Klett-Cotta-Verlag Psychology
Hauptbeitrag

Der analytische Prozess in der Behandlung einer Panikstörung


Mai 2017, 71. Jahrgang, Heft 5, pp 363-388

DOI 10.21706/ps-71-5-363



Zusammenfassung
Eine Panikstörung kann das soziale und berufliche Leben der Betroffenen in Mitleidenschaft ziehen. Psychopharmakologische und kognitiv-verhaltenstherapeutische Interventionen sind als Symptombehandlung mitunter hilfreich, doch ist die Besserung zumeist nur von kurzer Dauer. Vorgestellt wird der Fall eines Geschäftsmannes, der wegen einer Panikstörung mit Agoraphobie um Behandlung nachsuchte. Vorangegangene medikamentöse und nicht-einsichtsorientierte Therapien hatten seine Symptome nur unwesentlich lindern können. In einer psychoanalytischen Behandlung, die sich über 14 Monate erstreckte und eine längere Psychoanalyse einleitete, verschwanden seine Panikattacken fast vollständig. Zur Symptomlinderung trugen die Analyse von ödipalen Konflikten, Geschwisterrivalität und anderen Abkömmlingen der Aggression sowie das Verständnis der Bedeutung einer kindlichen Enurese und ihrer Auswirkungen auf seine Charakterentwicklung bei. Das therapeutische Ergebnis dieser Behandlung war zumindest partiell auf einen psychoanalytischen Prozess zurückzuführen, in dem Ängste und Konflikte im Kontext der als Medium therapeutischer Veränderung dienenden Übertragung identifiziert, gedeutet und erörtert wurden.

Abstract
Analytic process in the treatment of panic disorder. – Panic disorder can interfere with a person’s social and occupational functioning. Psychopharmacologic and cognitive-behavioral interventions, while helpful for symptomatic treatment, may produce only short-term gains. The following case is of a businessman who presented for treatment with panic disorder with agoraphobia that compromised his work and personal life. Psychopharmacologic and non-insight-oriented approaches had produced minimal symptom relief. A 14-month period of psychoanalytic treatment, the first phase of a longer psychoanalysis, was effective in the treatment of his panic attacks. Alleviation of his symptoms involved the analysis of Oedipal conflicts, sibling rivalry, other aggressive derivatives as well as understanding the meaning and effect of his childhood enuresis on his character development. The therapeutic result of this treatment was due, at least in part, to a psychoanalytic process in which anxieties and conflicts were identified, interpreted, and discussed in the context of the transference as a vehicle for therapeutic change.

Résumé
Le procès analytique dans le traitement d’un trouble panique. – Des troubles paniques peuvent affecter la vie sociale et professionnelle des individus. Les interventions psychopharmacologiques et les thérapies cognitives ou de comportement peuvent être efficaces dans le traitement des symptômes, mais l’amélioration est la plupart du temps de courte durée. Le cas dont il est ici question est celui d’un homme d’affaires à la recherche d’un traitement pour un trouble panique accompagné d’agoraphobie. Des thérapies médicamenteuses sans compréhension des troubles n’avaient pu alléger ses symptômes que superficiellement. Une thérapie psychanalytique de 14 mois suivie d’une psychanalyse plus longue fit disparaître presque complètement ses attaques de panique. L’analyse des conflits œdipiens, de la rivalité entre frères et sœurs et d’autres dérivés de l’agression, ainsi que la compréhension de la signification d’une énurésie infantile et de ses effets sur l’évolution du caractère contribuèrent à atténuer ses symptômes. Le succès thérapeutique de ce traitement est dû au moins partiellement au processus psychanalytique au cours duquel les angoisses et les conflits furent identifiés, interprétés et étudiés dans le contexte du transfert utilisé comme instrument des changements thérapeutiques.
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