Relationship between psychodynamic functioning, defensive mechanisms and trauma in patients with PTSD?

OBJECTIVE: Patients with Post-Traumatic Stress Disorder (PTSD) present a variety of symptoms, with different intensities, causing impairments in the individual, social and occupational functioning areas. The aim of this study was to understand the psychodynamic functioning of patients with PTSD, exploring the relationship between symptom severity, quality of life, subjective suffering, conflicts and psychic structure regarding sociodemographic characteristics, styles and defensive mechanisms. METHODS: This is a cross-sectional quantitative study with 60 participants. The following were used: sociodemographic questionnaire, the Operationalized Psychodynamic Diagnosis-2 (OPD-2) and the Defensive Style Questionnaire (DSQ-40). RESULTS: Participants had moderate to high symptom severity, with significant subjective suffering and isolation. The main conflict was Need for care x Self-sufficiency and the level of Total Structure was moderate/low. The use of immature, neurotic, and mature defensive styles was observed. More primitive personality structures, more rigid defenses and greater dependence were found in patients with history of past trauma. Other mental disorders were also associated. CONCLUSION: OPD-2 was effective to assess the psychodynamic functioning characteristics of patients with PTSD. Therapeutic treatment should focus on the psychic structure and not only on symptom control. Prevention strategies should target vulnerability factors and strengthening of protective factors.

Understanding the psychodynamic functioning of patients with PTSD and CPTSD: qualitative analysis from the OPD 2 interview.

The traumatic event produces intolerable excitations to the psychic apparatus that searches to relief them through the production of symptoms. When established, patients with post-traumatic stress disorders (PTSD) and complex post-traumatic stress disorder (CPTSD) may experience flashbacks, somatizations, negative emotions about themselves, and difficulty in social contact. This work seeks to understand how the psychodynamic functioning of women victims of interpersonal and urban violence, diagnosed with these disorders, is organized, identifying traumatic experiences, ways of interpersonal relationships, conflicts and psychic structures and use of defense mechanisms, and for peculiarities that may differentiate these disorders. The qualitative transversal method was used through the content analysis of clinical interviews based on the Operationalized Psychodynamic Diagnosis (OPD-2). The sample of this study consisted of five women with PTSD and five with CPTSD. The following categories were created: reasons for seeking care, symptoms and desire for treatment, traumatic developmental events, and characteristics of the psychic functioning. Early trauma generates psychic organizations with greater disintegration. A new traumatic event destabilizes the psychic organization and intensifies symptoms. Relationships were marked by dependence and isolation. Participants with CPTSD presented tendency to disintegration related to the object relation regulation and the psychic conflict was of Individuation versus Dependence, with more primitive flaws in object representations, existential need for the other and direct discharge of impulses. Participants with PTSD had moderate to low level of object relation integration and the conflict was need to be care of versus self-sufficiency, with self-representations being fragile and with reduced capacity to manage impulses. Thus, it could be observed that OPD-2 is capable of assessing in a broad and deep way patients with traumatic disorders, in addition to identifying essential peculiarities to guide health professionals towards treatment in the search for better quality of life for patients.

Mental health outcomes in Syrian refugees: A systematic review.

BACKGROUND: Syria is the main country of origin for refugees in the world. The prevalence of mental disorders in this population is high, but there is a lack of more comprehensive data on mental health issues in this population. AIM: This study aims to review the literature for mental health outcomes in Syrian refugees. METHODS: We performed a systematic quantitative literature review of original observational studies indexed on the MEDLINE via PubMed, Embase, Web of Science, PsycINFO, LILACS, and SciELO databases with quantitative data reporting mental health outcomes in Syrian refugees. A descriptive analysis was conducted, and the quality of the included studies was assessed using an adaptation from The National Institutes of Health (NIH) quality assessment tool for observational studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS: A total of 64 studies were included. The majority were published between 2019 and 2020, and focused on the prevalence of post-traumatic stress disorder (PTSD), depression, and anxiety, with a wide range of variations. Other outcomes were difficulties in the post-migration period and promotive factors for mental health, such as resilience, positive coping strategies, and psychosocial well-being. CONCLUSIONS: High prevalence rates of mental disorders were observed, as well as risk factors for their occurrence. Studies showed a very high variability of prevalence rates and heterogeneity in methodologies. There is a need for research focusing on other determinants and specific necessities for mental health, especially in the post-resettlement period.

Identifying posttraumatic stress disorder staging from clinical and sociodemographic features: a proof-of-concept study using a machine learning approach.

This proof-of-concept study aimed to investigate the viability of a predictive model to support posttraumatic stress disorder (PTSD) staging. We performed a naturalistic, cross-sectional study at two Brazilian centers: the Psychological Trauma Research and Treatment (NET-Trauma) Program at Universidade Federal of Rio Grande do Sul, and the Program for Research and Care on Violence and PTSD (PROVE), at Universidade Federal of São Paulo. Five supervised machine-learning algorithms were tested: Elastic Net, Gradient Boosting Machine, Random Forest, Support Vector Machine, and C5.0, using clinical (Clinician-Administered PTSD Scale version 5) and sociodemographic features. A hundred and twelve patients were enrolled (61 from NET-Trauma and 51 from PROVE). We found a model with four classes suitable for the PTSD staging, with best performance metrics using the C5.0 algorithm to CAPS-5 15-items plus sociodemographic features, with an accuracy of 65.6% for the train dataset and 52.9% for the test dataset (both significant). The number of symptoms, CAPS-5 total score, global severity score, and presence of current/previous trauma events appear as main features to predict PTSD staging. This is the first study to evaluate staging in PTSD with machine learning algorithms using accessible clinical and sociodemographic features, which may be used in future research.

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.

Association between anger expression and attempted suicide at a general emergency hospital in the south of Brazil.

INTRODUCTION: Suicide is one of the leading causes of death in the world. For every person who commits suicide, twenty or more have attempted to take their own lives. The emotional state of anger is often associated with suicidal behavior. However, this association needs to be further clarified. OBJECTIVES: This study sought to investigate the profiles of traits and expressions of anger in inpatients admitted to a general emergency hospital after surviving a suicide attempt. METHODS: In this case-control study, a sample of 28 suicide survivors was matched for sex, age, and educational level with 56 controls. The State-Trait Anger Expression Inventory-2 was used to measure anger traits and expression. RESULTS: Suicide survivors scored higher for anger traits and expression and lower for anger control than the control group. They also had lower levels of state anger and willingness to express anger verbally than the control group. CONCLUSIONS: Patients who attempted suicide and had high scores for anger expression (in and out) are inclined to have extreme difficulty in interpersonal relationships and rigidity towards change and are at higher risk of developing psychopathologies.

COVID-19 pandemic and social distancing: economic, psychological, family, and technological effects.

INTRODUCTION: The concept of social isolation is currently understood as a measure of epidemiological containment that aims to reduce the speed of spread of the disease, enabling health services to prepare their resources to cope with the likely increase in demand, while also seeking to provide additional protection to groups considered to be at higher risk. OBJECTIVE: The present narrative review aims to compile and synthesize the literature related to social isolation produced during the COVID-19 pandemic in 2020. METHOD: This study is a narrative review of the literature on social isolation in the context of the COVID- 19 pandemic. RESULTS: 73 publications were included for full-text reading and were classified into the following categories: levels of social isolation, economic effects, family relationships, health system, mental health of the population, and use of technology. CONCLUSIONS: It is necessary to plan an escalation of responses to the consequences of the pandemic, especially in view of the increased demand on the health sector and social services. The negative effects of social isolation can be prevented by public policies that offer a response to the economic recession, maintenance of social work, encouragement of quality care in mental health services, and community support for vulnerable families.

Validation of the Brazilian-Portuguese Version of the Clinician Administered Post Traumatic Stress Disorder Scale-5.

Objectives: The aim of this study was to validate CAPS-5 for the Brazilian-Portuguese language on a sample of 128 individuals from two centers (from the cities of São Paulo and Porto Alegre) who have been recently exposed to a traumatic event. Methods: We performed a reliability analysis between interviewers (with a subset of 32 individuals), an internal consistency analysis, and a confirmatory factorial analysis for the validation study. Results: The inter-rater reliability of the total PTSD symptom severity score was high [intraclass correlation coefficient =0.994, 95% CI (0.987-0.997), p < 0.001]. Cohen's Kappa for individual items ranged between 0.759 and 1. Cronbach's alpha coefficients indicated high internal consistency for the CAPS-5 full scale (α = 0.826) and an acceptable level of internal consistency for the four symptom clusters. The confirmatory factorial analysis for the 20-item original CAPS-5 did not fit the data well. A 15-item model with better results was then established by excluding the following CAPS-5 items: dissociative amnesia, recklessness, distorted cognitions, irritability, and hypervigilance. Conclusion: Despite the limitation of the predominance of female victims, and the high number of sexually assaulted women in our sample, the model with only 15 items provided a good fit to the data with high internal consistency (α = 0.835).

The association between traumatic experiences and suicide attempt in patients treated at the Hospital de Pronto Socorro in Porto Alegre, Brazil.

OBJECTIVE: To analyze associations between attempted suicide and childhood trauma. METHODS: A seven month comparative case-control study (28 subjects - patients with suicide attempt; 56 controls - patients without suicide attempt). The following instruments were used: Childhood Trauma Questionnaire (CTQ), Mini International Neuropsychiatric Interview (MINI), and Medical Outcomes Study (MOS). RESULTS: The group with suicide attempt had significantly higher scores for some variables: emotional abuse (p < 0.001), physical abuse (p < 0.001), emotional neglect (p < 0.001), and physical neglect (p < 0.001). CONCLUSIONS: The results suggest that variables related to previous trauma may influence future suicide attempts. The adoption of preventive and therapeutic actions related to mistreatments during child development is a crucial factor in reduction of suicide risk.

The use of machine learning techniques in trauma-related disorders: a systematic review.

Establishing the diagnosis of trauma-related disorders such as Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) have always been a challenge in clinical practice and in academic research, due to clinical and biological heterogeneity. Machine learning (ML) techniques can be applied to improve classification of disorders, to predict outcomes or to determine person-specific treatment selection. We aim to review the existing literature on the use of machine learning techniques in the assessment of subjects with ASD or PTSD. We systematically searched PubMed, Embase and Web of Science for articles published in any language up to May 2019. We found 806 abstracts and included 49 studies in our review. Most of the included studies used multiple levels of biological data to predict risk factors or to identify early symptoms related to PTSD. Other studies used ML classification techniques to distinguish individuals with ASD or PTSD from other psychiatric disorder or from trauma-exposed and healthy controls. We also found studies that attempted to define outcome profiles using clustering techniques and studies that assessed the relationship among symptoms using network analysis. Finally, we proposed a quality assessment in this review, evaluating methodological and technical features on machine learning studies. We concluded that etiologic and clinical heterogeneity of ASD/PTSD patients is suitable to machine learning techniques and a major challenge for the future is to use it in clinical practice for the benefit of patients in an individual level.

Intimate partner violence against women: Operationalized Psychodynamic Diagnosis (OPD-2).

INTRODUCTION: Intimate partner violence against women is one of the most common forms of violence. Different research fields are trying to understand the cycle of violence, such as the psychological field, to understand how these women's relational patterns and intrapsychic conflict function in the cycle of violence. OBJECTIVE: To investigate the operationalized psychodynamic diagnosis of women victims of domestic violence, exploring the severity and experience of violence, structural functions, dysfunctional interpersonal patterns, and intrapsychic conflicts. METHOD: We conducted a cross-sectional quantitative study using the OPD-2 Clinical Interviews, which were recorded and transcribed. The sample was composed by 56 women victims of domestic violence, mean age 30.07 (SD = ±9.65). Reliability was satisfactory for judges interviews(k>0,6). RESULTS: According to the OPD-2 evaluation, we found that the severity of the violence was associated with the intensity of women's subjective suffering. In the relational pattern, they stay in the relationship, leaving themselves vulnerable; perceive the partner as controlling, aggressive, offensive, and fear abandonment. As a defensive mechanism to relational discomfort and suffering victims anticipate the aggressor's desire, resulting in submissive behavior. The main psychic conflict was the "need for care versus self-sufficiency" (78.6%). And medium was the predominant structure level, in which they presented insecure internal objects, presenting difficulties in emotional regulation and perceiving reality in a distorted way. Hence, they do not recognize their limitations and needs. We found that 78.6% of the cases had some psychiatric disorder: MDD, PTSD. CONCLUSION: This study provides empirical evidence on clinical observations on the psychological functioning of this population and the issues that make up the maintenance of domestic violence against women. The understanding of internalized patterns, structural functions, and motivational tensions are fundamental for the prevention of re-victimization and improving coping mechanisms, as well as promoting greater adherence to treatment.

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.

Operationalized psychodynamic diagnosis: a systematic review of the literature.

INTRODUCTION: The Operationalized Psychodynamic Diagnosis (OPD-2) is an operational multiaxial diagnostic assessment and treatment planning tool. This systematic review sought to analyze empirical studies that used the OPD as an instrument. In addition to identifying the studies, we analyzed the topics covered and the results of research that used the OPD empirically. METHOD: Articles, dissertations and empirical theses that mentioned or used the OPD instrument in the last five years (2012-2017) were included in this review. The strategy included searching with combinations of the descriptors "Operationalized and psychodynamic and diagnosis" from the Portal de Periódicos CAPES on the PubMed, Google Scholar, and ResearchGate databases for work published in English, Portuguese or Spanish in the last five years. RESULTS: The search returned a total of 189 papers, but only 20 were included. The studies selected discussed the validity and reliability of the instrument, the therapeutic process and analysis of outcomes, assessment of different mental disorders, and also included studies comparing different instruments and techniques. Considerable scientific effort has evidently been dedicated to accumulating more consistent data on psychodynamic diagnosis. CONCLUSION: It was demonstrated that the OPD is an essential clinical tool for dimensional comprehension of the subject and for scientific research. However, the number of publications on the subject is not yet significant and the methods employed are diverse. Nevertheless, there is a growing body of data on topics such as applicability in different contexts and to different pathologies, promoting greater visibility and with greater representativeness of professionals who have experience with the instrument.

Cycle of violence in women victims of domestic violence: Qualitative analysis of OPD 2 interview.

INTRODUCTION: Domestic violence places woman as the victim and man as the aggressor in the family environment. There is limited consistent and clear information based on empirical evidence on the dynamic functioning of the victims. OBJECTIVE: To further understand the psychodynamics of women in the cycle of violence taking into account the aspects of psychological trauma. It is transversal research design. The sample was composed of ten women victim of domestic violence. Data collection was based on the OPD-2 Clinical Interview. Content analysis was performed from categories created by a posteriori: (a) Previous history; (b) Behavioral aspects; (c) Emotional aspects; (d) Reason for being in the relationship; (e) Type of violence and explanation for the reason of violence; (f) Support network and daily activities; and (g) Clinical and legal referral. RESULTS: Constant violence causes changes in the structural functioning and psychological conflict of the victims: difficulties in mentalization, instability in relationships, emotional dependence, abandonment of her own life for her partners, difficulty in having a sense of identity. Victims presented difficulties in making significant changes in daily life to break the cycle of violence. CONCLUSION: The research sought to collaborate with more evidence on the subject, suggesting a reformulation on forms of encounter to break the cycle of violence.

Cross-cultural adaptation of the Module for Assessment of Domestic Violence, adapted from Axis I of the Operationalized Psychodynamic Diagnosis (OPD-2), with a sample of Brazilian women, victims of domestic violence.

INTRODUCTION: Intimate partner domestic violence against women causes physical and psychological harm to victims. The relevance of this topic is indisputable and there is a need to identify in greater detail how these women experience violence, since these factors have considerable clinical implications. OBJECTIVE: To develop a Portuguese version of the Module for Assessment of Domestic Violence, adapted from Axis I of the Operationalized Psychodynamic Diagnosis (OPD-2), considering content validity and psychometric characteristics. METHOD: Cross-cultural adaptation was based on guidelines for the process of cross-cultural adaptation of self-report measures. OPD clinical interviews were recorded and transcribed. These interviews were analyzed by two independent judges trained in the OPD-2. RESULTS: The sample comprised 56 women who had been victims of domestic violence, with a mean age of 30.07 years (standard deviation = 9.65). The adapted version has content validity and good psychometric characteristics. Evaluation of semantic equivalence took into account the psychodynamic references, using the same ideas as the original instrument. Interexaminer reliability between the judges was substantial (k = 0.63) and Cronbach's alpha for the new version indicates good reliability. CONCLUSION: The OPD-2 offers a psychodynamic diagnosis of the victim that complements traditional nosological diagnosis, particularly in the context of domestic violence with the adaptation of Axis I. Certain biases could have been detrimental to aspects of this study, but they were controlled. The study objective was achieved and the Module was successfully adapted to Brazilian Portuguese. The results are in line with those of the original study.

Suicidal patients in a psychiatric emergency unit: clinical characteristics and aggression profile.

OBJECTIVE: To explore and describe a profile of patients admitted to a psychiatric emergency facility, comparing patients with and without a recent suicide attempt in terms of their clinical characteristics and aggression. METHODS: This was an exploratory comparative study where patients were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Scale (OAS). Participants with a suicide attempt in the last 24 hours (SA) were compared to participants with a prior history of suicide attempt but no recent attempt (PHSA). RESULTS: 63 individuals (SA: 26; PHSA: 37) were selected. Both groups had similar demographic and clinical characteristics. The most prevalent diagnoses were mood (57.1%) and personality (50.8%) disorders. The majority of patients in both groups had a history of aggression episodes. Physical aggression in the week prior to admission was more prevalent in the PHSA group (51.4 vs. 19.2%, p = 0.017). The PHSA group also presented higher activation scores (p = 0.025), while the SA group presented higher affect scores on BPRS dimensions (p = 0.002). CONCLUSION: The majority of individuals with a history of suicide attempt also presented a history of aggression. Inpatients with recent suicide attempt were hospitalized mainly due to the risk of suicide, while those with no recent suicide attempt were hospitalized mainly due to the risk of hetero-aggression. These findings support the hypothesis of an aggressive profile in suicidal patients and may open up a path for future research.

Trauma-related disorders in a low- to middle-income country: A four-year follow-up of outpatient trauma in Brazil.

Acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) are developed from exposure to traumatic events including war, interpersonal violence and natural disasters. We investigated prevalence and trauma-related information in patients from an outpatient psychiatric unit in Brazil among 2014-2017. A prevalence of ASD/PTSD of 40.8% was found in 179 patients. Female, Caucasian, married, mostly educated during 10-12 years long and employed patients composed a main profile. The presence of any previous trauma in adulthood and childhood were related to ASD/PTSD with longer follow-up time. This study provides evidence of stress-related disorders in a heterogeneous environment.

Evaluation of BDNF levels in patients hospitalized for physical trauma at an emergency hospital in Porto Alegre, southern Brazil.

OBJECTIVE: To assess the association between brain-derived neurotrophic factor (BDNF) levels and acute stress disorder (ASD) in patients who have suffered physical trauma. METHODS: Data were collected at an emergency hospital in Porto Alegre, state of Rio Grande do Sul, southern Brazil. Participants were over 18 years of age, victims of physical trauma, and had been hospitalized for a minimum of 48 hours. A total of 117 hospitalized patients who agreed to participate in the research were grouped according to the shift in which blood was collected (38 subjects from the morning shift and 79 from the afternoon shift), had their BDNF levels measured and responded to other questionnaires. Respondents were further grouped by age into three ranges: 18-30, 31-50 and 51-70 years. RESULTS: We found a significant difference in the distribution of BDNF between the two shifts in which blood samples were collected, with the afternoon group having higher BDNF levels (U = 1906.5, p = 0.018). A difference was observed only between the 18-30 group and the 51-70 group in the afternoon shift (Umorning = 1107, pmorning = 0.575; Uafternoon = 7175, pafternoon = 0.028). CONCLUSIONS: The population whose blood samples were collected in the afternoon showed significantly higher values of BDNF compared to those of the morning shift. This same population presented lower BDNF levels when associated with ASD subtypes A1, A2, and A. We hypothesize that the lower values of BDNF measured in the morning shift were due to a response to the circadian cycle of cortisol, whose action inhibits the expression of serum neurotrophins.

Afetos, tormentos e desabafos: histórias em psicoterapia e psiquiatria / Affections, torments and outbursts: stories in psychotherapy and psychiatry

Resenha do livro "Afetos, Tormentos e Desabafos: histórias em psicoterapia e psiquiatria"¹, de autoria do Dr. Fernando Lejderman, publicado pela Editora ARTMED em 2022, apresenta a trajetória médico-profissional de vários anos do autor, assim como algumas das vivências que ele experimentou com seus pacientes.

Transculturalidade na psicoterapia de orientação analítica: estudo de um caso e revisão de literatura / Transculturality in analytically oriented psychotherapy: a case study and literature reviewc

A cultura representa os sistemas de valores e simbolismos presentes em um grupo social, e sua influência no psiquismo humano é mencionada na literatura psicanalítica desde a obra Totem e Tabu, de Sigmund Freud. Diferenças culturais podem determinar maneiras diversas de sentir e de expressar o sofrimento psíquico, e no que diz respeito à psicoterapia de orientação analítica considera-se fundamental que o terapeuta esteja sensível aos componentes culturais que influenciam a dinâmica psicológica do paciente. O modelo da psicoterapia transcultural propõe a adaptação de alguns elementos, a fim de cumprir esta finalidade. Este relato foi desenvolvido a partir do atendimento de um paciente de origem africana, admitido em uma internação psiquiátrica por uma síndrome psicótica. Procuramos relacionar os elementos transculturais presentes no caso, como particularidades no idioma e crenças culturais, à prática da psicoterapia de orientação analítica neste contexto. Elementos do conflito psíquico, da transferência e vinculação com o terapeuta foram analisados, tendo por base autores psicanalíticos clássicos e contemporâneos. A partir desta análise, discutimos a respeito de elementos teóricos e técnicos relacionados à transculturalidade em psicoterapia. Espera-se que este relato possa auxiliar psicoterapeutas a trabalhar neste contexto.(AU)

Culture represents value systems and symbolisms present in a social group, and its influence on human psyche has been mentioned in psychoanalytic literature since Sigmund Freud's Totem and Tabu. Cultural differences can determine different ways of feeling and expressing mental distress, and with regard to analytical orientation psychotherapy it is considered essential that the therapist be sensitive to cultural components that influence patient's psychic dynamics. The transcultural psychotherapy model proposes the flexibility of some elements in order to fulfill this purpose. This report was developed from the care of a patient of African origin, admitted to a psychiatric hospital for a psychotic syndrome. We sought to relate the cross-cultural elements present in the case, such as language peculiarities and cultural beliefs, to the practice of analytical-oriented psychotherapy in this context. Characteristics of psychic conflict, transference, and attachment to the therapist were analyzed based on classical and contemporary psychoanalytic authors. From this analysis, we discussed theoretical and technical elements related to transculturality in psychotherapy. It is expected that this report can help psychotherapists to work in this context.(AU)

La cultura representa sistemas de valores y simbolismos presentes en un grupo social, y su influencia en la psique humana ha sido mencionada en la literatura psicoanalítica desde Tótem y tabú de Sigmund Freud. Las diferencias culturales pueden determinar diferentes formas de sentir y expresar el malestar mental, y con respecto a la psicoterapia de orientación analítica se considera fundamental que el terapeuta sea sensible a los componentes culturales que influyen en la dinámica psíquica del paciente. El modelo de psicoterapia transcultural propone la flexibilidad de algunos elementos para cumplir con este propósito. Este relato se elaboró ??a partir de la atención de un paciente de origen africano, ingresado en un hospital psiquiátrico por un síndrome psicótico. Buscamos relacionar los elementos transculturales presentes en el caso, como las peculiaridades del lenguaje y las creencias culturales, con la práctica de la psicoterapia de orientación analítica en este contexto. Se analizaron las características del conflicto psíquico, la transferencia y el apego al terapeuta con base en autores psicoanalíticos clásicos y contemporáneos. A partir de este análisis, discutimos elementos teóricos y técnicos relacionados con la transculturalidad en psicoterapia. Se espera que este informe pueda ayudar a los psicoterapeutas a trabajar en este contexto.(AU)