Dealing with Object Loss

The nature and outcome of working through an object loss depend on the proportions in which the lost relationship involved developmentally earlier (prestructural) and more advanced (poststructural), aspects. The two groups of elements are dealt with by entirely different methods, which are presented and discussed in this paper. For this purpose, some aspects of internalization are discussed and distinguishing a new form of internalization is proposed. The additional loss of objects following a major one are also briefly discussed.     

Psychoanalyse und Traumatherapie

The author is of the opinion that for patients with combined traumas of commitment and violence a psychoanalytical long-term treatment which takes into consideration the peculiarities of this group of patients will continue to be the therapy of choice. Special ??trauma therapies?? may be useful after acute traumas and in cases in which external conditions exclude psychoanalytical treatment. Depending on the situation of the individual case, though, specific modifications of the technique may be necessary, which possibly include proven specific trauma therapeutic techniques as parameters. Based on the parallelism of the economic aspect of the trauma and the aspect of object relationship, a decisive role in the therapeutic process befits the recognition of the traumatic reality and the working out of traumatic transference, which, however, must not traumatize under any circumstances. This is accompanied by the restitution of a good interior object, which only becomes possible within a frame giving security and support. The establishment and preservation of this frame may also be due to especially required parameters derived from trauma therapies, the psychodynamic significance of which must be analyzed with the individual patient. The author's approach is clarified by two case vignettes in which the theoretical reflections have led to very different technical procedures. The author comes to the conclusion that the psychoanalytical trauma therapy shows how therapeutic concepts aiming at an optimum result must still be tailored to the individual case.     

?Symbolisierung�� als intersubjektive und intrapsychische Dynamik

Igor A. Caruso (1914?C1981), one of the founders of the International Federation of Psychoanalytic Societies (IFPS) in 1962, began to discuss questions of the interplay of biological, social and evolutional realities and intrapsychic development in the early 1950s with the early Vienna Circle of Depth Psychology. Caruso understood that the specific human ability to transcend the overdetermined biological constitution into a development of consciousness, care and self-awareness is basic for the need and lifelong activity of intersubjective relationship. Sexual and survival drives as the biological basis contain their own transformation as cultural potency within the subject-object relationship. Each act of relationship to things and living objects creates a new reality which is a meaningful symbol for both parts of the relationship in their own individual reality. This new, third, reality gains full effectiveness for both actors as ??symbolic realism?? and initiates the ongoing development. In this understanding psychic development is a process of changing interactive creation and effectiveness, following biological drive dynamics as well as its inherent future transformations by attachment. Symbolization is therefore the main intrapsychic and intersubjective activity of development of object-awareness and self-awareness. Caruso emphasized the meaning of symbol and symbolization as an act of relationship to and within the world and consequently understood psychoanalytical theories as well as a changing symbolization of relationship.     

Soziales Netzwerk Psyche

In six steps I attempt to show how modernized psychoanalysis contributes to a ??social theory of mind?? (Mitchell, pp.?17?f.). First of all, the pluralism of schools is reflecting the lack of a psychoanalytic core theory, a shortcoming which is merely concealed by its conceptional oversupply and can only be overcome by scientific research. Secondly, I suggest to give up the inclination towards deep thinking, typical of our profession always on the lookout for new metaphors of the psyche, and to replace this inclination by the precise observation of interactions. Thirdly, I discuss the suggestion to understand the unconscious as a hidden link between self and the real world, as a relational tendency of the psyche to connect??a legacy of symbiotic experience??the inside with the outside not only in dreams but in reality. This is, fourthly, my understanding of the unconscious drive of human mind to express itself in a social world whose interactive platforms only allow that building of mental structures we call mentalization, according to Fonagy. Fifthly I point out that the monadic theory of mind implicated in classical drive theory is obsolete in a scientific sense in order to plead, sixthly, for a modernization of psychoanalysis replacing its central metaphor of the mental apparatus by that of a mental network: The modernized psyche is nowadays less in charge of managing intrapsychic drive-economy; its main duty in the age of modern reflexivity seems to be the skilful management of self-relation in the broadly stretched network of interpersonal relationships.     

Die DPG-Praxis-Studie

All psychotherapeutic methods must be scientifically evaluated. Empirical evaluation of evidence is a prerequisite for acceptance as scientific psychotherapy as well as for payment by health insurance. Currently the psychotherapy methods accepted within the German health system (behavioural therapy, psychodynamic psychotherapy, and analytic psychotherapy) are reviewed by a governmental evaluation committee concerning evidence, necessity and cost-effectiveness. The DPG practice study has basically two aims: 1) to conduct a large naturalistic study to investigate effectiveness, sustainability and economic aspects of psychodynamic and analytic psychotherapy and 2) to offer a framework for psychoanalytic institutes, members, candidates or groups to realize own research ideas by collecting additional data within the study. The present article describes the background, main research questions, structure and design of the DPG practice study with regard to the evaluation questions.     

?Omnipr?senz��

Excessive urge for free individual development even beyond moral law and social rules is discussed as part of the aftermath of severe political repression and traumatization. It is proposed to describe these phenomena which have not yet been sufficiently considered in the scientific literature as ??omnipresence??. In terms of psychoanalytic understanding these mechanisms result from specific unconscious defense activities. The relationship to other defense mechanisms, e.?g. of anal, phobic, paranoid and manic nature, is outlined, and illustrated by a short case vignette. The article ends with a differentiation between omnipresence as described above on the one hand and the phenomena of media-moderated expansion of individual development and acceleration typically and generally found in postmodern societies, on the other hand.     

Ambivalenz in der psychiatrischen Organisation

For the past 100 years Bleuler??s ambivalence terminology has been applied to many aspects of the psychiatric treatment of patients, particularly in the realm of diagnostics and therapy. It has, however, been adopted in an approach mainly limited to psychopathological phenomena. This article discusses whether advanced concepts of ambivalence can facilitate the analysis of current challenges and problems of institutional psychiatry, placing them in a new light. It describes a wide range of psychiatry-specific ambivalence experiences by investigating the field of activity of individual therapists as well as of interdisciplinary therapeutic teams. Particular attention is given to an ambivalence-oriented perspective of clinic management taking uncertainty and complexity into consideration. In such different contexts modern ambivalence concepts give way to a psychodynamic understanding of clinical areas of conflict, thus extending the possibilities of multimodal therapy. When dealing with complex leadership and planning tasks, sensibility and tolerance towards ambivalence phenomena and conflicts prove to be unusual but valuable problem solving resources.     

Psychosoziale Arbeitsbelastungen und depressive Symptome bei F��hrungskr?ften

Background

The present study examines the associations of psychosocial stress at work with depressive symptoms among managers.

Methods

In a cross-sectional study, 154 managers were questioned by means of standardized questionnaires measuring effort-reward imbalance at work and the German version of the CES-D scale. In addition to the effort-reward ratio separate ratios of the three reward dimensions were computed to analyze the effects of the three dimensions separately.

Results

After controlling for relevant confounders logistic regression analysis indicated an odds ratio of 4.4 for depressive symptoms among managers defined by an imbalance of high effort and low reward.

Conclusions

The results indicate that the three reward dimensions are of different relevance. Concerning prevention less significant health restrictions by depressive symptoms are to be expected by reducing the imbalance of effort and esteem reward at work.     

In Treatment

This article deals with current representations of psychotherapy in movies and television and focuses on the recent TV series In Treatment. It is discussed if and how this and other TV series might contribute to a change in the public image of psychotherapy. This discussion is based on studies investigating the public image of psychotherapy and its image within the media as well as the potential to use movies and TV as a stage for psychotherapeutic processes. Among several TV series dealing with psychotherapy, In Treatment plays a special role because of its conception as an intimate play. The series is described and discussed in relation to the question how realistic psychotherapy is staged and whether the hero of the series ??Dr. Paul Weston?? can be used as a model in psychotherapeutic training.     

Identit?t, Identit?tsdiffusion, Identit?tsst?rung

Identity takes place in the transitional space between the individual and society. It means that the individual has the feeling to be a unique being with past and future, to be different from others but also to be similar to them in many aspects and share a great deal with them. This sense of coherence and continuity in the context of social relatedness shapes life. A differentiation is made between primary identity, personal identity and current identity. The development is essentially determined by preverbal interpersonal processes. If the balance which sustains the feeling of identity becomes lost then disturbances of the identity occur, which compromise the sense of identity especially in social contexts. An identity diffusion arises. Depending on the fixation, a differentiation is made between phase-specific identity crisis, developmental disorder and reactive identity disturbance.