Die Auswirkungen der Wende 1989 auf Adoleszente

The significance of adolescence for psychosocial development is a controversial theme with discussions ranging from an emphasis on the importance of early childhood to the ideas propagated by Freud that the dynamics of adolescence play an important role in the psychological development of the individual and transculturation. The course of adolescence provides a starting point for understanding the psychodynamics of patients, which is often given insufficient consideration. Today, it can repeatedly be seen that patients in their mid-thirties are coming for treatment: patients who experienced their adolescence during the period of political upheaval in Germany. For a variety of reasons this proves to have been a vulnerable life phase, above all for East Germans. Puberty and adolescence comprise developmental tasks whose completion in a crisis situation, such as represented by the political change in East Germany with the reunification process, suffered considerably. Accordingly, the consequences of this conflict-laden coping process can be revealed during later therapy in transference and central relationship conflicts. The adolescents made considerable efforts to adapt to the new conditions, however, without adolescent altercations with GDR parents and conditions having taken place in sufficient measure. The treatment of a female patient is presented for whom the political change during adolescence proved to be a critical life event. Her narcissistic deficits together with her fragile identity were exacerbated as a result of the social upheavals. It is demonstrated how this ??critical life event?? was intertwined with her earlier psychological structure, the problems of adolescence and her search for identity during the course of psychoanalysis.     

Gibt es ein weibliches ?quivalent zur m?nnlichen Perversion?

Starting with the new definition of paraphilia as planned for the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) it will be shown that the topic cannot be handled without a structural definition of the former perversion. Using the most advanced definition for male perversions it will be investigated if there are female counterparts covering the same structural deficits and pseudosexual solutions. This is done using an interpretation by Beyer of a fairy tale from the brothers Grimm which can be considered as typical for these solutions. The basic clinical background will be exemplified using several long-term psychoanalytical cases of women during which it became clear that the creation and destruction of children??s lives is an equivalent to the reparative function of the sexual act in the male perversion, temporarily stabilizing an extremely vulnerable narcissistic structure. It will be discussed whether there are other structural equivalents of perverse solutions, for example taking power of the child??s or the own body as in anorexia or Munchhausen by proxy syndrome.     

Freud über Krankheit

The history of Freud??s illnesses shows us how he tried to circumvent the confrontation with his health disorders and consider them as unimportant. Similarly, in his personal letters, he left his ill body ??out there?? as if it were another person, Konrad, not himself. He avoids understanding it from the inside. In his correspondence, especially with Ferenczi, depressive symptoms were considered as somatic and were excluded from his reflexions. Important insights, e.g. about a relationship between cancer with hate do not change his basic attitude. Disavowel and masochism become important in his life and writings. In the post-Freudian literature these themes will be integrated in the dialogue, i.e. between analyst and analysand.     

Nebenwirkungen bei psychoanalytisch orientierten Therapien

Freud discovered that psychoanalysis is potentially a dangerous method consisting of multiple explosive elements. But what are the risks and where can they be found? The author describes the possible side effects of psychodynamic therapy, such as dependency on the therapist, avoidance of personal duties, fixation on problems, increased feelings of inferiority and difficulties in social relationships. He shows how these effects are connected with basic psychoanalytic techniques, such as free association, abstinence, interpretation and easing of the burden of the superego. Only if the therapist knows about such unwanted effects will he be able to identify them in time and be able to inform the patients as is obligatory according to current legal practice.     

Partizipationsverhalten schizophren erkrankter Patienten in Psychoedukationsgruppen

Background

The effectiveness of psychoeducation groups for people with schizophrenia is well documented; however, there are no studies which examined patient participation behavior although this behavior might be critical for accomplishment of the therapeutic goals. This article presents newly developed 4-point Likert scale, the participation quality rating scale (PQRS), together with initial results on practicability, validity, change sensitivity, sociodemographic and clinical correlates and on the question whether participation quality might be a significant predictor of the short and long-term outcome of psychoeducation.

Patient and methods

Within the framework of the Munich Study “Cognitive Determinants of Psychoeducation and Information in Schizophrenic Psychoses” (COGPIP) the individual participation behavior of 97 patients with schizophrenia was examined after each psychoeducational group session (4 weeks). Individual mean PQRS scores were correlated with sociodemographic, anamnestic and clinical variables. In addition to change sensitivity the ability of the scale to predict the acquisition of illness knowledge during psychoeducation was examined as well as readmission during a 9-month follow-up period and the psychopathological endpoint (positive and negative syndrome scale, PANSS).

Results

Practicability and change sensitivity of the PQRS were found to be sufficient. Significant correlations with independently rated illness insight and medication compliance indicated a construct validity of the scale. Higher age, female sex and less pronounced psychopathological symptoms (PANSS) were associated with better participation behavior. Even patients with clearly impaired participation behavior profited from psychoeducation in that they were able to catch up with the delay with regard to illness knowledge. However, the PQRS was not a predictor of readmission during the 9-month follow-up period or of psychopathological endpoints.

Conclusions

The PQRS is qualified as a new tool for the standardized assessment of participation behavior in people with schizophrenia attending psychoeducation groups. The scale can be applied in research as well as clinical contexts in order to further improve understanding of how psychoeducation works and how this kind of supplementary therapy could become even more effective.     

Kreuzvalidierung der Kurzform des Kindheitsfragebogens

Objectives

Existing questionnaires about parent-child relationships usually assess love and control only. The childhood questionnaire (CQ) offers a more differentiating alternative.

Methods

In a sample of approximately 1,400 patients and more than 500 controls the CQ was reduced from 22 to 11 scales and the number of items of each scale was shortened to 5.

Results

The shortened scales of the CQ also showed good reliability and item characteristics, as well as plausible intercorrelations.

Conclusion

By the use of 66 out of the former 128 items, the shortened version of the CQ assesses three further important dimensions in the parent-child relationship of adults towards their parents in childhood besides love and control: punishment, ambition and role reversal. Beside this, parental separation, divorce and job status as well as various parameters of the socio-economic status (e.g. educational, occupational and financial) of the parents can be assessed.