To report and discuss the use of psychoanalytic treatment for children victims of sexual abuse.

We report the psychoanalytic therapy of a seven year-old boy, sexually abused, discussing the “play technique” developed by Melanie Klein.

The boy does not speak to the analyst about the abuse. He has serious changes in his behavior and attempted suicide after that. In the first session with play materials, he draws a heart and partially paints it black, writing his name in it. He is very uncomfortable with the stains caused by black pencil on the white paper sheet. With scissors he cuts the heart and places it on the stretcher. He throws away the stained paper in the waste paper basket. Then he plays the game of catch-rods. At the end of the session, he puts all the toys in the box, and gives to the analyst the “cut up heart” that was on the stretcher, saying that it should be kept under the analyst's care.

With the use of the toy, Klein was able to extend the psychoanalytic concepts proposed by Freud from the analysis of adults, allowing children to be analyzed. By playing, children symbolically represent their fantasies, anxieties and defenses, expressing their models of relationship with the world. In the session of “play therapy”, children can communicate their anxieties and also find resources for the overcoming of their traumas. With his “cut up heart”, the child communicates his suffering, requiring care from the analyst.

To discuss the use of the psychoanalytic method in clinical research and treatment in cases of child sexual abuse, through the account of assistance to a 9 year old female victim of incest.

Session-report of the child.

The girl, abused by her father, shows up in her introspective first hour of play, refusing to address the abuse. Draws three hearts by writing down their names. In the first, writes her name inside the heart and the name of the mother. Under the second, she writes the name of her stepfather whom she calls “father”. Under the third “mother” and writes her name. Delivers to the design analyst and cries, saying she wants her father, calling the name of her stepfather. Later assembles a puzzle of Noah's Ark. She says that God sent Noah to build the ark to bring an animal of each species. The analyst wonders whether it would be a couple of animals. She curtly replied no.

Through the session hour, we observed the injuries produced by emotional abuse, and the child's need to seek a trusted father figure, represented in the drawing of her stepfather. Because of the loss of confidence, the analyst is an element of persecution for the child, and the “analytic couple” still cannot be formed. Note the importance of understanding the symbolic communication expressed in the play, which highlighted situations of psychic damage and the need to repair the damaged parts of the self.

Family-based interventions have shown to be effective in the treatment of major depression. In a recent RCT, systemic family groups led to significantly higher rates of treatment responders and higher rates of patients no longer using antidepressant medication at 15 months follow-up compared to standard care.

In order to better understand the underlying mechanisms of change, helpful treatment experiences of depressive patients and their partners in the family groups were explored.

34 depressive patients and their partners were asked to fill out an open-ended questionnaire investigating helpful experiences during treatment at the end of a 6 bi-weekly group session cycle. Responses were analyzed using the interpretative phenomenological approach (IPA) by three different researchers.

Ten recurring themes were reported as helpful by both the depressed patients and their partners:

1. (1) Presence,

2. (2) Cohesion,

3. (3) Support,

4. (4) Openness,

5. (5) Discussion,

6. (6) Self revelation,

7. (7) Insight,

8. (8) Progress,

9. (9) Observational experiences and

10. (10) Guidance from therapist.

The results of this study help to get insights in the therapeutic factors, which should be emphasized in family groups.

Negative life events can result in adjustment disorders. If there are feelings of having been treated unfair, been let down or been humiliated one type of reaction are prolonged states of embitterment, which has been described as Posttraumatic Embitterment Disorder, PTED. A new approach in the treatment of PTED is cognitive behavioral psychotherapy which uses special strategies based on wisdom psychology. Wisdom has been defined as the capacity to cope with unsolvable and serious problems and questions in life.

In a controlled clinical trial psychosomatic inpatients which suffered from PTED, were randomly assigned to “wisdom therapy” (N=28), which focusses on the reframing of the traumatic event and to “wisdom and headonia therapy” (N=29), which additionally encourages patients to focus on positive aspects in life. Another group of PTED patients (N=50) and patients with other mental disorders (N=50) received treatment as usual.

PTED patients who were treated with wisdom psychotherapy showed a reduction in the SCL-90-PST score of initially 55,7 and at the end of 40,1 and those treated with hedonia therapy of initially 58,7 and at the end of 41,3. Measures of therapist adherence showed that therapists in both groups used wisdom strategies. PTED controls started initially with a SCL-90-PST score of 52,2 and ended with 50,2. Other patients started treatment with 39,3 and finished with 25,9.

This first treatment study on cognitive wisdom therapy suggests that wisdom can be helpful in the treatment of adjustment and embitterment disorders.

Many studies showed the efficacy of interpersonal psychotherapy (IPT) on depression; however, there were limited studies concerning the universality of the IPT problem areas in different countries. This study identified whether the interpersonal triggers of depression defined in the manual were present in Thai depressed patients.

Thai Hamilton Rating Scale for Depression (Thai HRSD) and Thai Interpersonal Questionnaire were used to assess the 90 depressed and 90 non-depressed subjects in King Chulalongkorn Memorial Hospital, during July 2007 - January 2008. The association between interpersonal problem areas / sociodemographic variables and depressive disorder were analyzed by chi-square test. The logistic regression was performed to identify the predictors of depressive disorder.

Most of subjects were young and middle-aged females, living in Bangkok. All four interpersonal problem areas (grief, interpersonal role disputes, role transitions, and interpersonal deficits) were increased in the depressed as compared to the non-depressed subjects as well as in sociodemographic variables (low education, unemployment, low income, and having a physical illness). Logistic regression showed that all interpersonal problem areas still remained the significant predictors of depression. (grief: adjusted OR = 6.01, 95%CI = 1.93 - 18.69, p < 0.01; interpersonal role disputes: adjusted OR = 6.01, 95%CI = 2.18 - 16.52, p < 0.01; role transitions: adjusted OR = 26.30, 95%CI = 7.84 - 88.25, p < 0.01; and interpersonal deficits: adjusted OR = 2.92, 95%CI = 1.12 - 7.60, p < 0.05)

All four interpersonal problem areas are applicable to Thai depressed patients.

Systemic family therapy as psychosocial intervention is focused on family on the whole.It is considered that multidimensional approach is the most appropriate way of treatment.

We described psychoeducative working model in work with families with young schizophrenic member, aged 20-30years. We worked simultaneusly and paralelly with five families each, total 15 families, in form of network seances lasting 1,5 to 2 hours, during period of three months.Data were obtained through interview and unstandardized test questionnaires - beginning and evaluation one.

We got expected results, meaning that complete disfunctionality of actual organisation was confirmed. The feelings of helplesness, shame, guilt, uncertain future and anxiety prevails. Identified patient is central point, he/she occupies the top of hierarchy scale. Families have diffuse internal subsystem borders, rigidity of outer borders, and many alliances, triangles and coalitions.In communication there is no directivnes, and there is a presence of paradox, avoiding, denial, and emotional exchange varied from network to extremely distant.

Based on responses from our evaluation questionnaire, we concluded that implementation of this type of work is necesarry. Our clients accepted it, as it leads to improvement of everyday life, induce self-respect and sense of ones own efficiacy. Family members became supportive network to each other in specific conditions. Instead of network of professionals, the network of people with similar hard expirience and their own ways of help in family crisis situations was formed.

Outpatient group psychotherapy began in our department in 2002 as a complement to the acute inpatient unit. Patients with heterogeneous diagnoses were included before or after a short-duration stay in the unit. Clinicians’ impression was that re-entries to the acute unit were less frequent and shorter after group therapy.

The objective is to determine the real impact of group psychotherapy on the number and mean duration of these re-entries.

Data was collected for 156 patients during period of two years. The number and mean duration of hospitalization in the psychiatric acute unit were registered for each patient during the year before and in the year after therapy to be analyzed and compared.

Before attending group psychotherapy 60.3% of the patients were hospitalized in the acute unit (39.1% once, 12.8% twice, 6.4% three times, 1.9% four times). 65.4% had no re-entries in the following year; 71% of those who did had one re-entry. The mean number of entries per year in the acute unit before therapy was 0.92, while the mean after therapy was 0.52. The mean stay was 7.86 days before therapy, and 4.62 days after. The mean differences between before and after entries were significant in statistical analyses.

Group psychotherapy seems to have effects on number and duration of re-entries to the acute unit for most patients in the different diagnostic categories. These findings have important implications, as this form of therapy is cost-effective and available for a wide range of psychiatric patients.

Therapeutic Writing ist not yet commonly used in Psychiatry and Psychotherapy although it seems to be a promising supportive and well accepted therapeutic tool. Over the last years we have implemented group therapy for Therapeutic Writing at four psychiatric clinics.

Exclusion criteria were insufficiant knowledge of language, illiteracy or insufficiant ability to participate in therapeutic groups. We treated in-patients in a secure environment, on general psychiatric wards and in a day-clinic setting from adolescence to seniority mainly with Schizophrenia, Depression, Bipolar Disorders, Personality Disorders, Anxiety Disorders,and Eating Disorders.

This poster outlines our theoretical framework as well as practical aspects of implementing Therapeutic Writing as a group therapy in a psychiatric/psychotherapeutic setting.

To evaluate the changes in perceived social support in patients treated due to neurotic and personality disorders with intensive group psychotherapy.

An analysis of structural and functional social support and personality descriptors evaluated at the beginning and at the end of intensive group psychotherapy has been performed in the group of 60 patients. Social support has been evaluated in terms of informative, emotional and instrumental aspects with the use of Berlin Social Support Scales and in terms of the structure and functional properties with the use of Bizoń’s method of social network and social support assessment. Personality descriptors have been obtained using Neurotic Personality Inventory KON-2006 and NEO-PI-R.

Results of this research support previous findings that successful psychotherapy (in terms of favorable changes in personality descriptors) alters the perceived structure and function of social support. Less populated social support networks become more effectively utilized. Individual members of the networks become perceived as providing social support in a wider range of functional properties. Moreover an overall increase in patients’ satisfaction with available social support has been observed.

Promising results of this study, that support previous findings, show the need for further research on the subject matter. Further analysis of relationship between changes in limited personality traits and particular aspects of social support will provide additional valuable data.

As this is a time of great change in Romanian psychiatry we considered it was useful to analyze the availability of various types of psychotherapy and the commitment of psychiatry residents to psychotherapy training, comparing with data from 1998.

Same protocol study like in 1998 was used. The data from National Centre for Medical Training were analyzed. We examined the total number of residents undergoing psychotherapy training, year of residency and the type of psychotherapy they chose.

In 2009, there are 726 psychiatry residents in Romania (180 in 1998) distributed in 11 (6 in 1998) university training centres. We registered a response rate of 81.8% (77.7% in 1998), and only 30.13% residents are involved/ in a specific psychotherapy training comparing with 48.5% in 1998. The types of psychotherapy were: cognitive behavioural therapy, positive psychotherapy, transactional analysis, psychoanalysis, psychodrama, hypnosis, existential psychotherapy.

Even though training in psychotherapy is included in curricula like compulsory topic since 2007, the availability of psychotherapeutic training for residents is still restricted, due to high costs, the need to self-finance the training, organizational difficulties and low number of training centres and trainers.

Center for mental health is established in May of year 2005. Center for mental health promotes the mental health care in the community.

To evaluate the effect of group psychotherapy on chronic psychoses, ambulatory treated in Mental Health Center in Kotor, Montenegro.

The influence of the effect of group psychotherapy on chronic psychoses in the development of optimal socialization.

The group consists of patients who were coming for regular check-ups in our health center during previous 3 years. The group is semi-opened and it is heterogeneous in respect to gender and age. The effect is estimated by observing the behavior of group dynamics. There were 8 regular members in this group and additional ones who participated occasionally, on suggestion of their psychiatrist.

During the initial group meetings it was noticed that the patients are not familiar with each other, even though they were previously treated in our local psychiatric hospital and are inhabitants of a same, small town. They didn’t communicate with each other and didn’t even know each others names. They were distrustful toward new group members and couldn’t think of the questions to ask when the new members were presented to them. After six months, group members formed friendship relationships.

Evaluation of the effect of group psychotherapy on chronic psychoses treated ambulatory is facilitating the development of optimal socialization as well as optimal interpersonal relationships within group, in respect to the nature and progression of mental disorder.

Psychotherapy is usually viewed as a process of help, reparation and personal growth. Although creativity is the real essence of psychotherapy, few works have approached psychotherapy from its creative aspect. This work investigates some creative potentials of psychotherapy.

We tried to investigate the research question: “Can Psychotherapy follow the same stages/phases of a well known creativity model?” in two different therapy groups; an analytic group held in UK and an interactive dynamic group held in Egypt.

We aimed to follow the evolutionary phases of the therapeutic process in the two groups and find if they could be categorized into certain stages/phases that can match the stages/phases of well-known creativity models; namely Wallas’ (1926) and Barron's (1988).

1. - Clinical data were derived from two therapy groups that were held in the same time in two different cultural contexts; an analytic therapy group held in UK and an interactive dynamic therapy group held in Egypt.

2. - Analysis of the therapeutic work was done using Interpretative Phenomenological Analysis.

The therapeutic processes in the two different groups could follow the same stages and micro-processes of well known creativity models. However, the two therapeutic groups followed two different models of creativty (the British group followed Wallas’ model and the Egyptian one followed Barron's model). This could be explained by many sociocultural factors.

Psychotherapy can be regarded as a creative process in the sense that it can follow the same stages and micro-processes of well known creativity modes.

Behavioral addictions, like computergame addiction respectively internet addiction, have become a growing concern in research. Currently similarities between behavioral addictions and substance dependency are discussed in the scientific community controversially. Unfortunately a mismatch exists between high rates of treatment seeking people and low rates of scientific studies on computergame-addiction, especially concerning risk factors and their contribution to the etiology of computergame addiction.

The aim of this contribution is to shed light on possible etiological factors of computergame addiction concerning personality and vulnerability to stress in clients of the “Ambulanz für Spielsucht”, a specialized outpatient clinic at the University of Mainz.

131 clients were testet with several psychometric measures including ACA-S (Scale for the Assessment of Computergame-Addiction), SCL-90R (Symptom Checklist 90R), NEO-FFI (NEO Five-Factory-Inventory) and Brief-COPE.

69.4% (91 clients) fulfilled criteria for computergame addiction, 30.6% (40 persons) showed no psychopathology. The examination unveilled several caracteristics in addicted computergamers: They revealed higher levels concerning Global Severity Index (GSI), with increased subscales of depression and social insecurity. They showed significantly higher scores in the personality factor “Neuroticism” and decreased scores in the factors “Extraversion” and “Conscientiousness”. Addicted computergamers stand out from normal gamers in respect of nature of coping strategies, making predominantly use of avoiding ones.

The results contribute to a better understanding of underlying mechanisms leading to and sustaining addictive computergame behavior. The role of maladaptive coping strategies and social insecurity points out the necessity to add appropriate elements to psychotherapeutic intervention strategies.

The aim of our study was to compare the cognitive distortions in learning-disabled male sex-offenders before and after the administration of full 52-weeks Sex-Offenders Treatment Programme(SOTP).

As a part of the CBT-based Sex-Offenders Treatment Programme, 17 male adults were referred for therapy(over a period of 2 years) out of which 12 were accepted for SOTP. Mean age of the subjects was 32.5 years(Range: 22-50 years) and mean IQ was 65.16(Range: 53-75).

SOSAS(Sexual-Offenders Self-Appraisal Scale) was administered both pre and post treatment. This instrument consists of 20 statements from four sub-scales: Denial, Victim Blaming, Minimization and Realism to which each respondent was asked to indicate his degree of agreement or disagreement.

We noticed an improvement in Denial and Minimization scores in 58% of cases, Victim Blame scores in 25% of cases and Realism scores in 67% of cases.There was a little (< 5%) or no change in 25% of Denial scores, 17% of Victim Blame scores and 9% of Minimization and Realism scores.A deterioration in 17% of Denial scores, 58% of Victim Blame scores, 33% of Minimization scores and 24% of Realism scores.

Our results reveal beneficial effect of SOTP on the cognitive distortions of Denial, Minimization and Realism in more than half of the patients but deterioration in the cognitive distortion of Blame.

While the results suggest CBT-based Sex Offenders Treatments are beneficial in modifying cognitive distortions, further research is needed to validate the effectiveness of this approach, especially in long-term follow up studies.