title: [Between empathy and setting limits--reflections on psychodynamics and treatment techniques in psychoanalytic therapies for hyperkinetic disorders].
abstract: The rise in "hyperkinetic disorder" diagnoses is not based on better but rather on less precise diagnoses. As a rule the co-morbidities as mentioned in ICD-10 like emotional disorders, commitment disorders and social behaviour disorders, are the real clinical pictures accompanied by such symptoms as inattentiveness, hyperactivity and impulsiveness. These are disorder pictures based possibly on unconscious areas of conflict which can be managed by psychoanalytic treatment. However, this involves considerable treatment challenges taking into account that there are some major difficulties: Children showing said disorder pictures have not only symbolizing disorders but mostly also playing disorders. They experience playing not symbolically, no longer mainly "as if" and taking place in a space between imagination and reality. Their play may easily turn into concreteness or reality and get out of control all of a sudden. In addition, children and young people with externalizing disorders constantly attack basic conditions and seek to destroy them. Verbal intervention frequently does not reach the patients. Counter transferences are very difficult to bear and to control, and the tendency of psychotherapists to join in is strong. It is therefore of great importance to work on the ability of symbolization and mentalization, on relationship and transference, simultaneously however on frame and structure, with reliability and regularity of the settings. Analytic therapies as well as therapies founded on depth psychology may be indicated, possibly supplemented by parallel medication; at the beginning a particularly careful diagnosis should be made.
authors.affiliation: Therapiezentrum Osterhof, Baiersbronn. dr.hans.hopf@t-online.de
authors.forename: Hans
authors.initials: H
authors.lastname: Hopf
mesh_terms: D000342:Affective Symptoms / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D000374:Aggression / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D003220:Conflict, Psychological; D004645:Empathy; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D010989:Play Therapy; D011574:Psychoanalytic Theory; D011575:Psychoanalytic Therapy / Q000379:methods*; D019962:Reactive Attachment Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D013561:Symbolism; D014473:Unconscious, Psychology
chemical_list: D000697:Central Nervous System Stimulants