The Treatment Spectrum of Human Structural Dynamic Psychiatry

Journal/Book: Dynam Psych. 1994; 27: Kantstrasse 120/121, D-1000 Berlin 12, Germany. Pinel-Verlag Fur Humanistische Psych Philos. 171-186.

Abstract: In the present paper, the author describes the spectrum of verbal and nonverbal, out-patient and in-patient therapeutical methods, as they are at present used in the framework of Gunter Ammon's Dynamic Psychiatry. At the beginning, she emphasizes that man stands in the centre of humanstructural treatment and that he is seen in his wholeness and in his genuine need for identity and not as a carrier of symptoms of illness. A biological or psychological reduction of human nature is confronted with a holistic image of man, which comprises body, soul and mind alike. Illness is understood as a - temporary - disregulation of the homeostasis of body, mind and soul, which is always connected with an atrophy or disintegration of really existing multidimensional possibilities of man. > > Dynamic Psychiatry<< is the combination of psychiatry and psychoanalysis and has been extendecl by Gunter Ammon to the dimension of group dynamics, i.e. the dimension of interpersonal unconscious relationship dynamics with its importance for the healthy and sick development of man. The unconscious is understood as a primarily constructive-creative potential of an individual, which materializes in the relationship experiences that are important for life history. These unconscious interpersonal dynamics in groups in which the individual is living, find their specific expression in his personality structure. The main target of humanstructural treatment is not to make conscious what has been unconscious but rather to heal the unconscious through making available new, repairing experiences in social-energetic constructive groupdynamic fields, which permit the patient to undergo a repairing development of his human structure. The original psychoanalytic treatment conception aiming at the therapy of neurosis has been enlarged to an integrated treatment network of verbal and nonverbal therapeutic methodes in order to come up to the needs of severely ill patients suffering from archaic ego-diseases as they are called by Ammon (1979). I. In outpatient treatment, verbal therapeutic methods are prevalent (individual analysis, single and group psychotherapy); they are complemented by Humanstructural Dance (see below) and out-patient theatre therapie. As a principle, no patient is treated only with nonverbal methods in order to guarantee the necessary synergism of the verbal and nonverbal, which is necessary for a permanent structural gain. The standard method of couch analysis is still used in the case of patients who must be classified as neurotic, but sometimes also in the case of paranoic patients. In addition to the single therapy in a sitting position, particularly for patients with strong group fears, the treatment in groups is in the centre of psychothcrapeutic work. The psychotherapeutical group permits the patient to restore and relive the dynamics of his primary group, from which his illness resulted, in order to free himself from these dynamics through the internalization of repairing new emotional experiences (> > repeat and repair<<). Gunter Ammon and his co-workers consider the exclusive use of single therapy as being fundamentally contra-indicated in the therapy of psychoses and severe borderline diseases. The social-energetic needs of such patients as well as their strong ambivalence and the aggression which has become destructive are bound to break up the setting of a two-person-situation (Ammon, Burbiel 1992). The deeper the damage to the personality structures the lesser insigth in his pathogenic psychodynamics the patient will show and the more he will be dependent on the understanding and therapeutic use of his compulsive acting of all his problems into the surrounding groups. The general rule could be: The more severe the illness, the more the patient needs therapeutic situations for his healing, which coincide with his whole life situation. The out-patient and in-patient milieu therapy developed by Ammon as well as the whole treatment in Dynamic Psychiatric hospitals offer the patient corresponding interpersonal experience fields along these line (Ammon 1959, 1979). Milieu therapy focusses on a work project, mostly in the fields of arts or handicrafts. This project constitutes a socalled > > third object<< which allows both for contact and distance. II. The central component part of the treatment spectrum is the in-patient psychotherapy in the Dynamic Psychiatric Hospital Menterschwaige in Munich with which the out-patient Institutes of the German Academy of Psychoanalysis closely cooperate. The whole milieu of the hospital becomes effective as a groupdynamically structured milieu with its social-energetic network of treatment and relationship offers. In this spectrum the milieutherapeutic project work constitutes but one nonverbal method of therapy being applied. These methods have been developed in order to reach psychically severely ill patients who are often hardly in a position to verbalize themselves. - In the Humanstructural Dance developed by Gunter Ammon and Maria Berger since 1983, it is the archaic language of the body which opens up a new > > via regia to the unconscious<< (Ammon 1986) of the patient (Berger 1987, 1988). - Music therapy works through the acoustic communication medium, the earliest medium with which man enters into a relationship with his environment already in the prenatal phase. In contrast to Humanstructural Dance, the patient is not showing himself alone but in singing and playing together with others (Schmidts 1990). - The theatre therapy gives the patient the opportunity to face himself, to face facets of his own identity in playful seriousness (Doldinger, Etschmann 1991). - Therapeutic riding allows for bodily contacts with a living creature in case of those patients who due to their deep mistrust can only with great difficulty entrust themselves to a human being (Scheidhacker 1987). - Painting therapy is another sphere where the release and promotion of creativity becomes therapeutically effective. Shape and theme of a picture offers also valuable diagnostic hints on the respective stage of development (Kress 1987). In all nonverbal therapy methods, however, the subsequent verbalization has an essential integrating function (v. Bulow 1992). In general, the integration of the different treatment facets is of outstanding importance, if healing integration processes are to be set in motion with the patient. An eclectic non-related coexistence of different treatment methods alone does not have any healing effect. All treatment methods have to be coordinated by a treatment program that must be in accordance with the human structure of the patient and be based on a diagnosis comprising the ill and healthy parts of the patient in the sense of a differentiated personality profile. Integration is also effected paradigmatically through the communication among therapists in case conferences and control groups. In addition to that, the large group of all patients and staff members of the hospital constitutes an important integrating field. - Out-patient follow-up treatment is, as a rule, necessary for the permanent success of hospital treatment as well as for the further personality development of the patient. Therapeutic living communities may support this process (Reitz 1994). III. Psychoanalytical kindergarten and the intensive work with the children's parents serve the prevention of psychic diseases (Reitz, Doldinger 1994).

Note: Article G Vonbulow, Bregenzerstr 4, D-10707 Berlin, Germany

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The Treatment Spectrum of Human Structural Dynamic Psychiatry - A Survey