Mein Konzept der Supervision

The reflections on supervision presented in this paper were written against the background of a psychoanalytic training. The paper describes what – in the author's view – characterizes a patient in psychoanalytic psychotherapy, a psychoanalytic therapist, and a supervisor. In addition, the author reports on his personal experiences which he has made with supervision in the course of his activity as a psychoanalyst in the roles of supervised and supervisor. In this context, he presents some actual memories from supervisory experiences with M. Balint, H. Argelander and F. Morgenthaler.     

Kandidaten in psychotherapeutischer Ausbildung

In the context of the discussion about a reform of psychotherapeutic training in Germany the question arises, which factors influence the decision of psychologists and physicians for a particular training. 343 candidates in psychodynamic, behavioural or psychoanalytic training were asked about their motives for the training, their professional objectives in general and their satisfaction with their choice of training. The candidates' decision for a particular training was associated with personal attitudes and professional goals, with the given information about psychotherapeutic treatment within their studies and with their field of study. For the most part, the respondents are not satisfied with the quality and quantity of information on psychotherapeutic treatment within their studies. Candidates in analytic training are altogether more satisfied with their choice of training and do not plan to start an additional psychotherapeutic training as often as candidates in behavioral training. The consequences of these results in particular for the medical and psychological curricula (a more balanced representation of psychotherapeutic methods) are discussed.     

„Beyond efficacy“:

In this study, treatment efficacies of 30 short and long-term treatments with adolescents were presented from the perspective of the afflicted adolescent, the parents and the therapists. Assessments were made 3 times over 1.5 years after 97 therapy sessions on average. Short-term psychotherapy did not significantly contribute to symptom reduction. In the long-term treatments, therapists reported a strong reduction in symptomatology and in communicative disturbances with parents, siblings and friends over time. However, parents perceived less change in symptomatology compared to their children. The quality of the therapists' work with parents did not impact psychotherapy outcome. Tendentially, the type of treatment and the experience of the therapist were relevant for treatment efficacy.     

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.