Kognitive Verhaltenstherapie bei schizophrenen Psychosen

Cognitive behavioral therapy (CBT) can be regarded as an established intervention for the treatment of patients with schizophrenia. Based on randomized clinical trials and meta-analyses, which found evidence for the efficacy of CBT, almost all evidence-based treatment guidelines recommend CBT for routine treatment. This paper demonstrates that in psychoses CBT is a disorder-specific adaptation of general principles of CBT for the treatment of patients suffering from schizophrenia. The CBT procedure draws on cognitive models of symptoms for the identification of treatment targets and focuses on everyday problems of patients by implementing a self-management approach. Fostering motivation and the application of behavioral and cognitive treatment strategies characterize this approach. If the patients live in a family, other family members should be involved in order to improve crisis management and problem solving within the family. A major challenge for the future is to improve the availability of CBT under the German conditions of routine mental health care.     

Mentalisierungsbasierte Psychotherapie bei schizophrenen Psychosen

Recently, there has been growing interest in new methods of psychotherapeutic interventions for schizophrenic patients. Social cognition, social functioning and quality of life are central objectives. Mentalization-based therapy (MBT) is a specific psychodynamic method developed from the fundament of attachment theory and empirical psychotherapy research for the treatment of borderline personality disorder, particularly focusing on attachment relationships, mentalizing capacity and affect regulation. Studies have shown that MBT is able to ameliorate interpersonal experience and social life. The latest neuroscientific findings support this view and encourage the application of a modified form of MBT in the treatment of schizophrenic patients. The authors present a concept for disorder-specific interventions in schizophrenia, including psychoeducational aspects and mentalizing exercises which step-by-step lead to a more reflective work in mentalization-based group psychotherapy.     

Eigensinn und Psychose, Peer-Beratung und Psychotherapie

The narrow concepts of illness insight and compliance in psychiatry and psychotherapy will be discussed, not least because they contradict the dynamics of psychosis. Demands on therapeutic relations will be deduced from the therapeutic relationship between psychosis and ownness as well as of the experiences of untreated patients. The particular prospects of the accompaniment of a trained peer counsellor during convalescence will be represented and explained by the experiences of the Hamburg psychenet project. This new form of treatment in Germany is conceived as a supplement and not as competition to psychotherapy.     

Luise Meyer im Zeitfenster

The psychoanalyst Luise Meyer documents the inextricable entanglement of the inner and outer world in post-war Germany. With the assistance of psychoanalysis she hoped to find inner peace and a social niche which allowed a professional development.     

Übertragung von Schweigen in der psychoanalytischen Sozialisation

This work is based on two interview studies with psychoanalysts from the German Psychoanalytic Society (DPG) and the German Society for Analytical Psychology (DGAP) belonging to the war children generation. In one study the focus was on how childhood in war can be dealt with in teaching analysis and in the other, whether experience of childhood in war had contributed to choosing psychoanalyis as a profession. A theoretical overview on questions of teaching analysis and choosing psychoanalysis as a profession is given, the results of the interview studies and detailed excerpts from an interview are presented.     

Plädoyer für eine Direktausbildung zum Psychotherapeuten

The undisputed necessity of a reform of the Psychotherapist Act could open up the chance to reconsider the training of psychological psychotherapists and to completely renew the structure from the ground up. This article proposes that psychotherapy training should be designed based on the profession itself. Starting from the question of what a good psychotherapist needs to have learnt, a study curriculum is drafted which is structured towards this professional target from the very beginning. This direct training imparts psychotherapeutic competence based on a broad psychological, medical and social scientific education, encourages targeted social competences and enables clinical experience in advance. The training terminates after six years with a state examination and qualification for the profession of psychotherapist. Subsequently, qualified psychotherapists undertake a four-year in-house advanced professional education to an adult or pediatric and adolescent psychotherapist. After completing half of the study period, i.e. after three years, students decide on one of the scientifically recognized courses and subsequently the study course is partly procedure-related and mostly interprocedural. The study incorporates a practical year which accompanies the last four semesters as a half day practical training. Universities which want to offer this study course must be qualified to award doctorates and have a psychotherapy research walk-in clinic. They must also cooperate with recognized training partners who participate in the course of the study and professionally structure the four-year in-house advanced professional education.     

Das Ende der Analyse und die postanalytische Beziehung

In this article the author discusses two aspects of psychoanalysis which in contrast to other fields have received little attention in the specialist literature: (a) the end of the analysis and (b) the postanalytical relationship between analysand and analyst. The circumstances of this specialist lag are seen among others as being due to unresolved fears and demands still remaining in the unconscious mind for both sides of the analytical pair. In that the author turns against the metaphor of death as the end of an analysis it is apostrophied as a separation process and developed into aspects, such as objectivity, process of sorrow, loss suffering, gain of relief, return and departure as well as dialectically folded gain of autonomy. In this way separation and binding can be simultaneously understood as essential features of every psychotherapy. The postanalytical relationship patterns will be illustrated according to the various starting positions, therapeutic or training analysis relationship, in each case internal and external reality and again for both sides of the analytical pair. The author is also especially concerned with the practical consequences in the reacquaintance of trainee and trainer. The cooperation on the dissolution of the original fascination of psychoanalysis and its allure is promoted. Both are required to be successful but both must be transferred into the (new) reality, whereby the analyst, even against internal self-resistance, must offer help because the analysand will only gradually be freed from the fascination and allure and be able to mourn and also in time welcome this loss.     

The use of brief focal psychotherapy in the treatment of chronic pain

Material is presented from brief focal psychotherapy used in the treatment of four patients with chronic pain refractory to multiple forms of treatment. The value from therapy for each patient is described in terms of actual pain relief, in improvement in understanding the interpretation of past trauma into present bodily symptoms, and in subsequent ability to cope with the pain. Three reported treatment to have improved their pain; one reported an improvement in her ability to cope with it and consequent improvement in lifestyle. The place of pathological mourning in the aetiology of such pain is considered, together with a discussion on the constant finding of denial or displacement of intense anger towards important past figures and its manifestation in the transference. A discussion of the place of brief focal psychotherapy as a time- and cost-effective intervention in the treatment of chronic pain is presented.     

The psychotic personality: A psychoanalytic theory and its application in clinical practice

This paper presents and discusses aspects of Bion's theory of the psychotic personality. In particular, it focuses on the psychotic personality's attacks on the dependent and needy self. The paper considers how Bion's theory can be applied to understanding the schizophrenic patient. Examples are given to show its importance not only in analytic practice, but also within general psychiatry.