Psicoterapia Psicodinâmica de Crianças e Gravidez da Terapeuta: Estudo de Caso Sistemático

El presente estudio buscó describir las características del proceso psicoterápico psicodinámico de una niña con una terapeuta embarazada e identificar posibles repercusiones de ese embarazo en el tratamiento. Se realizó un estudio descriptivo, longitudinal, basado en el procedimiento de estudio de caso único sistemático. Participaron una niña de ocho años de edad y su terapeuta que se quedó embarazada durante el tratamiento. Se analizaron 40 sesiones de la psicoterapia a través del Child Psychotherapy Q-Set. El proceso terapéutico se dividió en cuatro períodos de acuerdo con el embarazo de la terapeuta: (1) terapeuta no estaba embarazada; (2) terapeuta sabía de su gestación, pero el asunto no había sido verbalizado; (3) tema fue tratado en el setting terapéutico; (4) retorno de la licencia por maternidad. Los resultados demostraron una disminución de la neutralidad y de la colocación de límites, y discusión de pausas e interrupciones en el tratamiento. Se concluyó que el embarazo de la terapeuta influye en el setting terapéutico de forma acentuada.The present study aimed to describe the characteristics of the psychodynamic psychotherapeutic process of a child with a pregnant therapist and to identify possible repercussions of this pregnancy in the treatment. A descriptive, longitudinal study was conducted, based on systematic single case study procedure. The participants were an eight-year-old girl and her therapist who became pregnant during treatment. Forty psychotherapeutic sessions were analyzed through Child Psychotherapy Q-Set procedure. The therapeutic process was divided into four periods related to the therapist’s pregnancy: (1) the therapist was not pregnant; (2) therapist knew of her pregnancy but the topic had not been verbalized; (3) the pregnancy was treated in the therapeutic setting; (4) return of maternity leave. The results demonstrated that the therapist has adopted a less neutral stance, used less limits, and breaks and pauses in treatment were increasingly discussed. It was concluded that the therapist´s pregnancy influences the therapeutic setting in a marked way.O presente estudo buscou descrever as características do processo psicoterápico psicodinâmico de uma criança com uma terapeuta grávida e identificar possíveis repercussões dessa gravidez no tratamento. Realizou-se um estudo descritivo, longitudinal, baseado no procedimento de estudo de caso único sistemático. Participaram uma menina de oito anos de idade e sua terapeuta que engravidou durante o tratamento. Foram analisadas 40 sessões da psicoterapia por meio do Child Psychotherapy Q-Set. O processo terapêutico foi dividido em quatro períodos de acordo com a gravidez da terapeuta: (1) terapeuta não estava grávida; (2) terapeuta sabia de sua gestação, mas o assunto não havia sido verbalizado; (3) assunto foi tratado no setting terapêutico; (4) retorno da licença maternidade. Os resultados demonstraram uma diminuição da neutralidade e da colocação de limites, discussão de pausas e interrupções no tratamento. Concluiu-se que a gravidez da terapeuta influencia o setting terapêutico de forma acentuada

Psychoanalytic psychotherapy and the pregnant therapist: a literature review

Researchers and clinicians seem to agree that the psychotherapist’s pregnancy is an unique moment of psychotherapy psychoanalytic process. In Brazil, 89% of psychologists belong to the female gender, being that the practice of psychotherapy, in its great majority, is performed by women. In spite of the relevance of the subject and of its impact on psychotherapies, there are few current studies, most of them dealing with adult patients. The objective of this study was to perform a systematic review of the literature about pregnancy of the psychotherapist in psychoanalytic psychotherapy. All the articles found in the search of indexed scientific publications, which can be accessed on-line, with an approach about the pregnant psychotherapist in psychoanalytic psychotherapy, were included and discussed in this revision. Besides this, the methods, the results and the repercussions of the treatment, were analyzed. It is revealed that there is a lack of studies in this area, because most of the found articles were dated twelve years ago or more. The studies are of a qualitative exploratory methodology, with small samples, from retrospective data collection from the period when the therapists were pregnant. Pregnancy is discussed as a strong catalyzer for the transference and/or for countertransferential reactions. No items of research were found on the subject from the patient or his family’s perspective, as well as studies about the psychoanalytic psychotherapy process. It is concluded that other studies on this issue are necessary for the better understanding of this psychotherapeutic moment

The relationship between general psychopathology in young people with family functioning and engagement with psychotherapy

Objective to examine whether an underlying general psychopathology factor (p factor) existed in children and adolescents attending psychodynamic psychotherapy and whether this general psychopathology factor was associated with family functioning and engagement with psychotherapy. Method Participants were 1976 children and adolescents, and their families, who sought psychodynamic psychotherapy from a community-based clinic in Southern Brazil. The Child Behavior Checklist and the Family Adaptability and Cohesion Evaluation Scales for assessing symptoms and family functioning were used, with treatment engagement data available through linked records. Confirmatory factor analytic methods examined psychopathology and regression models were constructed to examine associations. Results A general psychopathology factor and specific internalizing and externalizing factors were identified. Higher general psychopathology scores at assessment were associated with an increased likelihood of dropout and poorer attendance compared to completing treatment. Father’s educational level, living with both parents, lack of family adaptability and cohesion, and maltreatment experience were related to increased p factor severity. Conclusion General psychopathology severity seems to contribute to child and adolescent psychotherapy outcomes, increasing the risk of non-adherence and dropout. Family difficulties and traumatic experiences may increase p factor severity. Identifying general psychopathology routinely can be crucial for developing effective treatment plans

Association of Attachment and Reflective Function with Baseline Symptoms in Child and Adolescent Psychodynamic Psychotherapy

The present study aimed to verify the associations between symptoms reported at baseline, attachment style and reflective function (RF) in children and adolescents. For this, we conducted a cross-sectional and naturalistic study, including 90 children and adolescents aged between 9 and 17 years old (M = 13.04, SD = 2.72). Instruments were a demographic form, the Child Behavior Checklist, the Friends and Family Interview and the Reflective Function Questionnaire for Youths. From our findings, internalizing symptoms were reported in 74.4% of the cases, and externalizing symptoms in 55.6%. Concerning the attachment styles, 46.7% of the cases were classified as insecure-dismissing, 38.9% as insecure-preoccupied, 10% as secure and 4.4% as disorganized. Participants’ scores for RF were low. We found associations between attachment styles and anxiety, depression and withdrawal symptoms. We found significant differences between the insecuredismissing style and the insecure-preoccupied and disorganized styles groups regarding anxiety and depression symptoms. The secure attachment style group showed significant differences in withdrawal symptoms when compared to insecure attachment style groups. Further studies exploring associations between attachment styles, RF and psychopathology in childhood and adolescence, could contribute to the evaluation and planning of psychotherapies processes with this population

Child Psychodynamic Psychotherapy and Therapist Pregnancy: Systematic Case Study

Abstract The present study aimed to describe the characteristics of the psychodynamic psychotherapeutic process of a child with a pregnant therapist and to identify possible repercussions of this pregnancy in the treatment. A descriptive, longitudinal study was conducted, based on systematic single case study procedure. The participants were an eight-year-old girl and her therapist who became pregnant during treatment. Forty psychotherapeutic sessions were analyzed through Child Psychotherapy Q-Set procedure. The therapeutic process was divided into four periods related to the therapist’s pregnancy: (1) the therapist was not pregnant; (2) therapist knew of her pregnancy but the topic had not been verbalized; (3) the pregnancy was treated in the therapeutic setting; (4) return of maternity leave. The results demonstrated that the therapist has adopted a less neutral stance, used less limits, and breaks and pauses in treatment were increasingly discussed. It was concluded that the therapist´s pregnancy influences the therapeutic setting in a marked way

Ingestão alimentar e níveis séricos de ferro em crianças e adolescentes com transtorno de déficit de atenção/hiperatividade

Objetivo: Investigar as variáveis hematológicas relacionadas à deficiência de ferro e à ingestão alimentar no transtorno de déficit de atenção/hiperatividade. Método: Sessenta e duas crianças e adolescentes (6-15 anos) divididos em três grupos: Grupo 1: 19 (30,6%) pacientes com transtorno de déficit de atenção/hiperatividade com uso de metilfenidato durante três meses; Grupo 2: 22 (35,5%) pacientes com transtorno de déficit de atenção/hiperatividade sem uso de medicamento; e Grupo 3: 21 (33,9%) pacientes sem transtorno de déficit de atenção/hiperatividade. Ferro sérico, ferritina, transferrina, hemoglobina, volume corpuscular médio, amplitude de distribuição dos eritrócitos, concentração da hemoglobina corpuscular média, parâmetros de diagnóstico nutricional – Coeficiente de Índice de Massa Corporal, inquérito alimentar e a correlação entre os sintomas do transtorno e os níveis de ferritina foram avaliados. Resultados: O grupo com transtorno de déficit de atenção/ hiperatividade não medicado com metilfenidato apresentou maior amplitude de distribuição dos eritrócitos dentre os três grupos (p = 0,03). Nas outras variáveis hematológicas e inquéritos alimentares não encontramos diferença significativa entre os grupos. Não observamos correlação entre os sintomas do transtorno de déficit de atenção/hiperatividade e ferritina. Conclusão: Marcadores periféricos do estado nutricional de ferro e a ingestão alimentar de ferro não parecem estar modificados em crianças com transtorno de déficit de atenção/hiperatividade, mas mais estudos avaliando os níveis de ferro no cérebro são necessários para compreensão plena do papel do ferro na fisiopatologia do transtorno de déficit de atenção/hiperatividade.Objective: To investigate hematologic variables related to iron deficiency and food intake in attention-deficit/hyperactivity disorder. Method: The sample comprised 62 children and adolescents (6-15 years old) divided into three groups: Group 1: 19 (30.6%) patients with attentiondeficit/ hyperactivity disorder using methylphenidate for 3 months; Group 2: 22 (35.5%) patients with attention-deficit/hyperactivity disorder who were methylphenidate naïve and Group 3: 21 (33.9%) patients without attention-deficit/hyperactivity disorder. Serum iron, ferritin, transferrin, hemoglobin, mean corpuscular volume, red cell distribution width, mean corpuscular hemoglobin concentration, nutritional diagnostic parameters - Body Mass Index Coefficient, food surveys were evaluated among the groups. Results: The attentiondeficit/ hyperactivity disorder group drug naïve for methylphenidate presented the highest red cell distribution width among the three groups (p = 0.03). For all other hematologic and food survey variables, no significant differences were found among the groups. No significant correlation between dimensional measures of attention-deficit/ hyperactivity disorder symptoms and ferritin levels was found in any of the three groups. Conclusion: Peripheral markers of iron status and food intake of iron do not seem to be modified in children with attentiondeficit/ hyperactivity disorder, but further studies assessing brain iron levels are needed to fully understand the role of iron in attention-deficit/ hyperactivity disorder pathophysiology