Eine erfolgreiche Behandlunsgkette bei Zwangsstörung

Obsessive-compulsive disorder (OCD) belongs to a group of disorders with an estimated lifetime prevalence of 2?%, associated with a high socio-economic burden and the risk of chronification. In the latest version of the DSM-5, OCDs were detached from the chapter of anxiety disorders, similar to the ICD-10. Consequently, the fifth revision of the DSM highlights the fact that scientific results so far, like the overactivation of basal-ganglia thalamocortical circuits, basically support a common model for OCDs. Although in the past, OCDs have been ignored as a diagnostic entity, in the DSM-5, the concept of obsessive–compulsive spectrum disorders according to Hollander was partly realized. The present case report outlines an example of a successful therapeutic chain in the treatment of a severe case of OCD with a 90?% reduction of symptoms throughout a calendar-year, emphazising the importance of efficient treatment chains within psychiatric disorders.     

Das psychische Erbe der Menschheit

The historical development and importance in theory and practice of the term archetype, the core concept of Analytical Psychology, is extensively presented. Beginning with C.G. Jung’s definition of archetype through to the current state of the discussion, various conceptualizations of biological, developmental psychological and cultural theoretical basis are presented. The results show that there is empirical evidence for psychological archetypes, for instance in the neurosciences, developmental psychological and anthropological research and that the classical conception of inheritance of complex symbolic patterns cannot be substantiated by more recent results in human genetics and particularly in epigenetics. The prominent attempts at solving this problem from the contempory Analytical Psychology will be discussed, in particular emergence and system theoretical argumentation. Finally, various empirical, partially experimental studies from Analytical Psychology, among others from the authors themselves, will be presented which confirm the hypothesis of the existence of archetypes and of a collective (unconscious) memory. The article gives a total overview of the state of specialist discussions on the archetype concept for the readership above and beyond the narrow field of Analytical Psychology.     

The Paradox of Holding and Recognizing and the Local Moving Along of the Therapeutic Process

In an attempt to provide a first incomplete answer to the question raised by the editors as to “what cures traumatized patients,” I join my voice to that of the many authors who associate therapeutic action with the process of affect regulation that develops within the analytic dyad. I believe that we are yet to find effective ways of describing the therapeutic process so that the fundamental elements can be reflected upon and studied by therapists. This is especially important when we are working with severely traumatized patients. One of the challenges we are facing today has to do with the way in which therapists communicate such experiences to each other. In our reflections, it all depends on the level at which we situate ourselves, if the therapist places himself/herself at the local level of the interactive process he/she needs to learn to stand in the uncertainty of the security and change paradox relying on the intersubjective process itself. With traumatized patients the challenge in psychotherapy almost always involves the ‘treatment that hurts’ paradox.     

„Rocken statt Ritzen“

Background

Non-suicidal self-injury (NSSI) starts in adolescence and decreases during young adulthood. Despite a high prevalence among adolescents only a few therapeutic interventions directly addressing adolescents exist.

Aim

By connecting music therapy with elements from behavioral therapy an attempt was made to create a therapeutic program which is attractive to adolescents.

Material and methods

A pilot trial of the program “Stop cutting - rock!” was conducted with 12 adolescent females with a mean age of 15.15 years (standard deviation SD ±1.34). The study aimed to compare the frequency of NSSI throughout the treatment phase as well as a pre-post comparison of depression scores.

Results

The results showed a trend towards a decreasing frequency of NSSI. Depression scores decreased significantly between the assessment before therapy and at a 3-month follow-up after the end of the therapy.

Conclusion

The positive feedback concerning music therapeutic elements points to the attractiveness of the approach. By integrating multimodal therapeutic strategies it seems possible to create an individually tailored intervention for adolescents with NSSI.     

Psychodynamische Kurzzeittherapie bei dependenter und vermeidender Persönlichkeitsstörung

Although dependent and avoidant personality disorders are frequent in patient populations, there are only few studies in which the efficacy of psychotherapeutic interventions for these two personality disorders was reviewed. The purpose of this study was to examine whether psychodynamic short-term therapy based on the model of the cyclic maladaptive pattern (CMP) is effective for reducing the mental impairment of patients diagnosed with a dependent or an avoidant personality disorder. Data were collected via a self-report scale (Symptom-Checklist, SCL) and expert ratings by therapists [Global Assessment of Functioning (GAF) Scale and Severity of Impairment-Score (Beeinträchtigungsschwere-Score, BSS)]. In the study 20 patients received 25 sessions of outpatient therapy. Mental impairment decreased significantly from the beginning to the end of the therapy; moreover this decrease remained stable over a 2-year period following completion of the therapy. The findings show that psychodynamic short-term therapy can lead to an enduring improvement in the mental health of patients with a dependent or an avoidant personality disorder.     

Die Abschaffung der somatoformen Störungen durch DSM-5 – ein akademischer Schildbürgerstreich?

The new fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has introduced “somatic symptom disorder” as a diagnosis which is no longer differentiated into medically unexplained and explained physical symptoms. As a consequence, the status of somatoform disorders as an independent clinical group is called into question. Against all original intentions, the semantic, conceptual and practical problems of the previous classification have not been solved. The validity of the new diagnosis is doubtful because of its over-inclusive character. Further points of criticism are the less than optimal selection of psychological features, the abandonment of hypochondriasis as a homogeneous concept and imprecise workmanship of the diagnostic criteria where exclusion criteria needed for differential diagnosis are missing.