[Palliative psychosomatic medicine]. / Palliativmedizin in der Psychosomatik.

Psychotherapeutic medicine, the area of medicinal specialisation dealing with the foundations of psychosomatic medicine, so far dealt mostly with diagnosis and therapy of acute diseases. The course of illness in patients with bio-psycho-social disorders however ist most often chronic. Sigmund Freud the founder of scientific psychotherapy himself was a patient in palliative care for 26 years and underwent over 30 surgical procedures to treat his carcinoma of the palate and jaw. Some goals and psychotherapeutic strategies of intervention that can be used in palliative psychosomatic medicine are laid out. This important field has in itself so far not reached a wide spread recognition and there are hardly any theoretical concepts or empirical validation to be found.

Psychodynamic aspects of psychopharmacology in functional somatic complaints.

Psychiatrists as well as general practitioners frequently prescribe psychotropic drugs (tranquilizers such as benzodiazepines and increasingly low-dose long-acting neuroleptics) to treat functional organic complaints. We are interested in finding out the psychodynamics in the doctor-patient relationship that determine whether the doctor puts more emphasis on eliminating symptoms by prescribing psychotropic drugs or on solving the underlying conflicts by psychotherapy. Furthermore we describe some interactions which are of importance for illustrating whether drugs are effective or lead to side effects.

[Control of regressive processes in therapy groups]. / Steuerung regressiver Prozesse in Therapiegruppen.

At the outset a delineation is made of the concept of regression in the context of psychoanalysis. It is shown that partial and reversible regressive changes are a necessary pre-condition in order for progredient therapy developments to take place in a patient. This applies to the therapeutic process in the treatment of individuals as well as to group therapy. In analytic group therapy the development of a more mature personality structure can be facilitated by means of the carefully controlled use of such destructing measures as minimal structuring, abstinence, anonymity and rule of free interaction as well as the interpretation of the group analyst. In this way, the development and maintenance of psychoneurotic, functional somatic and character symptoms gradually become superfluous and psychic energies are liberated for more constructive forms of behavior. Some attention is given to the reciprocity between specifically psychoanalytic perception and a conclusion formation of an explanatory- hermeneutic nature. On the basis of the insights obtained in this way, the psychoanalytic group therapist designs his interventions which should, if possible, apply to all group participants. This approach is illustrated by means of a clinical case study.