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In Germany, as in many other countries, psychoanalytic and psychotherapeutic practice is becoming more and more concerned with the treatment of Bulimia nervosa. The treatment of bulimic patients often calls for certain modifications in psychoanalytical technique. The specific symptoms of the disorder; the conflicts and the ego structures, particularly defense; and the nature of the patients' interpersonal relationships must be taken into consideration. The following observations are based on many years of experience gathered in our special outpatient department for eating disorders. Various types of treatment are used, sometimes in combination with one another (e.g., psychoanalytic and psychodynamic individual therapy, family therapy, cognitive behavioral therapy, group therapy). This has presented grounds for discussion on the various parameters of psychoanalytic therapy.
In Germany, the background for this discussion is as follows:
In the conflict concerning the effectiveness of various therapeutic methods for the treatment of mental disorders, psychoanalysts are under increasing pressure to justify the time and costs their approach involves.
Dr. Reich is Training and Supervising Analyst, Lou Andreas-Salomé Institut für Psychoanalyse Göttingen (DPG). Trainer and Supervisor in psychoanalytic family therapy, Center for Family Therapy, University of Göttingen.
Dr. Cierpka is Professor of Psychosomatics and Psychotherapy, Department of Psychosomatics and Psychotherapy and Director, Center for Family Therapy, University of Göttingen.
Efforts to combine or integrate elements of different therapeutic approaches are on the increase. Some of these result from research or theoretical projects (Orlinsky 1994; Grawe, Donathi, and Bernauer, 1994) and some from practice. For example, Tobin and Johnson (1991), following on from Wachtel (1977), suggest the integration of psychodynamic and behavioral therapy in the treatment of eating disorders.
These discussions have an “ex