Mentalisierungsfähigkeit und Empathie in der Psychiatrie – eine Sozialisationsfrage?

Berufliche Sozialisation entwickelt sich im Kontext der Persönlichkeitsentwicklung und vorhandener Bedingungen unterschiedlich. Das Aufrechterhalten der Mentalisierungsfähigkeit im beruflichen Alltag und vor allem in herausfordernden Situationen ist keine Selbstverständlichkeit, sondern abhängig von Umgebungsbedingungen. Die Übernahme von Verantwortung für die gewählte berufliche Tätigkeit erfordert eine Auseinandersetzung mit dem jeweils spezifischen Anforderungsprofil; es stellen sich Lern- und Entwicklungsaufgaben. Die Integration der beruflichen Identität im Rahmen förderlicher Umgebungsbedingungen bedeutet, sich als Teil dieser Gruppe(n) zu erleben. Aus gruppenpsychoanalytischer Sicht stellt die Identifikation mit einer Gruppe eine Verinnerlichung eines „guten Objekts“ dar, einer Gruppenrepräsentanz, welche in herausfordernden Situationen zugänglich ist. Dies kann die Mentalisierungsfähigkeit verbessern.

[Predictors for patients' starting psychotherapy]

BACKGROUND

The aim of this study was to discover prognostic criteria for outpatients' making use of psychotherapy. Data from patients and therapists were collected.

SUBJECTS AND METHODS

After initial psychoanalytic interviews, 92 patients at a university psychotherapy outpatient department were asked to complete narrative forms and standardized questionnaires (FMP) regarding their motivation to seek psychotherapy. In addition, the therapists contributed a Global Assessment of Functioning (GAF) and estimate of the initial therapeutic working alliance (iTAB) for each patient. In the follow-up, we investigated patients' actual use of psychotherapy.

RESULTS

Sociodemographic variables, personality variables, and diagnoses had only minor prognostic relevance, whereas therapists' assessments of patient resources for therapeutic relationship and work proved to be of high predictive value.

CONCLUSION

Positive assessment of a patient's ability for therapeutic working alliance in the initial diagnostic interview is shown to be an important prognostic factor of a patient's entering psychotherapy.

Self-report versus interview data of women's subjective theories of illness: concordance and predictive validity in a psychosomatic-gynecological liaison service

Between-method comparisons of patient data from standardized self-report instruments and corresponding patient interview data frequently have poor agreement. We investigated the concordance and predictive validity of self-report measures and expert-rated interview data of women's subjective theories of illness in a psychosomatic-gynecological consultation liaison service. 31 patients completed two questionnaires (KKG, PATEF) on subjective theories of illness and were interviewed with a semistructured instrument on the same topic at the time of the initial appointment and after 1.5 years. External criteria for assessing the predictive validity of questionnaire versus interview data were: follow-up participation and psychotherapy utilization during the follow-up interval. Questionnaire and interview rating data were only modestly associated. Rater concordance on the interview data was low. Neither the initial-assessment interview nor the questionnaire data had predictive validity for patients' participation in the follow-up. None of the interview rating data but a portion of the questionnaire data, had predictive validity for patients' utilization of psychotherapy during the follow-up interval. The cognitive conceptualization of subjective theories of illness may fail in patients with psychosomatic disorders, due to their very mode of experience. A wider approach that includes assessment of nonverbal communication and countertransference might be useful.

Affective state of women following a prenatal diagnosis: predictors of a negative psychological outcome

OBJECTIVE

The benefits of prenatal diagnostic procedures are well documented. However, the investigation of psychological consequences related to these procedures has remained a surprisingly neglected area of research. The main aim of the present study was to investigate the potential relationship between psychological outcome and associated (socio-demographic, psychological and obstetric) variables in women attending a tertiary referral center for prenatal diagnosis and therapy for ultrasound scanning (due to the suspicion of a fetal malformation raised by the gynecologist in private practice), amniocentesis or chorionic villus sampling.

METHODS

Affective state was assessed by means of standardized measures of anxiety and depression (State-Trait Anxiety Inventory; Mood Scale) in 77 consecutive, unselected women. A follow-up investigation, including an additional assessment of coping mechanisms, took place 6 months after the first contact. Given the considerable number of intervening and correlating factors, a path analysis was undertaken.

RESULTS

We found that all women in our sample experienced acute distress, not only those with proven fetal malformations, genetic disorders or intrauterine fetal death, but also those with the diagnosis of a sonographic sign. At baseline (i.e. immediately after the diagnostic procedure), mood and anxiety scores in our sample were found to be comparable to those of patients with a major depressive episode. A high trait anxiety level, implementation of negative coping strategies and loss of the child during pregnancy were found to be predictive of a negative psychological outcome at follow-up. Socio-demographic variables did not have a significant predictive function for the psychological outcome.

CONCLUSIONS

We assume that a considerable number of women undergoing prenatal diagnostic procedures experience psychological distress, which may be underestimated by workers in prenatal care. Establishment of interdisciplinary treatment settings, in which access to psychological support is facilitated, may be extremely beneficial for women following a prenatal diagnosis.

Context-Oriented Model Development in Psychotherapy Planning ('COMEPP'): a useful adjunct to diagnosis and therapy of severe personality disorders

OBJECTIVE

Pathogenous interpersonal (e.g. interfamilial) relationships and reference styles can compromise treatment efforts in severely disturbed (i.e. psychotic or borderline) patients. The integration of family- and individual-centred starting points may be useful in establishing interdisciplinary treatment concepts in these patients. Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapy planning process, integrating both systemic and psychoanalytic conceptualizations.

METHOD

COMEPP is exemplified by the case of a young man with psychotic personality disorder who had previously been unresponsive to pharmacological and psychological treatment.

RESULTS

After psycho-dynamical conflicts (i.e. primitive projective processes from the patient's mother to her son) had been elucidated during the COMEPP process, a sufficient treatment setting could be established.

CONCLUSION

COMEPP provides a psychotherapeutical approach to treatment planning on case-specific premises and may serve as an adjunct to concomitant pharmacological and psychological treatment strategies in so-called 'therapy refractory' patients.

Gender and perversion--what constitutes a "bad mother"

BACKGROUND

There is a need for reconsidering the conceptualisations of female perverse behavior, especially in connection with motherhood.

METHODS AND FINDINGS

Based on case material obtained through psychoanalytic psychotherapy with female patients from a psychosomatic gynecological outpatient clinic, the characteristics of the psychic structure of these patients who presented symptoms of deliberate self harm and of misusing and mistreating their children, are outlined. Another common trait is the embeddedness of their perverse behavior in a generational chain of transmission. Female patients who mistreat their children had been victims of traumatising experiences in their own biography, inflicted by their mothers and directed towards their bodies.

DISCUSSION

Female perverse behavior, therefore, is fundamentally different from male perversion: the perverse act in women is aimed against themselves and/or their children. Currently used diagnostic statistical manuals lack categories to describe this symptomatology adequately. Further research is requested to understand a mother's perverse actions and thus develop treatment strategies, without marginalizing these patients.

[Relationship between symptoms of depression and anxiety and the quality of life in multiple sclerosis]

BACKGROUND

Health-related Quality of Life (QoL) is gaining increasing influence as a relevant evaluation criterium in clinical research. Several studies have investigated QoL in patients suffering from multiple sclerosis (MS) and the impact of therapeutic interventions on QoL. However, the influence of psychiatric complications, which occur frequently in MS (e.g. depression and anxiety disorders), on the autoassessment of QoL are hardly ever considered.

METHODS

Symptoms of depression and anxiety were rated in 74 outpatients with definite MS. The health-related QoL was assessed and set into relation to physical disability (measured with the Expanded Disability Status Scale) and duration of the disease. The results were compared with 74 normal controls of the same age.

RESULTS

A highly significant relationship between emotional state (Zerssen-scale), depression (Zung-depression-scale), anxiety (Zung anxiety scale) and Quality of Life was evident.

CONCLUSIONS

Clinical trials assessing Quality of Life in MS patients should consider the frequency of psychiatric comorbidity and the influence of depression and anxiety disorders on self-rated Quality of Life.