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.

Dynamics of Team Learning Behaviours: The Effect of Time and Team Culture.

This research study focused on team learning behaviours, particularly the extent to which teams use learning behaviours over time, as well as the influence of different team cultures on learning behaviours over time. Data from 33 university project teams were collected longitudinally at three moments (beginning, halfway point, and end of the project) and the analysis was conducted through growth modelling. A linear relationship between time and team learning through experimenting behaviour was found, suggesting that experimenting behaviour tends to increase over time in project teams. Moreover, the early development of team cultures that promote mutual understanding and good interpersonal relationships, the accomplishment of objectives, flexibility, and the search for alternative ways to perform tasks/problem solving are conducive to experimenting behaviours from the beginning of the teamwork. This study highlights the relevance of the temporal dynamics of team learning behaviours and their interaction with team culture.

Innovation in Teams: The Role of Psychological Capital and Team Learning.

The main purpose of the present research was to analyze the relationship between team psychological capital and innovation, considering team learning as a mediating variable. A field survey was carried out, which included 124 work teams belonging to organizations from different sectors of activity. Hypotheses were tested through PROCESS. Results supported a direct positive relationship between team psychological capital and team innovation and an indirect influence of team psychological capital on team innovation, through team learning. The findings of this study highlight the role of team learning as an intervening process between team psychological capital and team innovation. Accordingly, managers should seek to develop team psychological capital and learning behaviors among their teams to promote innovation.

Portuguese Version of Parker's (1998) Role Breadth Self-Efficacy Scale: Examining Its Factor Structure, Reliability and Validity to Predict Innovative Work Behaviour.

Drawing upon previous theorizing and empirical research efforts supporting the importance of role breadth self-efficacy (RBSE) as a key motivational antecedent of proactive forms of behaviour at work, including individual innovation, this paper reports the process of building and validating a Portuguese version of Parker's RBSE scale. Data from two studies with independent samples of employees (N = 103, N = 148) pertaining to an information technology company, showed that this version (RBSE-P) has, as expected, a unidimensional structure with a high level of factor structure similarity in both samples, as well as appropriate levels of internal consistency. Furthermore, evidence from the second sample (N = 148) revealed that, in line with preliminary research, this construct shows validity to predict the distinctive proactive behaviour of individual innovation, evaluated by the employee's corresponding direct supervisors. These results support the use of this scale for assessing RBSE in Portuguese-speaking work settings and the meaningful role of this construct for predicting this criterion, which is acknowledged as an important driver of organizational success and competitiveness.

Building Innovative Teams: Exploring the Positive Contribute of Emotions Expression and Affective Commitment.

The current challenging organizational context demands that organizations adapt quickly and continuously in order to survive and maintain their competitive advantage. Considering this need, one of the responses given by companies has been the valorization of work teams and their capacity for innovation, as well as fostering positive skills and emergent states in employees, such as emotional carrying capacity and affective commitment, respectively. The aim of this research is thus to study the relationship between emotional carrying capacity and group innovation, considering affective commitment as the mediating variable. To test these relationships, an empirical cross-sectional study was conducted including 138 Portuguese work teams belonging to different sectors of activity, composed of 625 members and their respective leaders. The results were analyzed through structural equation modeling (SEM) and showed positive relationships between emotional carrying capacity and affective commitment, as well as between affective commitment and group innovation. In addition, the mediating role of affective commitment in the relationship between emotional carrying capacity and group innovation was also supported. Therefore, the results suggest that a work context in which members openly express their emotions contributes to reinforcing their affective attachment to the group, making them feel more involved and available to test and implement new ideas and procedures. The findings reinforce the benefits of promoting the expression of emotions and the development of healthy bonds between team members.

Ultrasound block of first branch of the lateral plantar nerve (baxter nerve): case report of a promising and effective treatment for heel chronic pain.

Chronic heel pain is a challenging diagnosis and although it is a common and disabling condition frequently mistreated. Baxter Nerve (BN) entrapment is responsible for 20% of heel pain and can be managed by an ultrasound guide nerve block, a simple, safe, and durable technique. A 67-year-old woman complained of paraesthesia on the left heel and a "stepping on glass" feeling. Various techniques were performed to manage her symptoms without any results. An ultrasound BN block was finally performed with an instant relief and satisfactory pain control for the follow-up period of six months. This clinical report highlights the success of the ultrasound BN block as an effective and lasting solution for chronic heel pain.

[Recommendations in Male HPV from the Portuguese Society of Andrology, Sexual Medicine and Reproduction: Prevention]. / Recomendações em HPV Masculino da Sociedade Portuguesa de Andrologia, Medicina Sexual e Reprodução: Prevenção.

The prevention of HPV-related diseases is an important healthcare issue due to its increasing incidence. Primary prevention is most important in males as it avoids initial infection and includes the use of condom, circumcision and vaccination. Primary prevention with vaccination is effective in decreasing HPV-related lesions in women up to 45 years old and the existing data for men comes from the experience from vaccinating women. Although it is the only vaccine that prevents cancer, the worldwide rates of vaccination in males is very low due to lack of information related to efficacy and side effects, lack of recommendation from the treating doctor, price and concern about encouragement of sexual promiscuity.

Prevention of Human Papillomavirus Infection. Beyond Cervical Cancer: A Brief Review.

INTRODUCTION: Human papillomavirus is responsible for almost all cases of cervical cancer, an important portion of anogenital and oropharyngeal invasive and preinvasive lesions, as well as genital warts (condyloma acuminatum) and recurrent respiratory papillomatosis. Currently, three prophylactic vaccines against high-risk Human papillomavirus are commercialized in many countries worldwide. METHODS: To this non-systematic review the authors searched in MEDLINE/PubMed for systematic reviews, meta-analysis and randomized controlled trials, published in the last six years, using the terms "HPV", "non-cervical cancer" and "vaccine". Non-cervical cancers caused by human papillomavirus are less common lesions. However, its incidence has been increasing, while cervical cancer has declined, due mainly to highly effective screening programs. There are no formal screening programs for non-cervical cancers, so universal vaccination could have an important impact. The preventive effect of the vaccine is mainly studied and established in relation to cervical cancer, although it has also been demonstrated in the development of vulvar and vaginal lesions. To date, the efficacy in preventing anal and oropharyngeal diseases related with human papillomavirus is uncertain due to scarce supporting data and low vaccination coverage in men. The prevalence of injuries and subsequent absolute benefit of vaccination is lower in men, but it provides an additional benefit to the herd immunity achieved with the vaccination of women. CONCLUSION: The total fraction of malignant and pre-malignant lesions attributed to Human papillomavirus genotypes contained in the nonavalent vaccine is significant in both women and men, which turns this vaccine into a great asset in terms of Public Health.

Introdução: O vírus do papiloma humano é responsável por quase todos os casos de cancro do colo do útero, de uma importante fração de lesões anogenitais e orofaríngeas pré-invasivas e invasivas bem como de condilomas genitais e da papilomatose respiratória recorrente. Atualmente existem três vacinas profiláticas contra o vírus do papiloma humano de alto risco comercializadas em vários países do mundo. Métodos: Para esta revisão não-sistemática, os autores pesquisaram na MEDLINE/PubMed revisões sistemáticas, metanálises e ensaios clínicos randomizados, publicados nos últimos seis anos, utilizando os termos "HPV", "cancro não cervical" e "vacina". Os cancros não cervicais causados pelo vírus do papiloma humano são lesões menos comuns. Contudo, a sua incidência tem aumentado, a par de uma diminuição do cancro do colo do útero, devido principalmente à implementação de programas de rastreio altamente eficazes. Uma vez que não existem programas oficiais de rastreio para cancros não cervicais, a vacinação universal pode ter um impacto importante. O efeito preventivo da vacina é principalmente estudado e estabelecido em relação ao cancro do colo do útero, embora também tenha sido demonstrado no desenvolvimento de lesões vulvares e vaginais. Até ao momento, a eficácia na prevenção de doenças anais e orofaríngeas relacionadas com o vírus do papiloma humano é incerta, devido à escassez de dados na literatura e baixa cobertura de vacinação em homens. A prevalência de lesões e o consequente benefício absoluto da vacinação é inferior nos homens, porém proporciona um benefício adicional à imunidade de grupo alcançada com a vacinação de mulheres. Conclusão: A fração total de lesões malignas e pré-malignas atribuídas aos genótipos de vírus do papiloma humano contidos na vacina nonavalente é significativa tanto em mulheres quanto em homens, o que confere a essa vacina um grande potencial em termos de Saúde Pública.

Live birth after treatment of a spontaneous ovarian heterotopic pregnancy: A case report.

Spontaneous heterotopic pregnancies occur in about 1/30000 pregnancies, with the ovarian subtype comprising 2.3% of the total. We report the case of a healthy 32-year-old woman, gravida 4, para 3, who presented to the emergency room with severe abdominal pain. Two weeks earlier, pelvic ultrasound had revealed a 6-week intrauterine pregnancy. She was hemodynamically stable, but had rebound tenderness on the right iliac fossa. Transvaginal ultrasound revealed an evolutive intrauterine pregnancy with a gestational age (GA) of 8 weeks, with a synchronous evolutive adnexal pregnancy of the same GA and some free fluid in the pouch of Douglas. She underwent an urgent laparoscopy which showed an intact gestational sac containing an embryo on the right ovary associated with mild hemoperitoneum. An ovarian wedge resection was performed to preserve ovarian tissue. The intrauterine pregnancy had no complications and the patient delivered vaginally at term. Heterotopic pregnancy is potentially life-threatening. Despite being extremely rare after natural conception, and even more so in the absence of major risk factors, it should be considered in any pregnant woman with abdominal pain. A high index of suspicion is important for a prompt diagnosis, selection of the appropriate surgical treatment and successful obstetric outcomes.

Transformational leadership and team effectiveness: the mediating role of affective team commitment / El liderazgo transformacional y la eficacia grupal: el papel mediador del compromiso afectivo con el equipo

This paper investigates the effects of transformational leadership on team effectiveness. In particular, we studied the effects of transformational leadership on three criteria of team effectiveness: viability, team process improvement, and quality of group experience. In addition, we examined the indirect effect of transformational leadership on team effectiveness via affective team commitment. Ninety teams working in different organizational contexts in Portugal were surveyed. Two different questionnaires were administrated, respectively, to team members and team leaders. Team members (N = 445) were surveyed about leadership, team commitment, and quality of the group experience, whereas team leaders (N = 90) were asked to assess team viability and team process improvement. Hypotheses were tested through structural equation modelling. Results revealed that affective team commitment partially mediates the relationship between transformational leadership and quality of the group experience. The mediational role of affective team commitment between transformational leadership and both team viability and team process improvement was not supported. Implications for practice and suggestions for further research are provided

El objetivo de esta investigación fue contribuir a aclarar los efectos del liderazgo transformacional en la eficacia de los equipos. Hemos estudiado los efectos directos e indirectos del liderazgo transformacional en tres criterios de eficacia del equipo: la viabilidad, la mejora del proceso en equipo y la calidad de la experiencia grupal. Además, analizamos el efecto indirecto del liderazgo transformacional en la eficacia grupal a través del compromiso afectivo con el equipo. Se encuestó a 90 equipos que trabajaban en diferentes contextos organizacionales en Portugal. Se administraron dos cuestionarios diferentes respectivamente a los miembros del equipo y a los líderes. Los miembros del equipo (N = 445) fueron encuestados sobre el liderazgo, el compromiso con el equipo y la calidad de la experiencia grupal, mientras que a los líderes (N = 90) se les pidió que evaluasen la viabilidad del equipo y la mejora del proceso en equipo. Las hipótesis se examinaron mediante modelos de ecuaciones estructurales. Los resultados revelaron que el compromiso afectivo con el equipo media parcialmente la relación entre el liderazgo transformacional y la calidad de la experiencia grupal. El rol de mediación del compromiso afectivo del equipo entre el liderazgo transformacional, la viabilidad de éste y la mejora del proceso en equipo, no ha sido sustentado empíricamente. Además, presentamos implicaciones para la práctica y sugerencias para futuras investigaciones

Bouncing Back from Setbacks: On the Mediating Role of Team Resilience in the Relationship Between Transformational Leadership and Team Effectiveness.

The purpose of this study was to clarify the role of team resilience on different facets of effectiveness (team viability and quality of the group experience). Moreover, given the importance of team resilience for the organizational context, it was also our aim to contribute to the study of the conditions that promote team resilience, analyzing the role of transformational leadership. Finally, we examined whether the relationship between transformational leadership and team resilience stimulates positive team outcomes. Ninety teams (445 employees from 40 companies) were surveyed and path analysis was used in the test of the hypotheses. The results showed a positive direct effect of team resilience on both team viability and the quality of the group experience. Moreover, a positive relationship was also identified between transformational leadership and team resilience. Finally, support was found for the mediated effect of team resilience on the relationship between transformational leadership and the dimensions of team effectiveness considered. The findings of this study highlight the role of team resilience as an intervening process between transformational leadership and team effectiveness. Supervisors should promote team resilience, adopting transformational leadership behaviors, in order to contribute to increase team viability and the quality of the group experience.

Liderança transformacional e a eficácia grupal: o papel mediador dos comportamentos de suporte / Transformational leadership and team effectiveness. The mediator role of supportive behaviors

O objetivo deste estudo foi analisar o papel mediador dos comportamentos de suporte na relação entre a liderança transformacional e quatro critérios da eficácia da equipe (designadamente, o desempenho, a viabilidade, a qualidade da experiência grupal e os processos de melhoria). Conduziu-se um estudo empírico com uma amostra composta por 653 participantes de 117 equipes de diferentes setores de atividade (e.g., indústria, proteção civil, consultoria), onde foram testadas as relações previstas. Os resultados mostraram um efeito direto positivo da liderança transformacional nos comportamentos de suporte, assim como dos comportamentos de suporte na eficácia da equipe (nomeadamente, no desempenho, na viabilidade, na qualidade da experiência grupal e nos processos de melhoria). Além disso, foi igualmente identificado um efeito mediador dos comportamentos de suporte na relação entre a liderança transformacional e os quatro critérios da eficácia da equipe. Implicações para a investigação, para a prática profissional e pistas para futuras pesquisas foram apresentadas.

The aim of the present study was to analyse the mediator role of supportive behaviours in the relationship between transformational leadership and four team effectiveness criteria: performance, viability, quality of group experience, and improvement processes. An empirical study was conducted with a sample of 653 participants from 117 teams from different professional practice sectors (e.g., industry, civil protection, and consultancy), in which these relationships were tested. The results showed a positive direct effect of transformational leadership on supportive behaviours and on team effectiveness (including performance, viability, quality of the group experience, and improvement process). Furthermore, the present study also identified the mediator effect of supportive behaviours on the relationship between transformational leadership and the four team effectiveness criteria considered. Implications for research and professional practice were discussed, and suggestions for further studies were offered.

Psychometric properties of the Portuguese version of the Global Transformational Leadership (GTL) scale / Propiedades psicométricas de la versión portuguesa de la escala Global Transformational Leadership (GTL)

The aim of this study is to adapt and consequently validate the Global Transformational Leadership measuring scale (GTL). The scale was therefore applied to a sample of 456 members of 70 work groups, belonging to 26 organizations. The factorial structure of the scale was analysed through the exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), with the sample being split in two equal parts: EFA was conducted in both sub-samples and CFA was applied in the second sub-sample. The internal consistency was evaluated via Cronbach's alpha and the nomological validity was analysed via the evaluation of the GTL's correlations with both team-level autonomy and quality of group experience. The results revealed the presence of a unidimensional scale with a good level of internal consistency. Regarding the nomological validity, the results pointed to hypothetical relations, since the GTL showed positive correlations with the variables considered. Thus, the Portuguese version of the GTL is presented as a useful instrument for evaluating transformational leadership (AU)

El objetivo de este estudio fue adaptar y, consecuentemente, validar al portugués la escala Global Transformational Leadership (GTL). La escala se aplicó a una muestra de 456 miembros de 70 grupos de trabajo, pertenecientes a 26 organizaciones. La estructura factorial fue analizada mediante el análisis factorial exploratorio (AFE) y el análisis factorial confirmatorio (AFC), después de dividir la muestra en dos partes iguales: la AFE se aplicó en las dos muestras y la CFA en la segunda muestra. La consistencia interna se evaluó mediante el alfa de Cronbach y la validez nomológica se analizó mediante las correlaciones de GTL con la autonomía del grupo y la calidad de la experiencia del grupo. Los resultados revelaron la presencia de una escala unidimensional com un buen nivel de consistencia interna. Los datos sobre la validez nomológica confirmaron las relaciones previstas, habiendo presentado la GTL correlaciones positivas con las variables consideradas. La version portuguesa de la GTL se presenta como una herramienta útil para evaluar el liderazgo transformacional (AU)

A Cusp Catastrophe Model for Team Learning, Team Potency and Team Culture.

This paper examines team learning behaviors within a nonlinear dynamical system (NDS) perspective. The present research is based on a sample of 36 project workgroups, where data were collected at two moments of their life cycle, with visual analogue scales. Using both the least squares method and maximum likelihood, it proposes a cusp catastrophe model for explaining team learning. The cusp model is superior to its linear alternatives and implements team culture as the asymmetry variable and team potency as bifurcation. The findings of cusp structure in the data support the existence of discontinuous shifts in learning behavior and furthermore a proposition that the punctuated equilibrium model (PEM) might be a reasonable model for describing group functioning, since it encompasses such sudden changes between distinct stages (attractors). A discussion on small group research is also provided by highlighting the nonlinear dynamics of team processes, along with further implications for research and practice.

The effects on team emotions and team effectiveness of coaching in interprofessional health and social care teams.

The purpose of this study was to examine the effects of coaching behaviours provided by peers and by the leader on the emotions experienced by interprofessional health and social care teams and on members' satisfaction with the team, as well as on team performance. Data were obtained from a survey among 344 employees working in 52 interprofessional health and social care teams from nine Portuguese organizations. The results show that leader coaching and peer coaching have a positive effect on the level of team members' satisfaction with the team and on positive emotions, and a negative effect on negative emotions. Furthermore, coaching provided by peers presents a positive effect on team performance as assessed by the leader of the team. Our findings put forward the importance of engaging in coaching behaviours to promote quality of the team experience, as well as the achievement of team performance objectives. Further studies should explore how coaching behaviours impact the patient, whose well-being is the ultimate objective of a team in the health and social care system, namely in terms of the patient's perception of quality care or patient outcomes.

A Scary Onset of a Rare and Aggressive Type of Primary Breast Sarcoma: A Case Report.

Primary breast sarcoma, arising from connective tissue within the breast, is extremely rare, accounting for less than 1% of all primary breast malignancies and no more than 5% of all sarcomas. The rarity of this pathology limits most studies to case reports and small retrospective studies, which has led to a lack of consensus on the clinical management. We report a clinical case of a 52-year-old woman, perimenopausal, previously healthy, with regular breast surveillance, who presented with a large (>20 cm) and rapidly expanding hypervascularized tumor of the left breast developed over 10 days, with a very thin preulcerative skin over the last 4 days. There was no systemic dissemination. The patient was submitted to total mastectomy and excision of axillary adenopathy. The tumor was diagnosed histologically as malignant phyllodes tumor associated with areas of high-grade sarcoma. Due to rapid growth and aggressive histological characteristics, adjuvant chemotherapy and radiotherapy were performed. There is a lot of evidence that tumors larger than 5 cm are associated with a poor prognosis. Despite the poor prognosis associated with this aggressive entity, the patient had no recurrence during 5 years of follow-up. We review the relevant literature about primary breast sarcomas.

O fantoche como mediação para os sofrimentos psíquicos / The puppet as mediation for mental suffering / Los títeres como mediadores de los sufrimientos mentales

A presença de fantoches em dispositivos psicoterapêuticos existe há quase um século, e podemos dizer que hoje está entre as mediações frequentemente utilizadas no tratamento de crianças, bem como de adultos. Neste artigo, vamos nos concentrar no campo da psicopatologia clínica e no lugar que pode ser atribuído ao fantoche no encontro com as questões que atravessam a prática de um hospital-dia para crianças de um Centro Médico-psicológico (CMP).(AU)

The presence of puppets in psychotherapeutic devices exists for nearly a century, and we can say that today they are among the mediations often used in treating children and adults. In this article we focus on the field of clinical psychopathology and on the place that may be attributed to the puppet in the encounter with issues that cross the practice of a day hospital for children of a Medical Psychology Center (CMP).(AU)

La presencia de los títeres en los dispositivos psicoterapéuticos existe hace casi un siglo, y actualmente está entre las mediaciones que más se utilizan tanto en el tratamiento de los niños cuanto de los adultos. En este artículo se plantea el campo de la psicopatología clínica y el lugar que puede atribuirse a los títeres en las cuestiones que cruzan la práctica de un hospital-día de niños de un Centro Médico-Psicológico (CMP).(AU)

O fantoche como mediação para os sofrimentos psíquicos / The puppet as mediation for mental suffering / Los títeres como mediadores de los sufrimientos mentales

A presença de fantoches em dispositivos psicoterapêuticos existe há quase um século, e podemos dizer que hoje está entre as mediações frequentemente utilizadas no tratamento de crianças, bem como de adultos. Neste artigo, vamos nos concentrar no campo da psicopatologia clínica e no lugar que pode ser atribuído ao fantoche no encontro com as questões que atravessam a prática de um hospital-dia para crianças de um Centro Médico-psicológico (CMP).

The presence of puppets in psychotherapeutic devices exists for nearly a century, and we can say that today they are among the mediations often used in treating children and adults. In this article we focus on the field of clinical psychopathology and on the place that may be attributed to the puppet in the encounter with issues that cross the practice of a day hospital for children of a Medical Psychology Center (CMP).

La presencia de los títeres en los dispositivos psicoterapéuticos existe hace casi un siglo, y actualmente está entre las mediaciones que más se utilizan tanto en el tratamiento de los niños cuanto de los adultos. En este artículo se plantea el campo de la psicopatología clínica y el lugar que puede atribuirse a los títeres en las cuestiones que cruzan la práctica de un hospital-día de niños de un Centro Médico-Psicológico (CMP).

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)