Com o advento da psiquiatria, a ansiedade, quando propicia prejuízo do bem estar físico, social e emocional do indivíduo, passou a ser categorizada por específicos tipos de transtornos de ansiedade e relacionados ao estresse/trauma. Modelos etiológicos atuais apontam que tais transtornos se desenvolvem, com maior facilidade, em indivíduos com histórico de traumas na primeira infância, sendo estes considerados fatores de risco importantes, bem como, se correlacionariam à presença e desenvolvimento de traços de personalidade do indivíduo e a um déficit de discriminação ambiental do mesmo, em especial quanto ao reconhecimento das expressões de emoções faciais. Assim, objetivou-se verificar as possíveis associações entre os traumas emocionais precoces (TEP), traços de personalidade e o reconhecimento de expressões de emoções faciais (REFE) em sujeitos diagnosticados com transtornos de ansiedade social (TAS), ansiedade generalizada (TAG), e estresse pós traumático (TEPT), utilizou-se como parâmetro um grupo controle com sujeitos saudáveis. Participaram deste estudo 120 sujeitos que foram alocados em quatro grupos distintos, de 30 participantes cada, sendo três clínicos (TAS, TAG, TEPT) e um não clínico (NC). Como instrumentos de coletas de dados foram utilizados: a) Escala do transtorno de ansiedade generalizada (GAD7); b) Inventário de fobia social (SPIN); c) Entrevista Clínica Estruturada para o DSM-IV (SCID-IV) - versão clínica; d) Formulário Sociodemográfico e Clínico; e) Early Trauma Inventory Self Report - Short Form (ETISR-SF); f) Questionário sobre a Saúde do Paciente-9 (PHQ-9); g) Escala de ansiedade de Beck (BAI); h) Teste Rápido de Identificação do Uso Abusivo de Álcool (FAST); i) Teste de Dependência de Nicotina de Fagerström (FTND); j) Inventário de Cinco Fatores NEO Revisado (NEO-FFI-R - versão reduzida); k)Tarefa de Reconhecimento de Expressões Faciais. A coleta de dados dos grupos clínicos ocorreu em duas etapas, sendo: a) fase de rastreio: identificação e confirmação diagnóstica dos possíveis participantes; b) fase de avaliação de desfecho: confirmados os diagnósticos, os participantes eram convidados para a coleta em si. Como resultados, verificou-se que o grupo TEPT possuía um maior número de TEP gerais e totais, em especial eventos de ocorrência abruta, enquanto que o grupo TAG apresentou significativamente mais TEP emocionais, sexuais e totais. Quanto às características de personalidade, verificaram-se que o fator de neuroticismo foi significativamente presente nos grupos clínicos. Sobre a tarefa de reconhecimentos faciais, verificouse que o grupo TEPT apresentou significativa acurácia reduzida para a emoção de nojo e surpresa, bem como para faces masculinas, além de um maior tempo de resposta para o julgamento da emoção de surpresa. Por fim, através de análise de regressão, verificou-se para o TEPT, associações expressivas entre presença de traços de neuroticismo e reduzida acurácia da emoção surpresa; para o TAG, ocorreram associações significativas entre a presença de TEP emocional e sexual e maior acurácia para emoção de nojo; e para o TAS destacou-se a associação com traço de personalidade neuroticismo. Desta forma, os achados corroboram os dados prévios da literatura, indo além e explorando especificidades entre os diferentes transtornos. Acredita-se que a identificação de tais correlações proporcionam uma compreensão de forma integrada favorecendo condutas terapêuticas e preventivas. / Anxiety, when it damages the individual\'s physical, social and emotional well-being, has been categorized by specific types of anxiety and stress disorders, as a result of the advent of psychiatry. Current etiologic models point out that such disorders develop easier in individuals with a history of early childhood traumas, which are considered as important risk factors, as well as, if they correlate with the presence and development of personality traits of the individual and to a deficits of environmental discrimination, especially regarding the recognition of expressions of facial emotions. The aim of this study was to verify possible associations between early emotional traumas (EET), personality traits and recognition of facial expressions (REFE) in individuals diagnosed with social anxiety disorder (SAD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). A control group was used as a parameter including healthy individuals. A total of 120 individuals were randomly assigned to four groups of 30 participants, three of whom were clinicians (SAD, GAD, PTSD) and one non-clinical (NC). The instruments used to collect data were: a) Scale of generalized anxiety disorder (GAD7); B) Social phobia inventory (SPIN); C) Structured Clinical Interview for DSM-IV (SCID-IV) - clinical version; D) Sociodemographic and Clinical Form; E) Early Trauma Inventory Self-Report - Short Form (ETISR-SF); F) Patient Health Questionnaire-9 (PHQ-9); G) Beck\'s Anxiety Scale (BAI); H) Rapid Alcohol Abuse Identification Test (FAST); I) Fagerström Nicotine Dependence Test (FTND); J) Revised NEO Five Traits Inventory (NEO-FFI-R - reduced version); K) Facial Expression Recognition Task. The data collection of the clinical groups occurred in two stages: a) phase of screening: identification and diagnostic confirmation of the possible participants; b) phase of evaluation of outcomes: once the diagnosis was confirmed, the participants were invited to the data collection. The results showed that the PTSD group had a greater number of general and total EET, specially events of abrupt occurrence, whereas the GAD group showed significantly more emotional, sexual and total EET. Regarding personality traits, it was verified that the neuroticism trait was significantly present in the clinical groups. As the task of facial recognition, it was possible to verify that the PTSD group had a significantly reduced accuracy for the emotion of disgust and surprise, as well as for male faces, and a bigger response time for judgment of the surprise emotion. Finally, through regression analysis, there were significant associations between the presence of neuroticism traits and the low accuracy of the surprise emotion for PTSD; for TAG, there were noticeable associations between the presence of emotional and sexual EET and greater accuracy for the emotion of disgust; end for the SAD the association with personality trait neuroticism was highlighted. Thus, the findings of this research corroborate the previous literature data and also explore specificities between the different disorders. It can be assumed that the identification of such correlations can provide an integrated understanding, improving therapeutic and preventive behaviors.

O presente trabalho procura compreender o conceito de trauma psíquico a partir das teorizações de S. Freud e S. Ferenczi. Discutem-se as ideias expostas pelos dois autores sobre os aspectos intra e interpsíquicos envolvidos na formação do trauma, com o intuito de articulá-las de um modo que contemple as diferentes experiências de traumatização. A dissertação está dividida em três partes. Na primeira, composta de cinco capítulos, o eixo são experiências que parecem ter um efeito disruptivo tão logo acontecem, imediatamente ou após um curto intervalo de tempo. Incluem-se, aqui, as neuroses traumáticas, em geral, e as neuroses de guerra, em particular, assim como eventos de menor intensidade, mas que demandam um trabalho característico do aparelho psíquico. A atenção de Freud e Ferenczi voltou-se para esse tipo de formação traumática, em um tempo, após a Primeira Guerra Mundial, devido à necessidade de compreender e tratar soldados com sintomas que remetiam às experiências de trauma. Devido ao despreparo, à ausência de contrainvestimento do sistema consciente, e à intensidade da estimulação, o psiquismo é obrigado a acionar medidas defensivas primitivas, na tentativa de ligar o afluxo de excitação. Na segunda parte deste estudo, dividida em quatro capítulos, discutem-se as teorizações dos autores-base que explicitam a formação do trauma em dois tempos distintos. O modelo deriva do observado nas experiências de sedução. Para Freud, algumas vivências não são traumáticas no momento em que ocorrem, mas ganham esse atributo posteriormente, ao serem reativadas por uma nova experiência que as ressignifica. Para Ferenczi, algumas formas de traumatização envolvem o que chama de duplo choque: uma experiência causa comoção psíquica e, quando o indivíduo busca no ambiente a validação e o reconhecimento de suas sensações e percepções, estas são negadas. Utilizando casos clínicos colhidos da literatura sobre o tema, e cotejando a relação pessoal entre os autores, procura-se articular os modelos de traumatização observados. No capítulo final, conclusivo, acompanha-se a tentativa de Michael Balint de decompor a formação do trauma em três fases, unindo as ideias de Freud e Ferenczi, e propõe-se, com base no que foi discutido, a hipótese de que alguns tipos de formação traumática envolvem três tempos: o momento do choque, a reação do ambiente após o evento, e a ressignificação a posteriori das experiências anteriores / In this work I advance an understanding of the concept of psychic trauma based on Freuds and Ferenczis theoretical deliberations. I discuss both authors ideas concerning intra- and inter-psychic aspects of trauma formation so as to articulate them in such a way that I may distinguish different traumatic experiences. This work is divided into three parts. In the first five chapters I show that the focal point of a particular type of trauma is a set of experiences that appear to have an immediate or shortly delayed disruptive effect. In this set one finds traumatic neuroses in general and wartime neuroses in particular, as well as less intense events that nonetheless require a characteristic effort on the part of the psychic apparatus. Owing to the need to understand and treat soldiers whose symptoms derived from their traumatic experiences, both Freud and Ferenczi directed their attention to this type of trauma formation after the World War I. Because of psychic unpreparedness, the conscious systems lack of counter-cathexis, and the stimulations intensity, the psyche is forced into activating primitive defenses in its attempts to bind the overwhelming excitation. In the second part (four chapters), I discuss these foundational authors theoretical deliberations concerning the formation of trauma in two different stages. The model here derives from what has been observed in experiences of seduction. For Freud some experiences are not traumatic when they occur, but they become traumatic later, when they are reactivated by another experience that redefines them. For Ferenczi, some forms of traumatization entail what he calls a double shock: an experience causes psychic commotion, and, when subjects search their environment for validation and for acknowledgement of their sensations and perceptions, these are denied. Using pertinent clinical cases found in the literature and availing myself of Freuds and Ferenczis personal relationship, I attempt to delineate these two models of traumatization. In my concluding chapter I examine Michael Balints attempt to break down trauma formation into three phases by uniting Freuds and Ferenczis points of view. I propose, based on what has come before, the hypothesis that some types of trauma formation entail three phases: the moment of shock, the environments reaction after the event, and the a posteriori reinterpretation of the prior experiences

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.

Com o advento da psiquiatria, a ansiedade, quando propicia prejuízo do bem estar físico, social e emocional do indivíduo, passou a ser categorizada por específicos tipos de transtornos de ansiedade e relacionados ao estresse/trauma. Modelos etiológicos atuais apontam que tais transtornos se desenvolvem, com maior facilidade, em indivíduos com histórico de traumas na primeira infância, sendo estes considerados fatores de risco importantes, bem como, se correlacionariam à presença e desenvolvimento de traços de personalidade do indivíduo e a um déficit de discriminação ambiental do mesmo, em especial quanto ao reconhecimento das expressões de emoções faciais. Assim, objetivou-se verificar as possíveis associações entre os traumas emocionais precoces (TEP), traços de personalidade e o reconhecimento de expressões de emoções faciais (REFE) em sujeitos diagnosticados com transtornos de ansiedade social (TAS), ansiedade generalizada (TAG), e estresse pós traumático (TEPT), utilizou-se como parâmetro um grupo controle com sujeitos saudáveis. Participaram deste estudo 120 sujeitos que foram alocados em quatro grupos distintos, de 30 participantes cada, sendo três clínicos (TAS, TAG, TEPT) e um não clínico (NC). Como instrumentos de coletas de dados foram utilizados: a) Escala do transtorno de ansiedade generalizada (GAD7); b) Inventário de fobia social (SPIN); c) Entrevista Clínica Estruturada para o DSM-IV (SCID-IV) - versão clínica; d) Formulário Sociodemográfico e Clínico; e) Early Trauma Inventory Self Report - Short Form (ETISR-SF); f) Questionário sobre a Saúde do Paciente-9 (PHQ-9); g) Escala de ansiedade de Beck (BAI); h) Teste Rápido de Identificação do Uso Abusivo de Álcool (FAST); i) Teste de Dependência de Nicotina de Fagerström (FTND); j) Inventário de Cinco Fatores NEO Revisado (NEO-FFI-R - versão reduzida); k)Tarefa de Reconhecimento de Expressões Faciais. A coleta de dados dos grupos clínicos ocorreu em duas etapas, sendo: a) fase de rastreio: identificação e confirmação diagnóstica dos possíveis participantes; b) fase de avaliação de desfecho: confirmados os diagnósticos, os participantes eram convidados para a coleta em si. Como resultados, verificou-se que o grupo TEPT possuía um maior número de TEP gerais e totais, em especial eventos de ocorrência abruta, enquanto que o grupo TAG apresentou significativamente mais TEP emocionais, sexuais e totais. Quanto às características de personalidade, verificaram-se que o fator de neuroticismo foi significativamente presente nos grupos clínicos. Sobre a tarefa de reconhecimentos faciais, verificouse que o grupo TEPT apresentou significativa acurácia reduzida para a emoção de nojo e surpresa, bem como para faces masculinas, além de um maior tempo de resposta para o julgamento da emoção de surpresa. Por fim, através de análise de regressão, verificou-se para o TEPT, associações expressivas entre presença de traços de neuroticismo e reduzida acurácia da emoção surpresa; para o TAG, ocorreram associações significativas entre a presença de TEP emocional e sexual e maior acurácia para emoção de nojo; e para o TAS destacou-se a associação com traço de personalidade neuroticismo. Desta forma, os achados corroboram os dados prévios da literatura, indo além e explorando especificidades entre os diferentes transtornos. Acredita-se que a identificação de tais correlações proporcionam uma compreensão de forma integrada favorecendo condutas terapêuticas e preventivas. / Anxiety, when it damages the individual\'s physical, social and emotional well-being, has been categorized by specific types of anxiety and stress disorders, as a result of the advent of psychiatry. Current etiologic models point out that such disorders develop easier in individuals with a history of early childhood traumas, which are considered as important risk factors, as well as, if they correlate with the presence and development of personality traits of the individual and to a deficits of environmental discrimination, especially regarding the recognition of expressions of facial emotions. The aim of this study was to verify possible associations between early emotional traumas (EET), personality traits and recognition of facial expressions (REFE) in individuals diagnosed with social anxiety disorder (SAD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). A control group was used as a parameter including healthy individuals. A total of 120 individuals were randomly assigned to four groups of 30 participants, three of whom were clinicians (SAD, GAD, PTSD) and one non-clinical (NC). The instruments used to collect data were: a) Scale of generalized anxiety disorder (GAD7); B) Social phobia inventory (SPIN); C) Structured Clinical Interview for DSM-IV (SCID-IV) - clinical version; D) Sociodemographic and Clinical Form; E) Early Trauma Inventory Self-Report - Short Form (ETISR-SF); F) Patient Health Questionnaire-9 (PHQ-9); G) Beck\'s Anxiety Scale (BAI); H) Rapid Alcohol Abuse Identification Test (FAST); I) Fagerström Nicotine Dependence Test (FTND); J) Revised NEO Five Traits Inventory (NEO-FFI-R - reduced version); K) Facial Expression Recognition Task. The data collection of the clinical groups occurred in two stages: a) phase of screening: identification and diagnostic confirmation of the possible participants; b) phase of evaluation of outcomes: once the diagnosis was confirmed, the participants were invited to the data collection. The results showed that the PTSD group had a greater number of general and total EET, specially events of abrupt occurrence, whereas the GAD group showed significantly more emotional, sexual and total EET. Regarding personality traits, it was verified that the neuroticism trait was significantly present in the clinical groups. As the task of facial recognition, it was possible to verify that the PTSD group had a significantly reduced accuracy for the emotion of disgust and surprise, as well as for male faces, and a bigger response time for judgment of the surprise emotion. Finally, through regression analysis, there were significant associations between the presence of neuroticism traits and the low accuracy of the surprise emotion for PTSD; for TAG, there were noticeable associations between the presence of emotional and sexual EET and greater accuracy for the emotion of disgust; end for the SAD the association with personality trait neuroticism was highlighted. Thus, the findings of this research corroborate the previous literature data and also explore specificities between the different disorders. It can be assumed that the identification of such correlations can provide an integrated understanding, improving therapeutic and preventive behaviors.

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.

Experts in traumatology have postulated traumatized children play differently than non-traumatized children. These differences are called posttraumatic play and include the behaviors of intense play, repetitive play, play disruption, avoidant play and negative affect. The purpose of this study is the continued development of the Trauma Play Scale through the addition of a normative sample. The Trauma Play Scale is an observation-based instrument designed to distinguish the play behaviors of children in play therapy with a history of interpersonal trauma when compared to non-traumatized children. The present study compares two samples of children. One group (n=6) currently in play therapy with a history of interpersonal trauma and another group (n=7) considered normally developing (cognitively, emotionally, socially, and physically) by their parents with no known history of interpersonal trauma. Trained raters blind to the trauma history of the children rated a series of eight consecutive video-recorded play therapy sessions for each participant. One-way analysis of variance statistics, including effect sizes were compute to determine the discriminant validity of the Trauma Play Scale. Traumatized children scored significantly higher on the Trauma Play Scale than non-traumatized children on all domains of the scale as well as the overall Average Trauma Play Scale score. Large effect sizes indicated strong relationships between group membership (trauma history versus normally developing) and scores on the Trauma Play Scale.

Idag finns ett starkt forskningsstöd som visar att små barn utvecklar PTSD eller andra stressrelaterade symtom i samband med trauma i lika eller högre grad än äldre barn, ungdomar och vuxna. De yngsta barnens starka beroende av sina vårdnadshavare för överlevnad och skydd i kombination med deras utvecklingsmässiga omognad gör de minsta barnen till en särskilt utsatt och sårbar grupp. Syftet med denna litteraturöversikt är att undersöka forskningsstödet för olika psykoterapeutiska metoder för små barn (noll till fem år) med trauma. Översikten omfattar 29 artiklar med olika metodologiska tillvägagångssätt. Sammanfattningsvis visar litteraturöversikten att det saknas forskning om behandling av små barn samt att det finns studier som påtalar behov av att anpassa behandlingen till barnens ålder och behov. Detta inkluderar till exempel att involvera barnets primära omsorgsperson/er, att använda lek som metod, att ge åldersanpassad psykoedukation samt att identifiera känslor utifrån ålder och mognad. Framtida forskning om små barn har flera frågeställningar som behöver besvaras; Hur går en evidensbaserad diagnostisk process till för de små barnen? Vilka symtom behöver premieras i behandlingen? Vilka barn bör erbjudas behandling och hur kan effekten av terapin mätas? Ytterligare studier med fokus på genomförbarhet och enhetliga utfallsmått rekommenderas. / There is ample evidence to suggest that infants and small children can develop PTSD and other stress-related symptoms as a result of trauma, to an equal or greater degree than older children, adolescents and adults. Particularly, their strong reliance and dependence on their caregivers for protection and survival, in combination with their developmental immaturity, makes them an especially vulnerable group. This review aims to investigate the evidence base for varying psychotherapeutic methods specifically targeting small children zero to five years of age who have experienced trauma. A structured search was conducted using two databases; PsychInfo and Web of Science. The results includes 29 articles with diverse methodological approaches. In essence, the discussion highlights that there is sparse research concerning small children and the treatment of trauma. Studies that exist, put forward the need to conduct therapy with the small children and their caregivers, so called “dyadic therapy” regardless of psychotherapeutic orientation. Also, adapting therapy to suit the small children's cognitive, language and social development is imperative. This is done, for example, through the use of play, by providing age appropriate psychoeducation, and identifying emotions based on age and maturity. Still, there are many questions remaining that may need to be answered in order to provide evidence-based treatment to small children and their families, for example; How do we best conduct an evidence-based assessment of trauma in small children? Which trauma-symptoms should be treated and how should the treatment outcome be measured? Further studies are recommended.

Many of the sources indicated in this work are classical and not updated due to the fact that the origins of Gestalt Philosophy are found in classical works / Verskeie van die geraadpleegde bronne in die literatuurhoofstukke verteenwoordig klassieke werke wat nie binne die erkende periode vir relevante wetenskaplike navorsing val nie. Die oorsprong van die Gestalt Filosofie wat in hierdie studie benut is, word in hierdie klassieke werke gevind en is ook in hierdie werke geraadpleeg / The Gestalt approach was used as the contextual framework to explore how music can be used as a therapeutic medium in the treatment of the emotionally traumatized child. Music as a sensory experience was used during the therapeutic process with each case study, to facilitate the child's process towards healing. The conceptual framework of music as a therapeutic medium was researched in depth to bring clarity to the influence it has on the emotional well-being of the child. The child who entered into therapy was selected according to specific criteria, with the experience of emotional trauma being priority. The researcher also studied the concept of emotional trauma in depth and the consequences it has on a child's overall functional ability. Music was used as an expressive technique during the therapeutic process with each child. The conclusion drawn from this study indicated that the gestalt approach can be applied effectively in using music as a therapeutic medium in the treatment of the emotionally traumatized child. / Die Gestalt benadering is gebruik in hierdie navorsing ten einde 'n kontekstuele raamwerk daar te stel waarbinne musiek as terapeutiese medium in die behandeling van emosionele trauma in kinders gebruik kon word. Musiek kan beskryf word as 'n sensoriese ervaring. Hierdie sensoriese ervaring is binne die terapeutiese proses toegepas ten einde die kind se herstelproses te fasiliteer. Die studie is binne die navorsingskonteks van gevallestudieprosedures gedoen. Musiek is binne die konseptuele raamwerk bestudeer en nagevors ten einde die terapeutiese waarde daarvan in diepte te ondersoek. Hierdie in-diepte ondersoek het aan die navorser 'n duidelike beeld gegee hoe dit toegepas kon word in terapie. Deur dit toe te pas in terapie is die invloed van musiek op die emosionele welsyn van die getraumatiseerde kind gedokumenteer. Die navorsingskriteria vir insluiting in die ondersoek was gegrond op die literatuurondersoek en het onder meer die belewing van trauma ingesluit. Die belewing van emosionele trauma en invloed op die kind se geheelfunksionering was dus 'n verdere eenheid van ontleding en is in diepte deur die navorser bestudeer. Musiek is dus gebruik as 'n ekspressiewe tegniek tydens die terapeutiese proses met elke gevallestudie. Die gevolgtrekking waartoe in hierdie studie gekom kon word is dat musiek binne die konteks van die gestalt benadering suksesvol in die hantering van emosionele trauma by die kind gebruik kan word. / Practical Theology / M.Diac. (Play Therapy)

Many of the sources indicated in this work are classical and not updated due to the fact that the origins of Gestalt Philosophy are found in classical works / Verskeie van die geraadpleegde bronne in die literatuurhoofstukke verteenwoordig klassieke werke wat nie binne die erkende periode vir relevante wetenskaplike navorsing val nie. Die oorsprong van die Gestalt Filosofie wat in hierdie studie benut is, word in hierdie klassieke werke gevind en is ook in hierdie werke geraadpleeg / The Gestalt approach was used as the contextual framework to explore how music can be used as a therapeutic medium in the treatment of the emotionally traumatized child. Music as a sensory experience was used during the therapeutic process with each case study, to facilitate the child's process towards healing. The conceptual framework of music as a therapeutic medium was researched in depth to bring clarity to the influence it has on the emotional well-being of the child. The child who entered into therapy was selected according to specific criteria, with the experience of emotional trauma being priority. The researcher also studied the concept of emotional trauma in depth and the consequences it has on a child's overall functional ability. Music was used as an expressive technique during the therapeutic process with each child. The conclusion drawn from this study indicated that the gestalt approach can be applied effectively in using music as a therapeutic medium in the treatment of the emotionally traumatized child. / Die Gestalt benadering is gebruik in hierdie navorsing ten einde 'n kontekstuele raamwerk daar te stel waarbinne musiek as terapeutiese medium in die behandeling van emosionele trauma in kinders gebruik kon word. Musiek kan beskryf word as 'n sensoriese ervaring. Hierdie sensoriese ervaring is binne die terapeutiese proses toegepas ten einde die kind se herstelproses te fasiliteer. Die studie is binne die navorsingskonteks van gevallestudieprosedures gedoen. Musiek is binne die konseptuele raamwerk bestudeer en nagevors ten einde die terapeutiese waarde daarvan in diepte te ondersoek. Hierdie in-diepte ondersoek het aan die navorser 'n duidelike beeld gegee hoe dit toegepas kon word in terapie. Deur dit toe te pas in terapie is die invloed van musiek op die emosionele welsyn van die getraumatiseerde kind gedokumenteer. Die navorsingskriteria vir insluiting in die ondersoek was gegrond op die literatuurondersoek en het onder meer die belewing van trauma ingesluit. Die belewing van emosionele trauma en invloed op die kind se geheelfunksionering was dus 'n verdere eenheid van ontleding en is in diepte deur die navorser bestudeer. Musiek is dus gebruik as 'n ekspressiewe tegniek tydens die terapeutiese proses met elke gevallestudie. Die gevolgtrekking waartoe in hierdie studie gekom kon word is dat musiek binne die konteks van die gestalt benadering suksesvol in die hantering van emosionele trauma by die kind gebruik kan word. / Philosophy, Practical and Systematic Theology / M.Diac. (Play Therapy)

This study investigated the psychological approach and the classroom methodology needed by an educator to teach street children effectively in a special school created for them. Street children with their psychological trauma, their independent, self-sufficient outlook and educational deprivation make their adaption to the methods and educational environment of mainstream schooling difficult. To meet the special educational, psychological and emotional needs of street children, Masupatsela School was started. The study was carried out in this school. The qualitative research methodology used an action research design which consisted of a reconnaissance phase and three cycles. Each cycle made use of a planning, implementation and evaluation phase. A general plan was formulated after the reconnaissance phase and revised after each cycle. The teaching was done by the researcher using four grades of street children ranging form grade 7 to grade 10. Because of their specific psychological makeup, street children, who have lacked close, comforting and trusting relationships and role models, require a classroom environment, atmosphere and a relationship with the educator which is supportive, caring, warm and firm. To achieve this a client centred approach was used based predominantly on the therapeutic principles of congruence, empathetic understanding and unconditional positive regard. The interaction with the children was based on openness, tolerance, the affirmation of others and honest firmness. The teaching methodology was an eclectic one which made use primarily of a cognitive teaching style which was introduced incrementally over the three cycles. The main components of this style consisted of cognitive questioning, cooperative learning and strategic reading for information. The results of the study showed that both the psychological and educational approach in the classroom to be very appropriate and successful. However the wider negative contextual influences such as the school organization, staffing and curriculum made the classroom strategies difficult to sustain. It is recommended that a programme using these educational and psychological approaches and incorporating functional literacy and numeracy, vocational skills, recreation and a therapeutic programme be incorporated when designing a programme for street children in a formal setting. / Psychology / D. Litt. et Phil. (Psychology)