Theoretical Saturation In Qualitative Research: Psychoanalytical Contributions [saturação Teórica Em Pesquisas Qualitativas: Contribuições Psicanalíticas]

The methodological technique of theoretical saturation, commonly used in qualitative researches, particularly about clinic activities, dialogues and can benefit from theory and practice of psychoanalysis. Although some imprecision in the final sample size is inevitable and inherent to qualitative methods, it should not lead to techniques and procedures that can weaken or jeopardize the validity and credibility of both empirical analysis and findings. This essay discusses aspects of cognitive and affective dimensions present during data collection through interviews, in both informants and researchers. For this, the Freudian concepts of transference and countertransference are used, and also the notions of rêverie and beta elements, formulated by Wilfred Bion. It is postulated that these kind of phenomena help determine how much data coming from the sample elements are sufficient, necessary and possible to enhance the theoretical depth of the studied object.1716371Bion, W.R., (1962) Learning from experience, , London: Karnac BooksBion, W.R., (1973) Atenção e interpretação: uma aproximação científica à compreensão interna na psicanálise e nos grupos, , Rio de Janeiro: Imago (Original publicado em 1970)Bion, W.R., (1991) O aprender com a experiência, , Rio de Janeiro: Imago. (Original publicado em 1962)Bion, W.R., Uma teoria sobre o pensar (1994) Estudos Psicanalíticos revisados., pp. 127-138. , In W. R., Bion. Rio de Janeiro: Imago.. (Original publicado em 1967)Bion, W.R., Elementos de psicanálise (2004), (2a ed.). Rio de Janeiro: Imago (Original publicado em 1963)Bion, W.R., Transformações. Do aprendizado ao crescimento (2004), Rio de Janeiro: Imago (Original publicado em 1965)Bleger, J., (1989) Temas de psicologia: entrevista e grupos, , (4a ed.). São Paulo: Martins FontesDenzin, N.K., Lincoln, Y.S., (1994) Handbook of qualitative research, , Thousand Oaks: SageFerro, A., (2008) "Tecnica e criatividade": o trabalho analítico, , Rio de Janeiro: ImagoFontanella, B.J.B., Ricas, J., Turato, E.R., (2008) Cadernos de Saúde Pública, 24 (1), pp. 17-27. , Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricasFreud, S., (1969) Recordar, repetir e elaborar (novas recomendações sobre a técnica da psicanálise II)., , (J. Salomão, Trad.). Edição standard brasileira das obras psicológicas completas de Sigmund Freud (Vol.XII, pp. 191-203). Rio de Janeiro: Imago. (Original publicado em 1914)Freud, S., (1976) Inibições, sintomas e ansiedade, , (J. Salomão, Trad.). Edição standard brasileira das obras psicológicas completas de Sigmund Freud (Vol. XX, pp. 95-207) Rio de Janeiro: Imago. (Original publicado em 1926)Glaser, G., Strauss, A., (1967) The discovery of grounded theory: strategies for qualitative research, , New York: Aldine de GruyterParsons, M., Sobre a rêverie (2007) Rêverie: Revista de Psicanálise, 1 (1), pp. 73-76Pires, A.P., Amostragem e pesquisa qualitativa: ensaio teórico e metodológico (2008) A pesquisa qualitativa: enfoques epistemológicos e metodológicos, , Vários Autores. Petrópolis: VozesTurato, E.R., (2010) Tratado da metodologia da pesquisa clínicoqualitativa: construção teórico-epistemológica, discussão comparada e aplicação nas áreas de saúde e humanas, , (4a ed.). Petrópolis: Voze

Doctor-patient Relationship Barriers To Substance Dependents Seeking Treatment [barreiras Na Relação Clínico-paciente Em Dependentes De Substâncias Psicoativas Procurando Tratamento]

Introduction. Knowing the barriers substance dependents come across when seeking treatment has medical and public health implications. The study's aim was to formulate hypothesis on psychological and social and familiar variables forming subjective barriers to early treatment. Methods. A qualitative exploratory study was conducted in an intentional sample (selected through saturation and variety of types) of 13 substance dependents who sought treatment. In-depth open-question semi-structured interviews were conducted and the transcribed data underwent qualitative analysis. Results. The main barriers in doctor-patient relationship were fear of doctors and facilities which are regarded as "sadistic," and the perception of doctor-patient "distancing." Conclusions. Health care professionals should take into consideration the existence of barriers to treatment and should bear this in mind when promoting their services. Issues such as "fear of being abused" and "doctors wouldn't know how to treat me" should be covered in structured questionnaires of further quantitative studies.364439447Balint, M., (1975) O Médico, Seu Paciente E a Doença, , 2 a ed. Rio de Janeiro/São Paulo: AtheneuBardin, L., Análise de conteúdo (1979), 70. , Lisboa: EdiçõesBell, J., Treatment dependence: Preliminary description of yet another syndrome (1992) Br. J. Addict, 87, pp. 1049-1054Bleger, J., (1989) Temas De Psicologia: Entrevista E Grupos, , 4 a ed. São Paulo: Martins FontesCopeland, J.C., A qualitative study of barriers to formal treatment among women who self-managed change in addictive behaviours (1997) J. Subst. Abuse Treat, 14, pp. 183-190Denzin, N.K., Lincoln, Y.S., (1994) Handbook of Qualitative Research, , editors. Thousand Oaks: SageFerri, C., Cocaína: Padrão de consumo e fatores associados à procura de tratamento (1999), [Tese de doutorado]. São Paulo (SP): Universidade Federal de São PauloFontanella, B.J.B., Procura de tratamento por dependentes de substâncias psicoativas: Um estudo clínico-qualitativo (2000), [Tese de doutorado]. Campinas (SP): Universidade Estadual de CampinasFreud, S., (1924) Obras Psicológicas Completas De Sigmund Freud, 19, pp. 195-212. , 2 a ed. Rio de Janeiro: ImagoO problema econômico do masoquismo [Edição Satandard Brasileira]Hingson, R., Mangione, T., Allan, M., Scotch, N., Seeking help for drinking problems: A study in the Boston Metropolitan Area (1982) J. Stud. Alcohol, 43, pp. 273-288Klingemann, H.K., The motivation for change from problem alcohol and heroin use (1991) Br. J. Addict, 86, pp. 727-744Kolck, O.L.V., Tosi, S.M.V.D., Pellegrini, T.F., Auto-imagem em alcoólicos crônicos (1991) Temas, 42, pp. 374-382O'Leary, M.R., Speltz, M.L., Walker, R.D., Influence of reported helplessness on client-clinician relationships in na alcoholism program (1980) Hosp. Community Psychiatry, 31, pp. 783-784Oppenheimer, E., Sheehan, M., Taylor, C., Letting the client speak: Drug misusers and the process of help seeking (1988) Br. J. Addict, 83, pp. 635-647Radó, S., The psychoanalysis of pharmacothymia (drug addiction) (1933) Psychoanal. Q, 2, pp. 1-23Rohrer, G.E., Thomas, M., Yasenchak, A.B., Client perceptions of the ideal addictions counselor (1992) Int. J. Addict, 27, pp. 727-733Rosenfeld, H.A., Os estados psicóticos (1968), pp. 148-165. , Rio de Janeiro: ZaharDa taxonomiaRounsaville, B.J., Kleber, H.D., Untreated opiate addicts: How do they differ from those seeking treatment? (1985) Arch. Gen. Psychiatry, 42, pp. 1072-1077Thom, B., Sex differences in help-seeking for alcohol problems - 1 : The barriers to help-seeking (1986) Br. J. Addict, 81, pp. 777-788Turato, E.R., Introdução à metodologia da pesquisa clínico-qualitativa: Definição e principais características (2000) Rev. Port. Psicossom, 2, pp. 93-108Unis, G., Pons, A.H., Gus, G., Krahe, J.L., Amon, L.C., Carvalho, L.T., Influência do curso médico no aprendizado do alcoolismo (1987) Rev. AMRIGS, 31, pp. 300-30

Substance Dependents Seeking For Treatment And Their Perceptions Of Depressive Symptoms [percepção De Sintomas Depressivos Por Dependentes De Substâncias Psicoativas Procurando Tratamento]

Objective: Knowing the motivations and barriers substance dependents come across when seeking treatment has medical and public health implications. The study's aim was to formulate hypothesis on psychosocial variables forming subjective motivations to treatment related to the depressive symptoms. Methods: A qualitative exploratory study was conducted on an intentional sample of 13 substance dependents looking for formal treatment; transcribed in-depth semi-structured interviews underwent a content analysis. Results: Five categories were formulated, disclosing the possible extension of the relations between depressive symptoms and treatment demand: perceptions of feeling guilty; perceptions of low self-esteem, loss of confidence of nearby people; suicidal and self-harm ideas; perception of causality and chronology of depressive symptoms; a pharmacological logics related to these symptoms. Conclusions: The interviewees have a proper understanding on the seeking treatment process and seem to evaluate subjectively the involved variables, being prominent the evaluation of depressive symptoms' discomfort, hardly communicated or consciously perceived in their particularities. Therefore, it is required a professional attention on this issue, especially in primary care settings. Two hypotheses are formulated: a subpopulation identifies psychoactive substances depressive effects and seek treatment earlier; the identification of mild depressive symptoms agilize the process of seeking help. Representative topics of the formulated categories should be covered in structured questionnaires of further quantitative studies.544278284Bardin, L., (1979) Análise de Conteúdo, p. 70. , Lisboa: EdiçõesBleger, J., (1989) Temas de Psicologia: Entrevista e Grupos. 4. Ed., , São Paulo: Martíns FontesCarrol, K.M., Rounsaville, B.J., Contrast of treatment-seeking and untreated cocaine abusers (1992) Arch Gen Psychiatry, 49, pp. 464-471DuFort, G.G., Newman, S.C., Bland, R.C., Psychiatric comorbidity and treatment seeking. Sources of selection bias in the study of clinical populations (1993) J Nerv Ment Dis, 181, pp. 467-474Finney, J.W., Moss, R.H., Entering treatment for alcohol abuse: A stress and coping model (1995) Addiction, 90, pp. 1223-1240Fontanella, B.J.B., Turato, E.R., Barreiras na relação clínico-paciente em dependentes de SPA procurando tratamento (2002) Rev Saúde Pública, 36, pp. 439-447Fontanella, B.J.B., (2000) Procura de Tratamento por Dependentes de SPA: Um Estudo Clínico-qualitativo, , Tese de doutorado. Universidade Estadual de Campinas, CampinasFreud, S., O problema econômico do masoquismo (1924) (1976) Edição Standard Brasileira das Obras Psicológicas Completas de Sigmund Freud. 2. Ed., , Rio de Janeiro: ImagoHingson, R., Mangione, T., Allan, M., Scotch, N., Seeking help for drinking problems: A study in the Boston Metropolitan Area (1982) J Stud Alcohol, 43, pp. 273-288Montoya, I.D., Haertzen, C., Hess, J.M., Covi, L., Fudala, P.J., Johnson, R.E., Gorelick, D.A., Comparison of psychological symptoms between drug abusers seeking and not seeking treatment (1995) J Nerv Ment Dis, 183, pp. 50-53Oppenheimer, E., Sheehan, M., Taylor, C., Letting the client speak: Drug misusers and the process of help seeking (1988) Br J Addict, 83, pp. 635-647Prochaska, J.D., Diclemente, C.C., Stages and processes of self-change of smoking: Toward an integrative model of change (1983) J Clin Cons Psych, 51, pp. 390-395Rosenfeld, H.A., Psicopatologia da toxicomania e do alcoolismo (revisão crítica da literatura psicanalítica) (1964) (1968) Os Estados Psicóticos, pp. 245-273. , Rosenfeld HA. Rio de Janeiro: ZaharRounsaville, B.J., Kleber, H.D., Untreated opiate addicts: How do they differ from those seeking treatment? (1985) Arch Gen Psychiatry, 42, pp. 1072-1077Ross, H.E., Glaser, F.B., Germanson, T., The prevalence of psychiatric disorders in patients with alcohol and other drug problems (1988) Arch Gen Psychiatry, 45, pp. 1023-1031Ross, H.E., Lin, E., Cunningham, J., Mental health service use: A comparison on treated and untreated individuals with substance use disorders in Ontario (1999) Can J Psychiatry, 44, pp. 570-577Schuckit, M.A., Tipp, J.E., Bergman, M., Reich, W., Hesselbrock, V.M., Smith, T.L., Comparison of induced and independent major depressive disorders in 2,945 alcoholics (1997) Am J Psychiatry, 154, pp. 948-957Silveira, D.X., Jorge, M.R., Co-morbidade psiquiátrica em dependentes de substâncias psicoativas: Resultados preliminares (1999) Rev Bras Psiquiatr, 21, pp. 145-151Thom, B., A process aproach to womens's use of alcohol services (1984) Br J Addict, 79, pp. 377-382Turato, E.R., (2003) Tratado da Metodologia da Pesquisa Clínico-qualitativa, , São Paulo: VozesViertler, R.B., Alcoolismo entre os bororos (2000) Ciências Sociais e Saúde para o Ensino Médico, pp. 243-261. , Canesqui AM (org). São Paulo: HUCITEC/FAPESPWoodruff, R.A., Guze, S.B., Clayton, P.J., Alcoholics who see a psychiatrist compared with those who do not (1973) Q J Stud Alcohol, 34, pp. 1162-1171Zola, I.K., Pathways to the doctor: From person to patient (1973) Soc Sci & Med, 7, pp. 677-68

Dependence Syndrome Perception By Patients Undergoing Treatment [percepção Da Síndrome De Dependência Por Pacientes Em Tratamento]

The perception of the dependence symptoms is a key factor on the treatment seeking process by people who suffer from it, and its understanding is a relevant health issue. Objectives: The aim of the present study is to identify and understand the subjective meanings of the perceived dependence symptoms among patients who have sought treatment. Methods: Qualitative study conducted on an intentional sample of 13 substance dependents seeking formal treatment; in-depth semistructured interviews. Results: The diagnostic criteria on substance dependence were spontaneously reported by the participants. They show a clear understanding of the process of treatment, compulsion and lack in controlling substance-taking behavior; withdrawal state; tolerance; neglect of alternative pleasures or interests; perception of harmful consequences due to substance abuse. Conclusions: The interviewees have a proper understanding on the seeking treatment process and seem to evaluate subjectively and carefully the distress related to the dependence symptoms. These results need special attention of health professionals, especially in primary care settings and, once approached, it may collaborate with treatment searching

Saturation Sampling In Qualitative Health Research: Theoretical Contributions [amostragem Por Saturação Em Pesquisas Qualitativas Em Saúde: Contribuições Teóricas]

The transparency and clarity of research reports, emphasizing the data collection stage, are considered important parameters for evaluating the scientific rigor of qualitative studies. The current paper aims to analyze the use of saturation sampling as a methodological concept, frequently employed in descriptions of qualitative studies in various areas of knowledge, particularly in the field of health care. We discuss and confront the following topics: definition of sampling closure by theoretical saturation; difficulties in the acceptance and operationalization of intentional samples (with examples), adequate size of the intentional sample, the significance of valuing what is repeated or the differences contained in the sample reports, inadequate uses of expressions containing the term saturation, and finally possible metaphors for understanding the concept.2411727(1994) Handbook of qualitative research, , Denzin NK, Lincoln YS, editors, Thousand Oaks: Sage Publications;Glaser, B.G., Strauss, A.L., (1967) The discovery of grounded theory: Strategies for qualitative research, , New York: Aldine de Gruyter;Malterud, K., Qualitative research: Standards, challenges, and guidelines (2001) Lancet, 358, pp. 483-488Merton, R.K., (1970) Sociologia: Teoria e estrutura, , São Paulo: Mestre Jou;Rojas-Soriano, R., Manual de pesquisa social (2004) Petrópolis: Editora, , Vozes;Contandriopoulos, A.P., Champagne, F., Potvin, L., Denis, J.-L., Boyle, P., Saber preparar uma pesquisa: Definição, estrutura, financiamento (1994) São Paulo: Editora, , Hucitec;Fossey, E., Harvey, C., McDermott, F., Davidson, L., Understanding and evaluating qualitative research (2002) Aust N Z J Psychiatry, 36, pp. 717-732Minayo, M.C.S., O desafio do conhecimento - pesquisa qualitativa em saúde (1993) São Paulo: Editora, , Hucitec;Turato, E.R., Tratado da metodologia da pesquisa clínico-qualitativa (2003) Petrópolis: Editora, , Vozes;Sandelowsky, M., Sample size in qualitative research (1995) Res Nurs Health, 18, pp. 179-183Patton, M.Q., (1991) Qualitative evaluation and research methods, , 2nd Ed. Newbury Park: Sage Publications;Loyola Filho, A.I., Lima-Costa, M.F., Uchoa, E., Bambuí Projetct: A qualitative approach to self-medication (2004) Cad Saúde Pública, 20, pp. 1661-1669Goulart, L.M.H.F., Somarriba, M.G., Xavier, C.C., A perspectiva das mães sobre o óbito infantil: Uma investigação além dos números (2005) Cad Saúde Pública, 21, pp. 715-723Pope, C., Mays, N., Pesquisa qualitativa na atenção à saúde (2005) Porto Alegre: Artmed Editora, , 2a EdBrandão, H.H.N., Introdução à análise do discurso (2004) Campinas: Editora da, , 2a Ed, Unicamp;Sapir, E., (1968) Anthropologie, , Paris: Minuit;Freud S. The dynamics of transference. In: The standard edition of the complete psychological works of Sigmund Freud. v. 12. London: Hogarth Press1958. p. 97-108Sena SP. A representação social dos acidentes escolares por educadores em escola de primeira a quarta série do ensino fundamental, Belo Horizonte [Dissertação de Mestrado]. Belo Horizonte: Faculdade de Medicina, Universidade Federal de Minas Gerais2006Bion WR. Elements of psycho-analysis. London: Maresfield Library1989Moreira, A.S.P., Representações sociais: Teoria e prática (2001) João Pessoa: Editora, , Universitária;Bourdieu, P., Chamboredon, J.-C., Passeron, J.-C., A profissão de sociólogo: Preliminares epistemológicas (1999) Petrópolis: Editora, , Vozes