[Sándor Ferenczis' aspirations and failure. His approach to regression from the current viewpoint]. / Sándor Ferenczis Aufbruch und Scheitern. Sein Umgang mit der Regression aus heutiger Sicht.

In evaluating the findings of his experiments with psychoanalytic techniques, Ferenczi discovered the meta-function of the analyst's technique and the various forms of transference projected onto the psychoanalytic situation. What militated against a full understanding of his own discoveries was the lack of a genuinely comprehensive conception of the transference/counter-transference process as a functional unity. His experiments failed because he was unable to resolve the dilemma between technique and relationship that his dual objective had placed him in, seeking to combine a technique for transforming repetition into memory with an attitude communicating new experience.

[Spontaneous awakening and dreams of patients with psychophysiologic sleep disorders]. / Spontanerwachen und Träumen bei Patienten mit psychovegetativen Schlafstörungen.

The effect of dreaming on the formation of psycho-physiological sleep disorders is studied by an investigation of 26 patients and 15 control persons who were interviewed as to the occurrence of dream memory after spontaneous awaking and after being awaken systematically in the sleep laboratory. It turned out that the patients had less dream memory than the control persons after spontaneous awaking from REM sleep, but they did not differ after being awaken. In addition, dream reports after spontaneous awaking from REM sleep contained more abstract dream thoughts and less visible dream action. These findings are interpreted as a manifestation of disturbed "dream work" in patients with psychophysiological sleep disorders, i.e. disturbance of connecting thoughts and scenes from the unconscious. Thus, awaking in sleep disorder is interpreted to be a progression into awakeness as a matter of defense.

[The social network of families of HIV infected patients]. / Das soziale Netzwerk von Familien HIV-Infizierter.

This paper is focused at the social network of families of HIV-infected persons. 13 families were interviewed in a depth-psychological oriented semi-structured manner. The evaluation took place primarily according to a qualitative manner. The central result is that families with HIV-infected members inform more seldom other persons out of the informal social network in comparison to former coping tasks like haemophilia, dependence of drugs or homosexuality, events which happened before the HIV-infection. Accordingly to that only some single persons or whole families use informal help for their coping process with HIV-infection. The infected themselves claim more often professional psychosocial help, sometimes some relatives do it, seldom the whole family. We mostly find the familial tendency of social retreat and of coping with the burdens without help from the outside. This tendency is forced by distrust, social anxieties and projective separation of familial conflicts in order to maintain familial stability.

[Stresses and interaction problems of physicians and nurses in the management of AIDS patients]. / Belastungen und Beziehungsprobleme von Arzten und Pflegekräften bei der Betreuung von AIDS-Patienten.

Caring for people with AIDS physicians and nurses are confronted with special problems. Compared to other severe illnesses there are specific problems in the relationship between doctors and nurses with their patients due to the similarity in age, the risk of infection and that most of the patients belong to stigmatized, marginal groups, that represent despised and threatening impulses (homosexu-ality, promiscuity, addiction). The results of our survey of 85 physicians and 111 nurses suggest, that physicians and nurses react with a typically professional attitude concerning the identification with AIDS-patients. The "concordant identification", that is induced by the same age of many AIDS-patients, is followed by a "complementary identification" with the professional role that serves as a defence and helps in coping with threatening internal conflicts. Wherein physicians have a mainly neutral attitude and delegate their feelings to the nurses, nurses show an unlimited commitment for AIDS-patients delegating their aggressive reactions to the physicians.

A specific and taxonomic differentiation between psychovegetative disorders and psychoneuroses.

120 patients with psychovegetative disorders and 124 patients with psychoneuroses were differentiated by means of systematic and taxonomic statistical procedures underlying variables from personality questionnaires. Both groups of patients were found to be different. But the double strategy of the differentiation shows that the discrimination is a relative one.

[Regression in inpatient-analytic psychotherapy. Reflections on indications and treatment strategy from the viewpoint of applied ego psychology]. / Regression in der stationär-analytischen Psychotherapie. Uberlegungen zur Indikation und Behandlungsstrategie aus der Sicht der angewandten Ichpsychologie.

This paper points out the differences in the dynamic processes of the regression between patients with neurotic ego-structures and those with disturbances of the ego-development during the psychoanalytic inpatient therapy. The main consequence is, that the indication for inpatient therapy is depending on the sufficient ego-strength, but not on the stage of the ego-development, and that the tactic of the treatment, its clinical organization and the structure of communication in the hospital should be adapted to the ego-structure. General criteria are that the inpatient treatment of neurotic patients should be limited to three of four months at most to avoid artificial splitting mechanisms, and that the treatment of ego-disturbed patients should be organized as an integrative one and managed by a special kind of team-cooperation in order to further the integrating and differenciating ego functions.

[The psychovegetative disorders as an ego-structural problem]. / Die psychovegetativen Störungen als ich-strukturelles Problem.

The personality structure of patients suffering from psychovegetative disorders is described in the present article from aspects of the psychology of the ego. The focus of all such disorders is a defective desomatization of affectations and the functions of perception. In proportion to the extent of the developmental disorder this specific pathology of the ego is either employed regressively in the defense of conflicts or serves for the release of a structurally strongly limited ego. More precise investigation of the ego structure leads to the descrimination between vegetative neuroses as limited ego pathology on the one hand and psychovegetative disorders in the context of a more extensive ego pathology, as they occur in borderline syndromes or serious narcissistic disorders of the personality on the other. Diagnostically the discrimination may be made by considering the patients own description of their complaints and the structure of their characters, by evaluating the quality of anxiety and affectations, and on the basis of the dynamics of the psychotherapeutic relationship. Consequently there are characteristic differences for the course of treatment.

[Basis disturbances in depressive neuroses and psychosomatic disorders]. / Die Grundstörung bei depressiven Neurosen und psychosomatischen Strörungen.

Applying the concept of the "basic fault" (Balint) to depressive neuroses and psychosomatic disorders the author reports some analogies in the dynamic processes of both diseases. Both are based on a pre-verbel deficiency in communication which has an influence on further conflict-organisation. In the case of psychosomatic diseases this leads to a fixation on the pre-verbel, vegetative object-relation. At the stage of the re-activated psychovegetative basic fault only somatic reactions and satisfactions may be accepted by the patients. This impedes the working alliance, consolidates somatisation as a resistance mechanism, and may require discontinuation of psychoanalytic treatment. In the case of depressive neuroses the stage of the basic fault is characterised by a paradox form of sell-object-relationship which is both object-relation and narcistic isolation as well. Though at this stage verbal communication is less important the analist may advance dissolving of this paradox relationship by means of empathetic interventions.

[Differential indications in the clinical field. Empirical study of management of indications for analytic individual and group psychotherapy respectively in a psychotherayp clinic ]. / Differentialindikation im klinischen Feld. Empirische Untersuchung zur Handhabund der Indikationsstellung zur analytischen Einzel-bzw. Gruppenpsychotherapie in einer psychotherapeutischen Klinik

This study aims at a systematic description of factors which influence the practice of differential indication between psycho-analytic individual and group-therapy in apsychotherapeutic clinic. The self-description of inclinic patients for who individual therapy was indicated, was compared to the self-description of those who were expected to join a therapeutic group. Two personality-tests (Giessentest "GT" and Freiburger Persönlichkeitsinventar "FPI") and a symptom-questionnaire (Beschwerdenliste"BSB") were applicated. If the self-description fo patients is an important factor influencing differential indication, then a difference should be found in comparison of the self-description of both samples. The result is , that important differences are not to be found, and that, moreover the little differences are variable by the time. In conclusion, patient-centered explorations give no sufficient explanation, why group therapy was indicated in some cases and individual therapy in others. Basing on these results, differential indication in clinical psychotherapy is defined as an interactional process which is influenced by specific cognitive factors of the therapist and his clinical socialisation on the background of variable institution-bound experience.

The social control of organizations in the health care area.

Available data suggest that the influence and autonomy of health care professionals have been declining. Of course, professional impact remains higher in health care than perhaps any other economic sphere, but the locus of much health care decision making has been shifting from independent professionals to employed personnel of large-scale government, hospital, insurance, and research organizations. The question therefore arises as to what shall replace this previous reliance upon individual professional ethics to assure the society that its newly powerful health care organizations are functioning in a desirable manner. In other words, what are to be the preferred mechanisms for socially controlling health care organizations. This paper traces three dominant belief patterns about how the characteristics of health care organizations and their environments produce desired control. It proposes that belief patterns have emphasized (1) the non-profit motives of many health care organizations; (2) the system of interrelationships that surround health care organizations; and (3) the vast differences among health care consumers. Choices from among these models continue to depend less upon knowledge of organizational functioning than upon political dispositions and social fancy.