GERD RUDOLF
Department for Psychosomatic Medicine, Centre of Psychosocial Medicine of the University of Heidelberg, Germany

The Impact of Structural Functioning for the Embodied Self

As psychotherapists in the field of psychosomatic medicine we cannot think of the self but as embodied, especially reflecting the conditions of early development in early childhood. In psychodynamic treatment two types of disorders led us into great difficulties for a long time - personality disorders and somatoform disorders - until we changed our etiological and pathogenetic hypotheses and our psychodynamic view. On the basis of Operationalized Psychodynamic Diagnostic (OPD) we started to differentiate between pathology on a high structural level of unconscious conflicts and the lower lever of structural deficiencies concerning functions like self reflection, object perception, regulating and communicating of affects, empathy, understanding bodily signals, internalising gut relational experience and so on. Focusing therapeutic work on these points - similar to Fonagy's Mentalization Based Treatment or Heigl's Interactional Method - we were enabled to cooperate actively even with difficult patients and to develop structural tools, using a therapeutic attitude of parenting. This concept of a modified psychodynamic psychotherapy, which will be discussed in detail, has a great resonance in inpatient psychotherapy as well as in outpatient treatment, especially for patients with structural deficiencies across different diagnosis (e.g. in personality and somatoform disorders) and especially in adolescent and young adults.

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