Existenzanalyse 2/2017

WITHOUT FEELING? I AM NOT THERE!

On human’s reaching out for life

ALFRIED LÄNGLE

The task of this work is to phenomenologically uncover the core of Borderline. In order to achieve this, the disorder is first described on the level of symptoms in an overview and understood as a relationship disorder both inwardly as well as outwardly. A phenomenological approach to the specific suffering of Borderline patients reveals, in the depth of this impulsive, intense and unstable personality, an unendurable pain connected to the inner loss of self. The phenomenon of Borderline proves to be a fundamental being split accompanied by a split experience of the world. In this tension, the rearing up becomes comprehensible as a psychodynamic struggle essential for survival. Due to the painfulness and threat of these lacking and injured ego-structures this dynamic can only slowly be dismantled in therapy and replaced by increasing personal behavior . Finally, main features of treatment of the specific problems of Borderline happening are presented.
Keywords: Borderline, psychodynamics, Existential Analysis, Splitting, therapy

THE INJURED SELF

Personality disorders from an existential analytical point of view

CHRISTOPH KOLBE

Basic principles of human personality development are firstly outlined in this article. In comparison to this, the essential traits of personality disorders are described. By the example of histrionic and narcissistic as well as the borderline personality disorder it is described wherein the specific injury of these people lays, how it comes to such an injury, how these people typically deal with this injury and how it effects the relationship to other people.
Keywords: personality development, personality disorder, histrionism, narcissism, borderline

„ALL FAR TOO INTENSIVE – EVEN THIS IS TOO LITTLE“

LILO TUTSCH

This article renders an attunement into the central themes of borderline disorder, into the suffering of those affected and their inner pain such as emptiness, diffusion of identity, agonizing depression, a tremendous fear of loss of relationship, fear of closeness. Also the specific protective response in order to endure suffering, such as self-injury, splitting, alcohol, drugs etc. will be illuminated.
Keywords: pain, emptiness, identity diffusion, splitting, self-injury

MULTIDIMENSIONAL DIAGNOSTICS AND ETIOPATHOGENIC ASPECTS OF THE BORDERLINE PERSONALITY DISORDER AND THE DIFFERENTIATION TO POST TRAUMATIC STRESS DISORDERS

KARIN MATUSZAK-LUSS

The following article outlines diagnostic aspects of Borderline Personality Disorder and Post Traumatic Stress Disorders considering the concepts of DSM-5, ICD-10, layout of ICD-11 and existential analytical points of view. Thereafter aetiopathogenetic ideas concerning both disorders will be illustrated.
Keywords: diagnosis, DSM-5, ICD-10, layout of ICD-11,
Existential Analysis, aetiopathogenetic aspects

WAYS OF RELATIONSHIPS – BORDER EXPERIENCES IN THE STRUCTURING OF THERAPEUTIC RELATIONSHIPS

MARKUS ANGERMAYR

Reworked lecture from the GLE Congress 2017. On the basis of a case vignette, the dynamics of people suffering from borderline disorders become visible in the structuring of the psychotherapeutic relationship. In the process, the therapists are challenged in a unique way, since they are hurled out of their center and become directly entangled into occurrences of the relationship whose dynamics lead to one’s own limits.
Now what does it means to be present in such situations, interconnected and still staying clearly delimited and authentic, enabling the dynamics to turn into a personal happening again? What points of orientation do existential analytical therapists have and how can they deal with own border experiences? How can we succeed to dwell upon the border zone with the patient without being sucked into the vortex of the happenings? Which value does going through such experiences together have?
Keywords: bound to structure, fixed coping reaction, free space, authenticity

THE (SAFE) RIDE ON THE ROLLER COASTER

DORIS FISCHER-DANZINGER

Therapy with borderline patients confronts the therapist with a specific task: the rapid change between feelings of independency and great fear of autonomy, severe vulnerability and invitation to combat, experiencing the world as wonderful and soon after as unendurable. Phases appearing again and again of great inner emptiness as well as suicidal thoughts are similar to a ride on the roller coaster for the patient as well as for the therapist. So this ride can take place secure enough for patient and therapist on the one hand and provides sufficient room for change on the other, specific adaptations in setting and certain attitudes of the therapist are necessary. Special features of therapy with borderline personalities are described and practice-oriented case vignettes outlined.
Keywords: borderline, personality disorder, setting requirements, scenic understanding

I BLEED, THEREFORE I AM.

RUPERT DINHOBL

On self-injury and suicidality among patients with borderline personality disorder

Cutting and bleeding play an important role in the borderline disorder. In this lecture the question is dealt with what leads people to injure themselves. On the outset, a differentiation between self-injury and suicidal action is made. While blood must flow through self-injury in order to feel life, in suicidal action lays the intention to induce death. “I bleed, therefore I am”: Many borderline patients perceive this altered Cartesian principle as profoundly adequate. How this phenomenon can be dealt with therapeutically is subject of the second part of this article. Personal experiences from therapy with borderline patients complement the lecture.
Keywords: borderline personality disorder, self-injury,
suicidality, Dialectical behavioral method

SCHEMA THERAPY IN THE TREATMENT OF BORDERLINE PERSONALITY DISORDER

ECKHARD ROEDIGER

In the past 15 years schema therapy developed into a distinct therapy method within Cognitive Behavioural Therapies. As a specific contribution it explains current maladaptive behaviour based on early acquired schemas distorting the personality structure and operating behind the clinical symptoms. Thus many aspects of psychodynamic therapeutic concepts enter behaviour therapy, especially leading to a change in the comprehension of therapy relationship. The article introduces the 3 core elements of a schema therapy: the biographical model, the activating experiential techniques, and the therapy relationship, whilst taking into consideration an accepting attitude.
Keywords: Schema therapy, therapy relationship, experiential techniques, perspective change, 3rd wave of behaviour therapies

TORN BETWEEN THE EXTREMES – THE DISTRESS OF THE RELATIVES OF BORDERLINE PATIENTS

BARBARA JÖBSTL

In the following article, results from the workshop of the same name within the scope of the GLE-Congress 2017 on the topic of pain (“Schmerz-Haft”; meaning pain-custody), as well as experiences, observations and reflections from my work with relatives of borderline patients in my practice, are summarized.
As an initial approach towards the theme, three introductory short cases are outlined. The following part describes the split experience of the relatives, as it were a mirror to the psychopathology of the border liners themselves, and the destructive impact on the existential structure of fundamental motivations and personal abilities. Finally, the focus is set on therapeutic work with the relatives, and which aspects are to be dealt with in particular and should be reinforced.
Keywords: borderline-disorder, relatives, loss of self, delimitation, relationship stability

MALE AND FEMALE ACCENTUATIONS IN THE PHENOTYPE OF BORDERLINE DISORDERS

REINHARD PICHLER

For a long stretch of time, borderline personality disorders (BPS) were considered to be a typically female illness (cf. Banzhaf 2011). Newer studies show that BPS is equally represented among men and women in the general population. However, the manifold appearances of this disorder indicate that the typical borderliner does not exist – it is therefore neither sensible nor serious to characterize a typical male or a typical female borderliner. Studies on gender differences are therefore scarce as well. Nonetheless, there is evidence of diverse forms of disorder conditions with males and females, mainly due to gender-differentiated early childhood bonding experiences, styles of upbringing, socio-cultural environmental influences and gender role patterns acquired through the social background.
Keywords: borderline personality disorder, gender differences, clinical manifestation

ENCOUNTER WITH PATIENTS WITH BORDERLINE AND EGO-
STRUCTURAL DISORDERS

an approach from a depth-psychological and existential
analytical perspective

HANS-MARTIN ROTHE

Further development of psychoanalytical treatment technique of patients with early disorders and borderline disorders in particular has shifted the focus from conflicts towards the ego-structural abilities, entailing significant changes in psychodynamic and psychoanalytical treatment technique. With transference-focused treatment, the moment of encounter is in the here and now, the encounter during the active dialogue between patient and therapist, and with the structure-related psychotherapy direct work on maladaptive internalized patterns of experience, perception and behavior, thus the main causes of borderline symptoms, are brought to the fore. Conflictual transferences are worked on in a structure-forming manner. Processes of mentalization are fostered or even made possible in the first place. An independent stable and comprehensible internal space (“inner dialogue”) can develop with the help of relationship experience. This is where psychodynamic approaches meet with those of Existential Analysis, the complementary but also the controversial can be found. Both approaches have their own varying depth of focus and conciseness in different areas. With regard to personality and ego disorders, this is presented in detail.
Keywords: ego-structural deficits, structure related psychotherapy, ego-functions, fundamental motivations, orientation of meaning

„BORDER CROSSED“ – EXISTENTIAL ANALYTICAL REFLECTIONS ON THE SITUATION OF DETAINED WOMEN WITH BORDERLINE SYMPTOMS

WERNER GRUBER

The following contribution will grant insight into a prison for women in Austria from the perspective of a social worker with 18 years of professional experience in the social service of the Schwarzau prison. As an existential analytical psychotherapist in training and supervision, these reflections will be supplemented with the perspective of Existential Analysis, while regarding a traumatized imprisoned woman with borderline symptoms in particular. In doing so, the subjective experience of the conditions of detention should become transparent. Furthermore, the Schwarzau prison will be introduced as only correctional facility for women in Austria.
Keywords: borderline, penitentiary system, Personal Existential Analysis

HOT AND HATED

Borderline and Sexuality – Behavior Analysis

SUSANNE ADAMEK

The borderline disorder reveals itself primarily as a relationship disorder. Exuberant affection and hateful reluctance – the greater the closeness in a relationship the clearer the difficulties are. This especially is true when it comes to love affairs and sexuality. Sexual experience and sexual behavior provide insight into the relationship structure of someone; in patients with borderline disorder we find very different characteristics. This ranges from foreignness towards one’s own corporeity with total rejection of tender closeness and sexuality to extreme forms of promiscuity, self-destructively dangerous and countermeasure for emptiness and boredom. Examples from literature and practice illustrate varying phenomena.
Keywords: borderline disorder, sexuality, defense against anxiety, regulation attempt

“IT’S ME, ANITA, ENTIRELY PERSONAL!”

ERIKA LUGINBÜHL

Anita, a young woman suffering from Borderline disorder, takes us into her world. She has been in existential analytical psychotherapy as well as medical treatment for the past 7.5 years. In this long and intense time, an impressive personal development has taken place and the desire arose in her to share her experience with other people, to communicate and step out of anonymity. She has therefore written a book about her life with this disorder. In this article, the autobiographic memoirs of the emergence and development of her borderline disorder will be referenced and reflected upon from an existential analytical point of view.
Keywords: Borderline disorder, autobiographic memoirs, existential analytical reflection

SAFETY PLAN INTERVENTIONS FOR RELAPSE PREVENTION OF
SUICIDAL BEHAVIOR IN EXISTENTIAL ANALYSIS THERAPY

CLEMENS FARTACEK, ANTON NINDL, RUPERT DINHOBL & MARTIN PLÖDERL

Individuals who already have attempted suicide are at high risk for recurrence of suicidal behavior and are an important target group in suicide prevention. Safety planning is an internationally established and evidence-based tool to prevent recurrence of suicidal behavior. The objective of the paper at hand is to introduce this tool and adapt it for Existential Analysis therapy. The latter was realized by adding clients’ personal reasons for living and the method of Personal Existential Analysis in the safety planning process. Our experiences with the safety plan and suggestions for its application to clients with borderline personality disorder are discussed.
KEYWORDS: suicide, safety planning, Personal Existential
Analysis, suicide prevention

INQUIRY. INSTEAD OF INTERROGATION!

ESTHER KOHL

The text deals with the two major issues of how much space for the phenomenological attitude of open-mindedness can be found and provided in everyday learning in A-level education and whether a personal interaction with students is possible. Following theoretical considerations, it will be shown how the dialogical approach of inquiring the student’s person during the process of synchronizing his actions with reality can be successful on the basis of examples from day-to-day school life in the Wilhelm Wagenfeld Schule Bremen, a professional school of art, design and media. Thus, the student’s potentials and resources can be revealed and psychodynamics can be conciliated. This enables students to finish their school career successfully and gives them a competent orientation towards their future.
Keywords: personal action, phenomenological attitude of open-mindedness, will to meaning, meaning as experience of context, object orientation

“BETTER NOT LOSE ONE’S NERVES.“

Borderline dynamics in school

MARTIN HÖTZER

School also takes place in the polar field of tension between evaluation of right and wrong, sympathy and antipathy, power and helplessness, affiliation and isolation etc. Every now and then, painful and harsh “en-counters” take place in the interaction between juveniles, parents, and teachers. On the basis of two case examples insights are provided into characteristic borderline phenomena and approaches for comprehensive and de-escalating action are presented.
Keywords: school, juveniles, conflicts, borderline dynamics

PSYCHOMETRICS IN PURSUIT OF EXISTENCE: A NEW VERSION OF THE TEST OF EXISTENTIAL MOTIVATIONS

VLADIMIR B. SHUMSKIY, EVGENY N. OSIN, ELENA M. UKOLOVA

We present four studies aimed at the development and validation of a new Russian-language instrument measuring existential fulfilment and based on the hierarchical structure of the four existential fundamental motivations developed by A. Längle (2003; 2016). Based on phenomenological descriptions and focus groups, we created a set of 93 items. The first study used two online samples (N = 818 and N = 215, respectively). Using hierarchical cluster analysis, expert-rating procedure and confirmatory factor analysis with cross-validation we generated a hierarchically structured set of 36 items grouped into 4 fundamental motivation scales forming a general index of existential fulfilment, each comprised by 3 subscales corresponding to the prerequisites of respective fundamental motivation. The scales demonstrated acceptable reliability: Cronbach’s α was in the .79-.88 range for the fundamental motivation scales and .93 for the general existential fulfilment score. In the same study we explored evidence for the convergent and discriminant validity of the new TEM by examining its associations with measures of subjective well-being, basic psychological need satisfaction, and self-esteem. TEM showed moderate to strong associations with other measures of positive functioning. The second study using a large online sample (N = 3766) found weak associations of TEM scores with gender and age and moderate positive associations with measures of self-control and systemic reflection. The third study (N = 658) explored the associations of TEM scores with the Big Five and measures of anxiety and depression. Existential fulfilment was positively associated with extraversion and emotional stability and showed incremental validity over the Big Five traits in predicting state anxiety and depression. The fourth study found significant differences in existential fulfilment between females with symptoms of binge eating disorder (N = 188) and those from general population. The results indicate the new TEM is a reliable instrument with a theoretically predicted structure and provide preliminary evidence of its validity in research settings. We discuss the challenges and possibilities of development of psychometric tools based on existential-analytic theory.
Keywords: existential analysis, existential fulfillment, fundamental existential motivations, psychometrics, confirmatory factor analysis, psychological well-being, eudaimonia

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