[Selected aspects of coping with illness and psychotherapeutic treatment of stroke patients]

Starting out from a short description of typical life situations at stroke onset as well as a number of coping definitions, specific elements in stroke patients' disease experience are set out. Further, five typical intrapsychic reaction patterns during rehabilitation are outlined. Various variables relevant to the coping process are discussed in detail: somatic disease characteristics, personality traits and their impact on adaptability, previous crisis experience and coping strategies, social network, prognosis. Special attention is focussed on the significance of subjective perceptual, evaluation and interpretation processes. The implications specific disease symptoms (neuropsychological impairment, organic brain syndrome) may have for stroke patients' coping mechanisms are dealt with. By commenting on eight theses posited, psychotherapy specifies in stroke patients are described, emphasizing the need for careful diagnosis, also in view of somatic side effects of psychotherapeutic methods. A flexible approach is demanded, in line with each patient's capabilities. Highest initial priority is given to therapy elements that address basal human needs. With increasing recovery, a gradual transition from a verbal/unblocking/exercising methods to verbal/conflict-oriented ones as well as from a more guiding/supportive to an insight-oriented approach seems possible. The rank of behavioural therapy, psychoanalysis and group therapy is discussed in detail. Reasons are given for integration of system theory concepts, as well as constant availability of crisis intervention; participation in supervision activity is considered a must.