Die vakante Sitzung in Psychoanalyse und Supervision

In psychoanalysis and also in supervision the analyst’s and supervisor’s handling of the question of the vacant or missed session and a possible related fee are evident in word and action. In analysis the analyst and the analysand exchange views. In supervision the debate runs on two levels: the supervisand and the supervisor talk about the therapy processes that happen between the supervisand and the patient including the handling of vacant sessions and related fees. Above that there is a real and actual exchange on the question of vacant sessions in the supervisory relationship. Often the analyst’s, supervisor’s and supervisand’s own conscious views about unacceptability and unreasonable hardship define which so-called exceptions and goodwill arrangements they believe they are obliged to offer with respect to their supervisands and analysands without these having their say. This article illustrates how a (unconscious) “to-have-one’s-say” of analysands in treatment and of supervisands in supervision can be initiated and how this can lead to a deeper understanding of the emotions and conflicts of the analysand and the supervisand as well as the dynamics of transference and countertransference in analysis and supervision. The important aim of the article is not the search for an ideal and universally applicable rule for vacant sessions but rather the analysis, by means of the context-related method, of the themes, beliefs and conflicts emerging in these special relationships, which in turn allows individual insights and suitable ways to approach the topic of the handling of vacant sessions and related fees.     

Tracking the implicit self using event-related potentials

Negative biases in implicit self-evaluation are thought to be detrimental to subjective well-being and have been linked to various psychological disorders, including depression. An understanding of the neural processes underlying implicit self-evaluation in healthy subjects could provide a basis for the investigation of negative biases in depressed patients, the development of differential psychotherapeutic interventions, and the estimation of relapse risk in remitted patients. We thus studied the brain processes linked to implicit self-evaluation in 25 healthy subjects using event-related potential (ERP) recording during a self-relevant Implicit Association Test (sIAT). Consistent with a positive implicit self-evaluation in healthy subjects, they responded significantly faster to the congruent (self–positive mapping) than to the incongruent sIAT condition (self–negative mapping). Our main finding was a topographical ERP difference in a time window between 600 and 700 ms, whereas no significant differences between congruent and incongruent conditions were observed in earlier time windows. This suggests that biases in implicit self-evaluation are reflected only indirectly, in the additional recruitment of control processes needed to override the positive implicit self-evaluation of healthy subjects in the incongruent sIAT condition. Brain activations linked to these control processes can thus serve as an indirect measure for estimating biases in implicit self-evaluation. The sIAT paradigm, combined with ERP, could therefore permit the tracking of the neural processes underlying implicit self-evaluation in depressed patients during psychotherapy.     

Unerwünschte Wirkungen, Nebenwirkungen und Fehlentwicklungen

This paper is based on the observation that side effects, unwanted effects and undesirable developments in psychotherapy are still rarely discussed. Following an attempt to classify the phenomena some instruments which allow their assessment are described. Finally, studies indicating results about the frequency of the individual phenomena and their correlates are summarized. Focusing on side effects and unwanted effects of psychotherapy should start early and persist continuously throughout psychotherapeutic training.