Stationäre körperbezogene Psychotherapie bei Anorexia und Bulimia nervosa

Disturbances of body-images in women with anorexia and bulimia nervosa are described at the behavioral, perceptional and affective-cognitive level. The disturbances of body image, which are often accompanied by personality-structural deficits and have a decisive influence on the course of disease, can be reached only in part by verbal forms of therapy. Considering these facts, we present an integrative clinical procedure in which the application of body-related therapy modules play a central role in supplement to cognitive-behavioral and psychodynamic forms of therapy. Process-oriented body-perception therapy in an individual setting and a communicative movement group therapy are used and their relevance to the in-patient therapy process examined from the patient’s point of view. The study reveals a high value of body-psychotherapy, wherebydifferences were observed between anorexia (15) and bulimia (27) patients in the course of the process. The results suggest an indication for the application of combined individual and group body-psychotherapy for hospitalized anorexia patients. A communicative body therapy in group form is also very important in the in-patient treatment of bulimia patients, but there is a differential indication with regard to individual body therapy.     

Angststörungen bei Patienten mit implantiertem Kardioverter-Defibrillator (ICD)

Patients with an implantable cardioverter defibrillator (ICD) often show anxiety disorders as comorbid psychologycal disturbances. In a short review we discuss psychosocial aspects of the ICD-implantation. A case study of a 38 year old patient in inpatient treatment is presented for illustration of a cognitive-behavioral treatment method. The psychotherapeutic treatment was carried out in close cooperation with the clinic for cardiology.     

Fokusbezogene psychodynamische Psychotherapie

The OPD-based diagnostics allows to formulate the psychodynamically significant aspects of the unconscious conflict, of the structural limitations and of the dysfunctional relational dispositions. Considering the relative weight of the conflict- and the structural dynamics we are able to differentiate three types of disturbances: the conflict type, the structural type and the miscellaneous type. For these three types of disturbances the therapeutic consequences for setting and therapeutic attitude, for the hierarchy of the foci, and the working through of dysfunctional relational dispositions and at last for the conflict- vs. structure-related interventions are discussed. The Heidelberger Umstrukturierungsskala enables us to the focus-related documentation and evaluation of the progress and the result of the therapy.     

Freud heute

Zusammenfassung Aus Anlass des 150. Geburtstags von Sigmund Freud untersuchte der Autor in einem Festvortrag in der Universit?t München den Standort der Psychoanalyse in der gegenw?rtigen Kultur und Gesellschaft. Auf der Basis von Das Unbehagen in der Kultur und der Beobachtungen Bions in Gruppen sieht er den Einzelnen in einem Spannungsfeld zwischen individuellem und kulturellem über-Ich. Unbehagen entspringt daraus, dass die Entwicklung des Einzelnen mit den Fortschritten der Kultur nicht Schritt h?lt. Hinzu kommen die Verhei?ungen von Glück und Allmacht, die die Kultur an die Stelle Gottes gerückt hat, und die im Alltag entt?uscht werden. Die Psychoanalyse ist an der Entwicklung des Unbehagens nicht unbeteiligt. Sie strebt nach gesellschaftlicher Anerkennung und steht dadurch in Gefahr, das Unbewusste als ihr Zentrum aufs Spiel zu setzen. Ob sie überleben wird, h?ngt davon ab, ob es ihr gelingt, aus einer Randposition heraus hilfreich für den Einzelnen und die Gesellschaft zu sein.

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Freud today

Abstract On occasion of the 150th birthday of Sigmund Freud the author elaborated the position of psychoanalysis in the present culture and society in a lecture in the University of Munich. On the Basis of Freud’s “Civilisation and its Discontents” and of Bion’s “Experiences in Groups” he regards the individual within a discrepancy and tension between the personal and the cultural superego. Discomfort arises when the development of the individual subject is no longer in line with the progresses which occur in culture. In addition, the omnipotent promises of happiness and grandiosity, by which culture has replaced God and which are disappointed in the every day life, contribute to contemporary discontents. Psychoanalysis has participated in the development of discomfort and supported it. It has aspired for cultural acceptance and attractiveness and gets by this into danger to loose the unconscious as its center. Whether it will survive depends on whether it is successful in returning to a cultural boundary position where it can be of help for both—the subject and the civilisation.

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Münchener Freud-Symposion, Ludwig-Maximilians-Universit?t München, 5. Mai 2006. Aus dem Englischen übersetzt von Wolf Kohl und Michael Ermann, München. Dieser Beitrag erscheint in ver?nderter Fassung auch in Ermann M (Hrsg) Was Freud nicht wusste. Neues in der Psychoanalyse. Brandes und Apsel, Frankfurt aM (In Vorb.).     

The Arabic Origins of Romance Private Documents

The Christians who lived under Muslim rule in al-Andalus are known as Mozarabs. As immigrants from al-Andalus to the Christian kingdoms in the north, Mozarabs are depicted in current historiography as transmitters of Arabic and Muslim culture. Nevertheless, when the Mozarabs were observed by the Christian expansion southward, surprisingly, they are presented as isolated amidst the post-conquest order. Based on the case of Toledo, the first important city conquered by the kingdom of Castile in 1085, the present article shows how the Mozarabs had introduced Muslim notarial practices into the Christian society.     

Die Therapeutenvariable

Background

The objective of this study was to investigate the therapeutic attitude as a self-contained dimension of the therapeutic process.

Patients and methods

The psychotherapists’ beliefs and attitudes in therapeutic matters are measured according to the Therapeutic Attitude Scales (TASC) of the Therapeutic Attitude Questionnaire (ThAt) and were applied to investigate the therapist variable. The investigation concentrated on the therapist’s belief in the curative value of a number of ingredients of psychotherapy, on the therapist’s individual style of conducting psychotherapy and on basic assumptions about the nature of psychotherapy and the nature of the human mind. A total of 451 psychotherapists (81 psychodynamic psychotherapists, 208 psychoanalytic psychotherapists and 162 behaviour therapists) were investigated.

Results

There were highly significant differences between the three groups of therapists, a finding which is in line with the basic theory. Adaptation and insight of the assumed curative factors as well as supportiveness and neutrality of the technique factors, differentiate the groups highly significantly. The multivariate analysis underlines the importance of adaptation and insight to differentiate between all groups.

Conclusion

The results by and large confirm the general assumptions held on the differences between the groups. Thus the ThAt appears to be a valid instrument to grasp more subtle features of the therapist variable that may influence the outcome of psychotherapy.     

Psychoonkologie

Changes in the spectrum of illnesses have led to a predominance of chronic diseases, including oncological disorders, that are connected with substantial mental health problems. The needs of people with cancer are increasingly attracting the attention of psychosocial and psychosomatic disciplines as far as patient-oriented health care research and counselling practice are concerned. Psychosocial work in oncology appears to be becoming increasingly professionalized. Theories of the psychosocial origin of cancer are gradually losing ground in the scientific community, giving way to a rational attitude towards oncological diseases that counters the stigma of cancer. At the same time, the demand for psycho-oncological services is becoming more important if we take into account the high rate of psychiatric co-morbidity and the fact that these patients are poorly diagnosed and inadequately treated. This is all the more regrettable in that a broad range of evidence-based interventions are available which are gradually being implemented in the guidelines of rehabilitation facilities and oncological centres of excellence. The transfer of knowledge in the everyday care of cancer patients, however, has yet not been accomplished.