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PCE2006
7th World Conference for
Person-Centered and Experiential Psychotherapy and Counseling
July 12–16, 2006, Potsdam, Germany
Topic:
Specific Dysfunctions and Clinical issues
Symposium "Person-Centred Approaches in Medicine" (ÄGG)
Hildegard Böhme
Dipl.-Psych., Ilaenderweg 30 A, 45239 Essen, Germany. Tel.: 49 201
405543. e-mail: hildegard.boehme@arcor.de
Abstract:
Problem: Lack of a frank self-exploration is described by various concepts
("social desirability tendency", aggravation vs. dissimulation, defence mechanisms, defensivness). Therapy success of defensive patients is seen sceptically. In the frame of person-centred theory defensiveness is not a disturbing condition but a central request, meaning to detect and diminish
"incongruence" of self- perception. Therefore it was studied, whether in psychological tests measurable defence tendencies change in the course of a client-centred therapy.
Method: Scores of so-called validity (defence-) scales in standardized German personality inventories (MMPI-K n=125, FPI-R n=189, Giessen-Test n=185) were recorded in patients who underwent an inpatient client-centred therapy. Measurement points were admission, discharge and 1-y-follow-up. Defence scores were statistically proved for covariance with depression- and personality-scales.
Results: Only ¼ of the patient population showed defence, the others were characterized by self-defeating openness. Defensive patients diminished their retentiveness, but described better therapy results at discharge and follow-up. Patients with exaggerated self-criticism showed the contrary effect: Increase of defence, but over-all a more critical view of achieved psychopathological health.
Discussion: Results were commented with regard to studies on affect regulation and resilience. Defence is one form of self-protection, whilst feelings of incapability and guilt indicate depression. Client-centred therapy offers techniques to improve insight, self-acceptance and behaviour modification. In self-regulation it promotes a better balance between the tendencies of problem denial and problem catastrophysation, not a principal inversion of personality traits. For him who strives for a positive self-representation, it is equally important after therapy to reach more openness in communication as to be a
"successful patient"; for him who not protected himself enough by defence the goal becomes a more positive self-sight without loosing a critical distance.
Die Abnahme von Abwehrhaltungen im Verlauf einer Gesprächspsychotherapie
Hildegard Böhme
Dipl.-Psych., Ilaenderweg 30 A, 45239 Essen, Germany. Tel. : 49 201
405543. e-mail : hildegard.boehme@arcor.de
Abstract:
Problem: Mangelnde Offenheit wurde mit den verschiedensten Konstrukten umschrieben
("social desirability tendency", Aggravation vs Dissimulation, Abwehrmechanismen, Defensivität). Über den Therapieerfolg abwehrender Patienten wurden skeptische Vermutungen geäußert. Der Theorie der Gesprächspsychotherapie gilt Abwehr nicht unbedingt als störende Bedingung, denn es ist ein zentrales Anliegen,
"Inkongruenzen" in der Selbstwahrnehmung zu entdecken und aufzuheben. So sollte untersucht werden, wie sich mit psychologischen Testverfahren messbare Abwehrhaltungen im Verlauf einer Gesprächspsychotherapie verändern.
Methode: Die Werte sog. Validitäts- (Abwehr-) Skalen in standardisierten deutschen Persönlichkeitsfragebögen (MMPI n=125, FPI-R n=189, Gießen-Test n=185) wurden bei Patienten erhoben, die sich einer stationären Gesprächspsychotherapie (GPT) unterzogen. Messzeitpunkte: Aufnahme, Entlassung, 1-Jahres-Katamnese. Sie wurden auf statistische Kovarianz mit den Werten in Depressions- und Persönlichkeitsskalen geprüft.
Ergebnisse: Nur ¼ der Patienten zeigte bei der Aufnahme Abwehrtendenzen, die übrigen beschrieben sich mit selbstanschuldigender Offenheit. Anfangs abwehrende Patienten verminderten während der Therapie signifikant ihre Verleugnungshaltung, wurden offener, beschrieben aber bei der Entlassung und ein Jahr nach der Behandlung auch eine bessere psychische Gesundung. Bei den übrigen traten die umgekehrten Effekte ein: Positivierung der Selbstbeschreibung und Zunahme der Abwehr, aber eine insgesamt kritischere Sicht der eigenen Gesundung nach der Therapie.
Diskussion: Die Ergebnisse werden zur Forschung über Affektregulation und Resilience in Bezug gesetzt. Abwehr stellt auch einen Selbstschutz dar, Insuffizienz- und Schuldgefühle sind ein Indikator für Depressivität. Die mit den Techniken der GPT bewirkten Änderungen von Einsicht, Selbstakzeptanz und Verhalten erzeugen eine bessere Balance zwischen den vorhandenen Tendenzen, auf Probleme mit Verleugnung oder Selbstanklage zu reagieren, nicht aber eine grundsätzliche Umkehr. Demjenigen, dem an einer positiven Selbstdarstellung liegt, erscheint nun wichtig, zwar kommunikativer und offener, aber auch,
"ein erfolgreicher Patient" gewesen zu sein; dem, der sich zu wenig durch Verleugnung schützte, bleibt Selbstkritik wichtig, aber er mildert ihre Übertreibung.
Jobst Finke
Dr. med.,
Duisburg-Essen University, Rheinische Kliniken Essen, Virchowstr. 174, 43147 Essen, Germany.
e-mail: jobst.finke@uni-essen.de
Abstract:
Regarding the epistemological essence of Person-centered psychotherapy (PCT) today we find a strong controversy. Summarizing this controversial discussion we can say: PCT-methods are diverged into two positions regarding the therapeutic relationship. On the one hand PCT is defined simply as an effort to achieve understanding during therapy and encounter from person to person, rejecting any science of controlling and planning. On the other hand the scientific position of PCT is emphasized. This position implicates an instrumental point of view in which PCT is considered as an element of modern health care system and maintains the necessity of diagnosis and target oriented therapy regarding therapy planning and using therapy technique. I believe that the first mentioned position and its (post modern) frame of reference is an important completion of the scientific position and has a great deal to offer working in the medical context. This lecture attempts to create a bridge and to reconcile the two frames of reference.
Jobst Finke, Duisburg-Essen University, Rheinische Kliniken Essen, Virchowstr. 174,
43147 Essen, Germany. e-mail: jobst.finke@uni-essen.de
Ludwig Teusch, Duisburg-Essen University, Department of Psychiatry and Psychotherapy, Evangelisches Krankenhaus, Grutholzallee 21,
44577 Castrop-Rauxel, Germany. Phone: +49 2305 1022858. Fax: +49 2305 1022860.
e-mail: l.teusch@evk-castrop-rauxel.de
Abstract:
Within a medical framework person-centered working is committed to the paradigm of natural sciences, which means a distant position of perceiving and finding diagnoses in an objective way and a systematic goal oriented therapeutic proceeding. In different ways person-centered therapists contribute to the treatment of physically or mentally ill patients. Person-centered experts present their experiences and results of person centered treatment in different medical areas including psychosomatic medicine and psychiatry in the broad range of psycho-education, traditional person-centered treatment, and disorder or goal oriented treatment. The therapeutic proceeding will be outlined as well as problems to act within the medical framework. The person centered approach is seen to enrich treatment options in medicine.
Hans-Jürgen Luderer
Prof. Dr. med. M.D.,
Clinic of General Psychiatry and Psychotherapy, Klinikum am Weissenhof,
74189 Weinsberg, e-mail: h.luderer@klinikum-weissenhof.de
Abstract:
Psycho-education has become a very important element of schizophrenia treatment. Positive results in schizophrenia treatment encouraged therapists to develop psychoeducational models for other disorders. The concept of psychoeducation comprises information of patients and relatives about general aspects of a specific disorder and its treatment, and helping them to understand the disorder and to cope with it. Some aspects of this concept – patients’ responsibility and support in coping – are in accordance with traditional client-centered ideas, whereas others – active information and the importance of specific disorders and diagnoses – are not. The concept of patient-centered psychoeducation is based on the following theses:
- Person-centered interventions are related to patients’ internal frame of reference.
- The internal frame of reference is not exclusively defined by the person itself, but also by the
psychosocial and medical situation.
- As a consequence, the internal frame of reference is influenced to a considerable degree by a psychiatric disorder.
- Psychiatric diagnoses can help to understand patients’ internal frame of reference and to be empathic with respect to it.
These theses will be exemplified for alcohol dependency, mood disorders, anxiety disorders, and personality disorders.
Khalid Murafi
Westfalian Institute Hamm, Clinic for Child and Adolescents Psychiatry and Psychotherapy
Abstract:
Because of the high level of anxiety induced through self-harming behaviour in children and adolescents in their surrounding family and professional social contexts many therapists have to experience helplessness and powerlessness. Often, this results in directive sanctioning arrangements to stop self-harming behaviour as soon as possible. We want to discuss the possibilities how to intervene in a person centred way with self-harming children and adolescents and their social system.
Marlies Pörtner
Psychologist, psychotherapist SGGT/SPV, author
Abstract:
The large variety of very different persons embraced by the term "special needs" calls for a subtly differentiated individual approach in psychotherapy as well as in everyday care. The person-centered approach (including pre-therapeutic elements) is particularly helpful to better understand their sometimes strange and apparently, incomprehensible ways of expressing themselves. Quite a number of them suffer from psychological diseases and there is a need for person-centered psychotherapists willing and prepared to work with these clients.
Within a medical framework a person-centered orientation makes it easier for psychiatrists and general practitioners to understand the patient’s feeling and experiencing. To the "diagnostic eye", focused on deficiencies, the "person-centred eye", focused on resources, offers a helpful
– and in my opinion necessary – completion. Psychotherapy and treatment with mentally disabled clients need to be supported by their environment; therefore it is highly desirable in everyday care to work along person-centered concepts. Co-operation with caregivers can be useful as they might be in a position to translate the sometimes difficult
– verbal or non-verbal – "language" of a person with mental disability.
Lisbeth Sommerbeck
M.Sc., clinical psychologist
Abstract:
Client-centred therapy with pre-therapy as an extension is, in my experience from working more than 30 years in the Danish psychiatric system, ideally suited as a psychotherapeutic model for the persons this system tries to help. Further, the client-centred and pre-therapeutic work, as such, with these persons entails no problems in the relationship with the clients that are out of the ordinary, even if it takes place within a medical model context. Rather, the problems are, in my experience, found in the client-centred therapists’ relationship with the medical model context. The client-centred model assumes that the therapist is not an expert on what is best for the client and it is, thus, non-directive. The medical model assumes that the therapist is an expert on what is best for the client and it is, thus, directive. One can regard these assumptions as contradictory, but one can also regard them as complementary. This presentation aims to demonstrate the fruitfulness of regarding the client-centred model and the medical model as standing in a complementary relationship to each other. It will also discuss the practical implications of this perspective and, if time permits, an illustrative example will be offered.
Holger Süß
Dr. med. MD,
Department of Psychosomatics, Burgklinik, Burgstrasse 19, 36457 Stadtlengsfeld, Germany. Phone:
+49 36965 68573; e-mail: hsuess@burg-klinik.dbkg.de
Abstract:
Aspects of person-centred principles in the treatment of somatoform (pain) disorders will be discussed with a special view to disorder specificity, process specificity difficult therapy situations and individualization of the therapeutic relationship. What could be a professional handling with following comments: What do you want? I do not have problems. In my family everything is o.k. I feel my pain, but I can't do anything against. Why shall we talk about emotions? Do you get ideas where my pain is coming from? The therapeutic proceeding is presented and discussed. The person-centred principles are seen to be appropriate preconditions to understand the patient’s frame of reference and to develop a therapeutic alliance with highly defensive patients.
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