Facetten eines „deutschen“ Gegenübertragungsproblems

Departing from two case vignettes of psychoanalytic treatments of foreign children of parents who had collaborated with the Germans during the second world war, we are pondering whether there is a specific form of German counter transference defense, making it impossible to allow destructive narcissistic transference offers full of relish through the patients out of the fear that their activation in the analyst might end up in shame and horror as in the previous generations. The nearly complete renunciation to work analytically on the Nazi and Wartime could be described as a secret agreement of the protagonists, finding its justification in keeping out this delightful destruction. The consequences of this abandonment are the disability to establish a solid oedipal position and a regression to the anal world, being characteristic for both postwar German states including much of the analytic work.     

Gewalt und Vertrauen

Puzzles are often the result of wrong questions. Not the question is interesting, how it is possible that “quite normal men” are capable of extreme violence, rather the question why in face of world history this question persists and is still considered as being interesting. This article is an attempt to find an answer to this question by discussing the special relation developed by the cultural formation named “modern age” to violence in general and last but not least to its own violence. Violence underlies in modern age a pressure of legitimation which strongly differs from other cultures, and the trust in modern age is to a great extent based on the – all too often counterfactual – assumption that it is non-violent or at least on the way to that. In the course of these considerations it should be examined why there is no satisfying sociology of violence although just this lack is known and bemoaned –, as well as the question on which bases such a sociology could be established: systematically, considering a phenomenology of physical violence and the analysis of the relation of power and violence as well as the communicative function of violence; historically, considering the question how the special relation of modern age to violence was developing and to which changes it is subjected in face of the excesses of violence of the 20th century.     

Angriffe auf Körper und Seele

Experiences of abuse and neglect in early childhood generate mostly manifold adverse consequences differing from disturbances due to traumatizations in later developmental phases. They justify the diagnosis of developmental trauma disturbance. They lead to traumatization in the attachment with characteristic relationship configurations repeating the “attachment trauma”. For therapeutic work it is important to recognize these reenactments, otherwise it may come to entanglements at the level of the equivalence mode or because of pseudomentalization, thus preventing therapeutic work. In these cases the space for communication, the ability of symbolization in language and play collapses.     

Tinnitus und das Leiden am Tinnitus

Psychosomatic findings from 287 patients with tinnitus are presented in this article, who were seen by medical psychotherapists specialized in ENT for a period of 15 months. They were assigned to all of the therapeutic methods being offered. As relevant proved to be the neurootological professional competence, especially for recognizing and treating auditory limitations (in 41% of the patients) as well as noticing and treating the psychological comorbidity (in 45.3% of the patients). While neurophysiological and psychophysiological models interpret the subjective tinnitus stress as the failing of habituation, dysfunctional attention processes and assessments, from a psychodynamic view a symptom having pathological significance, such as the suffering from tinnitus (not the tinnitus itself) may develop if the defensive mechanisms are exhausted, a conflict cannot be resolved on the conscious level or traumatic experiences were made. It is recommended that an approach specifically matched with the disturbance is made taking into account both possible psychodynamic causes and sustaining factors in the cognitive behavioral sense, all on an audiologic background.     

Mentalisierung und externalisierende Verhaltensstörungen in der Adoleszenz

Social cognition creates the conditions for successful human interaction. Externalizing disorders are characterized by a failure of adequate social cooperation. Therefore, social cognition seems to be a key factor in understanding externalizing behavior, its etiology and treatment options. The present article combines the clinical theory of mentalization with the state-of-the-art of empirical data on externalizing behavior and of the theory-of-mind research as well as research on social information processing. Empirical evidence suggests that there are distinct deficits in social cognition depending on the type of aggression (proactive or reactive). However, even though it is known from a neurobiological perspective that social cognition is reorganized in adolescence, research on externalizing behavior and social cognition in adolescence is limited. Hence the analysis of two studies is presented which compared reflective functioning between a group of late adolescent violent offenders and a control group. A total of 42 young men participated in the studies and were interviewed with the adult attachment interview. Interviews were coded with the reflective functioning scale. Results showed that violent offenders scored significantly lower on the reflective functioning scale than age and gender matched controls. This result is independent of intelligence. Instrumental proactive aggression and psychopathic tendencies are also strongly associated with lower reflective functioning. The results underline the importance of therapeutic interventions for externalizing adolescents which enhance reflective functioning.     

Testpsychologische Ansätze der Beschwerdenvalidierung

The presence of cognitive impairment has been documented for a large number of diseases, conditions and mental disorders. Due to their impact on functioning in professional life and in everyday activities, there appears to be an increasing demand of qualified neuropsychological examinations in civil forensic contexts. While neuropsychological testing is the method of choice for determining the presence and the profile of cognitive impairment, it is easy to underperform in such tests. The authenticity of test results has to be thoroughly checked using modern approaches of symptom validity assessment. Without adequate validity checks, forensic psychological examinations are incomplete.     

Offener und verdeckter Narzissmus

Psychoanalytic theories and clinical practice refer to 2 types of narcissism which differ in the visibility of the narcissistic features: while overt narcissism is observable in open behaviour, covert narcissism is concealed behind an insecure appearance. This distinction was tested empirically by relating the two types of narcissism to self-esteem and the attachment dimensions avoidance and anxiety. Patients in a psychosomatic out-patient department (n=102) were examined with self-report measure. Overt narcissism is associated with a high, covert narcissism with a low self-esteem. Furthermore, while overt narcissism is not related to the attachment dimensions, covert narcissism is accompanied by high levels of attachment anxiety. The results support the theory that narcissism is divided into 2 subtypes which have different profiles in terms of self-esteem and attachment.     

Sexualität und Gewalt

Sexual assault as defined by law, psychiatry and sociological research is contrasted to the everyday definition of rape. Official figures on the frequency of sexual assaults as communicated in annual reports by the police differ greatly from figures found by research on sexual victimization or representative studies using different definitions of violence and abuse in sexual relations. Overpowering and violence is not a rare phenomenon in sexual relations – nearly every second woman and 10% of men are familiar with such situations. There are not only biological conditions (individual variance in neurophysiological parameters) but also psychological conditions favoring the use of power and threat instead of courting in sexual partnerships. External conditions are certain popular opinions in parts of society and certain subcultures which may also be more or less in favor of male superiority, thus helping the perpetrator to justify his assault or on the contrary helping the victim to find support in court procedures and therapy if necessary. Prevention therefore has two targets: a general one by changing popular opinions which are in favor of the use of power in sexual relations and informing persons in danger of becoming victims about the risks and the possibilities to protect themselves and an individual one by treating victims to overcome their psychological injuries and to treat perpetrators inside and outside the judicial system. The current discussion on increased availability of pornography in the internet shows both aspects: a general target to reduce negative influences of pornography which produces devaluating views on sexuality and women and the more individual task of tackling new forms of pathology created by the media at least for some of the consumers.