PSYCHOTERAPIA       ISSN 0239-4170

3 (146)

Psychoterapia 3/2008

 

Jakub Przybyła

Narodziny nieświadomego. Historia i znaczenie pojęcia 5-18

The birth of the unconscious. The genese and the meaning of the idea 5-18

Streszczenie

Autor przedstawia zarys znaczeniowy pojęcia „nieświadomego” w różnych paradygmatach filozoficznych pojawiających się w historycznym rozwoju filozofii. Ukazuje konsekwencje zaszczepienia tego pojęcia na gruncie psychologii i nauki i dzisiejsze jego znaczenie w psychoterapii.

Summary

The main task of this work is a presentation the topic of the unconscious, which is strictly associated with psychological and psychotherapeutic practice. The article concerns the functioning of the notion of the unconscious in the realm of different parts of knowledge. It analyses different meanings associated with this notion and the functions it performs in various conceptions. Furthermre, the text traces back the emergence and development of thought on the unconscious in philosophy, psychology and history of ideas. The term unconscious is used here in the most general sense, subsuming other forms of negating consciousness, such as unconsciousness and subconsciousness. The author strives to present the growth of reflection about the unconscious from the point of view of changing paradigms. By referring to H.Schnädelbach’s schema, he derives the discourse on the unconscious from the criticism of problem solutions proposed by the mentalist paradigm in philosophy, as represented by Descartes and Kant. Seen from this perspective, the notion of the unconscious is intended to overcome the ontological dualism between thinking and extended substance and the dualism between phenomena and things in themselves. This theme emerges in the metaphysical discourse on the unconscious. On the other hand, anthropological discourse on the unconscious springs from the difficulty of perceiving human beings as composed of body and soul, ontologically distinct from each other. Seen from this perspective, discourse on the unconscious serves to overcome the basic psychological mind-body problem.

 

Brian V. Martindale

Zastosowania podejścia psychodynamicznego we wczesnej interwencji w psychozach 19-33

Psychodynamic contributions to early intervention in psychosis 19-33

Streszczenie

Autor omawia wkład, jaki wnieść może podejście psychodynamiczne w pracę zespołów zajmujących się wczesną interwencją w psychozach. Psychodynamiczny sposób rozumienia wzbogaca koncepcję psychozy opartą o model podatności na stres (stress and vulnerability model); może dopomóc w zapobieganiu nawrotom; przyczynia się do indywidualizacji planów terapii i pozwala lepiej rozumieć postawy pacjentów wobec leczenia farmakologicznego. Przedstawia również argumenty uzasadniające prowadzenie długoterminowej indywidualnej, grupowej oraz rodzinnej psychoterapii przez zespoły wczesnej interwencji.

Summary

This article considers the contribution that psychodynamics can make to the work of teams providing early intervention in psychosis. Psychodynamic understanding enriches the stress and vulnerability psychosis model; it can contribute to resolving the issues involved in relapse prevention; informs individualised formulations; and can make sense of patients’ reactions to prescribing in psychosis. A rationale is given for longer-term individual, group and family dynamics psychotherapies within early intervention teams.

 

Małgorzata Janas-Kozik, Ewa Stachowiak

Objawy obsesyjno-kompulsyjne, depresyjność i lęk w przebiegu jadłowstrętu psychicznego. Propozycja ich rozumienia w perspektywie adolescencji 35-60

Obsessive-compulsive, depressive and anxiety symptptoms in patients with anorexia nervosa. A proposed understanding in the adolescent perspective 35-60

Streszczenie

W artykule przedstawione są wyniki pracy badawczej, której celem było zbadanie związków pomiędzy występowaniem i nasileniem objawów obsesyjno-kompulsyjnych, depresyjności i lęku a jadłowstrętem psychicznym. Grupa badawcza — dziewczęta chorujące na jadłowstręt psychiczny – była badana czterokrotnie: przy przyjęciu do oddziału, po dwóch, trzech i sześciu miesiącach leczenia. W badaniu użyte zostały metody kwestionariuszowe: Skala Dziecięca Zaburzenia Obsesyjno- -Kompulsyjnego Yale-Brown (CY-BOCS), Skala Depresji Hamiltona oraz Kwestionariusz STAI C.D. Spielbergera.

Summary

Aims and the studied group. The aim of the presented paper is to assess the correlations between the studied group of anorexia nervosa (AN) patients and the control group as far as the presence and intensification of obsessive-compulsive symptoms, depressive symptoms and anxiety during a 6-month observation. 50 AN patients aged 12.5–24 and 20 healthy control group girls aged 18–19 participated in the study. The AN diagnosis was based on ICD-10 and DSM-IV criteria.

Results. The assessment of intensification of obsessive-compulsive symptoms did not reveal a statistically significant difference between both studied groups. There was a statistically significant correlation of depressive symptoms in AN patients upon admission to the Ward as well as after 6 months of treatment. There was also a statistically significant intensification of anxiety as a state in AN patients upon admission to the Ward and after 2 months of treatment. And there was also a statistically significant intensification in anxiety as a trait in AN patients but only upon admission to the Ward.

Conclusions. 1. Extra caution is recommended when making a double diagnosis, i.e. AN and obsessive-compulsive disorder, AN and depression or AN and anxiety disorder, keeping in mind the diagnostic criteria. 2. Depressive, anxiety and obsessive-compulsive symptoms are not specific for all diagnosed AN patients. The fact that similar depressive, obsessive-compulsive and anxiety symptoms were present in both AN patients and in the control group, may suggest the presence of adolescence-specific psychic manifestations, rather than AN-specific co-occurring symptoms.

 

Małgorzata Starzomska

Egosyntoniczność jako patognomoniczny objaw anoreksji 61-74

Egosyntonicity as a pathognomonic symptptom of anorexia nervosa 61-74

Streszczenie

Zdaniem autorki rozumienie anoreksji jako głębokiego zaburzenia tożsamości, polegającego na tym, że choroba staje się gwarantem jej istnienia, umożliwia klinicystom adekwatne rozumienie postawy osoby z anoreksją wobec choroby oraz jej silnego oporu przed leczeniem. Wobec tego rozważane są kryteria oceny zdolności do podejmowania decyzji oraz przymusowego leczenia tych chorych.

Summary

Anorexia is a serious mental disturbance, whose symptomatic feature is egosyntonicity. It means that the afflicted person derives their sense of identity from it. The costs of the disorder are less outstanding for them than its advantages. Egosyntonicity influences the patients’ attitude to their disorder and treatment considerably, and therefore also - the course of anorexia. Anorexics usually believe that they are healthy, or assume that anorexia is very attractive for them. Thus resistance to treatment is one of the most important problems, which clinicians treating anorexia nervosa must cope with. Heated debates have been hold around the account of capacity and compulsory treatment in anorexic patients. They result mainly from the fact that the current conception of capacity, which is based on understanding and reasoning seems to be inadequate for patients with anorexia nervosa, for whom the disorder guarantees maintaining their sense of self. Therefore, it appears that identity should be considered as a relevant factor in the assessment of capacity of these patients, depending on how it affects their ability to make decisions

 

Maryla Sawicka, Anna Osuchowska, Joanna Waniek, Joanna Meder

Zjawisko podwójnej diagnozy w świetle teorii przywiązania - studium przypadku 75-83

The phenomenon of dual diagnosis in the light of attttachment theory - a case study 75-83

Streszczenie

Przedstawiona w artykule historia chorego na schizofrenię i uzależnionego od alkoholu oraz pochodzącego z rodziny dysfunkcyjnej jest podstawą dla zaobserwowania, jak z punktu widzenia teorii przywiązania wyraża się brak bezpiecznych więzi od początku życia i jak jest kontynuowany w jego relacjach z innymi, w dorosłym życiu, a także w relacji psychoterapeutycznej. Autorka analizuje to zagadnienie w świetle teorii M. Ainsworth, która dokonała oceny rodzaju przywiązania od najwcześniejszych momentów życia.

Summary

A key precept of Bowlby’s attachment theory is that every human being has a biologically and genetically imprinted need to develop relationships with other people. The relationship, which develops between a child and mother, constitutes the starting point for the development of ensuing emotional ties with people ever more distant than the mother – both within the family, as well as outside of it. Emotional disorders in adulthood are due to a disturbed early development of attachment. Fulfilment of the need for successful relationships in later life is the key for the building and sustaining one’s mental health. M. Ainsworth has assessed the quality of attachment styles from infancy onward. In the course of her research, she defined three categories of attachment styles: secure, avoidant, fearful-ambivalent. Regardless of attachment style, it is of utmost importance that the adult person’s need for relationships during the whole life comes to fruition on various levels of social interaction. The patient’s psychological representation of the object of attachment may also influence his/her compliance in treatment. The therapeutic relationship in the psychiatric setting can thus be viewed in the light of Attachment Theory. This point of view seems particularly relevant, when one considers the problems encountered in the treatment of dual diagnosis patients. Clinical experience shows that dual diagnosis (psychiatric disorder with concomitant substance dependency) patients are particularly difficult in terms of compliance. This case report describes a 32 year-old man suffering from schizophrenia, addicted to alcohol, with incident abuse of amphetamines, coming from a dysfunctional family background. Close scrutiny of the patient’s life from the perspective of attachment theory reveals a thorough lack of secure relationships from early childhood, through to his adult life, including failed marriage and parenthood. Every addiction therapy, he has hitherto undertaken, has failed, concurrent with psychotic relapse. For the therapist, he is a constant source of frustration.

 

Agata Brzozowska, Agnieszka Wzorek

Wielopokoleniowy przekaz wzorca zaburzeń więzi i krzywdzenia jako czynnik ryzyka trudności w terapii dziecka leczonego z powodu nadpobudliwości psychoruchowej (ADHD) oraz opozycyjno-buntowniczych zaburzeń zachowania (ODD) - studium przypadku 85-98

The transgenerative model of attttachment disorders and emotional abuse as a factor influencing the difficulties in psychotherapy of a child treated of attttention-deficit hyperactivity disorder (ADHD) and oppppositional-defiand disorder (ODD) 85-98

Streszczenie

Autorki piszą o efektywności różnych form terapii dzieci z ADHD ze współwystępującymi zaburzeniami. W oparciu o przegląd literatury oraz opis przypadku, dokonują analizy przyczyn trudności w terapii 10-letniego chłopca leczonego z powodu nadpobudliwości psychoruchowej oraz opozycyjno-buntowniczych zaburzeń zachowania. Gdy standardowe metody terapii, takie jak farmakoterapia, psychoedukacja i treningi rodzicielskie nie przyniosły poprawy w funkcjonowaniu dziecka, zwrócono uwagę na charakter więzi dziecka z opiekunami i jej transgeneracyjne uwarunkowania.

Summary

Based on literature review and data from the presented case report the authors have discussed possible reasons of difficulties in therapy of a 10-year old boy with attention-deficit hyperactivity disorder (ADHD) and oppositional-defiant disorder (ODD). Special attention was given to quality of attachment and its transgenerative conditionings. Standard therapy methods, such as pharmacotherapy, psychoeducation and parental skills training did not result in improvement of the child functioning. It seems to be important to include attachment therapy in the treatment of children with ADHD and ODD coexisting with emotional abuse.

 
Recenzje


Komunikaty
 

ISSN 0239-4170 (Print)

ISSN 2391-5862 (Online)

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www.psychiatriapolska.pl
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