Psychoanalyse mit Traumatisierten

Extreme and complex traumatisation represents a severe problem in today’s world. There is a need to develop treatment approaches that are efficient for traumatised persons who often live under very difficult circumstances. There are moreover certain societal conditions that are important for the treatment and rehabilitation of the traumatised patient. The paper will discuss how psychoanalytic therapy may be helpful for severely traumatised patients and what are the mechanisms of change in the therapeutic process. A focus is on how traumatic experiences are actualised in the transference and brings the analyst in a situation where enactments inevitably occur. It will be demonstrated how these processes may lead to symbolisation of these traumatic experiences. What are the therapeutic and societal preconditions for treating traumatised patients?     

Reviews

Abstract

Selected review of current books on sexuality and sex therapy, John P. Wincze, Brown University/V.A. Hospital, Providence

Becoming Orgasmic: A Program of Sexual Growth for Women. Heiman, J., LoPiccolo, L., and LoPiccolo, J. New Jersey: Prentice-Hall, 1976.

Female and Male: Dimensions of Human Sexuality. Pierson, E. and D'Antonio, W. New York: J.B. Lippincott Co., 1974.

Medical Aspects of Human Sexuality. Lief, H.I. Baltimore: The Williams and Wilkins Co., 1975.

Sex After Sixty. Butler, R. and Lewis, M. New York: Harper and Row, 1976.

Sex Therapy at Home. Kass, D. and Stauss, F. New York: Simon and Schuster, 1975.

SIECUS Study Guides. Sex Information and Education Council of the United States. New York, 1976 (6th printing).

Adulthood and aging: An interdisciplinary developmental view, Douglas Kimmel, New York, John Wiley & Sons, Inc., 1974, $12.50, 484 pages

Permanent weight control: A total solution to the dieter's dilemma, Michael J. Mahoney, Kathryn Mahoney, New York, W.W. Norton and Co., Inc., 1976, $7.95, 177 pages     

Distinguishing voluntary from involuntary attention to emotion

This study explored whether voluntary attention to emotion is distinguishable from involuntary attention to emotion. University students (N = 166) completed self-report questionnaires, designed for this study, intended to measure voluntary and involuntary attention to one’s own emotions. Moreover, participants completed questionnaires measuring other emotional constructs and distress. Finally, participants completed a dot probe task intended to obtain a behavioral measure of voluntary attention to emotion. Affect intensity was positively correlated with both voluntary and involuntary attention to emotion. As expected, dot probe emotional bias scores were associated with self-reported voluntary attention to emotion, but not with involuntary attention to emotion. Voluntary and involuntary attention to emotion were also differentially associated with clarity of emotion, anhedonic depression, and worry. The results of this study suggest it is important to distinguish between voluntary and involuntary attention to one’s own emotions.     

Linking Work and Domestic Problems With Police Suicide

We reviewed the records of 134 police officers who had undergone their first fitness-for-duty evaluation at our center. Fifty-five percent admitted to previous suicide attempts. We examined possible contributing factors. A logistic regression model correctly classified 79.1% of subjects as to whether or not they attempted suicide. Results indicated that officers reporting marital problems were 4.8 times more likely to have attempted suicide, and 6.7 times more likely if they had been suspended. Interestingly, complaints of being administratively harassed were associated with a lower likelihood that an officer would attempt suicide. Variance explained due to age, race, gender, and substance use was nonsignificant.     

Beyond Randomized Controlled Trials in Attempted Suicide Research

There is a lack of evidence about what is the best treatment for people who present to hospital after self harm. Most treatment trials have been small and involved unrepresentative groups of patients which result in inconclusive findings. Here we note some of the characteristics of attempted suicide which make it a difficult subject to study. We describe the problems of doing randomized controlled trials in attempted suicide and outline the advantages and difficulties of randomized controlled trials, Zelen designs, patient preference designs, and cluster randomized trials in attempted suicide intervention trials. Researchers and consumers should consider other research designs when asking what is effective after self harm.     

Risk for Suicide among Medicaid Beneficiaries

Demographic, diagnostic, and service expenditure characteristics of Florida Medicaid enrollees who died by suicide were investigated. Among persons receiving Medicaid and Supplemental Security Income (SSI), findings indicate the most powerful predictors of suicide were involuntary psychiatric examination, mental health hospitalization, and high mental health service use. Among Medicaid enrollees not receiving SSI, strongest suicide predictors were mental health hospitalization, high expenditures for physical health medications, and involuntary psychiatric examination. Findings suggest reducing involuntary psychiatric examinations and mental health hospitalizations while improving physical health may reduce suicide in the Medicaid population. Comprehensive hospital discharge planning, adherence monitoring with follow‐up care, training mental health providers in assessing suicide lethality, and providing adequate assessment time are all crucial to achieve these objectives.     

Today I'll use a condom, but who knows about tomorrow: a daily process study of variability in predictors of condom use

OBJECTIVE: Most models of health behavior change applied to condom use behavior have focused on individual differences in theoretical constructs to explain condom use or nonuse, while ignoring the possibility that day-to-day within-person changes in these constructs may contribute to understanding behavior. The goal of the present study was to investigate day-to-day variability in condom use attitudes, self-efficacy, and behavioral intentions and assess the utility of this variability in predicting the likelihood of condom use each day. DESIGN: A 30-day Web-based structured daily diary was used to collect daily reports of sexual behaviors and data on theoretical predictors of condom use behavior from sexually active college students (N = 116). MAIN OUTCOME MEASURES: The authors investigated whether condom use attitudes, self-efficacy, and behavioral intentions vary day to day; whether this within-person variability predicts condom use behavior; and whether negative affective states explain this variability. RESULTS AND CONCLUSIONS: Within-person variability was found for each of the constructs. Within-person day-to-day changes in behavioral intentions and attitudes predicted the instances in which an individual used a condom and daily negative affect partially explained within-person day-to-day changes in behavioral intentions and self-efficacy. Implications for models of health behavior change and for behavior change interventions are discussed.     

Effects of Expectancy and Attention in Vibrotactile Choice Reaction Time Tasks

The orienting of attention in space has not been considered in the tactile domain. This issue is examined using a modified version of a visual paradigm initially adopted by Posner, Snyder, and Davidson (1980), which manipulates the probability of a stimulus occurring at different spatial locations. Slower RTs at an unexpected stimulus location are thought to reflect the time required to shift attention from the expected to the unexpected location. In two experiments involving vibrotactile choice RT between left and right hands, the two hands were either crossed or uncrossed, and the hands were held both on the left side of the body, both on the right, or one on either side of the midline. There was no evidence to suggest that spatial location (left or right) affected the orienting of attention in the tactual modality. As predicted, RTs were slower when the arms were crossed compared with uncrossed, though this effect was smaller for the expected trials. A coding conflict hypothesis may explain both these findings, but the smaller effect in the expected trials may also reflect attentional factors. Both the relative and absolute location of the hands affected the magnitude of the crossed-arm effect and indicated that attention may play a role in the perceptual division of space into left and right sides. Possible reasons for hand or hemispace asymmetries in different simple and choice RT paradigms were discussed.