PSYCHOTERAPIA 3 2005
Manfred Mickley, Bodo Christian Pisarsky
Kompleksowa terapia zespołu nadaktywności z defi cytem uwagi (ADHD) z perspektywy systemowej 5
The complex therapy of ADHD from the systemic perspective 5
The authors of this review paper suggest the perception of ADHD as a diagnostic construct, which has its own place in the specific social-historical context. They shortly describe the criteria of the diagnostics of this disorder. They stress attention on the necessity of careful differential diagnoses. They present the current views on its aetiology and describe the most often used methods of ADHD treatment. The main part of the article deals with the presentation of systemic therapists’ ideas on the genesis and the development of the ADHD symptoms and the therapeutic proposals based on them. The consequences of acceptation of medical-psychiatric paradigms for the therapy of the hyperactive child and his family are discussed. The authors draw the readers’ attention to the value of integration of the biological and systemic way of thinking in therapy, especially in the aspect of various meanings connected with the child taking psychostimulant drugs.
Maria Zegarlicka-Poręba, Przemysława Jarosz-Chobot, Bernadetta Izydorczyk, Ewa Małecka-Tendera
Kompleksowa metoda leczenia młodzieży z cukrzycą typu 1 z udziałem grupy wsparcia psychologicznego 19
Complex treatment including participation in the Psychological Support Group in Adolescents with Diabetes Mellitus Type 1 19
Introduction: The maturation process in diabetic adolescents is characterized by an insufficient metabolic level. Maintaining normoglycemia is a necessity and it is expected from young people with Diabetes during developmental changes. The appearance of emotional disorders, as a result of this burden, inhibits their therapeutic activity. The aim of study is to present the concept and results of a complex treatment of diabetic adolescents who participated actively in the programme. Subjects and method: 30 adolescents (mean age 14.8 +/- 1.0), suffering from DM Type 1 (mean duration 4.3 +/- 2.9), treated with functional intensive insulinotherapy were subjects in study. The subjects forming a homogeneous psychotherapeutic group participated in the GCZDiM programme: Psychological Support Group for adolescents with DMT1 /PGS/. The aim of this programme was to help young diabetics recognize and cope effectively with situations that provoke unwillingness and to realize the therapeutic indications. The estimation of the complex treatment efficacy included a comparison of initial HbA1c and BMI with the values at the end of the study. Statistical analysis was performed using Student-t test (p<0.05). Results: The HbA1c levels decreased significantly in study group (HbA1c 8.7±1.5 vs. 7.9±1.2, p=0.0015; girls: HbA1c 9.1±1.5 vs. 8.0±1.2, p=0.0028; boys: HbA1c 8.2±1.3 vs. 7.7±1.2, p=0.21). In boys no statistically significant difference was confirmed. Initial BMI values were normal and didn’t change during the study. The differences in mean BMI values (study group: 20.1±2.1 vs. 20.4±2.1; girls: 19.9±2.3 vs. 20.2±2.3; boys: 20.3±1.9 vs. 20.7±1.8) weren’t confirmed statistically (p>0.05). Conclusions: Connection medical treatment and psychotherapy increases efficacy, efficiency of DM Type I treatment. The therapy method applying PGS is an effective element of general therapy in adolescents with DM Type 1.
Michał Mielimąka, Mateusz Paluch, Łukasz Kapusta
Różnice dotyczące wpływu sugestii analgezji na przeżywanie bólu w stanie relaksacji i w stanie hipnozy 33
The differences in the effect of suggestibility on pain in a state of relaxation and in hypnosis 33
The issue of pain relief plays an important role in contemporary medicine. Hipnoanalgesia is one of the safest methods of pain reduction. Suggestibility is a characteristic of every person; however, can a simple suggestion modulate pain perception?
The influence of suggestion on analgesia when given in a state of relaxation and a state of hypnosis has been evaluated in a group of 11 students. In the experiment the subjects received pain stimuli in the following four states: 1 – relaxation, 2 – relaxation with a suggestion of analgesia, 3 – hypnosis, 4 – hypnosis with a suggestion of analgesia. The information on the change of the characteristics of pain, its intensity, the course of hypnosis, unexpected phenomena and possible interruptions or disturbances has been gathered with the use of an interview method. A similar interview was conducted in 9 months after the experiment.
The results show differences in the subjective pain perception in the state of hypnosis with the suggestion of analgesia and in the state of relaxation. The differences in intensity and character of pain as well as emotional response to pain stimuli have been observed. Furthermore, in the state of hypnosis with the suggestion of analgesia additional sensations have occurred including formication of limbs, changes in perception of temperature and shape of the object used to deliver the pain stimuli. The hypnosis alone has reduced pain perception in some subjects. One person perceived pain as stronger and more unpleasant. Suggestion alone has decreased the intensity of pain in half of the subjects, but only according to the data collected during the first interview. Moreover, one person has reported a major qualitative change in the nature of the sensation after receiving the suggestion of analgesia in the state of relaxation. The same person has accounted for an impact of suggestion alone on pain perception in the second interview.
In conclusion, the results of this research encourage future study of the impact of suggestion of analgesia on pain perception and the use of hipnoanalgesia as a safe and effective method of pain management.
Karma i indywiduacja: chłopiec bez twarzy 47
Karma and individuation: the boy with no face 47
Karma is a traditional Eastern concept, mirrored in Western analytical psychology as “individuation”. These notions about how meaning is made are concepts near the top of the hierarchy of ideas in their respective traditions: both are theories about connections between a time-bound part of the mind, which analytical psychologists call ego, and a time-free, transcendent experience, which we call self. The concept “complex” describes both a structure and a process: repetitive patterns of thought and behaviour create suffering. From stillness and clarity, self unfolds into unresolvable oscillations; its developmental spiral is arrested, forming instead a “strange attractor”, ever circling and never reaching its archetypal core in the psyche.
Jung saw individuation as task involving working through complexes, a project for second half of life, requiring a stable identity and persona. His “classical” view, emphasizing the role of archetypes and the collective unconscious in the individuation process, contrasts with that of Michael Fordham and “the developmental school. The latter are close to Eastern ideas — both see self as a gradual unfolding from potential to actual throughout the whole of a life.
This paper explores karma and individuation, through the work I did with Yukio, a young Japanese man born with severe bilateral cleft palate. Overwhelmed by shame, he believed himself beyond help due to “bad karma”. Repeated emotional traumas hindered identity formation, producing deep problems in forming symbols and relation to others. Born with a malformed face, he felt fated continually to “lose face”. As a new sense of identity emerged, with it came the courage to have a new face. The enactment, “gaining face” by plastic surgery, was a counterpoint to our work.
Łukasz Müldner-Nieckowski, Krzysztof Rutkowski
Terapia w piaskownicy 63
The sandtray therapy 63
In the article, the Sandplay therapy, which is one of psychotherapeutic techniques used in analytical psychology since 1960’s, has been presented. An outline of the concept, the technique development and also the theoretical background and practical course of the therapy have been described.
The Sandplay therapy is a well established therapeutic technique, mostly used by Jungian analysts. It’s originators – Margaret Lowenfeld and Dora Kalff – recognised a spontaneous play in a safe and protected therapeutic space as both healing and transforming for children as well as for the adult patients. The authors suggest to use the Polish translation “terapia w piaskownicy” which is not exact, but gives a better sense of the way sandtray is used in this method. The Sandplay Therapy consists of multiple sessions, in most cases during verbal analysis, during which the patient is encouraged simply to play with small figurines of different kinds in a small sandtray.
An analytical interpretation of factors activated in the process of the Sandplay therapy and the ones that play a basic role in the process of healing have been considered in detail.
Wyzwanie okrutne, lecz pasjonujące 69
The cruel challenge, but a fascinating one 69
The author shares with the readers her own experience of the psychiatric illness, and the ways of dealing with it.
Ile psychoterapii w rehabilitacji? 75
How much psychotherapy in rehabilitation? 75
Using the example of the ‘U Pana Cogito’ Hotel project, the author presents the mutual influence of the elements of the rehabilitation and psychotherapy processes in those with an experience of psychiatric illness. The difficulties connected with undertaking the job by these patients, entering the new social roles and interactions are described. The therapeutic factors connected with group dynamic process and the building-up of independence and the patients’ own identity are indicated. A clinical case is presented for clarity.