The silence in absent and mute words: A psychoanalytical listening

Muitas mudanças foram observadas na clínica psicanalítica desde a sua origem. Uma importante evolução teórica e técnica pode ser atribuída ao papel do silêncio, não sendo apenas compreendido como um fenômeno da resistência, mas também como um valoroso recurso de manejo clínico. Trata-se da necessidade de reconhecer a função do silêncio do terapeuta e do paciente na especificidade da escuta proposta pela Psicanálise. Com o objetivo de investigar a compreensão do silêncio e suas possibilidades de manejo pelo olhar de terapeutas que utilizam o referencial psicanalítico em sua prática clínica, foi utilizado o método qualitativo exploratório. Na coleta de dados, foi realizada uma entrevista semiestruturada com quatro psicólogos de orientação psicanalítica com, no mínimo, dez anos de experiência clínica. Os dados coletados foram analisados qualitativamente por meio da Análise de Conteúdo, resultando em duas categorias: (i) conjunturas sobre a compreensão do silêncio na clínica psicanalítica; (ii) o manejo do silêncio na clínica psicanalítica — possibilidades de uma escuta. Os resultados proporcionaram uma rica discussão sobre o silêncio, ressaltando sua importância na clínica psicanalítica atual e a relevância de compreendê-lo em sua diversidade. Destaca-se a manifestação do silêncio por meio das palavras mudas, que são passíveis de elaboração e interpretação e do silêncio vazio, que se dá na ausência de palavras e na necessidade de sua construção. Não foram observados critérios enrijecidos no manejo do silêncio. O rigor técnico de um manejo flexível e adequado se desenvolve a partir da singularidade da dupla terapêutica e envolve, de maneira concomitante, preservar o silêncio e, também, interrompê-lo.Palavras-chave: silêncio, escuta psicanalítica, clínica contemporânea.Many changes have been observed in the psychoanalytical clinic since its origin. One important theoretical and technical evolution may be assigned to the role of silence, understood not only as a resistance phenomenon, but also as a valuable resource of clinical management. It is about the need for recognizing the purpose of therapists’ and patients’ silences in the specificity of listening as proposed by Psychoanalysis. Aiming to investigate the comprehension of silence and possibilities of management through the gaze of therapists who use psychoanalysis in their clinical practice, we used an exploratory qualitative method. In the data collection, we performed semi- structured interviews with four psychologists of psychanalytical orientation, with at least ten years of clinical experience. The gathered data were analyzed with Content Analysis, resulting in two categories: (i) Junctures on understanding silence in the psychoanalytical clinic; (ii) Managing silence in the psychoanalytical clinic — possibilities of listening. The results provided a rich discussion on silence, highlighting its importance in the current psychoanalytical clinic, and the relevance of understanding its diversity. We emphasize the manifestation of silence through mute words, which are susceptible of elaboration and interpretation, and of empty silence, which happens in the absence of words and in the need for their construction. We did not observe rigid criteria in silence management. The technical rigor of a flexible and appropriate management starts on the singularity of the therapeutic duo, and it involves, concurrently, the preservation and also the interruption of silence.Keywords: silence, psychoanalytical listening, contemporary clinic

Proceedings of the 8th Annual Conference on the Science of Dissemination and Implementation

A1 Introduction to the 8(th) Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers, Lisa Simpson D1 Discussion forum: Population health D&I research Felicia Hill-Briggs D2 Discussion forum: Global health D&I research Gila Neta, Cynthia Vinson D3 Discussion forum: Precision medicine and D&I research David Chambers S1 Predictors of community therapists’ use of therapy techniques in a large public mental health system Rinad Beidas, Steven Marcus, Gregory Aarons, Kimberly Hoagwood, Sonja Schoenwald, Arthur Evans, Matthew Hurford, Ronnie Rubin, Trevor Hadley, Frances Barg, Lucia Walsh, Danielle Adams, David Mandell S2 Implementing brief cognitive behavioral therapy (CBT) in primary care: Clinicians' experiences from the field Lindsey Martin, Joseph Mignogna, Juliette Mott, Natalie Hundt, Michael Kauth, Mark Kunik, Aanand Naik, Jeffrey Cully S3 Clinician competence: Natural variation, factors affecting, and effect on patient outcomes Alan McGuire, Dominique White, Tom Bartholomew, John McGrew, Lauren Luther, Angie Rollins, Michelle Salyers S4 Exploring the multifaceted nature of sustainability in community-based prevention: A mixed-method approach Brittany Cooper, Angie Funaiole S5 Theory informed behavioral health integration in primary care: Mixed methods evaluation of the implementation of routine depression and alcohol screening and assessment Julie Richards, Amy Lee, Gwen Lapham, Ryan Caldeiro, Paula Lozano, Tory Gildred, Carol Achtmeyer, Evette Ludman, Megan Addis, Larry Marx, Katharine Bradley S6 Enhancing the evidence for specialty mental health probation through a hybrid efficacy and implementation study Tonya VanDeinse, Amy Blank Wilson, Burgin Stacey, Byron Powell, Alicia Bunger, Gary Cuddeback S7 Personalizing evidence-based child mental health care within a fiscally mandated policy reform Miya Barnett, Nicole Stadnick, Lauren Brookman-Frazee, Anna Lau S8 Leveraging an existing resource for technical assistance: Community-based supervisors in public mental health Shannon Dorsey, Michael Pullmann S9 SBIRT implementation for adolescents in urban federally qualified health centers: Implementation outcomes Shannon Mitchell, Robert Schwartz, Arethusa Kirk, Kristi Dusek, Marla Oros, Colleen Hosler, Jan Gryczynski, Carolina Barbosa, Laura Dunlap, David Lounsbury, Kevin O'Grady, Barry Brown S10 PANEL: Tailoring Implementation Strategies to Context - Expert recommendations for tailoring strategies to context Laura Damschroder, Thomas Waltz, Byron Powell S11 PANEL: Tailoring Implementation Strategies to Context - Extreme facilitation: Helping challenged healthcare settings implement complex programs Mona Ritchie S12 PANEL: Tailoring Implementation Strategies to Context - Using menu-based choice tasks to obtain expert recommendations for implementing three high-priority practices in the VA Thomas Waltz S13 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Siri, rate my therapist: Using technology to automate fidelity ratings of motivational interviewing David Atkins, Zac E. Imel, Bo Xiao, Doğan Can, Panayiotis Georgiou, Shrikanth Narayanan S14 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Identifying indicators of implementation quality for computer-based ratings Cady Berkel, Carlos Gallo, Irwin Sandler, C. Hendricks Brown, Sharlene Wolchik, Anne Marie Mauricio S15 PANEL: The Use of Technology to Improve Efficient Monitoring of Implementation of Evidence-based Programs - Improving implementation of behavioral interventions by monitoring emotion in spoken speech Carlos Gallo, C. Hendricks Brown, Sanjay Mehrotra S16 Scorecards and dashboards to assure data quality of health management information system (HMIS) using R Dharmendra Chandurkar, Siddhartha Bora, Arup Das, Anand Tripathi, Niranjan Saggurti, Anita Raj S17 A big data approach for discovering and implementing patient safety insights Eric Hughes, Brian Jacobs, Eric Kirkendall S18 Improving the efficacy of a depression registry for use in a collaborative care model Danielle Loeb, Katy Trinkley, Michael Yang, Andrew Sprowell, Donald Nease S19 Measurement feedback systems as a strategy to support implementation of measurement-based care in behavioral health Aaron Lyon, Cara Lewis, Meredith Boyd, Abigail Melvin, Semret Nicodimos, Freda Liu, Nathanial Jungbluth S20 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Common loop assay: Methods of supporting learning collaboratives Allen Flynn S21 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Innovating audit and feedback using message tailoring models for learning health systems Zach Landis-Lewis S22 PANEL: Implementation Science and Learning Health Systems: Intersections and Commonalities - Implementation science and learning health systems: Connecting the dots Anne Sales S23 Facilitation activities of Critical Access Hospitals during TeamSTEPPS implementation Jure Baloh, Marcia Ward, Xi Zhu S24 Organizational and social context of federally qualified health centers and variation in maternal depression outcomes Ian Bennett, Jurgen Unutzer, Johnny Mao, Enola Proctor, Mindy Vredevoogd, Ya-Fen Chan, Nathaniel Williams, Phillip Green S25 Decision support to enhance treatment of hospitalized smokers: A randomized trial Steven Bernstein, June-Marie Rosner, Michelle DeWitt, Jeanette Tetrault, James Dziura, Allen Hsiao, Scott Sussman, Patrick O’Connor, Benjamin Toll S26 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A patient-centered approach to successful community transition after catastrophic injury Michael Jones, Julie Gassaway S27 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - Conducting PCOR to integrate mental health and cancer screening services in primary care Jonathan Tobin S28 PANEL: Developing Sustainable Strategies for the Implementation of Patient-Centered Care across Diverse US Healthcare Systems - A comparative effectiveness trial of optimal patient-centered care for US trauma care systems Douglas Zatzick S29 Preferences for in-person communication among patients in a multi-center randomized study of in-person versus telephone communication of genetic test results for cancer susceptibility Angela R Bradbury, Linda Patrick-Miller, Brian Egleston, Olufunmilayo I Olopade, Michael J Hall, Mary B Daly, Linda Fleisher, Generosa Grana, Pamela Ganschow, Dominique Fetzer, Amanda Brandt, Dana Farengo-Clark, Andrea Forman, Rikki S Gaber, Cassandra Gulden, Janice Horte, Jessica Long, Rachelle Lorenz Chambers, Terra Lucas, Shreshtha Madaan, Kristin Mattie, Danielle McKenna, Susan Montgomery, Sarah Nielsen, Jacquelyn Powers, Kim Rainey, Christina Rybak, Michelle Savage, Christina Seelaus, Jessica Stoll, Jill Stopfer, Shirley Yao and Susan Domchek S30 Working towards de-implementation: A mixed methods study in breast cancer surveillance care Erin Hahn, Corrine Munoz-Plaza, Jianjin Wang, Jazmine Garcia Delgadillo, Brian Mittman Michael Gould S31Integrating evidence-based practices for increasing cancer screenings in safety-net primary care systems: A multiple case study using the consolidated framework for implementation research Shuting (Lily) Liang, Michelle C. Kegler, Megan Cotter, Emily Phillips, April Hermstad, Rentonia Morton, Derrick Beasley, Jeremy Martinez, Kara Riehman S32 Observations from implementing an mHealth intervention in an FQHC David Gustafson, Lisa Marsch, Louise Mares, Andrew Quanbeck, Fiona McTavish, Helene McDowell, Randall Brown, Chantelle Thomas, Joseph Glass, Joseph Isham, Dhavan Shah S33 A multicomponent intervention to improve primary care provider adherence to chronic opioid therapy guidelines and reduce opioid misuse: A cluster randomized controlled trial protocol Jane Liebschutz, Karen Lasser S34 Implementing collaborative care for substance use disorders in primary care: Preliminary findings from the summit study Katherine Watkins, Allison Ober, Sarah Hunter, Karen Lamp, Brett Ewing S35 Sustaining a task-shifting strategy for blood pressure control in Ghana: A stakeholder analysis Juliet Iwelunmor, Joyce Gyamfi, Sarah Blackstone, Nana Kofi Quakyi, Jacob Plange-Rhule, Gbenga Ogedegbe S36 Contextual adaptation of the consolidated framework for implementation research (CFIR) in a tobacco cessation study in Vietnam Pritika Kumar, Nancy Van Devanter, Nam Nguyen, Linh Nguyen, Trang Nguyen, Nguyet Phuong, Donna Shelley S37 Evidence check: A knowledge brokering approach to systematic reviews for policy Sian Rudge S38 Using Evidence Synthesis to Strengthen Complex Health Systems in Low- and Middle-Income Countries Etienne Langlois S39 Does it matter: timeliness or accuracy of results? The choice of rapid reviews or systematic reviews to inform decision-making Andrea Tricco S40 Evaluation of the veterans choice program using lean six sigma at a VA medical center to identify benefits and overcome obstacles Sherry Ball, Anne Lambert-Kerzner, Christine Sulc, Carol Simmons, Jeneen Shell-Boyd, Taryn Oestreich, Ashley O'Connor, Emily Neely, Marina McCreight, Amy Labebue, Doreen DiFiore, Diana Brostow, P. Michael Ho, David Aron S41 The influence of local context on multi-stakeholder alliance quality improvement activities: A multiple case study Jillian Harvey, Megan McHugh, Dennis Scanlon S42 Increasing physical activity in early care and education: Sustainability via active garden education (SAGE) Rebecca Lee, Erica Soltero, Nathan Parker, Lorna McNeill, Tracey Ledoux S43 Marking a decade of policy implementation: The successes and continuing challenges of a provincial school food and nutrition policy in Canada Jessie-Lee McIsaac, Kate MacLeod, Nicole Ata, Sherry Jarvis, Sara Kirk S44 Use of research evidence among state legislators who prioritize mental health and substance abuse issues Jonathan Purtle, Elizabeth Dodson, Ross Brownson S45 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 1 designs Brian Mittman, Geoffrey Curran S46 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 2 designs Geoffrey Curran S47 PANEL: Effectiveness-Implementation Hybrid Designs: Clarifications, Refinements, and Additional Guidance Based on a Systematic Review and Reports from the Field - Hybrid type 3 designs Jeffrey Pyne S48 Linking team level implementation leadership and implementation climate to individual level attitudes, behaviors, and implementation outcomes Gregory Aarons, Mark Ehrhart, Elisa Torres S49 Pinpointing the specific elements of local context that matter most to implementation outcomes: Findings from qualitative comparative analysis in the RE-inspire study of VA acute stroke care Edward Miech S50 The GO score: A new context-sensitive instrument to measure group organization level for providing and improving care Edward Miech S51 A research network approach for boosting implementation and improvement Kathleen Stevens, I.S.R.N. Steering Council S52 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - The value of qualitative methods in implementation research Alison Hamilton S53 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Learning evaluation: The role of qualitative methods in dissemination and implementation research Deborah Cohen S54 PANEL: Qualitative methods in D&I Research: Value, rigor and challenge - Qualitative methods in D&I research Deborah Padgett S55 PANEL: Maps & models: The promise of network science for clinical D&I - Hospital network of sharing patients with acute and chronic diseases in California Alexandra Morshed S56 PANEL: Maps & models: The promise of network science for clinical D&I - The use of social network analysis to identify dissemination targets and enhance D&I research study recruitment for pre-exposure prophylaxis for HIV (PrEP) among men who have sex with men Rupa Patel S57 PANEL: Maps & models: The promise of network science for clinical D&I - Network and organizational factors related to the adoption of patient navigation services among rural breast cancer care providers Beth Prusaczyk S58 A theory of de-implementation based on the theory of healthcare professionals’ behavior and intention (THPBI) and the becker model of unlearning David C. Aron, Divya Gupta, Sherry Ball S59 Observation of registered dietitian nutritionist-patient encounters by dietetic interns highlights low awareness and implementation of evidence-based nutrition practice guidelines Rosa Hand, Jenica Abram, Taylor Wolfram S60 Program sustainability action planning: Building capacity for program sustainability using the program sustainability assessment tool Molly Hastings, Sarah Moreland-Russell S61 A review of D&I study designs in published study protocols Rachel Tabak, Alex Ramsey, Ana Baumann, Emily Kryzer, Katherine Montgomery, Ericka Lewis, Margaret Padek, Byron Powell, Ross Brownson S62 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Model simulation techniques to estimate the cost of implementing foundational public health services Cezar Brian Mamaril, Glen Mays, Keith Branham, Lava Timsina S63 PANEL: Geographic variation in the implementation of public health services: Economic, organizational, and network determinants - Inter-organizational network effects on the implementation of public health services Glen Mays, Rachel Hogg S64 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Implementation fidelity, coalition functioning, and community prevention system transformation using communities that care Abigail Fagan, Valerie Shapiro, Eric Brown S65 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Expanding capacity for implementation of communities that care at scale using a web-based, video-assisted training system Kevin Haggerty, David Hawkins S66 PANEL: Building capacity for implementation and dissemination of the communities that care prevention system at scale to promote evidence-based practices in behavioral health - Effects of communities that care on reducing youth behavioral health problems Sabrina Oesterle, David Hawkins, Richard Catalano S68 When interventions end: the dynamics of intervention de-adoption and replacement Virginia McKay, M. Margaret Dolcini, Lee Hoffer S69 Results from next-d: can a disease specific health plan reduce incident diabetes development among a national sample of working-age adults with pre-diabetes? Tannaz Moin, Jinnan Li, O. Kenrik Duru, Susan Ettner, Norman Turk, Charles Chan, Abigail Keckhafer, Robert Luchs, Sam Ho, Carol Mangione S70 Implementing smoking cessation interventions in primary care settings (STOP): using the interactive systems framework Peter Selby, Laurie Zawertailo, Nadia Minian, Dolly Balliunas, Rosa Dragonetti, Sarwar Hussain, Julia Lecce S71 Testing the Getting To Outcomes implementation support intervention in prevention-oriented, community-based settings Matthew Chinman, Joie Acosta, Patricia Ebener, Patrick S Malone, Mary Slaughter S72 Examining the reach of a multi-component farmers’ market implementation approach among low-income consumers in an urban context Darcy Freedman, Susan Flocke, Eunlye Lee, Kristen Matlack, Erika Trapl, Punam Ohri-Vachaspati, Morgan Taggart, Elaine Borawski S73 Increasing implementation of evidence-based health promotion practices at large workplaces: The CEOs Challenge Amanda Parrish, Jeffrey Harris, Marlana Kohn, Kristen Hammerback, Becca McMillan, Peggy Hannon S74 A qualitative assessment of barriers to nutrition promotion and obesity prevention in childcare Taren Swindle, Geoffrey Curran, Leanne Whiteside-Mansell, Wendy Ward S75 Documenting institutionalization of a health communication intervention in African American churches Cheryl Holt, Sheri Lou Santos, Erin Tagai, Mary Ann Scheirer, Roxanne Carter, Janice Bowie, Muhiuddin Haider, Jimmie Slade, Min Qi Wang S76 Reduction in hospital utilization by underserved patients through use of a community-medical home Andrew Masica, Gerald Ogola, Candice Berryman, Kathleen Richter S77 Sustainability of evidence-based lay health advisor programs in African American communities: A mixed methods investigation of the National Witness Project Rachel Shelton, Lina Jandorf, Deborah Erwin S78 Predicting the long-term uninsured population and analyzing their gaps in physical access to healthcare in South Carolina Khoa Truong S79 Using an evidence-based parenting intervention in churches to prevent behavioral problems among Filipino youth: A randomized pilot study Joyce R. Javier, Dean Coffey, Sheree M. Schrager, Lawrence Palinkas, Jeanne Miranda S80 Sustainability of elementary school-based health centers in three health-disparate southern communities Veda Johnson, Valerie Hutcherson, Ruth Ellis S81 Childhood obesity prevention partnership in Louisville: creative opportunities to engage families in a multifaceted approach to obesity prevention Anna Kharmats, Sandra Marshall-King, Monica LaPradd, Fannie Fonseca-Becker S82 Improvements in cervical cancer prevention found after implementation of evidence-based Latina prevention care management program Deanna Kepka, Julia Bodson, Echo Warner, Brynn Fowler S83 The OneFlorida data trust: Achieving health equity through research & training capacity building Elizabeth Shenkman, William Hogan, Folakami Odedina, Jessica De Leon, Monica Hooper, Olveen Carrasquillo, Renee Reams, Myra Hurt, Steven Smith, Jose Szapocznik, David Nelson, Prabir Mandal S84 Disseminating and sustaining medical-legal partnerships: Shared value and social return on investment James Teufe

A travessia do si mesmo na passagem para a reserva: enlaces entre trabalho e narcisismo

O caráter central do trabalho para a vida humana remete à lógica capitalista em que se vive atualmente, visto que a atividade profissional é um dos requisitos para a participação do homem nos processos produtivos de uma sociedade. Além de prover o sustento, a vida laboral desempenha uma função que permite ao sujeito configurar e reconfigurar a percepção da realidade externa e do si mesmo por meio da dinâmica integração social que o trabalho possibilita. Nesse contexto, é inegável que o rompimento com a atividade profissional decorrente da aposentadoria se configure como uma vivência de grande impacto psíquico. Esta dissertação de mestrado tem o objetivo de realizar uma reflexão a respeito do papel do trabalho na dinâmica e na economia psíquicas, bem como busca explorar as especificidades do processo de aposentadoria no contexto militar. Foram elaboradas duas seções acerca dessa temática: uma teórica e uma empírica. Na seção teórica propõe-se uma leitura sobre os sentidos e significados contemporâneos da vida laboral, considerando sua função narcísica para o psiquismo humano. Com base em aportes teóricos da Psicanálise, busca-se uma compreensão do trabalho como importante recurso no processo de construção da subjetividade, e também para o desenvolvimento cultural da sociedade. A seção empírica, mediante a utilização de uma metodologia qualitativa, investiga as peculiaridades do trabalho e da passagem para a reserva, no âmbito da vida militar. Foram realizadas entrevistas semiestruturadas com 13 militares aposentados por tempo de serviço no ano de 2008.Os achados neste estudo foram analisados e discutidos por meio da Análise de Conteúdo. Identificaram-se três categorias finais, assim nomeadas: O trabalho e a vida militar: singulares enlaces entre narcisismo e ideais; Demandas psíquicas frente ao rompimento com a atividade de trabalho; O recurso da escuta na pesquisa desvelando a reserva do sujeito. Dessa forma, viabilizou-se investigar a maneira pela qual a vida militar e o trabalho encontram-se entrelaçados aos processos identificatórios do sujeito. Constatou-se a busca de atribuição de sentido, por parte dos militares, para a experiência de afastamento do serviço ativo, bem como a tentativa de compensar frustrações advindas desse processo. A escuta na pesquisa revelou-se como um recurso promotor de manifestações de singulares reservas humanas a partir dos relatos sobre as experiências no trabalho e no espaço privado dos participantes.The central character of labor to human life refers to a capitalist logic which we are living nowadays, as the professional activity is one of the requisites to man’s participation in the productive processes of society. Besides providing a living, the labor life has a function which allows to oneself to configure and reconfigure the perception of the external reality and the self through the dynamical social integration that labor enables. In this context, it is undeniable that the rupture with the professional activity caused by retirement configures itself as an experience of great psychic impact. This master’s dissertation aims to make a reflection about the labor role in the psychic dynamics and economy, as well as intends to explore the specificities from the retirement process in the military context. This dissertation has two sections: a theoretical and an empirical one. The theoretical section proposes a lecture about the contemporary meanings and senses of labor life considering its narcissist function to the human psyche. From psychoanalytical theoretical contributions, it is proposed an understanding of labor as an important resource in the process of subjectivity construction and also to the cultural development of society. The empirical section with qualitative methodology investigates labor’s peculiarities and moving to reservation as part of military life. Thirteen retired military officers for length of service in 2008 were interviewed in a semistructured one. The outcomes of this study were analyzed and discussed from Analysis of Content. Three final categories were identified and named as: Labor and Military life: unique links among ideals and narcissism; Psychic demands facing the rupture with labor activity; The resource of listening in the research revealing the reservation of the individual.Thus, feasible to investigate the way which how military life and labor are linked in the identification process of someone. It was found the search to attribute sense about the experience of separation from active service, as well as the attempting to compensate some frustration originally from this process. Listening in the research was revealed as promoting resource of manifestations of unique human reserve from the reports about the labor experiences and the private space of the participants

Nuances do traum?tico e desdobramentos ps?quicos no exerc?cio do cuidado em cat?strofes

Submitted by Caroline Xavier ([email protected]) on 2017-07-06T17:59:11Z No. of bitstreams: 1 TES_PAULA_KEGLER_PARCIAL.pdf: 4490825 bytes, checksum: 76f33b1ce97a6121281912f528f39216 (MD5)Made available in DSpace on 2017-07-06T17:59:11Z (GMT). No. of bitstreams: 1 TES_PAULA_KEGLER_PARCIAL.pdf: 4490825 bytes, checksum: 76f33b1ce97a6121281912f528f39216 (MD5) Previous issue date: 2017-06-08Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESThe growing responsibility of Brazilian soldiers regarding care of people struck by catastrophes reinforces the need to extend attention to these professionals. This study aimed to investigate, from the ramifications which exist in this modality of work, elements related to trauma and their deployment on subjects. This thesis is organized in three Sections: a theoretical and two empirical ones. The first Section, Narratives of excess: the potential of words in Psychoanalysis, discusses the function of words in the necessary drive connection of psychic work. On reviewing the formation of Psychic apparatus and conditions of representability, we have approached the possibilities of metabolism of exceeding psychic intensities. Before the devastating death drive domain, there is the obstacle of (im)possible narratives. Words, with their articulation and elaboration potentials, are perceived as a possible way to restrain and to historicize lived contents. The subjects? active position makes it possible to break with Thanatos predominance of repetition. The narrative experiences transform, therefore, into vital resistance before what is harmful regarding drive unrepresentativeness. The second Section, From protocol to the unexpected: subject of affection: exercising care during catastrophes, investigates the narratives of ten health care soldiers in order to unveil the meanings and the effects of their working experiences. We have explored elements related to health care professionals? particularities and psychic conditions of processing what has been experienced in a job marked by devastation. From the interviews, analyzed with Interpretative Analysis (Erikson, 1997), we have built three assertions: Demands of affection before de (un)predictable in catastrophes; The inscription of Others into the Self: the foreigner paradox in care practice; Institutional obstacles facing ?a posteriori?: disavowal and legitimation. The interviews allowed us to access unpredictable tensioning following interventions guided by care. The identified obstacles on others? and self?s effective care practice have alluded to institutional barriers which impede and/or make it difficult for the affective processing which usually follows professional action. On the third Section, The 'a posteriori' in times of research in Psychoanalysis: narrative and hospitality, we have worked with contents built along the development of a narrative research (Creswell, 2014) before offering protection to the subjects? narratives about themselves. In the interviews, it was shown that soldiers experience meanings in both tragedy and research contexts. Knowledge production was ?a posteriori?: in participants? narratives about what has been already experienced, and in hospitality conditions to these narratives. This ?a posteriori? convergence of narrative and hospitality opened access to particular changes of working in catastrophes, and unveiled new phenomenon facets produced in and by research. Psychoanalysis has given theoretical support to the investigative modalities which guided the three Sections of this Thesis. It was possible, in this epistemological mark, to give priority to elements of subjectivity itself when a real devastation setting can, dangerously, make the attention to working professionals succumb.A crescente responsabilidade dos militares brasileiros no cuidado ?s popula??es atingidas por cat?strofes consolida a necessidade de estender o olhar a esses profissionais. Este estudo objetivou investigar, a partir das complexidades presentes nessa modalidade de trabalho, elementos relativos ao traum?tico e seus desdobramentos no sujeito ps?quico. Esta Tese est? organizada em tr?s Se??es, sendo uma te?rica e duas emp?ricas. A primeira Se??o, intitulada Narrativas do excesso: a potencialidade da palavra em Psican?lise, problematizou a fun??o da palavra no necess?rio trabalho ps?quico de liga??o pulsional. Na revis?o sobre o processo de constitui??o do aparelho ps?quico e as condi??es de representabilidade, foram abordadas as possibilidades de metaboliza??o de excessivas intensidades ps?quicas. Frente ao dom?nio devastador da puls?o de morte, tem-se o impasse de (im)poss?veis narrativas. A palavra, tanto em seu potencial enunciador como elaborativo, se mostra como uma via poss?vel de conten??o e historiza??o do vivido. A posi??o ativa do sujeito enunciador possibilita (re)compor enlaces e produzir caminhos associativos que rompem com o predom?nio tan?tico da repeti??o. As experi?ncias narrativas se transformam, portanto, em resist?ncia vital frente ao danoso da irrepresentabilidade pulsional. A segunda Se??o, nomeada Do protocolo ao imprevisto: o sujeito de afeta??o no exerc?cio do cuidado em cat?strofes, investigou narrativas de dez militares da ?rea da sa?de, a fim de desvelar os sentidos e o efeito de suas experi?ncias laborais. Foram explorados elementos relacionados a singularidade do profissional do cuidado e ?s condi??es ps?quicas de tramita??o do vivido no trabalho marcado pela devasta??o. A partir das entrevistas, analisadas por meio da An?lise lnterpretativa (Erikson, 1997), foram constru?das tr?s Asser??es: Demandas ? afeta??o no trabalho frente ao (im)previsto em cat?strofes; A inscri??o do Outro no Eu: o paradoxo do estrangeiro no exerc?cio do cuidado; Os impasses institucionais frente ao a posteriori: desmentido e legitima??o. As entrevistas oportunizaram acessar imprevis?veis tensionamentos decorrentes de interven??es orientadas pelo cuidado. Os impasses identificados na efetiva pr?tica de cuidado ao outro e a si pr?prio aludem a barreiras institucionais que impedem e/ou dificultam os tr?mites afetivos decorrentes da a??o profissional. Na terceira Se??o, denominada O a posteriori nos tempos da pesquisa em Psican?lise: narrativa e hospitalidade, foram trabalhados os conte?dos que se constru?ram no desenvolvimento de uma pesquisa narrativa (Creswell, 2014) frente a oferta de acolhimento a narrativa do sujeito sobre si. Nas entrevistas apareceram os significados da experi?ncia dos militares no contexto da trag?dia, e, tamb?m, no contexto da pesquisa. A produ??o de conhecimento deu-se no a posteriori de dois tempos: na narrativa do participante sobre o j? vivido e nas condi??es de hospitalidade a essa narrativa. O encontro a posteriori entre narrativa e hospitalidade permitiu o acesso a singulares vicissitudes do trabalho em cat?strofes e desvelou novas facetas do fen?meno produzidas na e pela pesquisa. A Psican?lise deu sustenta??o te?rica ?s modalidades investigativas que orientaram as tr?s Se??es desta Tese. Foi poss?vel, nesse marco epistemol?gico, dar primazia aos elementos pr?prios a subjetividade quando um cen?rio de devasta??o real pode, perigosamente, fazer sucumbir o olhar ao sujeito trabalhador

Síndrome de Munchausen by proxy: definición, contextualización y factores psíquicos involucrados

The Munchausen syndrome by proxy refers to a pathology characterized by physical and emotional abuse in which the simulation or production of symptoms is directed towards a child, which involves taking him or her to health treatments and unnecessary surgeries. The difficulties in the diagnosis of this form of abuse and the emotional aspects involved highlight the destructive effects in the infancy subjectivity due to the lack of loving capacity protecting and prioritizing the child demands. Psychoanalysis offers a differentiated view, comprehending that the mother attempts to elaborate her own psychic conflicts by the repetition of traumatic experience. There is a necessity of comprehension of the instinct destructivity presented in the maternal unconscious dynamics revealed in the modality of caring which is reflected in violenceEl Síndrome de Munchausen by proxy se refiere a una patología caracterizada por el abuso físico o emocional, en donde la simulación o producción de síntomas es direccionada al hijo, llevando a tratamientos de salud y cirugías innecesarios. Las dificultades diagnósticas de este tipo de abuso y los aspectos emocionales implicados llaman atención por los efectos destructivos en la subjetividad infantil, fruto de una falla en la capacidad de amar, proteger y priorizar las demandas del hijo. El Psicoanálisis ofrece una mirada que retrata un intento de elaboración de los propios conflictos psíquicos por la vía de la repetición de vivencias traumáticas. Así, se percibe la necesidad de una comprensión de la destrucción pulsional presente en la dinámica inconsciente materna revelada por esta modalidad de cuidado que se traduce en violenci

Sentimentos e percepções da equipe de saúde frente ao paciente terminal

O atendimento a pacientes terminais pelas equipes de saúde, comprovadamente apontado por evidências na literatura, mostra a grande dificuldade que esses profissionais têm em lidar com o tema "morte". O presente estudo objetivou compreender como as equipes de saúde definem e vivenciam o paciente terminal. Para tanto, utilizou-se uma abordagem qualitativa que empregou a pesquisa etnográfica através de observação não-participativa, além de entrevistas semi-estruturadas nas unidades de hemato-oncologia e de infectologia de um hospital público. Os resultados certificaram as dificuldades por parte da equipe em lidar com pacientes terminais, bem como em defini-los como tais e comunicar aos mesmos a sua condição. Dessa forma, percebeu-se a intensa necessidade da realização de um trabalho direto com as equipes de saúde com o intuito de lhes proporcionar um espaço de reflexão e de entendimento, propiciando a continência das emoções suscitadas na equipe de saúde perante a situação da morte

Síndrome de Munchausen by proxy: definición, contextualización y factores psíquicos involucrados

El Síndrome de Munchausen by proxy se refiere a una patología caracterizada por el abuso físico o emocional, en donde la simulación o producción de síntomas es direccionada al hijo, llevando a tratamientos de salud y cirugías innecesarios. Las dificultades diagnósticas de este tipo de abuso y los aspectos emocionales implicados llaman atención por los efectos destructivos en la subjetividad infantil, fruto de una falla en la capacidad de amar, proteger y priorizar las demandas del hijo. El Psicoanálisis ofrece una mirada que retrata un intento de elaboración de los propios conflictos psíquicos por la vía de la repetición de vivencias traumáticas. Así, se percibe la necesidad de una comprensión de la destrucción pulsional presente en la dinámica inconsciente materna revelada por esta modalidad de cuidado que se traduce en violencia

Síndrome de Munchausen by proxy: definición, contextualización y factores psíquicos involucrados

The Munchausen syndrome by proxy refers to a pathology characterized by physical and emotional abuse in which the simulation or production of symptoms is directed towards a child, which involves taking him or her to health treatments and unnecessary surgeries. The difficulties in the diagnosis of this form of abuse and the emotional aspects involved highlight the destructive effects in the infancy subjectivity due to the lack of loving capacity protecting and prioritizing the child demands. Psychoanalysis offers a differentiated view, comprehending that the mother attempts to elaborate her own psychic conflicts by the repetition of traumatic experience. There is a necessity of comprehension of the instinct destructivity presented in the maternal unconscious dynamics revealed in the modality of caring which is reflected in violence.El Síndrome de Munchausen by proxy se refiere a una patología caracterizada por el abuso físico o emocional, en donde la simulación o producción de síntomas es direccionada al hijo, llevando a tratamientos de salud y cirugías innecesarios. Las dificultades diagnósticas de este tipo de abuso y los aspectos emocionales implicados llaman atención por los efectos destructivos en la subjetividad infantil, fruto de una falla en la capacidad de amar, proteger y priorizar las demandas del hijo. El Psicoanálisis ofrece una mirada que retrata un intento de elaboración de los propios conflictos psíquicos por la vía de la repetición de vivencias traumáticas. Así, se percibe la necesidad de una comprensión de la destrucción pulsional presente en la dinámica inconsciente materna revelada por esta modalidad de cuidado que se traduce en violencia