Abstracts - Zusammenfassungen

Plena - SP01-05 - SP06-10 - SP11-15 - SY01-06,14 - SY07-13 - SM01-06
SM07-13 - SM14-20 - SM21-27 - SN01-05 - SN06-10 - SN11-15 - SN16-21
SN22-26 - SN27-32 - SN33-37 - SN38-43 - P01-13 - P14-28


Seminars Noon - Seminare Mittags
Thursday - Donnerstag, 30.09.2004, 13.15 - 14.15 h

SM07 - SM08 - SM09 - SM10 - SM11 - SM12 - SM13


SM07: Future Oriented Systemic Practice in Different Contexts (Zukunftsbezogene systemische Praxis in unterschiedlichen Kontexten) - English

Filipa Catarina Caetano Cristovão, Renata Jorge Ribeiro Carvalheiro Dias, Catarina de Jesus Vaz Lourenço (P):

Going Forward… Going Back… (Nach vorne…, zurück…)

We are working towards a more urban, consumerist, automatic and individualistic society. Families, attempting to adapt, adopt educative styles that have marked impact on their children. Observation shows that children choose to pursue passive activities (e. g. TV and computer games) which, despite being adapted to contemporary demands, do not stimulate representation of reality with creativity.
Based on Golomb (1992) who states, “the representation does not aspire to copy the original”, we suggest a revival of some of the more traditional educative practices, including the co-creation of toys, games and stories. The goal is to provide a symbolic environment where a child uses imagination, thereby improving the quality of interaction with parents and peers. Autonomy, confidence and adaptive skills also benefit. Thus it is believed that parents will have greater involvement in a child’s world. Based on Hohwmann & Weikart’s (1995) view that parents support creative representation in the context of the active learning process by supporting the interests/interaction of children in a daily routine, it is desired that parents nurture these creative skills- (“not giving the fish, but teaching how to fish”).
Our suggestions have potential social implications. It is expected that changes in families based on these suggestions would present some contrasts to the normal trend in society. Therefore we propose some interventions aimed more widely (school/community) to promote the process of change to society.

Ulf Axberg, I. Wirtberg (S):

Marte Meo and Collaboration Meetings. The Development of a School-Based Intervention - an Open Trial (Marte Meo und Kooperationstreffen. Die Entwicklung einer schulbezogenen Intervention - ein offener Versuch)

Children who display anti-social behaviour in their early years run a high risk of having severe problems later in life. Experience has shown that this can be a difficult group to reach with conventional treatment methods. It is also known that there is a high drop-out rate from treatment. Against this background a decision was made to develop a model of intervention using the school as a base: virtually all children attend school, and it is known that teachers are good predictors of a child’s development. The study described below had four major objectives. First to develop a school-based intervention model for early detection of 4- to 12-year-old children who exhibited anti-social behaviour in school. Second to develop an intervention model which would support the normal development of the child. Third to bring different professionals (special-teachers, social-workers, psychologists) from different organisations together to collaborate in working with the child’s teachers and parents. Fourth, the effects of the methods were to be evaluated. 33 children, their parents and teachers participated in the study.
The results are promising and encouraging. There is a statistical as well as a clinically significant decrease in the children’s symptoms rated on CBCL, TRF, Conner’s Parent Rating Scale and Conner’s Teacher Rating Scale.
Even in those cases where the intervention were only carried out in the school context there has been a change in the children’s behaviour at home according to the mother’s ratings. This would appear to demonstrate that a change in the school which is positive for the child’s development can even have a “spill-over” effect where the family is concerned. The project demonstrates that it is possible to work effectively with many of these children in a non-clinical setting with the help of the child’s parents and school staff. Interestingly the mixture of Marte meo and systemic theory proved of great value to thee staff who carried out the intervention work: the normative approach embodied in Marte meo was of importance in working directly with the child and his development, whilst in the collaboration meetings the more relative approach permitted by post-modern constructivist theories was more appropriate and helpful in balancing and supporting the development of a constructive relationship between parents, teachers and other helpers.


SM08 - Kooperation zwischen Hilfe und Kontrolle (Cooperation between Help and Control) - Deutsch

Eugene K. Epstein, Manfred Wiesner, Michael Schlicksbier-Hepp (D):

Sinn und Kultur von Kooperation in der Psychotherapie von Kindern und Jugendlichen

Der Sinn von Kooperation in der Psychotherapie und in psychiatrischen Kontexten wird von niemandem ernsthaft bestritten. Andererseits wird der Begriff Kooperation scheinbar für so selbstverständlich gehalten, daß eine Elaborierung von Kooperationskonzepten als vernachlässigbar angesehen wird. Wir wollen verschiedene Konstruktionen von Kooperation in der Therapie – auch unter Berücksichtigung ihrer politischen und sozialen Bedeutung – darstellen und diskutieren.
Das von uns in unserer klinischen Arbeit einer Kinder- und Jugendpsychiatrie favorisierte Kooperationsmodell folgt dem sozial-konstruktionistischen Ansatz. Dieser eröffnet der Beziehungsgestaltung ungewohnte Perspektiven, so auch in der Psychotherapie. Nicht zuletzt an Hand von Fallbeispielen aus unserer klinischen Praxis wollen wir das von uns im Laufe der Jahre im Zusammenwirken mit Familien, KollegInnen und anderen Professionellen entwickelte Konzept der „Reflexiven Kooperation“ zur Diskussion stellen und die TeilnehmerInnen einladen, sich unter Zuhilfenahme der `Didaktik der Fairführung´ auf diesen Blickwinkel einzulassen.

Reflecting on "Cooperation" or Reflective Cooperation in Systemic Therapy with Children and Adolescents

It is pretty much universally accepted by psychotherapists that "cooperation" in therapy is a good thing. But then again, the meaning of cooperation seems to be very much taken for granted and few see the need to question or further elaborate on the manifold possible meanings of the concept. We will discuss various constructions of "cooperation" in psychotherapy as well as their political and social relevance. With case examples from our work as systemic therapists in a clinic for child and adolescent psychiatry in northern Germany, we will elaborate upon the practical implications of our concept of "reflexive cooperation", as it has evolved through our work together as colleagues, our work with clients, as well as in our work with other professionals. The possibilities and possible limits of this perspective will be discussed.

Andreas Wahlster (D):

Spielerischer Umgang mit Hilfe und Kontrolle

Der Vortrag befasst sich mit dem im psychosozialen Bereich allgegenwärtigen Problem von Hilfe und Kontrolle. Das Unbehagen, das viele im Umgang mit Kontrollaufgaben erfasst, entsteht aber nicht nur durch Schwierigkeiten im Arbeitskontext, sondern viel mehr durch das innere Management der beiden Beziehungsformen „Hilfe“ und „Kontrolle“. „Hilfe“ bedient edle Motive, „Kontrolle“ wird negativ bewertet, sie ist die „dreckige Arbeit“, man assoziiert mit ihr Zwang, Autonomieverlust und Freiheitsentzug. Gerade in Zwangskontexten wie z. B der Psychiatrie und Jugendhilfe stellt sich dieses Gefühl penetrant ein. In diesem Vortrag sollen praktische Wege gezeigt werden, wie kontrollierende Beziehungsformen so gehandhabt werden können, dass gerade durch sie wieder autonome Handlungsmöglichkeiten entstehen. Es werden Strategien und Haltungen vorgestellt, die es dem Praktiker ermöglichen sollen, sich in diesem Dschungel zu orientieren, seinen Weg zu gehen und das Spiel mit Hilfe und Kontrolle als notwendigen Bestandteil einer gelingenden Therapeut – Klienten Beziehung zu erleben.

Playfully Dealing with "Help" and "Control"

This presentation deals with the widespread problem of help and control in psychological work. The discomfort that many of us experience when exercizing control roots not only within the difficulties of the working area but rather in the internal management of the two types of relationships: the “help relationship” and “control relationship”. “Help” serves noble intentions, “control” is connoted negatively, it is “dirty work”, associated with coercion, loss of autonomy and arrest. Especially people who work in areas where control needs to be exercised such as psychiatry and youth welfare are confronted with these feelings. The aim of this presentation is to delineate practical ways of dealing with controlling forms of relationships in order that the latter can give rise to autonomous forms of behaviour. Strategies and attitudes will be demonstrated, which will guide the therapist through this jungle, find his own way and experience the playful dealing with “help” and “control” as a vital part of a successful therapist – client relationship.


SM09: Arbeit mit Multi-Familien-Gruppen (Multi-Family Groupwork) - Deutsch

Susanne Altmeyer (D):

Leben in einem unbekannten Land – Mehrfamilien-Diskussionsgruppen für MS-Patienten und ihre Familien (We are Forced to Live in an Unknown Country - Multi-Family-Discussion-Groups for Patients with MS and their Families)

Mehrfamilienansätze sind in der Regel sehr hilfreich für Familien, die mit einer chronischen Krankheit konfrontiert sind. Eine spezielle Form der Mehrfamiliengruppen, die Mehrfamiliendiskussionsgruppen, die von Peter Steinglass entwickelt wurden, wurde bei MS-Patienten und ihren Familien angewandt. Die Autorin beschreibt ein Forschungsprojekt, in dem die praktische Durchführbarkeit und die Nützlichkeit der Methode bei MS-Patienten und ihren Familien getestet wurde. 27 an MS erkrankte Patienten wurden in drei Gruppen geteilt: eine Gruppe erhielt gruppentherapeutische Sitzungen (Gruppe 1), eine zweite Gruppe nahm zusätzlich an dem MFDG-Programm mit ihren Familien teil, die Kontrollgruppe erhielt weder gruppentherapeutische Sitzungen noch MFDG-Sitzungen. Videoaufnahmen der MFDGs zeigen die unterschiedlichen Techniken wie group-within-a-group-Diskussionen, Arbeiten mit Symbolen und Metaphern, etc. Die Ergebnisse der Prä- und Post-Evaluation sowie der ein-Jahres-Katamnese und einer telefonischen Befragung zwei Jahre nach Gruppenende werden dargestellt. Zwei Fallbeispiele demonstrieren, in welcher Art die Patienten und ihre Familien von der Teilnahme an den Gruppen profitiert haben, außerdem wird eine manualisierte Form der MFDGs speziell für MS. -Patienten vorgestellt. MFDGs sind eine nützliche Therapieform für MS-Patienten und ihre Familien. Die Autorin demonstriert in ihrem Vortrag einige Elemente des Programms.

Cornelia Hennecke (D):

Gruppentherapie mit mehreren Familien als Ressource in familientherapeutischen Prozessen bei ADS Diagnose (Multiple Family Group Therapy as a Resource in Family Therapy Processes for ADHD Diagnosis)

Die Diagnose ADS (Aufmerksamkeitsdefizitstörung) bei Kindern erfordert einen produktiven Dialog von Eltern und Helfersystemen. In dem Projekt „ADS - Unternehmen lernende Familien“ verfolgen wir das Ziel, Familien in ihrem Wunsch nach Überwindung und Veränderung Leid erzeugender Dynamiken von Hilflosigkeit, Abwertung, lähmendem Chaos und sozialer Isolation nachhaltig zu unterstützen. Über 12 Monate finden sechs 2-tägige Seminaren mit 5-7 Familien und 4 systemischen Therapeuten statt, wofür ein Konzept zur systemisch-therapeutischen Gruppenarbeit die Grundlage bildet. Begleitend zu den Seminaren werden mit jeder Familie 12 familientherapeutische Sitzungen durchgeführt. Zwischen den Seminaren organisieren die Familien Treffen in eigener Verantwortung. Ein halbes Jahr nach dem letzten Seminar erfolgt ein erneutes Gespräch der Familien mit den Therapeuten zur Reflexion der Erfahrungen. Bisher arbeitete das Team mit 24 Familien in vier Projektgruppen. Die Ergebnisse der Evaluierung zeigen, wie bedeutsam die direkte Begegnung und der Austausch von Eltern, Kindern und Familien für Veränderungen und die Erweiterung von Sichtweisen innerhalb der Familien wahrgenommen werden. Therapeuten werden dabei vor allem in ihrer moderierenden Rolle geschätzt. Wir stellen praktische Erfahrungen und Ergebnisse der Evaluierung vor.


SM10 - Systemic Concepts and Ethical Issues in Psychotherapy (Systemische Konzepte und ethische Aspekte der Psychotherapie) - English

Maria R. Negrete Ramos (E/I), Rodolfo De Bernart (I):

Ethic Codes: the European Landscape (Ethische Codes: die Europäische Landschaft)

The analysis of some European ethic codes (Italian, Spanish, French, British, German, Meta-Code of Ethics of EAPA, and preliminary EFTA Ethic Code) attempts to three objectives:
1. study of the three basic aspects in ethic codes in relation to psychologist's professional activity: the relationship between psychologist and clients or society, the relationship among colleagues and the analysis of what is required to put into practice these ethical principles.
2. consequently, the analysis of general principles, forms of abilities and educational necessities for a proper professional activity in the different ethic codes.
3. the establishment of common features toward defining a set of guidelines for ethical relationships at the European level.
Knowledge of common features will allow the creation of a unified standard for consequence of violation. Tthere are certain principles made evident in the partial analysis of some of these codes (Italian and Spanish). The principles of : respectfulness of the individual, safeguard of human rights, sense of responsibility, integrity, sincerity towards clients, caution in the application of the techniques, valid treatments and professional competence.

Katia Charalabaki, Kia Thanopoulou (GR):

Welcoming the Unpredictable in Systemic Therapy: (Das Unvorhersehbare in der systemischen Therapie begüßen)

Therapists are educated to serve scientific predictability. Since Freud’s time, they have been overwhelmed with an incessant anxiety to ensure that the theory and experience of therapy enhance the capacity for an accurate scientific classification and therapeutic outcome. A number of approaches (not only systemic), after crossing swords in order to establish their identity, are currently going through a new maturity stage which is strikingly convergent. The significance of the therapeutic relationship is at the core of these processes for an interactional perspective. Concepts such as resonance, therapeutic conversation and intersubjectivity comprise the fundamental materials for the construction of the therapeutic relationship. However, the therapist is frequently trapped within his bias towards his hypotheses. Nevertheless, the initial prediction of the therapy is often overthrown and hence diverted, whether by intense feelings of surprise, meaningful words, or even haphazard life events. These unpredictable moments may provide a new dimension in the therapeutic relationship, thus leading to a series of therapies within a single therapy. The therapist must be prepared to relinquish his ‘scientific’ tools and welcome the unpredictable. S/he has to be both presumptuous and modest to create together with the family an exceptional piece of trash-art.
In the presentation we shall discuss therapies of families, couples and individuals where the unpredictable elicited a new therapy within the therapy.


SM11: Somatic Illness and Family Dynamics (Körperliche Erkrankung und Familiendynamik) - English

Ivano Cazziolato, Aldo Mattucci, Marilina Bolcato (I):

Cancer, the Hurricane (Krebs, der Hurrikan)

Background: For several years GPs working in Veneto have been collecting data on cancer in their patients by Veneto Cancer Register. GPs are privileged observers, indeed they look at and care for the ill, not so much the disease; GPs are personal and family’s doctor and observe the cancer’s arrival, the hurricane. Aims: To recover the Cancer Data Collecting Schedule (CDCS) and translate it in a “Bio-psychosocial” one, through the work of a Veneto GPs group. Methods: It’s possible to take advantages by gathering data of a large population, obtaining the support of Local Health Authority, elaborating data at different levels. Is there a concomitance between cancers and the phases of Family Life Cycle (FLC)? Does exist a relation between a FLC’s phase and the wounded organ ? Can we find some differences between sex gender? Have previous important family events happened before the cancer onset (sons getting autonomy, a partners’ divorce, a violence or a death, a work lost or changed, an economic debacle)? CDCS compares the critical event with the cancer and the family reactions. Conclusions: CDCS could implement not only bio medical strategies, but also and more a psychological intervention where particular difficulties or sufferings are evident.

Marco Vannotti (I/CH):

Chronic Pulmonary Disease and Family (Chronische Lungenerkrankung und Familie)

This case study was designed to assess whether a psychosocial intervention at an individual and family level, as well as in multidisciplinary mode, could improve the care of chronic-disease patients. For this purpose, we chose patients suffering from chronic pulmonary disease. This qualitative study implied an investigation and a "systemic" intervention in a limited number of patients and families during a few months. The results show how significant the impact of chronic disease is on the patients’ relatives, a phenomenon which is often underestimated by care providers. Our study also highlights how the disease of a parent influences the development and the process of autonomy in children. The authors propose a intervention model for practitioners. By helping the family members to cope with the disease and to face up to the threat of death, the physician also helps the patient himself.


SM12 - Paartherapie (Couple Therapy) - Deutsch

Wolfgang Rüdiger Lind (D/P), J. Wittig (D):

Bikulturelle Paare: Hindernisse und Ressourcen

Problemstellung: Die Anzahl bikultureller Ehen ist in der ganzen Welt gestiegen. Erst in den letzten Jahren ist den Familientherapeuten und systemischen Wissenschaftlern bewusst geworden, wie stark kulturelle Normen und Werte unser gesamtes Denken, Fühlen und Verhalten prägen. Einige Studien zeigen, dass in bikulturellen Ehen mit größerer Komplexität und größeren Hindernissen umgegangen werden muss und sie daher einem höheren Risiko ausgesetzt sind. Was uns jedoch mehr interessiert, sind ressourcenfördende Aspekte in bikulturellen Ehen. Unsere Grundfrage ist: Was kann die Zufriedenheit dieser Paare fördern?
Methode: 29 Ehepartner aus portugiesisch-deutschen Beziehungen wurden in 4 verschiedene Focus Gruppen aufgeteilt. In jeder Gruppe wurde ein halbstrukturiertes Interview durchgeführt und auf Video aufgenommen. Eine Inhaltsanalyse in Form einer cluster analysis wurde durchgeführt um Risiko- und Ressourcenfaktoren zu ermitteln.
Ergebnis: Die Ergebnisse weisen auf wichtige Ressourcenfaktoren hin: individuelle (z.B. tolerant sein), familiäre (z.B. Integration von Familienritualen) und soziokulturelle (z.B. Personen der Kultur des Ehepartners kennen lernen).
Schlussfolgerung: In diesem Teil diskutieren wir mögliche Auswirkungen dieser Untersuchungsergebnisse auf die Familientherapie bikultuller Ehen und entwickeln Vorschläge für weitere Forschung.

Bicultural Couples: Adversities and Resources

The number of bicultural marriages is increasing all over the world. Only recently family therapists and systemic researchers started to become aware of the great importance of this issue: Cultural norms and values frame our whole thinking, feelings and behaviour. Some studies show that bicultural couples have to cope with greater complexity and adversity, and therefore are in higher risk. However, we are more interested in what may enhance their resources. Our main question is: what can be related to marital satisfaction in bicultural couples?
29 spouses from Portuguese-German couples were divided in 4 separate focus groups. With some guideline questions a semi-directed interview was conducted and video taped in each group. A content analysis in form of cluster analysis was carried out in order to find risk and resource factors for these couples. Results suggest the importance of individual resource factors (e. g. being tolerant), family resource factors (e. g. integrating family rituals) and sociocultural resource factors (e. g. meeting people from the spouse’s culture). We will discuss some implications of these findings for family therapy with bicultural couples and make suggestions for further research.

Renate Weihe-Scheidt, Thomas Bay (D):

Zwischen Mut und Verzweiflung - Paar- und Familientherapie bei Depressionen

Depression betrifft immer die gesamte Familie, doch die Belastung der Partner und auch der Kinder ist oft weniger auffällig. Paar- und Familientherapie ist notwenig und hilfreich, auch wenn sie nicht selten mühsam erscheint, weil zunächst wenig Veränderung deutlich wird. Auf dem Hintergrund unserer langjährigen Erfahrung als Familientherapeuten in einer Psychiatrischen bzw. Psychosomatischen Klinik wollen wir einige typische Interaktionsmuster depressiver Familien verdeutlichen. Im Anschluss geben wir Anregungen für das therapeutische Vorgehen mit diesen Familien, die die Teilnehmer auf dem Hintergrund ihrer eigenen Erfahrung reflektieren können.

Between Courage and Despair. Marital and Family Therapy with Depressed Patients

Depression always affects the whole family, but the burden laying on the spouses and the children is often little expressed and easily overlooked. Familytherapy is helpful and needed, though it often seems discouraging when little change becomes visible.
On the background of our experience as familytherpists in a psychiatric and psychosomatic hospital we will illustrate some specific patterns of interaction in couples and families with a depressed member. We will also give some major ideas about therapeutic attitudes and techniques. The participants are invited to reflect these ideas on the background of their own therapeutic experience.


SM13 - Working with Families (Arbeit mit Familien) - Spanish

José N. Gongora, M.J. Moriano, M. Beyebach, B. González:

Preventive Psychosocial Interventions for Premature Children´s Parents (Präventive psychosoziale Interventionen für die Eltern frühgeborener Kinder)

Objectives: The main goal is to help the mother to develop a secure attachment with her premature baby. Also contemplates, to inform the parents about his medical condition and pattern of responses; teaching basic caring skills and to instruct the husbands to play an emotional support and respite roles for their wives. In developing such a programme, a collaboration between mental health and neo-natal services must be created. Reference: Due to the increase of teenagers and delayed births, the number of premature babies have dramatically risen. They are at risk of developing disabilities and fatal diseases. Their immaturity hinder the development of an adequate attachment with their mothers, adding further risks for their survival. Parents suffer the effects of lack of information about their medical conditions and pattern of responses; lack of support; the terror of loosing them; the fear of been inadequate trained for handling such kind of babies; and the repulsion for their appearance. It is sensitive to intervene in all these problems. Conclusions: Premature children are at risk of developing permanent disabilities and dying. The parents suffer a considerable stress related to the lack of information, the ignorance of how to handle such frail children and the lack of emotional support. Finally, in order to develop this preventive programme it is also needed a good collaboration between mental health and the neo-natal services. This presentation suggests a number of ideas for addressing the three problems.

Cristina Pérez Díaz-Flor and J. Joaquín Cuadrado Rodríguez (E):

Build my Own Peace with the Other: Circular Thought beyond the Systemic Familiar Intervention (Meinen eigenen Frieden mit dem anderen aufbauen: ein zirkulärer Gedanke über die systemische Familienintervention hinaus)

Objectives: Create a new culture by means of a systemic relational model in groups, where individuals resolve personal and relationship problems. In short, to extend the social network beyond the family system of origin, including a new system, as the group itself is. Show some ways of treatment aimed at creating a new thought, more constructive and hopeful, by developing spontaneity.
Our experience is put into practice with systemic therapeutic groups, from eight to ten people over twenty years old, who show heterogeneous demands. These individuals come from systemic familiar therapy, receiving some of them treatment in both related areas (Group A). At the same time, families whose members don't belong to the therapeutic groups, due to different reasons, only undergo a systemic therapy (Group B). Both groups (A and B) are asked to periodically asses their treatment by using the same questionnaires. By analysing the different assessments made by the patients, group A compared to group B achieves a deeper personal knowledge that makes a new social positioning, more successful and amiable, possible. Conclusions. This new way of intervention in families, using a systemic relational approach and introducing other disciplines gives the opportunity to give an answer to a specific demand arisen in a therapy. Besides, the involvement of the individual in these new social networks prepares him for discerning in social groups what has to do with health, considering this as a continuous interaction between the internal and the external in order to live in a more autonomous, joyful and fraternal way.