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Psychotherapy is an interpersonal and interactive process. As this view gained acceptance, methods in psychotherapy research for analysing the intersubjective dimension of the psychotherapeutic dialogue became more important. Ethnomethodology with its research program of conversation and context analysis has a long tradition in research on social interaction and can follow this development. With a conversation analytic approach means and practices can be reconstructed that patient and therapist use to coproduce the psychotherapeutic encounter.

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Already the first version of the resistance concept as a force of the paint against which Freud had to summon psychic work names an interactive event. The conversational-analytic examination of therapeutic dialogs may bring to light that resistances are not just embedded in the interpersonal relationship of patient and psychotherapist, but are produced with verbal and non-verbal means with which patient and psychotherapist handle their interactions. This is described with a micro analysis of the therapeutic interaction in videographed sequences from an analytic oriented short therapy of a patient with phobic and compulsive symptoms.

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Though the existing independency of the psychotherapeutic and psychosomatic medicine in Germany there is the necessity of developing personnel clue numbers for this clinical specification. By the analytic method the required trade groups of the regular inpatient psychosomatic-psychotherapeutic treatment thus far and their engagement in time are investigated. In a 2. step the fields of business for physicians, psychologists, nurses, social workers, special-therapists and secretary/documentation as well as regular business for the consultation/liaison-service are defined. For a model station the concret personnel clue numbers of all named business groups are referred.

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We inform about development of the Tiefenbrunn documentation system for inpatient psychotherapy. Aims and scaffolding of the system and some difficulties to make the system run are outlined. The newly developed instruments are sketched. Patients received a questionnaire concerning their social situation and their family of origin. At the same time therapists indicate symptoms, diagnosis, work ability, prognosis, pretreatments and chronification (diagnosis sheet I) and results of treatment (diagnosis sheet II) when patients leave. During treatment complementary therapy (as e.g. massage etc.) is documented. From 1988 on we have 230 variables on every patient in our computers. Actual and further use of the system is described.

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The concept and organization of inpatient psychotherapeutic treatment as focal psychotherapy has proven helpful in many cases. The focus takes on an integrative and guiding function since various therapeutic activities are oriented toward the same focus. The focus recurs in varied thematic guises in different areas of therapeutic interaction. Among patients with so-called structural disturbances, the focus does not usually pick up a focal conflict but the typical disturbances of the self and object relations. Considerations of method retreat into the background of the thoughts and actions of all those involved in treatment. In their place, treatment is considered as a focally determined process of therapeutically conscious social interaction based on the individual patient and his or her particular disturbance.

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Among other factors the prognosis of psychoneurotic and psychosomatic disorders depends upon how soon after the onset of the symptoms a specific psychotherapeutic treatment is initiated. A group of one hundred test subjects, selected at random from among the patients admitted for treatment at a special clinic, was used to determine the factors responsible for the duration of the so-called careers of these patients. Contrary to what was expected it turned out that particularly three factors correlate positively with a speedy admission to psychotherapy. Thus younger psychoneurotic or psychosomatic patients, patients who in their own conception consider their disorder to be psychogenic, and patients in whom psychic or psychosomatic complaints have caused an impairment of their function at work, are the ones who are admitted to psychotherapy relatively soon after the first manifestation of their complaints. It must be noted that none of these three factors is explanatory for any of the others.

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According to the differentiation "normative" and "interpretative" paradigm, as coined by symbolic interactionism for the social sciences, two types of investigatory measures corresponding to these paradigms are distinguished in psychoanalysis: Investigation of psychoanalysis and psychoanalytic investigation. Psychoanalytic investigation in the narrower sense of the term is associated with the psychoanalytic method of investigation where the recorded sentences are sentences concerned with statements in need of interpretation and not sentences about events which, in principle, can be observed and the validity of which requires a divided system of interpretation. Diagnostic opinions in psychoanalysis are the result of the linking of such recorded sentences to the diagnostician's pool of theoretic knowledge along the lines of specific rules of discrimination or background hypotheses. This may be considered as one of the central objects of psychoanalytic investigation.

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The functional aspect in psychoanalytic ego therapy seems to be especially useful with regard to obtaining diagnostic criteria for the decision of whether and to what extent the patient's ego deviates from a "fictitious normal ego" and whether or not modifications must, therefore, be introduced into the therapeutical procedure. Such criteria are required in particular when psychoanalysis and psychotherapy are concerned with patients suffering from severe structural ego deficiencies. It seems, moreover, that such patients, in obviously increasing numbers, are hospitalized in psychotherapeutic clinics and, even more frequently, taken care of in psychiatric institutions. In the diagnosis of structural ego deficiencies, however, a certain dilemma is observed which has an impact on both single and group therapy with the patients concerned: when, on the one hand, the diagnosis of an 'ego alteration' is inevitable, the diagnosis of functional ego deficiency, because of its so to say impartial mode of reasoning, on the other hand, offers to pronounce as an ego deficiency in the patient much of what has its origins more or less in the counter-transference reactions and the limits of adaptability in the therapist, both qualities being especially in demand when dealing with patients suffering from structural ego deficiencies, as e.g. in psychiatric institutions. It is suggested that the functions of the ego be interpreted as consistent symbolic capacities of the ego which constitute reality. Their diagnosis in each case remains tied to an interpersonal process in the course of which the parties concerned alternate in typefying and interpreting one another.

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This paper is concerned with patients whose success and prestige aspirations are oddly connected to "failures". At a first glance, these behavioral patterns resemble a form of "failure at success" and have a particular bearing upon the patient's professional field. These patients who have grown up in working-class families, are attempting to escape the social surroundings of their origin and attain higher status through university education. The development of all these patients proceeded under relatively similar conditions: Relatively impermeable boundaries were found to exist between the interior of their families of origin, which were considered to be "morally better", and the social environment, which, distorted through projection, was perceived as "dangerous" and "bad"; the children's social radius of experience was largely limited to the private sphere of the family; as a result, their ego development remained partially impaired. The children were commissioned by their parents to carry out contradictory missions which, on an intra-psychic level, resulted in inconsistent egoideal demands. The children are all the less capable of carrying out the mission of success commissioned by the parents due to the fact that an adequate inner-familial offer of operative modes of identification--in the sense of "this is how it can be done" (Hoffmann, Trimborn, 1979)--is for the most part lacking. This results in narcissitic crises. Particularly in the psychosocial field of their professional lives these patients have developed a unique adjustment pattern which is distinguished by an entanglement of their efforts at professional success and reputation with occupations considered to be of "no avail" but which serve to maintain undissolved infantile object fixations. This adjustment pattern is the more stable the better efforts at success and infantile object fixations can be accommodated for in the same social role.

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