Imaginationen in der psychodynamischen Psychotherapie

Imaginations establish a direct access to central relational and emotional schemes. Thereby, they have considerable therapeutic potential, apt to enrich psychodynamic treatment to a high degree. In the experiential space of imaginations central wishes, anxieties and conflicts come to the fore, thus the earlier ones can be worked through and new ones may be tried. The continuous therapeutic support allows for a reasonable focussing of the imaginations by applying regression, progression, support, confrontation and stimulation. After an introduction into the therapeutic applications of imaginations the actual clinical work with imaginations as developed by the katathym-imaginative psychotherapy (KIP, guided affective imagery) is presented, exemplified by a case study. Finally, this example is discussed in the light of new theoretical and empirical findings.     

Acting out in the treatment situation

More and more frequently the deficiencies and deprivations of early life are seen in the inability of patients to utilize psychic process to ameliorate conflict and painful affect. As a result, the tendency to act out anger and violent feelings in the external world in ways that are destructive and damaging is a prominent symptom. In the course of therapy, this somatic expression enters the treatment situation itself, often directed to the person of the analyst as the transference object. Understanding dynamics of what is actually being reenacted and using this information to convert somatic language to psychic process is the central focus of this paper. Acting out is defined and what places it apart from other pathological symptoms is described, along with associated ego functions, triggering mechanisms, affects, narcissistic and preoedipal factors, speech and symbolization, and stability and quality of mental representations. Acting out has been linked to somatization in recent years, and is understood as a defense against hostile wishes and impulses in an attempt to eliminate internal dangers from awareness. Treatment focuses on moving acting out into the realm of talking out, free association, dream interpretation, and interpretation in general with the proper timing in assessing the patient's ability to transfer experiences with early objects onto the analyst.