Ego-psychological indicators of diffeential diagnosis between borderline and psychotic personality

Pitanje dijagnostičkog stadija i dalje je relevantno u kliničkoj psihoanalizi i psihoanalitičkim psihoterapijama. Dijagnostička procjena nije bila od primarne važnosti u klasičnoj psihoanalizi. Psihoanalitičar je jednostavno uključio analitičke metode i tehnike u svoju kliničku praksu kako bi utvrdio pogodnost pacijenta za analizu. Prvi odlučujući razvojni poticaj specifične psihoanalitičke dijagnostičke procjene slijedio je pomak prema odnosnim teorijama i kliničkoj praksi s pacijentima s graničnim poremećajima. Psihijatrijski intervju koji je uveo Harry Stack Sullivan (1954) otkrio je potrebu za specifičnom psihoanalitičkom procjenom. Sljedeći je korak bio razvoj Hartmanove ego-psihologije. Ego (regulacijski mehanizam između stvarnosti i osobe), uključuje procese regulacije i organizacije iskustava koji su relevantni za razumijevanje bliskopsihotične i psihotične ličnosti. Taj način istraživanja omogućava diferencijalni opis interpretativne psihodimanike i razvoj procjene, uključujući kriterije pokazatelja i prognoze.The question of diagnostic phase is still relevant in clinical psychoanalysis and psychoanalytical psychotherapies. Orthodox psychoanalysis was not preoccupied with the question of diagnostic assessment. The psychoanalyst simply introduced the methods and techniques of analysis into his clinical work to determine the analysability of a patient. The first decisive developmental thrust on specific psychoanalytic diagnostic assessment followed the shift to relational theories and clinical practice with borderline patients. The Psychiatric Interview introduced by Harry Stack Sullivan (1954) exposed the question of the need for a specific psychoanalytic assessment. The next step was the development of Hartmann’s Ego-Psychology. The Ego (mechanism of regulation between reality and the person), includes the processes of regulating and organizing experiences that are particularly relevant to understanding near-psychotic and psychotic personalities. Examined as such, it enables the differential descriptive interpretative psychodynamic as well as developmental assessment, including the criteria of indication and prognosis

THE TECHNICS, PHASES AND PROCESSES OF SUPERVISION

Rad donosi osim povijesne perspektive početka i razvoja supervizijske prakse u svijetu i u Sloveniji na koju su utjecala pretakanja iskustava različitih profesija, objašnjenje pojma supervizije, modela i tehnika skupljanja supervizijskog materijala. Nadalje, rad donosi podakte o poraznoj učinkovitosti poslijediplomskih programa na praktični rad te naglašava da supervizija nije zamjena za formalnu, tradicionalnu akademsku naobrazbu već je njezina dopuna. Autor predstavlja faze supervizijskog proces kao i poteškoće koje se tijekom procesa učenja javljaju objašnjavajući ih s dinamske perspektive te s perspektive kognitivnih teorija i teorija učenja.Apart from the historical perspective of the beginnings and development of supervisory practice in the world and in Slovenia, which was influenced by merging of experiences of various professions, this paper brings us the explanation of the term supervision, and of models and techniques of collecting supervisory material. Furthermore, this paper provides data to show how poorly postgraduate programmes equip the students for practical work and emphasizes the fact that supervision is not an alternative to formal, traditional, academic education, but its complement. The author presents the phases of supervisory process as well as the difficulties which arise in the course of learning, explaining them from the dynamic perspective, and from the perspective of cognitive theories and theories of learning

A dimensional taxonomy of behavioral problems and emotional difficulties in three-year olds

U svijetlu kontroverze o dijagnostičkoj klasifikaciji i epidemiologiji predškolskih psihičkih poremećaja, čini se da su opravdana daljnja istraživanja taksonomije psihopatologije kod predškolske djece. U Sloveniji se provodi testiranje psihopatologije kod predškolske djece pomoću Sistematskog psihološkog pregleda trogodišnjeg djeteta (SPP-3). Cilj ovog istraživanja bio je utvrditi taksonomiju bihevioralnih problema i emocionalnih poteškoća dobivenim pomoću SPP-3 te dokumentirati valjanost u odnosu na Achenbachovu check-listu dječjeg ponašanja (CBCL), međunarodno priznatu mjeru dječje psihopatologije. Prikupljeni su podaci za 26 000 djece, koji su korišteni za eksploratorno i potvrdno uspoređivanje strukturalnih modela, dok su podaci za 212 djece korišteni za utvrđivanje usporedne valjanosti sa CBCL-om. Osmofaktorski potvrdni model najbolje je odgovarao prikupljenim podacima (RMSEA = 0,023, CFI = 0,951), a uključivao je dimenzije internaliziranog ponašanja, povučenog ponašanja, problema hranjenja, poteškoća u eliminaciji, problema sa spavanjem, eksternaliziranog ponašanja, tikova i navika te somatskih problema. Naši se rezultati preklapaju s utvrđenim empirijskim modelima psihopatologije kod predškolske djece te upućuju na mogući zajednički okvir za opisivanje psihopatologije kod predškolske djece pomoću različitih mjernih instrumenata. Također ističu moguće istraživačke pravce te prevenciju u području mentalnog zdravlja predškolske djece.In light of the controversy regarding the diagnostic classification and epidemiology of preschool psychiatric disorders, more research into the taxonomy of preschool psychopathology seems warranted. In Slovenia the signs and symptoms of preschool psychopathology are screened for in the population using the Psychological Screening Survey of Three-year olds (SPP-3). The current study aimed to establish a taxonomy of behavioral problems and emotional difficulties obtained via the SPP-3 and document its concurrent validity in regard to the Achenbach Child Behavior Checklist, an internationally well-established measure of child psychopathology. Data from over 26000 children was used for exploratory and confirmatory structural equation modeling, while data from 212 children was used to establish concurrent validity with the CBCL. An eight-factor confirmatory model provided the best fit to the data (RMSEA = 0.023, CFI = 0.951) and included the dimensions of Internalizing Behavior, Withdrawn Behavior, Eating Problems, Elimination Difficulties, Sleep Problems, Externalizing Behaviors, Tics and Habit Behaviors and Somatic Problems. Our results overlap with previously established empirical models of preschool psychopathology and point towards a possible common framework for describing preschool psychopathology across different assessment instruments. They also highlight avenues for research and prevention work in the field of preschool mental health

The difficult patient in combined therapy: A case study

After the shift of the psychotherapeutic treatments towards the patients with ego-deficits and severe pathology, combined therapy is considered to be one of most important innovations of the last decade – to be correct – in the USA, while Europe still hesitates to explore this possibility. The term Combined therapy indicates individual (mostly developmental analytic) and group (mostly group-analytic) psychotherapy, led by the same therapist. The presented case study includes the carefully examined therapeutic process of a severe shizoid patient. The process was controlled by constant supervision, including both: the patient's changes and reactions of the group, the transference and countertransference phenomena, advantages and difficulties, as well as the outcome

From chaos through cosmos toward coinonia: A group-analytic developmental line

The phenomenon of group cohesion is among most examined in group psychotherapy and repeatedly confirmed as the one of the most important curative factors. It is defined as a force of a symbiotic unity. On the other hand, the phenomenon of coherence is mainly understood as a harmonic connection of different members. Both phenomena, observed through sequences of the time in a groupanalytic group, appeared as the result of the developmental processes of individuals in the group and of the group as a whole. The observation brought to a hypothesis that we are facing the parallelism of the individuation processes and group developmental process that have involved both – group-analytic and everyday interpersonal life. Group cohesion appeared as the result of the overcome chaotic paranoid position. The group, previously experienced as unknown and intimidating, becomes a symbiotic object, safe place gradually supporting the improving autonomy of individual members, mainly through important everyday relationships. Simultaneously and gradually group-analytic culture is changing from chaos and autism to equality, cohesion in the sense of "one mind", toward coherence of interesting different members, from "forming and norming" to "performing". It seems that group cohesion and group coherence are not phenomena per se but rather two positions in a group-developmental line, going from autism through cohesion and differentiation towards coherent interactive relationships

Therapeutic working alliance: From a psychoanalitical to a pantheoretical conception

Although the concept of therapeutic working alliance was rooted in psychoanalysis, today it is more prominent in psychoanalytic psychotherapies than psychoanalysis. It is rather surprising that we cannot find the concept in the Laplanche and Pontalis Dictionary. During the last two decades a growing body of empirical research material on therapeutic working alliance was published, confirming the idea of the alliance as a separate dimension of therapeutic relationship with few recognisable components. The dimension of the therapeutic working alliance was examined in several approaches and proved as one of the most important therapeutic factors, regardless of the approach, and it has finally been accepted as a pantheoretical concept

Libido, aggression and aggressiveness

Referat, predstavljen na prvem Vzhodnoevropskem psihoanalitičnem seminarju,na Dunaju, (april 1993) predstavlja pregled zadnjih sprememb v psihoanalitičnem konceptu agresije. Zavzema se za doslednejšo rabo pojmov agresije in agresivnosti - prvega za destruktivne pojave in oblike, drugega za označevanje gonskih silnic, agresivnih teženj, ki se kažejo kot potreba po obvladovanju, samorazvoju, storilnosti, veljavi ... Med obema, agresijo in agresivnostjo, obstaja prikrita povezava. Osrednji del referata predstavlja predlagani koncept razumevanja libida in agresivnosti v njuni adaptacijski in razvojni funkciji. Na osnovi kliničnih psihoterapevtskih izkušenj ter epidemioloških študij otrok je postavljena trditev, da je pravi pomen libidnih in agresivnih teženj mogoče prepoznati šele potem, ko oba opazujemo v njuni medsebojni povezanosti. Libidna motivacijska energija, investirana v senzorične sisteme (in tako po prehodu iz cenestetičnega v diakritično zaznavanje povezana z ego-funkcijami), omogoča receptivne funkcije (input), medtem ko agresivna motivacijska energija, investirana v mišične sisteme (in povezana z motoriko, torej prav tako z ego-funkcijami), omogoča akcijo (output). Tako ustvarjene krožne reakcije predstavljajo otrokovo kapaciteto za interakcijo z okoljem in omogočajo vstop v objektni odnos. Ta je karakterističen, od drugih odnosov drugačen, po po intenziteti libidne in agresivne izmenjave.The paper was presented on the First East-European Psychoanalytic Seminar, (Vienna, April, 1993). It represents an overview of recent changes in psychoanalytic understandin of aggression. A clear differentiation in the meaning of the terms (Aggression and Aggressiveness) has been supported - the Aggression as a destructive and even hostile tendency, and the Aggressiveness as a constructive motivational force, leading to assertiveness, mastery, individuation and separation. The article offers an original proposition of understanding libido and aggressiveness in their common adaptive and developmental functions. Libido, invested into sensory systems, is supporting receptive functions (input), while aggressiveness, invested into moscular systems, is supporting action and externalization processes (output). Both drives, linked to the ego, represent someone\u27 capacity for relatedness. Drives, supporting circular reactions, become representatives of ongoing object relations

Phase specific games

Psihoanalitična razvojna psihologija, ki temelji na teoriji objektnih odnosov ter preučuje strukturiranje ega, je najsodobnejši trend v razvoju psihoanalize. Novosti ne uvaja le v teorijo, ampak se dotika tudi klinične prakse. Prične že s tem, da redefinira psihoterapijo tako, da se jedro prizadevanja preusmeri iz predelav temeljnih konfliktov (ida) na podporo razvoja po ključnih razvojnih linijah ter jačanje adaptacijskih zmožnosti (na ego). Skozi prizmo razvoja danes drugače razumemo in ocenjujemo travmatska doživetja. Posebno nevarne so "za fazo specifične travme", to so tiste, ki razvoj po neki razvojni liniji zadenejo v kritičnih točkah, nakar se prične rušiti notranja struktura povezav med razvojnimi linijami. Kot enemu od pionirjev psihološke preventive se mi je porodila ideja, da bi bilo mogoče v kritičnih točkah razvoj tudi usmerjati in pospeševati. Igra - še posebej domišljijska - ima pri otrocih vedno tudi to funkcijo. Tako se mi je porodil pojem "za fazo specifične igre". Ustavili se bomo ob najbolj tipičnih razvojnih linijah ter pogledali mesto in vlogo domišljijskega igranja in prehoda na igranje iger (kar je že samo po sebi vaja avtonomije in samoiniciativnosti ob umeščanju samokontrole, kar zahteva, da se otrok identificira s pravili igre). Delavnica naj bi nam približala izkušnjo o tem, kam smo umestili svojo lastno igro in igranje. Za terapevta in še posebej za preventivca, ki mora biti inventiven in kreativen, bi namreč bilo porazno, če je izgubil otroški svet igre.Psychoanalytic developmental psychology, based on theory of object relations, have had one of the greatest impacts on the clynical practice lately, redefining psychotherapy as the support of development of the ego.. Taking the development into account, among all traumatic experiences, we can observe the danger of "phase specific traumas", damaging the development in critical points. As a preventionist I developed an idea to turn this course of development. Introducing PHASE SPECIFIC GAMES I am trying to give the development in critical point a new developmental thrust

Dinamično interpretativna, ali tudi razvojna diagnoza v tretmanu nepsihotičnih pacientov?

Človekova osebnost je kot objekt opazovanja ena najtežjih področij raziskovanja. Do danes tudi moderne znanosti niso razvozljale te enigme. Psihoanaliza, ta misteriozna psihologija v senci, se je v zadnjih tridesetih letih razvila do dokaj konstinentne in koherentne teorije. Skozi klinično prakso je ohranila svojo moč obnavljanja in tako nadaljevala pot iz klasične Freudove teorije preko ego psihologije do teorije objektnih odnosov. Tako je psihoanaliza postala obenem psihoanalitična razvojna teorija. Po Freudovi teoriji psihoseksualnega razvoja so teorijo objektnih odnosov kot drugo razvojno teorijo pogosto zoperstavljali Freudovi teoriji. Sprožili so prepir kaj je pomembnejše - zadovoljevanje potreb in doživljanje ugodja ali navezovanje kontakta. Danes smo presegli nivo tega prepira, podobnega vprašanju, kaj je pomembnejše - kokoš ali jajce. Vemo, da govorimo o dveh aspektih razvoja. Z vidika klinične prakse Freudova teorija psihoseksualnega razvoja predstavlja osnovo dinamično - interpretativne diagnoze, medtem ko teorija objektnih odnosov, povezana z ego psihologijo, predstavlja izhodišče razvojne diagnoze, ki osvetljuje strukturiranje ega in selfa. Prispevek vključuje diskusijo o najpomembnejših razvojnih linijah ter o možnosti integracije obeh - dinamične in razvojne diagnoze.Human personality, as an object of research is one of the most complicated fields of investigation. We can hardly say that this enigma has been resolved by modern science. Recently Psychoanalysis, the mysterious psychology in a shadow, has been paid all the attention as a rather consistent and coherent theory. Through its clinical practice psychoanalysis has kept its clinical practice psychoanalysis has kept its selfrenovating strenght. So - after Freud\u27s classical theory and Hartmann\u27s Ego psychology, we have been present to its third birth: to the birth of the theory of object relations or, in other words, psychoanalytic developmental psychology. After Freud\u27s theory of psychosexual development, the theory of object relations, as a second developmental theory, has been opposed to Freud\u27s theory. Nowadays as we have reached beyond the quarrel about what was the first and the most important - an egg or a hen - we know that we are talking about two aspects of a development. In terms of clinical practice, Freud\u27s theory of psychosexual development represents the basics of the Dynamic - Interpretative Diagnosis while, on the other hand, theTheory of Object Relations, linked to Ego psychology takes into consideration the developmental diagnosis concerning theprocess of structuring of the Ego and Self. The paper includes the discussion about the most important developmental lines and the possibility of the integration of both - the Dynamic and the Developmental Diagnosis