This study is a qualitative enquiry into family therapists’ experiences of working with young people who self-harm and their families. To date, in spite of self-harm being a serious public health concern, there is relatively little exploration of the subject in family therapy literature. The study attempts to describe, understand and illuminate family therapists’ experiences: the therapeutic issues encountered, the stances adopted in response to the issues encountered, and the emotional impact on the therapist of working with this client group. A total of nine experienced family therapists participated in semi-structured interviews. The study employed a grounded theory method for data analysis. The analysis yielded a theory of therapists’ experiences that included a Core Category and three Main Categories. The Core Category that emerged was: •Cultivating the Practice of Hope – Withstanding the Pull to Hopelessness. The three Main Categories were: •Making the Situation Safe •Conversing Therapeutically – The Practice of Hope •Team and Organisational Processes: Supporting Therapists. The Core Category is the central feature of this theory. It proposes that the central concern for the therapist is how to stay engaged with the family and the young person in the context of serious risk of self-harm and in situations where change is difficult to achieve and hopelessness can pervade. The therapist has to try to understand and make sense of family members’ distress, and be touched by and open to their feelings of despair and hopelessness without becoming overwhelmed and despairing themselves. The therapist response to this dilemma is the stance of hopefulness. It is both a therapeutic stance and orientation, and is enacted in practice through finding ways to cultivate hope in the therapeutic encounter. While the Core Category is the central ‘story’ the three Main Categories are linked to the Core Category. The Main Category, Making the Situation Safe describes the initial stage of the work, with its focus on ensuring the safety of the young person. The Main Category, Conversing Therapeutically – the Practice of Hope describes how the therapists enacted the ‘practice of hope’. The Main Category, Team and Organisational Processes: Supporting Therapists describes how the context in which the therapists work, the nature of relationships, the team and organisational structures, play a critical role in supporting therapist hope, so that they can withstand the pull to hopelessness. This study aims to make a contribution towards articulating a framework for family therapy with adolescents who self-harm and introduces a new vocabulary – the language of hope and hopelessness.

Made available in DSpace on 2016-04-28T20:38:38Z (GMT). No. of bitstreams: 1 Thais Lyrio Lima.pdf: 1879604 bytes, checksum: d96b09e22e03490c557c5d810d92bdc0 (MD5) Previous issue date: 2013-03-19 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This work had as objective to understand the meanings attributed to obesity and family for an obese young adult, under the systemic theory perspective. Despite the number of studies and significant advances, the obesity problem appears to not be solved effectively by the approaches that have been proposed and evidence the need to reflect about new ways to follow the obese subject, in the present study with a proposal of a relational approach. In order to that, we adopted the qualitative method of survey that was designed by a case study and it was used a semi-structured interview, Genogram and a Timeline as data collect instruments. It was interviewed an obese young adult with 27 years old, BMI of 36.1 kg/m² , that means obesity level II. The results indicated a family behavior based on rigidity and inability to deal with crisis and conflicts, beyond the presence of secrets that work for holding off and keeping way relationships. It was noted also the relationship between food and affection in this family, that as well as the overweight, represent the identity of the familiar group and give to the participant the belonging feeling. Thus, we could reflected about her loyalty and the limitation imposed by her, complicating the identification out of the family system and the constitution of an autonomous and adult identity. Understanding the histories of the individuals and their families is a facilitator strategy in the development of interventions that are connected with family beliefs and needs and can imply as an important agent of changing. In this way, the Family Therapy proved to be a relevant resource in working with obese individuals / Este trabalho teve como objetivo compreender os significados atribuídos à obesidade e família por uma jovem adulta obesa, sob a perspectiva da teoria sistêmica. Apesar do número de estudos e avanços significativos, o problema da obesidade parece não responder de forma efetiva às abordagens que vêm sendo propostas, o que evidencia a necessidade de refletir sobre novas formas de acompanhar o indivíduo obeso, no presente estudo com uma proposta de abordagem relacional. Para tanto, adotamos o método qualitativo de pesquisa delineado por meio de estudo de caso e utilizamos a entrevista semiestruturada, o Genograma e a Linha do Tempo como instrumentos de coleta de dados com uma jovem adulta obesa, universitária, de 27 anos e IMC igual a 36.1 kg/m², ou seja, obesidade de grau II. Os resultados indicaram um funcionamento na família da participante marcado pela rigidez e inabilidade para lidar com crises e conflitos, além da presença de segredos que operam no sentido de distanciar e afastar relacionamentos. Mostraram ainda a relação existente entre comida e afeto nesta família, que, assim como o excesso de peso, constitui a identidade do grupo familiar e dão à participante o sentimento de pertencimento. Pudemos, então, refletir sobre sua lealdade e a limitação que ela impõe, dificultando uma identificação fora do sistema familiar e o estabelecimento de uma identidade autônoma e adulta. Conhecer, portanto, as histórias dos indivíduos e suas famílias é uma estratégia facilitadora no desenvolvimento de intervenções que sejam conectadas com as crenças e necessidades da família e que possam implicá-la como um importante agente de mudança. Neste sentido, a Terapia Familiar se mostrou um recurso relevante na atuação com indivíduos obesos

Made available in DSpace on 2016-04-28T20:38:50Z (GMT). No. of bitstreams: 1 Caroline Wajss Zylberkan.pdf: 2254771 bytes, checksum: a14c7ebac62788f157bfaaf15dba62f4 (MD5) Previous issue date: 2014-02-21 / The main objective of this project was to understand the implications of family therapy in the treatment of a patient cared for in the program for eating disorders of the Hospital das Clínicas, at the Instituto de Psiquiatria de São Paulo (IPq HC-FMUSP). This objective was drafted from the possibility of creating a space for dialogue among those participating in this research project, by way of semi-structured interviews which could increase the understanding and the reach of family therapy in this context. An effort was made specifically to extend knowledge of treatment of eating disorders beyond family therapy, with a view to perceive and analyze the context of the relationships and life both within the family organization of the patient being treated, as well as within the professional system involved in the treatment. For this end, interviews were held with three of the professionals who were part of the multidisciplinary team which took care of the chosen case during the last five years, being one a psychiatrist, one a nutritionist and one an individual psychologist, apart from the patient herself and members of her family. For data analysis information was gleaned from the interviews of each participant, according to the importance of their content and the objective of this research project. Thus some themes were identified which could didactically outline some specific points relevant to the discussion. Taking into consideration the collaborative approach proposed by Harlene Anderson (2011), we understand the different voices offered by our participants as possible interpretations capable of communicating amongst themselves. From this material it was possible to identify some of the expectations of the multidisciplinary team in relation to the effects of family therapy in the treatment of eating disorders in a hospital setting, and also the relevance of this care both to the patient as well as her family. It became evident that family therapy was valued by all those involved in the research project as a necessary support for the patient and her family, insofar that from the specific point of view of each one it contributed to greater adhesion to the treatment. However this valuing implies in fitting the family therapy into a format of behavior which is aimed at the symptom, and this research project endeavored to reflect on the use of this space for the inter-relational process in which the symptom arises, and on the possible reach of this care for a long term process which would look at the dynamics of the relationships and also beyond the symptom / O objetivo principal deste trabalho foi compreender os significados da terapia familiar no tratamento de uma paciente atendida no programa para transtorno alimentar do Hospital das Clínicas, no Instituto de Psiquiatria de São Paulo (IPq HC-FMUSP). Esse objetivo foi delineado a partir da possibilidade de criar um espaço de diálogo entre os participantes desta pesquisa, por meio de entrevistas semiestruturadas que pudessem ampliar o entendimento e o alcance da terapia familiar nesse contexto. De maneira específica, buscou-se estender o conhecimento sobre o tratamento dos transtornos alimentares para além da terapia familiar, com vistas a perceber e analisar os contextos das relações e da vivência tanto na organização familiar da paciente em tratamento, quanto na organização do sistema profissional envolvido no tratamento. Para isso, foram entrevistados três profissionais que participaram da equipe multidisciplinar que tratou do caso escolhido durante os últimos cinco anos, sendo um psiquiatra, uma nutricionista e um psicólogo individual, além da própria paciente e de seus familiares. Para a análise dos dados foram feitos recortes das entrevistas de cada participante, a partir da importância do conteúdo relatado e do objetivo desta pesquisa. Assim, levantaram-se alguns temas que pudessem delinear de forma didática alguns pontos específicos e relevantes para discussão. Levando em consideração a abordagem colaborativa proposta por Harlene Anderson (2011), compreendemos as diferentes vozes oferecidas por nossos participantes como possibilidades de entendimentos capazes de dialogar entre si. Diante desse material, foi possível verificar algumas expectativas da equipe multidisciplinar em relação à atuação da terapia familiar no tratamento dos transtornos alimentares no contexto hospitalar, bem como a relevância desse atendimento tanto para a paciente quanto para os seus familiares. Ficou evidente que a terapia familiar foi valorizada por todos os envolvidos na pesquisa como um suporte necessário à paciente e seus familiares, na medida em que, do ponto de vista específico de cada um contribuiu para maior adesão ao tratamento. No entanto, essa valorização implica em colocar a terapia familiar dentro de um formato de conduta voltada para o sintoma, e esta pesquisa buscou refletir sobre a utilização desse espaço para a compreensão do processo inter relacional no qual se produz o sintoma e nas possibilidades de alcance desse atendimento para um trabalho a longo prazo que olhe para as dinâmicas da relação e para além do sintoma

Este trabalho objetivou conhecer o processo de busca e a clientela atendida em terapia de casal e família. Para tanto, realizaram-se dois estudos. Inicialmente, através de uma revisão sistemática da literatura, foram identificados seis fatores associados à busca pelas terapias de casal e família: fatores pessoais, relacionais, culturais, de gênero, estratégias anteriores de ajuda e tipo de problema. Posteriormente, através de um estudo empírico, a clientela atendida em terapia familiar em uma clínica-escola de Porto Alegre (RS) foi caracterizada. Foram realizadas entrevistas estruturadas com 41 adultos encaminhados para terapia familiar, nas quais foram investigadas variáveis sociodemográficas e familiares, o processo de busca de ajuda, o problema apresentado, tentativas anteriores de ajuda utilizadas e expectativas sobre o tratamento. Os resultados permitem reflexões sobre a prática clínica com famílias em clínicas-escola, especialmente a respeito do envolvimento dos clientes no processo terapêutico e à transição da queixa para a demanda desde o período de avaliação inicial. / This research aimed to investigate the help seeking process and the clients attended in couples and family therapy. To achieve this objective, two studies were realized. First, a systematic literature review identified six factors associated with the search for couples and family therapy: personal factors, relationship factors, gender, cultural aspects, prior sources of help and type of problem. After that, a second study characterized the clients attended in family therapy in a school clinic located in Porto Alegre (RS). Structured interviews with 41 adults referred for family therapy were realized. Sociodemographic and familial variables, the search for help process, the main problem, the prior sources of help and the expectations about the treatment were investigated. These results allows reflections about family therapy practice in school clinics, especially about the involvement of the clients on therapeutic process and the transition from the first complaint to the real demand since evaluation period.

Atualmente há uma grande mobilização social envolvendo a questão do abuso sexual, tamanha a ocorrência deste fenômeno. A OMS (Organização Mundial da Saúde) estima que entre 7-36% de meninas e 3-29% de meninos já sofreram abuso sexual em algum momento de sua vida. No entanto, muitos dos casos de abuso sexual acabam não sendo revelados e notificados, agravando a situação por não ter a possibilidade de obter tratamento para os envolvidos. O incesto, abuso sexual que ocorre dentro da família, é um tipo de violência sexual que apresenta uma dinâmica específica, que não somente a violência envolvendo seus participantes. O presente trabalho se apoia na visão psicanalítica para a compreensão das características desta dinâmica familiar, pois a trama incestuosa indica que houve uma falha na estruturação mental de todos os participantes, demarcando uma leitura intra/intersubjetiva e relacional para além de um estigma agressor e uma vítima. Objetivos do trabalho: refletir acerca de categorias de funcionamento psíquico destas famílias, que serão vislumbrados dentro do eixo psicanalítico e analisados a partir de dados apreendidos em entrevistas de triagens obtidas em uma instituição que oferece tratamento para tal população e frente a um questionário elaborado, cujo produto foi a construção de um inventário para detecção de atuação incestuosa / Currently there is a great social mobilization involving the issue of sexual abuse, because of the phenomenon occurrence. WHO (World Health Organization) estimates that between 7-36% and 3-29% of girls and boys have already been sexually abused at some point in their lives. However, many cases of sexual abuse do not end up being revealed and reported, aggravating the situation by not having opportunity for treatment of those involved. Incest, sexual abuse that occurs within the family is a type of sexual violence and has a specific dynamic that not only has violence with the participants. This work is based on psychoanalytic view in order to understand the characteristics of incestuous family dynamics, wich the incestuous abuse indicates that there was a flaw in the mental structure of all members, marking a intra/inter subjective and relational as well beyond an aggressor/victim stigma. Goals of work: to reflect on these categories of mental functioning families, contemplated within the psychoanalytic theory and analysed data from an institutions archives that provides treatment for this population and compared to a questionnaire, wich product will be used to create an Inventory for detection of an incestuous activity

Adolescentes do sexo feminino são a população mais frequentemente acometida pela anorexia nervosa (AN), com prevalência média de 2,5%, quando considerados critérios diagnósticos adaptados para esta faixa etária. A apresentação da AN em adolescentes é semelhante a de adultos, no entanto existem particularidades nos sintomas relacionadas ao nível de desenvolvimento cognitivo e emocional. A AN manifesta-se por: perda de peso, perturbações na forma de vivenciar a forma corporal, medo de engordar, restrição alimentar, comportamentos compensatórios e alterações menstruais. No Brasil, existem poucos recursos especializados para o tratamento da AN na adolescência e não foram realizados previamente estudos sistematizados sobre o tema. Estudos realizados em países de língua inglesa demonstram que o tratamento familiar (TF) apresenta bons resultados no tratamento da AN em adolescentes. Este estudo tem como objetivo a comparação de efetividade e de custos entre o TF e o tratamento multidisciplinar (TM). Inicialmente foi realizado um estudo piloto, incluindo nove pacientes de 11 a 17 anos do sexo feminino com diagnóstico de AN, tratadas com o TF. Posteriormente foi realizado um estudo comparativo, com os mesmos critérios de inclusão, com 20 pacientes que receberam o TF e foram comparadas com um grupo-controle histórico de 24 pacientes tratadas com TM. Foram calculados os custos diretos de ambas as modalidades de tratamento. Foram utilizadas como medidas de avaliação: DAWBA, CGAS, EDE-Q. No estudo piloto, as variáveis peso, IMC, EDE-Q, CGAS e amenorreia foram comparadas antes e após o TF. Foram observados resultados estatisticamente significativos em recuperação de peso e IMC (p=0,036). Foi observada melhora das demais variáveis após o tratamento, no entanto estes resultados não foram estatisticamente significativos. No estudo comparativo, 75% das pacientes que receberam o TF e 62,5% das pacientes que receberam TM apresentaram recuperação dos sintomas de AN, sem diferença estatisticamente significativa entre os grupos (p=0,378). Ambos os grupos apresentaram recuperação de peso, IMC e CGAS satisfatórias após o tratamento, sem diferença estatisticamente significativa entre os grupos. Tanto no TF quanto no TM, o maior tempo de sintomas antes do início do tratamento interferiu negativamente na resposta ao tratamento, reduzindo a chance de recuperação dos sintomas. Os custos diretos do TM são aproximadamente o dobro dos custos do TF. Tanto o TF quanto o TM demonstraram-se alternativas efetivas de tratamento para AN ! na população estudada. No entanto, o custo do TM é consideravelmente maior. O TF é uma alternativa de tratamento efetiva e economicamente viável, podendo ser disseminado para outros centros, possibilitando maior acesso a tratamento para adolescentes com AN / Female adolescents are the population most frequently affected by anorexia nervosa (AN), with average prevalence of 2.5% when adapted diagnostic criteria for this age group are considered. AN presentation in adolescents is similar to that of adults, but there are peculiarities in symptoms related to the level of cognitive and emotional development. AN main symptoms are: weight loss, disturbance in the way body shape is experienced, fear of becoming fat, dietary restriction, compensatory behaviors and menstrual abnormalities. In Brazil, there are few specialized resources for AN treatment in adolescence and no previous systematic studies have been conducted on this theme. In English-speaking countries, some studies have shown that the family-based treatment (FBT) is effective for adolescent AN. The aim of this study is to compare the effectiveness and the costs between the FBT and the multidisciplinary treatment (MT). Initially, a pilot study was conducted, including nine female patients from 11 to 17 years old diagnosed with AN, and treated with FBT. It was later performed a comparative study with the same inclusion criteria. Twenty patients who received FBT were compared with a historical control group of 24 patients treated with MT. We calculated the direct costs of both treatment modalities. The evaluation measures were: DAWBA, CGAS, EDE-Q. In the pilot study, the variables weight, BMI, EDE-Q, CGAS and amenorrhea were compared before and after FBT. We observed statistically significant results in weight and BMI recovery (p=0.036). The other variables have improved after treatment, although results were not statistically significant. In the comparative study, 75% of patients receiving FBT and 62.5% of patients receiving MT recovered from AN symptoms, no statistically significant difference was found between groups (p=0.378). Both groups have shown satisfactory recovery of weight, BMI and CGAS after treatment, with no statistical significant difference between groups. Both in the FBT and in the MT, the greater duration of symptoms before starting treatment had negative influence on treatment response, reducing the chance of recovery. The direct costs of the MT are approximately twice the cost of the FBT. Both the FBT and the MT were shown to be effective for AN treatment in the study population. However, the costs of MT are considerably higher. The FBT is an effective and economically viable treatment alternative and, can be disseminated to other centers, allowing ! greater treatment access for adolescents with AN

The current study investigated how three distinct types of childhood abuse—witnessing of parental domestic violence, experiencing physical abuse and total in-home violence, and experiencing sexual abuse—predicted partner reports of relational violence through the mediating factors self-perceptions of attachment and partner reports of relational aggression. The study used paired dyadic data from 1,658 couples who had completed the RELATionship Evaluation (RELATE). The Family Violence, the Brief Accessibility and Responsiveness, Couples Relational Aggression and Victimization, and the Conflict Tactics scales were the measures used. Data was analyzed by using structural equation modeling to estimate an actor-partner interdependence model exploring these relationships. Results showed only female childhood sexual abuse had direct associations with male relational violence; however, several mediating paths were identified.

The purpose of this study was to investigate the relationship between relational aggression and sexual satisfaction, as well as the mediating role of attachment on this relationship. Data came from the Relationship Evaluation Survey (RELATE) comprised of the matched-pair responses of 797 couples in serious dating, engaged, or married relationships. Results showed the greater the perceived relational aggression the lower the sexual satisfaction for both self and partner, regardless of gender. Additionally, it appears a more satisfying sexual relationship can occur when an individual experiences a secure attachment base and can feel confident that his/her relationship is safe. For both genders, the more relationally aggressive behaviors reported, the lower the reports of secure attachment behaviors. Implications for clinicians and future research are discussed.

This pilot study examined the effectiveness of Emotionally Focused Couples Therapy (EFT) compared to Treatment As Usual (TAU) in improving cortisol functioning among distressed couples. It also investigated the role of gender in cortisol functioning. Measures for cortisol were collected at five time points, both at pre- and posttreatment. Data were collected from a total of 60 couples, 20 of which received EFT and 40 of which received TAU. Overall, results from a two-way analysis of variance suggest that there are no significant differences between men or women, nor among couples in EFT and TAU, in posttreatment cortisol functioning. Directions for future research are discussed.

Couple therapy is successful in treating relationship distress. However, couple therapy does not benefit everyone. Consequently, it is important to study factors that predict therapeutic success. One such factor is what predicts the development of the therapeutic alliance in couple therapy. The purpose of this study was to code therapist behaviors, therapist warmth, empathy, presence, validation, collaboration, and technique factors (systemically-based techniques and session structure), in the first session of couple therapy to examine their ability to predict two aspects of the therapeutic alliance, between- and within-alliance, after the session for males and females. The hypotheses were tested utilizing multiple one-way ANOVAs. Results indicated that none of the therapist variables predicted either of the outcome alliance variables for males or females. More research needs to be done to find what therapist behaviors predict the therapeutic alliance.