Impact of Early Relational Trauma on Psychic Processes: Implications for Treatment of vulnerable Children and Families / Impacto do Trauma Relacional Precoce nos Processos Psíquicos em Famílias Vulneráveis: Implicações para o Tratamento de Crianças e Famílias

ABSTRACT Numerous works and clinical research conducted in various institutions have cast fresh light on the notion of trauma and have contributed to the emergence of the concept of early relational trauma. Early relational trauma is a form of trauma rendered complex by the multiplicity of its sources and its modes of expression. Its main features are often attachment and acting-out disturbances. In families where such trauma occurs, links could sometimes be perverted and form a narcissistic configuration. This mode of functioning, organized around negativity, impacts the plurality of psychic processes and interferes with the treatment approaches of multidisciplinary teams. In order to promote a multifocal approach to care tailored to differences in situations, educational and socio-judicial practitioners.

RESUMO Inúmeros trabalhos e pesquisas clínicas realizados em diversas instituições trouxeram à luz a noção de trauma e contribuíram para o surgimento do conceito de trauma relacional precoce. O trauma relacional precoce é uma forma de trauma complexo pela multiplicidade de suas fontes e seus modos de expressão. Suas principais características são frequentemente distúrbios de apego e atuação. Nas famílias onde ocorre tal trauma que às vezes pode ser pervertido em configurações narcísicas, esse modo de funcionamento organizado em torno da negatividade impacta a pluralidade do psíquico e interfere nas abordagens de tratamento das equipes multidisciplinares. Para promover uma abordagem multifocal de cuidados adaptados às diferenças de situações, profissionais de educação e sócio judiciais.

The experience of bullying among adolescents receiving mental health care: an interpretative phenomenological analysis.

BACKGROUND: Bullying, the most prevalent form of abuse among adolescents, is associated with emotional and behavioural problems as well as psychiatric morbidity. Moreover, it has been shown that adolescents with previous mental health problems are at increased risk of being bullied and that the psychopathological repercussions of bullying are greatest among them. However, little is known about the experience of bullying in adolescents receiving treatment from mental health services. The aim of this study was to explore the subjective experience of bullying in adolescents receiving mental health care. METHODS: The study was developed in the context of a French multicentre research program and employed an exploratory phenomenological approach. A purposeful sampling strategy was used to select adolescents who had experienced bullying (according to the Olweus criteria) and who were able to relate their experiences clearly. In-depth, semistructured interviews with participants were conducted; written transcriptions of these interviews were analysed using thematic analysis. RESULTS: Twenty-one adolescents (age range: 12-17 years; 13 girls) participated in the study. The analysis indicated a three-axis structure: (1) negative emotions and violent feelings, describing adolescents' fear, sadness, aggression against themselves, and generalized mistrust; (2) isolation and loneliness, underlining the need to take refuge within oneself and the experiences of rejection, helplessness, and secret-keeping; and (3) self and identity repercussions, including experiences of shame and lowered self-esteem, identity questions, and a vision of bullying as a life experience. CONCLUSIONS: The results of this study may have practical implications for clinicians: (1) a situation of bullying should be sought when an adolescent is seen for unexplained externalized behavioural misconduct; (2) low levels of emotional expression in a bullied adolescent may warn about associated self-harm; (3) a bullied adolescent's tendency to hide this situation from his or her parents may reflect underlying family-related vulnerability; and (4) the phenomenological analysis showed potential particularities in the assumptive world of these adolescents and suggested that relationality may play a crucial role in their experiences. These results suggest incentives to design specific individual and group therapeutic interventions for bullied adolescents with significant levels of social withdrawal, including family support. Additional research is necessary to improve our understanding of the psychopathological and intersubjective aspects of bullying in adolescents.

Mentalization-Based Training Program for Child Care Workers in Residential Settings.

Most of the children placed in child welfare residential care have experienced complex traumas linked to various forms of abuse and neglect, which have many important developmental impacts. Research shows that maltreatment is associated with increased aggression and disruptive behavior, internalizing difficulties, violence towards self and others, sexualized behaviors, academic difficulties, and early drug abuse. These experiences also negatively affect the attachment system and the mentalization process of the child. Consequently, working with this population represents a challenge for child care workers. This article describes a mentalization-based training program for child care workers who care for children aged six to 12 years old. First, the general framework of the training program is presented. Then, some of the therapeutic strategies used to improve the children's mentalizing capacity are described. Those strategies are adapted to the psychic functioning level of the child. Finally, a summary of a preliminary study of the program's efficacy are presented. This work suggests that mentalization-based interventions might represent a valuable approach in child welfare residential care.

Considerações sobre os sofrimentos da infância e a passagem para a idade adulta a partir da experiência das terapias psicanalíticas familiares / Considerations of childhood suffering and the passage to adulthood from the experience of family psychoanalytic therapies / Consideraciones sobre los sufrimientos de la infancia y el pasaje a la edad adulta desde las experiencias de las terapias familiares

A experiência do trabalho terapêutico familiar enfatiza a influência do sofrimento traumático nas relações pai-filho, especialmente quando estas se constituem sobre os modos de filiação narcisistas em que predomina o que se incorpora por violências transgeracionais e transubjetivas. A abordagem da terapia familiar é hoje bem reconhecida no tratamento de crianças e adolescentes e, apesar de sua difícil aplicação, é muito promissora para famílias que lidam com jovens adultos atraídos pelas lógicas de ruptura (violência, isolamento social, vícios), fornecendo meios para desenvolver dispositivos de trabalho clínico plurifocais apoiados em uma rede interinstitucional.(AU)

The experience of family therapy work emphasizes the influence of traumatic suffering in parent-child relationships, especially when they are constituted over the narcissistic membership modes motivated by the predominance of what is incorporated and by transgenerational and transsubjetive violence (shame, uprooting, cultural violence). The approach of family therapy is currently well recognized in the treatment of children and adolescents, and despite its difficult application, it is very promising, being focused on families dealing with young adults attracted by the rupture logics (violence, social isolation, addictions), providing means to develop multifocal clinical work devices supported by an inter-institutional network.(AU)

En la experiencia de trabajo terapéutico familiar se destaca la influencia del sufrimiento traumático en las relaciones entre padre-hijo, sobre todo cuando están constituidas por los modos de afiliación narcisistas motivados por la predominación a lo que se incorpora y por las violencias transgeneracionales y transubjetivas (la vergüenza, el desarraigo, las violencias culturales). El enfoque en la terapia familiar es más aceptado actualmente para el tratamiento de niños y adolescentes y, a pesar de su difícil aplicación, es promisorio por destinarse a familias que tratan de jóvenes adultos atraídos por la ruptura de la lógica (la violencia, el aislamiento social, las adicciones), así proporciona medios para el desarrollo de dispositivos de trabajo clínico plurifocales que se apoyan en una red interinstitucional.(AU)

Considerações sobre os sofrimentos da infância e a passagem para a idade adulta a partir da experiência das terapias psicanalíticas familiares / Considerations of childhood suffering and the passage to adulthood from the experience of family psychoanalytic therapies / Consideraciones sobre los sufrimientos de la infancia y el pasaje a la edad adulta desde las experiencias de las terapias familiares

A experiência do trabalho terapêutico familiar enfatiza a influência do sofrimento traumático nas relações pai-filho, especialmente quando estas se constituem sobre os modos de filiação narcisistas em que predomina o que se incorpora por violências transgeracionais e transubjetivas. A abordagem da terapia familiar é hoje bem reconhecida no tratamento de crianças e adolescentes e, apesar de sua difícil aplicação, é muito promissora para famílias que lidam com jovens adultos atraídos pelas lógicas de ruptura (violência, isolamento social, vícios), fornecendo meios para desenvolver dispositivos de trabalho clínico plurifocais apoiados em uma rede interinstitucional.

The experience of family therapy work emphasizes the influence of traumatic suffering in parent-child relationships, especially when they are constituted over the narcissistic membership modes motivated by the predominance of what is incorporated and by transgenerational and transsubjetive violence (shame, uprooting, cultural violence). The approach of family therapy is currently well recognized in the treatment of children and adolescents, and despite its difficult application, it is very promising, being focused on families dealing with young adults attracted by the rupture logics (violence, social isolation, addictions), providing means to develop multifocal clinical work devices supported by an inter-institutional network.

En la experiencia de trabajo terapéutico familiar se destaca la influencia del sufrimiento traumático en las relaciones entre padre-hijo, sobre todo cuando están constituidas por los modos de afiliación narcisistas motivados por la predominación a lo que se incorpora y por las violencias transgeneracionales y transubjetivas (la vergüenza, el desarraigo, las violencias culturales). El enfoque en la terapia familiar es más aceptado actualmente para el tratamiento de niños y adolescentes y, a pesar de su difícil aplicación, es promisorio por destinarse a familias que tratan de jóvenes adultos atraídos por la ruptura de la lógica (la violencia, el aislamiento social, las adicciones), así proporciona medios para el desarrollo de dispositivos de trabajo clínico plurifocales que se apoyan en una red interinstitucional.

Ataques ao corpo e traumatofilia na adolescência / Bodily attacks and adolescence traumatophilia

Discute-se a dimensão paradoxal e o sentido intersubjetivo dos comportamentos suicidas e de risco no adolescente. O corpo adolescente é, muitas vezes, objeto de sofrimento intenso. Trata-se de lutar contra tensões que se lhes colam à pele. Esses vividos estão ligados a múltiplas fontes traumáticas reveladas pela efração pubertária. Formula-se também a hipótese de que esses ataques corporais estejam ligados a mecanismos paradoxais, porque se são indicadores tanto de desafios pulsionais quanto da fragilização dos laços intersubjetivos, podem também revelar-se como sinal de reconstrução dos envoltórios, evidenciando trabalho de intersubjetividade em ação entre o adolescente e seus grupos de referência.(AU)

We wish to discuss the paradoxical dimension and the intersubjective sense of the suicidal and risky behaviors of adolescents. The adolescent body is often an object of intense sufering. It's about fighting the tensions that stick to their skin. Such experiences are linked to many traumatic sources revealed by pubertal breaking in. We also hypothesize that these bodily attacks are linked to paradoxical mechanisms, for if they are evidence both of drive challenges and of the enfeeblement of intersubjective bonds, they are likely to reveal themselves as a sign of reconstruction of the envelopes evidencing intersubjectivity at work between the adolescent and their reference groups.(AU)

Ataques ao corpo e traumatofilia na adolescência / Bodily attacks and adolescence traumatophilia

Discute-se a dimensão paradoxal e o sentido intersubjetivo dos comportamentos suicidas e de risco no adolescente. O corpo adolescente é, muitas vezes, objeto de sofrimento intenso. Trata-se de lutar contra tensões que se lhes colam à pele. Esses vividos estão ligados a múltiplas fontes traumáticas reveladas pela efração pubertária. Formula-se também a hipótese de que esses ataques corporais estejam ligados a mecanismos paradoxais, porque se são indicadores tanto de desafios pulsionais quanto da fragilização dos laços intersubjetivos, podem também revelar-se como sinal de reconstrução dos envoltórios, evidenciando trabalho de intersubjetividade em ação entre o adolescente e seus grupos de referência.

We wish to discuss the paradoxical dimension and the intersubjective sense of the suicidal and risky behaviors of adolescents. The adolescent body is often an object of intense sufering. It's about fighting the tensions that stick to their skin. Such experiences are linked to many traumatic sources revealed by pubertal breaking in. We also hypothesize that these bodily attacks are linked to paradoxical mechanisms, for if they are evidence both of drive challenges and of the enfeeblement of intersubjective bonds, they are likely to reveal themselves as a sign of reconstruction of the envelopes evidencing intersubjectivity at work between the adolescent and their reference groups.