Zeitschrift fur Psychosomatische Medizin und Psychoanalyse最新文献

Verbatim transcripts of 12 psychotherapeutic interviews with patients suffering from phobia and panic disorders were examined, focussing on subjective theories of illness, biography, and descriptions of the own personality. The results of our qualitative content analysis allow the reconstruction of some central features of these patients, like characterizing the own personality as normal and without any problems in a stereotype way (1), at the same time feeling wrong understood and exploited from other persons (2), feeling as an outsider and left alone (3), and being no more able to compete with others (4). These and other findings are discussed in the context of psychoanalytic concepts of phobia and panic disorders.

With a casuistry we tried to show how disturbances in the free-floating attention of the reporter, which take on the character of micro-symptoms, can be based on the structural similarity of experience moments of therapist and patient; we were able to show how these experience moments influenced the report of an analytic supervision group. Only after a third person joined the others, the triangular relationship within the supervision, was it possible to consciously perceive the structural similarity. Within such a triangular relationship, where the person opposite can always also be seen through the eyes of a third party, it is possible that the capabilities of self-reflection and self-evaluation, which characterize the analytic attitude, can develop via identifications.

"Crisis" is defined as the lack of the development of defense- and/or coping-mechanisms in the conflict between drive-claims or narcissistic needs versus the influences of the super-ego and/or conditions of outside reality. The term crisis, introduced by Erich Lindemann (1944), characterizes a state which was already known to Sigmund Freud. Central to his thought was an antagonism between the pleasure principle dominating the unconscious and the reality principle being directed toward the outside world. Different possible causes of crises are for example sudden and unexpected intrusions in a life situation which was previously experienced as stable, or a narcissistic trauma and loss that could not be worked through as grief and that lead to a reactive-depressive state, or a shock resulting from demands of the super-ego during inner or outer experiences. Principles of a psychoanalytically oriented therapy are discussed, the outcome of which is the better, the more there is a good working alliance and good development of insight.

Couples with neurotic partner problems are characterized by considerable psychic and/or psycho-somatic complaints. Men usually judge the relationships with their spouses more satisfactory than women do. Women suffer more from conflicts in partner-relationships than men do responding to such conflicts with psychic and/or psycho-somatic complaints. Men are more disturbed by a conflict mobilizing therapy than women are. The strongest decrease of men's psychic symptoms can be found in the year after their therapy. Women's defence against psychic problems is less strong than men's. Decrease of women's symptoms can be found during therapy already. Character neuroses don't make psychic and/or psycho-somatic symptoms in a direct manner. Character neuroses rather give rise to conflicts with other people, and stress by those conflicts cause symptoms.

Long-term follow-up investigations contribute to our knowledge and understanding of illnesses, their prognosis and the effectiveness of treatments. In the evaluation and interpretation of results of long-term follow-up studies many conceptual and methodological aspects have to be considered. Using the example of long-term follow-up investigations of anorexia nervosa some of the most important issues are discussed in a more general framework.

Thomas and Schmitz claim that they "deliver a proof for the effectiveness of humanistic methods" (p. 25) with their study. However, they did not or were not able to verify their claim due to several reasons: The authors did not say if and if so to what extent the treatments carried out within the framework of the TK-regulation were treatments using humanistic methods. The validity of the only criterium used by the authors, the average duration of the inability to work, must be questioned. The inferential statistical treatment of the data is insufficient; a non-parametrical evaluation is necessary. Especially missing are personal details concerning the treatment groups (age, sex, occupation, method, duration and frequency of therapy), which are indispensable for a differentiated interpretation. In addition there are numerous formal faults (wrong quotations, mistakes in tables, unclear terms etc.). In view of this criticism we come to the conclusion that the results are to a large degree worthless, at least until several of our objections have been refuted by further information and adequate inferential statistical methods. This study is especially unsuitable to prove a however defined "effectiveness of out-patient psychotherapies", therefore also not suitable to prove the effectiveness of those treatments conducted within the framework of the TK-regulation and especially not suitable to prove the superiority of humanistic methods in comparison with psychoanalytic methods and behavioural therapy.

In this article we will depict the relevance of follow-up studies for evaluative psychotherapy research. Follow-up studies distinguish themselves from pure result studies in that they are clinically more meaningful as they examine the stability of psychotherapy results over a longer period of therapy-free time. The special methodical problems of follow-up studies are discussed and the minimal essentials for the research design of such studies are called for.

Progress in the new science of chaos has made it possible for scientists of several different disciplines to extend their understanding of complex systems and to quantify some phenomena which are called transition states. These transitions occur when the nature of system changes noticeably, for example when a fluid changes from a laminar to a turbulent flow. Nonlinear systems (which are best modelled by chaos) are described in this article and are compared to the psychoanalytic model of the soul. Some psychoanalytic phenomena are examined with methods of the chaos principles. The author claims that a sufficient number of interrelations between operative models in the disciplines which have profited from the application of chaos principles and psychoanalytic models of the soul exist in order to justify theoretical and experimental efforts to use these principles. These efforts could enrich our understanding of the soul and suggest a new methodology for psychoanalytic research.