Theoretical and clinical concepts of psychoanalysis are presented here in terms of their relevance for forensic psychotherapy. They can be applied to individual psychotherapy, special nursing care, and the theory and practice of a therapeutic community. Essential concepts of seduction and traumatisation are presented in the language of drive psychology, as well as in the modern terms of self psychology and object relations theory. The criminal act forms the basis of forensic psychotherapy, the aim of which is to prevent a repetition of this or a similar act. This means that a certain type of act, namely a criminal act, lies at the heart of not only forensic psychotherapy, but also the concept of action itself. Psychoanalytic concepts stress the unconscious processes around and after the act. These processes are repeated in the everyday life of the therapeutic community and in the specific psychotherapeutic situations. Empiric evaluations are methodologically very difficult, as they must investigate multiprofessional settings.
The German pilot Andreas Lubitz, who intentionally crashed a plane with 149 passengers, killing all on board including himself, had been a patient in psychiatric and psychotherapeutic consultations. This paper deals with the legal and psychoanalytic consequences of this action, including terminological issues concerning terrorism.
Reply to Ann‑Louise Silver
(1999)
The Institut für Psychoanalyse Zürich-Kreuzlingen (IfP) was founded as a working group in 1972. Its founder Norman Elrod graduated from the Carl-Gustav-Jung-Institute in Zurich and followed a politically and philosophically reflected psychoanalysis. In addition, he was engaged in the treatment of psychotic patients. Quite a few of his co-workers worked in the Psyichiatria Democratica in Italy as well as in institutions in Germany and Switzerland, where they also contributed greatly to psychoanalytically inspired multiprofessional care for severely ill individuals, including forensic patients.
The paper presents historical remarks about psychoanalysis in institutions with a special focus on the contributions of nurses working in psychoanalytic settings. A case report of the forensic psychotherapy ward in Reichenau Mental Hospital, which is organised as a therapeutic community, shows how individual psychotherapy, group psychotherapy and special nursing care contribute to significant progress in the treatment of a severely narcissistic arsonist.
Reviewing the new German edition of selected papers of Ludwig Binswanger, an overview of Binswanger's life and work is given. Deeply rooted in a psychiatric sanatorium tradition established in the nineteenth century by his grandfather, Binswanger sought contact with Bleuler, Jung and Freud, and tried to treat his severely ill patients with individual psychoanalysis. In addition, the therapeutic milieu always played a great role in his work and thinking. Binswanger's experiences with psychotic patients lead him to a philosophical, existential view of psychiatry and psychoanalysis. Moving beyond Freud, he dealt with psychotic phenomena and maintained that paranoia, mania and depression can be treated by psychotherapy if the therapist exposes himself in an existential manner with the patient. The author expresses his critical opinion of the editors of the present collection for leaving out important psychoanalytic papers written by Binswanger. Binswanger's deviations from the psychoanalytic mainstream is overemphasized – as a matter of fact he remained a member of the Swiss Psychoanalytic Society until his death and can be regarded as one of the most important theorists of modern psychoanalysis dealing also with psychotic phenomena.
The paper discusses Frieda Fromm-Reichmann's theoretical contributions on the psychotherapy of psychoses and refers it to other authors' views. Today widely accepted, she stressed transference and countertransference as es-sential issues in the treatment of severely disturbed patients. She disagreed with authors like Federn who interpreted the concept of regression in a way that to treat schizophrenics means to treat children of different ages. Different from Federn, she advocated interpretations also of the positive transference to show the patient where he stands in life. Later on, Fromm-Reichmann opposed John Rosen and his direct analysis interpreting first the contents of the psychotic's speech. She stressed the form of the interaction and of the everyday behaviour where she saw where the patient stands in the world. The discussion shows that Fromm-Reichmann developed her theories and practice in cooperation and discussion with other psychoanalysts working with psychotic patients.