Johannes Kaufhold

The importance of reflective functioning to the diagnosis of psychic structure

OBJECTIVE This pilot study examines the connection between the concept of Fonagy and Targets reflective functioning and the structure axis of operationalized psychodynamic diagnostics (OPD) and assesses the potential of both scales to predict therapy success. METHOD In the study, 24 (female) patients of the psychotherapy ward of the Frankfurt University Hospital for psychosomatic medicine and psychotherapy aged 18 to 55 were assessed on the basis of a 90-minute, semi-structured interview with regard to their capability for reflective functioning as well as with regard to their structural level according to OPD. In addition, the SCL-90-R was administered at the beginning and end of the 3-month in-patient therapy. RESULTS A significant correlation was found between reflective functioning and the structure axis of OPD. Reflective functioning also predicted improvement in overall mental condition through a 3-month in-patient therapy. This remained significant even when the influence of the overall assessment of structure according to OPD was removed. CONCLUSIONS The independence of the concept of reflective functioning (RF) and its implications for the clinical stance are discussed.

Object Relations and Interpersonal Problems in Sexually Abused Female Patients: An Empirical Study With the SCORS and the IIP

In this study, we examined how retrospective reports of experiencing traumatic sexual abuse in childhood relates to both the development of self-representations and object representations and the occurrence of interpersonal problems. A total of 30 psychosomatic female patients who reported sexual abuse in childhood were compared with a corresponding number of eating-disordered patients and a nonclinical control group. The object relations technique (ORT; Phillipson, 1955), evaluated using the Social Cognition and Object Relations Scale (SCORS; Westen, 1985, 1991b), and the Inventory of Interpersonal Problems (Horowitz, Rosenberg, Baer, & Ureno, 1988) were used to measure the groups. The patients reporting sexual abuse achieved significantly lower scores in the cognitive scales of the SCORS; in the affective scales, they differed from the control group but not from the patients with an eating disorder. Concerning interpersonal problems, the patients reporting childhood sexual abuse reported interpersonal conflicts more frequently. The results of the study support the influence of traumatic sexual abuse on the formation of self-representations and object representations and on the occurrence of interpersonal conflicts.

Narcissistic Regulation of the Self and Interpersonal Problems in Depersonalized Patients

Background: Psychoanalytical theories coincide in understanding depersonalization (DP) as a disorder of narcissistic self-regulation. DP is described as an ego defense against overwhelming shame resulting in a splitting of an observing ego detached from the experiencing self. In contrast to a behavioral-cognitive theory on DP, which suggests that the catastrophic appraisal of normal transient DP maintains the disorder, psychodynamic approaches stress that DP is an important defensive function for the individual. We examine this psychodynamic aspect more closely as it relates to narcissistic self-regulation and interpersonal behavior in depersonalized patients. Sampling and Methods: Thirty-five patients with pathological DP are compared with 28 patient controls concerning their narcissistic self-regulation and interpersonal behavior. For the assessment, we used the German Narcissism Inventory and the Inventory of Interpersonal Problems. The two groups were controlled for sociodemographic data, comorbidity with a personality disorder, and the General Severity Index of the Symptom Check List-90-R. Results: Bonferroni-corrected group comparison showed that the depersonalized patients are characterized by perceiving themselves as helpless, hopeless, socially isolated and worthless, perceiving others as bad and disappointing, and that they avoid interpersonal relations and reality significantly more than other patients with equal symptom severity. Conclusions: Treatment approaches on DP should take the issue of low self-esteem, pervasive shame and the related defensive social avoidance into account. Further empirical research on psychodynamic concepts of DP is warranted also for the sake of linking modern neurobiological findings with clinical experience.

Depersonalization and social anxiety

Although the literature on depersonalization (DP) indicates links between DP and anxiety disorders, there has been no systematic investigation of the association of DP with social anxiety. The present study explores a hypothesized connection between DP and social anxiety by using correlative and regression analyses in a sample of 116 psychotherapy inpatients, 54 outpatients with epilepsy, and 31 nonpatients. Corresponding to our hypothesis, we found a connection of medium to large effect size between DP and social fears exceeding the impact of general psychopathologic symptom severity both for the psychotherapy patients and the nonpatients. The association of social anxiety with DP merits further research. A general consideration of DP in clinical and neurobiological trials on anxiety disorders like social phobia is warranted.

Childhood trauma from a patient and a psychoanalyst perspective: linking chronic depression to relational multiple trauma

The relationship between multiple childhood trauma, as well as adversity, and chronic depression has been reported repeatedly. However, there is a lack of clinical differentiations of these findings. We complemented patient self-ratings, using the Childhood Trauma Questionnaire (CTQ), with psychoanalysts’ perspectives in order to provide finer grained clinical differentiations of the trauma behind chronic depression. These differentiations connect the trauma scales with early relational experiences. We developed a bespoke instrument derived from psychoanalytic trauma concepts. A subsample of 52 cases of chronically depressed patients alongside their 24 psychoanalysts was taken from the LAC depression study, in order to complement patient and psychoanalyst ratings. Our results confirm the connection between multiple childhood trauma and chronic depression. Besides relational trauma, the psychoanalysts’ perspective found separation trauma and transgenerational transmission of trauma to be significant. These traumatic relationships seem to precede and accompany adverse life events and/or traumatic experiences. They may even prevent adequate coping and/or processing of such experiences. Patient interview material from study intake and five-year follow-up further provides an insight into the changes the trauma narratives undergo throughout time. These changes emerged due to a joint reconstruction of the meaning of traumatic experiences throughout the course of the psychoanalytic process.

The therapeutic relationship as reflected in linguistic interaction: Work on resistance

Abstract Although resistance is a concept that, since Freud, has been regarded as central to the course of the therapeutic relationship, it has been the focus of relatively little empirical research. In this case study, the authors attempt to bring to light the resistance in the course of a psychoanalytically oriented short-term therapy in formal-linguistic terms as well as in the interactive behavior between therapist and patient and to examine the connections between them. The interactive behavior is tracked using the Structural Analysis of Social Behavior. Resistance as manifested in speech is analyzed using several Formal Psycholinguistic Text Analysis (Overbeck, Müller, Jordan, & Grabhorn, 1996) items: speech activity, style of conversation, pauses, acknowledgment tokens, interrupting, overlapping, various personal pronouns, and use of passive voice. Various parameters in both methodological approaches provide evidence of a pronounced resistance behavior at the beginning of therapy. Diminished resistance and the establishment of a working alliance characterize the middle phase of therapy. In the last therapy segment, there are signs of beginning autonomy development. Because of the convergence of the measurements, the results of this study can largely be considered reliable.

Differentiation in Self- and Object-Perception as a Goal in Psychodynamic Short-Term Therapy: A Cluster-Analytical Evaluation

In this paper, the question is examined as to how object relationship patterns can be adequately recorded and evaluated in the therapy process. Based on the consideration that the differentiation of object perception and its relationship patterns is a goal of psychodynamic therapy, a method for measuring repetitive interaction patterns is presented as an indicator of change. An approach based on cluster analysis offers the opportunity to record and evaluate the entire structure of a therapy without taking individual qualitative features out of their context to one another and to the specific object. The therapy records of a 3-month inpatient psychotherapy were evaluated with a content analysis, using the Structural Analysis of Social Behavior (SASB). The results of the cluster-analytical evaluation of this content analysis provide convincing evidence that the structure of the described object relationships can be recorded, and their transformation processes can be demonstrated with this process in the cou...