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Biomedical subjects

U Porsch

Publications and source records attributed to U Porsch.

15 recordsLinked to original sources
PubMed2001

[A consecutive study of patients with irritable bowel disease in two tertiary referral centers].

OBJECTIVES: We investigated the nature of illness behavior and the meaning of emotional deficiencies during childhood in patients with irritable bowel diseases (IBS). DATA: A consecutive study in two tertiary referral centers was conducted with 48 patients suffering from irritable bowel diseases (IBS) and 91 patients with inflammatory bowel disease (IBD). METHODS: The diagnosis of IBS was made by following the Manning criteria, a positive diagnosis of IBD was established through physical, endoscopic and radiologic examinations and was confirmed histologically. Psychological data were obtained by structured psychiatric interviews and psychological self-report measures (GBB). RESULTS: We found that the rate of physician visits given in the course of the disease, is increased for those having irritable bowel disease (IBS). These patients are dissatisfied with the physicians and prone to psychophysiological complaint. In the daily routine and in occupation they are more impaired than those with inflammatory disease. This finding emphasizes in particular that patients with irritable bowel diseases (IBS) have experienced emotional deficiencies in childhood as an after effect of loss, divorce of the parents etc. CONCLUSIONS: Implications for doctor-patient relationship and the necessity for epidemiological studies in Germany are discussed.

Adult↗
PubMed1997

[Countertransference in schizoid disorders].

Twelve experienced psychoanalysts diagnosed during a depth-psychological examination of 604 patients, coming from two different outpatient institutions, distinct clinical schizoid personality traits of 65 patients (10.7%). A further analysis researched the contribution to patient and therapist bindings and influences on the diagnosis. With the aid of a step by step regressions analysis including "solid" patient and therapist data as well as countertransference reactions of the investigator, we were able to establish an accurate diagnostical model, which enables a correct assignment with the probability of 90%. The most important diagnostic criterion proved to be the countertransference of the investigators. This demonstrates that affective processes from the therapist side-should be assessed as a potent criterion that distinctively increases the validity of the diagnosis.

Adult↗
PubMed1997

[Internal representation of diseased organs and symbolic disguise of conflictual object relations].

Psychoanalytic-psychosomatic hypotheses assume, among other things, that patients with psychosomatic diseases tend to represent conflict-laden object relationship experiences symbolically in the diseased organ of the body. This assertion was tested on 139 patients having inflammatory and irritable bowel diseases with the help of the repertory grid technique. Univariate analysis showed that this hypothesis not only applies to the primary object, but is also valid for the partner relationship. Neither gender nor illness behaviour affect the connections observed here. Although patients with irritable bowel diseases as well as those suffering from Crohn's disease or colitis ulcerosa, have differing pathogeneses, there is a comparable tendency in all three diagnostic groups to represent object relationships leaded with conflict symbolically in the diseased organ of the body. The finding that the physical and psychological condition of the moment in the sense of a reactive component like-wise has to intervening influence, leads to the supposition that, in accordance with theoretical assumptions, this is a general factor.

Adult↗
PubMed1992

[Psychogenic pain conditions. Defense structure and taxonomic subgroups].

According to the results of the prospective Grant-Study the maturity of the individually available defence mechanisms has an essential influence on both physical and psychic well-being. Psychogenic pain patients are characterized by a "turning against self": an immature defense mechanism. By means of a cluster analysis, three taxonomic subgroups (types A, B, C) were defined. Type A is characterized by immature defense mechanisms (projection, turning against self and against object) and type C by neurotic defances (reaction formation and intellectualization), whereas type B manifests both intellectualization and a turning against self. Raised scores for anxiety, abnormal illness behaviour, depressive self-image, depressive mood and suicidal ideas are additional features which distinguish types A and B from type C. In contrast to type B, type A shows a negative social resonance, "doctor shopping" and drug abuse. The diagnostic differentiation of types A, B and C could be the basis of a differential indication to the different psychotherapeutic treatment approaches to chronic pain patients.

Adult↗
PubMed1988

[Psychotherapy institutions and their patients].

This article investigates a number of institutions and private practices involved in the Berlin psychotherapy study from the point of view of their patients and their offerings in the area of therapy. Certain similarities have been found to exist between the institutions in the sex and age structure of the patients as well as in terms of the high level of previous experience with psychotherapy and psychoanalysis and previous medical measures. None of the institutions or practices saw primarily socially privileged patients, as is sometimes maintained. To a considerable degree the people they see live in a destabilized situation or one that is not yet stabilized and enjoy little social certainty (ca. 50%). The rate of the indication for psychotherapy and its actual initiation varies considerably from one institution to another. It runs the spectrum from the municipal counseling services, whose little motivated patients are only open to psychotherapy at all at a rate of 50% (actual therapy 22%) to patients in private psychotherapeutic practices who have gone through a long motivational process and who begin therapy at a rate of 70%. Study of the relationship between the location of the institution and the area in which the patients live shows on the one hand a tendency toward regionalism insofar as institutions are preferred by the patients who live near by. On the other hand, these special institutions are also sought out by patients from more distant locations and from differently structured areas; these patients are represented to the same degree as patients from the immediate area. Although psychotherapeutic institutions are often situated in the "better" residential areas, their patients are by no means only from such privileged areas but from all regions, including those that are socially weak.

Adult↗
PubMed1988

[The Berlin psychotherapy study (decision on indications and the therapeutic reality in various fields of psychotherapy practice].

This article presents concepts, problems, and approaches used in a completed observational study carried out by 47 therapists in analytical/psychotherapeutic private practices and institutions. The diagnostic situation (of 739 patients) and the initial phase of therapy (involving 381 patients) were studied with the help of a comprehensive system of documentation. What is documented here is the patient perspective on the one hand and the perspective of the therapists on the other with regard to numerous self-evaluations and evaluations by others, evaluations that throw light on the diagnostic-therapeutic process from different observational levels. Most of the scales used were developed in the study group. Given the complex structure of the data, new methods of storing and evaluating data had to be found. In addition to the description of the therapeutic reality of a large city, the main goal of the study was to examine the patient-therapist relationship and the prognostic elements it contains since these elements influence the indication for psychotherapy and the possibility of its successful realization and thus have the character of predictors for the course of psychotherapy. A number of other results of the study are presented in the succeeding contributions to this issue.

Berlin↗
PubMed1988

[The initial patient-therapist relation as a predictor of the course of treatment. An empirical study of prognostic factors in psychotherapy].

This article presents the results of investigation of prognostic factors (in terms of the decision concerning indication and the course of therapy) that can be deduced from the initial diagnostic situation involving 739 patients and their therapists within the framework of the Berlin psychotherapy study. Four groups of predictors for the course of therapy can by identified. Of greatest value are a related group of factors that describe the readiness for therapeutic cooperation against a background of feelings of individual self-esteem. Another group of predictors signals an unfavorable course of therapy in the presence of social stress, social incompetence and disintegration combined with avoidance behavior and somatic demands for consideration. The next group of negative predictors includes evidence of anxious-distrustful avoidance of contact and simultaneous helplessness on the part of the patient. A final positive group of indicators is based on a positive evaluation of a biography that has given the patient positive relational experiences and supportive introjects. The complex of therapists' descriptions and patient evaluations confirms the therapists as prognostic experts but allows for the recognition of differentiation in the patients' judgments. The results are discussed from an interactional point of view and with regard to the congruence of the mutual offers made by patient and therapist.

Adaptation, Psychological↗
PubMed1988

[Forms of therapeutic working relations].

Five different forms of therapeutic cooperation were identified on the basis of evaluations by therapists and patients of the therapeutic working relationship using a multivariate method; the forms were compared with the diagnostic and prognostic information derived from the initial patient history. Differences were determined on the basis of age, economic situation, and behavior during illness, whereas education in the sense of the Yavis hypothesis and also sex had no predictor function for the quality of the therapeutic working relationship. It could also be shown that the patient's neurotic interaction patterns, readiness for transfer, and concept of illness all carry greater weight in a prognosis for the therapeutic working relationship than the establishment of a diagnosis.

Countertransference↗
PubMed1988

[Patterns of therapeutic cooperation and their relation to results of therapy].

Drawing on 121 cases of inpatient psychotherapy, this study investigates the evaluation of therapeutic cooperation by both patient and therapist and the predictions that can be made about the success of therapy on the basis of these evaluations. The authors discuss four different patterns of therapeutic cooperation that differ in the degree of positive judgment expressed and in relation to correlations and contradictions in the evaluations of the two parties to the dyad. The psychological characterization of these patterns makes it clear that they are specific types of mutual relational offers that correspond with the background of the personality structure of the patient in question. Factors of therapy motivation and expectations with regard to therapy, as well as certain defensive reactions, (e.g., denial) and the social class of the patient play an important role. In the second part of the discussion, the authors study the question of how the evaluations of the therapeutic working relationship and the four relational patterns are connected to results of therapy as determined at the end of therapy as well as in a catamnestic examination; it is shown that the degree of the relationship is dependent on the type of changes (structural vs. symptom-centered) that are measured, as well as on the person (therapist or patient) making the evaluation of success.

Humans↗
PubMed1988

[How do patients develop after inpatient psychotherapy?].

The following study examines the attitudes six months after stationary psychotherapeutic treatment of 82 patients examined on a monthly basis. The image presented is consistently positive with regard to improvement in both physical and psychological symptoms, changes in abnormal behavior, the relationship to partners and other people, and with regard to the satisfaction with therapy itself. Complementing the statistical results are citations from lengthy written evaluations by the patients of their stay in the hospital and the influence it has had on their current situation.

Follow-Up Studies↗
PubMed1987

[Status of indications and therapeutic interaction in dynamic psychotherapy and standard analytic treatment?].

The present study concerns itself with the factors that are important in making an indication-based decision for either dynamic psychotherapy or psychoanalysis. In keeping with the interactional approach of our group, we have considered not only certain characteristics of patients but also particular initial relational patterns in the meeting between therapist and patient that lead to the establishing of indications. Examination of patient characteristics shows that older patients with less education are more likely to enter into dynamic psychotherapy but that therapists tend to be skeptical about the prognosis for therapeutic cooperation. With regard to the interaction of therapist and patient, the following specific contact and relational readiness among patients undergoing dynamic psychotherapy could be determined: These patients emphasize their autonomy by means of an over-compensatory stance in which they reject regression, thus presenting themselves as less needful of help. The therapist reacts to this stance by offering a shorter course of treatment with limited goals and less subordination to an established setting. In the case of psychoanalysis, the situation is reversed. This study further analyzes the elements of personality structure and socio-demographic background behind the relational offer of the groups indicated for treatment. A group of patients for whom there are no indications for psychotherapy is drawn upon for purposes of comparison.

Defense Mechanisms↗
PubMed1986

[Neurotic interaction patterns. Scale structure based on the Psychological and Social-Communication Findings Report].

Findings concerning the neuroses in 615 patients who had consulted either of two psychotherapeutic out-patient departments because of neurotic or psychosomatic complaints were documented in the "Psychischer und sozialkommunikativer Befund" (PSKB; Psychic and Sociocommunicative Findings Sheet). Factor analysis resulted in the discovery of ten dimensions of neurotic behaviour which clinically can easily be interpreted as patterns of interaction. The scaling of the factors provides a would-be random sample for calibrating purposes which is applicable to further investigations of psychoneurotic and psychosomatic out-patients. The present article in its methodological part deals with the establishment of the factors, the development of the scales, and the evaluation of quality criteria. The clinical part contains a detailed description and a psychodynamic interpretation of the ten neurotic interaction patterns. Finally the applicability of neurosis profiles from PSKB scales is delineated in the light of examples from our own investigations.

Communication↗
PubMedDate not supplied

[Psychoanalytically oriented group therapy with psychogenic pain patients. A contribution to the treatment method].

Psychoanalytically oriented therapies are widespread in the treatment of chronic pain patients in Germany but there are still few evaluation studies especially for long-term therapies. Derived from the therapy process of a homogenous pain group and its evaluation modifications from the usual psychoanalytical group therapy method necessary for pain patients are outlined.

Adult↗