Mudança nos Conflitos Interpessoais de uma Paciente Borderline em Psicoterapia Psicodinâmica / Modificación de los conflictos interpersonales de un paciente límite en psicoterapia psicodinámica / Change in Interpersonal Conflicts of a Borderline Patient in Psychodynamic Psychotherapy

Pacientes com Transtorno de personalidade borderline(TPB) possuem características relacio-nais disfuncionais que impactam seus relacionamentos interpessoais. O objetivo foi o de des-crever os padrões relacionais de conflito de uma paciente com TPB da psicoterapia psicodinâ-mica. Trata-se de um estudo de caso sistemático. Utilizou-se o método Tema Central de Confli-to nos Relacionamentos (CCRT). Juízes independentes analisaram as gravações e transcrições das sessões do tratamento. A análise foi realizada com base na frequência dos componentes do CCRT. Os resultados indicam que o conflito central da paciente se mantém o mesmo ao longo do tempo, assim como seu desejo principal, mas háuma mudança significativa nas respostas, ou seja, na forma como a paciente interage em seus relacionamentos, apresentando maior fle-xibilidade para lidar com os outros e os percebendo mais positivamente. O estudo fornece sub-sídios aos psicoterapeutas para identificar e trabalhar o padrão de relacionamento disfuncional de pacientes com TPB. (AU)

Patients with borderline personality disorder (BPD) have dysfunctional relational characteris-tics that impact their interpersonal relationships. The aim of this study was to describe the conflicting relational patterns of a BPD patient of psychodynamic psychotherapy. This is a sys-tematic case study. Core Conflictual Relationship Theme —CCRT method was used to identify in relationship episodes the components of the central conflict. Independent judges reviewed the recordings and transcripts of the initial sessions of treatment and the final sessions of each year of treatment. The analysis was performed based on the frequency of CCRT compo-nents. The results indicate that the patient’s core conflict remains thesame over time, as does her core desire, but there is a significant change in the way the patient interacts in her relationships. As a clinical contribution, the study provides support to psychotherapists to identify and work on the central pattern of dysfunctional relationships of patients with BPD. (AU)

Relações de apego e Transtorno de Déficit de Atenção com Hiperatividade infantil / Attachment relationships and child Attention Deficit Hyperactivity Disorder

A insuficiência de condições seguras de apego pode estar associada a dificuldades no desenvolvimento infantil e vulnerabilidade para o surgimento de condições clínicas diversas, como o Transtorno do Déficit de Atenção com Hiperatividade (TDAH). Foi realizada uma revisão narrativa da literatura buscando contribuições da Teoria do Apego para a compreensão de fatores ambientais associados ao TDAH infantil. A revisão incluiu artigos teóricos e empíricos dos Portais do Index Psi, PubMed, Capes e Google acadêmico publicados nos idiomas português, inglês e espanhol entre 2002 a 2021. Os estudos apontaram que: crianças com TDAH apresentam em geral as mesmas dificuldades no desenvolvimento das que possuem apego primário inseguro; o apego de crianças com TDAH difere das crianças típicas, sendo predominantemente inseguro; estudos com pais dessas crianças têm encontrado dificuldades na função reflexiva destes. Conclui-se que o laço estabelecido entre criança e cuidador principal pode ser considerado um fator de proteção ou risco para o desenvolvimento infantil. A Teoria do Apego pode oferecer suporte para pensar diferentes fatores ambientais associados ao TDAH.(AU)

The insufficiency of secure attachment conditions may be associated with difficulties in child development and vulnerability to the onset of various clinical conditions, such as Attention Deficit Hyperactivity Disorder (ADHD). A narrative literature review was carried out seeking contributions from Attachment Theory to the understanding of environmental factors associated with childhood ADHD. Revision included theoretical and empirical articles from Index Psi, PubMed, Capes and Scholar Google published in Portuguese, English and Spanish between 2002 and 2021. The studies showed that: children with ADHD generally have the same difficulties in development of those with primary insecure attachment; the attachment of children with ADHD differs from typical children, being predominantly insecure; studies with parents of these children have found difficulties in their reflective function. It is concluded that the bond established between the child and the main caregiver can be considered a protective or risk factor for child development. Attachment Theory can support thinking about different environmental factors associated with ADHD.(AU)

La insuficiencia de las condiciones de apego seguro puede se asociar con dificultades en el desarrollo infantil y vulnerabilidad a la aparición de diversas condiciones clínicas, como el trastorno por déficit de atención con hiperactividad (TDAH). Se llevó a cabo una revisión de la literatura narrativa buscando contribuciones de la Teoría del Apego a la comprensión de los factores ambientales asociados con el TDAH infantil. La revisión incluyó artículos teóricos y empíricos de los portales Index Psi, PubMed, Capes y Academic Google publicados en portugués, inglés y español entre 2002 y 2021. Los estudios mostraron que: los niños con TDAH generalmente tienen las mismas dificultades de desarrollo que aquellos con inseguridad apego primario; el apego de los niños con TDAH difiere del de los niños típicos, ya que es predominantemente inseguro; Los estudios con padres de estos niños han encontrado dificultades en su función reflexiva. Se concluye que el vínculo que se establece entre el niño y el cuidador principal puede considerarse un factor protector o de riesgo para el desarrollo infantil. La Teoría del Apego puede apoyar el pensamiento sobre diferentes factores ambientales asociados con el TDAH.

Reações contratransferenciais de psicoterapeutas frente a uma paciente borderline em psicoterapia: um estudo qualitativo / Countertransferential reactions of psychotherapists towards a borderline patient in psychotherapy: a qualitative study

A contratransferência (CT) é um elemento do relacionamento terapêutico que possui valor clínico, especialmente com pacientes com personalidade borderline (PB). Este estudo, qualitativo e exploratório, visou identificar os sentimentos despertados em psicoterapeutas frente a um caso de paciente com PB, buscando compreendê-los em relação às características da paciente ou da sua narrativa, bem como explorar de que forma a CT seria idealmente manejada. Oito psicoterapeutas assistiram ao vídeo de uma sessão real com paciente com PB e, após, responderam a uma entrevista. As transcrições das entrevistas foram analisadas com o método Consensual Qualitative Research (CQR). Os dados organizaram-se em relação às facetas da CT, características da paciente que mobilizam afetos, e manejo da CT. Os resultados sugerem que pacientes com PB tendem a suscitar sentimentos intensos, vinculados a sua história e seu funcionamento em situação observacional, apontando para a viabilidade do método para o estudo empírico da CT. Resultados de estudos como esse podem ser utilizados como guia para jovens terapeutas compreenderem o mundo interno dos seus pacientes. A validação empírica de hipóteses clínicas fortalece a teorização e enriquece a prática psicanalítica.(AU)

Countertransference (CT) is an element of the therapeutic relationship that has clinical value, especially with borderline personality patients (BP). This qualitative and exploratory study aimed to identify the feelings aroused in psychotherapists in the case of a BP patient, seeking to understand them in relation to the patient's characteristics or her narrative, as well as exploring how the CT would be ideally managed. Eight psychotherapists watched the video of a real session with a BP patient and responded to an interview. The interview transcripts were analyzed using the Consensual Qualitative Research (CQR) method. The data were organized in relation to the facets of the CT, characteristics of the patient that mobilize affections, and management of the CT. The results suggest that patients with BP tend to elicit intense feelings, linked to their history and functioning, in an observational situation, pointing to the feasibility of the method for the empirical study of CT. Results from studies like this one can be used as a guide for young therapists to understand the inner world of their patients. Empirical validation of clinical hypotheses strengthens theorization and enriches psychoanalytic practice.(AU)

La contratransferencia (CT) es un elemento de la relación terapéutica que tiene valor clínico, especialmente en pacientes con personalidad límite (BP). Este estudio cualitativo y exploratorio tuvo como objetivo identificar los sentimientos que despiertan los psicoterapeutas en el caso de un paciente con BP, buscando comprenderlos en relación con las características de la paciente o su narrativa, así como explorar cómo se manejaría idealmente la CT. Ocho psicoterapeutas vieron el video de una sesión real y luego respondieron a una entrevista. Las transcripciones de las entrevistas se analizaron utilizando el método de Investigación Cualitativa Consensual (CQR). Los datos se organizaron en relación a las facetas del CT, características del paciente que movilizan afectos y manejo de la CT. Los resultados sugieren que los pacientes con BP tienden a provocar sentimientos intensos, ligados a su historia y funcionamiento, en una situación de observación, lo que apunta a la viabilidad del método para el estudio empírico de la CT. Los resultados de estudios como este pueden usarse como una guía para que los terapeutas jóvenes comprendan el mundo interior de sus pacientes. La validación empírica de hipótesis clínicas fortalece la teorización y enriquece la práctica psicoanalítica.(AU)

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life.

INTRODUCTION: A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. METHODS: The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. RESULTS: Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. CONCLUSIONS: This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

Indícios de eficácia dos tratamentos psicoterápicos pelainternet: revisão sistemática / Evidences of efficacy of internet psychotherapeutic treatments: systematic review

A utilização das tecnologias de informação e comunicação em saúde mental é uma tendência crescente. Nos últimos anos, as pesquisas centraram-se sobre sua influência nos tratamentos psicoterápicos mediados pela internet. Este estudo realizou uma revisão sistemática de resultados dos tratamentos psicoterápicos online, a fim de verificar os indícios de sua eficácia. Buscas foram realizadas nas bases PsycINFO, Scielo e Periódicos da CAPES com os descritores "tratamento pela internet", "psicoterapia online", "telepsicologia" e "eficácia". Foram encontrados 16 estudos para análise final; os resultados indicam indícios de eficácia dessas intervenções para uma série de transtornos psicopatológicos. A terapia cognitivo comportamental foi a abordagem teórica mais utilizada nas intervenções. As intervenções online, com psicoterapeuta, foram superiores aos outros tipos de intervenções. Poucos trabalhos descreviam as características dos grupos controles e o treinamento dos psicoterapeutas. A heterogeneidade clínica e instrumentos de avaliação de resultados limitam a generalização dos achados e a comparação entre os estudos.

The use of information and communication technologies in mental health is a growing trend. In recent years, research has focused on its influence on internet-mediated psychotherapeutic treatments. This study conducted a systematic review of the results of online psychotherapeutic treatments to verify the indications of its efficacy. Searches were performed in the databases PsycINFO, Scielo and Periódicos da CAPES with the descriptors "treatment by the internet", "online psychotherapy", "telepsychology" and "effectiveness". Sixteen studies were found for final analysis; the results indicate evidence of efficacy of these interventions for many psychopathological disorders. Cognitive-behavioral therapy was the theoretical approach most used in the interventions. Online interventions with a psychotherapist were superior to other types of interventions. Few papers described the characteristics of the control groups and the training of psychotherapists. Clinical heterogeneity and outcome assessment tools limit the generalization of findings and comparison between studies.

Longitudinal Distress among Brazilian University Workers during Pandemics.

The present study aimed to examine changes in mental distress in Brazilian university workers during the pandemic. All workers (n ≃ 1850) of an institution were invited to respond to a survey that took place in three stages, with collections in May (n = 407), June/July (n = 258), and August (n = 207) 2020, and included questions on demographic, health, general and psychological support, and psychometric assessment of mental distress (Clinical Outcome Routine Evaluation- CORE-OM) combined with an open question about major concerns. The results of the Multilevel Modeling analysis pointed to the absence of significant differences across the repeated measures of distress. The only variable associated with increased psychological distress over time was a lower level of support for household chores. Qualitative analysis of the reported major concerns was carried out with a sub-sample who showed reliable deterioration in CORE-OM across time (n = 17). The diversity of concerns reported by this group reinforced that work-life imbalance contributes to mental distress of university workers during the pandemic. Low response rate, although not unexpected due to the circumstances, limits the generalization of findings. The present data suggest that in addition to issues related to contagion and specific restricted measures to contain the spread of the disease, the personal reorganization of life required to maintain activities at home and work can be an important contributor to pandemic-related psychological distress.

Relationship between childhood trauma, parental bonding, and defensive styles and psychiatric symptoms in adult life

Abstract Introduction A relationship between different types of childhood trauma, parental care, and defensive styles and development of psychiatric symptoms in adulthood is proposed in this study. Understanding the nature of this association is essential to assist psychotherapists who treat patients with a history of past trauma. This study aims to examine the associations between childhood trauma, parental bonding, and defensive styles and current symptoms in adult patients who sought care at an analytical psychotherapy clinic. Methods The sample comprised 197 patients from an analytically oriented psychotherapy clinic. Participants responded to four self-report instruments that assessed, respectively, presence and frequency of several types of early trauma, type of parental attachment, styles of defenses, and current symptoms encompassing a wide variety of psychopathological syndromes. Results Only 5% of patients reported not having experienced any traumatic experience in childhood. Several traumas such as emotional and physical abuse, emotional neglect, and physical neglect showed positive and significant associations with several dimensions of current symptoms, and also with parental bonding and defensive styles. When analyzed together with the other variables, defensive styles explained the level of psychological suffering caused by the symptoms. Conclusions This study offers additional support for understanding the associations between childhood trauma, parental bonding styles, and defense styles and the psychiatric symptoms of patients in analytically oriented psychotherapy.

Desenvolvimento e Relato de Experiência de um Protocolo de Primeiros Cuidados Psicológicos a Distância (PCPd) durante a Pandemia COVID-19 / Development and Experience Report of a Protocol of Psychological First Aid on line (PFAo) during the COVID-19 Pandemic

A pandemia e as medidas para conter sua propagação tiveram efeitos significativos na saúde mental da população em geral e na dos profissionais da linha de frente nos atendimentos. Como consequência, o impacto em saúde mental pode ser considerado uma nova emergência sanitária. No entanto, os protocolos de atendimento não foram desenvolvidos para o contexto atual. Portanto, o objetivo do presente estudo foi adaptar o protocolo de Primeiros Cuidados Psicológicos desenvolvido pela Organização Mundial da Saúde para a modalidade de atendimento a distância (PCPd), bem como, relatar a experiência de sua aplicação em termos de perfil dos atendidos, principais demandas e técnicas aplicadas, e encaminhamento. Foram realizados atendimentos usando o protocolo PCPd a 15 participantes classificados como em sofrimento psicológico em um estudo prévio realizado para levantamento de saúde mental. A maioria dos participantes era do gênero feminino (73%) e possuía histórico de doenças psiquiátricas (60%). Com relação às demandas, 87% (n=13) dos participantes relataram causas de sofrimento mental atreladas à pandemia, particularmente em função da sobrecarga decorrente do excesso de demandas nas atividades domésticas e de trabalho. Foram utilizadas técnicas de normalização e de resolução de problemas no atendimento em quase todos os casos. Devido a alta intensidade de estresse e de ansiedade foi necessário aplicar técnicas de respiração diafragmática em três casos e o teste de realidade em um caso. Com relação ao encaminhamento, 40% dos participantes já estavam em atendimento psicoterápico e os demais foram encaminhados. Salienta-se que 20% optou por modalidades online de encaminhamento. Por fim, o presente relato de experiência apresenta a adequação do PCPd às necessidades de cuidados psicológicos a distância diante da emergência causada pela pandemia, bem como, a potencialidade do protocolo adaptado em promover suporte inicial e encaminhamento a rede de saúde mental. Estudos experimentais e mais controlados poderão fornecer mais evidências da prática desenvolvida.(AU)

The pandemic and measures to contain its spread had major effects on the mental health of the general population and of frontline professionals. As a consequence, the impact on mental health can be considered a new healthcare emergency, but the healthcare protocols were not developed for the current context. Thus, the goal of the present study was to adapt the Psychological First Aid protocol developed by the World Health Organization to the online health service (PFAo), as well as to report the experience of its application in terms of patients profile, key demands and techniques used for treatment, and forwarding. Consultations were carried out using PFAo protocol to 15 participants classified as having psychological distress in a previous survey. Most participants were female (73%) and had a history of psychiatric illness (60%). Regarding the demands, 87% of participants reported that their primary causes of mental suffering were linked to the pandemic, particularly due to the overload resulting from the overwhelming demands in their home and work activities. Normalization and problem solving techniques were used during consultations in almost all cases. Due to intense stress and anxiety observed in participants, diaphragmatic breathing techniques were recommended to three patients and reality test was used to one. With regard to referral, 40% of participants were already receiving psychological care and the remaining ones were referred to local psychotherapists. About 20% of participants showed a preference for online referral modalities. Finally, the present experience report shows the adequacy of the PFAo to the needs of psychological online healthcare in the face of the emergency caused by the pandemic, as well as the potential of the adapted protocol to promote initial support and referral to mental health network. Experimental and more controlled studies may provide more evidence of the developed practice.(AU)

La pandemia y las medidas para contener su propagación tuvieron efectos importantes en la salud mental de la población en general y de los profesionales de primera línea. Como consecuencia, el impacto en la salud mental puede considerarse una nueva emergencia sanitaria, pero los protocolos sanitarios no se desarrollaron para el contexto actual. Así, el objetivo del presente estudio fue adaptar el protocolo de Primera Ayuda Psicológica desarrollado por la Organización Mundial de la Salud a la modalidad de atención a distancia (PAPd), así como reportar la experiencia de su aplicación en términos de perfil del paciente, demandas clave y técnicas utilizadas para el tratamiento y reenvío. Las consultas se llevaron a cabo mediante el protocolo PAPd a 15 participantes clasificados como con distrés psicológico. La mayoría de los participantes eran mujeres (73%) y tenían antecedentes de enfermedad psiquiátrica (60%). En cuanto a las demandas, el 87% de los participantes refirió que sus principales causas de sufrimiento mental estaban vinculadas a la pandemia, particularmente por la sobrecarga resultante de las abrumadoras demandas en sus actividades domésticas y laborales. Se utilizaron técnicas de normalización y resolución de problemas durante las consultas en casi todos los casos. Debido al intenso estrés y ansiedad observados en los participantes, se recomendaron técnicas de respiración diafragmática a tres pacientes y se utilizó una prueba de realidade a uno. En cuanto a el referimiento, el 40% de los participantes ya estaban recibiendo atención psicológica y los restantes fueron derivados a psicoterapeutas locales. Aproximadamente el 20% de los participantes mostró preferencia por las modalidades on line. Finalmente, el presente relato de experiencia muestra la adecuación del PAPd a las necesidades de la atención psicológica online ante la emergencia provocada por la pandemia, así como el potencial del protocolo adaptado para promover el apoyo inicial y lo referimiento a la red de salud mental. Los estudios experimentales y más controlados pueden proporcionar más evidencia de la práctica desarrollada.(AU)

The association between reflective function and global functionality in patients with borderline personality disorder.

OBJECTIVE: To examine the association between reflective function and global functionality in borderline personality disorder (BPD) patients, controlling for symptomatology and defensive style. METHOD: Thirty-nine female inpatients were evaluated employing a sociodemographic questionnaire, the Structured Clinical Interview for Personality Disorders-II (SCID-II), the Self-Reporting Questionnaire (SRQ-20), the Reflective Functioning Questionnaire (RFQ), the Defence Style Questionnaire-40 (DSQ-40) and the Global Assessment of Functioning (GAF). RESULTS: Functionality was inversely associated with the reflective function uncertainty score (-.458; p < .01) and neurotic defences (-.335; p < .05). Symptom severity (SRQ-20) was associated with the use of immature defences (-.445; p < .01). The association between functionality and the reflective function uncertainty score remained significant, even when controlled for symptoms and defensive style (p = .002). CONCLUSION: The ability to mentalise seems to play a central and somehow independent role in BPD psychopathology.

Influência da percepção de risco sobre a COVID-19 no sofrimento psicológico dos profissionais de saúde / Influence of risk perception of COVID-19 on psychological distress of health professionals / Influencia de la percepción de riesgo del COVID-19 en el sufrimiento psicológico de los profesionales de la salud

A saúde mental dos profissionais de saúde da linha de frente durante a pandemia da doença coronavírus 2019 (COVID-19) está relacionada a uma percepção qualitativa de risco sobre a doença, segundo a Teoria do Traço Difuso. Uma pesquisa de levantamento foi realizada com 134 profissionais de saúde da linha de frente em um município da região metropolitana do Rio Grande do Sul. Os participantes responderam a um questionário on-line sobre percepção de risco e a Clinical Outcome Routine Evaluation - Outcome Measure. Análises de regressão linear corroboraram a literatura, indicando que a percepção qualitativa do risco estava relacionada a menor sofrimento psicológico e uma avaliação quantitativa, a maior sofrimento. Os resultados demonstraram a importância da Teoria do Traço Difuso para compreensão dos riscos associados ao sofrimento mental (potencialmente clínico) de profissionais de saúde durante a pandemia

Mental health of frontline health professionals during the coronavirus disease 2019 (COVID-19) pandemic is related to a qualitative perception of risk about the disease, according to Fuzzy Trace Theory. A survey was carried out with 134 frontline health professionals in a city within the metropolitan area of Rio Grande do Sul. Participants answered an online questionnaire on risk perception and the Clinical Outcome Routine Evaluation - Outcome Measure. Linear regression analysis corroborated the literature, indicating that a qualitative perception of risk was related to less psychological distress and, a quantitative assessment, to greater suffering. Results showed the importance of Fuzzy-Trace Theory for understanding the risks associated with (potentially clinical) psychological distress of health professionals during the pandemic

La salud mental de los profesionales de la salud de primera línea, durante la pandemia de enfermedad por coronavirus 2019 (COVID-19), está relacionada con una percepción cualitativa de riesgo sobre la enfermedad, según la Teoría del Rasgo Difuso. Se realizó una encuesta a 134 profesionales de la salud de primera línea en un municipio de la región metropolitana de Río Grande del Sur. Los participantes respondieron un cuestionario en línea sobre percepción de riesgo y la Clinical Outcome Routine Evaluation ­ Outcome Measure. Los análisis de regresión lineal corroboraron la literatura, indicando que la percepción cualitativa del riesgo se relacionó con un menor sufrimiento psicológico y, una valoración cuantitativa, con un mayor sufrimiento. Los resultados demuestran la importancia de la Teoría del Rasgo Difuso para comprender los riesgos asociados con el sufrimiento mental (potencialmente clínico) de los profesionales de la salud durante la pandemia

Intervenção psicológica grupal com pais de crianças com transtorno de déficit de atenção e hiperatividade em unidade assistencial pública: relato de experiência / Group psychological intervention with parents of children with attention deficit disorder and hyperactivity in public care unit: An experience report / Intervención psicológica grupal con padres de niños con trastorno de déficit de atención y hiperactividad en una unidad asistencial pública: relato de experiencia

O artigo relata uma prática psicológica com um grupo de pais de crianças diagnosticadas com Transtorno de Déficit de Atenção/Hiperatividade (TDAH), no Centro de Referência Especializado de Assistência Social (CRAS) em um município situado ao noroeste do estado do Rio Grande do Sul (RS). Foram realizados seis encontros semanais, com duas horas e meia de duração e participação de treze pais que integraram o grupo. A estrutura dos encontros consistiu no oferecimento do espaço de escuta para as principais queixas dos pais em relação aos aspectos do TDAH apresentados pelos filhos e psicoeducar sobre os sintomas, curso do transtorno e intervenções para execução no manejo de problemas com os filhos. Como resultado da intervenção, os pais relataram ter melhorado a capacidade de compreender as situações relacionadas ao transtorno dos seus filhos e encontrar soluções assertivas. A intervenção grupal com pais de crianças com TDAH contribuiu como dispositivo para melhorar a qualidade de vida das famílias que vivenciam dificuldades relacionadas aos aspectos do transtorno dos seus filhos.

The article reports a psychological practice with a group of parents of children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), at the Centro de Referência Especializado de Assistência Social (CRAS) in a city located in the northwest of the state of Rio Grande do Sul. Six weekly meetings were held, lasting two and a half hours, and with the participation of thirteen parents who were part of the group. The structure of the meetings consisted of offering the space for listening to the main complaints of parents regarding aspects of ADHD presented by their children and psychoeducation about the symptoms, course of the disorder, and interventions for execution in the management of problems with their children. As a result of the intervention, parents reported having improved their ability to understand the situations related to their children's disorder and to find assertive solutions. The group intervention with parents of children with ADHD contributed as a device to improve the quality of life of families that experience difficulties related to the aspects of their children's disorder.

El artículo relata una práctica psicológica con un grupo de padres de niños diagnosticados con el Trastorno por Déficit de Atención e Hiperactividad (TDAH), en el Centro de Referencia Especializado de Asistencia Social (CRAS) de una ciudad situada en el noroeste del estado de Rio Grande do Sul. Se realizaron seis reuniones semanales, de dos horas y media de duración, en las que participaron trece padres que formaban parte del grupo. La estructura de las reuniones consistió en ofrecer un espacio para escuchar las principales quejas sobre los aspectos del TDAH que presentan sus hijos y psicoeducar sobre los síntomas, el curso del trastorno y las intervenciones de ejecución en el manejo de los problemas con sus hijos. Como resultado de la intervención, los padres informaron que habían mejorado su capacidad para comprender las situaciones relacionadas con el trastorno de sus hijos y para encontrar soluciones asertivas. La intervención grupal con padres de niños con TDAH contribuyó como un dispositivo para mejorar la calidad de vida de las familias que experimentan dificultades relacionadas con los aspectos del trastorno de sus hijos.

Asociaciones entre contratransferencia y características del paciente en psicoterapia psicoanalítica / Associações entre contratransferência e características do paciente na psicoterapia psicanalítica / Associations between countertransference and patient characteristics in psychoanalytic psychotherapy

Resumen Objetivo: explorar las reacciones de contratransferencia de los terapeutas en la fase inicial de la psicoterapia psicoanalítica (entre las sesiones 4 y 5) y verificar las posibles asociaciones entre estas y las características personales del paciente (sociodemográficas, psicológicas y psicopatológicas). Método: estudio naturalista, transversal, correlacional y observacional con enfoque descriptivo-analítico. La muestra consta de 180 pares de pacientes y terapeutas, de los cuales 180 eran pacientes adultos (32.82 ± 12.66 años) y 48 terapeutas (32.69 ± 10.01 años). Resultados: la contratransferencia se ve afectada por la edad del paciente, los aspectos psicológicos de su vida anterior (traumas y apego parental) y elementos de su personalidad (habilidades de empatía y mecanismos defensivos), pero no por los síntomas que presenta. Conclusiones: los hallazgos respaldan la literatura científica, que señala la relevancia de las experiencias infantiles y las características de personalidad del paciente para evocar patrones específicos de contratransferencia en el terapeuta. Conocer tales relaciones puede ayudar a los clínicos a identificar sus propias reacciones y usarlas terapéuticamente, según corresponda.

Resumo Objetivo: explorar as reações contratransferenciais de terapeutas na fase inicial de psicoterapia psicanalítica (entre a 4a e a 5a sessão) e verificar possíveis associações destas com as características pessoais do paciente (sociodemográficas, psicológicas e psicopatológicas). Método: estudo naturalístico, transversal, correlacional e observacional de abordagem descritivo-analítica. A amostra é composta por 180 duplas paciente-terapeuta, dos quais 180 eram pacientes adultos (32,82 ± 12,66 anos de idade) e 48 terapeutas (32,69 ± 10,01 anos de idade). Resultados: a contratransferência é afetada pela idade do paciente, aspectos psicológicos da sua vida pregressa (traumas e vinculação parental) e elementos de sua personalidade (habilidades empáticas e mecanismos defensivos), mas não pelos sintomas. Conclusões: os achados apoiam a literatura científica, a qual sinaliza a relevância das experiências infantis e de características da personalidade do paciente na evocação de padrões contratransferenciais específicos no terapeuta. Conhecer tais relações pode ajudar os clínicos a identificar suas próprias reações emocionais e utilizá-las terapeuticamente, quando for o caso.

Abstract Objective: to explore therapists' countertransference reactions in the initial phase of psychoanalytic psychotherapy (between sessions 4 and 5) and to verify possible associations between these and the patient's personal characteristics (sociodemographic, psychological, and psychopathological). Method: naturalistic, cross-sectional, correlational, and observational study with a descriptive-analytical approach. The sample consists of 180 patient-therapist dyads, of which 180 were adult patients (32.82 ± 12.66 years old) and 48 therapists (32.69 ± 10.01 years old). Results: countertransference is affected by the patient's age, psychological aspects of his or her previous life (traumas and parental attachment) and elements of personality (empathetic skills and defensive mechanisms), but not by the showed symptoms. Conclusions: the findings support the scientific literature, which points to the relevance of childhood experiences and personality characteristics of the patient to evoke specific countertransference patterns in the therapist. Understanding such relationships can help clinicians identify their own reactions and deliver the therapy, as appropriate.

O uso de métodos empíricos para formulação de caso: a contribuição do CCRT na avaliação de uma paciente borderline / The use of empirical methods for case formulation: the contribution of CCRT to the assessment of a borderline pacient

A formulação psicodinâmica é uma narrativa descritiva sobre a natureza e a etiologia dos problemas psíquicos do paciente que serve para orientar o tratamento e nortear a avaliação da mudança. Neste artigo, apresenta-se Core Conflictual Relationship Theme (Tema Central de Conflitos nos Relacionamentos; CCRT) CCRT e ilustra-se a sua aplicabilidade para sistematizar a formulação psicodinâmica de caso. Para isso, foram analisadas as três sessões iniciais de uma psicoterapia de uma paciente com transtorno de personalidade borderline. Discute-se as vantagens da aplicação do CCRT para sistematizar a formulação diagnóstica no contexto do ensino, da pesquisa e da prática clínica. Este estudo integra um projeto maior "A personalidade borderline e seu impacto nos processos de vinculação e mudança em psicoterapia psicanalítica", aprovado pelo Comitê de Ética em Pesquisa (CEP 14/184).(AU)

The psychodynamic formulation is a descriptive narrative about the nature and etiology of the patient's psychological problems that serves to guide the treatment and guide the assessment of change. In this article, Core Conflictual Relationship Theme is presented (CCRT) CCRT and its applicability to systematize the psychodynamic formulation of the case is illustrated. For this, the initial three sessions of psychotherapy of a patient with borderline personality disorder were analyzed. The advantages of applying the CCRT to systematize the diagnostic formulation in the context of teaching, research and clinical practice are discussed. This study is part of a larger project "The borderline personality and its impact on the processes of attachment and change in psychoanalytic psychotherapy", approved by the Research Ethics Committee (CEP 14/184).(AU)

La formulación psicodinámica es una narración descriptiva sobre la naturaleza y etiología de los problemas psicológicos del paciente que sirve para guiar el tratamiento y guiar la evaluación del cambio. En este artículo, se presenta el tema de relación de conflicto central (CCRT) CCRT y se ilustra su aplicabilidad para sistematizar la formulación psicodinámica del caso. Para esto, se analizaron las tres sesiones iniciales de psicoterapia de un paciente con trastorno límite de la personalidad. Se discuten las ventajas de aplicar el CCRT para sistematizar la formulación diagnóstica en el contexto de la enseñanza, la investigación y la práctica clínica. Este estudio es parte de un proyecto más amplio "La personalidad límite y su impacto en los procesos de apego y cambio en la psicoterapia psicoanalítica", aprobado por el Comité de Ética de Investigación (CEP 14/184).(AU)

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF)

Abstract Introduction The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. Objectives To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. Methods The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. Results The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. Conclusion The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

Psychological Distress of University Workers during COVID-19 Pandemic in Brazil.

The study aimed to explore mental distress during COVID-19 quarantine in a sample of university workers in Brazil. The survey included sets of questions about demographics, health, and support, an open question about major concerns, and the Clinical Outcome Routine Evaluation (CORE-OM), a measure of mental distress. A total of 407 professionals, mean age 40, SD 11.2, fulfilling social distancing (99%) participated in the study. Participants were mostly female (67.8%) and married (64.8%). Using the Consensual Qualitative Research process for simple qualitative data (CQR-M), the main areas of concern were grouped into six domains, as follows: work, health, isolation, personal life and routine, social environment, and future. Many responses were multiple. They form categories indicating specific concerns within these domains. Quantitative data were analyzed by identifying the simple effects of potential predictors of mental distress. The results indicated medium effects of help with household chores (η2 = 0.06, 95% confidence interval (CI) (0.022-0.095)), psychiatric treatment (η2 = 0.06, CI (0.030-0.110)), age (η2 = 0.12, CI (0.070-0.170)), and physical exercise (η2 = 0.12, CI (0.079-0.180)). Having someone available to listen was the only variable with a large effect associated with reduced mental suffering (η2 = 0.18; CI (0.118-0.227)). Psychological experiences of the pandemic are multifaceted and complex. Thus, substantially larger surveys, with both quantitative and qualitative components, are needed.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions.

INTRODUCTION: Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. OBJECTIVE: To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). METHODS: The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. RESULTS: The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

The Brazilian-adapted Working Alliance Inventory: preliminary report on the psychometric properties of the original and short revised versions

Abstract Introduction Alliance is an essential component of all psychotherapies and a consistent predictor of its outcomes. The Working Alliance Inventory (WAI) is a widely used and psychometrically sound measure of alliance. It assesses three key aspects of the construct: a) agreement on the tasks of therapy; b) agreement on the therapeutic goals; and c) development of an affective bond. Objective To preliminarily analyze the psychometric properties of the Brazilian version of both the original, 36-item WAI, and of the short form revised, 16-item version (WAI-SR). Methods The sample comprised 201 psychodynamic psychotherapy patients. Alliance assessments were made after the 4th treatment session. Results The inventory adapted to Brazilian Portuguese, in both the original and short forms, appears to be reliable and valid to measure alliance and its dimensions by clients in psychotherapy. Further studies are needed to replicate and expand the findings.

Translation and cultural adaptation of the DSM-5 Personality Inventory - Brief Form (PID-5-BF).

INTRODUCTION: The Personality Inventory for the DSM-5 - Brief Form (PID-5-BF) - is an instrument for assessment of the five pathological personality traits from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) alternative model of personality disorders. OBJECTIVES: To determine the psychometric properties of the version of the PID-5-BF translated and adapted to Brazilian Portuguese. METHODS: The process of translating and cross-culturally adapting the text was carried out by independent translators and the resulting version was administered to 176 patients in two hospitals in Rio Grande do Sul. The internal structure was tested by means of confirmatory factor analysis. Evidence of reliability was tested by examining the internal consistency of the scales and their convergent and concurrent validity with other methods of psychopathology. RESULTS: The five factors were replicated in the present sample with adequate indicators of fit of the data to the model. Appropriate reliability coefficients for the scales and evidence of validity were observed, indicating the clinical usefulness of the PID-5-BF in the Brazilian context. CONCLUSION: The psychometric properties of PID-5-BF proved satisfactory in an initial sample of Brazilians.

Conjugando métodos clínico e empírico no estudo de caso de interrupção precoce em psicoterapia psicanalítica / Combining clinical and empirical methods for understanding a case of premature interruption in psychoanalytic psychotherapy

O objetivo deste estudo é conjugar métodos clínico e empírico de avaliação do processo psicoterapêutico para a compreensão dos fatores associados à interrupção precoce em um caso de psicoterapia psicanalítica. Os participantes foram uma díade terapêutica. A paciente é jovem adulta, atendida em uma clínica-escola, por um período de três meses. A psicoterapeuta registrou sua impressão das sessões e sua compreensão dinâmica do caso. O método de estudo do caso foi análise sistemática por meio do Psychotherapy Process Q-Set (PQS) e do Shedler-Westen Assessment Procedure (SWAP). As sessões foram gravadas em vídeo e posteriormente codificadas com os instrumentos por avaliadores externos treinados. As características do processo indicam foco nos relacionamentos amorosos e nas situações de vida atual; a paciente trazia material significativo; tendia a concordar com as intervenções da psicoterapeuta e demonstrava se sentir entendida. A psicoterapeuta, por sua vez, mostrou empatia e adotou atitude de apoio, realizando intervenções exploratórias. A sessão 6 constituiu um momento de mudança na direção do processo. Os resultados fornecem elementos para a compreensão dos fatores relacionados com a interrupção, tais como o incremento da resistência e ambivalência por parte da paciente não devidamente abordados pela terapeuta.(AU)

This study aims to combine clinical and empirical methods of therapeutic process evaluation for understanding factors associated with premature interruption in psychoanalytic psychotherapy. The participants were a therapeutic dyad. The patient is a female young adult treated in an outpatient clinic of a psychoanalytic psychotherapy training institution. The treatment lasted three months, and the patient attended 8 sessions. The psychotherapist made records about her impressions of the sessions and about her understanding of the case dynamics. The case was analyzed systematically through the Psychotherapy Process Q-Set (PQS) and the Shedler-Westen Assessment Procedure (SWAP). Therapy sessions were videotaped and later coded by external trained raters. The general features of this process indicated that psychotherapy focused on romantic relationships and actual life situations; patient usually had brought significant materials; patient tended to agree with therapist´s interventions, and appear to feel understood by the therapist. The therapist showed empathy and adopted a supportive attitude while conducting exploratory interventions. Session 6 was a turning point in the process direction. Results provide some elements for understanding process factors related to treatment interruption such as the increase of resistance and ambivalence on the part of the patient, which were not adequately addressed by the therapist.(AU)

Online psychotherapy practice by psychodynamic therapists / Prática da psicoterapia online por terapeutas psicodinâmicos / Práctica de psicoterapia online por terapeutas psicodinámicos

Online psychotherapy was recognized by the Federal Council of Psychology Resolution n. 11/2018. With the official recognition of this practice, many professionals raised questions about its equivalence to face-to-face psychotherapy and the possible need of technical adaptations. Considering the lack of research on this theme, this study aimed to explore how psychodynamic/psychoanalytical psychotherapists perceive their own practice in online settings, including technical and relational aspects of the therapeutic process, in comparison to their experience in face-to-face treatments. This is a qualitative study with an exploratory approach. Eight psychologists responded to videoconference interviews. The interviews were audiotaped, fully transcribed, and analyzed by thematic analysis. Results were organized in two major themes (online psychotherapy practice and technique and psychodynamic process in online psychotherapy). Main results indicate online psychodynamic psychotherapy has many distinctive features (e.g. relying on quality of internet connection, fostering focal process, occurring in a more vulnerable setting, and eliciting a different pattern of communication) that require adaptation from the-rapist. Implication of findings to psychotherapy training and practice are discussed.

A psicoterapia online foi reconhecida pela Resolução nº 11/2018 do Conselho Federal de Psicologia. Com o reconhecimento oficial dessa prática, profissionais levantaram questões sobre sua equivalência à psicoterapia presencial e sobre a possível necessidade de adaptações técnicas. Considerando a falta de pesquisas sobre esse tema, este estudo teve como objetivo explorar como os psicoterapeutas psicodinâmicos percebem sua prática clínica on-line, incluindo os aspectos técnicos e relacionais do processo terapêutico, em comparação com a experiência em tratamentos face a face. Este é um estudo qualitativo, com abordagem exploratória. Oito psicólogos foram entrevistados em videoconferência. As entrevistas foram gravadas em áudio, transcritas integralmente, e analisadas por análise temática. Os resultados foram organizados em dois grandes temas (prática da psicoterapia online e técnica e processo psicodinâmico na psicoterapia online). Os principais resultados indicam que a psicoterapia psicodinâmica on-line tem muitas características específicas (por exemplo, depender da qualidade da conexão de Internet, promover um processo focal, ocorrer em um ambiente mais vulnerável e eliciar outro padrão de comunicação) que exigem adaptação do terapeuta. As implicações dos achados para o treinamento e prática da psicoterapia são discutidas.

La psicoterapia online fue reconocida por la Resolución no. 11/2018 del Consejo Federal de Psicología. Con el reconocimiento oficial de esta práctica, los profesionales plantearon preguntas sobre su equivalencia a la psicoterapia presencial y sobre la posible necesidad de adaptaciones técnicas. Teniendo en cuenta la falta de investigaciones sobre este tema, este estudio tuvo como objetivo explorar cómo los psicoterapeutas psicodinámicos perciben su práctica clínica online, incluidos los aspectos técnicos y relacionales del proceso terapéutico, en comparación con la experiencia en tratamientos cara a cara. Este es un estudio cualitativo con un enfoque exploratorio. Ocho psicólogos fueron entrevistados en videoconferencia. Las entrevistas fueron grabadas en audio y analizadas por análisis temático. Los resultados se organizaron en dos temas generales (práctica de psicoterapia online y técnica y proceso psicodinámico en psicoterapia online). Los principales resultados indican que una psicoterapia psicodinámica online tiene muchas características distintivas (por ejemplo, confiar en la calidad de conexión de Internet, promover un proceso focal, ocurrir en un ambiente más vulnerable, y provocar otro modo de comunicación) que exige la adaptación del terapeuta. Se discuten las implicaciones de los hallazgos para el entrenamiento y la práctica de psicoterapia.