Psychoanalytical Developmental Theories, Diagnostics
and Psychoanalysis for Children and Youth
Stromstr. 3b - Room 1.01
Tel.: +49 30 300 117-712
My clinical work has brought me into contact with numerous children, adolescents and adults who have experienced severe stress and trauma during their development. The various development theories, each formulated from a different perspective, are not only helpful regarding normal development and developmental conditions, but are also essential for clinical practice. Such theories trace the paths followed by both young and older people as they evolve either towards health or towards mental illness and can shed light on the chronological sequence of such development and on its epistemic follow-up.
In my courses on developmental psychology and developmental psychopathology, I teach students the theoretical concepts of development, illustrated by concrete examples from my clinical practice. I stress the importance of both the classical psychoanalytical theories of development and the more recent complex theories that are largely backed by research results. These theories, in combination with the neurobiological findings on development, form the foundation of modern diagnostic and therapeutic procedures.
The diagnosis of mental disorders is a double-edged sword. In his day, Freud declared that the boundaries between normality and pathology were fluid. Nowadays, the diagnostic classification systems in use show a tendency to pathologize conspicuous behaviour. The resulting constant increase over recent years in the number of diagnoses that define abnormalities as pathological has attracted considerable negative attention from many quarters.
Clinical diagnosis of mental disorders is based, on the one hand, on countable and measurable data, which are regarded as disease indicators, and, on the other hand, on a holistic psychoanalytical perception that includes sensory impressions, aspects of relationship formation and countertransference, as well as interpersonal interaction during patient diagnosis. During the diagnostic process, prejudices or reflexive reactions, along with concrete facts and repetitive compulsion are used as sources of unconscious knowledge.
Severe developmental disorders in childhood and adolescence are associated with a variety of impairments that for many years have remained beyond the grasp of genetic research or that have been only inadequately determined by these means. The complexity of such disorders is poorly reflected in the diagnostic classification systems. In clinical work with severely disturbed children and adolescents, we are repeatedly confronted with the question of what an effective psychotherapeutic treatment that takes this complexity into account should look like. This is especially the case when the young patients do not have a space for reflection and their impairments are not expressed in words, but are represented through actions. Cognitive and sensorimotor limitations add further complications. Our studies on ADHD and its treatment as part of a naturalistic therapy study have revealed the multiplicity of patients’ physical, cognitive and psychological impairments.
My research focuses in particular on therapeutic practice. We are currently developing and evaluating psychotherapeutic concepts for those adolescents who meet the diagnostic criteria of borderline personality disorder and exhibit complex traumatization. The aim is to treat this group of patients adequately as early as possible. For the psychoanalytic-interactional method (PIM-A) derived from psychoanalysis, we were able to prove by means of a first randomized controlled study that this therapy represents an effective treatment option in an inpatient setting for adolescent patients with a borderline personality disorder. The existing inpatient treatment concept of the psychoanalytic-interactional method (PIM-A) for adolescents with borderline personality disorder is now being adapted and implemented by a small therapy study in Berlin for use in an outpatient context.
The anxiety study for children (ASK study), which we have been conducting since 2014, is a multi-centre study being undertaken in cooperation with the three universities of Berlin, Göttingen and Heidelberg and is aimed at researching and improving the psychotherapeutic treatment of children with anxiety disorders. Although the psychotherapeutic treatment of anxiety disorders in adults and adolescents has been fairly well investigated, there are significantly fewer studies on the psychotherapeutic treatment of anxiety disorders in children. The ASK study involves children aged 7-13 who suffer from separation anxiety, generalised anxiety disorder or social phobia. The focus-related short-term therapies for young patients take place in the respective university outpatient clinics as well as with cooperating therapists in private practice. This is also a randomised controlled multicentre study.
Finally, my research interests also include adolescence with its crises and new identities (e.g. gender diversity) as well as the integration problems of young migrants (e.g. the #MeTwo movement against racist harassment).
2006 - 2009: Scientific support on the "Time for a child" project within the framework of the Göttingen Community Foundation.
2007 - 2011: Implementation of a randomized controlled therapy study of adolescents with social-behaviour and emotional disorders. Funded by the Förderverein für analytische Kinder- und Jugendlichen-Psychotherapie e.V. Krefeld (Association for Analytical Psychotherapy for Children and Adolescents).
2009-2013: Therapy study with waiting-time control group in children and adolescents with ADHD.
From 2014: Implementation of a randomized controlled therapy study on the different anxiety disorders in children and adolescents at the IPU in cooperation with the department of Psychosomatics and Psychotherapy at the University of Göttingen (Prof. Salzer) and the department of Psychiatry at the University of Heidelberg (Dr. Stefini).
2017: Feasibility study for outpatient psychotherapy among adolescents with borderline personality disorders (in cooperation with Prof. Salzer)