[Inpatient Psychodynamic Therapy for Children and Adolescents with Complex ADHD: Results of a Naturalistic Clinical Trial]. / Stationäre psychodynamische Therapie bei Kindern und Jugendlichen mit komplexer ADHS: Ergebnisse einer naturalistischen klinischen Studie.

The Attention deficit/hyperactivity disorder (ADHD) is a common mental disorder in childhood and adolescence. However, it is a very heterogeneous disorder with subgroups of patients with mild symptoms and others with severe and complex impairments. Patients suffering from complex ADHD are usually characterized by multiple developmental disorders and impaired personality development. Due to the multimodal origin of the disorder, multimodal treatment approaches aimed at reducing the various deficits are usually indicated. The current study evaluated a multimodal inpatient psychodynamic treatment (PDT) for children and adolescents suffering from ADHD. 47 patients (age 9-17 years) were included in the study. Next to complex impairments (comorbid mental disorders, deficits regarding psychic structure, learning disorders and sensorimotor integration disorders), a high number of adverse childhood experiences (M = 11.71) was particularly remarkable in the sample. The PDT led to significant improvements regarding ADHD symptoms and general level of functioning. However, first symptom improvements were already evident at the end of the waiting period. For ten patients who participated in the follow-up assessment effects remained stable six months after treatment. Due to the high drop-out rate, however, the study results have to be regarded as preliminary.

[Evidence for Psychodynamic Therapy for Children and Adolescents]. / Evidenz für psychoanalytisch begründete Verfahren für Kinder und Jugendliche.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

[Changes in OPD-CA Axis Structure During Inpatient Psychodynamic Treatment of Adolescents Suffering from Comorbid Disorders of Conduct and Emotions]. / Veränderungen der psychischen Struktur im Verlauf der stationären psychodynamischen Behandlung von jugendlichen Patienten mit einer kombinierten Störung des Sozialverhaltens und der Emotionen.

In a randomized controlled clinical trial (RCT) we evaluated an inpatient psychodynamic treatment for adolescents suffering from mixed disorders of conduct and emotions. The sample consisted of severely impaired adolescents with remarkable deficits regarding psychic structure. The current study wanted to examine if the manualized treatment did not only reduce symptoms but also enhance the structural level of the patients. The axis structure of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) was used to assess the structural level of N = 46 adolescent inpatients. To examine differences between the patients' structural level at the beginning and at the end of inpatient treatment we conducted a repeated measures ANOVA. The overall score as well as the three subscores of the axis structure improved significantly during inpatient treatment. The corresponding effect sizes were large (η(2) = .29 to .47). The inpatient psychodynamic treatment led to significant improvements regarding symptomatology as well as psychic structure. However, further studies with larger sample size and control group data should be conducted to confirm these results.

IDENTITY FORMATION DIFFICULTIES IN IMMIGRANT ADOLESCENTS: THREE CASES FROM GERMANY.

Adolescence is a period of instability caused by biological changes and restructuring of the personality. An immigration background renders the process of identity formation even more difficult or fragile, with an additional burden coming from persecution and harassment. Three case studies of mentally disturbed adolescents with different immigration backgrounds illustrate the problems in diagnosis and psychotherapy. All three cases share a common feature--the particular influence of the native country on the psychic disorder of the adolescent, be it a suitable target of narcissistic self-aggrandizement, a reactivated metaphor of the past or a deposited conflict. I point out and discuss the danger of diagnostic colonization and activation of perpetrator-victim constellations--such as the Nazi past in the present. Offering a transcultural transitional space as a container yields a therapeutic approach to the different worlds of these borderland adolescents.

Early Intervention for Borderline Personality Disorder: Psychodynamic Therapy in Adolescents.

OBJECTIVES: Borderline personality disorder (BPD) should be understood as a disorder of development (Streeck-Fischer 2008, 2013) that has its first manifestation in late childhood and adolescence. There are only few treatment studies of adolescents meeting the diagnostic criteria of borderline personality disorder, although early interventions for these patients are urgently needed (see Chanen & McCutcheon 2013). We examined the effectiveness of an inpatient psychodynamic therapy (PDT). METHODS: Twenty-eight adolescents fulfilling the DSM-IV diagnostic criteria of borderline personality disorder were treated with psychodynamic therapy. The mean duration of treatment was 29.87 weeks (SD = 15.88). Outcomes were remission rates, GAF, GSI, SDQ, IIP and BPI scores. Assessments were made at admission and after treatment. Pre-post comparisons and comparisons with normative data were conducted. RESULTS: At the end of treatment 39.29% of the patients were remitted. We found significant improvements for the GAF, GSI, SDQ, IIP (all p0.001) and the BPI (p = 0.006). CONCLUSIONS: These clinically relevant improvements demonstrate the effectiveness of psychodynamic therapy in adolescents with borderline personality disorder and stress the usefulness of an early intervention for these patients.

Academic model of trauma healing in post-war societies.

OBJECTIVE: The aim of this paper is to examine the implications for healing in a contemporary Balkan post-war context, and to provide a bridge-building model of trauma transformation, reconciliation and recovery through academic reconstruction and cross-border dialogue. Post-war societies are marked by the effects of massive, large group traumatization, and if not properly dealt with, long-term rehabilitation and social recovery cannot be expected. Unprocessed cumulative trauma that has become deeply embedded in the collective memory of the Balkan peoples over centuries, "chosen trauma", its trans-generational transmission and periodical reactivations across the Balkan have often been addressed in recent literature, in ethno-psychology, psychoanalysis, psychiatry, sociology and anthropology. In order to deepen our understanding of the roots of collective (social) trauma and the specific traumatic experiences of different groups, and to offer different perspectives and information on how trauma can be dealt with, the "Trauma Trust Memory" multinational interdisciplinary research network is being established, and a groundbreaking workshop was held in May 2013 in Tuzla, Bosnia-Herzegovina. CONCLUSION: The Tuzla Workshop showed that the active participation of affected groups in adequate coping with the past is required for post-conflict reconstruction, trauma healing and peacebuilding in the long run.

[Developmental trauma--differences between the course of inpatient treatment in adolescent patients with or without trauma history]. / Traumatisierungen in der Entwicklung--unterschiedliche Verläufe stationärer Psychotherapie bei jugendlichen Patienten mit und ohne Traumatisierung.

SUMMARY OBJECTIVE: Aim of the study was to examine differences between the course of inpatient treatment in adolescents with different extents of trauma history. METHODS: Using multilevel analysis, we investigated the differences between the course of inpatient treatment in adolescents without trauma history, with emotional trauma and complex trauma. RESULTS: Regarding the GSI of the SCL-90-R, patients with trauma history showed significantly more symptom reduction than patients without trauma history. In terms of interpersonal problems (IIP) especially adolescents with emotional trauma seemed to benefit. CONCLUSIONS: Especially patients with trauma history benefited from the examined inpatient treatment concept. However, our results also show that the complex traumatized patients required longer treatment duration since they benefited particularly in the last phase of inpatient treatment.

[Inter-rater reliability and construct validity of the OPD-CA axis structure: first study results regarding the integration of OPD-CA into clinical practice]. / Interrater-reliabilität und Konstruktvalidität der OPD-KJ-Achse Struktur--Erste Forschungsergebnisse zum Einsatz der OPD-KJ im Rahmen der klinischen Routine.

The axis structure of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) has proven to be a reliable and valid diagnostic tool under research conditions. However, corresponding data regarding the integration of OPD-CA axis structure into clinical practice is still lacking. Hence, this aspect was examined as part of a randomized controlled clinical trial realized at Asklepios Fachklinikum Tiefenbrunn. Here, the OPD-CA axis structure has been applied to assess the structural level of 42 adolescent patients (15-19 years). In contrast to previous studies, the assessment was not carried out by independent raters using a videotaped OPD-CA interview, but the rating was part of clinical routine procedures. Also under these conditions, inter-rater reliability was high, in particular regarding the four subscales of the OPD-CA axis structure. With respect to construct validity, the results of our study supported a two-factor solution, which is in accordance with the findings of two previous works. One factor corresponded to the dimension "self-regulation" while the other factor included both the dimension "self-perception and object perception" as well as the dimension "communication skills". Implications of the findings for research and practice are discussed.

[Containing, right hemisphere: projective identification as an interpersonal mechanism, the ability for affect regulation]. / Rechtshemisphärisch aushalten statt linkshemisphärisch deuten--Projektive Identifizierung als interpersonaler Mechanismus zur Entwicklung der Fähigkeit zur Affektregulation.

The capacity of affect regulation develops with priority in reciprocal, non-verbal communication processes between the early caregiver and the baby. In this process, the projective identification plays the role of crucial means of communication. Processes of projective identification which emerge in therapeutic and educational interactions can be understood as such an early form of communication which contributes to the afterward-ripening of the capacity of affect regulation. Before the background of recent neuro-psychological findings it becomes clear, why the reciprocal and non-verbal communication between the early caregiver and infant as well as between the therapist and the patient is of such fundamental importance for the structural (re-) maturation of the right cerebral hemisphere, as well as for the connections between the left and right hemisphere. In case the projective identification persists as a defensive strategy in dealing with other people, pathological interaction circles can develop which can be overcome only when, for example, the other person assumes the role of the "regulating other".

[Psychoanalytic-interactional psychotherapy of severely disturbed adolescents]. / Psychoanalytisch-interaktionelle Psychotherapie von Jugendlichen mit strukturellen Störungen.

Due to specific developmental conditions of adolescence like deficient self reflective capacities or reduced potential to articulate, the psychotherapy of adolescents is faced with special problems. In adolescents with severe Ego-structural disorders like Borderline (Development) Disorders these problems are increased exponentially. Patients replicate their negative and often traumatic relational experiences in everyday life as well as in therapy. The therapeutic treatment of relational entanglements often results in malignant repetitions. Here the Psychoanalytic-interactional Method (PiM) is suitable as intervention where the therapist approaches the patient as a person who influences the development positively and strives for Ego-structural advancement within the therapeutic relation. The Psychoanalytic-interactional Method allows for the adolescence-specific conditions of limited mentalization and particulary for the problem of Ego-structural disorders in adolescence. The method is demonstrated by treatment sequences of the therapy of a juvenile female patient with Borderline (Development) Disorder.

[Effects of traumatic stress]. / Folgen von Gewalterfahrungen.

The diagnosis PTSD does not adequately describe the impact of exposure to childhood trauma of the developing child. The objective of the study was to examine the prevalence of different interpersonal trauma types and to describe the long-term effects of maltreatment and neglect in a clinical sample of 34 adolescents. The majority (62%) of the sample was exposed to two different types of trauma during childhood. Emotional abuse and emotional neglect have been the most common trauma types (59%; 53%). 71% of the traumatized adolescents did not meet the criteria for PTSD. The most common diagnosis in the sample was Borderline Personality Disorder. All average scores at SCL-90-Symptom-Scale were clinical significant. Half of the sample reported suicide attempts and self destructive behavior. One third reported substance abuse and aggressive behavior against others respectively. None of the traumatized adolescents had a positive Self-concept. Altogether the results show that abused children and adolescents have a range of psychological sequelae that are not captured in the PTSD diagnostic criteria. Therefore the results support the necessity for a new and more precise diagnosis for chronically traumatized children and adolescents.

[The borderline personality (development) disorder during adolescence. Psychological assessment, treatment prerequisites, framework design, treatment phases]. / Die Borderline-Persönlichkeit(entwicklung)sstörung im Jugendalter. Diagnostik, Behandlungsvoraussetzungen, Gestaltung des Rahmens, Phasen der Behandlung.

Following a critical discussion on the term Borderline Personality Disorder during adolescence, assessment criteria are compiled that illustrate this disorder. In an overview of the psychodynamic literature it is clearly stated that already in the 1960s Borderline Disorders were described in childhood and adolescence without any development of valid criteria for these since then. Except for numerous case studies of these Borderline Disorders, there has been no research undertaken within psychodynamic psychotherapy on this disorder during childhood and adolescence to date. Specific disorder-related therapy approaches, whose effectiveness have been confirmed in therapy studies on Borderline Disorders in adults, have so far not been adapted to treating children and adolescents that have Borderline Disorders. These are portrayed as well as the treatment prerequisites and framework conditions that allow for a disorder-specific development oriented interactional psychotherapy of adolescents with Borderline Disorders. The interactional psychotherapy in its adolescence-adapted form is only gone into on the side. In conclusion there is an overview given of the various phases of the treatment.

[The relationship between the experience and success of inpatient psychotherapy treatment among children and adolescents]. / Der Zusammenhang zwischen Behandlungserleben und Behandlungserfolg bei der stationären Psychotherapie mit Kindern und Jugendlichen.

OBJECTIVE: Examined here is the degree to which particular aspects of treatment experience in the inpatient psychotherapy of children and adolescents correlate significantly with the actual success of treatment. METHODOLOGY: Data of 95 patients hospitalised between 2002 and 2006 in the Department of Child and Adolescent Clinical Psychotherapy at the NLKH Tiefenbrunn were analysed. To assess the relationships multiple regression analyses were carried out, whereby the dependent variable was on the one hand, the retrospective estimate of treatment success by the patients by means of the Questionnaire to Assess Treatment (Fragebögen zur Beurteilung der Behandlung/FBB), and on the other, the difference on the General-Severity-Index (GSI) of the Symptom Checklist 90-R (SCL-90-R) between the time of admission and release from hospital. Patients' experience of treatment was assessed by MEANS OF THE WARD EXPERIENCE QUESTIONNAIRE (STATIONSERFAHRUNGSBOGEN/SEB) BY SAMMET AND SCHAUENBURG (1999). RESULTS: The direct measurement of success (FBB-P-Scale Success of Treatment) correlated highly significantly with the SEB scales Expectation of Self-Efficacy, Individual Therapeutic Relationship, Atmosphere among Co-Patients, Group Cohesion, Relationship to Therapy Team, Intensity of Treatment, and with the Difference in the Estimate of Individual Therapeutic Relationship between Patient and Therapist. The indirect measure of success also correlated highly significantly with the Atmosphere among Co-Patients and the perceived Expectation of Self-Efficacy. The relationship between the Relationship to Therapy Team was also significant at the 5% level. In the subsequent regression analyses the SEB scales explained 51% of the variance between the retrospective estimates of success (FBB). The subscales Relationship to Therapy Team (beta= 0.47, t(df) = 4.15(84), p < .01) and Expectation of Self-Efficacy (beta = 0.32, t(df) = 3.30(84), p < .01) proved to be significant predictors of treatment success. Using the difference in the GSI values on the SCL-90-R as the dependent variable, the SEB scales explained 23% of the variance in treatment success, whereby Atmosphere among Co-Patients was the only significant individual subscale (beta = 0.35, t(df) = 2.63(84), p < .01). CONCLUSIONS: The success of inpatient psychotherapy treatment among children and adolescents in the sample studied correlated significantly with particular aspects of treatment experience. In this connection, the reduction in symptoms apparent in the comparison of values at admission with those at release seems to be primarily related to the Atmosphere among Co-Patients, whereas the success of treatment as estimated directly by the patients correlates more strongly with Relationship to Therapy Team and Expectation of Self-Efficacy. Due to the correlative design of the study, the issue of causality could not be completely resolved.

["Better to be restless than locked up in a deep hole!" Understanding and therapy of attention deficit and hyperactivity disorder from a psychodynamic viewpoint]. / "Lieber unruhig sein als in einem tiefen dunklen Loch eingesperrt". Zum Verständnis und zur Therapie der Aufmerksamkeitsdefizit- und Hyperaktivitätsstörung aus psychodynamischer Sicht.

Psychodynamic models will be presented after a critical discussion of the biomedical-psychiatric model of attention deficit and hyperactivity disorder (dimensional diagnostics, genetic disorder, dopamine deficiency, neuronal developmental disorder). Research findings on early mother-child interactions refer to specific psychosocial developmental conditions amongst children who develop ADHD. Factors which lead to gene expression can be traced here. A psychodynamic-oriented developmental psychotherapy which centres on regulatory procedures, de-centration, mentalisation, de-somatisation and symbolisation of treated notifications is helpful, particularly amongst children with complex disorders. The underlying conflicts and dealing with them are thus elucidated in the presentation of a treatment.

['Trauma und entwicklung' folgen von traumatisierung in kindheit und jugend.].

Cumulative and complex traumatization during development are often the result of chronic abuse such as neglect, violence and/or sexual abuse. Chronic abuse leads to manifold disorders which may be accompanied by a chronic posttraumatic stress reaction as well as developmental disorders. Destructive behavior is one of the results. These disorders are seen in the development of emotional disturbances, of stress regulation, of memory and the activation or down regulation of certain areas of the brain and their neuronal connections.