Jacek Bomba
Spojrzenie na depresje z perspektywy psychoterapii 35-42
Depression as seen from the psychotherapy perspective 35-42
Streszczenie
Autor artykułu podejmuje próbę uporządkowania wiedzy i wyjaśnienia natury depresji, w tym również u dzieci i młodzieży w kontekście historycznym, w oparciu o zajmujące się tym teorie psychoterapii oraz różne nurty psychiatrii. Odwołuje się również do badań nad wynikami leczenia farmakologicznego. Poszukując odpowiedzi na pytanie o to, jaka psychoterapia jest skuteczna w leczeniu depresji dzieci, młodzieży i osób dorosłych zwraca uwagę na jej skomplikowaną naturę i stawia pytanie, czy psychoterapia jest rzeczywiście skierowana na zmianę hipotetycznych mechanizmów depresji.
Summary
Childhood and adolescent depression have been the point of interest of child and adolescent psychiatrists since the 60's of the last century. The antidepressants have not brought the expected results in treatment. Some - because of the immaturity of the metabolic system, others - because of the risk connected with the earlier influence on the activity level rather than on other dimensions of depression psychopathology.
The earliest links between understanding and treating of childhood and adolescent depression are these of the psychoanalytical and psychodynamic tradition; although depression described in the psychodynamic psychopathology language is different from this described by descriptive psychopathology. The important publications are these of Anna Freud, Eva Frommer, Gerhardt Nissen and - later - of Antoni Kępiński.
Lack of safe support during adolescence has been discussed as pathogenic for adolescent depression. The concept of adolescent depression was introduced by Antoni Kępiński.
The last years' studies of family relations (e.g. Stierlin) and brain development (Fonagy, Schore) point out the importance of care continuity, adjusted to the developing child's needs, from babyhood till full individuation. The main problem - from the psychotherapeutic perspective - is not the support, which the patient can get from the therapist, but the patients' own possibility of taking advantage of it.
