Confirmatory factor analysis of the Parental Bonding Instrument in a Brazilian female population.

OBJECTIVE: The Parental Bonding Instrument (PBI) is a widely used measure of parenting. Recent studies have proposed different factor structures. There is a disagreement in the literature about whether the PBI is best used as a two-factor or a three-factor measure. METHOD: Two hundred and fifty-seven female adults were recruited from a clinical population (139 psychiatric patients and 118 controls) and were requested to complete the PBI. Maximum likelihood confirmatory factor analyses were performed to compare the five different factor structures in terms of model fit. RESULTS: The poorest fit to the data was obtained by the Parker et al. model. The Kendler model was the only model that had an adjusted goodness-of-fit index >0.8 regarding both paternal and maternal PBI. When considering invariance of factor structure across age subgroups, the Kendler model was also the only acceptable model. CONCLUSION: Three-factor structures are preferable to two-factor structures. The Kendler model was the only one to provide an acceptable fit, but it must be considered that it was a female sample, and when considering gender subgroups other studies have found the same results. Despite the gender limitation, the present study contributes to a better understanding and use of the PBI in Brazilian samples.

Serum levels of brain-derived neurotrophic factor in acute and posttraumatic stress disorder: a case report study.

OBJECTIVE: The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls. METHOD: Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning, and Clinical Global Impression were assessed before and after 6 weeks of treatment. RESULTS: Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only. CONCLUSIONS: These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder.

Mental states as part of countertransference responses in psychotherapists facing reports of traumatic events of mourning and sexual violence.

The study aims to compare the mental states and countertransference responses of 92 psychodynamically oriented psychotherapists, male and female, experienced and inexperienced, facing written reports of real patients who experienced traumatic events. Two vignettes were presented: one of a sexual violence, the other the sudden death of a significant person. The Mental States Rating System (MSRS; Bouchard, Picard, Audet, Brisson, & Carrier, 1998), the MSRS Self-Report (Goldfeld & Bouchard, 2004), and the Inventory of Countertransference Behavior (ICB; Friedman & Gelso, 2000) were used. Results showed that the mourning vignette led to more reflective responses (MSRS) and the rape case was associated with more negative countertransference reactions (ICB). Female participants were more reflective (MSRS); male therapists used less mentalized states (MSRS Self-Report) and expressed more negative reactions (ICB) for both scenarios. Experienced therapists showed more positive reactions on the ICB. The construct validity of the instruments is discussed in relation to the findings.

The clinical concept of analytic process: a conceptual investigation.

The authors discuss the term 'analytic process', confirming the variability of the meanings ascribed to it. Although all the psychoanalysts of this and previous times acknowledge the existence of something called analytic process, as well as its importance, it has not been possible up to now to establish a consensual definition of it. The definitions are not only numberless, they also contradict one another. The possible advantages to analytic theory and practice proceeding from a uniform concept are incontrovertible. A review of the subject in the psychoanalytic literature has been performed. A conceptual study concerning the term, carried out among members of a psychoanalytic society affiliated to the IPA is presented, no consensual conceptualization for the term analytic process having been found. The subjects referred to the term as deriving from a variety of elements, some in common, but there was no agreement regarding the elements themselves. There was consensus regarding the role of the analytical relationship in the process, considered fundamental, as well as that of the extent to which the individual life experiences in that relationship de?ne the unique character acquired by the process within it.

Reflexos da (in)capacidade de estar só em tempos de isolamento social na pandemia COVID-19 / Reflections of the (in)ability to be alone in times of social isolation in pandemia COVID-19

As medidas adotadas em diversos países, necessárias como tentativa de contenção da pandemia causada pelo novo coronavírus (COVID-19), desencadearam mudanças radicais no dia a dia dos indivíduos, ocasionando sentimentos de incerteza, angústia, ansiedade e depressão na população em geral. O aumento do sentimento de solidão levou muitos indivíduos a utilizarem recursos internos e pôs à prova a capacidade de estar só. Alguns conceitos psicanalíticos evidenciam que o indivíduo que atinge um ego integrado, através de cuidados maternos suficientemente bons nos momentos primitivos, como bebê, adquire a capacidade de estar só. Isso ressalta a importância das primeiras relações objetais para a construção de um mundo interno satisfatório. Em contrapartida, a interrupção desse amadurecimento emocional pode despertar no sujeito adulto a utilização de mecanismos de ordem externa, como diversos tipos de adições, exposição a comportamentos de risco e, provavelmente, no caso da pandemia, desrespeito às medidas de distanciamento social. Diante disso, observa-se quão importante é o desenvolvimento saudável das primeiras relações objetais para que o indivíduo seja capaz de lidar com a solidão, e adote estratégias saudáveis ao longo da vida, inclusive em situações críticas. Assim, esse artigo se propõe a revisar alguns aspectos da teoria psicanalítica sobre a capacidade de estar só dentro do desenvolvimento emocional e compreender as consequências psíquicas resultantes das falhas nessa etapa da vida psíquica dos indivíduos.(AU)

The measures adopted in several countries, necessary as an attempt to contain the pandemic caused by the new coronavirus (COVID 19), triggered radical changes in the daily lives of individuals, causing feelings of uncertainty, anguish, anxiety and depression in the general population. The increased feeling of loneliness has led many individuals to use internal resources and test their ability to be alone. Some psychoanalytic concepts show that the individual who reaches an integrated ego, through maternal care good enough in primitive moments, as a baby, acquires the ability to be alone. This underscores the importance of early object relations for building a satisfying inner world. On the other hand, the interruption of this emotional maturation can awaken in the adult the use of external mechanisms, such as various types of addictions, exposure to risky behaviors and probably, in the case of the pandemic, disrespect to the measures of social distancing. Therefore, it is observed how important the healthy development of the first object relations is for the individual to be able to deal with loneliness, and to adopt healthy strategies throughout life, including in critical situations. Thus, this article set out to review some aspects of psychoanalytic theory about the ability to be alone within emotional development and to understand the psychic consequences resulting from failures in this stage of the psychic life of individuals.(AU)

Las medidas adoptadas en varios países, necesarias como intento de contener la pandemia por el nuevo coronavirus (COVID 19), desencadenaron cambios radicales en la vida cotidiana de las personas, causando sentimientos de incertidumbre, angustia, ansiedad y depresión en la población en general. El aumento de la sensación de soledad ha llevado a muchas personas a utilizar recursos internos y ha puesto a prueba la capacidad de estar solos. Algunos conceptos psicoanalíticos muestran que el individuo que alcanza un ego integrado, a través del cuidado materno suficientemente bueno en momentos primitivos, como un bebé, adquiere la capacidad de estar solo. Esto resalta la importancia de las primeras relaciones de objeto para la construcción de un mundo interno satisfactorio. Por otro lado, la interrupción de esta maduración emocional puede despertar en el sujeto adulto el uso de mecanismos externos, como varios tipos de adicciones, la exposición a conductas de riesgo y probablemente, en el caso de la pandemia, la falta de respeto a las medidas de distanciamiento social. Por lo tanto, se observa cuán importante es el sano desarrollo de las primeras relaciones de objeto para que el individuo sea capaz de afrontar la soledad y adoptar estrategias saludables a lo largo de la vida, incluso en situaciones críticas. Así, este artículo se propuso revisar algunos aspectos de la teoría psicoanalítica sobre la capacidad de estar solo dentro del desarrollo emocional y comprender las consecuencias psíquicas derivadas de los fracasos en esta etapa de la vida psíquica de los individuos.(AU)

[Historical evolution of the concept of posttraumatic stress disorder]. / A evolução histórica do conceito de estresse pós-traumático.

The authors elaborate on the historical evolution of the concept of Posttraumatic Stress Disorder (PTSD). The authors quote the French scholars, mainly Charcot and Janet, as the first to connect traumatic events and symptoms of hysteria. The contributions of Freud are described with enphasis on his effort into integrating the intra-psychic and environmental dimensions. Kardiner is referred as the author who coined the concept of 'war neurosis', which was deemed as an important one during the Second World War and Vietnam War. In conclusion, the authors highlight that the concept of PTSD used in the Diagnostic and Statistical Manual of Mental Disorders (DSM) by the American Psychiatric Association assess, at the same time, how treatening was the traumatic event and the list of symptoms presented by the patients.

[Brazilian-Portuguese version of the Defense Style Questionnaire (DSQ-40) for defense mechanisms measure: a preliminary study]. / Versão em português do Defense Style Questionaire (DSQ-40) para avaliação dos mecanismos de defesa: um estudo preliminar.

UNLABELLED: The aim of this study is to describe the translation and adaptation process of the Defense Style Questionnaire (DSQ-40) into Brazilian-Portuguese version. The instrument has also contended validation evaluation. METHODS: The first version of the scale was presented to five individuals with different schooling for language adaptation. Afterwards the instrument was presented to three experts that evaluated its content validation. The final version was back-translated and accepted by the original author. RESULTS: Vocabulary adjustments were needed in 9 items and language adaptation in 4 items in order to render the final DSQ-40 Brazilian-Portuguese version. The mean of experts' correlation to each defense was 89%, being 100% to mature, neurotic and immature factors. CONCLUSION: The adaptation of DSQ-40 by different individuals and the group of experts enabled the necessary adjustment to the Brazilian socio-cultural reality.

Association between childhood trauma and loss of functionality in adult women with fibromyalgia.

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression.

Resilience and psychoanalysis: a systematic review / Resiliência e psicanálise: uma revisão sistemática / Resiliencia y psicoanálisis: una revisión sistemática

The aim of this paper was to investigate the concept of resilience by studying texts published in the field of psychoanalysis (over a ten-year period). Through a systematic review of articles published between 2004 and 2014, using descriptors in Portuguese, Spanish and English. Five data bases were searched, namely Pubmed, Lilacs, Scielo, BVS Index Psi and PsycInfo. We gathered 280 published items, including articles, papers, reviews and other types of material. After exclusion criteria, 11 articles were selected for analysis. The majority of the analysed articles were theoretical reviews. The concept of resilience in Psychoanalysis tends to be related to other concepts (e.g. trauma and violence). By itself it indicates an ability that was built fundamentally in through relationships: between subjects, and between subjects and their environments. The studies agree on the notion of resilience as a process that goes beyond simple adaptation. It is in fact an ability to survive, related to intra-psychic capabilities and early emotional experiences. In this respect, resilience emerges as a characteristic that is closely related to the social context of the subject. In fact, it develops from and within this context.

O objetivo deste trabalho foi investigar o conceito de resiliência estudando textos publicados no campo da psicanálise (em um período de dez anos). Através de uma revisão sistemática de artigos publicados entre 2004 e 2014, usando descritores em português, espanhol e inglês. Foram pesquisadas cinco bases de dados: Pubmed, Lilacs, Scielo, BVS Index Psi e PsycInfo. Reunimos 280 artigos publicados, incluindo artigos, artigos, revisões e outros tipos de material. Após os critérios de exclusão, 11 artigos foram selecionados para análise. A maioria dos artigos analisados foram revisões teóricas. O conceito de resiliência na psicanálise tende a estar relacionado a outros conceitos (por exemplo, trauma e violência). Por si só indica uma habilidade que foi construída fundamentalmente através de relacionamentos: entre sujeitos e entre sujeitos e seus ambientes. Os estudos concordam com a noção de resiliência como um processo que vai além da simples adaptação. Na verdade, é a capacidade de sobreviver, relacionado às capacidades intra-psíquicas e às experiências emocionais iniciais. A este respeito, a resiliência surge como uma característica intimamente relacionada com o contexto social do sujeito. Na verdade, ela se desenvolve a partir de e dentro desse contexto.

El objetivo de este trabajo fue investigar el concepto de resiliencia mediante el estudio de textos publicados en el campo del psicoanálisis (durante un período de diez años). A través de una revisión sistemática de artículos publicados entre 2004 y 2014, utilizando descriptores en portugués, español e inglés. Se realizaron búsquedas en cinco bases de datos, a saber, Pubmed, Lilacs, Scielo, BVS Index Psi y PsycInfo. Reunimos 280 artículos publicados, incluidos artículos, documentos, reseñas y otros tipos de material. Después de los criterios de exclusión, se seleccionaron 11 artículos para su análisis. La mayoría de los artículos analizados fueron revisiones teóricas. El concepto de resiliencia en el psicoanálisis tiende a estar relacionado con otros conceptos (por ejemplo, trauma y violencia). Por sí mismo, indica una habilidad que se construyó fundamentalmente en las relaciones: entre sujetos, y entre sujetos y sus entornos. Los estudios coinciden en la noción de resiliencia como un proceso que va más allá de la simple adaptación. De hecho, es una habilidad para sobrevivir, relacionada con capacidades intrapsíquicas y experiencias emocionales tempranas. En este sentido, la resiliencia emerge como una característica que está estrechamente relacionada con el contexto social del sujeto. De hecho, se desarrolla desde y dentro de este contexto.

Trauma and countertransference: development and validity of the Assessment of Countertransference Scale (ACS).

OBJECTIVES: The aim of the present study was to investigate the construct validity of the Assessment of Countertransference Scale (ACS) in the context of the trauma care, through the identification of the underlying latent constructs of the measured items and their homogeneity. METHODS: ACS assesses 23 feelings of CT in three factors: closeness, rejection and indifference. ACS was applied to 50 residents in psychiatry after the first appointment with 131 victims of trauma consecutively selected during 4 years. ACS was analyzed by exploratory (EFA) and confirmatory (CFA) factor analysis, internal consistence and convergent-discriminant validity. RESULTS In spite of the fact that closeness items obtained the highest scores, the EFA showed that the factor rejection (24% of variance, α = 0.88) presented a more consistent intercorrelation of the items, followed by closeness (15% of variance, α = 0.82) and, a distinct factor, sadness (9% of variance, α = 0.72). Thus, a modified version was proposed. In the comparison between the original and the proposed version, CFA detected better goodness-of-fit indexes for the proposed version (GFI = 0.797, TLI = 0.867, CFI = 0.885 vs. GFI = 0.824, TLI = 0.904, CFI = 0.918). CONCLUSIONS: ACS is a promising instrument for assessing CT feelings, making it valid to access during the care of trauma victims.

Countertransference in the initial visit of women victims of sexual violence.

OBJECTIVE: To identify demographic and clinical correlates associated with therapists' countertransference feelings on the first visit of women victims of sexual violence. METHOD: Forty patients were seen by 26 therapists, during 2 consecutive years, at the Center for the Study and Treatment of Psychological Trauma, Hospital de Clínicas de Porto Alegre , Brazil. After the first visit with the patient, the therapist completed the Assessment of Countertransference Scale and the patient was evaluated with the Davidson Trauma Scale, the Standardized Assessment of Personality - Abbreviated Scale, the Beck Depression Inventory, and the Defense Style Questionnaire. RESULTS: The therapists showed a predominance of feelings of closeness (Mean = 5.42, SD = 1.25) in relation to the feelings of indifference (Mean = 1.82, SD = 1.22) and distance (Mean = 1.57, SD = 1.08) [p < 0.001]. Multivariate analyses did not present significant associations between countertransference feelings and clinical characteristics of patients. The gender of the therapists did not influence the pattern of countertransference feelings. In the subgroup of female therapists, we detected an inverse correlation between a higher probability of patients' personality disorders and feelings of closeness in the therapists. CONCLUSION: We did not detect a differential pattern of countertransference feelings associated with specific clinical characteristics. Therapists of both genders presented a similar pattern of feelings of empathy towards women victims of sexual violence, although the gender of the therapist may moderate the feelings evoked by patients with increased likelihood of personality disorders.

Can countertransference at the early stage of trauma care predict patient dropout of psychiatric treatment?

OBJECTIVES: To investigate the association between feelings of countertransference (CT) at the early psychiatric care provided to trauma victims and treatment outcome. METHOD: The Assessment of Countertransference Scale was used to access CT after the first medical appointment. Fifty psychiatric residents cared for 131 trauma victims of whom 83% were women, aged 15 to 64 years. Patients had been consecutively selected over 4 years. Were evaluated the clinical and demographic characteristics of patients and the correlation with the therapists' CT feelings. Patients were followed-up during treatment to verify the association between initial CT and treatment outcome, defined as discharge and dropout. RESULTS: The median number of appointments was 5 [4; 8], absences 1 [0; 1], and the dropout rate was 34.4%. Both groups, namely the discharge group and the dropout group, shared similar clinical and demographic characteristics. A multivariate analysis identified that patients with a reported history of childhood trauma were 61% less likely to dropout from treatment than patients with no reported history of childhood trauma (OR = 0.39, p = 0.039, CI95% 0.16-0.95). There was no association between initial CT and treatment outcome. CONCLUSIONS: In this sample, CT in the initial care of trauma victims was not associated with treatment outcome. Further studies should assess changes in CT during treatment, and how such changes impact treatment outcome.

Serum brain-derived neurotrophic factor in patients with trauma psychopathology.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) has an important role in learning, motivation and regulation of mood. The aim of this study was to investigate levels of serum BDNF in patients with trauma psychopathology (acute and post-traumatic stress disorder) when compared to age and gender matched controls. METHOD: A consecutive sample of 34 patients was evaluated regarding socio-demographic and clinical variables by means of a standard protocol, Davidson Trauma Scale, Beck Depression Inventory, Clinical Global Impression and the Global Assessment of Functioning. BDNF serum levels were measured right after the intake interview. RESULTS: Patients had higher BDNF levels than controls. Those levels, however, were higher right after the traumatic event, decreasing over time. When two groups of patients (recent and remote trauma) were investigated in separate, the recent trauma group (less than 1year since the traumatic event) had higher BDNF than controls, but this effect was not detected in the remote trauma group. The recent and remote trauma groups had different BDNF levels. Those findings persisted, even controlling for symptom severity, use of psychotropic medication, and history of psychiatric disease. CONCLUSIONS: As far as we know this is the first report of elevated serum BDNF levels in patients with recent trauma. Based in animal models that implicate BDNF in memory formation and consolidation, higher BDNF in recent PTSD could be related to memory and learning disruption central in PTSD psychopathology.

Efeito de um modelo de intervenção psicodinâmica ultrabreve para mulheres com transtorno de estresse agudo e transtorno de estresse pós-traumático: estudo naturalístico / Effect of an ultra brief psychodynamic intervention model for women with acute stress disorder and post-traumatic stress disorder: a naturalistic study

O objetivo deste estudo foi avaliar o efeito de um modelo de psicoterapia psicodinâmica ultra-breve em mulheres com transtorno de estresse pós-traumático (TEPT) e transtorno de estresse agudo (TEA). MÉTODO: 27 mulheres que completaram 4-6 sessões de tratamento foram avaliadas antes e após a intervenção por meio de um protocolo padrão: Davidson Trauma Scale (DTS), Inventário Beck de Depressão (Beck), Defesa Style Questionnaire (DSQ-40), Clinical Global Impression (CGI) e Avaliação Global do Funcionamento (GAF). RESULTADOS: Após o tratamento, verificou-se redução dos sintomas de acordo com o DTS, BECK, CGI e escalas de GAF, mesmo controlando para o uso de psicofármacos, com tamanho de efeito elevado n: CGI d = 1,18, GAF d = 1,03, DTS d = 0,95 e BDI d = 0,9. Houve redução na utilização de projeção e aumento da defesa humor após o tratamento. A redução dos sintomas do TEPT foi correlacionada com a diminuição do escore do fator imaturo. CONCLUSÕES: Embora estudos controlados sejam necessários para confirmar esses resultados, este estudo sugere que uma intervenção psicodinâmica ultra-breve pode ser uma alternativa interessante no tratamento para TEPT e TEA, principalmente no âmbito da saúde pública.(AU)

The aim of this study was to evaluate the effect of an ultra-brief psychodynamic intervention (UBPI) for women with post-traumatic stress disorder (PTSD) and acute stress disorder (ASD). METHODS: 27 women who completed 4-6 treatment sessions were assessed before and after the intervention by means of a standard protocol, Davidson Trauma Scale (DTS), Beck Depression Inventory (BECK), Defense Style Questionnaire (DSQ-40), Clinical Global Impression (CGI) and the Global Assessment of Functioning (GAF). RESULTS: After treatment, there was a reduction in symptoms according to DTS, BECK, CGI and GAF scales, even controlling for the use of psychotropic drugs. The Cohen's effect size was large CGI d =1,18, GAF d =1,03, DTS d =0,95 e BDI d =0,9. There was a reduction in the use of projection and an increase in the humour defense, after treatment. The reduction in PTSD symptoms was correlated with immature factor score decreasing. CONCLUSIONS: Although, controlled studies are required to confirm these findings, this study suggest that an ultra-brief psychotherapy intervention could be an interesting treatment alternative for PTSD and ASD patients especially in public health settings.(AU)

Association between childhood trauma and loss of functionality in adult women with fibromyalgia / Associação entre trauma na infância e perda de funcionalidade em mulheres adultas com fibromialgia

OBJECTIVE: To investigate whether history of childhood trauma is associated with loss of functionality in adult women with fibromyalgia (FM). A secondary objective was to assess the presence of differences between depressed and non-depressed adult women with FM in a regression model for functionality. METHODS: A total of 114 adult women with FM according to the American College of Rheumatology diagnostic criteria answered the Childhood Trauma Questionnaire and the Fibromyalgia Impact Questionnaire. All subjects were interviewed by trained psychiatrists and evaluated for depression using the Mini International Neuropsychiatric Interview (MINI) - Brazilian version 5.0.0. Correlation and regression models were used to investigate associations between childhood trauma and loss of functionality among patients with FM. The sample was stratified by presence and absence of clinical depression. RESULTS: Overall, childhood trauma was associated with of loss of functionality in adult women with FM. When stratified by depression, the regression model significantly increased the association among non-depressed patients, even after adjustment for age and use of psychotropic medications. CONCLUSIONS: Childhood trauma showed a clinically important association with loss of functionality among adult women with FM. The associations were more pronounced among subjects without comorbid depression

OBJETIVO: Investigar se a presença de história de trauma na infância está associada com perda de funcionalidade em mulheres adultas com fibromialgia (FM). Um segundo objetivo foi avaliar a presença de diferenças entre mulheres adultas deprimidas e não deprimidas com FM utilizando um modelo de regressão para funcionalidade. MÉTODOS: Um total de 114 mulheres adultas com FM de acordo com os critérios diagnósticos do American College of Rheumatology responderam o Childhood Trauma Questionnaire e o Questionário de Impacto da Fibromialgia. Todos os indivíduos foram entrevistados por psiquiatras treinados e avaliados para depressão utilizando o Mini International Neuropsychiatric Interview (MINI) - versão brasileira 5.0.0. Modelos de correlação e regressão foram utilizados para investigar associações entre trauma na infância e perda de funcionalidade em pacientes com FM. A amostra foi estratificada pela presença e ausência de depressão clínica. RESULTADOS: Em geral, o trauma na infância esteve associado com perda de funcionalidade em mulheres adultas com FM. Quando estratificadas por depressão, o modelo de regressão aumentou significativamente a associação em pacientes não deprimidos, mesmo após ajuste para idade e uso de medicação psicotrópica. CONCLUSÕES: Trauma na infância esteve associado de forma clinicamente importante à perda de funcionalidade em mulheres adultas com FM. As associações foram mais pronunciadas nos indivíduos sem depressão comórbida

Countertransference in the initial visit of women victims of sexual violence / Contratransferência no atendimento inicial de mulheres vítimas de violência sexual

OBJECTIVE: To identify demographic and clinical correlates associated with therapists' countertransference feelings on the first visit of women victims of sexual violence. METHOD: Forty patients were seen by 26 therapists, during 2 consecutive years, at the Center for the Study and Treatment of Psychological Trauma, Hospital de Clínicas de Porto Alegre , Brazil. After the first visit with the patient, the therapist completed the Assessment of Countertransference Scale and the patient was evaluated with the Davidson Trauma Scale, the Standardized Assessment of Personality - Abbreviated Scale, the Beck Depression Inventory, and the Defense Style Questionnaire. RESULTS:The therapists showed a predominance of feelings of closeness (Mean = 5.42, SD = 1.25) in relation to the feelings of indifference (Mean = 1.82, SD = 1.22) and distance (Mean = 1.57, SD = 1.08) [p < 0.001]. Multivariate analyses did not present significant associations between countertransference feelings and clinical characteristics of patients. The gender of the therapists did not influence the pattern of countertransference feelings. In the subgroup of female therapists, we detected an inverse correlation between a higher probability of patients' personality disorders and feelings of closeness in the therapists. CONCLUSION: We did not detect a differential pattern of countertransference feelings associated with specific clinical characteristics. Therapists of both genders presented a similar pattern of feelings of empathy towards women victims of sexual violence, although the gender of the therapist may moderate the feelings evoked by patients with increased likelihood of personality disorders.

OBJETIVO: Identificar os correlatos demográficos e clínicos associados com sentimentos contratransferenciais de terapeutas na primeira consulta de mulheres vítimas de violência sexual. MÉTODO: Quarenta pacientes foram atendidas por 26 terapeutas, ao longo de dois anos consecutivos, no Núcleo de Estudos e Tratamento do Trauma Psíquico do Hospital de Clínicas de Porto Alegre, Brasil. Após a primeira consulta com a paciente, o terapeuta preenchia a Escala para Avaliação da Contratransferência. Os pacientes foram avaliados com a Escala Davidson de Trauma, a Standardized Assessment of Personality - Abbreviated Scale, o Inventário de Depressão de Beck, e a versão em português do Defense Style Questionaire. RESULTADOS: Os terapeutas apresentaram predominantemente sentimentos de proximidade (Mean = 5,42, SD = 1,25) em comparação aos sentimentos de indiferença (Mean = 1,82, SD = 1,22) e de distanciamento (Mean = 1,57, SD = 1,08) [p < 0,001]. As análises multivariadas revelaram a ausência de associações entre os sentimentos contratransferenciais e características clínicas dos pacientes. O gênero dos terapeutas não influenciou o padrão de sentimentos contratransferenciais. No subgrupo de terapeutas mulheres, detectamos uma correlação inversa entre alta probabilidade de transtornos de personalidade nos pacientes e sentimentos de aproximação dos terapeutas. CONCLUSÃO: Não detectamos um padrão diferencial de sentimentos contratransferenciais associados com características clínicas específicas. Terapeutas de ambos os gêneros apresentaram um padrão similar de sentimentos de empatia em relação a mulheres vítimas de violência sexual, embora o gênero do terapeuta possa moderar os sentimentos evocados por pacientes com alta probabilidade de transtornos de personalidade.

Can countertransference at the early stage of trauma care predict patient dropout of psychiatric treatment? / Contratransferência no atendimento inicial de vítimas de trauma pode predizer o abandono do tratamento psiquiátrico?

OBJECTIVES: To investigate the association between feelings of countertransference (CT) at the early psychiatric care provided to trauma victims and treatment outcome. METHOD: The Assessment of Countertransference Scale was used to access CT after the first medical appointment. Fifty psychiatric residents cared for 131 trauma victims of whom 83 percent were women, aged 15 to 64 years. Patients had been consecutively selected over 4 years. Were evaluated the clinical and demographic characteristics of patients and the correlation with the therapists' CT feelings. Patients were followed-up during treatment to verify the association between initial CT and treatment outcome, defined as discharge and dropout. RESULTS: The median number of appointments was 5 [4; 8], absences 1 [0; 1], and the dropout rate was 34.4 percent. Both groups, namely the discharge group and the dropout group, shared similar clinical and demographic characteristics. A multivariate analysis identified that patients with a reported history of childhood trauma were 61 percent less likely to dropout from treatment than patients with no reported history of childhood trauma (OR = 0.39, p = 0.039, CI95 percent 0.16-0.95). There was no association between initial CT and treatment outcome. CONCLUSIONS: In this sample, CT in the initial care of trauma victims was not associated with treatment outcome. Further studies should assess changes in CT during treatment, and how such changes impact treatment outcome.

OBJETIVOS: Investigar a associação entre contratransferência (CT) no atendimento psiquiátrico inicial de vítimas de trauma e desfechos do tratamento. MÉTODO: A contratransferência de 50 terapeutas foi avaliada através da Assessment of Countertransference Scale após o primeiro atendimento de 131 vítimas de trauma (83 por cento mulheres, idade entre 15 e 64 anos) selecionadas consecutivamente durante 4 anos. Foram avaliadas características demográficas e clínicas dos pacientes, e investigaram-se seus correlatos com os sentimentos contratransferenciais dos terapeutas. Os pacientes foram acompanhados ao longo do tratamento para verificar a associação entre a CT e o desfecho do tratamento, operacionalizado como alta ou abandono. RESULTADOS: A mediana de consultas realizadas foi 5 [4; 8], faltas 1 [0; 1] e taxa de abandono 34,4 por cento. As características demográficas e clínicas dos pacientes dos grupos alta e abandono foram similares. Na análise multivariada, identificou-se que pacientes com relato de trauma na infância tiveram uma chance 61 por cento menor de abandonar o tratamento que pacientes sem relato de trauma na infância (OR = 0,39; p = 0,039; IC 95 por cento 0,16-0,95). Não foi detectada associação entre sentimentos contratransferenciais iniciais com os desfechos do tratamento. Conclusões: A CT no atendimento inicial de vítimas de trauma não esteve associada ao desfecho do tratamento. Estudos futuros devem avaliar a modificação da CT ao longo do tratamento e seu impacto sobre os desfechos.

Serum levels of brain-derived neurotrophic factor in acute and posttraumatic stress disorder: a case report study / Nível sérico do fator neurotrófico derivado do cérebro no transtorno de estresse agudo e no transtorno de estresse pós-traumático: relato de casos

OBJECTIVE: The aim of this study was to evaluate brain-derived neurotrophic factor levels in two patients, one with posttraumatic stress disorder and one with acute stress disorder, before and after treatment, and to compare those levels to those of healthy controls. METHOD: Brain-derived neurotrophic factor level, Davidson Trauma Scale, Beck Depression Inventory, Global Assessment of Functioning, and Clinical Global Impression were assessed before and after 6 weeks of treatment. RESULTS: Brain-derived neurotrophic factor levels were higher in patients than in matched controls before treatment. After 6 weeks, there was a reduction in symptoms and an improvement in functioning in both cases. At the same time, brain-derived neurotrophic factor levels decreased after treatment, even in case 2, treated with psychotherapy only. CONCLUSIONS: These results suggest that serum levels of brain-derived neurotrophic factor, as opposed to what has been described in mood disorders, are increased in posttraumatic stress disorder as well as in acute stress disorder.

OBJETIVO: O objetivo do estudo foi avaliar os níveis séricos do fator neurotrófico derivado do cérebro em um paciente com transtorno de estresse pós-traumático e em um paciente com transtorno de estresse agudo antes e após o tratamento, comparando esses níveis aos de controles saudáveis. MÉTODO: Os níveis do fator neurotrófico derivado do cérebro, a Escala Davidson de Trauma, o Inventário de Depressão de Beck, a Avaliação do Funcionamento Global e a Impressão Clínica Global foram medidos antes e após seis semanas de tratamento. RESULTADOS: Os níveis de fator neurotrófico derivado do cérebro foram maiores nos pacientes, quando comparados aos controles, antes do tratamento. Depois de seis semanas houve redução dos sintomas e melhora do funcionamento nos dois casos. Ao mesmo tempo, houve redução dos níveis de fator neurotrófico derivado do cérebro, mesmo no caso 2, tratado exclusivamente com psicoterapia. CONCLUSÕES: Esses resultados sugerem que o fator neurotrófico derivado do cérebro está aumentado tanto no transtorno de estresse pós-traumático quanto no transtorno de estresse agudo, de forma oposta às alterações até então descritas nos transtornos do humor.

A relação entre os mecanismos de defesa e a qualidade da aliança terapêutica em psicoterapia de orientação analítica / The relationship between defense mechanisms and the quality of therapeutic alliance in analytic psychotherapy

INTRODUÇÃO: O estabelecimento de uma aliança terapêutica de boa qualidade em uma psicoterapia psicanalítica é fundamental para o processo terapêutico. Este estudo avaliou a influência do nível de funcionamento defensivo do paciente na qualidade da aliança terapêutica estabelecida durante a psicoterapia. MÉTODO: Para avaliação da qualidade da aliança estabelecida, pacientes em psicoterapia psicanalítica e seus respectivos terapeutas responderam ao Helping Alliance Questionnaire (versão paciente e versão terapeuta, respectivamente). O nível defensivo foi inferido através da Escala de Funcionamento Defensivo proposta no Manual de Diagnóstico e Estatística das Perturbações Mentais, quarta edição, texto revisado. RESULTADOS: Não houve associação entre o estabelecimento de uma aliança terapêutica de boa qualidade e o nível defensivo do paciente. No entanto, houve diferença significativa quando a versão do terapeuta foi comparada com a respondida pelo paciente: os pacientes estabeleceram uma aliança terapêutica de melhor qualidade em relação a seus terapeutas do que o inverso. CONCLUSÕES: O fato de a aliança terapêutica de boa qualidade ter se estabelecido independentemente do nível defensivo do paciente sugere que o treinamento e as características pessoais do terapeuta podem levar a uma capacidade de conectar-se com o paciente, apesar do grau de comprometimento do seu funcionamento psíquico.

BACKGROUND: The quality of a therapeutic alliance is essential in psychoanalytic psychotherapy and influences the therapeutic process. This study evaluated the relationship between the level of defense mechanisms and the quality of therapeutic alliance established during psychotherapy. METHOD: Patients in psychotherapy and their respective therapists completed the Helping Alliance Questionnaire (patient version and therapist version, respectively). The level of defenses was inferred by the Defensive Functioning Scale proposed in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision. RESULTS: There was no association between the quality of therapeutic alliance and the patient's level of defense mechanisms in this sample. On the other hand, there was a difference when the therapist version was compared to the patient version: patients established a stronger therapeutic alliance in relation to their therapists. CONCLUSIONS: The lack of influence of defense level in the quality of therapeutic alliance suggests that the therapist's training and personal characteristics may lead to the ability of connecting with the patient, despite impairment in their psychic functioning.

Adaptação transcultural do Mental States Rating System para o português brasileiro / Cross-cultural adaptation of the Mental States Rating System to Brazilian Portuguese

INTRODUÇÃO: O artigo apresenta a adaptação transcultural do Mental States Rating System, uma escala de análise de conteúdo do discurso, seja ele falado, descrito ou filmado, que abrange de modo amplo tipos de contratransferência. MÉTODO: Foram realizadas as etapas de equivalência conceitual, equivalência de itens, equivalência semântica, equivalência operacional, equivalência funcional e aprovação da versão final pelo autor original do instrumento. RESULTADOS: Os critérios de equivalência foram satisfeitos, tendo a versão final sido aprovada pelo autor do instrumento original. CONCLUSÃO: A adaptação do Mental States Rating System disponibiliza para uso um instrumento que não só abrange todas as categorias de contratransferência descritas na literatura, mas as amplia, através da Teoria dos Estados Mentais. Constitui, desse modo, uma ferramenta de grande utilidade para pesquisa em psicoterapia e psicanálise, onde a contratransferência tem se mostrado um importante recurso, tornando-se ainda mais crucial nas patologias fundamentadas em estágios precoces do desenvolvimento, nos casos graves e nos traumas severos.

INTRODUCTION: This article presents a cross-cultural adaptation of the Mental States Rating System, a content analysis scale applied to spoken, written or taped material, which covers a wide range of countertransference categories. METHOD: The following steps were performed: conceptual equivalence, item equivalence, semantic equivalence, operational equivalence, functional equivalence, and approval of the final version by the author of the original instrument. RESULTS: The study has reached the objectives of equivalence, and the final Brazilian Portuguese version has been approved by the original author. CONCLUSION: The study provides a Brazilian Portuguese version of an instrument that not only covers all the range of categories encompassed by countertransference described in the literature, but also expands it through the Mental States Theory. This represents a valuable tool for research on psychotherapy and psychoanalysis, where countertransference has proved to be an important resource, especially for the treatment of diseases based on early stages of development, for severe mental diseases and severe trauma.