THE SIGNIFICANCE OF CASE CONFERENCES IN I NPATIENT HUMANSTRUCTURAL PSYCHOTHERAPY

A survey of literature on the topic of case conference during the past 20 years, which predominantly stems from the USA and Great Britain, s hows the following fields of application: child psychiatry and pedagog ics, psychiatry and psychotherapy, geriatrics, oncology, psychosomatic s and general medicine. Case conferences are used: in diagnosis, thera py planning, and prognosis, as cooperation of different institutions a nd professions, for education and supervision, as a possibility for im proving the therapist-patient relationship and the basic ethical attit ude of the therapist, in the field of unconscious, group dynamic and c ommunicational processes under consideration of the cultural and instu tional framework, for health prophylaxis, In the tradition of psychoan alytically oriented psychotherapy and psychiatry, ''parallel processes '' (Sigman 1985) were observed in individual supervision. Sigman descr ibes the parallel process as a form of a countertransference in which the reporting therapist behaves, without consciously realizing it, in accordance to the patient's projections. Sigman (1989) describes the a ppearance of parallel processes in case conferences in inpatient psych otherapy and uses the term of ''unsonscious repetition''. Sachs and Sh apiro (1974, 1976) use case conferences for training purposes to learn to know the own unconscious assumptions and expectations of the train ees. Thus, the clinical case conference can be an important experience in order to understand the principles of analytical psychotherapy. In the first Dynamic Psychiatric Hospital in Obermenzing (1975-1979) and later, since 1979, in the Dynamic Psychiatric Hospital Menterschwaige , Ammon introduced the case conference as a diagnostic and therapeutic instrument. In the case conference the following items are discussed: a detailed diagnostic investigation at admission by psychiatrists, ps ychologists, specialists in internal medicine, social workers, and the reports on course of treatment in different therapeutic settings. On the occasion of the case conference test-psychological investigations are accomplished. The direct observation of the patients in their dail y life in the hospital is of central significance, just as their behav iour in different treatment situations. The milieu therapy is of outst anding importance. After an intensive discussion of all informations a nd findings, the patient himself is asked to attend the conference tog ether with co-patients, to present his own ideas about future aims, wi shes for change in the therapy, etc. Of special interest are also the perceptions and contributions of the co-patients. Deriving from his ex periences in the Menninger Foundation (1956-1965) in this context Ammo n (1979) described the unconscious reflecting processes he observed in control groups and case conferences as the Ekstein-Wallerstein-law. N ew in Ammon's concept is that total group dynamics can be reflected an d not only the dyadic interaction between patient and therapist. Throu gh the reports of the different therapists and through unconscious ide ntification with the patient, the actual group dynamics around the pat ient in the context of the hospital is reflected in the case conferenc e. The reflection of transference manifestations of the patient, the r ecognizing of real relationship experiences as well as countertransfer ence feelings of the therapists give hints on aspects of the early pri mary group dynamics of the patient. It is Ammon's specific contributio n that he gave the case conference a central meaning for psychoanalyti c diagnostic and treatment in Inpatient humanstructural psychotherapy. He used in particular the group-dynamic principle to gain findings ab out the conscious and unconscious dynamics of the patient. One must em phasize that the fact that the patient and co-patients participate act ively the case conference, shows a therapeutic partnership attitude. T he strengthening of the healthy parts and creative potentials, and the developing of a future vision together with the patient, are necessar y to remove the life-restricting power of disease. This therapeutic op timism, the belief in developmental possibilities inherent in every pe rson, together with the perspective of a need-oriented future, have be en always central in Ammon's thinking.