Escolar Documentos
Profissional Documentos
Cultura Documentos
Zusammenfassung
Integrationprozesse von Krper, Vorstellung und Sprache: Kasuistik aus einem psychologisch-psychotherapeutischen und einem krperpsychotherapeutischen Blickwinkel.
In dieser Falldarstellung aus dem Kontext der Forensischen Psychiatrie wird ber den Entwicklungsprozess einer
jungen Frau mit einer schweren Form der PTBS berichtet. Symptomatische Charakteristika der (durch den Freiheitsentzug akzentuierten) Borderlinedynamik waren Mutismus, Dissoziationen, Suizidversuche und ausgeprgte krperliche Missempfindungen. Neben der psychologischen und krperbezogenen Psychotherapie kamen Psychopharmakotherapie, DBT, Milieutherapie und Kreativtherapie zum Einsatz.
Die Klientin imponierte im Alltag nicht nur durch Suizidversuche und dissoziative Episoden, sondern darber
hinaus durch eine ambivalente Beziehungsgestaltung mit Polarisierungen von Vermeidung und Provokation, von
Angst, Sehnsucht und Aggression, von An- und Abwesenheit wechselnder Krperlichkeit. Das psychotherapeutische Setting war als komplementre Behandlungsstruktur (intra-/extramural, stationr/ambulant, Mann/Frau,
Psyche/Krper, verbal/nonverbal, reflexiv/expressiv) konzipiert: Als therapeutische Grundhaltung ging es, fundiert durch das DBT-Konzept der Station, um Gelassenheit, Angstfreiheit und Gewissheit, um Akzeptanz, Holding und Containing, um Zuversicht und Humor.
Es werden 5 Phasen des therapeutischen Prozesses mit ihren Hauptmerkmalen beschrieben und die Bezge
zwischen psychologischer und krperbezogener Psychotherapie verdeutlicht.
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Documentary transcript of a powerpoint-based oral presentation. 4th International Congress on Borderline Personality Disorder and Allied Disorders Bridging the Gap from Basic Science to Treatment Implementation. 8
10 September 2016, University of Vienna (Austria). [The acronym UK stands for ULRICH KOBB, the acronym AR
for ANDREA RADANDT.]
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_ Our patient, well call her Mary3, came 20 years old form a psychiatric hospital where she had been isolated for about 5 months because of a
non-specified dangerousness. The index-delinquency was a suicidal acting-out: She had tried to burn herself during a hospitalisation and exposed many people to danger.
We met a hostile autistic young woman which avoided any contact, which
seemed to be seriously disturbed, sometimes hallucinating, often dissociating.
Biographic information were very vague. We knew that she had been violated by her father and other male family members during almost 10
years.
The anonymous patient gave the permission as well to report her case as to reproduce her drawings.
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ble, until someone came along who didnt know that and just did it. This
was a step to another work.
One of the first interventions was to create containers for her intrusive
recollections and flash-backs.
_ She came back with the drawing of a brick wall container for her violating past, of a steel container for her nightmares and a third container
for her fears to loose her 2 years old son here named Giorgio who had
been placed in a foster family.
In the same time, the patients group was occupied with zen-related reflections concerning the principles of DBT and the idea of hope.
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In this phase I was convinced to have enough bases with Mary to ask Andrea Radandt [AR] to come inside the forensic hospital and to work with
her:
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_ I planned to begin with little functional and experience-focused exercises allowing her to feel her body, move it on purpose and give personal meanings to certain movements. It was all about enhancing the
ability to perceive herself: inward and outward bodily movements,
thoughts, associations, feelings, impulses. In the course of time we also
tried to find movements that could support the exercises she had already
learned to regain control, when being flushed by traumatic memories and
body-memories.
o finding movements to support known techniques to stop ash backs
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_ About the daily and sometimes stressful life on the ward, about her
family, her wish to be dead, about painful bodily memories that felt like
real. Sessions 32 to 37 I focused on PBSP-work, mainly letting her experience the basic needs of protection and support through her body. Sessions 38 to 40 she tried to convince me that she really had experienced a
sexual molesting through a staff member. I tried to keep neutral in this
complex topic.
Sessions 41 to 53: Close to the end of the clinical phase sessions were
marked by ambivalence, hostility and breaking off the therapy sessions.
Finally she could talk about the reasons for her behavior: as a therapist I
had become too close to the mother she had wished for herself as child.
She believed that this was not okay, these feelings were not allowed. I
declared these feelings as quite normal during an intense therapy process
and also as a progress.
After that she wanted to talk about her traumatic experiences during the
last clinical sessions and wanted me to write down what she reported and
she also wanted to go to the designated therapy room in the basement.
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_ During this process Mary was occupied with emotions of hate while
she tried not to reveal her counter-aggressive and self-aggressive impulses. It was easier to come to me first with drawings like the sketch
above which opened not only a transitional space but let also see indefinable black holes.
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_ Step for step we were able to identify and to rename emotions or affects like hate, rage, pain, sadness, emptiness and helplessness, but also
love, hope fear and courage.
Even the double-bind became a more conscious and a more explicated
definition: As soon as a limit has been transgressed, everything will be
permitted.
_ Concerning the therapeutic process, we used or varied a lot of methods and settings: Very difficult subjects like the violation and the torture
by her father and his partners she insisted to tell me these atrocities
could only be reported by telling it or to my dog assistant or by speaking
to the wall, by using the wall as a sort of Wailing Wall, at one and the
same time as a containing and reflecting board.
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_ What we developed was a process from being overwhelmed by flashbacks and intrusions, by hate and self-hate, by fear rage and pain, by frozen affect and isolation
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Rehabilitation phase
_ After the client rst did not want to continue the body-oriented psychotherapy she nally changed her mind. Not having seen her for 7 weeks
I drove to the small town on the edge of the Teutoburger Wald to meet
her in her new home.
She greeted me in a very friendly way and then asked me to explain to a
staff member what had been going on with her - but not too detailed - so
that the people in her new surrounding would know how she could react
experiencing stress or being in dissociative phases and how they could react to it. Thus she took control and at the same time arranged self-care in
a way, informing the new staff about her sometimes strange behavior with
loss of control, with intense ash backs, bodily misperceptions and phases
of dissociation.
She also wanted me to inform the staff about early signals for decompensation, possibilities to react to those moments and the things we developed to stop ash backs, regain control and get back into the here and
now (get in touch with the present through haptic/sensorial/acoustic tools:
cherry stone pillow4 and music she likes to hear).
We agreed to meet once a month - it was a long ride for me. During the
rst couple of sessions I seemed to have a function of supporting the
change - like a transitional object - from living behind walls to living in a
place, where the doors were always open for her. Where she could come
and go.
She would complain to me about fellow clients, about staff, about the doctor. And at the same time support the exchange of knowledge about her
between me and the new team around her in both directions.
She very soon was able to grasp the possibilities that lay in living in this
place. Within short time she arranged different staff members as her
ideal family - based on what she learned from PBSP: imagining ideal
parents or parents like she would have needed them, when she was little,
so that her basic needs could be answered in a tting way. There was a
mother, grandmother, sister, aunt, uncle. But no father.
She arranged her room like a room for a girl, declaring herself to be 11
years old, with pink as a main color. She got story books and staff members would read fairy tales to her.
At the beginning of 2016 I was informed by the team, that dissociative
phases no longer occurred. Instead the client could remember consciously
what had happened to her. Often this (overwhelming) memories would
cause impulsive aggressive outbursts.
End of April we analyzed these situations and tried to nd solutions. From
then on we met twice a month. The client showed a high motivation to
improve her situation. She had begun to meet different members of her
family. To my opinion this was understandable on the one hand - she
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Kirschkernkissen.
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_ At the beginning of the summer she reported flash backs and bodymemories. She could differentiate between actual bodily sensations and
body memories.
This led to another body chart - this one also focused on emotions.
The picture shows what she was able to perceive and able to report.
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_ In the early summer she was preoccupied with marrying. The following therapy session she would not talk at all.
The next one she talked about her family and gave the impression - despite my sceptical attitude - to be able to handle it. In July/August she
experienced a severe crisis with auto-aggressive behavior that was caused
by the problematic family constellation, experiencing negative intrafamiliar interaction (disrespect for rules she had set up for her own protection, banalizing the sexual abuse) and deep disappointments on her
side.
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She could reect the complex situation with support and in the following
session wanted to learn new techniques to handle her now frequently upcoming bodily tension.
_ A week later, I was informed that the client had wanted to go back to
the forensic clinic. I met her there. She told me, that she was afraid of
loosing control. Thus preferring the clinic.
It turned out, that the reason for her fear was the temporarily rejection of
her wish to see her family In two individual sessions with Ulrich Kobb [UK]
and me, Mary was able to understand that two Marys in conict could
have provoked the latest crisis:
The little one had powerfully made her way out of a violent and destructive family and still wanted to know more, understand and also wanted
justice.
The adult one just wanted to experience the normal family life of the present.
And at the same time she seemed to need reassurement of her second
family, especially the fatherly gure of my colleague.
Andrea Radandt
Wilfried-Rasch-Klinik
Leni-Rommel-Str. 207
D-44139 Dortmund
E-Mail: ulrkobbe@lwl.org
E-Mail: a.radandt@web.de
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