The randomized clinical trial results of the anxiety treatment in patients with somatoform dysfunction and neurotic disorders.

The existing treatments for somatoform dysfunction (SfD), reaction to severe stress (RSS), and adjustment disorders (AjD) are insufficiently effective and safe. Anxiolytic drug Tenoten proved effective in clinical trials (CT). The aim of this multicenter double-blind placebo-controlled randomized CT was to investigate the safety and efficacy of Tenoten in the treatment of anxiety in adults with SfD, RSS, AjD and other neurotic disorders (oNDs). 390 adult patients with SfD, RSS and AjD or oNDs with the Hospital Anxiety and Depression scale-anxiety (HADS-A) score ≥ 11 were randomized into 4 groups (n = 127 in Tenoten group 1 (4 tablets/day); n = 131 in Tenoten group 3 (8 tablets/day), n = 132 in combined Placebo group 2 + 4). The changes from baseline in the mean Hamilton Anxiety Rating Scale (HAM-A) score in groups 1 and 3 after 12 weeks were the primary outcome. The decrease of the HAM-A score from 18.81 ± 5.81 to 7.26 ± 4.63 (in group 1) and from 18.38 ± 4.3 to 6.40 ± 4.02 (in group 3) was observed post-treatment (pgroup 1/placebo = 0.0055, pgroup 3/placebo < 0.0001). Overall, 46 adverse events (28 in the Tenoten groups and 18 in the Placebo) were reported without any difference between the study groups. Tenoten performed significantly more effective than placebo in the anxiety treatment of adults with SfD, RSS, AjD and oNDs (clinicaltrials.gov NCT03036293).

Neurotic personality traits and associated dysfunctional attitudes as factors predisposing patients to suicidal ideations at the end of intensive psychotherapy. / Nerwicowe cechy osobowosci i zwiazane z nimi dysfunkcjonalne postawy pacjentów jako czynniki predysponujace do wystapienia mysli samobójczych pod koniec intensywnej psychoterapii.

OBJECTIVES: To determine the relationshipsbetween personality traits typical for neurotic disorders and dysfunctional attitudes declared by patients without suicidal ideations (SI) prior to treatment and SI at the end of an intensive psychotherapy with a predominant psychodynamic approach in the day hospital for neurotic, behavioral, or personality disorders. MATERIAL AND METHOD: KO "O" Symptom Checklist for assessing SI, Neurotic Personality Questionnaire KON-2006 for evaluation of neurotic personality characteristics and patients' attitudes, and a Life Questionnaire, all completed by a group of 680 patients of a day psychotherapy ward, treated for the first time. Statistical analysis encompassed 466 non-SI patients, 4% of whom had SI at the end of treatment. RESULTS: A number of attitudes have been identified in patients who were significantly predisposed to SI at the end of intensive psychotherapy: physical aggression towards relatives (p < 0.001), grandiose fantasies (p = 0.043), resignation tendencies (p = 0.022), resignation feeling associated with the experience of loss of life opportunities (p = 0.037), and being guided mainly by intuition (p = 0.035). It was also observed that declaring certain attitudes was significantly associated with less than average chance of SI at the end of treatment. CONCLUSIONS: In patients who declared these attitudes, there was a higher risk of SI at the end of the psychotherapy cycle than in the remaining patients (10-30% vs. 4%), which indicates the presence of specific dysfunctions of personality, in the case of which intensive psychotherapeutic work requires particular caution -it can trigger emotional stress leading to SI instances. It can be assumed that SI are the result of the reconstruction of defense mechanisms while working on insight, confrontation with the causes and consequences of the patients' own physical aggression towards the loved ones, the realization of the size of their grandiose thinking and the insight into its function, and the insight into the causes of resignation attitudes.

The Marriage and Divorce of Little Willy: Psychoanalysis and Addiction.

Psychoanalysis can't treat addicts; Alcoholics Anonymous can't treat neurotics. Contrasting the two proffered therapeutics, they are obviously opposed as a rich discourse and a banality of letters or as individual and group therapy. And yet they emerged as one confused tangle in the cocaine addiction of Sigmund Freud. Finally, both have been condemned as bourgeois constructions, as the discourse of capitalism.

Psychological Therapy in Secondary Mental Health Care: Access and Outcomes by Ethnic Group.

OBJECTIVE: To explore the differences in access to, and outcomes of, psychological therapy for different ethnic groups across a South London Mental Health Trust. METHOD: This study used Trust data to explore the proportions of ethnic groups accessing psychological therapy as a proportion of all patients supported by the Trust, as well as their outcomes within broad diagnostic clusters. RESULTS: Compared to proportions in the local population, there were significantly more White/White British patients and significantly fewer patients from 'other ethnic groups' in the Trust (p < .05). There was also significantly greater proportion of Black/Black British patients with schizophrenia diagnoses compared to the proportion of Black/Black British people in the local population (p < .001). Of those accessing psychological therapy, there were significantly more White/White British and 'other ethnic group' patients and significantly fewer Black/Black British patients (p < .05). For schizophrenia diagnoses, significantly fewer Black/Black British and 'other ethnic group' patients were accessing psychological therapy (p < .05); however for behavioural and emotional disorders, there were significantly higher proportions of 'other ethnic group' and White/White British patients. Outcomes varied by diagnosis; Black/Black British patients experienced significantly higher distress scores at the beginning of therapy for depression and neurotic diagnoses (p < .05), with the latter persisting at the end of treatment. CONCLUSIONS: Across the Trust, there were significant differences in the proportion of ethnic groups in accessing psychological therapy, as well as in outcomes. More research is needed to understand the factors that may underlie these disparities.

[A comparative study of the efficacy of personality-oriented (reconstructive) and cognitive-behavioral psychotherapy in neurotic anxiety disorders with insomnia]. / Sravnitel'noe issledovanie éffektivnosti lichnostno-orientirovannoi (rekonstruktivnoi) i kognitivno-povedencheskoi psikhoterapii pri trevozhnykh rasstroistvakh nevroticheskogo urovnia s insomniei.

AIM: To study personality-oriented (reconstructive) and cognitive-behavioral psychotherapy in patients with neurotic anxiety disorders with insomnia. MATERIAL AND METHODS: Ninety-eight patients with disorders coded in ICD-10 as F 40.0; F40.1; F41.0; F41.1; F48.0 were studied. Clinical, psychometric, experimental-psychological methods and polysomnography were used. RESULTS AND CONCLUSION: Phenomenological insomnia types characteristic of neurotic anxiety disorders and their relationship with types of intrapersonal conflicts are described. A quantitative analysis of the dynamics of symptomatic complains, anxiety level, and insomnia is presented. The efficacy of the both psychotherapeutic treatments is shown. However the personality oriented (reconstructive) psychotherapy has demonstrated better and more stable results. This can be explained first of all by its pathogenesis-oriented nature and involvement of the cognitive emotional and behavioral spheres as well as the resolution of the intrapersonal conflicts, which are the cornerstone of neurotic disorders.

Changes in ego strength in patients with neurotic and personality disorders treated with a short-term comprehensive psychodynamic psychotherapy. / Zmiany w zakresie sily ego u pacjentów z zaburzeniami nerwicowymi i zaburzeniami osobowosci leczonych krótkoterminowa kompleksowa psychoterapia psychodynamiczna.

OBJECTIVES: Analysis of changes in ego strength in the course of group psychotherapy in patients treated with neurotic and selected personality disorders (F40-F61, ICD-10). METHODS: 82 patients (61 women and 21 men) participated in the study. They underwent intensive short-term group psychotherapy treatment in a day hospital for neurotic and behavioural disorders. The assessment of the patients' personality functioning was carried out at the onset and the end of the psychotherapy. The assessment was reported as a value on the ego strength scale by means of the MMPI-2 questionnaire. RESULTS: The comparative analysis with the use of the t-Student test for related measurements, which was carried out for the measurement of ego strength values at the onset and the end of the therapy, demonstrated a statistically significant positive change both for the entire examined group and the groups which considered the gender and diagnosis distribution. CONCLUSIONS: Short-term intensive comprehensive group psychotherapy with elements of individual psychotherapy results in obtaining the desired changes in the personality functioning manifested through the increase in ego strength.

Increase in the number of admissions to psychiatric hospitals immediately after the Great East Japan Earthquake.

INTRODUCTION: Major natural disasters have a significant impact on the mental health of survivors in affected communities. Although it has been speculated that the number of survivors requiring admission to psychiatric hospital increases immediately after a major disaster, few studies have examined the issue. METHODS: On March 11, 2011, the Great East Japan Earthquake and subsequent tsunami devastated the relatively isolated city of Kesennuma. We therefore compared the weekly number of patients admitted to 2 psychiatric hospitals in Kesennuma in the 4 weeks immediately after the earthquake with those in the 4 weeks immediately preceding the earthquake. We also made comparisons between this 8-week period and the corresponding 8-week periods in 2009, 2010, and 2012. RESULTS: The number of patients admitted to the 2 psychiatric hospitals increased in 4 weeks after the disaster in 2011, with a weekly median (range) of 13 (9-16), compared with 6 (5-9) in the preceding 4 weeks in 2011. The corresponding figures were 5.5 (2-10) in 2009, 6.5 (5-9) in 2010, and 4 (3-7) in 2012 (P = .01, H = 13.05). By diagnostic category, admissions for schizophrenia spectrum disorder and neurotic stress-related disorder increased significantly following the disaster. DISCUSSION: Demands for inpatient psychiatric treatment increased immediately after the Great East Japan Earthquake. Government officials and mental health professionals must strengthen support for survivors with mental illness, especially those with schizophrenia spectrum disorder. This should include support for mental health authorities and medical staff in the affected community.

[Gelototherapy in the practice of the psychotherapist]. / Gelototerapiia v praktike psikhoterapevta.

AIM: To evaluate the efficacy of gelototherapy (laughter therapy) in the complex treatment of borderline (neurotic) disorders. MATERIAL AND METHODS: One hundred and ten patients with the ICD-10 diagnosis of neurotic disorder were studied. Of them, 70 received gelototherapy, along with pharmacotherapy; the comparison group of included 40 patients. Common clinical methods and psychiatric evaluation, which was supplemented by two questionnaires for quantitative assessment of symptom severity, were used. RESULTS AND CONCLUSION: A positive (highly reliable for a number of indicators) effect of gelototherapy on the mental state of patients was demonstrated. The results suggest that gelototherapy can be used within the framework of psychotherapy of borderline mental disorders, including in combination with pharmacotherapy.

Elaboración [Verarbeitung] y reelaboración [Durcharbeiten] en el análisis de los pacientes no neuróticos / Working-over [Verarbeitung] and working through [Durcharbeiten] in the analysis of non-neurotic patients / Elaboration [Verarbeitung] et perlaboration [Ducharbeiten] dans l'analyse de patients non névrotiques

El artículo parte del concepto de elaboración psíquica [Verarbeitung] en la obra freudiana para luego adentrarse en la reelaboración o per-elaboración [ Durcharbeiten ], de esencial importancia dentro del proceso psicoanalítico y concebida como superación de las distintas formas de resistencia del analizando. Habiendo sido ya motivo de distintos desarrollos en lo que atañe al análisis de neuróticos, la alta incidencia de los trastornos no neuróticos hace ahora necesario preguntarnos en qué consiste la reelaboración en dichos casos. Para ello se recurre al modelo de las resistencias descrito por Freud en Inhibición, síntoma y angustia. Entre las provenientes del yo, las de los mecanismos defensivos se caracterizan por el predominio de defensas prerrepresivas. Las resistencias de transferencia proceden de formas primitivas de esta y adoptan diversas modalidades. Las del superyó devienen de la acción de un superyó sádico sobre un yo masoquista y las del ello incluyen la compulsión de repetición «más allá del principio de placer». Estamos ante el análisis del trauma precoz e irrepresentable. Cabe acudir a la noción de Verarbeitung en tanto ligazón [Bindung], intento de ligar la cantidad de energía -liberada por el trauma- con una representación, especialmente a través de las construcciones. Se incluye una viñeta clínica

Departing from the Freudian notion of psychical working-over [Verarbeitung], this article explores working through [Durcharbeiten], conceived as overcoming the analysand's vanous forms of resistance, vital to the psychoanalytic process. Having already prompted various developments in the analysis of neurotics, the high incidence of non-neurotic disorders necessitates a reconsideration of what working through entails in these cases. To do this the author turns to the model of the resistances described by Freud in Inhibition, Symptom and Anxiety. Of the resistances emanating from the ego, those of the defence mechanisms are characterized by the predominance of pre-repressive defences. The transference resistances derive from primitive forms of transference, adopting diverse modalities. The superego resistances stem from the action of a sadistic superego upon a masochistic ego, while those of the id include the compulsion to repeat "beyond the pleasure principle". This is the analysis of early and unrepresentable trauma. The notion of Verarbeitung may be considered a form of binding [Bindung]; the attempt to bind the energy-released by trauma-with a representation, particularly through construction. A clinical vignette is also considered

L'article part du concept d'élaboration psychique [Verarbeitung] dans l' ceuvre freudienne, pour s' aventurer ensuite dans la réélaboration ou perlaboration [Ducharbeiten ], d'importance essentielle dans le processus psychanalytique et conçue comme le surpassement des différentes formes de résistance de l' analysant. Etant donné que par rapport a l' analyse des névrotiques différents développements ont déjà eu lieu, l'incidence élevée de troubles non névrotiques nous oblige maintenant a nous demander en quoi consiste la perlaboration dans ces cas. Pour cela, l'auteur emploie le modele des résistances décrit par Freud dans Inhibition, symptóme et angoisse. Parmis celles qui viennent du moi, celles des mécanismes défensifs se caractérisent par la prédominance de défenses pré-répressives. Les résistances de transfert procedent de formes primitives de celui-ci et empruntent des modalités diverses. Celles du surmoi résultent de l'action d'un surmois adique sur un moi masochique et celles du ça comprennent la compulsion a la répétition «au dela du príncipe de plaisir». Nous sommes face à l' analyse du trauma précoce et irreprésentable. Il est possible de se servir de la notion de Verarbeitung en tant que liaison [Bindung], essai de lier la quantité d' énergie -libérée par le trauma- avec une représentation, spécialement a travers les constructions. L'auteur presente une vignette clinique

[Psychiatric and Somatic Comorbidities of Eating Disorders and Obesity in Female Adolescent and Adult Inpatients]. / Häufigkeit von Komorbiditäten bei der stationären Behandlung von Essstörungen und Adipositas bei Mädchen und jungen Frauen.

Objective The main aim of this study was to determine the prevalence of somatic and psychiatric comorbidities in female inpatients diagnosed with an eating disorder or obesity. Methods Statutory health insurance data (11 - 25 years, N = 1269) was analysed. Results The most frequent comorbidities for both groups were affective, neurotic, stress-related and somatoform as well as personality disorders and diseases of the digestive system. Conclusion Close to half of the patients diagnosed with an eating disorder suffered from psychiatric comorbidities. The majority of obese patients were diagnosed with somatic comorbidities.

Changes in intensity of neurotic symptoms associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders. / Zmiany w nasileniu objawów nerwicowych wiazace sie z redukcja mysli samobójczych u pacjentów poddanych psychoterapii w dziennym oddziale leczenia nerwic i zaburzen behawioralnych.

OBJECTIVES: Analysis of associations between changes in the intensity of neurotic symptoms and reduction of suicidal ideation (SI) or lack of SI reduction, in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital. METHODS: Symptom Checklist KO"O" and Life Inventory completed by 461 women and 219 men treated in the psychotherapeutic day hospital due to neurotic, behavioral or personality disorders between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. RESULTS: The reduction of neurotic symptoms intensity was greater in patients of both genders who improved in terms of SI than in those who did not. This referred to global intensity of neurotic symptoms (OWK coefficient) in both genders (p<0.001), as well as to the majority of the neurotic symptoms subtypes in both genders (p<0.05): Phobic disorders, Other anxiety disorders, Obsessive-compulsive disorders, Conversions and dissociations, Autonomic disorders, Somatization disorders, Neurasthenia, Avoidance and dependence, Sexual dysfunctions, Dysthymia; and in case of women (p<0.05): Hypochondriasis, Depersonalization and derealization, Impulsiveness and histrionism and Non-organic sleep disorders. CONCLUSIONS: The results show effectiveness and comprehensiveness of intensive psychotherapy as a treatment method that leads to improvement in terms of both SI and neurotic symptoms. This suggests that the applied therapy may be effective in preventing suicidality in this group of patients. The observed associations also point in favor of hypothesis on similarities in etiopathogenesis of and partly identical personality-related factors predisposing to SI and neurotic disorders.

Dr. Karol de Beaurain - a psychiatrist's profile. Part 1. / Dr Karol de Beaurain ­ sylwetka psychiatry. Czesc 1.

The paper sets out to recall the profile of Karol de Beaurain, a psychiatrist who belonged to the circle of first Poles who used psychoanalysis in treatment. So far, dr Beaurain has been known from brief references in publications relating to the life and works of Stanislaw Ignacy Witkiewicz (Witkacy) whose psychoanalytic sessions he conducted between 1912 and 1913. De Beaurain was born in 1867 and studied medicine at Swiss universities (Zurich, Berne, Geneva) where he defended his doctoral thesis as well. He was prepared for the career of a health resort physician and when he returned to Poland, he settled down in Poronin where except for working as a district physician, he also engaged in social and cultural activities. Around 1910 his professional interest shifted towards psychiatry and psychotherapy. In the final months of 1911 he relocated to Zakopane where he opened a private practice for "neu-rotic diseases". At the same time he started treating patients with the use of psychoanalytic methods. The first part of the paper concerns the life of doctor de Beaurain from birth and the period of studies and preparation for his professional career until the time when he started his psychoanalytic work.

Dr. Karol de Beaurain - a psychiatrist's profile. Part 2. / Dr Karol de Beaurain ­ sylwetka psychiatry. Czesc 2.

The paper sets out to recall the profile of Karol de Beaurain, a psychiatrist, who was one of first Poles to use the psychoanalytic method in treatment. So far, he has been mostly known as the one who was Witkacy's psychoanalyst. Stanislaw Ignacy Witkiewicz and Eugenia Dunin-Borkowska are the first patients who are known by their names and who received psychoanalytic treatment in the history of the Polish medicine. Stanislaw Ignacy Witkiewicz's letters and drawings originating from the psychoanalysis period served as a source of information about Witkacy's psychoanalysis. The paper illustrates dr Beaurain's fate during World War I when he was first a military doctor in Skoczów and then an assistant in prof. Piltz's Neurological-Psychiatric Clinic in Kraków where he actively participated in the creation of a multidimensional programme of war neurosis treatment. After the war finished, initially Beaurain stayed at his assistant post at the Psychiatric Clinic in Kraków but then in 1921 he relocated to the National Psychiatric Hospital in Dziekanka near Poznan. With his professional expertise he contributed to the strengthening of the Great Poland region psychiatry that had experienced qualified personnel shortages after the German qualified staff left. The growing numbers of patients and the overload of professional duties were probably the factors that led to dr. Beaurain's premature death while he was holding the position of the head physician at the National Psychiatric Hospital in Owinska in February 1927.

A MODEL FOR INTEGRATING ACTUAL NEUROTIC OR UNREPRESENTED STATES AND SYMBOLIZED ASPECTS OF INTRAPSYCHIC CONFLICT.

In psychoanalytic theory, the importance of actual neuroses-considered to be devoid of psychic content-diminished as Freud and subsequent analysts focused on unconscious intrapsychic conflict. This paper explores the relationship between actual neurotic and unrepresented states, which are believed to be best addressed through attention to countertransference, intersubjectivity, and enactments rather than interpretation of intrapsychic conflict. Models suggesting how actual neurotic states and symbolized intrapsychic conflict may interact with each other and environmental stressors are described. Symbolizing actual neurotic states and establishing meaningful linkages between somatic/affective experiences and intrapsychic conflict are viewed as necessary for effective treatment of many disorders.

Trait and state anxiety in patients treated with intensive short-term group psychotherapy for neurotic and personality disorders. / Lek-cecha i lek-stan u pacjentów leczonych intensywna, krótkoterminowa psychoterapia grupowa z powodu zaburzen nerwicowych i osobowosci.

OBJECTIVES: The study aimed to determine the severity of trait and state anxiety in patients treated for neurotic and personality disorders with intensive, short-term group psychotherapy and to analyse the change of anxiety intensity in the course of treatment. METHODS: 116 patients (81 females and 35 males) participated in the study. The measurement of anxiety intensity was conducted with the State-Trait Anxiety Inventory (STAI) at the beginning and at the end of treatment. RESULTS: The majority of patients (69% of the study group) demonstrated a high intensity of state anxiety at the beginning of the treatment with 47.4% being classified as very high. High intensity of trait anxiety was observed in 64.7% of participants (50.9% -very high). RCI (Reliable Change Index) and RCV (Reliable Change Value) indicated a significant change in state anxiety intensity in 62.1% of participants (48.3% - significant decrease, 13.8% increase). At the end of treatment more than a half of patients manifested medium and low intensity of both trait and state anxiety. CONCLUSIONS: At the beginning of psychotherapy the majority of patients demonstrated high intensity of both trait and state anxiety. In the course of therapy a considerable reduction of intensity of trait and state anxiety is observed. Significant deterioration in trait anxiety is observed in one out of every thirteen treated patients. Polish adaptation of STAI questionnaire is a useful tool for monitoring effectiveness of psychotherapy and may be successfully applied for screening and detailed diagnosis of neurotic and personality disorders.

De la precariedad psíquica a la subjetivación. Proceso analítico de una niña pequeña / From psychic precariousnes to subjectivization. The process of analysis of a young girl

Este trabajo pretende poner de relieve el valor del psicoanálisis de niños al servicio de la estructuración psíquica y la subjetivación, en pacientes de temprana edad, cuando estos procesos han sido interferidos por importantes desencuentros en los vínculos primarios. La temática es abordada a través del proceso analítico de una niña pequeña, que fue llevada a la consulta a los tres años de edad, manifestando graves dificultades en su funcionamiento, con significativo compromiso de su motricidad y su expresión verbal. Se hace especial hincapié en el relato de las sesiones iniciales, en las que intercambios profundamente impregnados de elementos no verbales cobraban especial valor dentro del vínculo transferencial, para ir generando una apertura de sentidos que iba promoviendo en la paciente despliegues de creciente complejidad. Luego el relato de algunos momentos significativos del proceso y de una sesión final que acontece a los tres años y medio del inicio, van dando cuenta de una progresiva estructuración psíquica, que habilitó a la niña hacia vicisitudes propias de la neurosis infantil (AU)

This paper aims to highlight the value of child psychoanalysis in the service of psychic structuring and subjectivization in patients during early childhood, when these processes have been impeded by significant failed connections in primary attachments. This thematic focus is considered through the process of analysis of a young girl, for whom consultation was sought at three years of age, with serious difficulties in functioning and significantly compromised motor function and verbal expression. Particular emphasis is placed upon the account of the initial sessions, where exchanges deeply imbued with non-verbal elements acquired particular value within the transference link, which in turn opened up meaning, fostering a series of unfoldings of increasing complexity in the patient. Later, the account of certain significant moments of the process, and of a final session taking place three and a half years after the beginning of treatment, describe a progressive structuring of the child´s psychic apparatus, equipping het for the own vicissitudes or infantile neurosis (AU)

Entre lo interno y lo externo: una experiencia de juego grupal para la creatividad compartida / Between the internal and the external: an experience of group game for shared creativity

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[What do Interpreters Cost? - A Retrospective Analysis of the Costs for Interpreters in Treatment of Refugees in a Psychiatric Outpatient Clinic in Berlin]. / Was kosten uns Dolmetscher? ­ Eine retrospektive Analyse der Dolmetscherkosten in der Behandlung von Flüchtlingen in einer Psychiatrischen Institutsambulanz in Berlin.

Clinical diagnostics of mental disorders especially among refugees and asylum seekers come with unique difficulties: language barriers, different forms of expression and concepts of the understanding of mental illness as well as a different cultural background. Therefore professional interpreters are needed but associated with a higher effort related to costs and time. We conducted a retrospective analysis of costs, which incurred by the use of professional interpreters in our outpatient clinic in Berlin, Germany, in the first quarter 2016 for the treatment of refugees and asylum seekers. The sample consisted of 110 refugees and asylum seekers; the highest costs in the use of interpreters incurred among Neurotic, stress-related and somatoform disorders (53.04%), especially Posttraumatic Stress Disorder (39.04%), as well as affective disorders (38.47%), especially major depressive episodes (25.23%). Our data point out the crucial need of a regulation of costs with regard to the service of professional interpreters in Germany.

The Emergence of Psychodynamic Psychotherapy for Treatment Resistant Patients: Intensive Short-Term Dynamic Psychotherapy.

Intensive short-term dynamic psychotherapy (ISTDP) was developed out of the need for relatively short psychodynamic psychotherapeutic treatment approaches to complex and resistant patient populations so common in public health systems. Based on extensive study of video recordings, Habib Davanloo discovered, and other researchers have validated, some important clinical ingredients that align the therapist with healthy aspects of the patient striving for resolution of chronic neurotic disorders and fragile character structure. In the case of character neurotic highly resistant patients, these approaches including "pressure," "clarification," "challenge to defenses," and "head on collision" can be used in a tailored and properly timed way to help the chronically suffering patient to overcome his or her own resistance and access core drivers of these pathologies. In this article the meta-psychological basis of ISTDP is reviewed and illustrated with an extended case vignette.

Manipulation tactics of patients with neurotic disorders in everyday life and during therapy.

OBJECTIVES: The objective of the study was to examine the repertoire and intensity of manipulation tactics of neurotic patients in everyday life and during therapy, as well as diagnosing the intensity of Machiavellianism in neurotic patients. METHODS: There were 111 study subjects: 44 patients with diagnosed neurotic disorders, 44 people from the control group and 23 therapists. The manipulation tactics were measured by means of survey methods of E. Mandal and D. Kocur and Machiavellianism was measured using the MACH-IV scale of M. Christi and F. Geis. RESULTS: In comparison to people from the control group, the patients were more willing to use manipulation tactics such as guilt induction, threatening to break up the relationship, and self-mutilation but less willing to use supplication/begging. The intensity of tendency to undertake manipulation was higher in everyday life than during therapy. The Machiavellianism of patients was positively correlated with the tendency to employ manipulation tactics. Differences within the scope of general Machiavellianism between the patients and the control group were not noted. CONCLUSIONS: The manipulation tactics of neurotic patients are of morbid nature. They are related to anxiety, feeling of guilt and hostility. The tendency to manipulate correlates with Machiavellianism.