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In the methadone treatment evaluation study in North-Rhine Westfalia a high psychiatric comorbidity with opiate substance abuse was diagnosed. The formulation of diagnoses according to operationalized criteria (e.g. DSM-III-R) is usefully supplemented by a psychodynamic structural diagnosis in order to get an integrative concept of the psychic problems of the patient. With an example of an opiate addict with narcissistic personality disorder the interplay of drug abuse and behaviour in substitution treatment respectively and the patient's psychic problems is demonstrated and discussed within the theoretical framework of ego-psychology and object-relation-theory. Though many patients in substitution treatment are not motivated for formal psychotherapy, the daily contacts with the patients can be usefully structured according to the principles of psychotherapy of preoedipal or ego-structural disorders.

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With a casuistry we tried to show how disturbances in the free-floating attention of the reporter, which take on the character of micro-symptoms, can be based on the structural similarity of experience moments of therapist and patient; we were able to show how these experience moments influenced the report of an analytic supervision group. Only after a third person joined the others, the triangular relationship within the supervision, was it possible to consciously perceive the structural similarity. Within such a triangular relationship, where the person opposite can always also be seen through the eyes of a third party, it is possible that the capabilities of self-reflection and self-evaluation, which characterize the analytic attitude, can develop via identifications.

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25 neurotic patients, 25 alcoholics, and 25 patients suffering from Crohn's disease were rated with a german adaption (by Streeck) of Bellak's Ego Function Assessment scales. Crohn's disease patients showed personality characteristics similar to those of patients suffering from psychosomatic illnesses. Ego function disturbances could be found with respect to Introspection as a subfunction of Reality Testing, Creativity and Capacity for Abstraction as a subfunction of Thought Processes. The results indicated a remarkable heterogeneity of the Crohn's-patient group as well as possible influences of gender-specific personality differences in that group.

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This study investigated rater-agreement and the factorial structure of the Rating-Scales for the assessment of object-relations and ego-functions developed by Bellak and coworkers. A subset of the original scales with the modifications and translations performed by Streeck was used, altogether 19 scales consisting of sub-components of seven functions. These were applied in assessing patients with neurotic disorders, alcohol addiction and Crohn's disease (n = 25 each). Rater-agreement was not satisfactory: In almost all scales there were significant differences in central tendency; only in seven scales rater-agreement was adequate, it's height varying for diagnostic groups and functions. Results of factor-analysis showed a two-dimensional structure. Implications for further research with these scales are discussed.

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Violent and sexual child abuse represents an extreme traumatization that can continue to influence the lives of affected children into adulthood. Freud (1917) provided a concept of the influence of this extreme form of traumatization in his model of the traumatic neurosis. It is described as an after-the-fact attempt to master the flood of sensations that characterizes the trauma. More recent theoretical models identify a collapse of the ego during trauma as well as the effects of this collapse on the formation of self and object representants at the heart of the traumatic event. As a result of the collapse of the ego during trauma, the traumatized individual does not succeed in forming mature memories of the experience. Immature memories of trauma are marked by, among other things, very diffuse, near physical feelings that cannot be integrated into the ego (Cohen 1980). From the perspective of object relation theories, the lack of integration of "bad" and "good" self of the traumatized individual is emphasized by the abuser. Drawing on case studies, the authors illuminate the importance of the principle of the answer (Heigl-Evers/Heigl 1979, 1983) to the efforts to differentiate and integrate in the treatment of extremely traumatized patients.

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The theoretical justification for two psychoanalytic, therapeutic offers, one of them oriented toward the principle of "interpretation" the other toward that of the "answer", is based on the differences in the psychopathology of two groups of disturbances: In the case of classical (transfer) neuroses, conflict pathology is dominant, in the case of preoedipal or ego structure disturbances, development pathology is dominant. The differences in these forms of illness are related above all to the degree of structuring of the patient. Neuroses exhibit a higher degree of structure than ego structure disturbances, if we understand 'structure' as the differentiation of the psychic apparatus in a certain number of systems with certain programs, i.e. fixed forms of organized behavior. Classical neuroses are more highly structured forms of disturbance with an oedipal superego, intra-psychic conflicts, and an ego which, as an organization process, reveals a potential for integration and a greater tolerance for frustration; they stand in contrast to less highly structured preoedipal forms of disturbance with precursors of a superego in the form of an externalization of guilt, the ego as a kind of battlefield between the id and the superego, with a low tolerance for frustration, i.e., an intolerance of failure. Therapy in these two cases must differ according to the differences in the level of organization: In the case of classical neuroses, application of the therapeutic principle of "interpretation" is indicated, in the case of ego structure disturbances, the principle of "answer" should be applied.

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The significance of the term affect, its development und change within the framework of psychoanalytic theory are described and the perspective and the results of recent empirical research into affects are briefly considered. Then the importance of affects within the process of diagnosis and therapy is examined. It is especially the signal function of affects which serves as an important guideline in the attempt to understand connections of personal experience which have become fragmentary and disrupted, to restore those connections and make them conscious to the patient. Both the affective experience of the patient and that of the therapist are involved in this process. It is also pointed out which phenomenological distinctions are to be made between patients with preoedipal and oedipal disorders in the way they perceive and express affects; from these distinctions the significance of affects for differential-diagnosis can be deduced. Here the signal function of affects is also of central importance. Wherever this function is not fully developed, deficits in differentiation of affects and emotional inundation can be observed. The two different kinds of disorders require different therapeutic techniques when dealing with affects; these are described and illustrated by case vignettes.

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Separation from one's primary maternal love object is a crucial prerequisite for the acquisition of female sexual identity, for becoming a productive person and for loving. Using case vignettes, this paper attempts to show that the experience of separation can effectively be developed in the therapy process by means of six forms of experiencing active and passive abandonment.

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After introducing the terms "morality" and "ethics" as defined by Patzig, the discussion focuses on applying to the practicing of psychotherapy the guidelines for ethics in medicine formulated by Beauchamp and Childress, i.e. respect of the autonomy of the patient, the doctor's duty to prevent injury, the obligation to give assistance and the principle of fairness. In particular, it is pointed out that to hale respect for the autonomy of the patient, a thorough and patient inquiry concerning diagnosis, indication and therapy is necessary in order for the patient to develop intrinsic motivation based on insight into his condition and evaluation of the prognosis. In connection with the discussion of the nil nocere, reference is made to the therapist's duty to take a patient's various limits of tolerance into account. Emphasis is also placed on the psychotherapist's duty to "service" his own psychic apparatus with the help of continued education and in-service training, supervision and self-analysis. Applied to psychotherapy, the obligation to give assistance means encouraging the patient to go in the direction of greater autonomy which means the reduction of helplessness. In psychotherapy, problems of distributing resources fairly may be manifested in unjustifiably long waiting lists or in the form of patient selection carried out in a way that is not justifiable on medical grounds but based rather on a tendency to eliminate certain groups of disorders by using contra-indications that are basically rationalizations of countertransference reactions and which are not in keeping with the professional and personal identity of therapists.

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German training analysts, members of the DGPPT-institutes, were questioned about the personality qualities of psychoanalysts. The item-list of the questionnaire contained 66 adjectives which were judged on their degree of adequacy as to a description of qualities of the psychoanalyst. The following characteristics of the analyst were judge: 1. What is required of the analyst, 2. how does one like to see the analyst, 3. how is the analyst perceived. The answers received were analyzed with the help of a Fuzzy Analysis in order to attain the sharpest, that means best solution, respectively the least sharp, that means worst solution, through which a nested categorial framework could be found. The results show that 5 adjectives satisfy an empirical denoting of the categories. The qualities are: "Unnahbarkeit" (unaccessibility), "Unzufriedenheit" (dissatisfaction), "Schwermut" (melancholy), "Trockenheit" (dryness), and "Schönheit" (beauty). The numerical results are transformed into iconic images with the help of a "detectivistic principle", and the meaning of these images is discussed.

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We have attempted to demonstrate the importance of the concept of value testing set forth by Hartmann in 1960 in terms of both clinical practice and the theory of psychoanalysis. We use a case study to illustrate the way in which this subfunction of the inner reality testing ties in with the subfunction of signal guilt (the function of affect differentiation as one of the subfunctions of the perception of internal reality) and with the anticipation of the interpersonal effect of one's own behavior and the appropriateness of this behavior as subfunctions of judgment. In conclusion we discuss the suitability of the concept of value testing as a way of relating the psychoanalytic idea of the moral organization of action to the ethics of utilitarianism.

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At the outset a delineation is made of the concept of regression in the context of psychoanalysis. It is shown that partial and reversible regressive changes are a necessary pre-condition in order for progredient therapy developments to take place in a patient. This applies to the therapeutic process in the treatment of individuals as well as to group therapy. In analytic group therapy the development of a more mature personality structure can be facilitated by means of the carefully controlled use of such destructing measures as minimal structuring, abstinence, anonymity and rule of free interaction as well as the interpretation of the group analyst. In this way, the development and maintenance of psychoneurotic, functional somatic and character symptoms gradually become superfluous and psychic energies are liberated for more constructive forms of behavior. Some attention is given to the reciprocity between specifically psychoanalytic perception and a conclusion formation of an explanatory- hermeneutic nature. On the basis of the insights obtained in this way, the psychoanalytic group therapist designs his interventions which should, if possible, apply to all group participants. This approach is illustrated by means of a clinical case study.

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We have shown that while on the one hand interactional psychotherapy is based on the nosology of psychoanalysis, in the realization of its methods and techniques it is nevertheless clearly distinguished from the standard approach of psychoanalysis. We developed this specific therapeutic procedure to meet the needs of patients with ego-pathological phenomena, more and more of whom are now turning to the analytic psychotherapist and in whom psychoanalysts are also showing a more and more intensive interest. This is demonstrated by the work of Kernberg (1978), Kohut (1971) and Blanck and Blanck (1978), as well as that of Fürstenau (1977) and König (1975) in the German-speaking world. We perceive the interactional psychotherapy that we have proposed (Heigl-Evers and Heigl, 1973 and 1979) as a therapy for ego-pathogenic phenomena. It is indicated in the case of patients with this type of disorder in a certain phase, usually the initial one. If a patient succeeds, with the help of this treatment, in developing an ego state roughly equivalent to what Freud referred in 1937 as the normal ego and which he considered to be a prerequisite for psychoanalytic therapy, then it should be possible to treat the conflict pathology which is also usually present in such patients, using the classical repertoire of psychoanalysis according to the principle of interpretation.

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