O presente estudo visa investigar a supervisão psicanalítica da ludoterapia de crianças que sofreram trauma e abandono, a partir da contribuição dos processos de transferência e contratransferência. Faz um estudo das relações transferenciais e contratransferenciais percebidas de forma mais destacada nas supervisões, utilizando como principal embasamento teórico, a literatura baseada na psicanálise inglesa, principalmente as concepções Kleinianas e pós-Kleinianas, partindo do pensamento de Freud, cujas formulações originaram e serviram de ponto de partida para os desenvolvimentos da teoria e da técnica psicanalítica. Ao discutir o trauma, o abandono, a ludoterapia e a supervisão psicanalítica, nesses contextos, utiliza-se, também, de elaborações teóricas de autores, como Anne Alvarez e contemporâneos, os quais tiveram grande interlocução com as teorias de Melanie Klein, e também conhecimentos provenientes de estudos e pesquisas de outras áreas que são compatíveis com esta orientação. Como material clínico, faz uso de transcrições de sessões de supervisão nas quais estão incluídas as transcrições de sessões feitas pelos psicoterapeutas para a supervisão. Para a análise do material, adota a postura investigativa própria da situação de supervisão psicanalítica sobre o que acontece nas relações paciente/supervisionando e supervisionando/supervisor. Conclui que o trauma e o abandono provocam perturbações e desorganizações psíquicas nas crianças que os sofrem, que são percebidas e vivenciadas de forma específica na sua relação com seu psicoterapeuta e na situação de supervisão. As dificuldades apresentadas na ludoterapia de crianças traumatizadas e abandonadas na instituição - as angústias mobilizadas pela realidade física e emocional delas, a transmissão dos sentimentos negativos do trauma e do abandono e convites à atuação e ao abandono do lugar de psicólogo e supervisor fazem parte da avalanche de sentimentos perturbadores, transferenciais e contratransferenciais, que envolvem psicólogos e supervisores no trabalho clínico com as crianças traumatizadas. / This study investigates the psychoanalytical supervision of the play therapy with children of have suffered trauma and abandonment, taking into account the transference and the countertransference processes in the supervision of these psychotherapeutic processes, in the view of the English psychoanalysis, in special of Melanie Klein and her followers. The discussion of the concepts of trauma and abandonment, and of the psychoanalytical supervision of play therapy in these contexts, considered also several authors who have great affinity with Kleins ideas, such as Anne Alvarez, as well as researches in other fields that were compatible with the same theoretical approach. The clinical material analysed was based in the transcriptions of the play therapy sessions with the children, brought by their psychotherapists to supervision. For this analysis it was adopted an investigative approach compatible with the psychoanalytical supervision, focussing in the relationship patient/psychotherapist, and in the relationship psychotherapist/supervisor. The investigation concluded that trauma and abandonment can cause psychological disorders in the children that were exposed to them, and these experiences have also specific influences in the child/psychotherapist relationship as well as in the psychotherapists supervision. The difficulties presented in the play therapy of traumatized and abandoned children living in a public institution, as well as the anguishes that their physical and emotional reality mobilized in their environment and in the psychotherapist, the transmission of the negative feelings related to their traumatic experiences and, the constant challenges to have acting-outs and to leave the role of psychotherapist and of supervisor, are all important elements in the transference and countertransference of the emotional disorder, that psychotherapist and supervisor have to face in their clinical work.

Inledning: Sigmund Freud omnämner 1912 för första gången i publicerad form det psykoanalytiska lyssnandets princip med begreppet Jämnt svävande uppmärksamhet (JSU) (1912/2002). Begreppet har frekvent refererats till i publikationer om psykoanalys och psykoterapi sedan Freud myntade det.  Syfte: Syftet med föreliggande studie är att ge innebörd åt och förstå mer om Freuds begrepp och hur psykodynamiska psykoterapeuter med utgångspunkt i Freuds grundregel lyssnar kliniskt idag.  Metod: Genom intervjuer med fem psykoterapeuter söks begreppets kliniska relevans och tillämpbarhet. Intervjuerna analyseras enligt en kombinerad deduktiv och induktiv Tematisk analys.  Resultat: Resultatet visar att jämnt svävande uppmärksamt lyssnande utgörs av en historiserande positionering i förhållande till berättelsen. Lyssnande som läsning utgörs av uppmärksamhet efter semantiska och vokaliserande aspekter av mänskliga erfarenheter bortom språk och begrepp. Lyssnandet i samtalets form karaktäriseras av med-lyssnande.  Diskussion: Analysen visar terapeuternas uppfattning av tillämpbarheten av JSU med hänsyn till begreppets referensvärde. Terapeuternas förståelse av och syn på dess kliniska relevans diskuteras utifrån tillgängliga forskningsresultat från studier av empatisk förståelse och kliniskt lyssnande inom psykoterapi. / Introduction: In 1912, Sigmund Freud first mentions in published form the principle of psychoanalytic listening with the concept ofEvenly Hovering Attention(EHA) (1912/2002). The term has been frequently referenced in publications on psychoanalysis and psychotherapy since Freud coined it.  Research questions: The purpose of this study is to give meaning to and understand more about Freud's concepts and how psychodynamic psychotherapists, based on Freud's groundrule, listen clinically today.  Method:Through interviews with five psychotherapists the clinical relevance and applicableness of the concept is sought. The interviews are analyzed according to a combined deductive and inductive Thematic Analysis.  Results:The results show that evenly hovering attentive listening consists of a historizing positioning in relation to thestory. Listening as readingconsists of attention aftervocalizing aspects of human experiences beyond language. Listening in the form of conversationis characterized by co-listening.  Discussion:The analysis shows the therapists' perception of the applicableness of EHAtaking into account the reference value of the term. The therapists' view of its clinical relevance is discussed based on available research results from studies of empathetic understanding and clinical listening in psychotherapy.

[pt] Os estados-limite têm feito parte da literatura psicanalítica desde os primórdios da psicanálise. A partir da última metade do século passado, entretanto, o interesse pelo assunto aumentou consideravelmente e a produção de artigos e matérias vem tomando um vulto cada vez maior. Não obstante, a polêmica em torno do tema parece também crescer na mesma proporção. Este trabalho apresenta um pequeno histórico do termo estados- limite e algumas controvérsias nos diferentes meios psicanalíticos, principalmente no que diz respeito às relações entre a clínica dos estados-limite e a das personalidades narcísicas. São tratadas também questões ligadas à constituição da subjetividade e à sua incidência na clínica dos estados-limite. Finalmente, são revistas algumas patologias limítrofes e alguns aspectos clínicos importantes, como as implicações transferenciais e contratransferenciais dos estados-limite. A preferência pelo termo estados-limite tem por objetivo ampliar o escopo que outros termos, tais como casos-limite, ou distúrbios limítrofes, possam sugerir. Enquanto que estes últimos possuem conotações marcantemente patológicas, pertencendo, portanto a uma clínica psicanalítica específica, o termo estados-limite permite também designar situações com características semelhantes, porém episódicas e suscetíveis de ocorrer em qualquer tipo de clínica psicanalítica, inclusive a da neurose. / [en] Borderline conditions have been part of psychoanalytical literature since the early stages of psychoanalysis. However, since the second half of the last century, interest in this subject has grown considerably and there has been a steady increase in the number of articles and essays published. Nevertheless, polemic around this theme seems also to grow in the same proportion. This work covers a brief history of the term borderline and some of the controversies in the different psychoanalytical environments, principally as to the relationship between the borderline treatment and that of narcissistic personalities. Issues regarding the constitution of subjectivity and its incidence in the borderline therapy are also dealt with. Finally, some forms of borderline pathology and important clinical aspects, such as transference and counter transference implications, are reviewed. The preference for the term borderline conditions aims to broaden the scope that other terms, such as borderline cases or borderline disturbances may suggest. While these latter possess strong pathological connotations, belonging, therefore, to a specific psychoanalytical treatment, the term borderline conditions allows for the designation of situations with similar characteristics, although episodic and liable to occur in any type of psychoanalytical treatment, including the neurotic.

[pt] Trauma e regressão são dois conceitos que sempre suscitaram debates e mesmo controvérsias em Psicanálise. No decorrer da presente tese, procuramos analisar o desenvolvimento de ambos nas teorizações de Freud e de alguns dos principais teóricos das relações objetais precoces, dentre os quais destacam-se Donald Winnicott e Michael Balint, que, na esteira das mudanças operadas na teoria e na técnica analíticas por Sàndor Ferenczi, ampliaram de forma original o escopo teórico em torno de determinados fenômenos clínicos que implicam em formas singulares de sofrimento subjetivo. Neste sentido, buscamos articular nossa reflexão com alguns outros conceitos fundamentais propostos por esses autores; mais especificamente, os conceitos de amor primário e falha básica em Balint, e os de holding e fenômenos transicionais em Winnicott. A partir daí, sustentamos que o pensamento teórico-clínico baseado no modelo relacional tem possibilitado uma melhor apreensão dos processos determinantes da constituição psíquica e das diferentes formas de subjetivação e elaboração do trauma, nas quais a compreensão da situação analítica como campo comum inconsciente passa a ser relevante para o processo terapêutico. / [en] Trauma and regression are concepts that have always raised some debate and controversy in Psychoanalysis. Throughout the present thesis, the development of both will be analyzed in Freud s theories and also in some of the main authors on the early object relations, among which Donald Winnicott and Michael Balint stand out for improving the changes made in the analysis theory and techniques developed by Sàndor Ferenczi. The two enlarged in an inventive way the theoretical scope around certain clinical phenomena that bring about unique subject suffering. In this line of thought, this paper aims to associate some reflection to other fundamental concepts proposed by these authors; more specifically, the concepts of primary love and of basic fault in Balint, and those of holding and transitional phenomena in Winnicott. On this ground, it can be concluded that the clinical-theoretical thinking based on the relational model has enabled a better apprehension of the processes which are essential in the psychic constitution and in the various ways to take power over and elaborate on trauma, in which understanding of the analytical situation, as an unconscious common ground turns out to be relevant for the therapeutical process.

This research incorporates a heuristic method of inquiry to reflect on the researcher’s response to clients with substance abuse. The research investigates if countertransference with this population comes off as empathy (taking in the perspective of the clients) or pity (feeling sorry for clients). Data was collected over a structured 6-week period through the researcher’s self-reflective process of creating art in responses to client artwork made during her practicum experience. Research is solely based on the researcher’s personal response to a select few clients and the resulting artwork and reflective writing. Four themes were initially extrapolated from immediate reflections, which were combined to form a more central understanding of the researcher’s countertransference. Through this process of investigation, the researcher addresses and challenged personal biases, stereotypes, and assumptions about this population to better understand the meaning of her countertransference.

During apartheid numerous atrocities, including torture were committed by the security forces in South Africa. Most atrocities were directed at black people, during the political violence. The question which the researcher investigated was how people who worked in the police and had tortured and committed other atrocities re-established meaning and identity after South Africa became a democracy. South Africa’s history was discussed, focussing on factors which created an environment which was conducive to the committing of atrocities. The basic tenets of social constructionism were considered and how they relate to concepts such as agency, power, essentialism, identity, morality, meaning-making, torture, illness and posttraumatic stress disorder. Dialogic analyses were conducted on each participant’s narrative. The researcher is seen as an integral part of the storytelling event. The ways in which the participants positioned themselves in telling their stories are discussed as attempts to reconstitute themselves. The impact on the researcher of working with perpetrators is discussed. Themes were distilled from participants’ narratives. These are discussed with attention given to the problems they identified as having led to perpetration, such as racism, enacting of masculinity and militarisation. Problems they identified which arose as a result of perpetration include aggression, alienation, illness and addiction to violence. They demonstrated extreme shame and remorse in telling their stories. / Psychology / D.Litt. et Phil. (Psychology)

Au cours du siècle dernier, des améliorations au niveau des conditions de vie ainsi que des avancées importantes dans les sciences biomédicales ont permis de repousser les frontières de la vie. Jusqu’au début du XXe Siècle, la mort était un processus relativement bref, survenant à la suite de maladies infectieuses et avait lieu à la maison. À présent, elle survient plutôt après une longue bataille contre des maladies incurables et des afflictions diverses liées à la vieillesse et a le plus souvent lieu à l’hôpital. Pour comprendre la souffrance du malade d’aujourd’hui et l’aborder, il faut comprendre ce qu’engendre comme ressenti ce nouveau contexte de fin de vie autant pour le patient que pour le clinicien qui en prend soin. Cette thèse se veut ainsi une étude exploratoire et critique des enjeux psychologiques relatifs à cette mort contemporaine avec un intérêt premier pour l’optimisation du soulagement de la souffrance existentielle du patient dans ce contexte. D’abord, je m’intéresserai à la souffrance du patient. À travers un examen critique des écrits, une définition précise et opérationnelle, comportant des critères distinctifs, de ce qu’est la souffrance existentielle en fin de vie sera proposée. Je poserai ainsi l’hypothèse que la souffrance peut être définie comme une forme de construction de l’esprit s’articulant autour de trois concepts : intégrité, altérité et temporalité. D’abord, intégrité au sens où initialement l’individu malade se sent menacé dans sa personne (relation à soi). Ensuite, altérité au sens où la perception de ses conditions extérieures a un impact sur la détresse ressentie (relation à l’Autre). Et finalement, temporalité au sens où l’individu souffrant de façon existentielle semble bien souvent piégé dans un espace-temps particulier (relation au temps). Ensuite, je m’intéresserai à la souffrance du soignant. Dans le contexte d’une condition terminale, il arrive que des interventions lourdes (p. ex. : sédation palliative profonde, interventions invasives) soient discutées et même proposées par un soignant. Je ferai ressortir diverses sources de souffrance propres au soignant et générées par son contact avec le patient (exemples de sources de souffrance : idéal malmené, valeurs personnelles, sentiment d’impuissance, réactions de transfert et de contre-transfert, identification au patient, angoisse de mort). Ensuite, je mettrai en lumière comment ces dites sources de souffrance peuvent constituer des barrières à l’approche de la souffrance du patient, notamment par l’influence possible sur l’approche thérapeutique choisie. On constatera ainsi que la souffrance d’un soignant contribue par moment à mettre en place des mesures visant davantage à l’apaiser lui-même au détriment de son patient. En dernier lieu, j'élaborerai sur la façon dont la rencontre entre un soignant et un patient peut devenir un espace privilégié afin d'aborder la souffrance. J'émettrai certaines suggestions afin d'améliorer les soins de fin de vie par un accompagnement parvenant à mettre la technologie médicale au service de la compassion tout en maintenant la singularité de l'expérience du patient. Pour le soignant, ceci nécessitera une amélioration de sa formation, une prise de conscience de ses propres souffrances et une compréhension de ses limites à soulager l'Autre. / Until the beginning of the 20th century, death was a relatively brief process occurring in the home, most often resulting from diverse infectious diseases. Nowadays, death predominantly occurs inside institutions, after a long battle with an incurable disease or due to the multiple debilities of aging. To understand and address patients' suffering at their end-of-life today, we must better grasp what this new type of death engenders in terms of emotional experience as much for the patient as for the clinician taking care of him. This thesis is an exploratory and analytical study of the psychological issues related to contemporary death with a prime interest for the optimization of existential suffering relief in this context. First, I will focus on the patient's suffering. Through an analytic review of the literature, I will propose a precise and operational definition of existential suffering in the end-of-life context, with some distinctive features. I will propose the hypothesis that suffering can be defined as a construction of the mind. This hypothesis will be articulated around the idea that existential suffering stems from three sources: integrity, otherness, and temporality. First, integrity in the sense that the patient initially feels threatened in his own person (relation to the self). Then, otherness in the sense that the perception of his external conditions has an impact on his distress (relation to the Other). And finally, temporality in the sense that the patient suffering existentially often seems trapped in a specific time frame (relation to time). After, I will focus on the clinician's suffering. In the end-of-life context, high-stake interventions such as palliative sedation or invasive treatments are sometimes brought up or even proposed by a clinician. I will describe many sources of suffering affecting the clinician and generated by his contact with the patient (examples of clinician's sources of suffering: damaged ideals, personal values, sense of failure, transference and countertransference reactions, identification processes, death anguish). Then, I will illustrate how these sources of suffering can constitute barriers to addressing the patient's suffering by influencing the choice of therapeutic approaches. Through this exercise we will discover that the clinician's suffering sometimes causes him to initiate interventions aimed at relieving his own distress at the expense of his patient. Finally, I will elaborate on how the encounter between a patient and a clinician can become a privileged context to address suffering. I will suggest ways of improving end-of-life care by providing a context of care that manages to put biotechnology in the service of compassion and by maintaining the singularity of the patient's experience. For the clinician, this will require an improvement of his training, an acknowledgement of his own sources of suffering and an understanding of his limits to help others.

Migration, exil, déportation, transplantation, exode, expatriation, autant de mots pour qualifier le départ d’un pays. Autant les sciences sociales se sont attachées à comprendre la migration sous toutes ses formes depuis longtemps, autant la psychologie « de la migration » n’en est qu’à ses débuts. Elle s’est, pour l’heure, surtout intéressée aux difficultés rencontrées par les immigrés, mais peu à l’émigré.Il est donc question dans ce travail de tenter de mettre à jour les processus psychiques, et dynamiques préalables au départ. Pour ce faire, j’ai choisi de me mettre également en situation de migration pendant le travail de la recherche, pour rencontrer, accompagner et prendre en charge des candidats aux départs, et des migrants en situation de transit. S’est révélé, au cours de ce travail, la complexité due aux emboitements des différents espaces de réalités auxquelles chaque sujet a à faire. Malgré tout, il est possible de dire que les processus migratoires se mettent en place à partir de contextes tyranniques (familiaux, sociaux) au sein desquels l'emprise et la violence sont au cœur du lien. Le prétexte économique, souvent mis au premier plan, vient symboliser la dualité dette / réparation de la dette, et semble consécutif au fantasme de meurtre qui agite le groupe familial. La migration manifeste une forme de libido d'expression épistémophilique. Elle est la mise en acte d'une quête de sens sur la jouissance de l'autre, parent, de la violence qu'il a agie en tyrannisant le groupe. La migration est métaphore, mais elle est aussi symptôme ; elle est à la fois tentative de mise en conflit par le déplacement de l’originaire aliénant, et répétition par retournement de mécanismes de rejet, d’exclusion. / Migration, exile, deportation, transplantation, exodus, expatriation are as many words to describe leaving a country. Though for a long time, social sciences have been attempting to understand all forms of migration, migration psychology is starting out. Up to now, it was interested in studying the immigrant's difficulties more than the emigrant.This study tries to update the psychic and dynamic process preliminary to departure. This is why I deliberately became a migrant during the whole research: I encountered, accompanied and took in charge prospective and transit migrants.My work enlightened on the complexity due to the diverse and intricate spaces of realities each subject has to deal with.However, migratory processes can be described as induced by oppressive contexts (in family or society) where control and violence are at the core of the bond. Economic motives are often put forward: they symbolize the duality of debt and reparation, and seem to be resulting from the murder fantasy in the family group.Migration denotes a form of libido and of epistemophilic drive. It is the actuation of a quest for the meaning of the other's (the parent's) narcissistic pleasure; it questions the violence and the control the other exerts over the group.Migration is both a metaphor and a symptom; it is the attempt to challenge and to modify the original alienation, as well as a repetition and a reversal of mechanisms of rejection and exclusion.

During apartheid numerous atrocities, including torture were committed by the security forces in South Africa. Most atrocities were directed at black people, during the political violence. The question which the researcher investigated was how people who worked in the police and had tortured and committed other atrocities re-established meaning and identity after South Africa became a democracy. South Africa’s history was discussed, focussing on factors which created an environment which was conducive to the committing of atrocities. The basic tenets of social constructionism were considered and how they relate to concepts such as agency, power, essentialism, identity, morality, meaning-making, torture, illness and posttraumatic stress disorder. Dialogic analyses were conducted on each participant’s narrative. The researcher is seen as an integral part of the storytelling event. The ways in which the participants positioned themselves in telling their stories are discussed as attempts to reconstitute themselves. The impact on the researcher of working with perpetrators is discussed. Themes were distilled from participants’ narratives. These are discussed with attention given to the problems they identified as having led to perpetration, such as racism, enacting of masculinity and militarisation. Problems they identified which arose as a result of perpetration include aggression, alienation, illness and addiction to violence. They demonstrated extreme shame and remorse in telling their stories. / Psychology / D.Litt. et Phil. (Psychology)

[pt] Inserida no campo contemporâneo da intersubjetividade, esta dissertação transita entre a metapsicologia e a técnica à procura de constructos e articulações que facilitem a comunicação com o paciente. Com este objetivo, percorre, em Freud, o afeto e a comunicação entre inconscientes; em Klein e Bion, a identificação projetiva e o processo de formação de símbolos; com Heimann e Money-Kyrle, a contratransferência; em Ferro, o conceito de campo; e de Ogden, a posição autista-contígua, a matriz da transferência, interpretação em ação e o terceiro analítico. / [en] From the contemporary context of intersubjectivity comes this research for concepts and articulations that facilitate the communication between analyst and patient. Among metapsychology and clinical technique, it focuses the affect and the direct communication between unconscious in Freud, the projective identification and the symbol formation process in Klein and Bion, the countertransference with Heimann and Money-Kyrle, the concept of analytic field in Ferro, and the autistic-contiguous position, the matrix of transference, interpretation in action and the analytic third from Ogden.