Q46(092($7!7260!6(B&$06!):!1647#)2*2<4606!Z$(#!7#%)*$7!&01%0660&! Z$(#$*!(#0!:%290!):!(#0!A=8!O01%066$)*!Q(B&4!
A0BC$*D0%EF)#<030%_!@>![$*!1%066^?!K)%M$*D!Z$(#!60Y0%0<4!(%2B92($C0&_!7#%)*$7!&01%0660&!12($0*(6>! ;*(0%*2($)*2![+,-]^?!O01%066$)*!2*&!(%2B92?!(#0!1647#)2*2<46$6!):!2!12($0*(!6B::0%$*D!:%)9!7#%)*$7! &01%066$)*>!;*?!=<(92**_!@>['&>^!"$90!:)%!8#2*D0>!A)*&)*?!I2%*27_!1>-++!::>! >-001(3! Surprisingly often in the psychoanalyses of chronically depressed patients, depression represents an unconscious attempt to psychically cope with unbearable psychic pain following severe traumatisation: dissociative states, a chronified psychic state of shock, a disappearance of emotions, an emptying of the self and the object relationships, as well as a disappearance of the psyche in the body are among the possible consequences. The treatment of these difficult groups of analysands can also frequently bring analysts to the limits of the endurable. Often related to this is the repeated danger of denying the trauma, and a re-traumatisation of the analysand in the analytic situation. This systematic clinical case study discusses the fact that in comparison with other therapeutic approaches, psychoanalysis disposes over a highly differentiated conceptualisation of the psychic determinants and the treatment of chronic depression. However, in order to retain its creativity and innovation as a scientific discipline and to be thus perceived in the non-psychoanalytic world, it must constantly further develop its conceptualization by way of systematic and extra-clinical research as is witnessed in the insufficient conceptual account of severe traumatisation during the genesis of chronic depression. In this connection, several exemplary examples from extra-clinical studies in the sphere of psychotherapeutic research, neurobiology, epigenetics and embodied cognitive science will be accounted for. As will be treated in the final part of this paper, of no less importance are the conceptualizations in clinical research on psychoanalysis, which are based on meticulous, careful analyses of trauma reactivation in the transference, and understanding and working through them in the psychoanalytic relationship. This systematic clinical case study is based on expert validations wihtin the frame of the LAC Depression Study (see psychoanalytical expert validation, LAC Depression study). Similar expert validated systematic clinical case studies are in preparation. @)15-1.*$#! The systematic clinical case studies within the frame of the large extraclinical LAC Depression Study have proven to be fruitful to communicate the clinical experiences with this difficult to treat group of patients. Book publications with several case studies in German and English are in preparation. G$#.1/.!! Marianne Leuzinger-Bohleber m.leuzinger-bohleber@sigmund-freud-institut.de ! Ulrich Bahrke: bahrke@sigmund-freud-institut.de
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