Introduction: Cardiovascular disease (CVD) risk assessment is becoming increasingly common in routine clinical practice. Consequently many individuals are likely to be identified as being at increased CVD risk and risk reducing strategies implemented with a view to preventing future CVD. There are many steps along the pathway from CVD risk assessment to the prevention of CVD events. First, CVD risk needs to be accurately estimated using an appropriate CVD risk calculator. Secondly CVD risk information needs to be effectively communicated to the individual identified as being at increased risk. Thirdly, the risk information communicated needs to be capable of motivating behaviour change and finally behaviour change needs to result in a reduction in CVD risk. The evidence base for many of these steps has yet to be fully established. Aims: The overall aims of this work were first to adapt the United Kingdom Prospective Diabetes Study (UKPDS) Risk Engine to better display risk and achievable risk. Secondly to investigate lay perceptions of risk and to develop two interventions designed to reduce CVD risk. The two interventions were a personalised 10-year CVD risk estimate and a brief lifestyle advice intervention. Finally, the capacity of these interventions to increase physical activity and improve CVD risk factors in adults at increased CVD risk was tested. Methods: Three focus groups were held to investigate lay perceptions of risk and to inform the design of the UKPDS Risk Engine interface and a brief lifestyle advice intervention designed to motivate risk reducing behaviours. The two interventions were then tested in a 2x2 factorial randomised controlled trial. Results: The focus group results demonstrated that public interest and understanding of risk was high. In addition participants expressed clear views regarding how risk information and lifestyle advice should be presented. 194 participants at increased 10-year CVD risk (≥ 20%) were recruited from 4 Oxfordshire general practices. Neither a personalised 10-year CVD risk estimate nor a brief lifestyle advice intervention was capable of increasing physical activity or reducing estimated 10-year CVD risk in this group. Conclusions: Whilst public interest in CVD risk appeared to be high this study was unable to demonstrate that a 10-year personalised CVD risk estimate or a brief lifestyle advice intervention was able to increase physical activity in adults at increased CVD risk.

Considering serious health, social and subsequently economic impacts which are rising due to the heavy alcohol consumption in the Czech Republic and the whole of Europe, the WHO proposed scientifically based tools, the aim of which is to minimize damage caused by alcohol. Health service is, therefore, highly recommended to establish Screening and brief interventions (SBI). The SBI method belongs to behavioural and cognitive-behavioural therapies. The goal is to identify people with risk or harmful alcohol consumption, to stop its usage, to diminish risks and get a motivation to seek specialized assistance. The majority of recommendations to establish SBI for risk and harmful drinking are especially aimed at primary care, mostly at doctors. Nurses with their broad competence in a lot of medical fields are left behind even though their activity including direct contact with patients involves analysing the levels of risk factors which alcohol is a part of. The purpose of the study is to clarify under which circumstances it is possible to effectively apply the SBI methodology into nursing practice in a selected Czech district, to describe the current engagement and extent of nurses' motivation to deal with alcohol prevention, to look for possibilities of SBI integration into real nursing practice and...

Gegenstand der Untersuchung ist die Patientenkorrespondenz von Samuel Hahnemann mit seiner Patientin Friederike Lutze in der Zeit von 1831 bis 1833. Anhand von Briefen und Tagesberichten werden die Symptome der Patientin, die nach gegenwärtigem Ermessen hauptsächlich psychischer Natur waren, dargelegt und analysiert. Hierbei wird versucht, die zugehörigen Medizinkonzepte und zeitgenössischen Wissensbestände herauszufiltern. Der Zeitraum der Korrespondenz stellt eine Umbruchphase in der Deutung von Gemütssymptomen dar, so dass sowohl humoralpathologische Vorstellungen, wie auch die "Vapeurs" und Nervenleiden als Konzept aufzufinden sind. Selbst die noch in den Kinderschuhen befindliche Psychologie wird von der Patientin aufgegriffen und im Rahmen des Arzt-Patientenverhältnisses thematisiert. Abgeschlossen wird die Arbeit von der Edition aller verfügbaren Krankenberichte und Briefe der Korrespondenz. / The subject of the study is the patient correspondence between Samuel Hahnemann and Friederike Lutze in the period from 1831 to 1833. On the basis of letters and daily descriptions the perceptions of the patient are shown and analysed. These symptoms were mainly of a mental or psychic nature regarding the current point of view. Hereby among others the medical concepts and contemporary knowledge are focused. The period of time, in which the correspondence took place, represents a time of change concerning the interpretation of mental sensations and perceptions. The tradition of humoral pathology as well as the "vapeurs" and the rise of the "nerves" can be found in the descriptions of the patient. Friederike Lutze even addresses the incipient discipline "psychology", it becomes an important issue in the doctor-patient relationship. The last part of the dissertation represents the transcription of the handwritings.

INTRODUÇÃO: As Estratégias de Diagnóstico e Intervenções Breves (EDIB) propostas pela Organização Mundial de Saúde são consideradas efetivas para o diagnóstico e prevenção dos agravos decorrentes do uso do álcool. Atitudes, crenças e expectativas dos profissionais de saúde em relação ao uso de álcool influenciam o efeito destas novas propostas. OBJETIVO: Este trabalho propõe a avaliação do efeito do treinamento em EDIB sobre as crenças e expectativas a respeito do uso de álcool. MÉTODOS: O estudo é do tipo observacional, transversal, comparativo, sobre uma amostra de 88 profissionais da atenção primária à saúde, provenientes de Ribeirão Preto e região, que concordaram em participar da pesquisa conforme os procedimentos éticos recomendados, treinados pelo Programa de Ações Integradas para Prevenção e Atenção ao Uso de Álcool e Drogas na Comunidade (PAIPAD) no período de 2003 a 2006. Os dados foram coletados através de questionários individuais aplicados antes do treinamento e no período de 4 a 6 meses depois. Os questionários incluíram um formulário sócio-demográfico, o Teste de Conhecimento sobre álcool e Intervenções Breves (IB), o Inventário de Expectativas e Crenças Pessoais acerca do Álcool (IECPA) e um formulário de estimativas sobre o uso do AUDIT (Alcohol Use Disorder Identification Test) e das IB. A amostra foi caracterizada quanto à prática e preparação profissional na atenção primária, papel, atitudes e crenças dos profissionais em relação aos problemas relacionados ao uso de álcool ou outras drogas pelos seus pacientes. RESULTADOS: No Teste de Conhecimento sobre álcool e Intervenções Breves, a pontuação média foi maior após o treinamento, passando de 4,1 para 5,57(Wilcoxon Test: z= -4,936; p 0,001). Os resultados médios do IECPA passaram de 93,45 pontos na fase pré para 78,74 pontos na fase pós-treinamento (Wilcoxon, z=-4,138; p 0,001). Através do teste de Spearman observou-se tendência à correlação positiva entre a aquisição de conhecimento e as variações no IECPA (p=0,095); o nível de conhecimento pré-treinamento e as estimativas de realização de EDIB(p=0,082); as estimativas de aplicação de AUDITS e o intervalo de tempo(p=0,009). As variações do IECPA se correlacionaram positivamente com as expectativas de aplicação de EDIB (Nonparametric Chi-Square: p=0,053). No Teste de Conhecimento, o nível médio (incompleto e completo) apresentou menor nível de aproveitamento que os outros níveis de escolaridade. As maiores variações no IECPA foram observadas entre os profissionais de nível de escolaridade superior (incompleto e completo). Os profissionais com ocupações de nível superior apresentaram maiores variações positivas quanto ao conhecimento que os de nível técnico, e maior redução na pontuação do IECPA. CONCLUSÕES: A estratégia de formação oferecida pelo PAIPAD foi efetiva, promovendo mudanças nas crenças e expectativas da equipe sobre uso de álcool, interferindo positivamente na conduta preventiva dos profissionais treinados junto aos pacientes. / BACKGROUND: The Strategies of Screening, Brief Intervention and Referral to Treatment (SBIRT) proposed by World Health Organization (WHO) are considered effective to perform the diagnosis and the prevention of damage caused by alcohol. Attitudes, beliefs and expectations of health professionals in relation to alcohol use have influence over the effect of these new proposals. OBJECTIVE: This study aimed at evaluating the effect of training in SBIRTs on the beliefs and expectations of professionals about the alcohol use. METHODS: The study is observational, cross-sectional and comparative, with a sample of 88 professionals of primary care, from Ribeirão Preto and region, who agreed to participate following ethical procedures, trained by Program of Integrated Action for Prevention and Attention to Alcohol and Drug Use in the Community (PAIPAD), in period from 2003 to 2006. Data were collected through individual questionnaires applied before the training and in the period from 4 to 6 months later. The questionnaires included a socio-demographic inventory, the Test of Knowledge about alcohol and brief interventions (IB), the Inventory of Positive Expectations and Beliefs about Alcohol (IECPA) and an inventory of estimates on the use of the AUDIT (Alcohol Use Disorder Identification Test) and brief interventions. The sample was characterized in relation to the practice and professional preparation in primary care, the professional role in primary care and attitudes and beliefs of professionals about problems related to alcohol or other drugs for their patients. RESULTS: In the Test of Knowledge about alcohol and brief interventions, the average score was higher after the training, increasing from 4.1 to 5.57 (Wilcoxon test: z =- 4.936, p0001). The IECPA average changed from 93.45 points to 78.74 points after intervention, in the post-training (Wilcoxon, z =- 4.138, p0001). A trend toward positive correlation between the acquisition of knowledge and changes in IECPA (p = 0,095) was found (Spearman test), as well the level of pre-training knowledge and estimates of conducting SBIRTs (p = 0,082), estimates of implementing AUDIT and the time (p = 0,009). In the Test of Knowledge, the intermediate level of schooling (complete and incomplete) showed lower score than the others. Variations of IECPA correlated positively with the expectations of applying SBIRTs (Nonparametric Chi-Square: p = 0,053). The highest changes in IECPA were seen among higher level professionals (complete and incomplete). The professionals of higher-level occupations showed bigger positive changes in knowledge than workers of technical level and higher reduction in scores of IECPA. CONCLUSIONS: The strategy of training offered by PAIPAD was effective, promoting changes in beliefs and expectations of the team about alcohol use, interfering positively in the preventive attitudes of trained professionals with the patients.

Teve-se por objetivo investigar se o tempo de exposição das informações de profundidade afeta a comparação de tamanho de objetos pictóricos. Para isso, 120 participantes distribuídos aleatoriamente em 12 grupos julgaram qual de duas barras verticais, uma a teste e outra a padrão, era maior. Usando o método dos estímulos constantes, estas barras podiam ser apresentadas simultaneamente por 50ms, 100ms ou 200ms em quatro condições de fundo de tela: (1) sem textura, (2) com apenas a linha do horizonte, (3) com o horizonte e o gradiente de linhas de compressão, e (4) com o horizonte e o gradiente de linhas de perspectiva. A inclinação das curvas psicométricas, os pontos de igualdade subjetiva (PIS) e o erro relativo foram calculados. A análise dos erros relativos indicou uma diferença significativa entre o gradiente de perspectiva e outras duas condições (controle e horizonte). Embora os tempos de exposição não tenham apresentado diferenças significativas entre si, observou-se uma maior superestimação do tamanho com apresentações de 100ms nas condições com indícios de profundidade (perspectiva e compressão). A análise das inclinações das curvas psicométricas mostrou uma maior sensibilidade dos participantes para efetuarem as comparações sob um tempo de 200ms em relação ao de 50ms, independentemente do fundo de tela. Os erros relativos maiores para a condição com linhas de perspectiva confirmam evidências de que esta é uma informação de profundidade eficiente na modulação do tamanho percebido. Além disso, é possível que essa eficiência seja maximizada nas condições em que os estímulos são expostos em torno dos 100ms. / The aim of this study was to investigate the effects of the duration of pictorial depth cue exposures on perceived sizes of stimuli. For this, 120 volunteers distributed randomly in 12 groups compared two vertical bars, one the test and other the standard, in to order to report which one was bigger. Using the method of constant stimuli, these bars could be presented simultaneously for 50, 100 or 200ms in four background conditions: (1) without depth cues, (2) with only the horizon, (3) with the horizon and compression line gradient, and (4) with the horizon and perspective line gradient. The slope of the psychometric curves, the points of subjectivity equality (PSE) and relative errors were calculated. The analysis of relative errors indicated a significant difference among the perspective gradient and other two conditions (without texture and horizon). Although exposure time had not presented significant differences among them, it was observed size overestimation during the 100ms exposure in depth cues conditions (compression and perspective). The analysis of slopes psychometric function showed a greater sensibility in the participants who made comparisons with 200ms than the ones who made with 50ms, independently of depth cue background. Pronounced relative errors in comparisons with perspective gradient tend to agree with previous studies, which demonstrate higher influence of this cue in perceived size modulation. Besides, this efficiency seems to be maximized when stimuli exposure time was 100ms.

Cette étude consiste à embrasser dans un même mouvement les différents récits courts stendhaliens. Elle s'articule en cinq temps. Les trois premiers moments consistent à analyser, séparément, les anecdotes, nouvelles et récits inachevés stendhaliens. Une fois ces différentes typologies établies, l'étude se focalise sur la notion d'énergie, dénominateur commun de l'ensemble des récits courts composés par Stendhal. Enfin, le dernier chapitre cherche à montrer aussi bien la portée que la place de ces textes hétérogènes dans le vaste ensemble de la création stendhalienne. L'un des principaux intérêts de ce travail est de réhabiliter des textes qui, pour des raisons aussi bien génériques qu'éditoriales, n'ont pas encore été l'objet d'une étude exhaustive. Notre réflexion vise également à montrer tout à la fois la permanence et l'unité du genre bref dans l'œuvre de Stendhal, malgré l'existence d'indéniables différences entre les textes. Notre étude établit également une continuité entre récits courts et récits longs, ce qui permet de mieux comprendre des phénomènes stendhaliens aussi essentiels que l'inachèvement, la réécriture ou encore l'intertextualité. / This study is to embrace in the same movement the various short stories Stendhal. It is divided into five times. The first three stages are to analyze separately the anecdotes, news stories and unfinished Stendhal. After these established typologies, the study focuses on the concept of energy, the common denominator of all short stories composed by Stendhal. The last chapter seeks to show both the extent that instead of these heterogeneous texts in the broad set of Stendhal's creation. One of the main interests of this work is to rehabilitate texts that, for reasons both generic editorial, have not yet been subject to a comprehensive study. Our thinking is also intended to show the permanence and unity of the short kind in Stendhal's work, despite the undeniable existence of differences between the texts. Our study also establishes continuity between short stories and long stories, allowing a better understanding of phenomena as essential as Stendhal incompleteness, rewriting or intertextuality.

O uso de álcool na gestação traz sérios riscos à saúde da mãe e do bebê. As prevalências do uso de risco de álcool entre gestantes encontradas em estudos nacionais giram em torno de 20%. Nos EUA, estudos sobre avaliação das intervenções breves têm mostrado uma na redução do uso de álcool em gestantes. O objetivo deste estudo foi elaborar um protocolo de intervenção breve (IB) para gestantes e avaliar sua eficácia na redução do consumo de álcool comparativamente ao recebimento de um folheto informativo sobre os riscos do uso de álcool na gestação. Foi realizado um ensaio clínico, cego, comparativo e prospectivo, com distribuição randômica das participantes em dois grupos (IB e folheto), com dois tempos de coleta de dados (T1 e T2). Foram recrutadas 86 gestantes em serviços de saúde de Ribeirão Preto e Araraquara com uso de risco de álcool utilizando o instrumento T-ACE (pontuação maior ou igual a dois). As gestantes eram maiores de 18 anos e possuíam até 16 semanas de gestação. Todas responderam a um questionário incluindo avaliação do padrão de uso de álcool e receberam IB ou um folheto informativo sobre os riscos do uso de álcool na gestação. Foram excluídas gestantes com diagnóstico prévio de dependência de álcool ou drogas, as que pontuaram acima de 20 no instrumento AUDIT, as que declararam uso, nos últimos três meses, de outras drogas, exceto tabaco e aquelas incapazes de compreender e fornecer informações aos pesquisadores. No segundo tempo da pesquisa (a partir da 25ª semana gestacional) compuseram a amostra 80 gestantes, sendo 39 do grupo folheto e 41 do grupo IB. As gestantes do grupo IB apresentaram menor média de doses consumidas e maior prevalência de abstinentes. Contudo, não foram observadas diferenças estatisticamente significativas entre os grupos em relação ao padrão de consumo de álcool. A avaliação intra-grupos também não detectou diferenças no padrão de consumo de álcool entre T1 e T2 seja para o grupo folheto ou para o grupo IB. Apesar disso, a autoavaliação das gestantes tanto no grupo folheto quanto no grupo IB sobre a mudança no comportamento de consumo de bebidas alcoólicas indicou uma diminuição estatisticamente significativa do consumo (Grupo folheto, Wilcoxon, Z=-2,74; p<0,01; r=0,31) (Grupo IB, Wilcoxon, Z=-4,43; p<0,001; r=0,49). / Alcohol use during pregnancy causes serious health risks to the mother and baby. National studies indicate prevalence around 20% of risky drinking by pregnant women. In the U.S., researches on evaluation of brief interventions have shown a reduction in alcohol consumption among pregnants. A prospective, blind and randomized clinical trial was developed to evaluate the efficacy of a brief intervention (BI) protocol in reducing alcohol use among pregnant women. Participants were randomized by opaque and sealed envelopes in two groups (IB and brochure), with two periods of data collection (T1 and T2). We recruited 86 risky drinking and pregnant women in health care services using T-ACE (score more than two points). Women were older than 18 years and had up to 16 weeks of gestation. All completed a questionnaire including evaluation of standard alcohol and received IB (IB group) or information leaflet about the risks of alcohol use during pregnancy (brochure group). We excluded women with (1) a previous diagnosis of alcohol or drugs dependence, (2) those scored above 20 points in AUDIT instrument, (3) those reported drugs use (except tobacco) in the past three months, and (4) those unable to understand and provide information to researchers. In T2 period (up 24 weeks gestation), 80 participants remained in the study (39 brochure group and 41 IB group). IB group presented a lower average doses consumed and a higher prevalence of abstinent. However, there were no statistically significant differences between the groups in relation to the pattern of alcohol consumption. Intra-group evaluation also did not detect differences in the pattern of alcohol consumption between T1 and T2 in both groups. Nevertheless, self-assessment of pregnant women about the change in drinking behavior indicated a statistically significant decrease of alcohol consumption in brochure group (Wilcoxon, Z= -2.74, p <0, 01, r = 0.31) and IB group (Wilcoxon, Z= -4.43, p <0.001, r = 0.49).

O objetivo deste trabalho foi investigar a eficácia terapêutica da Interpretação Teorizada na Psicoterapia Breve Operacionalizada - PBO. Os instrumentos utilizados foram a Entrevista Psicológica conforme o Sistema Diagnóstico Adaptativo Operacionalizado SISDAO e a Psicoterapia Breve Operacionalizada PBO. Um grupo experimental (n=30) foi comparado a um grupo controle (n=30) através da aplicação da Escala Diagnóstica Adaptativa Operacionalizada EDAO no início e ao final de um período de três meses para ambos os grupos, constituídos de adultos, de ambos os sexos. O grupo experimental (constituído aleatoriamente) foi submetido à Psicoterapia Breve Operacionalizada - PBO e o grupo controle (constituído de pacientes em fila de espera numa Clínica-Escola de Faculdade de Psicologia) não recebeu nenhum tratamento. Da aplicação da Escala Diagnóstica Operacionalizada - EDAO, por meio de entrevistas no início e ao final, foram obtidos diagnósticos e escores, que foram então comparados. A análise estatística foi feita ao nível de 1% de significância. Além da análise e comparação de escores, foram avaliadas correlações clínicas dentro do grupo experimental; entre elas, graus de adaptação, situações-problema nucleares, os diferentes setores adaptativos e os níveis de melhora. A Interpretação Teorizada é o instrumento principal da Psicoterapia Breve Operacionalizada - PBO e quando se avalia a eficácia da PBO avalia-se também, por extensão, a eficácia da Interpretação Teorizada. Concluiu-se que há claras evidências de que o tratamento com Psicoterapia Breve Operacionalizada - PBO é eficaz: 86,66% da amostra melhorou na eficácia adaptativa e 13,33% permaneceu no mesmo grupo adaptativo. No grupo controle 86,66% da amostra permaneceu no mesmo grupo adaptativo; 6,66% piorou; e 6,66 % melhorou. / The goal of this study is investigate the therapeutic efficacy and theoretical interpretation on Operational Brief Psychotherapy - OPB. The instruments employed were Psychological Interviews according to the Adaptive Diagnosis Operationalized System and Brief Psychotherapy Operationalized OPB. An experimental group (n=30) was compared to a Control group (n=30) through the employment of the Operationalized Adaptive Diagnostic Scale, OADS at the beginning and the end of a three months time for both groups, formed by adults from both sexes. The experimental group (randomly constituted) was submitted to Operationalized Brief Psychology and the Control Group (constituted by patients queuing for the College\'s Psychotherapy Clinic) were not given any treatment beforehand. The employment of Operationalized Adaptive Diagnostic Scale, through interviews at the beginning, diagnostics and scores were obtained to be later compared. The statistical analysis was made at 1% significance . Besides analyzing and Scores Comparison were evaluated clinical correlations inside the experimental group, among them adaptation degree, nuclear situation-problems, the different adaptation sections and the levels of improvement. The Theoretical Interpretation is the main tool employed by Operational Brief Psychotherapy, and while evaluating the efficacy of OPB, the efficacy of Theoretical Interpretation is as well evaluated as extension. The conclusion obtained shows clear evidence that the treatment with Operational Brief Psychotherapy is effective: 86,66% of the sample group improved their adaptive efficacy and 13,33% remained in their adaptive group. On the control group results, 86,66% of the sample group remained in the same adaptive group; 6,66% decayed and 6,66% improved.

O conceito de individuação, proposto por Carl G. Jung, estabelece que o indivíduo, como um ser continuum, em conexão com seu Self é guiado a uma jornada rumo à sua plenitude. Assim, esse processo é interminável e ocorre na vida de todas as pessoas, desde seu nascimento. Quando uma pessoa sofre algum dano que interfere nesse caminho, a oportunidade de mudanças em vários âmbitos se presentifica, sendo importante que o ego integre essa experiência, ocorrendo uma simbolização psíquica. Neste estudo, busco avaliar como o processo de individuação pode ocorrer de forma criativa em pessoas que adquiriram uma deficiência física motora, podendo ser esta propiciadora de modificações necessárias para a promoção de ampliação da consciência. Para isso, utilizo como recurso metodológico narrativas de intervenções psicoterápicas de três pacientes por mim atendidos em psicoterapia breve em centros de reabilitação para pessoas com deficiência física. As causas e os diagnósticos das deficiências são distintos, sendo uma mulher vítima de acidente vascular cerebral, um homem tetraplégico e uma paciente com amputação transfemural. A partir dos meus relatos das intervenções, busquei refletir sobre alguns elementos que se evidenciaram durante o acompanhamento e que me auxiliaram no embasamento de uma psicoterapia breve de abordagem junguiana. Os eixos visualizados durante o processo psicoterápico referemse a: apropriação da persona do deficiente físico e integração criativa dos aspectos sombrios que caracterizam a perda física; corpo deficiente como símbolo da maneira de se relacionar com o mundo e consigo mesmo; análise do destino que vinha se configurando em contraposição às alterações propiciadas pela deficiência e retomada do caminho engendrado pelo Self, a partir da assimilação criativa da deficiência ao cotidiano. Coloco-me como terapeuta-narradora das intervenções psicoterápicas desses pacientes sob a ótica da psicologia analítica, utilizando como referencial literário a escritora Clarice Lispector, cuja obra se delineia sobre a ficção trágica de contos baseados em histórias de vida. Os resultados observados refletem a importância de um trabalho multidisciplinar no acompanhamento a essas pessoas e na possibilidade de se resgatar o caminho configurado previamente, embora com modificações importantes simbolizadas no corpo limitado. / The concept of individuation, proposed by Carl G. Jung, establishes that a person, as a continuum being, in connection with its Self is guided to a journey to its fullness. Thus, this is an endless process and occurs in everyone\'s life, since birth. When a person suffers trauma that interferes with this journey, the opportunity of changes in multiple scopes is present, and it is important that the ego integrates this experience, occurring a psychic symbolization. In this study, I try to evaluate how the individuation process can occur in a creative form to people with acquired motor physical deficiency, which may bring necessary modifications for the promotion of an amplification of the conscience. So, as methodological resourse, I took narratives of psychotherapic interventions of three patients atended under brief psychotherapy in different physical rehabilitationcenters. The etiologies and the types of deficiencies are distinct: a woman with cerebral vascular event sequel, a tetraplégic man and a another woman with transfemural amputation. Based on the reports of interventions, I tried to reflect on some elements highlighted during the treatment of those patients, which. helped me to apply a brief junguian psychotherapy. The cores detected during the psychotherapic process refer to: appropriation of physical deficient persona and creative integration of the shady aspects that characterize physical loss; deficient body as symbol of the relationship with the world and himself; the analysis of destiny that was being configured in contraposition to alterations resulting from deficiency, and the return to the way produced by the Self, from the creative assimilation of deficiency to the daily life. I have placed myself as therapist-narrator of those patients psychotherapic interventions under analytical psychology view, using as referencial literary the writer Clarice Lispector, whose publications are delineated on the tragic story fiction based on real life histories. The observed results the need for a multidisciplinary approach to this kind of patients and for the possibility of rescuing the way configured previously, even so with symbolized important modifications in the impaired body.

Este trabalho buscou contribuir, através de análise teórica, com a Orientação Profissional (OP) na Estratégia Clínica, a partir das discussões sobre enquadre e técnica na clínica psicanalítica conduzida por autores da Psicoterapia Breve (PB). Apresentou-se a estratégia clínica em OP proposta por Bohoslavsky e as contribuições de Y. Lehman, R. Levenfus, M. Müller, J. Corbal e A. Costa; explorou-se o panorama da PB Psicanalítica e as propostas de F. Alexander, M. Hegenberg, E. Gilliéron, M. Balint, P. Sifneos, T. Mann, E. J. Fiorini; procurou-se traçar semelhanças e diferenças entre essas duas práticas, para melhor compreender as especificidades de cada uma. Propõe-se que a problemática da escolha e a compreensão do tempo futuro, na OP, pertencem ao enquadre; que a atitude interior do orientador pode, em grande medida, seguir as diretrizes da psicanálise e respeitar o par associação livre atenção flutuante; considera-se a importância da reação emocional do orientador, no estabelecimento do diagnóstico inicial e contínuo; concebe-se que a interpretação carrega, como objetivo último, os aspectos referentes à projeção do futuro e apresenta-se uma representação gráfica de seu percurso; e aborda-se a importância da noção de crise para OP. Conclui-se que a OP clínica pode fundamentar sua prática com base na produção do campo da PB psicanalítica, visando à ampliação do repertório técnicoteórico e à flexibilização do enquadre, para abarcar as demandas contemporâneas que se apresentam / The aim of this study was to enrich the practice of Vocational Guidance (VG) in Psychologys Clinical Strategy (Estratégia Clínica) through theoretical analysis of discussions conducted by authors of Brief Psychotherapy (BP), which focused the setting and technique in a psychoanalytic clinic. This paper brings the VG clinical strategy proposed by Bohoslavsky, as well as contributions of Y. Lehman, R. Levenfus, M. Müller, J. Corbal and A. Costa. It addresses the Psychoanalytic Brief Psychotherapy scene, along with its propositions and their authors such as F. Alexander, M. Hegenberg, E. Gilliéron M. Balint, P. Sifneos, T. Mann, E.J. Fiorini. Finally, the paper traces similarities and differences between the two practices for a better understanding of the particularities of each one of them. We propose that choosing and future in VG are part of the setting. We also argue that the counselors inner attitude may largely follow psychoanalysis guidelines and respect the pair free association fluctuating attention. The study takes into consideration the importance of the emotional reaction of the counselor in the process of establishing the initial and ongoing diagnosis. It also considers that interpretation ultimate goal are the aspects related to the projection of the future, and provides a graphical representation of its course. Lastly, the paper addresses the importance of the concept of crisis to Clinical Strategy in VG. We close our argument concluding that VG may base its practices on the field of Psychoanalytic BP with the aim of expanding the technical and theoretical repertoire and increasing settings flexibility, in accordance with the contemporary changes and new demands now presented