PSYCHOTERAPIA       ISSN 0239-4170

4 (131)


Psychoterapia 4/2004

Dov Aleksandrowicz
Co nowego w psychoanalizie?         5
What is new in psychoanalysis?      5

Anna Sarol-Kulka
Jacob Levy Moreno i jego teoria kreatywności i spontaniczności    9
Jacob Levy Moreno and his theory of creativity and spontaneity    9
This article is about Jacob Moreno and the development of his theory of creativity and spontaneity. Moreno believed that creativity results from the need of change; it is a process of co-operation between people who improve old concepts and create new ones. Moreno claimed that creativity lies at the heart of psychodrama; it is a form of inspiring energy which helps society to become aware of the problems of the individual and helps the individual to become aware of the problems of society. Spontaneity, according to Moreno, is a physical, mental and interpersonal process, given direction by creativity. Creativity is a form of action, the act of creation, whereas spontaneity is the readiness to create. Moreno said: "Spontaneity operates in the present, here and now; it induces the individual to respond adequately to a novel situation or to respond in a novel way to an old situation".

Elżbieta Galińska
Elementy reparacji w psychodramie i w muzykoterapii według teorii Melanie Klein      17
Elements of reparation in psychodrama and music therapy according to Melanie Klein      17
The paper presents fragments of reparative work with non-psychotic patients, using the Moreno's psychodrama method and music therapy (the Musical Portrait method of E. Galińska, concerning the "self" structure of the patient and the identity therapy) in the light of Melanie Klein's theory. Reparation of mourning (based on the dreams of the patient) and early childhood traumas, requiring the use of regression, up to the moment preceding the birth and directly after, using "musical breast-feeding" (played by mother and child by means of musical instrument) is described. All examples show the symbolic transformation of the "bad" object into a "good" one, with which the patient begins to identify himself.

Bogdan de Barbaro, Lucyna Drożdżowicz, Bernadetta Janusz, Katarzyna Gdowska
Terapia małżeńska jako "szukanie dobrych słów"   29
Marital therapy: seeking "the right words"   29
A key point in marital therapy is a contract defining the aim and form of the therapy. Contrary to appearances this is a difficult task. The problem arises because in spite of external declarations of interest in and readiness to undergo therapy, the partners remain rooted in very different stories, in which the common denominator is the treatment of the marital problems in categories of "guilt — wrong". In these stories, the partners generally level mutual accusations, assuming, usually defensively, the ill will of the other person. This creates destructive connections that make agreement impossible. In therapy the partners are encouraged to "exchange words", seek new versions and attribute new meanings. The new words agreed upon together in time become their own, familiar ones. The fundamental aim of this concept of therapy is to "come out of the courtroom" into a space of mutual understanding. Therapy can be considered successful when exchanges and agreement of words are followed by changes in behaviour.

Magdalena Muszalska
Byłem kobietą, byłam mężczyzną — tajemnica, fenomen i paradoks transseksualizmu. Część I.    37
I was a woman, I was a man — the mystery, the wonder and the paradox of transsexualism. Part I.     37
The first part of the chapter provides a general introduction to the field of transsexualism: its definition, historical notes and etiological concepts. This part aims at explaining (and understanding) what transsexuality really is, and (just as importantly) what it isn't. The lonely, frightening, experience of being a transgendered child is painted in a way that few outsiders can intuitively imagine, and few transsexuals wish to relive.

Magdalena Muszalska
Byłem kobietą, byłam mężczyzną — tajemnica, fenomen i paradoks transseksualizmu. Część II.   45
I was a woman, I was a man — the mystery, the wonder and the paradox of transsexualism. Part II.    45
The second part summarises the current medical viewpoint on the causation of the condition, analyzes clinical criteria, describes how transsexual people deal with the condition, and briefly describes the process of gender reassignment ("sex change"'). The article includes a summary of current medical and scientific opinion about the condition, as well as observations on how it feels to actually be a transsexual woman or man.

Joanna Mikulska, Anita Bryńska
Zaburzenie obsesyjno-kompulsyjne — metody leczenia i czynniki determinujące ich skuteczność      55
Obsessive-compulsive disorder — methods of treatment and the factors influencing their efficacy 55
The aim of this review is to summarize the known factors which can determine the efficacy of therapy (pharmacotherapy and cognitive-behavioural therapy) in OCD. The Medline and Psych.Info (1966-2003) were reviewed with key words: OCD and CBT, OCD and BT. The emerging data suggest that there exist some factors which can influence the efficacy of therapy in OCD: metabolism of fluorodeoxyglucose in the left orbitofrontal cortex, the clinical picture of the disease - predominance of obsessions or compulsions, predominance of a specific group of symptoms (i.e. sexual/religious obsessions, compulsive hoarding and saving), associated symptoms of depression, duration of illness, the number of previous therapies, the level of functioning before treatment, Y-BOCS score before treatment, compliance with the therapist during the first week of psychotherapy and reduction of anxiety between sessions (two last factors refer to cognitive-behavioural therapy).

Barbara Bętkowska-Korpała, Jolanta Ryniak, Barbara Zawadzka, Piotr Jankowski, Marek Kuźniewski, Kalina Kawecka-Jaszcz
Program grupowej terapii psychologicznej w kompleksowym leczeniu osób uzależnionych od nikotyny w ramach prewencji chorób układu krążenia — doświadczenia własne   69
A group psychotherapy programme in the complex treatment of patients addicted to nicotine, conducted in the course of cardiovascular disorder prevention — personal experience     69
This original programme of psychological therapy within the comprehensive management of tobacco dependence can be used in psychotherapy centres and other institutions for the management of dependence. In the course of psychological therapy, patients build and enhance their internal motivation to quit smoking as well as they learn to identify personal mechanisms of dependence and techniques to prevent recurrences. They also learn how to deal with nicotine urge and daily stress. Generally, they gain more self-awareness and motivation to start a healthy life. The immediate effects of comprehensive management were a discontinuation of smoking by 80.4%, reduction of the number of smoked cigarettes by at least 50% by 14.3% of the participants. In 5.2% of the participants therapy did not produce the desired results. The findings of the present study indicate that pharmacotherapy combined with psychotherapy is the most effective form of treatment of nicotine abuse in the context of immediate and long-term effects.

Jerzy A. Sobański
Dynamika globalnego nasilenia objawów zaburzeń nerwicowych podczas intensywnej psychoterapii na oddziale dziennym       77
Global neurotic symptoms index dynamics during intensive psychotherapy in a day hospital setting    77
Aim: Analysis of the dynamics of the global neurotic symptom level during intensive integrative psychotherapy in a day-hospital setting, and its relation to therapy outcome. Method: 4345 symptom check-lists "0", filled in by 319 patients treated in day-hospital in the years 1990-1998 were analysed. The studied group consisted in 235 women and 84 men with somatization disorders, generalized anxiety disorder, dissociative disorders and a combination of those mentioned above. Results: In groups of patients with different therapy outcome, different types of global symptom level sequential changes were observed. Some phenomena like weeks of invariant symptom level ("a plateau") occurred with a different frequency related to the final therapy outcome. During treatment, the global symptom level fall below 200 pts in women and 165 in men often preceded global symptom exacerbations and occurred even in therapies with non-beneficial final results. Conclusion: Some traits of global neurotic symptom level dynamics may be understood as additional markers of beneficial or non-beneficial therapy processes. Sequences of symptom decrease, as well as sequences of short increase were connected with better therapy results. Weekly filled in symptom check-lists may be useful for monitoring of the psychotherapy process, but a decrease of the global symptom level (OWK) to values typical for healthy population does permit one to consider a patient as a "cured" one. Even a decrease of OWK below 100/82 pts is not always connected to a further maintaining of a global symptom level in the healthy subject domain.

Wiesław Sikorski
Zachowania proksemiczne (przestrzenne) w relacji terapeutycznej   89
Proxemic behaviours in the therapeutic relation 89
In the article the meaning of physical environment and the role of personal space during a therapeutic session is presented. In the first case the author focuses on the characteristic of various physical features of the room intended for therapy running. In turn, the furnishings: furniture, equipment, wall colouring, lighting as well its location are considered. All in all, a suitably designed room creates a favourable atmosphere: warmth, intimacy, privacy and a lack of embarrassment. This results in the activation of different kinds of non-specific therapeutic factors, i.e. ritual therapist's work. By giving the examples of his own therapeutic practice, the author proves the effectiveness of therapy when the care of therapeutic environment is taken into account. In the second case the author considers the influence of interpersonal space, physical distance between a therapist and a patient on the quality of insight work. There is a hint that the optimal distance for the proper progress of therapeutic communication is the area indicated by an upper limit of the personal zone or a lower limit of the social zone, up to 20 centimetres. This is the best physical distance as neither patient nor therapist feels uncomfortable in their private territory invisible "air balloons" surrounding their bodies are carefully protected. Moreover, the author brings up the problem of the proper choice of the table and the way of the patient seats. The best choice is a round table which gives the impression of partnership. If a table is square or rectangle the best option is to seat patients next to a therapist or diagonally on the opposite corner. The first choice emphasizes the willingness of cooperation and identification with patient's problems while the second choice shows a friendly attitude and makes conversation comfortable.


ISSN 0239-4170 (Print)

ISSN 2391-5862 (Online)

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