Horst Kächele

Stereotypical Relationship patterns and psychopathology

Background: We explored the relationship between the consistency of relationship patterns and the severity of psychopathology. Method: Relationship patterns were assessed by means of Relationship Anecdote Paradigm interviews rated according to the Core Conflictual Relationship Theme (CCRT) method. The repetition of the same type of CCRT components across relationship narratives indicated stereotypical patterns. Results: Subjects treated in an inpatient setting (n = 25) told narratives with more consistent patterns than subjects in an outpatient setting (n = 32). Relationship episodes of normal adults (n = 23) were more flexible compared with the two clinical groups. Especially repetitions of the wish component were closely associated with the severity of psychopathology assessed by SCL-90R. Conclusions: The consistency of relationship patterns seems to be connected with the severity of psychopathology.

Reformulation of the Core Conflictual Relationship Theme (CCRT) categories: The CCRT-LU Category System.

The Core Conflictual Relationship Theme (CCRT) method, developed by Lester Luborsky, is regarded as an established technique for assessing central relationship patterns in psychotherapy research. Numerous studies have investigated associated research areas and clinical applications. Many of these studies have reported problems with the CCRT method attributable to the underlying construct of the CCRT categories. This study describes the development of alternative German CCRT categories, the CCRT-LU categories, in which LU stands for the place of development (Leipzig/Ulm) and for the ‘logically unified’ aspect of the system. For the 1st time, the CCRT-LU categories are assigned to a sample of clinical intake interviews with 32 female patients.

On the Connection Between Affective Evaluation of Recollected Relationship Experiences and the Severity of the Psychic Impairment

This study, carried out at three different university centers contributes to validating the valence dimension of the CCRT-method. Working on the state of the CCRT-research on affective evaluation of relationship narratives, the connection between the valence dimension of the responses from others (RO), responses of the self (RS) and the severity of the psychic disorder has been analysed with the help of two different samples (n = 266 resp. n = 32) taken from female patients. Both, therapists as well as patients themselves, evaluated the severity of the impairment similarly. The more the patients were impaired, the more negatively they describes both their own reactions and those of their interaction partners as shown in the relationship episodes.

A Session of Psychoanalysis as Analyzed by the Psychotherapy Process Q-Set: Amalia X, Session 152

Freud initiated the study of speciman reports of psychoanalytic work with the so-called Irma-dream [1]. This material has been re-analyzed a number of times (for example [2]). In the same vein, the Dora-case [3] has retained a prestigious pivotal position in availing itself to continuous re-elaboration and re-interpretation [4]. However, few detailed examples are available to extended scrutiny where “primary data” [5] are at hand. We leave utilized primary verbation data in our process analysis of a session of the psychoanalysis at process.

The significance of dreams: Bridging clinical and extraclinical research in psychoanalysis

This book looks at dreams from a twenty-first century perspective. It takes its inspiration from Freud’s insights, but pursues psychoanalytic interest into both neuroscience and the modern psychoanalytic consulting room. The book looks at laboratory research on dreaming alongside the modern clinical use of dreams and links together clinical and empirical research, integrating classical ideas with the plurality of psychoanalytic theoretical constructs available to modern researchers. Psychoanalysts writing about dreams have traditionally represented the cutting edge of clinical and theoretical development, and this book is no exception. Many of the contributions, as well as the epistemological position taken by the writers, represent a kind of radical openness to new ways of thinking about the clinical situation and about theory. In line with the ambition of the editors, this volume represents an integration of theories and disciplines, and a scientific context for modern psychoanalysis. The link between clinical research and extraclinical research via the royal road of dreaming is a theme that runs through all the contributions. These cover dreaming as it sheds light on clinical conditions such as depression and trauma, or dreams as they form a core aspect of clinical work; be that as a co-construction, or as shared play between therapist and patients. The book provides insight through dreams to understanding mental functions in all clinical situations and across all conditions.

Single-Case Research: The German Specimen Case Amalia X

In a pivotal review of the problem of psychoanalytic treatment research some 40 years ago, Wallerstein and Sampson [1] enthusiastically recommended performing systematic single-case studies to enhance the field. Three decades later, Wallerstein [2] concluded: “that we are without warrant… to claim the greater heuristic usefulness or validity of anyone of our general theories over the others, other than by the indoctrination and allegiances built into us by the happenstance of our individual trainings, our differing personal dispositions and the explanatory predilections then carried over into our consulting rooms” (p. 1,251). In the same vein, Gabbard and Westen [3] urge that “we attempt to move from arguing about the therapeutic action of psychoanalysis to demonstrating and refining it” (p. 338). The best possibility for resolving these differences and for developing some consensus about the fundamental tenets of psychoanalysis rests on empirical research generating relevant data that can provide a basis for consensual agreement about fundamental psychoanalytic principles [4].

Zur Stellung der Krankengeschichte in der klinisch-psychoanalytischen Forschung

Die Diskussion uber die Psychoanalyse als wissenschaft liche Disziplin hat in den letzten Jahren in der ganzen Welt eine grose Intensivierung erfahren. Je deutlicher im Allgemeinen Bewusstsein die Tatsache wird, dass die Psychoanalyse als psychologisches System einen grosen Einfluss auf die psychosoziale Profession wie auch auf die zeitgenossische Kultur ausgeubt hat und noch weiter ausuben wird, desto mehr fallt der Umstand auf, dass auch nach uber 100 Jahren seit der Entstehung dieses theoretischen und praktischen Systems fundamentale Konzepte noch kontrovers beurteilt werden (Grunbaum 1998). Es durft e jedoch nicht ubertrieben sein, Freuds Versuch, die neurotischen Symptome prinzipiell anders zu erklaren als seine Zeitgenossen, als wissenschaft liche Revolution zu bezeichnen. Vor Freuds Versuchen betrachtete die Psychiatrie hysterische Symptome als Ergebnis einer degenerierten Konstitution, als Folge einer somatischen Anlage. Freuds entscheidender Beitrag zur Entwicklung der psychologischen Forschung bestand in der Ausarbeitung zweier Annahmen: Hysterische Symptome seien primar als psychische Phanomene unter besonderer Berucksichtung unbewusster Prozesse, und als sinnvolle seelische Gebilde zu betrachten.

Amalie X — ein deutscher Musterfall (Ebene I und Ebene II)

Beginnen wir mit der simplen Frage: warum brauchen wir Musterfalle? Psychoanalytiker erinnern sich unmittelbar, dass Freud vom Traummuster der Psychoanalyse gesprochen hat (1900) und Erikson (1954) diesen Irma-Traum als Beispiel gebendes Exemplar erneut durchgearbeitet hat.

From a Psychoanalytic Narrative Case Study to Quantitative Single-Case Research

Narrative case studies concerning the psychoanalytic process date back more than a century; Breuer and Freud were the pioneers of this research path. A great shift in methodology occurred after the development of computers that could work with both text and numbers. On the one hand, it became possible to store detailed, verbatim protocols of therapy sessions. On the other hand, it was possible to analyze derived quantitative data by using sophisticated statistical procedures. This is exemplified in three different methods that analyze different psychoanalytical cases. We conclude by mentioning that research on the psychoanalytic process has to start with clinical experience, which can be used when introducing new observational tools to check for the appropriateness of each tool. This is made possible by the synergetic work of people and processes that were mentioned above.

Neural Correlates of Emotion, Cognition, and Attachment in Borderline Personality Disorder and Its Clinical Implications

Borderline personality disorder (BPD) is a heterogeneous constellation of symptoms characterized by severe and persistent problems across interpersonal, cognitive, behavioral, and emotional domains of functioning [1, 2]. Diagnostic symptoms of BPD include: (1) frantic efforts to avoid abandonment, (2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, (3) markedly and persistently unstable self-image or sense of self, (4) chronic feelings of emptiness, (5) transient, stress-related paranoid ideation or severe dissociative symptoms, (6) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior, (7) impulsivity in at least two areas that are potentially self-damaging, (8) affective instability due to a marked reactivity of mood, and (9) inappropriate, intense anger, or difficulty controlling anger. These criteria are according to the DSM-IV, published in 2000 by the APA.