Zeitschrift fur Psychosomatische Medizin und Psychoanalyse最新文献

Until now psychoanalytic training and literature have hardly considered the transference love of homosexual patients. We summarized the scarce literature and related it to the background of our knowledge of heterosexual transference love. The discussion leaves no doubt that, like the heterosexual, homosexual transference love must be read on all levels of psychosexual development instead of reading it on only one and definitely not on an amorphous "preoedipal" level. This is particularly true for the level of the adult homosexual patient, as the case history demonstrates.

Already the first version of the resistance concept as a force of the paint against which Freud had to summon psychic work names an interactive event. The conversational-analytic examination of therapeutic dialogs may bring to light that resistances are not just embedded in the interpersonal relationship of patient and psychotherapist, but are produced with verbal and non-verbal means with which patient and psychotherapist handle their interactions. This is described with a micro analysis of the therapeutic interaction in videographed sequences from an analytic oriented short therapy of a patient with phobic and compulsive symptoms.

With this comes the question: Are there typical relationship patterns and affects, that appear in physicians experience of their relationships to patients with different illnesses? We asked 33 physicians about impressive experiences with one AIDS-, one cancer- and one metabolic disorder patient each. The narratives we received were evaluated with two contentanalytic methods. The relationship patterns were assessed by the Core Conflictual Relationship Theme (CCRT), developed by Luborsky. The affects were assessed by the Gottschalk-Gleser Content Analysis Scales. We found some significant differences between the relationship experience with AIDS- and cancer patients on the one hand, and metabolic disorder patients on the other hand. In relationships with critical ill AIDS- and cancer patients the physicians verbalize more death anxiety and more diffuse or nonspecific anxiety. Furthermore they show more covert hostility against the AIDS- and cancer patient, whereas they verbalize more overt hostility against the metabolic disorder patients. We found also some fine distinction between the relationship experiences with AIDS-patients on the one hand and cancer patients on the other hand. The physicians get more involved with the relationships to AIDS-patients and the closeness-distance-regulation seems to be one central issue in this relationships.

Numerous empirical studies indicate a higher frequency of eating disorders such as anorexia or bulimia nervosa in young female diabetic patients compared to the normal population. The comorbidity of the two syndromes usually leads to a continuous metabolic disorder bearing high risks of acute metabolic failure or early microangiopathic lesions. In addition to "restraint eating" as an essential element of diabetic therapy a premorbid neurotic malformation and/or poor coping strategies are further predisposing aspects for the development of an eating disorder. The inpatient treatment of a 22 year old patient suffering from both diabetes mellitus and bulimia nervosa demonstrates the association of neurotic malformation, poor coping style and the directive function of diabetic therapy.

Social support is widely believed to be an important buffer against stress in patients coping with cancer. Support efforts can, however, in turn prove to become a source of distress in themselves, both in patients and support providers. The present study was designed to explore the connections between support and emotional distress. N = 120 lung cancer patients and their relatives (n = 57) are interviewed at three intervals. Social support is assessed by multiple methods: Content analysis, a questionnaire and a confidant rating performed by experts. Cross-sectional and longitudinal analyses are combined. Content-analytical and self-report data show a correlation of support efforts and emotional distress. In the confidant rating, however, the expected differences between supportive and non-supportive spousal relationships emerge. The results are discussed from an interactional point of view.

In the scope of our study for evaluation of the differential effect of inpatient psychotherapy we investigated by retrospective analysis of data at admission and 6. week of treatment, which factors were prognostic relevant for therapy success. We defined therapy-success as an equally weighted combination of patients' assessment of satisfaction with treatment success, which was evaluated by the Helping Relationship Questionnaire of Luborsky (1984), and the therapists' assessment of symptomatic and ego-structural improvement of the patients. For the variables, which were related to the patients or therapists, especially the therapists' judgement of the ego-structural disturbance of the patients (r = -.43, N = 218, p < 0.1) and motivation for psychotherapy (r = .27, N = 70, p < .01) exhibited relevant prognostic potency. The variables concerning the therapeutic relationship however gained increased prognostic value first after six weeks of treatment duration.

In this article the question is discussed in how far the processes of understanding in the nomological social sciences an "objectivication", which is demanded of psychoanalysts, can be used for psychoanalytically gained insights to human behavior. For one it is shown that it is impossible in principle to verify or falsify hypotheses within the nomologically oriented methodological self understanding. Furthermore the logical, empirical scientific process obligated to proving hypotheses is pursued in the perspective of a psychoanalytic social psychology and the thesis is developed that these insights, which are gained in nomological research projects are also always products of neurotic-blind interaction, so that nothing can be said of the value of knowledge gained in these research findings as long as the scientists do not clarify their research practice psychoanalytically.

The present study reports findings concerning the hypothesis whether patients with narcissistic self-system disturbances show more obsessive-compulsive (OC) symptoms as compared to patients without such disturbances. Ninety-one patients meeting DSM-III-R criteria for anorexia nervosa (AN) or bulimia nervosa (BN) were investigated using the Narzissmusinventar (NI), the Hamburger-Zwangsinventar (HZI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Eating Disorder Inventory (EDI). The NI-data demonstrated a great variance of self-system disturbances in AN and BN; a cluster analysis identified two different clinical features. In comparison to eating disorder patients without concomitant disturbances of the self-system (n = 34) the patient group with such narcissistic deficits (n = 57) showed significantly higher Y-BOCS and HZI-scores indicating more and severer OC symptoms. These patients also had significantly higher and hence pathologic means on seven of eight EDI scales. The results suggest that OC behaviour may be an unconscious attempt to stabilize the self-system equilibrium, i.e. counteracting narcisstic desintegration. Regulatory processes of the self-system and OC symptoms may present additional prognostic factors and lead to new approaches in psychotherapy research.

The bio-psycho-social model serves as a guideline to the presentation of the main results of a longitudinal study of Crohn's disease (Heidelberg research project on Crohn's disease). The interactions and interrelations of the biological, psychological and social dimension during a 3 years' course of the disease are presented; in addition, the psychological data based on different theoretical concepts are compared to and linked with each other (defense/coping; disease concepts/personality and coping). Conclusions are drawn in respect to the biopsychosocial research on Crohn's disease and, more generally, to bio-psycho-social research designs and research methodology.

The case reports at hand describe the discordant and the common characteristics of two pairs of monozygotic twins, concordant for anorexia nervosa. The resulting test scores of psychometric questionnaires including the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI) are descriptively presented and compared with each other. Finally the psychodynamic and the psychogenetic implications considering biogenetic findings are discussed.