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PubMedDate not supplied

[Model of residential psychoanalytic integrative parent-child therapy].

Deriving from an integrative psychoanalytic concept for single grownup patients treatment in a psychotherapeutic clinic based on the integrative model of P. Janssen the author tries to apply this model and to expand it to the treatment of families in a similar context. This setting mainly relies on three columns: 1. the psychoanalytic group therapy of the parents (or the mother resp. father), 2. the psychoanalytic psychotherapy of the child (resp. children) and 3. the psychotherapy sessions with the family, resp. the single therapy sessions of the grown up patients. This clinical model offers the opportunity to distinguish between accompanying children and children as patients in a stricter sense. The psychodynamic processes of transference, countertransference and resistance are integrated in and by regular team sessions. This paper discusses the parallel processes in the different applied therapeutic methods and their positive mutual influences on each other centered around a detailed case vignette of a family (a mother with two boys) that underwent psychotherapeutic treatment in the described manner for 12 weeks.

Adult↗
PubMed1975

[Psychoanalytical understanding of childhood psychoses].

This short paper, placed in the symposium on child psychiatry within the Congress, is concerned with the psychoanalytic points of view which support the theory of treatment of children with autistic phenomena. After a brief description of the clinical of an autistic three-year boy with mutism, a theoretical point of view is elaborated through a concise revision of the contributions of various classical authors; focusing mainly on M. Mahler and the symbiotic and separation-individuation processes, M. Klein and the schizo-paranoid mechanisms, and finally the technique of treatment based on the transference-countertransference phenomena in the analytic situation.

Autistic Disorder↗
PubMed1999

Therapists' responses during psychotherapy of holocaust survivors and their second generation.

Human personality contains three layers of identity: the collective, the familial, and the individual, intra-psychic. All three have been directly traumatized and damaged in Holocaust (Shoah) survivors and indirectly through overt and covert transmission in their children. Survivors and the second generation usually contain a few of these identity components in a state of fragmentation, which become central in the therapeutic dialogue between therapists and the patients. When the therapist belongs to the same traumatized population there exists a unique complexity of an a priori countertransference. Sharing the same traumatogenic reality that the patient seeks to alleviate through therapy poses unique difficulties and challenges for the therapist. In working with survivors, pre-war intra-familial traumatizations are of little significance in the face of the massive traumas and death suffered in the Holocaust. In the case of the second generation, "ordinary" developmental impairments and difficulties cannot be fully understood without knowledge of the parents' war experiences and the resultant family atmosphere. Thus, every therapist has to examine both his knowledge and especially his responses not only about the Shoah as a massive trauma but the specific war history of both parents families. Self-knowledge and awareness are necessary to a far greater extent than usual if one is not to be shocked or surprised into acting out. The depth and degree of openness which therapists need when dealing with Holocaust survivors and their children are at least as important as clinical skills.

Defense Mechanisms↗
PubMed1999

Complexity of therapist's feelings in the work with war-traumatized patients.

AIM: To present the complexity of therapist's feelings and emotions in the work with war-traumatized persons and the importance of psychological mechanisms taking place in such circumstances. METHODS: The method of psychoanalytical psychotherapy was used, adapted to the work with war-traumatized persons. The therapy sessions were held once a week and lasted for 50 minutes. The patients were given transference interpretations differing from customary transference interpretations. They were modified to provide support, aiming at overcoming of the feelings overwhelming each patient. RESULTS: The diversity of the therapist's feelings amalgamated into countertransference was one of the most important psychological mechanisms in the therapy procedures, and served as an indicator of the patient's feelings in the procedure. It was related to the processes of projective identification as a framework of the complex patient-therapist relationship CONCLUSION: + In the work with a war-traumatized patient, it is inevitable that the patient's feelings are partly shared by the therapist through projective identification. This can lead to the "burnout" syndrome and threaten the boundaries of the therapist's psychological system. The role of the therapist includes not only knowledge but also the personal experience of work on himself. Through the process of therapy and by using interpretations as the powerful tool, the therapist is capable to accept such traumatic feelings and help the patient overcome them, but also to remain within the framework of his role.

Combat Disorders↗
PubMed2000

[Successful treatment of an elderly woman after stubborn resistance].

A 72-year-old depressed woman was admitted by court order after a long history of ¿successful' resistance to any treatment, both at home and in a psychiatric hospital. The nature of her disorder had not been recognised and she was diagnosed elsewhere as suffering from factitious disorder, probably based on intense countertransference. The diagnosis of depression with mood-congruent psychotic features was made. After several unsuccessful combination treatments and refusal of electroshock therapy, she finally responded to combination therapy with tranylcypromine, lithium carbonate and clozapine. Dutch medicolegal regulations need not be an impediment in such cases, intercollegiate consultation is most useful and strict adherence to therapy guidelines is beneficial.

Aged↗
PubMed2000

The dreams of a cancer patient: a "royal road" to understanding the somatic illness.

In this paper we have presented the principal dreams of a 39-year-old female patient in order to demonstrate how closely the dreams were linked with the understanding of her cancerous condition. The analysis, lasting over a period of eight years, ended with the remission of the patient's cancerous condition to the point where she was without pain and symptom-free. The findings suggested that her dreams played a special role in her analysis by providing important landmarks regarding her treatment's progress and state of her cancerous condition. In a general sense, it was concluded that the patient's dreams did provide a "royal road" to understanding her somatic illness. Specifically, it was concluded that, first, the patient's dreams were able to represent quite reliably, in symbolic form, the state of her cancerous condition; second, that the cancer condition and transference-countertransference reactions were closely entwined; and third, that each of the patient's dreams seemed to be introduced by a crisis situation connected with a traumatic early memory.

Adult↗
PubMed2001

Cooperation between mental health professionals and doctors in a Balint-oriented supervision group.

A Balint-oriented supervision group for physicians is described concentrating on the study of the patient-doctor relationship, the recognition and diagnosis of psychiatric problems, and the planning of psychiatric treatment. The group includes five general practitioners, a gynecologist, a dermatologist, a psychiatrist and a psychologist, who have met once a month for an hour over a period of 12 years. Interaction between the physicians and the mental health professionals is illustrated by two clinical examples. The group helps the physician recognize, tolerate and use his countertransference feelings, and facilitates the examination and treatment of patients suffering from psychiatric problems. In Balint-oriented group work, the focus can be moved from physical symptoms to include observation of the patient's emotional life and significant object relations, to the factors that are crucial for his psychological balance. This kind of holistic observation in the examination and treatment of psychiatric problems is as important as appropriate laboratory investigations in the diagnosis and care of physical diseases.

Adult↗
PubMedDate not supplied

[Sibling relations in processing sexual trauma: the film "The Celebration"]].

Movies appeal as a subject of psychoanalytical art interpretation due to their structural closeness to "scenical understanding" and enrich our Insight into human relationships. The movie Das Pest is worth seeing because of its particular aesthetic form and because of its message about sibling relationships. According to the assessment of film journalists the movie shows the dismantling of middle class society and the reinscenation of destructive violence. In this author's interpretation, however, the movie leads out of passing violence on through the generations and herein differs from numerous current movies about siblings. The movie is about the process of a constructive development in the reciprocal relationships between four siblings and shows this in the formal structure of a film. With countertransference and our "viewing habits" the author discusses why this development could be overlooked. The movie shows neither a sibling fixation nor an idealization of sibling love as a regressive, timeless topos, but rather a horizontal relationship process. This is open towards partners and allows for a conciliatory attitude towards the parents. The movie is able to show this process conclusively under the burden of intergenerational violence and in its creativity enriches our image of sibling relationships.

Adolescent↗
PubMed1975

Mobilizing ego strengths.

In certain special situations in psychoanalytic treatment there is a need to mobilize ego strength: (1) those patients who are "so infantile" that they need ego strengthening to mature sufficiently to cope with their lives; (2) patients who regress partially during psychoanalysis and cannot progress without analytic intervention to help strengthen their ego; (3) those patients with a strong tendency toward regression whose egos need immediate strengthening in analysis to prevent an immobilizing regression; (4) those patients for whom a stressful reality situation so undermines their confidence that they fall into a severe regression and need to be helped out of this as an emergency to avoid permanent trouble, such as flunking out of school or getting fired from their jobs. All attempts to mobilize ego strengths require an especially thorough understanding of the psychodynamics and especially of the transference and countertransference. In addition, the patient's ego must be assessed as having the potential for more effective functioning. Usually the patient has been unable to realize this potential because of the various degrees of regression, and the analyst has already made exhaustive analytic interpretation of the unconscious material, including the transference and resistance. He may then shift to a more direct approach, pointing out the patient's ego strengths and giving him an accurate picture of the way he can use these strengths toward his own goals. The aim is to help the patient use his own willpower and ego functions gradually to work on and finally resolve some of his neurotic problems. Accurately and honestly mirroring the patient's ego potentials, encouraging him to use his ego, and providing examples of how others have used their own willpower in comparable situations are usually helpful. The analyst must not impose his own values or goals on the patient but must work with the goals, problems, and strengths the patient has. Seven analytic cases are presented to illustrate different ways of helping the patient to mobilize and utilize his own ego strength. We are not suggesting any new "technique," but only that there is something, which can be recognized as willpower, that can be mobilized for therapeutic effect; the appeal is make primarily by the usual procedure of pointing out reality but with encouragement to the patient in coping with both external and internal stresses, these latter being most often regressive tendencies.

Adaptation, Psychological↗
PubMed1989

[Between Freud and Ferenczi: their patients. One aspect of their relationship].

The importance given to the subject of patients and their treatment in the correspondence exchanged between Freud and Ferenczi for more than twenty-five years (1908-1933) is one aspect of the very dense relationship established betweem the two correspondents throughout this long period of time. The exchanges on the subject of their patients deal all at once with their psychoanalytic practice and the clinical, theoretical and technical problems it involved. Countertransference and the question of how to handle it within the psychoanalytic cure provide the main thread in their constant questioning about their treatments. Thus, a number of cures examined within this correspondence--those of friends or colleagues such as Ernest Jones, Anton von Freund, Elma Palos and Eugenia Sokolnicka--involved in each case specific counter-transferential problems that are evoked and commented upon. However it was the analysis that Ferenczi underwent with Freud (between 1914 and 1916) that definitively marked the relationship between the two protagonists, as well as playing a determining role relationship between the two protagonists, as well as playing a determining role in what they were most given to share as from then, that is, their analytic passion.

History, 20th Century↗
PubMed1992

Psychic change: the analytic relationship(s) and agents of change.

Psychic change, the agents of change, and the theory of technique have gradually changed pari passu with other changes in the field. Rather idealized concepts of structural change have been supplanted by current emphasis on experience-near clinical and functional change. There are varied processes and agents of change, but interpretation and insight are crucial to psychoanalysis. Attention to noninterpretive agents of change includes contemporary theoretical and technical interest in the analytic relationship(s). As analyses become much longer, the real relationship expands, and may impede the analysis of inter-weaving transference and countertransference ramifications. The ambiguous concept of 'new object' primarily refers to the analyst's analytic attitude, role, and analysing functions. Analysis progresses with internalization of the analytic process, but internalization of the analytic relationship and experience may also contribute to psychic change. The analyst should have a stable analytic attitude and identity, and be able to change with new knowledge and experience.

Ego↗
PubMedDate not supplied

[Problems in diagnosis of borderline disorders in childhood].

While, for adults, there exists an instrument for diagnosing borderline-disorders (DSM-III-R, ICD 10), this is not the case for children and adolescents. Several attempts of classifying borderline-disorders are discussed (Bemporad et al., Pine, Vela et al.). Exemplified by a case study of the treatment of a ten-year-old borderline girl originally diagnosed as "hysteria", eight criteria are listed and explained that seem relevant for diagnostic purposes: (1) heredity and affective disorders, (2) diseases and traumata during the first year of life, (3) development in early childhood, (4) character and intensity of anxiety, (5) self-destructiveness, (6) defensive mechanisms, (7) object relationships, (8) countertransference. Attention is drawn to a large-scale empirical study in which, by means of an elaborate questionnaire, child psychiatrists and therapists are asked to characterize symptoms, personality traits and aetiological factors of young borderline patients. This will hopefully solve some problems of differential diagnosis discussed in the article.

Adaptation, Psychological↗
PubMed1992

The development of the work ego in the beginning analyst: thoughts on identity formation of the psychoanalyst.

This developmental process by which analysts consolidate their professional identities after formal training is a topic which has not been discussed sufficiently in the psychoanalytic literature. The aim of this paper is to elucidate the process of identity formation with particular emphasis on how the 'work ego' of each analyst is formed through various experiences which help the practitioner wed theoretical knowledge with clinical experience. Emphasis is given to the psychic reality of the newly graduated analyst, the integration of theory and practice, and the importance of countertransference experiences in the understanding of clinical material. A thread running through the paper is the modification of each analyst's 'psychoanalytic work superego' in the direction of greater flexibility and openness, such that he/she may work comfortably with a variety of patients. In this regard, an examination is undertaken of stereotyped beliefs and practices which many analysts learn during their training, which must be modified in order to acquire a secure professional identity.

Ego↗
PubMed1992

Eating disorders in the 1990s: clinical challenges and treatment implications.

Eating disorders are, and most likely will continue to be, a ubiquitous clinical and therapeutic challenge. The high morbidity and mortality rate of anorexia nervosa and bulimia nervosa presents a major psychiatric problem in contemporary mental health treatment. The author briefly reviews the importance of comorbidity and sexual abuse in this patient population, the special problems of males with eating disorders, salient countertransference paradigms, the role of masochism, and the impact of projective identification on the treatment process. She describes the major clinical considerations, treatment strategies, and psychodynamic issues, giving particular attention to the role of extended inpatient treatment for the refractory patient. The author urges treaters to be emotionally available to these patients, who struggle with the interpersonal dilemma of maintaining separateness while establishing mature connectedness.

Body Image↗
PubMed2005

[Treatment and prevention for suicidal patients with severe personality disorders].

Suicide is a complex behavior of multiple, inter-related factors. The author, in this paper, discusses several issues of the psychodynamic psychotherapy for chronic suicidal patients with severe personality disorders. With regard to psychotherapy for them, the author firstly points out the treatment difficulties that stem from the training system both of psychiatry and psychotherapy where students are not systemically trained with treatment of suicidal behavior. Secondly he discusses psychodynamic evaluation, therapeutic attitude, treatment setting, counter-transference, and grief work. In terms of psychodynamic evaluation, it is suggested that a therapist needs to recognize self-maintaining function, unconscious fantasy of re-union with great pleasure, internal object relations that lead to self-destructiveness, resentment toward self, capacity for loving good aspects of personality, specific sensitiveness to certain object loss, disorganization of self representation, and ego regression. With regard to, the attitude of, the therapist and the treatment setting, the author stresses that psychotherapy should be conducted in a highly structured treatment setting with the attitude of the therapist such as active intervention, honesty (openness), awareness of treatability, and conviction. Countertransferences frequently develop based on the feelings that the therapist experiences narcissistic injury with regard to his/her own ego ideal in the psychotherapy process, in which he/she develops the various defense mechanism against the increasing aggression of his/her own. A therapist needs to be aware of the patient's dependency, make frequent interpretations of patient's destructiveness, and make effective use of the consultation at the time when he/she places himself/herself at the impasse of treatment. Finally, the author emphasizes the grief work for both therapist and family in the case when the patient unfortunately has committed suicide and open communications among therapist, other staff involved and family members should be strongly recommended. These works not only help persons concerned to work through their mourning work, but also prevent the transmission of suicides over generations.

Communication↗
PubMed2006

Emotional and psychological effects of physician-assisted suicide and euthanasia on participating physicians.

UNLABELLED: This is a review and evaluation of medical and public literature regarding the reported emotional and psychological effects of participation in physician-assisted suicide (PAS) and euthanasia on the involved physicians. MATERIALS AND METHODS: Articles in medical journals, legislative investigations and the public press were obtained and reviewed to determine what has been reported regarding the effects on physicians who have been personally involved in PAS and euthanasia. RESULTS AND DISCUSSION: The physician is centrally involved in PAS and euthanasia, and the emotional and psychological effects on the participating physician can be substantial. The shift away from the fundamental values of medicine to heal and promote human wholeness can have significant effects on many participating physicians. Doctors describe being profoundly adversely affected, being shocked by the suddenness of the death, being caught up in the patient's drive for assisted suicide, having a sense of powerlessness, and feeling isolated. There is evidence of pressure on and intimidation of doctors by some patients to assist in suicide. The effect of countertransference in the doctor-patient relationship may influence physician involvement in PAS and euthanasia. CONCLUSION: Many doctors who have participated in euthanasia and/or PAS are adversely affected emotionally and psychologically by their experiences.

Euthanasia↗
PubMed2006

The professional responsibility of lawyers: emotional competence, multiculturalism and ethics.

Traditional legal education and the Socratic method it utilises are by and large successful at training lawyers to think, reason and analyse. The cultivation of lawyers' intrapersonal and interpersonal skills, however, has been, at best, neglected by the profession. All lawyers, like all human beings, are emotional. Emotions affect who they are and how they practise law, whether or not they are conscious of them. As emotions cannot be removed from the practice of law, it is essential that lawyers learn to understand and manage their emotions, as well as learn to be attuned to their clients' emotional lives. Ignorance of concepts such as countertransference, denial and unconscious bias adversely impact the lawyer-client relationship. Lawyers who understand basic psychological principles and behaviours, who are aware of their own psychological makeup, understand their cultural perspective and recognise and credit their clients' differences, will enhance their effectiveness as counsellors. The client whose lawyer has these competencies will enjoy a therapeutically superior counselling or representational experience. The neglect of either the lawyer's or the client's emotional life threatens to sabotage the lawyer's ability, and thus professional responsibility, to render competent and impartial legal advice. Through drawing parallels to the training and practice in other counselling disciplines and relationships, this article argues that psychological-mindedness and multicultural competence are essential elements of ethically responsible legal representation.

Behavior↗
PubMed1989

[The aggressive patient in a psychiatric environment : conter-transference and management problems.].

The author draws from his extensive psychiatric experience with violent patients to expose the dynamics of their violent acts, and the effects of these acts on patients and care personnel. Taking analysis as a reference point, he describes patients' defence mechanisms (denial, identification with the aggressor, things leading to the act, cleavage) and the therapists' negative countertransference reactions (delay in intervention, prescription, fear, anger, and powerlessness) and their negative cognitive responses.

English Abstract↗