Stationäre oder teilstationäre Psychotherapie?

In a pilot study we compared two groups, one of inpatients and one of day clinic patients who were treated between January 1999 and December 2001 at the Department of Psychosomatics and Psychotherapeutic Medicine in Freiburg/Germany. Both settings offer a similar, multimodal and intensive psychotherapy program on a psychodynamic background. In a first explorative data analysis (sociodemographic data, SCL-90-R, IIP-C) we studied differences in severity of initial symptomatology and differences in outcome (prae/post). Patients with anorexia nervosa and a very low weight were preferentially treated in the inpatient setting. In addition the inpatient group of patients with a somatoform disorder showed higher degrees of somatization, as compared to patients with a somatoform disorder in the day clinic. Therapeutic change with respect to psychopathology however did not differ between the two settings: both groups showed a significant improvement during the course of therapy.     

Psychotherapeuten ins Internet

This contribution provides recommendations and guidelines for the development of a Web site for psychotherapists, whereby the conception of the presentation predominates. In comparison, practical realisation and care of the site require only a relatively small effort. The way to a Web appearance is presented in seven steps. In addition, the way to deal with (unwanted) e-mail will be considered. The article is centered on clarity and practice orientation.     

Die Geschichte der „Stellungnahme zur psychoanalytischen Therapie“

Ohne Zusammenfassung

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Spezifische psychoanalytische Interventionen

It is held that specific ingredients are responsible for the effectiveness of various psychotherapies and it is supposed that for this reason particular therapeutic approaches are more efficient than others. First, this article presents Bruce E. Wampold’s research on psychotherapeutic efficacy, which gives evidence that psychotherapies efficiency is due to general, not to specific factors. It is shown that in the end the common factors like alliance, compliance, empathy and the fact, that therapists generally make best use of their personality, are interpersonal factors. The impact of these empirical results on psychotherapy, on theory and practice is described in the light of two metatheories, the “medical modell”and the “contextual model”. The author delineates some consequences, for instance that in psychotherapeutic practice the diagnosis-based indication for therapy has to be replaced by fitting-indication. Regarding outcome research, the randomized goldstandard research design has to be replaced by a fitting indication concerning therapist /patient and patient/paticular treatment. Further it is shown that although specific ingredients in a strict sense are not active, therapists have to realize that they are nessessary even if active only as a component of the healing context. How specific ingredients might be realized within a healing context is shown with regard to the adaptive approach to psychoanalysis.     

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.     

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.