[The co-evolutional focus in individual, couple and family therapy]. / Der koevolutive Fokus in der Einzel-, Paar- und Familientherapie.

A concrete formulation of focus is proposed that in structure and use is suitable for individual as well as couples and family therapy. The concept of coevolution (Willi 1985, 1991) forms a basis for the supposition that important personal developments are realised in human relationships. The development of one person is challenged, taxed, or hindered by the development of other persons. The formulation of a coevolutional focus consists of four steps: 1) The context of the relationship in which the current conflict emerges; 2) The identification of delayed stages of development; 3) The personal and interactional conditions which block this development; 4) Concrete changes which make the progress in the intended development recognizable. The focus in couples and family therapy integrates the impending development of the participants in their collusive interactions.

Couples therapy using the technique of construct differentiation.

A central problem in couples therapy is the clients' tendency to persist in endless and fruitless alternation between attacking the partner and justifying themselves. The technique of construct differentiation described in this article has proved helpful in coping with this situation. In three clearly structured steps, the therapist explores the personal constructs of each partner in the presence of the other. Instead of concentrating in the usual way on circularity of thoughts, feelings, and behavior, the partners are hindered from interacting and are confronted by the therapist's questions concerning their own inner process, independently of that of the partner. By becoming aware of their own ambivalent constructs and those of the partner, the eagerness to convert the partner to their own point of view can be reduced, and the construct system of each partner can be enriched by the other's constructs. Construct differentiation proves especially useful in the treatment of power struggles and narcissistic collusions.

Update on the epidemiology of anorexia nervosa in a defined region of Switzerland.

In this follow-up investigation, the authors studied all Swiss women in the canton of Zurich who developed anorexia nervosa between ages 12 and 25 years and who were hospitalized for the first time with this diagnosis between 1983 and 1985. Data were compared with those from an earlier study, which focused on the periods 1956-1958, 1963-1965, and 1973-1975. The incidence of anorexia nervosa did not increase significantly during 1983-1985 compared to 1973-1975, in contrast to the constant increase found between 1956 and 1975. However, the more frequent use of vomiting and abuse of laxatives in 1983-1985 may indicate an increase in cases with mixed features of anorexia nervosa and bulimia.

[Sexual problems in schizophrenic patients treated by ambulatory care]. / Sexuelle Schwierigkeiten ambulant behandelter Schizophrener.

Two groups comparable in age of 20 male and 20 female schizophrenics, all under neuroleptic treatment, were asked by way of questionnaire about their attitude towards sexuality, their sexuality, their sexual behaviour and their sexual difficulties. Sexuality was considered to be an important aspect of a person's life. More than one third of the patients indicated regular sexual contacts. In the group of males a high incidence of erectile dysfunctions was apparent, whereas the women showed a prevalence of general sexual dysfunctions. Both sexes indicated an inhibition of sexual desire. The impaired ability for sexual reaction and experience was felt partly to be positive, partly negative. Etiologically such disorders are caused by the side effects of the neuroleptic treatment, as well as by a disturbed capacity for interpersonal relationships. In the longterm treatment of schizophrenics, increased attention should be paid to sexual counselling.

[A 10-year follow-up of cases with anorexia first hospitalized in the Canton of Zürich]. / 10-Jahres-Katamnese der 1973-1975 im Kanton Zürich erstmals hospitalisierten Anorexie-Fälle.

Out of all 38 anorexia nervosa patients hospitalized for the first time in a private or state hospital for pediatrics, internal medicine or psychiatry in the Canton of Zurich during the period 1973-1975, 28 cases could be assessed 10 years later using a semistructured interview. Catamnestic data were categorized according to Morgan and Russel (1975) in a general outcome score and an average outcome score. Regarding somatic and psychosocial dimensions, 11% of the patients examined can be considered symptom-free, 71% improved and 14% unchanged. One patient (4%) had died from the sequelae of anorexia. 64% increased in weight, nevertheless more than half of the patients had disturbed eating behavior at the time of this catamnestic study. An equally frequent finding was considerable impairment of psychologic well-being chiefly reflected in anxiety and depression. The time necessary to attain the normal weight range had varied between a few months and 11 years. Of 8 variables often claimed to be prognostic in the literature on the course of anorexia nervosa, only a short duration of illness before hospitalization was shown to be relevant. The patients with good or medium outcome most often consider psychotherapy or a partner relationship a decisive factor in the favorable course of their eating problem.