorientiertes Lernen in der Psychotherapie

Background

Based on principles of experiential learning, psychophysical exposure (PPE) on a tightrope course offers a promising intervention in the treatment of patients with mental disorders. A PPE program conducted on a hospital tightrope course is presented as an adjunct in inpatient psychotherapy.

Methods

The acceptance and effectiveness of the PPE were evaluated in a prospective controlled naturalistic study. A total of 155 patients, who were exposed at least once during their inpatient therapy, were compared with 92 control patients, who did not participate in the tightrope course. The main outcome criteria were self-reported depressive symptoms, state anxiety, locus of control, self-efficacy, and trait anxiety.

Results

The PPE was highly accepted by the participants. Patients who attended the tightrope courses showed greater improvement in the outcome criteria than patients who received inpatient treatment as usual. Particularly better effects were found on the personality variables.

Conclusions

Psychophysical exposure can successfully and effectively be integrated into a psychosomatic inpatient treatment program. Methodological limitations of the study, especially threats to internal validity, are discussed.     

Die „Seelenkulturrevolution“

In this paper the work of the author as a psychoanalytic training therapist and supervisor at a counselling centre in a Chinese metropolis will be described. In the first part her experiences with adults of the age cohort 25–35 years will be described, the second generation after the Cultural Revolution. Special attention is devoted to biographically relevant life stages such as childhood, education and marriage in a transient society between a system of traditional Confucian values and that of the new capitalism. The second part of the paper focuses on culture-specific characteristics of a collectivist society from a psychoanalytic perspective, such as setting limits, saving face, empathy, transference and sexuality.     

When being a girl matters less: Accessibility of gender‐related self‐knowledge in single‐sex and coeducational classes and its impact on students' physics‐related self‐concept of ability

Background . Establishing or preserving single‐sex schooling has been widely discussed as a way of bringing more girls into the natural sciences. Aims . We test the assumption that the beneficial effects of single‐sex education on girls' self‐concept of ability in masculine subjects such as physics are due to the lower accessibility of gender‐related self‐knowledge in single‐sex classes. Sample . N = 401 eighth‐graders (mean age 14.0 years) from coeducational comprehensive schools. Methods . Random assignment of students to single‐sex vs. coeducational physics classes throughout the eighth grade. At the end of the year, students' physics‐related self‐concept of ability was measured using a questionnaire. In a subsample of N = 134 students, the accessibility of gender‐related self‐knowledge during physics classes was assessed by measuring latencies and endorsement of sex‐typed trait adjectives. Results . Girls from single‐sex physics classes reported a better physics‐related self‐concept of ability than girls from coeducational classes, while boys' self‐concept of ability did not vary according to class composition. For both boys and girls, gender‐related self‐knowledge was less accessible in single‐sex classes than in mixed‐sex classes. To the extent that girls' feminine self‐knowledge was relatively less accessible than their masculine self‐knowledge, their physics‐related self‐concept of ability improved at the end of the school year. Conclusions . By revealing the importance of the differential accessibility of gender‐related self‐knowledge in single‐ and mixed‐sex settings, our study clarifies why single‐sex schooling helps adolescents to gain a better self‐concept of ability in school subjects that are considered inappropriate for their own sex.     

Die sexuelle Entwicklung Jugendlicher und Heranwachsender im Kontext von Sexualstraftaten und Körperverletzungsdelikten

To find out possible differences concerning the sexual development of juveniles who had committed either sexual or assaultive offenses. In order to reduce confounding variables a defined group of perpetrators was studied during ongoing criminal proceedings: 107 German single perpetrators, of average intelligence, between 14 and 21 years old, committing hands-on offenses, were investigated in respect to their physical-sexual development (i.e. maldescensus testis, orchitis and others), their socio-sexual development (i.e. attitude to masturbation, to sexuality within the family and others), and their psycho-sexual development (i.e. homo- or heterosexual experiences by mutual agreement like petting or sexual intercourse). 38 subjects had sexually forced female juveniles or women, 36 subjects had sexually abused children of both sexes, 33 subjects had committed assaultive offences towards male juveniles or men (control group). No differences were found between the groups concerning their physical-sexual development. The socio-sexual development distinguished between the sexual offender groups and the control group. The outcome concerning the psycho-sexual development was specific for every single offender group. Many of the juveniles who had committed sexual offences were acting like this already before the age of 14 (limit of criminal responsibility in Germany). This was so as well for some few subjects of the control group. After the age of 14 juveniles of the sex offender groups - in contrast to the control group - committed sexual offences which were not reported. Considering further characteristics of the biography and the results of psychometric instruments of the 107 subjects investigated, this study describes early markers of the development of deviant sexual fantasies in juvenile sex offenders.     

Begegnung im Dienste des Begreifens

Starting with the question of why in certain instances acting out a counter-transference can lead to an “encounter in the service of comprehension” (Trimborn 1995), first Winnicott’s squiggle game in Gadamer’s (1960) sense is analyzed as an interpersonal hermeneutic circle. Then the effect and structure of recognition is clarified with sequences from Trimborn and Warsitz. This is done using Weiss and Simpson’s (1986) thought testing and Hegel’s concept of the fight for recognition in the form reworked by Honneth (1994). Finally, based on a case reported by Laimböck, the general significance of recognition in the analytical process is discussed. Recognition seems to be a cognitive and interactional moment of the analytical process that inexplicitly usually accompanies successful analysis, but when a narcissistic disorder is present it becomes the center of attention and important for successful analysis.     

Somatoforme Störungen bei ambulanten dermatologischen Patienten

Zusammenfassung In der vorliegenden Studie wurde die Häufigkeit somatoformer Symptome in einer dermatologischen Universitätsambulanz untersucht. An der Studie nahmen n=195 Patienten teil, die Screeningfragen zu somatoformen, dermatologischen und depressiven Symptomen ausfüllten. Zusätzlich wurde eine dermatologische Beurteilung der Symptome hinsichtlich der Ätiologie erfasst. Danach wiesen 26,2% der Patienten Hinweise auf eine somatoforme Störung auf; am häufigsten waren somatoforme Schmerzstörung (16,9%) und körperdysmorphe Störung (15,4%). Unter den spezifischen dermatologischen Symptomen wurde Juckreiz besonders häufig (10,3%) als somatoform klassifiziert. Der Anteil von Patienten mit erhöhten depressiven Beschwerden lag bei 17,3%. Die Ergebnisse sprechen für eine erhöhte Prävalenz somatoformer Störungen bei dermatologischen Patienten. Die Identifizierung und psychotherapeutische Versorgung dieser Patientengruppe sollte in der dermatologischen Routineversorgung mehr Beachtung finden.