“Zhong De Ban” (German–Chinese class): training in psychoanalytically oriented psychotherapy at the Shanghai Mental Health Center

German psychoanalysts have played a special role in the spread of psychoanalytically oriented psychotherapy in China. This article describes the history of the training programme anchored at the Shanghai Mental Health Center, its specific design, the cooperation with Chinese colleagues, and the importance of self-experience in groups. It reflects on the sociocultural background of the involvement of German psychoanalysts and the promotion of the project by German institutions. Conscious and unconscious aspects of group dynamics on both the German and Chinese sides are presented and discussed.

Coming Together Through Falling Apart

Assessing change during long-term psychotherapy can be a challenging and uncertain task. Psychological assessments can be a valuable tool and can offer a perspective from outside the therapy dyad, independent of the powerful and distorting influences of transference and countertransference. Subtle structural changes that may not yet have manifested behaviorally can also be assessed. However, it can be difficult to find a balance between a rigorous, systematic approach to data, while also allowing for the richness of the patient’s internal world to emerge. In this article, the authors discuss a primarily qualitative approach to the data and demonstrate the ways in which this kind of approach can deepen the understanding of the more subtle or complex changes a particular patient is undergoing while in treatment, as well as provide more detail about the nature of an individual’s internal world. The authors also outline several developmental frameworks that focus on the ways a patient constructs their reality and can guide the interpretation of qualitative data. The authors then analyze testing data from a patient in long-term psychoanalytically oriented psychotherapy in order to demonstrate an approach to data analysis and to show an example of how change can unfold over long-term treatments.

Defensive mechanisms and personality structure in an early adolescent boy: process and outcome issues in a non-intensive psychoanalytically oriented psychotherapy

The main aim of this paper is to empirically assess defense mechanisms trends and personality structure in a once a week psychoanalytically oriented psychotherapy with an early adolescent, affected by a General Anxiety Disorder (GAD). Assessment and outcome measure included the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A); process was evaluated through defensive mechanisms analysis, using Defense Mechanisms Rating Scale (DMRS). The paper focused on 12 sessions divided into three periods, along 2 years of treatment. Quantitative and narrative profiles of SWAP-200-A and DMRS were integrated; a log linear procedure was chosen to assess defensive mechanisms trends longitudinally during the treatment. Moreover a Multiple Correspondence Analysis (MCA) was applied to DMRS to provide a map of the evolution of the patterns of defense mechanisms throughout the course of treatment. Personality assessment and defensive mechanisms showed an inhibited self-critical image with obsessive, narcissistic and disavowal patterns. According to trends during treatment phases, MCA analysis identified decreasing in defensive patterns, while mature defenses increased significantly. The study highlighted how non-intensive psychoanalytic psychotherapy can help early adolescents with clinical problems to improve their overall mental functioning. Outcome in terms of personality structural changes and process according to defense mechanisms were discussed to highlight improvement not just in symptomatology, but also in personality structure and functioning.

Defensive mechanisms and personality structure in an early adolescent boy: process and outcome issues in a non-intensive psychoanalytically oriented psychotherapy.

<p class="MsoNormal" style="line-height: 200%; margin: 0cm 0cm 0pt;"><span style="font-family: Times New Roman; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US">The main aim of this paper is to empirically assess <span style="color: black;"><span style="color: black;">d</span></span>efenses mechanism trends (process) and personality structure (outcome) in an audio-recorded non-intensive psychoanalytically-oriented psychotherapy with an early adolescent <span style="color: black;"><span style="color: black;">boy, Gabriele. </span></span></span></span><span style="font-family: Times New Roman; color: #0a0905; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; color: #0a0905; font-size: 12pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';" lang="EN-US">Defensive mechanisms were evaluated through the Defense Mechanisms Rating Scale (DMRS, Perry 1990), assessment and outcome measure included the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A, Westen, Dutra, &amp; Shedler, 2005). </span></span><span style="font-family: Times New Roman; color: black; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; color: black; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US"><span style="mso-spacerun: yes;">&nbsp;</span></span></span><span style="font-family: Times New Roman; color: #0a0905; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; color: #0a0905; font-size: 12pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';" lang="EN-US">The paper focused on 12 sessions divided into three periods, SWAP-200-A were scored at the assessment and outcome phases while all the sessions were evaluated according DMRS. Quantitative and narrative profiles of SWAP-200-A and DMRS were integrated, a log linear procedure was chosen to assess defensive mechanisms trends longitudinally during the treatment. Moreover a Multiple Correspondence Analysis (MCA, Benzecri, 1973a) was applied to DMRS to </span></span><span style="font-family: Times New Roman; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 12pt; mso-ansi-language: EN-GB;" lang="EN-GB">provides a map of the evolution of the patterns of defense mechanisms throughout the course of psychotherapy.</span></span><span style="font-family: Times New Roman; color: black; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; color: black; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-GB"> </span></span><span style="font-family: Times New Roman; color: #0a0905; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; color: #0a0905; font-size: 12pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';" lang="EN-US">Personality assessment and defensive mechanisms showed an inhibited self-critical image with obsessive, narcissistic and disavowal patterns. According to trends during treatment phases these defensive patterns decreased while mature defenses increased significantly. MCA analysis </span></span><span style="font-family: Times New Roman; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US">identified also this trajectory. <span style="color: black;"><span style="color: black;"></span></span></span></span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; margin: 0cm 0cm 0pt; text-autospace: ideograph-numeric;"><span style="font-family: Times New Roman; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US">The study highlighted how non intensive psychoanalytic oriented treatment might by effective in treating internalizing disorders, and specifically discussed outcome and process issues in terms of personality structural changes and defense mechanisms with empirically based measures. </span></span></p><p class="MsoNormal" style="text-align: justify; line-height: 200%; margin: 0cm 0cm 0pt; text-autospace: ideograph-numeric;"><span style="font-family: Times New Roman; font-size: small;"><span style="line-height: 200%; font-family: &quot;Times New Roman&quot;,&quot;serif&quot;; font-size: 12pt; mso-ansi-language: EN-US;" lang="EN-US">&nbsp;</span></span></p>

Dove va la COIRAG? Dove va la psicoterapia psicoanalitica?

- The question in the title gives the author the opportunity to "take stock of" the state of psychoanalytically oriented psychotherapy, as, from a statutory viewpoint, COIRAG belongs to this sphere, even though it mainly focuses on the various aspects of group analysis and research. The article points out how difficult it is to define current psychoanalytic psychotherapy as such, since, according to the author, it has not satisfactorily solved the incongruities that were present in Freud's original theories. Thus, different orientations have emerged that are often intensified by such incongruities. Conflicting areas of psychotherapy where oppositions are created that - often - only make sense because they express irrelevant original theoretical defects are examined: for instance, the idea that "drive" is in contrast with "relation" or else the evaluation, or, on the contrary, the devaluation of Freudian metapsychology. Finally, the author identifies what can be allowed and developed in classical psychoanalytical tradition, presenting an outline of a practical-theoretical model for psychotherapy that he also points out as a prospect for COIRAG's development. .Parole chiave: psicoterapia, psicoanalisi, neuroscienze, scientificitŕ, relazione, sogno. .Key words: psychotherapy, psychoanalysis, neurosciences, scientificity, relation, dream.

The Correspondence of Bruno Bettelheim and Rudolf Ekstein 1. Introduction

This paper provides the historical, cultural, and clinical context for the relationship between Bruno Bettelheim (1903–1990) and Rudolf Ekstein (1912–2005). Both were Viennese-born and trained intellectuals who received doctorates in the human sciences from the University of Vienna in 1937. Both were deeply identified with lay analysis, emphasizing that for psychoanalysis to perpetuate itself it needed to promote serious and rigorous forms of research. Because Bettelheim was the better known of the two, this introduction focuses on Ekstein's family history, with special emphasis on his experience of loss and trauma and his capacity to recover from personal and educational obstacles. It argues that Ekstein was a representative product of Austro-Marxism in the period between the wars, embracing the ethical brand of democratic socialism and group solidarity that was integral to the theory and practice of Austrian Social Democracy. It discusses Ekstein's training with Moritz Schlick in philosophy and his immersion in the Vienna Circle of logical positivism. From Schlick, Ekstein evolved into a philosophical thinker who learned how to think his own thoughts. Ekstein joined the circle of psychoanalytic pedagogues who clustered around the Vienna Psychoanalytic Society, under the tutelage of Willi Hoffer,August Aichhorn and, above all, Anna Freud. The clinical component of psychoanalysis emanated from his commitment to understanding the inner world of the child. Bettelheim and Ekstein first became aware of each other from reading the analytic literature and finally met in America in the 1950s. They shared a professional interest in conducting research and doing clinical work on severely disturbed children and adolescents, including those with psychotic, borderline and autistic diagnoses. They debated the value of milieu therapy versus psychoanalytically oriented psychotherapy on such children. As their relationship evolved, the two collaborated and began a fascinating correspondence that gradually evolved into an intimate friendship. They both engaged in a polemic with Bernard Rimland, who was massively critical of their clinical work and a hostile critic of psychoanalytic approaches to the treatment of disturbed children. Rimland was an advocate of a neurological approach to mental illness, with an emphasis on biology and psychopharmacology. The 22 letters that constitute the Bettelheim-Ekstein exchange began with clinical concerns, including the varieties of solitude, isolation and countertransference disruptions that may trouble the psychoanalytic researcher and clinician in dealing with primitively disordered children. It moves to other issues, including mutual support during the Rimland Affair. As the two became more friendly, a pattern of good-natured competition and envy appeared. The two engaged in a heated exchange on the question of whether contemporary Vienna remained as anti-Semitic as it had been in their respective youths: Bettelheim, the concentration camp survivor, argued that nothing had changed and that most Austrians remained viscerally anti-Semitic; Ekstein, the Austro-Marxist, contended that one could not blame a generation born after World War II, holding that in his experience many Austrians had examined their consciences and held distinctly different opinions from their parents or grandparents. Toward the end of their correspondence, we encounter Ekstein's tender sensitivity to Bettelheim's descent into depression as a result of the death of his wife, Trude, leading eventually to recurrent episodes of suicidal ideation and plans for his own suicide. The letters testify to a unique friendship with a somewhat old-world quality.

Psychotherapy between Medicine, Psychoanalysis, and Politics: Concepts, Practices, and Institutions in Germany, c. 1945–1992

Looking back at almost fifty years of psychotherapy in post-war Germany, Annemarie Dührssen (1916–98), one of the grand old ladies of the discipline, proudly presented a story of success in 1994. In the immediate post-war years, between 1946 and 1950, there were already a considerable number of individuals and groups all over the country active in establishing hospitals or outpatient clinics exclusively devoted to psychosomatic medicine and psychotherapy; in 1950, the first university programme in the subject was set up in Heidelberg; in 1967, psychoanalytically oriented psychotherapy was included in the catalogue of services offered by the statutory health insurance system; and in 1970, psychosomatic medicine and psychotherapy had become obligatory subjects in the curriculum of medical students, resulting in the establishment of chairs in these areas at almost every medical faculty in West Germany.