Exploring parents' experience in the decision-making process for children with haematological diseases receiving haematopoietic stem cell transplantation in China based on genograms.

PURPOSE: To explore parents' experience in the decision-making process for children with haematological diseases receiving haematopoietic stem cell transplantation (HSCT) based on genograms. DESIGN AND METHODS: A qualitative study based on genogram was conducted. Seven pairs of parents completed their genogram and a semi-structured interview. Two related donors were interviewed to discuss their experiences in the decision-making process of donating bone marrow to their loved ones. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. RESULTS: The genogram presents the complete family structure, family member relationships and incident-related conflicts. Two superordinate themes emerged from the data analysis. The first theme was transplantation decision motivations, including four subthemes: the values of life priority, empathy based on kinship, inheritance of family blood, trust in doctors and medical science. The second theme was transplantation decision conflicts, including four subthemes: decision-making conflicts among family members, related-donor decision-making conflicts, risk-benefit game, blind optimism and insufficient cognition conflict. CONCLUSIONS: Genogram can show the hidden resources and conflicts of each family and help the care providers better understand parents' experience and the decision-making dilemmas in the decision-making process for children with haematological diseases receiving HSCT. The needs of transplant families for treatment-related information were not fully met. PRACTICE IMPLICATIONS: It is necessary for medical staff to increase psychological and informational support for donors and their families when the parents of patients make bone marrow transplant decisions. Medical staff should engage in family-focused systematic interventions to reduce the psychological burden and conflicts of decision makers.

Centering the family in their system: a framework to promote family-centered AAC services.

Families are the most significant communication partners for an individual with complex communication needs. Even though family-centered approaches are recommended to support augmentative and alternative communication (AAC) services for an individual, it is difficult to establish a successful plan that fits each individual's family. A framework for practitioners is proposed to effectively obtain and understand information about a family's unique dynamics as part of service delivery to positively impact AAC device uptake and long-term use. The goal of using this model is to minimize the disruption to the family while maximizing the integration of the AAC system. This paper proposes and illustrates a framework to enrich AAC services through the integration of several theoretical models of family systems theory, family paradigms, and a procedure called the self-created genogram. This paper begins by reviewing ecological family systems theory and family systems to guide and provide a framework to support effective AAC implementation. The process of self-creating genograms is then introduced as a means to obtain a rich perspective on family characteristics and dynamics that is informed by the individual who uses AAC. All of this information allows professionals to provide relevant information and tailor options for the family. As a result, the family is able to make informed decisions about AAC intervention in a manner most consistent with how they typically operate. Finally, we apply this framework to a hypothetical case of a child with autism and complex communication needs across three timepoints (preschool, late elementary/early middle school, and high school/post-secondary transition) to demonstrate how this framework can be used in clinical practice.

Aspectos intergeracionais de famílias em situação de violência / Intergerational aspects of families in situation of violence

A violência intrafamiliar, sendo considerada como um problema de saúde pública indica a necessidade de estudos e intervenções voltadas para mudanças na maneira de pensar e conduzir as relações entre as pessoas. Esta pesquisa consistiu em um estudo qualitativo com o objetivo de compreender os aspectos intergeracionais de famílias em situação de violência. Participaram doze famílias com filhos de um a dez anos. Utilizou-se um roteiro de entrevista elaborado para esta pesquisa, baseado em instrumentos sobre táticas de resolução de conflitos e sobre funcionamento familiar. A entrevista foi utilizada para a elaboração dos genogramas, abordando temas como conflitos conjugais e parentais, bem como a conjugalidade dos pais dos entrevistados e as práticas intergeracionais. Os genogramas foram construídos por meio do programa genopro. Os resultados apontaram que nas relações representadas houve episódios de conflitos, retratando a violência dentro daquele meio, sendo possível identificar a transmissão intergeracional da violência presente nestes casos.

Intrafamily violence, being considered a public health problem, indicates the need for studies and interventions aimed at changes in the way of thinking and conducting relationships between people. This research consisted of a qualitative study with the objective of understanding the intergenerational aspects of families in situations of violence. Twelve families with children from one to ten years participated. An interview script designed for this research was used, based on instruments on conflict resolution tactics and family functioning. The interview was used to prepare the genograms, addressing topics such as marital and parental conflicts, as well as the conjugality of the interviewees' parents and intergenerational practices. The genograms were constructed using the genopro program. The results showed that in the relationships represented, there were episodes of conflict, portraying violence within that environment, making it possible to identify the intergenerational transmission of violence present in these cases.

O Genograma para compreensão do processo migratório de famílias em vulnerabilidade social / The Genogram for understanding the migratory process of families in social vulnerability / El Genograma para comprender el proceso migratorio de familias en vulnerabilidad social

O Trabalho Social com Famílias realizado no Sistema Único de Assistência Social (SUAS) abarca vários desafios. Um deles é a utilização de instrumentos adequados que possibilitem uma compreensão mais abrangente sobre a construção do sujeito, das desigualdades incidentes sobre ele, das estratégias de enfrentamento de vulnerabilidade e a contextualização desse processo em relação ao território em que vive. O objetivo deste artigo é apresentar, a partir de um relato de experiência, diferentes possibilidades de uso do genograma no trabalho social com famílias em situação de vulnerabilidade em contexto de migração. O genograma mostrou-se um instrumento importante para a compreensão da construção dos vínculos sociais no processo migratório. Este recurso possibilitou tanto para as profissionais quanto às famílias o entendimento da história de vida, da dinâmica de migração, da estrutura de desigualdades que motivam o fluxo migratório e das estratégias de sobrevivência vivenciadas pelas famílias diante das situações de exclusão social.

The Social Work with Families performed under the Unique System of Social Assistance (SUAS) covers various challenges. One of them is the use of appropriate instruments that allow a more comprehensive understanding of the subjects' construction, the inequalities that affect them, the strategies to face vulnerability and the contextualization of this process in relation to the territory in which they live. This article's aim is to present, based on an experience report, different possibilities of using the genogram in social work with families in situations of vulnerability in the context of migration. The genogram proved to be an important tool for understanding building social bonds in the migratory process. This resource made it possible for both professionals and families to understand life stories, migration dynamics, the structure of inequalities that motivate the migratory flow and the survival strategies experienced by families in the face of social exclusion.

El Trabajo Social con Familias del Sistema Único de Asistencia Social (SUAS) engloba varios desafíos. Uno de ellos es el uso de instrumentos adecuados para una comprensión más integral de la construcción del sujeto, las desigualdades que lo afectan, las estrategias para enfrentar la vulnerabilidad y la contextualización de este proceso en relación al territorio en el que vive. El objetivo de este artículo es presentar, a partir de un relato de experiencia, diferentes posibilidades de uso del genograma en trabajo social con familias en vulnerabilidad en el contexto de migración. El genograma resultó ser una herramienta importante para comprender la construcción de vínculos sociales en el proceso migratorio. Este recurso permitió, tanto a los profesionales como a las familias, conocer su historia de vida, la dinámica migratoria, la estructura de las desigualdades que motivan el flujo migratorio y las estrategias de supervivencia que enfrentan las familias ante la exclusión social.

[In Chile, the family at the heart of prevention and health promotion]. / Au Chili, la famille au cœur de la prévention et de la promotion de la santé.

During a five-week placement in southern Chile, a nursing student learned about community health interventions. This immersion in the local, mainly Indian, population led her to discover the importance of family dynamics as a resource for supporting the patient in his or her care, as well as the tools supporting this approach. Remote feedback and perspective on her current practice as a neonatal nurse.

[The relational work of the psychiatric nurse: a self-commitment]. / Le travail relationnel de l'infirmier en psychiatrie, un engagement de soi.

The young psychiatric nurse has to adapt his posture in order to identify the challenges of his profession. The relationship with the subject and the desire to understand the issues must be at the heart of his professional life. What skills should be required to build up oneself? If this work is essentially relational, how can the right professional distance be apprehended? This is based on a commitment, an assumption of responsibility centred on analysis, an understanding of the patient and the ability to motivate him. In this context, the contributions of Carl Rogers, the characteristics of the clinical interview and the techniques favouring communication are valuable tools.

Sistemas familiares conflituosos e cuidado feminino com crianças acolhidas / Conflicting family systems and female care with institutionalized children / Sistemas familiares conflictivos y cuidado femenino con niños acogidos

O estudo de famílias como um sistema permite desfocalizar sofrimentos e problemáticas em uma única pessoa. Essa compreensão facilita entender o cuidado realizado por mulheres com seus filhos, a partir das heranças transgeracionais que compõe a história de vida familiar. Em casos extremos no cuidado, a criança pode parar em uma instituição de acolhimento infantil. A presente pesquisa investigou a relação entre crianças institucionalizadas e a dinâmica de suas famílias num serviço de acolhimento para crianças de zero a seis anos. Trata-se de um estudo de caso com duas famílias e com os seguintes instrumentos: entrevistas semiestruturadas e o genograma. A discussão dos resultados evidenciou que a herança de abandono foi atualizada em até três gerações, a partir de uma história que se construiu a base de perdas emocionais e financeiras. Tais perdas foram somadas as dificuldades do núcleo, ao exteriorizarem conflitos que resultaram na posterior desagregação familiar e acolhimento infantil.

The understanding of families like systems allows defocus problems and sufferings on one single person. When this logic is used do compreheend female care, it is perceptive that the way women deal with their children is influenced bytransgenarational heritage whose shape the story of the group - which may be enriched or dreadful. In extreme cases, the child goes to a shelther care. This research aimed investigate how family system dynamic contributed to the stay of one of their children in a institutionalized space. The multiple case study was used as the method, whereby semi-estructured interview and genogram were the following instruments. As results' discussion, it was evidenced the abandonment's inheritance refreshed in three generations, based on a story of financial and emotional losses. These losses were added to the difficulties of the nucleus, when externalizing conflicts that resulted in the subsequent family disaggregation and child care.

El estudio de familias como un sistema, permite desfocalizar sufrimientos y problemáticas en una única persona. Esta visión, facilita entender el cuidado realizado por mujeres con sus hijos, el cual es influenciado por las herencias transgeneracionales que componen la historia de vida -las cuales pueden ser enriquecedoras o conflictivas. En casos extremos en el cuidado, el niño puede ir a parar a una institución de acogida infantil. La presente investigación indagó la relación entre niños institucionalizados y la dinámica de sus familias. Se trata de un estudio de casos múltiples desarrollada con entrevistas semiestructuradas y genograma. La discusión de los resultados evidenció que la herencia del abandono influyó en hasta tres generaciones, a partir de una historia que se construyó en pérdidas emocionales y financieras. Tales pérdidas se sumaron a las dificultades del núcleo, al exteriorizar conflictos que resultaron en la posterior disgregación familiar y en la institucionalización infantil.

Exploring the use and experience of an infant feeding genogram to facilitate an assets-based approach to support infant feeding.

BACKGROUND: A lack of perceived social support influences women's infant feeding behaviours. The Infant Feeding Genogram is a visual co-constructed diagram which details people/services that can provide support to women and can facilitate a connection between mothers and their existing assets landscape. The aim of this study is to explore women's and infant feeding helpers' experiences and use of an infant feeding genogram delivered to the intervention group of the "Assets-based infant feeding help Before and After birth (ABA)" randomised feasibility trial. METHODS: 103 primiparous mothers aged 16+ years were recruited to the trial (trial registration number) in two sites (Site A and Site B) with low breastfeeding prevalence in the UK. Infant feeding helpers (IFHs) co-constructed a genogram at the first antenatal meeting for the intervention group (n = 50), and then provided proactive, woman-centered support from ~ 32 weeks gestation to up to 5 months postnatal. Infant feeding helpers' and women's experiences of the infant feeding genogram were collected via interviews or focus groups. Completed genograms were shared with researchers. Content analysis of the genograms and qualitative data from the interviews and focus groups were analysed thematically. RESULTS: Data comprised 32 completed genograms, and qualitative insights from all 13 infant feeding helpers (two focus groups; 4 interviews) and interviews with a purposive sample of 21 of 50 intervention group women between 4 and 21 weeks after birth. Content analysis of the genograms highlighted variations, with more personal, individualised genograms completed at Site B compared to Site A. The perceived impact of the genogram was related to the IFHs' application of the tool. The genogram was either used as intended to raise women's awareness of available assets and motivate help-seeking behaviour, or as a data collection tool with limited perceived utility. Negative and positive unintended consequences of genogram use were highlighted. CONCLUSIONS: The genogram has the potential to offer a woman, family and community-centred approach that focusses on building assets for infant feeding. However, variations in genogram application indicate that revised training is required to clarify the purpose and ensure it is used as intended. TRIAL REGISTRATION: ISRCTN ISRCTN14760978 ; Registered 30 January 2017.

O fenômeno da transgeracionalidade no ciclo de vida familiar: casal com filhos pequenos / The influence of the transgerational phenomenon on the family life cycle of couples with small children / El fenómeno de la transgeneracionalidad en el ciclo de vida familiar: pareja con hijos pequeños

O presente trabalho investiga a influência do fenômeno da transgeracionalidade no ciclo de vida familiar de casal com filhos pequenos. A partir dos dados levantados por meio de genogramas, foi possível obter uma leitura sistêmica a respeito da família de origem de cada um dos cônjuges, bem como da família nuclear por eles constituída. Durante as sessões de terapia de casal, foi trabalhado, entre outros temas, o conceito de diferenciação do self, possibilitando ao casal o entendimento acerca da origem de seus problemas conjugais, os quais emergiram após o nascimento das filhas. Como consequência, o casal pôde vivenciar mudanças evolutivas na relação conjugal, confirmando o que a terapia boweniana diz sobre o entendimento ser o veículo de cura.

This work investigates the influence of the transgenerational phenomenon on the family life cycle of couples with small children. As of collection of data from genograms, it was possible to obtain a systemic reading on the family origin of each spouse, as well as the nuclear family constituted by them. During the couple’s therapy sessions, they worked on the concept of self-differentiation, allowing the couple to understand the origin of their marital problems, which emerged after the birth of their daughters. As a consequence, the couple may experience evolutionary changes in their marital relationship, confirming what the Bowenian Therapy says about understanding as to the vehicle of healing.

El presente trabajo investiga la influencia del fenómeno de la transgeneracionalidad en el ciclo de vida familiar de pareja con hijos pequeños. A partir de los datos levantados por medio de genogramas, fue posible obtener una lectura sistémica al respecto de la familia de origen de cada uno de los cónyuges, así como de la familia nuclear constituida por ellos. Durante las sesiones de terapia de pareja, fue trabajado, entre otros temas, el concepto de diferenciación del self, posibilitándole a la pareja el entendimiento acerca del origen de sus problemas conyugales, los cuales emergieron después del nacimiento de sus hijas. Como consecuencia, la pareja pudo vivenciar cambios evolutivos en la relación conyugal, confirmando lo que la terapia boweniana dice sobre que el entendimiento es el vehículo de cura.

"GENOGRAM Physician Involvement Model" New Approach for Indonesian Physician Involvement with Family.

BACKGROUND: The family, as the smallest social institution, has responsibilities across many functions, including maintaining family health. Increases in chronic diseases and life expectancy require more family support to prevent disease and implement treatment for family members with chronic diseases. Therefore, physician involvement in not only the treatment of diseases but also their prevention and rehabilitation is required In Indonesia. Hence, a new approach for physician involvement with families is required, especially with regard to comprehensiveness. This study aimed to develop a physician involvement program with the family model for primary healthcare in Indonesia. METHODS: A two-round Delphi method with family medicine experts from 17 of the highest accredited medical faculties in Indonesia as participants was conducted, and factor analysis performed thereafter. The items were considered relevant at ≤0.8 validity content ratio. The second step of this research is survey using e-questionnaire involving 101 primary care physician from all over Indonesia. They live scattered in several provinces in the main islands of Indonesia such Sumatra, Java, Kalimantan, Sulawesi dan Bali. RESULTS: Results showed an adequately measured sample and correlation for all items (Kaiser-Meyer-Olkin of sampling=0.821; Bartlett's test <0.001). Seven dimensions were derived from results with eigenvalue of >1, and 25 items were filtered after determining the loading factor of >0.5. The Cronbach's α for each factor varied from 0.602 to 0.829, and that for the total 25 items was 0.913, with a total variation documented as high as 66%. CONCLUSION: A new physician involvement model with the family approach model, known as the "GENOGRAM model," was developed, which consisted of seven dimensions and 25 items.

Genetic cancer risk assessment: A screenshot of the psychosocial profile of women at risk for hereditary breast and ovarian cancer syndrome.

OBJECTIVE: There is a lack of information describing Brazilian women at risk of hereditary breast and ovarian cancer syndrome (HBOC) who undergo genetic cancer risk assessment (GCRA). This study aims to characterize the psychosocial profile of women at risk for HBOC at their first GCRA to obtain an overview of their families' profiles and the challenges of the oncogenetics setting. METHODS: This was a cross-sectional study in which interviews were conducted with 83 cancer-affected women at their first GRCA appointment after the pedigree draw. Tools to evaluate psychological outcomes were applied. The pedigree genogram and ecomap were constructed and analyzed with content analysis using the "life course perspective" theory. RESULTS: Individuals perceived their breast/ovarian cancer risk to be equal to that of the general population, although they were highly concerned about developing cancer. No evidence of anxiety or depressive symptoms was identified. Participants used the coping strategy of searching for religiosity. The genograms and ecomaps resulted in five major themes: support and social support; attitudes, feelings and emotions; cancer causes; communication; and relationships with relatives. Individuals between 20-29 years of age and those with no family history of cancer tended not to communicate with relatives, which may indicate future problems in the GCRA process regarding genetic testing. CONCLUSIONS: This study demonstrated that knowing the families who undergo the GCRA process can help professionals provide more individualized and thorough attention during GCRA and genetic testing, which results in better follow-up and prevention strategies.

Treating Multidimensional Presenting Problems with a Mutually Integrative Approach Using the Genogram.

The present article introduces a case study and describes a mutually integrative approach to treating a complex presenting problem. This article examines the specific issues surrounding integration when a supervisor and supervisee hold different theoretical perspectives. On occasion, such a relationship demands that the supervisee adhere to the model being taught by the supervisor. Examining integration in this format presents many advantages for both treatment and training. The key to the mutual integration is that two schools of psychotherapy can be combined in a way that creates a synergy; in that, together they are more powerful than either may be in isolation. A genogram with symbols from each model is incorporated to focus the treatment and create a format for the mutual integration.

Este artículo presenta un caso práctico y describe un enfoque mutuamente integrador para el tratamiento de un problema complejo motivo de consulta. Se analizan los problemas específicos en torno a la integración cuando un supervisor y una persona supervisada tienen diferentes perspectivas teóricas. Ocasionalmente, dicha relación exige que la persona supervisada se ajuste al modelo que le enseña el supervisor. El análisis de la integración en este formato presenta muchas ventajas tanto para el tratamiento como para la capacitación. La clave para la integración mutua es que puedan combinarse dos escuelas de psicoterapia de una manera que genere una sinergia; es decir, que juntas sean más poderosas de lo que puede ser cualquiera individualmente. Se incorpora un genograma con símbolos de cada modelo para centrar el tratamiento y crear un formato para la integración mutua. El caso se conceptualiza utilizando una fusión de la teoría de sistemas y la teoría psicoanalítica sobre la base del modelo estratégico de sistemas familiares y de un modelo psicoanalítico tradicional influenciado por la psicología del yo del modelo freudiano (Hall, 1999; Fenichel, 1945) y McWilliams (2011). El genograma sistémico tradicional (con símbolos interaccionales) se transforma en un genograma "integrado", con la incorporación de símbolos nuevos para representar los mecanismos psicoanalíticos de defensa. Los problemas presentados en el caso son preocupaciones relacionales y problemas de autoestima en un "paciente identificado" adolescente, obesidad y antecedentes de trauma sexual. Se proporcionan las razones para la integración mutua en este caso específico junto con las razones para la intervención.

Depression and anxiety in pet owners after a diagnosis of cancer in their pets: a cross-sectional study in Japan.

OBJECTIVE: To determine the presence and predictors of depression and anxiety in pet owners after a diagnosis of cancer in their pets. DESIGN: Cross-sectional study. SETTING: A veterinary medical centre specialised in oncology for dogs and cats and two primary veterinary clinics in Japan. PARTICIPANTS: The participants for analysis were 99 owners of a pet with cancer diagnosis received in the past 1-3 weeks and 94 owners of a healthy pet. MAIN OUTCOME MEASURES: Self-reported questionnaires were used to assess depression and anxiety. Depression was assessed using the Center of Epidemiologic Studies Depression Scale, and anxiety was measured by using the State-Trait Anxiety Inventory-Form JYZ. RESULTS: Depression scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders (p<0.001). Within the owners of a pet with cancer, depression was significantly more common in those who were employed than those who were unemployed (p=0.048). State anxiety scores were significantly higher in owners of a pet with cancer than owners of a healthy pet, even after adjustment for potential confounders, including trait-anxiety scores (p<0.001). Furthermore, in owners of a pet with cancer, state anxiety was higher in owners with high trait anxiety (p<0.001) and in owners whose pets had a poor prognosis (p=0.027). CONCLUSION: The results indicate that some owners tended to become depressed and anxious after their pets had received a diagnosis of cancer. Employment may be a predictor of depression. High trait anxiety and a pet with a poor prognosis may increase owners' state anxiety. Including the pet in a family genogram and attention to the pet's health condition may be important considerations for family practice.

Boys who work on the streets of Iraq are exposed to more traumatic events such as torture than schoolboys of the same age.

AIM: Information is scarce about the issues faced by street working. This study examined traumatic events experienced by boys working on the streets of Iraq compared to schoolboys. METHODS: We compared 100 street working boys aged 8-16 years who were attending a drop-in centre for street working children in Duhok City, Kurdistan, Iraq, in 2004/2005 with 100 age-matched schoolboys randomly selected from six local schools. The instruments that were used included the Harvard-Uppsala Trauma Questionnaire for Children. RESULTS: Most of the street working boys were involved in activities such as selling goods or shoe shining, and some were stealing or begging. None were involved in drugs or prostitution. The street working boys showed a significantly higher rate of traumatic events than the control group (96% versus 64%, p < 0.001) and higher rates of moderate to severe trauma levels (78% versus 25%, p < 0.001). A varying degree of association was found for reporting different traumatic events. The largest effect size was found for torture, with an odds ratio of 28.4, and the smallest for maltreatment or assault (2.7). CONCLUSION: Street working boys in Iraq faced a higher risk of exposure to traumatic events than age-matched schoolboys.

Family Patterns and Suicidal and Violent Behavior among Adolescent Girls-Genogram Analysis.

An increase in extreme self-destructive and aggressive behaviors in adolescents has been observed in recent years. Therapeutic effectiveness seems to depend on an adequate recognition of factors that might increase the risk of extreme destructive behaviors. The aim of this study was to identify the family patterns that should draw therapeutic attention due to their importance for suicidal or violent behaviors in adolescent girls. The study involved 140 participants, aged 13⁻17, including 40 girls after suicide attempts, 40 girls using violence, and 60 girls without destructive behavior at all. The Genograms were used to assess the family structure, relationships between family members, and family projections. The data was analyzed by polynomial logistic regression, analysis of variance, and discriminant analysis. Emotional distance and hidden projections (related to diseases) were the most significant predictors of suicidal behaviors in the studied adolescent girls. Alcohol abuse by significant family members, especially by male family members, and a lesser role of hidden projections, were the most significant predictors of violent behaviors. Interventions designed to reduce risk of destructive behaviors among adolescents need to take account of the specific family patterns.

Overview of the Extended Consultation Model

@#In the usual medical consultation, history taking, physical examination, and investigations lead us to a diagnosis list from which management ensues. When the patient’s problems need further exploration of the mind. We can extend the medical consultation beyond the biomedical to include psychosocial dimensions. The usual clinical methods of history, examination and investigation may be extended by various tools. History is extended by the use of three tools: the time-line of events in the patient’s life; the family genogram including recent changes; and the Johari window. Examination of the patient physically may be extended by reflective communication. Just as we investigate the body by various tests, we also investigate the patient’s thinking processes using Socratic inquiry techniques. Based on the information collected, we arrive at a 4P’s formulation of the patient’s problem(s). We can then integrate one or more of the 4P’s of psychosocial work into the usual management.

Gravidez na adolescência: o uso do genograma como facilitador na elaboração de conteúdos transgeracionais / Adolescence pregnancy: the use of the genogram as a facilitator in the elaboration of transgenerational contents / Embarazo en la adolescencia: el uso del genograma como facilitador en la elaboración de contenidos transgeracionales

Partindo-se do referencial teórico da psicanálise vincular e valendo-se, sobretudo, dos conceitos de Kaës acerca da noção de transmissão psíquica, discute-se a gestação na adolescência enquanto um fenômeno multifatorial que sofre influência do legado familiar. Trata-se de um relato de experiência acerca de um grupo de acolhida de jovens gestantes em situação de vulnerabilidade social no qual o genograma foi aplicado. Os resultados obtidos demonstraram as vantagens da utilização deste recurso para a conscientização e elaboração das histórias e/ou conflitos familiares. Pôde-se compreender, por meio desta atividade, que o uso de recursos mais livres dentro de dispositivos de intervenção clínica, ainda que em settings diferenciados dos processos psicoterápicos, promove a emersão de conteúdos inconscientes transmitidos geracionalmente. Entende-se, assim, que os grupos de acolhida e o uso do genograma podem favorecer a construção de novas formas de vinculação, familiar e social, caracterizando-se também como uma estratégia preventiva.

Starting from the theoretical framework of linking psychoanalysis, especially from the concepts of Kaës about the notion of psychic transmission, gestation in adolescence is discussed as a multifactorial phenomenon that is influenced by the family legacy. This is an experience report about a group of young pregnant women in situations of social vulnerability in which the genogram was applied. The results obtained demonstrated the advantages of using this resource for the awareness and elaboration of family histories and/or conflicts. It was possible to understand, through this activity, that the use of freer resources within clinical intervention devices, even in differentiated settings of the psychotherapeutic processes, promotes the emergence of unconscious contents transmitted generationally. It is understood, therefore, that the host groups and the use of the genogram can favor the construction of new forms of attachment, family and social, and it is also characterized as a preventive strategy.

A partir del referencial teórico del psicoanálisis vincular y valiéndose sobre todo de los conceptos de Kaës acerca de la noción de transmisión psíquica, se discute la gestación en la adolescencia como un fenómeno multifactorial que sufre influencia del legado familiar. Se trata de un relato de experiencia acerca de un grupo de acogida de jóvenes gestantes en situación de vulnerabilidad social en el que se aplicó el genograma. Los resultados obtenidos demostraron las ventajas de la utilización de este recurso para la concientización y elaboración de las historias y/o conflictos familiares. Se pudo entender, por medio de esta actividad, que el uso de recursos más libres dentro de dispositivos de intervención clínica, aunque en ajustes diferenciados de los procesos psicoterápicos, promueve la emersión de contenidos inconscientes transmitidos generacionalmente. Se entiende, así, que los grupos de acogida y el uso del genograma pueden favorecer la construcción de nuevas formas de vinculación, familiar y social, caracterizándose también como una estrategia preventiva.

Transmissão Geracional Familiar em Adolescentes que Cometeram Ofensa Sexual / Family Generational Transmission in Adolescents who Committed Sexual Offense / Transmisión Generacional Familiar en Adolescentes que Cometieron Ofensa Sexual

Trata-se de uma pesquisa qualitativa sobre a transmissão geracional familiar de quatro adolescentes que cometeram violência sexual contra crianças. O texto enfoca o adolescente em uma perspectiva de interdependência dos adultos responsáveis por sua educação e sobrevivência, pois é sabido que o adolescente que comete ofensa sexual apresenta grandes conflitos em suas relações familiares. O objetivo foi aprofundar o conhecimento sobre essa realidade pouco conhecida em nosso país e tecer uma conexão com a repetição de padrões de violência na vida familiar desses adolescentes, por meio do estudo das dinâmicas familiares. O instrumento utilizado foi o genograma, construído em entrevistas com cada família. Os resultados apontam para relações familiares que reproduzem condições de pobreza da vinculação afetiva, negligência e maus-tratos, pais ausentes e mães autoritárias. A discussão enfoca o processo de transmissão geracional no sentido do cometimento de várias violências que dificultam as condições mínimas de desenvolvimento emocional de seus membros. Em consequência, esses adolescentes acabam por manter relações violentas, mesmo em suas experimentações sexuais iniciais, reproduzindo um padrão presente nas várias gerações. As limitações do estudo referem-se às dificuldades na recuperação dos fatos relativos às histórias familiares, porque, além de valorizarem pouco essas informações, as famílias se queixam do sofrimento que a narrativa traz para todos. Conclui-se que uma proposta de intervenção com adolescente que comete ofensa sexual não pode prescindir da presença da família como protagonista....(AU)

This is a qualitative research on family generational transmission of four adolescents who committed sexual violence against children. The text focuses on the adolescent in a perspective of interdependence of the adults responsible for their education and survival, as it is known that adolescents who have committed sexual offense present major conflicts in their family relationships. The objective was to deepen the knowledge about this little known reality in our country and to make a connection with the repetition of patterns of violence in the family life of these adolescents, through the study of family dynamics. The instrument used was the genogram, built in interviews with each family. The results point to family relations that reproduce poverty conditions of affective attachment, neglect and mistreatment, absent parents and authoritarian mothers. The discussion focuses on the process of generational transmission in the sense of committing various forms of violence that hinder the minimum conditions of emotional development of its members. As a result, these adolescents end up in violent relationships, even in their initial sexual experiments, that reproduce a pattern present in the various generations. The limitations of the study refer to difficulties in retrieving facts about family histories because, in addition to valuing this information little, families complain about the suffering that the narrative brings to everyone. It is concluded that a proposal of intervention with adolescents who commit sexual offense cannot dispense the presence of the family as protagonist....(AU)

Se trata de una investigación cualitativa sobre la transmisión generacional familiar de cuatro adolescentes que cometieron violencia sexual contra niños. El texto enfoca al adolescente en una perspectiva de interdependencia de los adultos responsables de su educación y supervivencia, pues es sabido que el adolescente que cometió ofensa sexual presenta grandes conflictos en sus relaciones familiares. El objetivo fue profundizar el conocimiento sobre esa realidad poco conocida en nuestro país y establecer una conexión con la repetición de patrones de violencia en la vida familiar de esos adolescentes, a través del estudio de las dinámicas familiares. El instrumento utilizado fue el genograma, construido en entrevistas con cada familia. Los resultados apuntan a relaciones familiares que reproducen condiciones de pobreza de la vinculación afectiva, negligencia y malos tratos, padres ausentes y madres autoritarias. La discusión enfoca el proceso de transmisión generacional en el sentido de la comisión de varias violencias que dificultan las condiciones mínimas de desarrollo emocional de sus miembros. En consecuencia, esos adolescentes acaban por mantener relaciones violentas, incluso en sus experimentos sexuales iniciales, que reproduce un patrón presente en las distintas generaciones. Las limitaciones del estudio se refieren a las dificultades en recuperar hechos relativos a las historias familiares, porque, además de valorar poco esas informaciones, las familias se quejan del sufrimiento que la narrativa trae para todos. Se concluye que una propuesta de intervención con el adolescente que comete ofensa sexual no puede prescindir de la presencia de la familia como protagonista...(AU)

Degradação do vínculo parental e violência contra a criança: o uso do genograma familiar na prática clínica pediátrica / Degradation of parental bonding and violence against children: the use of family genogram in the pediatric clinic

RESUMO Objetivo: Demonstrar a importância da utilização do genograma familiar na consulta pediátrica como ferramenta de análise da presença de degradação do vínculo parental e da violência contra a criança. Métodos: Estudo qualitativo, conduzido em 2011. A população compreendeu 63 crianças, com idades entre 2 e 6 anos, matriculadas em creche. Para a construção do genograma, a coleta dos dados se deu em quatro momentos: avaliação pediátrica na creche; entrevista dos cuidadores; entrevista dos professores; e entrevista da coordenadora da creche. Foram utilizados os dados sobre as famílias para a construção dos genogramas, com auxilio do programa GenoPro®-2016. Na avaliação da qualidade de vínculo, foram incluídos na representação do genograma: violência contra a criança, dependência química, negligência, transtorno mental, tipo de relação entre os membros da família. Resultados: As crianças e respectivas famílias avaliadas deram origem a 55 genogramas. Em 38 deles, observaram-se arranjos familiares funcionais e com vínculos afetivos próximos ou muito próximos. Em 17 dos casos, evidenciaram-se situações que envolviam violência física, emocional ou sexual contra as crianças. Dentre esses, quatro representavam casos mais extremos, com esgarçamento do vinculo parental e arranjos familiares disfuncionais. Nessas famílias predominava a dependência química de múltiplos membros, transtorno mental grave, agressões física e verbal persistentes e abuso sexual. Conclusões: A utilização do genograma auxilia na identificação precoce da degradação do vínculo parental e da violência praticada contra a criança e, quando incorporada à prática pediátrica rotineira, pode contribuir para a promoção de uma assistência integral à saúde da criança, independentemente da presença de vulnerabilidades social.

ABSTRACT Objective: To demonstrate the importance of using the family genogram in pediatric consultation, as an analysis tool to evaluate the degradation of parental bonding and also violence against children. Methods: A qualitative study was conducted in 2011 wherein 63 children, aged between 2 and 6 years, enrolled in a slum nursery, was studied. In order to construct the genogram, data were collected in four stages: pediatric evaluation at nursery; interview with caregivers; interview with teachers; and interview with the nursery coordinator. The data about the families were used to construct the genograms with the aid of GenoPro®-2016 software. In order to evaluate the quality of bonding, the following items were included in the genograms: violence against children, drug addiction, neglect, mental disorder, type of relationship among family members. Results: The evaluated children and their families generated 55 genograms. In 38 of them, functional family arrangements, and close or very close emotional ties were observed. In 17 cases, situations involving physical, emotional, or sexual violence against children were perceived. Among these, four represented extreme cases, with fraying parental bonding, and dysfunctional family arrangements. In these families, chemical addiction was prevalent among multiple members, as well as severe mental disorder, persistent physical and verbal abuse, and sexual abuse. Conclusions: The use of the genogram helps to identify at an early stage the degradation of parental bonding and violence against children, and when it is incorporated into the pediatric practice routine, it may contribute to the promotion of the comprehensive health care of the child, regardless of the presence of social vulnerability.

Terapia familiar inclusiva: en busca de padres efectivos / Terapia familiar inclusiva: em busca de pais efetivos / Inclusive family therapy: in search of effective fathers

Este trabajo se enfoca en la paternidad, específicamente en aquellas personas que otorgan un gran poder a la narrativa de la familia tradicional machista y que vivieron maltrato o ausencia del padre biológico. Este se sustenta en el paradigma del afrontamiento desde la Terapia Familiar Inclusiva. Se utilizó la metodología estudio de casos exploratorio, en el contexto clínico. Mediante un diálogo biográfico, desde los discursos de tensión, se recuperan experiencias vividas, en particular de otras personas de la red de apoyo que cumplieron con una parentalidad nutricia, con el fin de restaurar el bienestar psicológico de las personas.(AU)

Este trabalho centra-se na parentalidade, especificamente naquelas pessoas que dão grande poder à narrativa da família tradicional machista e que viveram maltrato ou ausência do pai biológico. Isto é baseado no paradigma de confronto desde a Terapia Familiar Inclusiva. Foi utilizada a metodologia estudo exploratório de casos na prática clínica. Através de um diálogo biográfico dos discursos de tensão, se recuperam experiências vividas, especialmente de outras pessoas da rede de apoio que cumpriram com uma parentalidade nutrícia, a fim de restaurar o bem-estar psicológico das pessoas.(AU)

This paper focuses on parenting, specifically those that give great power to the narrative of the traditional family and lived sexist abuse or absence of his biological father. This is based on coping's paradigm from Inclusive Family Therapy. The exploratory case study methodology in the clinical setting was used. Through a biographical dialogue from the strain narratives, life experiences recover, in particular other people's network support that accomplish a nurturing parenting. The aim is to restore the person's wellbeing.(AU)