Uma leitura teórico-clínica de uma análise: o fato clínico como operador metodológico / A theoretical-clinical reading of an analysis: the clinical fact as a methodological operator / Una lectura teórico-clinica del análisis: el hecho clínico como herramienta metodológica

O presente artigo é oriundo de pesquisa acadêmica que teve como objetivo estudar a clínica psicanalítica e seus efeitos por meio da apresentação de fragmentos de uma análise já encerrada. Para alcançar esse objetivo, utilizamos a ferramenta metodológica do fato clínico, articulando o material clínico com alguns pontos da teoria psicanalítica. Como resultado, apontamos que é possível fazer uma leitura teórico-clínica de uma experiência de análise sob a perspectiva dos movimentos discursivos, em especial do sujeito do inconsciente ($) e do objeto a, conforme apresentados na proposição dos Quatro Discursos de Lacan. Acreditamos que este estudo enfatiza a importância da especificidade da pesquisa em psicanálise em sua dimensão clínica e os possíveis efeitos produzidos por esse processo terapêutico. Dessa maneira, entendemos que a divulgação deste trabalho pode contribuir para a discussão da prática clínica entre colegas do campo psicanalítico e acadêmico, bem como para a difícil tarefa da apresentação do material clínico com a sustentação teórica necessária, a fim de fortalecermos a sempre fundamental transmissão da psicanálise.(AU)

This article comes from academic research that aimed to study the psychoanalytic clinic and its effects by presenting fragments of an analysis that has already ended. To achieve this goal, we used the methodological tool of the clinical fact, articulating the clinical material with some points of psychoanalytic theory. As a result, we point out that it is possible to make a theoretical-clinical reading of an analysis experience from the perspective of discursive movements, in particular, the subject of the unconscious ($) and of the object a, as presented in the proposition of Lacan's Four Discourses. We believe that this study emphasizes the importance of the specificity of research in psychoanalysis in its clinical dimension and the possible effects produced by this therapeutic process. In this way, we understand that the dissemination of this work can contribute to the discussion of clinical practice among colleagues in the psychoanalytic and academic fields, as well as to the difficult task of presenting clinical material with the necessary theoretical support, to strengthen the always fundamental transmission of psychoanalysis.(AU)

Este artículo surge de una investigación académica que pretendió estudiar la clínica psicoanalítica y sus efectos mediante la presentación de fragmentos de un análisis que ya terminó. Para lograr este objetivo, se utilizó la herramienta metodológica del hecho clínico articulando el material clínico con algunos puntos de la teoría psicoanalítica. El resultado permite señalar que es posible realizar una lectura teórico-clínica de una experiencia de análisis desde la perspectiva de los movimientos discursivos, en particular el sujeto del inconsciente ($) y el objeto a, como se presenta en la proposición de los cuatro discursos de Lacan. Este estudio enfatiza la importancia de la especificidad de la investigación en psicoanálisis en su dimensión clínica y los posibles efectos que produce este proceso terapéutico. De esta forma, la difusión de este trabajo puede contribuir a la discusión de la práctica clínica entre colegas del campo psicoanalítico y académico, así como a la difícil tarea de presentar material clínico con el soporte teórico necesario para fortalecer la siempre fundamental transmisión del psicoanálisis.(AU)

PSYCHOANALYSIS AS A TWO-PERSON MEDITATION: FREE ASSOCIATION, MEDITATION AND BION.

This paper is based on the commonality between free association and the practice of Buddhist meditation in light of the surprising fact that both great traditions devoted to healing human suffering rely on the same fundamental method. After reviewing some aspects of free association and evenly-suspended attention, relevant aspects of Buddhist meditation and Buddhism as a psychology, including thinking and emotion, are compared and contrasted with psychoanalysis. The Buddhist insight of impermanence is highlighted. Freud's telephone metaphor becomes the basis for a discussion of psychoanalysis as a two-person meditation. Bion's proposal for the analyst to eschew memory and desire to be in the moment with his patients serves as an introduction to a case by Thomas Ogden which illustrates both Bion's points and provides an example of a two-person meditation.

Social representations of integrative community therapy by the elderly. / Representações sociais sobre terapia comunitária integrativa construídas por idosos.

OBJECTIVE: To elicit the social representations of the elderly regarding integrative community therapy (ICT). METHOD: This is an exploratory study conducted with 273 elderly people in a municipality of northeastern Brazil, in 2014. It is based on the theory of social representations and the free-association test for the inductor term "integrative community therapy". The data were processed using EVOC software and examined with the structural approach of social representations, followed by a similarity analysis and confrontation with literature. RESULTS: The organisation and meaning of the representations of ICT chiefly occurred through the core element: Group. CONCLUSION: The analysis revealed that the ICT is a support network for the elderly, where they feel they belong to a group and feel empowered through participation in the sessions.

Representações sociais sobre terapia comunitária integrativa construídas por idosos / Representaciones sociales acerca de la terapia comunitaria integradora construida por ancianos / Social representations of integrative community therapy by the elderly

RESUMO Objetivo Conhecer as representações sociais dos idosos concernentes à terapia comunitária integrativa (TCI). Método Estudo exploratório, realizado com 273 idosos de um município no nordeste do Brasil, em 2014, tendo por base a teoria das representações sociais e a aplicação do teste de associação livre de palavras por meio do termo indutor "terapia comunitária integrativa". Os dados foram processados pelo software EVOC e examinados pela abordagem estrutural das representações sociais, realizando-se uma análise de similitude, bem como o confronto com a literatura. Resultados A organização e o significado das representações de terapia comunitária integrativa ocorreram, principalmente, através do elemento central: Grupo. Conclusão A análise permitiu inferir que a TCI constitui uma rede de apoio para idosos, na qual se verificam um sentimento de pertencimento a um grupo e o empoderamento dos participantes através de sua participação nas rodas.

RESUMEN Objetivo Conocer las representaciones sociales de los ancianos acerca de la Terapia Comunitaria Integradora (TCI). Método Estudio exploratorio, con 273 ancianos de una ciudad en el nordeste de Brasil, en 2014, basado en la teoría de las representaciones sociales y la aplicación de la prueba de asociación libre de palabras, por medio del término inductor "terapia comunitaria integradora". Los datos fueron procesados por el software EVOC y examinados por el enfoque estructural de las representaciones sociales, poniendo de relieve un análisis similar, así como la confrontación con la literatura. Resultados La organización y el significado de las representaciones de la TCI se producen a través, sobre todo del elemento central: Grupo. Conclusión El análisis permite inferir la función TCI como una red de apoyo para la tercera edad, reflejada en el sentimiento de pertenencia a un grupo. Por último, refleja el empoderamiento de los ancianos mediante la participación en las ruedas de TCI.

ABSTRACT Objective To elicit the social representations of the elderly regarding integrative community therapy (ICT). Method This is an exploratory study conducted with 273 elderly people in a municipality of northeastern Brazil, in 2014. It is based on the theory of social representations and the free-association test for the inductor term "integrative community therapy". The data were processed using EVOC software and examined with the structural approach of social representations, followed by a similarity analysis and confrontation with literature. Results The organisation and meaning of the representations of ICT chiefly occurred through the core element: Group. Conclusion The analysis revealed that the ICT is a support network for the elderly, where they feel they belong to a group and feel empowered through participation in the sessions.

O desenvolvimento da regra fundamental na obra de Freud: da hipnose à associação livre / The development of the fundamental rule in Freud's work: from hypnosis to free association

Uma das principais ferramentas da técnica psicanalítica é a associação livre, intitulada pelo próprio Freud como a regra fundamental da psicanálise. Essa regra pode ser conceituada como o compromisso assumido pelo paciente de comunicar ao analista tudo o que lhe vier à mente, independentemente de suas inibições ou do fato de achá-las insignificantes ou não. Freud desenvolveu a técnica da associação livre gradualmente a partir da hipnose e do método catártico. O conhecimento desses métodos anteriores à associação livre torna possível uma maior compreensão a respeito do desenvolvimento da regra fundamental. Esse aprimoramento na técnica psicanalítica possibilitou o acesso do material recalcado para a consciência e revelou ao paciente a natureza de seu inconsciente. O presente trabalho se propõe a realizar um estudo da evolução da regra fundamental na obra de Freud através de seus sucessivos períodos, passando da hipnose à associação livre.(AU)

One of the main tools of psychoanalytic technique is free association, headed by Freud himself, as the fundamental rule of psychoanalysis. This rule can be defined as the commitment of the patient to communicate to the analyst whatever comes to mind, regardless of their inhibitions or fact find them insignificant or not. Freud developed the technique of free association gradually from the hypnosis and the cathartic method. Knowledge of these previous methods to free association makes possible a greater understanding about the development of the fundamental rule. This enhancement in psychoanalytic technique allows access of the repressed material for awareness and revealed to the patient the nature of his unconscious. This paper aims to conduct a study of the evolution of the fundamental rule in Freud's work through its successive periods through hypnosis to free association.(AU)

Increased response time of primed associates following an "episodic" hypnotic amnesia suggestion: a case of unconscious volition.

Following a hypnotic amnesia suggestion, highly hypnotically suggestible subjects may experience amnesia for events. Is there a failure to retrieve the material concerned from autobiographical (episodic) memory, or is it retrieved but blocked from consciousness? Highly hypnotically suggestible subjects produced free-associates to a list of concrete nouns. They were then given an amnesia suggestion for that episode followed by another free association list, which included 15 critical words that had been previously presented. If episodic retrieval for the first trial had been blocked, the responses on the second trial should still have been at least as fast as for the first trial. With semantic priming, they should be faster. In fact, they were on average half a second slower. This suggests that the material had been retrieved but blocked from consciousness. A goal-oriented information processing framework is outlined to interpret these and related data.

Current developments in the practice of individual psychoanalytic psychodrama in France.

The authors present the history of individual psychoanalytic psychodrama and its current developments as practised in France. They put forward the technique, objectives and rules, along with the indications, limits and risks that ensue from the specific nature of this therapeutic approach. Through its technical adjustments, individual psychoanalytic psychodrama provides a therapeutic option that is appropriate to the defences prevalent in many patients that cause classical psychotherapies to fail: massive inhibition, operative functioning far removed from affects or in false self mode; phobias, disavowal or splitting of the internal psychic life and emotions; prevalence of short discharge circuits in acted-out behaviours and bodily or visceral complaints and expressions. Psychodrama utilizes these defences not in order to eliminate them but to 'subvert' them so that they can continue to carry out their protective role, in particular ensuring narcissistic continuity. At the same time, psychodrama relaxes these defences and facilitates a possible filtering through of the repressed material. Through the number of actors and the diffraction of transference that this allows, psychodrama provides a possibility of adjusting the potentially traumatic effect of the encounter with the object and the instigation of the transference in the regressive dimension induced by any psychotherapeutic process.

O neutro em psicanálise: da técnica à ética / The neuter in psychoanalysis: from technique to ethics

O presente artigo retoma a noção de neutralidade proveniente da técnica clínica psicanalítica, confrontando-a com noções próximas, tais como a neutralidade científica e o neutro na semiologia de Barthes. Procuramos demonstrar como tal noção descreve bem a postura analítica, exigida tanto do paciente (associação livre) quanto do analista (atenção flutuante), e como ela nasce na prática clínica freudiana, respondendo a problemas decorrentes dela. Assim, abordaremos os temas da hipnose e da sugestão, como também aqueles ligados à contra-transferência. Defenderemos, ainda, que a neutralidade não é apenas questão de técnica, mas é central para o entendimento da própria ética da psicanálise.(AU)

This article takes the notion of neutrality from the psychoanalytical clinic technique and confronts it with nearby notions like scientific neutrality or the neuter on Roland Barths' semiology. We attempt to demonstrate how such notion describes well the analytical posture demanded from the patient (free association) and the analyst (floating attention), and how it borns on the Freudian's practice to respond to problems found on that practice. For that, we'll discuss the themes of hypnosis and suggestion, as well as the ones related to the counter-transference. We'll yet defend that the neutrality isn't just about technique, but it is also central to the comprehension of psychoalysis' ethics itself.(AU)

O neutro em psicanálise: da técnica à ética / The neuter in psychoanalysis: from technique to ethics

O presente artigo retoma a noção de neutralidade proveniente da técnica clínica psicanalítica, confrontando-a com noções próximas, tais como a neutralidade científica e o neutro na semiologia de Barthes. Procuramos demonstrar como tal noção descreve bem a postura analítica, exigida tanto do paciente (associação livre) quanto do analista (atenção flutuante), e como ela nasce na prática clínica freudiana, respondendo a problemas decorrentes dela. Assim, abordaremos os temas da hipnose e da sugestão, como também aqueles ligados à contra-transferência. Defenderemos, ainda, que a neutralidade não é apenas questão de técnica, mas é central para o entendimento da própria ética da psicanálise.

This article takes the notion of neutrality from the psychoanalytical clinic technique and confronts it with nearby notions like scientific neutrality or the neuter on Roland Barths' semiology. We attempt to demonstrate how such notion describes well the analytical posture demanded from the patient (free association) and the analyst (floating attention), and how it borns on the Freudian's practice to respond to problems found on that practice. For that, we'll discuss the themes of hypnosis and suggestion, as well as the ones related to the counter-transference. We'll yet defend that the neutrality isn't just about technique, but it is also central to the comprehension of psychoalysis' ethics itself.

Suppression-induced forgetting on a free-association test.

The repeated suppression of thoughts in response to cues for their expression leads to forgetting on a subsequent test of cued recall (Anderson & Green, 2001). We extended this effect by using homograph cues and presenting them for free association following suppression practice. Cue-target pairs were first learned under integrating imagery instructions; then in the think/no-think phase students practised suppressing thoughts connected to some homograph cues, with or without the assistance of thought substitutes that changed their meaning. Below-baseline forgetting on the subsequent free-association test was found in the production of suppressed targets. Following aided suppression this effect was also obtained in the production of other responses denoting the target-related meaning of the homograph cues. Discussion emphasises the ecological value of the test; rarely do people deliberately attempt recall of unwanted thoughts.

The Relationship between Psychotherapy and Neurobiological Findings

The mechanism of psychotherapy is explained by the recent developments in neuroscience and neuroimaging. The purpose of this study is to understand the nature of psychotherapy and to discuss the future of psychotherapy improvement with the help of advances of the neurobiological findings in psychotherapy. For this study, we investigated a wide range of materials. We searched for various researches on psychotherapy, brain, and neurobiology. In addition to the conventional psychodynamic psychotherapy, we investigated research findings on cognitive behavioral therapy, interpersonal psychotherapy and eye movement desensitization and reprocessing (EMDR). Moreover, based on the actual experiences of treating patients, we speculated the neurobiological mechanisms of the process and results of psychotherapy. With the development of neuroscience, we are now able to understand the personal consciousness, unconsciousness and developmental process. Also subdividing the disease is made possible. Personalized treatment has become available, and we are able to predict the prognosis of patients. Our memories are composed by implicit memory and explicit memory. By psychotherapy, we can consciously remember explicit memory, and it becomes easier to explore implicit memory through free association. Through psychotherapy, we will also be able to learn the effect of acquired environment and experience. Psychotherapy is able to correct human behaviors by modifying the memories. Through the regulation of emotions, it becomes possible to modify the memories and correct the behaviors. In this process, doctor-patient relationship is the main factor which cause positive treatment effects. Furthermore imagination therapy or unconscious, non-verbal stimuli could bring about positive treatment effects. Now psychotherapy could be explained and studied by neuroscientific researches. In this sense, we could provide the direction of future advances in neuroscience by the neurobiological understanding of psychotherapy.

[How postmodern youths find their way into life--views on imaginative psychotherapy of adolescents]. / Wie postmoderne Jugendliche ihren Weg ins Leben finden--Einblicke in die Katathym Imaginative Psychotherapie von Adoleszenten.

The author describes the course of an adolescent psychotherapy with guided affective imagery (Leuner 1985) using the therapeutic material of a 15 year old female adolescent with a severe depression und automutilative behaviour. She considers this therapeutic method as very useful especially for severely disturbed adolescents, because the method enhances the creativity of the patient and enables him to express traumatizing experiences in a symbolical form thus facilitating their integration.

Art, dreams and active imagination: a post-Jungian approach to transference and the image.

The term active imagination is sometimes applied rather uncritically to describe all forms of creative activity that take place in depth psychology. Whilst there are many forms of expression that evoke or are evoked by active imagination, they cannot automatically be classed as active imagination. In this article investigation of visualized mental imagery, dreams and art reveals three distinct forms of image-based psychological activity. Integrated and mediated within the transference and countertransference dynamic, it is proposed that the engagement in active imagination reflects and is influenced by the transference. Distinctions between sign and symbol, simple and big dreams as well as diagrammatic and embodied imagery clarify the differences. Examples from clinical practice demonstrate each mode in action within the analytic frame.

Cortisol, prolactin, growth hormone and neurovegetative responses to emotions elicited during an hypnoidal state.

The present study describes the responses of cortisol, prolactin and growth hormone (GH) to emotions elicited during sessions in which an hypnoidal state was induced. The purpose of the study was to provide answers for the following questions: 1) Do sessions with an emotional content have more hormonal surges than baseline, relaxation-only, sessions? 2) Does the induction of a fantasy of pregnancy and nursing elicit a prolactin response? 3) Are there any associations between surges of different hormones? 4) Are hormonal responses related to the intensity, type, or mode of expression of the emotions? For this purpose, thirteen volunteers and twelve patients with minor emotional difficulties were studied during sessions under hypnosis. The period of observation lasted for about three hours. Heart rate (HR), skin conductance (SC) and vagal tone (VT) were monitored. Serum cortisol, prolactin and growth hormone were sampled every 15 minutes. The volunteers had three types of sessions- "blank", consisting of relaxation only (12 sessions), "breast feeding", in which a fantasy of pregnancy and breast feeding was induced (12 sessions) and "free associations" in which the subjects were encouraged to evoke experiences or feelings (17 sessions). The patients had only sessions of free associations (38 sessions). Sessions of free associations had more hormonal surges than "blank" and "breast feeding" sessions. This was true for cortisol (8/17 v.3/24; p < 0.03), prolactin (7/17 v. 3/24; p < 0.05) and GH (9/17 v. 4/24; p < 0.02). During the 55 sessions of free associations (volunteers plus patients) there were 32 surges of cortisol, 18 of prolactin and 28 of GH. Cortisol and prolactin surges were negatively correlated (p < 0.03). GH had no significant association with either cortisol or prolactin. Visible emotions were positively associated with GH surges (p < 0.05). but not with cortisol or prolactin. Cortisol surges were correlated positively with evocations of real events (p < 0.01) and negatively with evocations containing defensive elements (p < 0.01). Cortisol correlated positively with shock and intimidation (p < 0.02) and negatively with rage (p < 0.04). The AUC of the cortisol peaks during shock and intimidation was significantly higher than that of the pool of all other cortisol peaks (12.4 micromol x min x l(-1) v. 7.1 micromol x min x l(-1); p < 0.005). Rage had a marginally significant positive association with prolactin surges (p=0.07). The distribution of GH surges did not show any significant association with types of emotions. The present study provides evidence that cortisol, prolactin and GH respond to psychological stress in humans. However, they are regulated differently from one another. Cortisol and prolactin surges appear to be alternative forms of response to specific emotions. GH surges depend on the intensity of the emotion, probably as a consequence of the associated muscular activity. The current paradigm of stress, implying corticotrophin-releasing hormone (CRH) as the initial step of a cascade of events, is insufficient to account for the diversity of hormonal changes observed in psychological stress in humans.

Um estudo sobre a técnica na psicanálise freudiana: contribuições à metapsicologia da atenção flutuante / A study about technique in Freud´s Psychoanalysis: contributions to floating attention metapsychology

Este estudo examina as posições que o analista ocupa no setting da clínica psicanalítica, procurando desenhar a extensão de seu espaço de trânsito e os limites de sua mobilidade que demarcariam o território a partir do qual suas intervenções são produzidas. No registro dos procedimentos técnicos do exercício do analista em psicanálise, a pesquisa busca verificar de que maneira os fenômenos da atenção flutuante, da associação livre, dos estados hipnóides e do trauma se articulam. Por meio, principalmente, dos textos freudianos relativos ao trauma, à hipnose, à histeria e ao sono e sonhos, e dos trabalhos de Ferenczi sobre a técnica em psicanálise, a investigação se propõe a oferecer contribuições a uma `metapsicologia da associação livre', vinculando-a aos fenômenos de regressão da libido no aparelho psíquico, conforme apresentado por Freud. Pretende-se dar maior visibilidade a duas forças que operam no cenário psicanalítico, resultando no que chamamos, em nosso estudo, de uma clínica do desejo e uma clínica do trauma. Nesse sentido, este trabalho se vincula a um movimento atual de resgate freudo-ferencziano

O abandono da hipnose e a leitura metapsicologica dos sintomas

A passagem de Charcot a Freud e a passagem da visibilidade do sintoma para a sua escuta: a teoria que Freud elaborou a partir dai - a metapsicologia - pode ser compreendida como uma nova psicopatologia.

[Significance of symbolism in analytic and analytically oriented psychotherapy]. / Zur Bedeutung der Symbolisierung in der analytischen und analytisch orientierten Psychotherapie.

Since the very beginning of psychoanalysis there has been a long lasting discussion about the definition and the role of symbols and symbolization within the theoretical framework of psychoanalysis. The discussion has been summarized by Orban (1976) and Speidel (1978). In this paper a psychoanalytic understanding of creative processes and the relevance of symbolization for the course of treatment is presented.

Analysis by gender and Visual Imagery Reactivity of conventional and imagery Rorschach.

Examined here are the effects of gender and Visual Imagery Reactivity in 80 consecutively selected psychiatric outpatients. The participants were grouped by gender and by the amounts of responsiveness to preceding therapy work using imagery (Imagery Nonreactors and Reactors). In the group of Imagery Nonreactors were 13 men and 22 women, and in the Reactor group were 17 men and 28 women. Compared were the responses to standard Rorschach (Conventional condition) with visual associations to memory images of Rorschach inkblots (Imagery condition). Responses were scored using the Visual Imagery Reactivity (VIR) scoring system, a general, test-nonspecific scoring method. Nonparametric statistical analysis showed that critical indicators of Imagery Reactivity encoded as High Affect/Conflict score and its derivatives associated with sexual or bizarre content were not significantly associated with gender; neither was Neutral Content score which categorizes "non-Reactivity." These results support the notion that system's criteria of Visual Imagery Reactivity can be applied equally to both men and women for the classification of Imagery Reactors and Nonreactors. Discussed are also the speculative consequences of extending the tolerance range of significance levels for the interaction between Reactivity and sex above the customary limit of p < .05 in borderline cases. The results of such an analysis may imply a trend towards more rigid defensiveness under Imagery and toward lesser verbal productivity in response to either the Conventional or the Imagery task among women who are Nonreactors. In Reactors, men produced significantly more Sexual Reference scores (in the subcategory not associated with High Affect/Conflict) than women, but this could be attributed to the effect of tester's and subjects' gender combined.

Hypnotically recalling dreams during analysis.

This study described the procedure, the theoretical rationale, and clinical material relating to the hypnotic recalling of dreams during periods of protracted "dreamless" analyses. Two clinical examples were used to demonstrate the efficacy of using a special hypnotic procedure close to the analytic free-association method for the remembering or recalling the dreams. Discussion of the clinical material found: 1. the main factors contributing to a "dreamless" analysis were to be found in the transference-countertransference resistances of the analysis; 2. the justification for introducing the special hypnotic procedure as a parameter in the analysis was discussed and confirmed; 3. the remembering-recalling of the first dream--following the hypnotic intervention--lead to the recovery of a critical childhood memory; and 4. the parameter of using hypnosis as a method of breaking the intractable resistance of a "dreamless" analysis did not become an alien force which intervened whenever strong resistances appeared. On the contrary, it seemed to serve as a temporary therapeutic mechanism for allowing an energy shift to occur in the all-or-none defensive state of a "dreamless" analysis.

Shall drawing become part of free association?: Proposal for a modification in psychoanalytic technique.

Three psychoanalytic case vignettes are presented where drawing is used beneficially as part of the free-associative process. The history of the psychoanalytic use of drawing is briefly reviewed, together with a new technical proposal regarding the role of drawing in free association. Justification for testing this modification leads to a consideration of methodological issues and the nature of free association. Possible advantages of this modification, including enhanced clinical understanding through integration of pictorial and verbal modes, and greater potential for access to the period of life where experience is more visually dominated, are considered and also discussed in relation to dual hemispheric mental organization.