PETER HENNINGSEN
Clinic for Psychosomatic Medicine and Psychotherapy, Techical University of Munich, Germany

Disordered self on many levels - any chance for therapeutic integration?

One of the aims of DISCOS is to map out therapeutical and ethical implications of a multi-level model of the embodied self and its disorders. The aim of this talk is to indicate some aspects of this part of the project. Promotion of an integrative therapeutic perspective within DISCOS needs a pragmatic least common denominator of what the self is about across the scientific disciplines, irrespective of their differences. Two examples for a least common denominator of an interdisciplinary understanding of the self are:

• the importance of intentional person-environment interactions
• the significance of 'lower', e.g. sensori-motor processes in explaining 'higher', e.g. cognitive processes.

In terms of therapy for disorders of the self this would imply, among others:

• that therapeutic interventions, be they 'psychological' or 'biological', always have inter-level effects that need to be monitored regularly.
• that therapy, biological as well as psychological, always implies a therapist who is an active participant and not only an external observer.
• that the aims of therapy cannot be determined in a fixed way beforehand
• that the evaluation of therapies has to transcend current evidence based medicine with its reliance on randomized controlled trials, e.g. through systematic consideration of hypothesized mechanisms of change and context effects in so-called realist reviews.

Implications like these could help to define a common denominator also for therapeutic approaches to disorders of the self and hence help to bridge old polarities between biomedical and interpersonal models of therapeutic approaches.

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