Issue 1 – February 2016



A quarterly publication          25th year, issue 1 February 2015




Lili Valkó, Márta Takácsy



Methodological study

John S. Kafka: Chestnut Lodge and the Psychoanalytic Approach to Psychosis.Translated by: Lili Valkó

Theoretical study

Gitta Nikoletta Szanyi, Anita Szemán-Nagy: The psychotherapeutic approach of sadomasochistic impulses and sexuality

Work study

Ágnes Hódi, Márta Merényi: Concerted plays, concerted games


Mária Tornyossy: Comment on the study of László Bokor: Laius and Jocasta in marital therapy.

László Bokor: Response to the reflections of Mária Tornyossy



The way we work…

Zsuzsa Lovas: Whom we never meet in our practice

Gyöngyi Vad: Comment on the study of Zsuzsa Lovas

László Bokor: Comment on the study of Zsuzsa Lovas

Panorama – Psychotherapy and counselling at district psychiatric centers around the country–practice, dreams and possibilities

Team presentation interview – Magyar Szupervizorok és Szupervizor Coachok Társasága

Competition – Fruits of forced solutions: What can we gain from difficult circumstances? – Viola Szebeni¨Gabriella Novotny

Society corner – Hungarian Psychoanalytic Association




Starting the psychotherapeutic section of Hungarian Psychiatric Society interview with Gábor Paneth by Gábor Szőnyi

Discussions, comments

Debate: Role of religion – does it hinder or foster therapy or consultation? – Anikó Kézdy¨ Csaba Horgász¨ Katalin Szőke

Debate: Body – to use (or not to use) in therapy? – Márta Merényi

Ethical questions in therapeutic practice 15. – Antal Bugán ¨ Judit Csonka¨ Réka Pálfy

Letter to the Editor– Amaryl Árkovits


News and information


Conferences – Gergely Biró, Márta Porkoláb ¨ Katalin Kádár ¨ Dóra Lőrik ¨ Erika Szautner, Zsolt Deák ¨ Katalin Vermes

Book reviews – Noémi Berger¨ László Pásztor¨ Márta Takácsy ¨ István Tiringer

List of professional books and periodicals

Professional programs

Editorial announcements – Renewal of genres




Methodological study

John S. Kafka:

Chestnut Lodge and the Psychoanalytic Approach to Psychosis.

Translated by: Lili Valkó


The study of psychosis has a long history in psychoanalysis, as does the debate over the suitability of psychoanalysis for treating schizophrenia. For decades, Chestnut Lodge was not only a hospital but also a clinical research and educational institution. A unique patient-staff ratio – about twenty analytic therapists for a hundred patients – made possible prolonged and intense clinical work with schizophrenic and other severely disturbed patients. Interstaff discussions were encouraged and facilitated. This quasi-academic approach to in-depth individual case studies led to clinical findings and theoretical formulations that had a significant impact on developments in psychoanalysis, both here and abroad. Many of these findings and theoretical formulations are relevant to current studies and treatments of psychotic and nonpsychotic patients. This study after presenting the changes in the understanding of psychosis and narrating the formation of Chestnut Lodge, briefly provides a taste of the work of Fromm-Reichmann, Searles, Pao and McGlashan, after which the term „atmospheric object” is introduced, which is characteristic specifically but not solely of schizophrenic patients.

Keywords: psychosis – psychoanalysis – Chestnut Lodge – healthy part –  atmospheric object




Theoretical study

Gitta Nikoletta Szanyi, Anita Szemán-Nagy:

The psychotherapeutic approach of sadomasochistic impulses and sexuality


The theories of sadistic and masochistic urges were well known in psychoanalyst writings, but they rarely come up in psychology literature and during the psychology training nowadays. The sadism and masochism are diagnosed as sexual disorders. They were just planned to be also personality disorders (sadistic and self-defeating personality disorder). This idea was not realised with the publication of DSM-IV. The sadomasochism can appear in sexual life, but also in attachment, behaviour and self-assessment. It is a complex phenomenon. Because of the egodyston aspect of the paraphilia it is quite rare that someone comes to the therapy with these sexual disorders. Shame and the fear of rejection or prison sentence also can be important in some cases. The psychical background of sadistic and masochistic personality might be important, mainly problems in early attachment and child abuse. The sadomasochistic personal traits and their appearance in sexual life might be also a relevant aspect. It can be an attendant phenomenon, namely in the case of sadistic or masochistic personality disorder the probability of sadomasochistic sexual behaviour is higher. It is also thinkable that sexual sadomasochism functions as a let out in the person’s life. We would like to describe some results in theory and investigation.

Keywords: paraphilias – sadomasochism – trauma – attachment



Work study

Ágnes Hódi, Márta Merényi:

Concerted plays, concerted games


The psychotherapy of patients with severe personality disorder often involves the administration of psychiatric medication. Whether considered or not, the pharmaceutical treatment in these cases has certain psychodynamic preliminaries and consequences. The quality of the joint work of the psychologist and the psychiatrist becomes different if both also have a psychotherapist identity and a psychodynamic stance within that. Psychodynamic thinking in this case means a focus on observation, and analysis of unconscious and non-conscious phenomena in the relationship of the therapist, the psychiatrist, and the patient. When a psychiatrist joins the psychotherapeutic process, the relational space and transferences built by the patient and the therapist suddenly expand – while this space is already populated by many persons. Observation shows that maintaining the unity of this system is difficult for many reasons. The entry of a third person – especially in case of serious personality disorders – strengthens primitive defences, while it also makes it difficult to see through them. The transparent relationship of the psychiatrist and the psychologist is of key importance: the template of the parental couple cooperating in supporting the child’s interests is replayed.

In this article the authors, who used to work together in the team of Ego Klinika, describe their co-therapist approach that had developed gradually, and the practical consequences of it from 15 years of experience. They use partial case studies to illustrate some of the factors that facilitate the reflective concerted play between the therapists; or eventually hinder that, which may lend the cooperation the character of a game. How does the necessity of medication arise? Thinking through the decision process. Which experiences, events allow the recognition of typical psychodynamic traps in the combined treatment of personality disorders? What are the forms and events that obviate the strengthening of primitive defences and destructive contents in the relational space of the psychologist – psychiatrist – patient? How can such a concerted play turn into a concerted game? How can they help each other and the patient in maintaining the therapeutic character of the process?

Keywords: cooperation between psychologist and psychiatrist – pharmaceutical treatment and parallel psychotherapy – psychodynamics of personality disorder – therapeutic partnership



The way we work…

Zsuzsa Lovas:Whom we never meet in our practice

Gyöngyi Vad: Comment on the study of Zsuzsa Lovas

László Bokor:Comment on the study of Zsuzsa Lovas


The case study introduces an event occurring in a thematic group session, held for homeless people. The participants of the group are accused of the theft of a lock, even the police was sent to them. Members of the group are painfully affected by the additional prejudice and failure.

Many participants come to the group to find the lost hope after a lot of failure, rejection, it is hoped that they can succeed, and they get back to the world of normal people. The stakes are huge. Is the group able to come over the learned helplessness/hopelessness, is the group able to support its members to recover their self-confidence.

Keywords: homeless unemployed – prejudice – insinuation, learned helplessness/hopelessness



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