Made available in DSpace on 2016-08-03T16:34:47Z (GMT). No. of bitstreams: 1 Isabel Cristina Mal.pdf: 1230942 bytes, checksum: 559ed4faab30555f3a2230e2f3edf27f (MD5) Previous issue date: 2009-04-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The Morbid Obesity and Bariatric Surgery clinic demands long term studies and applicant follow-up. The risks and benefits of surgically induced weight loss must serve as a warning beacon for health professionals. The interview usage within the psychology service is a guideline for the psychological therapy. Objectives: 1) Describe the social and demographical profile of the obese patients, applying for the bariatric surgery. 2) Analyze the patients perception about personality characteristics associated with obesity and feeding disorders. 3) Describe the psychodynamic contents of the subject s speech and evaluate the unconscious strain system of two patients, through the Phillipson s Object Relations Test (ORT). Method: methodological planning with data analysis through the epidemiological method and clinical case study, from a psychoanalytical orientation. At the first stage, 300 protocols from the psychological service were consulted and at the second stage, two patients with weight gain were followed after 24 months. They are patients who sought treatment at a specialized health center located in a Brazilian southeastern metropolis, under post-informed consent. The protocols were filled by 227 women and 73 men; average age around 36 years old; 53% of them with college and secondary education; most of them married; BMI between severe and super morbid (94,3%). Appointed surgical techniques Capella Bypass and Fobi- Capella (67%). Results: psychological characteristics mentioned by the patients; anxiety appeared in 93,7% of the answers, followed by hastiness, nervousness, depression, tolerance to frustration, low self-esteem, concern, problem solver (more than 50%). Family history of obesity is present in more than 70%. Depression and alcohol abuse in 30%; psychotherapy attendance (30%) and depression / anxiety control medication (10%). In the second stage, the psychodynamic diagnosis, using the Phillipson s Object Relations Test with two patients, whose analysis showed a need for psychoanalytic sychotherapy, because they had fixations on the schizo-paranoid position and displayed difficulty in dealing with losses and low motivation for change and insight. Conclusions: with the interview superposing and the empyrical observations registration, this semi directed interview script brings better conditions to assess and evaluate the contents disclosed by the patients. The contradictions between the answers and the speech, in the individual contact with the psychologist, point that an investment in preparing the patient for the surgery is needed, and, more acutely, the psychological follow-up in the first post-operatory year. There is a magical thought to be working through during the questionnaire application about beliefs toward the surgery and the weight loss and so invite the patient to fullfil the place of the subject implied in the pre and post operatory process. The Phillipson s ORT contributed to a better understanding of mental functioning of obese patients with weight gain after surgery.(AU) / A clínica da Obesidade Mórbida e a Cirurgia Bariátrica exige estudos e acompanhamentos do paciente. Os benefícios e riscos do emagrecimento por tratamento cirúrgico devem servir como ponto de alerta aos profissionais da saúde. O uso do questionário no serviço de psicologia é norteado pela escuta psicológica. Objetivos: 1) Descrever o perfil sócio-demográfico candidatos à cirurgia bariátrica. 2) Analisar a percepção dos pacientes sobre características de personalidade associadas à obesidade e transtornos alimentares. 3) Descrever os conteúdos psicodinâmicos da narrativa do sujeito e avaliar o sistema tensional inconsciente de dois pacientes por meio do Teste das Relações Objetais de Phillipson (TRO). Método: O delineamento metodológico com análise de dados pelo método epidemiológico e estudo de caso clínico, orientação psicanalítica. Na primeira etapa foram consultados 300 questionários do serviço de psicologia e na segunda dois pacientes com ganho de peso após 24 meses. São pacientes que procuraram tratamento em clínica especializada, em uma metrópole do sudeste brasileiro, sob consentimento pós-informado. Os questionários foram preenchidos por 227 mulheres e 73 homens; com média de idade igual a 36 anos; escolaridade ensino médio e superior, 53%; maioria casados; IMC entre grave e super mórbido (94,3%). Técnicas cirúrgicas indicadas Capella Bypass e Fobi-Capella (67%). Resultados: características psicológicas referidas pelos pacientes, a ansiedade apontou em 93,7% das respostas, seguidas por impulsividade, depressão, tolerância à frustração, baixa auto-estima, resolvedor de problemas dos outros (mais de 50%). No histórico familiar da obesidade está em mais de 70% depressão e uso do álcool em 30%; realização de psicoterapia (30%) e medicamentos para depressão e ansiedade (10%). Na segunda etapa, foi realizado o diagnóstico psicodinâmico, por meio do Teste das Relações Objetais de Phillipson com duas pacientes, cuja análise indicou necessidade de psicoterapia psicanalítica, pois tinham fixações na posição esquizoparanóide e apresentavam dificuldade em lidar com perdas e baixa motivação para mudança e insigth. Conclusões: Com a aplicação do questionário e o registro das observações empíricas, este questionário de entrevista semidirigida preenche condições de melhor acessar e avaliar os conteúdos revelados pelos pacientes. As contradições entre as respostas e o discurso, no contato individual com o psicólogo, apontam a necessidade de investimento no preparo do paciente para a cirurgia e mais acentuadamente o acompanhamento psicológico no primeiro ano do pós-operatório. Há um pensamento mágico a ser trabalhado durante a aplicação do questionário sobre as crenças frente à cirurgia e o emagrecimento e assim convocar o paciente a ocupar o lugar do sujeito implicado em seu processo pré e pós-operatório. O TRO contribuiu na compreensão do diagnóstico psicodinâmico de pacientes com ganho de peso após cirurgia e reforçou a necessidade de maior investimento no pré-operatório.(AU)

This dissertation reports on the lived experiences of four child psychiatric nurses. The territory of child psychiatric nursing is explored in this investigation through the punctuation of many voices within this field of study. The methodology of the investigation is descriptive phenomenology and Colaizzis’ steps in descriptive phenomenology (map) are used to discover and describe the different template theories (the territory) that are unique to each of the four child psychiatric nurses who were interviewed. Following this, a story is punctuated, which is referred to as the structural synthesis. It is the heartbeat of the investigation. The dissertation concludes by reflecting on the paradox of how the invisibility of the child psychiatric nurses allowed for the visibility of the dissertation and encourages the reader to ask pivotal questions about the important role of the child psychiatric nurse, working as part of a multidisciplinary team, in order to improve patient care. / Psychology / M.A. (Clinical psychology)

This descriptive research addressed the challenges of working with the conscious and unconscious aspects of diversity in order to enhance insights into covert and deeper diversity dynamics in organisations. The research supported the evolving trend of shifting the systems psychodynamic orientation from the group to the individual context. The general aim was to describe a systems psychodynamic coaching model, and to determine its trustworthiness in assisting executives to work effectively with conscious and unconscious diversity dynamics. Literature was reviewed to provide a theoretical foundation of diversity challenges which executives face in South African organisations. This was augmented by systems psychodynamic literature, which provided a theoretical basis upon which to understand the intrapsychic aspects of the executives and their interplay with systemic dynamics. The empirical study was conducted over ten months to determine the trustworthiness of executive coaching in diversity from a systems psychodynamic perspective. Data was gathered using the organisational role analysis approach, and analysed by means of the systems psychodynamic discourse analysis method. Nine major themes and their related sub-themes were identified, namely, gender, race, ethnicity, authority, disability, language, age, de-authorisation of diversity work, and the coaching process. Through the coaching, the executives gained insights into their intrapsychic environment and the complex, multifaceted and intersecting nature of diversity in their organisations. They were assisted to take up their leadership roles more effectively and to take action on behalf of their organisations. The research hypothesis formulated and the conclusion made was that executive coaching from a systems psychodynamic perspective displays trustworthiness. / Industrial and Organisational Psychology / D. Litt. et Phil. (Consulting Psychology)

Consulting to the RIDE from a systems psychodynamic stance is different from other group relations training events. Consultants found it difficult to take up their roles as consultants and containers. They were not prepared for the impact of the island on the event and especially on themselves as consultants. The consultants had to work harder to contain their own feelings and anxieties in order to take up their roles. The symbolically laden setting of the RIDE predetermined that the diversities of race and gender were worked with while other diversities were largely ignored. During the RIDE, the consultants felt more anxious, fearful and inhibited. The consultants had to provide containment for the event as a whole, for the group and their fellow consultants as well as for themselves. The consultants found that they had never experienced a more enriching experience than they did with the RIDE. / Industrial and Organisational Psychology / M.Com. (Industrial and Organisational Psychology)

This study explored the Object Relations of a sample of 45 subjects who were using alcohol and were diagnosed with co-morbid Depressive or Bipolar disorders and/or Personality disorders. All subjects were receiving treatment at a government psychiatric hospital in South Africa. The similarities and differences in the Object Relations of these individuals were identified. A biographical questionnaire, the Alcohol Use Disorder Test (AUDIT), which was used as a screening measure, and the Bells Object Relations and Reality Testing Inventory (BORRTI) were administered to obtain information from a purposive sample. Descriptive and inferential statistics were used to analyse the results of the assessment measures. Analysis of the BORRTI data indicated a high rate of depressive and personality disorders within this sample. Results of the sub-sample (n=29) whose scores were included in the Pearson’s Correlation Coefficient analysis indicate that higher levels of alcohol consumption result in increased levels of hallucinations and delusions. Other correlations were identified between high levels of alcohol consumption and heightened levels of reality distortions and more uncertainty in the perceptions of these individuals. Significant differences in the scores of the male and female participants were identified. With the female participants, the higher the level of alcohol consumption, the lower the individuals scored in terms of pathological levels of egocentricity, uncertain perceptions, insecure attachments, alienation, social incompetence as well as hallucinations and delusions. Alternatively, in the male sample, higher levels of alcohol consumption result in increased hallucinations and delusions, reality distortions, uncertainty in perceptions, alienation, social incompetence and egocentricity. / Psychology / M.A. (Research Psychology)

The objective of the study was to observe the quality of the object-relations in maltreated and institutionalized boys and girls, assessed with the Rorschach inkblots and the Mutuality of AutonomyScale (MOA) of Urist. The participants were 23 children of both sexes, aged 8 to 10,who had been maltreated in their household and were institutionalized in an orphanage. The results showed that both tools reflect object-relations well. There are significant differences, depending on the sex, time of Separation from their maternal figure and the type of maltreatment they received. Furthermore, the children represent more adaptative, conventional and positive object relations what is related with their resources. / El objetivo fue conocer cómo es la calidad de las relaciones objetales en Jos niños y niñas institucionalizados, que han sido objeto de algún tipo de maltrato, a través del Psicodiagnóstico de Rorschach (Exner) y de la Escala de Mutualidad de Autonomía (MOA) de Urist. Los participantesfueron 23 niños de ambos sexos, entre 8 y 1 O años que habían recibido maltrato en su entorno familiar. El grupo de estudio provino de los niños institucionalizados que se encuentran internados en un puericultorio, pertenecientes a un sector socio económico bajo. Los resultados mostraron que ambos instrumentos reflejan la calidad de las relaciones objetales de manera adecuada. Asimismo, existen diferencias significativas de acuerdo al sexo, momento de separación de la figura materna y tipo de maltrato recibido. Por otro lado, los menores de nuestro estudio logran representarse relaciones más adaptativas, convencionales y positivas que nos ligancon sus recursos.

Der Einfluss frühkindlicher Beziehungsangebote der Primärobjekte, besonders aber der Mutter, auf die Entwicklung des Selbst und seiner Beziehungen gilt als gesichert. Die Zusammenhänge des späteren, episodisch erinnerbaren Erziehungsverhaltens der Eltern mit der weitere Ausreifung der psychodynamischen Strukturkomponenten ist allerdings weniger untersucht und findet eher in der Persönlichkeits- und Erziehungsstilforschung statt. An diesem Punkt setzt die vorliegende Arbeit an, die versucht eine Integration des psychodynamischen Konstrukts in eine erziehungspsychologische Befragung zur Aufklärung der weiteren Ausdifferenzierung der Struktur in der späteren Kindheit vorzunehmen. Dafür wurden neben der Messung des generellen Strukturniveaus und den Subskalen des Selbst und der Objektbeziehungen des OPD-Strukturfragebogens vier Skalen zur retrospektiven Erhebung des elterlichen Erziehungsverhaltens verwendet. Diese waren die drei inhaltlichen Skalen des Fragebogens zu erinnertem elterlichen Erziehungsverhalten (Wärme, Kontrolle & Überbehütung, Ablehnung & Strafe) sowie eine angepasste Version der formalen Dimension der Inkonsistenz des Erziehungsstil-Inventars. Die Befragung wurde online an insgesamt N = 98 Probanden durchgeführt. Es konnten dabei signifikant korrelative Zusammenhänge zwischen ungünstigem Erziehungsverhalten und niedrigerer struktureller Integrität für alle Skalen aufgezeigt werden. Die Skala Ablehnung & Strafe zeigte dabei einen verstärkten Zusammenhang mit den selbstregulativen Fähigkeiten. Eine regressionsanalytische Vorhersage des Strukturniveaus aus den Erziehungsdimensionen wies einen starken Effekt (f² = 0,70) bei einer Varianzaufklärung von R²korr = 0,37 auf. Mütterliche und väterliche Erziehung unterschieden sich dabei kaum in ihrem prädiktiven Vorhersagewert, die mütterlichen Dimensionen Wärme sowie Kontrolle & Überbehütung wiesen aber signifikant höhere Mittelwerte auf, was als ein Unterschied in der Intensität der Beziehung gewertet wird. Mütterliche Wärme wies dabei, wie hypothetisch angenommen, im Vergleich zu allen anderen Dimensionen die signifikant höchsten Werte auf. Um diesen Zusammenhang zwischen erinnerbarem elterlichen Erziehungsverhaltens und der strukturellen Integrität allerdings von Einflüssen in der Frühkindheit kausal klar zu trennen, wären umfangreiche Verlaufsstudien nötig, die in größeren Rahmen möglichst breit konzipierte dynamische Wechselwirkungen innerhalb der Familie aufdecken.

This case study based on a fieldwork carried out in a Day-Care Center tries to describe the process of the transition from mothering to wider society which is represented by a classroom of preschool children. Within this process we can note and describe specific ways of parent's, teacher's and especially children's actions. These activities are repeatedly produced. The point of departure is the Hirschfeld's article "Why Don't Anthropologists like Children?" (Hirschfeld, 2002) and his affirmation that children are active participants within process of accepting of social regulations and values and that they create their own culture, "children culture". This study ilustrates that the process of the transition from mothering to wider society is in the first place the process of the separation of child and mother. Within this process we note the function of the "object transitional" that compensate the absence of mother. And we can also observe how the group of pupils is formed and how their group identity is created. This group is situated in a specific place and time. And we observe that all individual actions concerning child are "embodied"- it's because we talk about an "experience that involve the whole person, including the body" (Abu-Lughold, Lutz, 1990 cit. in Ben-Ari, 1998: 138).

The aim of the diploma thesis "Maternal Identification in Anorexia Nervosa" is to map the developmental context of the onset of anorexia nervosa in female patients related with the formation of relationships with immediate caregivers and the detailed focus on the daughter's relationship with the mother. The theoretical part offers a cross-section of psychoanalytic theories that specifically deal with such process. These are mainly the object relations theory, the attachment theory as well as the recent theory of mentalization. The initial premise of the whole work is the femininity itself, the age of the patients when the period of adolescence and female gender are amongst the main risk factors for the development of anorexia nervosa and contribute to the disproportion between male and female patients. The concept of identification between daughter and mother within the separation-individuation process is described both in early childhood and during adolescence. The empirical part focuses on a particular examination of the patient's relationships with primary caregivers, the immediate environment from childhood to adulthood and the factors involved in the development of the disease. Through a semi-structured in-depth interview, the study monitors key moments of psychosocial development in four...

Der Einfluss frühkindlicher Beziehungsangebote der Primärobjekte, besonders aber der Mutter, auf die Entwicklung des Selbst und seiner Beziehungen gilt als gesichert. Die Zusammenhänge des späteren, episodisch erinnerbaren Erziehungsverhaltens der Eltern mit der weitere Ausreifung der psychodynamischen Strukturkomponenten ist allerdings weniger untersucht und findet eher in der Persönlichkeits- und Erziehungsstilforschung statt. An diesem Punkt setzt die vorliegende Arbeit an, die versucht eine Integration des psychodynamischen Konstrukts in eine erziehungspsychologische Befragung zur Aufklärung der weiteren Ausdifferenzierung der Struktur in der späteren Kindheit vorzunehmen. Dafür wurden neben der Messung des generellen Strukturniveaus und den Subskalen des Selbst und der Objektbeziehungen des OPD-Strukturfragebogens vier Skalen zur retrospektiven Erhebung des elterlichen Erziehungsverhaltens verwendet. Diese waren die drei inhaltlichen Skalen des Fragebogens zu erinnertem elterlichen Erziehungsverhalten (Wärme, Kontrolle & Überbehütung, Ablehnung & Strafe) sowie eine angepasste Version der formalen Dimension der Inkonsistenz des Erziehungsstil-Inventars. Die Befragung wurde online an insgesamt N = 98 Probanden durchgeführt. Es konnten dabei signifikant korrelative Zusammenhänge zwischen ungünstigem Erziehungsverhalten und niedrigerer struktureller Integrität für alle Skalen aufgezeigt werden. Die Skala Ablehnung & Strafe zeigte dabei einen verstärkten Zusammenhang mit den selbstregulativen Fähigkeiten. Eine regressionsanalytische Vorhersage des Strukturniveaus aus den Erziehungsdimensionen wies einen starken Effekt (f² = 0,70) bei einer Varianzaufklärung von R²korr = 0,37 auf. Mütterliche und väterliche Erziehung unterschieden sich dabei kaum in ihrem prädiktiven Vorhersagewert, die mütterlichen Dimensionen Wärme sowie Kontrolle & Überbehütung wiesen aber signifikant höhere Mittelwerte auf, was als ein Unterschied in der Intensität der Beziehung gewertet wird. Mütterliche Wärme wies dabei, wie hypothetisch angenommen, im Vergleich zu allen anderen Dimensionen die signifikant höchsten Werte auf. Um diesen Zusammenhang zwischen erinnerbarem elterlichen Erziehungsverhaltens und der strukturellen Integrität allerdings von Einflüssen in der Frühkindheit kausal klar zu trennen, wären umfangreiche Verlaufsstudien nötig, die in größeren Rahmen möglichst breit konzipierte dynamische Wechselwirkungen innerhalb der Familie aufdecken.:Inhaltsverzeichnis Tabellenverzeichnis Abkürzungsverzeichnis Zusammenfassung 1. Einleitung 2. Die psychische Struktur 2.1 Psychodynamisches Verständnis des Strukturbegriffs und Operationalisierung nach OPD-2 2.2 Dynamischer Entwicklungsprozess der Struktur 3. Erziehung 3.1 Dimensionen von Erziehung und deren Einfluss auf die Entwicklung 3.2 Die Rolle des Vaters 4. Fragestellungen und Hypothesen 5. Methodik 5.1 Fragebogeninstrumente 5.1.1 Erinnertes elterliches Erziehungsverhalten 5.1.2 Psychodynamische Struktur 5.2 Stichprobenbeschreibung und Vorgehen 5.3 Statistische Analyse 6. Ergebnisse 7. Diskussion 7.1 Bedeutung und Einordnung der Ergebnisse 7.2 Grenzen der Studie 7.3 Fazit und Ausblick 8. Literaturverzeichnis 9. Anhang 10. Selbstständigkeitserklärung