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To many psychoanalysts dreams are a central source of knowledge of the unconscious-the specific research object of psychoanalysis. The dialog with the neurosciences, devoted to the testing of hypotheses on human behavior and neurophysiology with objective methods, has added to psychoanalytic conceptualizations on emotion, memory, sleep and dreams, conflict and trauma. To psychoanalysts as well as neuroscientists, the neurological basis of psychic functioning, particularly concerning trauma, is of special interest. In this article, an attempt is made to bridge the gap between psychoanalytic findings and neuroscientific findings on trauma. We then attempt to merge both approaches in one experimental study devoted to the investigation of the neurophysiological changes (fMRI) associated with psychoanalytic treatment in chronically depressed patients. We also report on an attempt to quantify psychoanalysis-induced transformation in the manifest content of dreams. To do so, we used two independent methods. First, dreams reported during the cure of chronic depressed analysands were assessed by the treating psychoanalyst. Second, dreams reported in an experimental context were analyzed by an independent evaluator using a standardized method to quantify changes in dream content (Moser method). Single cases are presented. Preliminary results suggest that psychoanalysis-induced transformation can be assessed in an objective way.
Background: Despite limited effectiveness of short-term psychotherapy for chronic depression, there is a lack of trials of long-term psychotherapy. Our study is the first to determine the effectiveness of controlled long-term psychodynamic and cognitive-behavioral (CBT) treatments and to assess the effects of preferential vs. randomized assessment.
Methods/design: Patients are assigned to treatment according to their preference or randomized (if they have no clear preference). Up to 80 sessions of psychodynamic or psychoanalytically oriented treatments (PAT) or up to 60 sessions of CBT are offered during the first year in the study. After the first year, PAT can be continued according to the ‘naturalistic’ usual method of treating such patients within the system of German health care (normally from 240 up to 300 sessions over two to three years). CBT therapists may extend their treatment up to 80 sessions, but focus mainly maintenance and relapse prevention. We plan to recruit a total of 240 patients (60 per arm). A total of 11 assessments are conducted throughout treatment and up to three years after initiation of treatment. The primary outcome measures are the Quick Inventory of Depressive Symptoms (QIDS, independent clinician rating) and the Beck Depression Inventory (BDI) after the first year.
Discussion: We combine a naturalistic approach with randomized controlled trials(RCTs)to investigate how effectively chronic depression can be treated on an outpatient basis by the two forms of treatment reimbursed in the German healthcare system and we will determine the effects of treatment preference vs. randomization.
In Deutschland hängen Bildungschancen wie in kaum einem anderen Land vom Bildungsstatus der Herkunftsfamilie ab. Vom Ideal einer Chancengleichheit sind wir weit entfernt. So verlässt beispielsweise jedes vierte Kind mit Migrationshintergrund die Schule ohne Abschluss. Viele Kinder aus sozial schwierigen Verhältnissen enden wie meist schon ihre Eltern in der Arbeitslosigkeit und in einem Leben am Rande der Gesellschaft.