Psychotherapie in Westdeutschland nach 1945

Protagonists during the formation of post-World War II medical psychotherapy (e.g. Ernst Speer, Berthold Kihn) had been involved in Nazi selection and ??hereditary health?? policies and continued to express related attitudes and views in the post-war period. To contextualize and analyze these findings, the broader institutional structures and dynamics in psychotherapy before and after 1945 are described. It is argued that for gaining attention, acceptance and resources, psychotherapy and psychiatry are much more dependent on the specific political and economic contexts than somatic medical disciplines, due to the focus on experiences and behavior of human beings. This is related to the fact that such political and economic contexts are themselves bound to anthropological conceptions and norms of behavior. In a further step three paradigms of dealing with the Nazi past are identified for post-World War II psychotherapy and psychiatry: the isolation paradigm, the continuity paradigm and the localizing-complex paradigm.     

Neurobiologische Grundlagen psychotherapeutischer Verfahren

In the last few years the investigation of the neurobiological basis of psychotherapeutic treatments has gained importance. Therapy-associated functional changes have been studied in a number of different psychiatric diseases. It has been shown that diseases with a central role of emotions (e.g. depression, anxiety disorders, borderline personality disorder) often demonstrate dysfunctions in brain areas that are linked to emotional regulation. Psychotherapeutic interventions can lead to a kind of normalization of brain responses in these areas (e.g. amygdala, ventromedial prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex). In addition, therapy-associated transformations were also demonstrated in areas which are related to attention processes and visual perception. Other studies have aimed at finding neurobiological parameters that can be used to predict a therapeutic outcome or to choose between various therapeutic strategies. For instance, in depression, the amygdala and the anterior cingulate cortex are assumed to play a major role. Altogether, knowledge on the neurobiological basis of psychotherapeutic procedures is limited. A comparatively small number of studies and several methodological problems (e.g. small sample sizes, insufficient control groups, variability of methods used) make it difficult to propose reliable statements.     

Kultursensible Diagnostik in Forschung und Praxis

Nearly one fifth of the German population are migrants of the first and second generation. Evidence-based knowledge about mental health of migrants, their health care needs and the actual mental health care situation of this population is limited. Psychometric instruments are helpful for the assessment of mental disorders. Although a culture-sensitive approach in diagnostics is necessary it is often neglected in research as well as in clinical practice. This article describes culture-specific and linguistic challenges and specifies specific communication problems. In most cases psychometric instruments are not developed simultaneously in different languages but are translated later on. After translation psychometric instruments should be culturally validated and adapted with respect to linguistic, cultural and metric equivalence. The article gives an overview about the different aspects of equivalence and explains these aspects on the example of the PHQ-9.     

R?ume der Gewalt

Violence is everywhere, just as love and the need for sexual satisfaction are omnipresent, nowadays just as it was 1,000 years ago. However, one is taken for granted as a part of fundamental human behavior and needs no explanation, while violence is considered an anomaly which should disappear from our lives. People who live in peace are irritated when they hear of massacres and violent acts which do not occur in their world. They cannot believe that people kill, abuse and sexually assault each other for no apparent reason and that some actually gain pleasure from this. Then the belief that violence is abnormal behavior under any circumstances helps them to imagine its reality as a space in which argumentation triumphs over fists. Humans, however, will not be what they are: they have always been complete. Violence is a human capability: that was always so and everywhere. It is a resource for action which is not only available for everybody but can also be used by everyone. Even the smallest can achieve an increase in power and gain respect by the use of the fists. The source of violence lies in the fundamentals of the powers of imagination. All atrocities can be imagined and what has once become engraved in the memory can never be removed. When one has understood what violence does to man and what man does with violence, it can no longer only be comprehended as an expression of ideas, intentions and programs, as a deviation which can be redressed by moral persuasion but as a consequence of an unlocking of safety measures which protect people from killing and injuring each other. Even in the future violence will be part of our lives. The belief in the healing powers of civilization is nothing more than romantic idealism. It always concerns only situations and people. Undoubtedly a depressing outlook but when one has comprehended that violence is an integral part of life, measures can also be taken to enclose it. Violence is an experience which creates order because death means the end of everything. For dreamers who crave eternal peace, this recognition is depressing but for realists it is a comfort.     

Zur Validit?t des Prognoseinstruments ?Rückfallrisiko bei Sexualstraft?tern“

The Risk for Recidivism in Sexual Offenders (RRS) procedure is an actuarial risk assessment tool designed to predict recidivism in sexual offenders released from prison. So far it is the only tool developed with a German sample and uses a combination of 11 static and dynamic risk markers. The goal of the current study was to test the predictive validity of the 3 RRS prognostic scores in a sample of 104 sexual offenders whose prison files and recidivism data were analysed after a mean period of 8 years after release from a German prison. The H-score of the RRS developed to assess the probability of reimprisonment showed moderate to good predictive power in relation to any new convictions, new convictions leading to a prison term and new convictions for an aggressive or sexual criminal offence. As expected it was not able to predict sexual recidivism which had a base rate of 8.7% in this sample. The S-score and the K-score of the RRS developed to predict this criterion, performed hardly better in this task. These scores showed moderate to good predictive validity only in the small subsample of extrafamilial sexual offenders.     

The Analysis of Preconscious Phenomena and Its Communication

Thoughts and feelings of both patients and analysis may be influenced by perceptions that remain outside of conscious awareness. A preconscious communication exists between patient and analyst. Appreciation of the preconscious elements of communication may enable a better understanding of what may be otherwise experienced as a mysterious occurrence. Transference-countertransference interactions create a place to observe the manifestation of preconscious phenomena. This paper addresses how the analytic method enables the discovery of consciously unrecognized stimuli or selective attention to certain phenomena which have created a sense of the uncanny or surprising. Both intersubjective reflection and more formal, systematic methods, which include logic and reasoning, serve to illuminate these events. The paper discusses and illustrates the role of preconscious communication in the analytic situation and its relation to the analytic process.     

A Specific Developmental Deficit in Obsessive-Compulsive Disorder: The Example of the Wolf Man

In this paper I suggest that the origins of the “contamination/cleaning” form of obsessive compulsive disorder (OCD) include a developmental history characterized by marked overprotectiveness allied with parental failure to respond to core aspects of the child's personal reality. The combined effect of these parental behaviors is likely to impede the establishment of a mature conception of the boundary between inner and outer worlds. The consequence of such a deficiency is the persistence of the magical form of thinking which is essential to the production of OCD. In addition, the individual is left with a disruption of personality development, the main features of which include timidity and falseness. The Wolf Man provides an example of both the characteristic development history in OCD and its consequences. Treatment based on this theoretical background may provide benefit not predicted by current psychoanalytic pessimism.