Magister en Psicología Clínica de Adultos / La presente investigación entrega una revisión conceptual acerca del abordaje psicoterapéutico grupal desde el modelo cognitivo conductual para los trastornos de pánico midiendo la efectividad de una propuesta de intervención psicoterapéutica grupal aplicada a un grupo piloto de pacientes del Hospital Adriana Cousiño de Quintero utilizando seis instrumentos de medición. Concluida la intervención, y contemplando un seguimiento a tres meses, se observaron cambios estadísticamente significativos cercanos al 50% de las mediciones comparadas y una reducción de los síntomas del pánico en todos los participantes, así como también una reducción de los síntomas agorafóbicas con respecto a situaciones evitadas. Al seguimiento de tres meses, ningún participante reportó la presencia de crisis de pánico sufridas / The present research provides a conceptual review of the group psychotherapeutic approach from the cognitive behavioral model for panic disorders by measuring the effectiveness of a proposal of group psychotherapeutic intervention applied to a pilot group of patients of the Hospital Adriana Cousiño de Quintero using six measuring instruments. After the intervention, with a three-month follow-up, statistically significant changes were observed close to 50% of the measurements compared and a reduction of panic symptoms in all participants, as well as a reduction of agoraphobic symptoms with respect to situations avoided. At the three-month follow-up, no participants reported the presence of panic attacks

El objetivo de esta investigación es mostrar la relación que existe entre el papel de la función paterna en la actualidad y la presencia de síntomas somáticos de origen psíquico, como son los ataques de pánico. Se intenta con ello, realizar un aporte a la comprensión de estos síntomas, que se encuentra básicamente conceptualizada desde la problemática de la díada madre-hijo. Para ello, se describen las características de estos síntomas y su ubicación en la cultura, así como se presentan los principales aportes conceptuales que se han desarrollado desde el psicoanálisis para su comprensión. Ellos son: la revisión del concepto de neurosis actual, el desamparo del Yo, la ruptura de la simbiosis y el cortocircuito de lo simbólico. Es esto último, lo que condujo la investigación hacia una profundización sobre la inclusión de la función paterna en esta problemática. Se revisan autores como Green (2009), Castoriadis (2005), Milmaniene (2004) y Dor (2004), para reflexionar sobre la relación que el declive en la función paterna podría tener en la manifestación de estos síntomas psicopatológicos, en los que falla precisamente la capacidad simbólica, función directamente asociada al padre / The aim of this investigation is to show the relation that exists between the paper of the paternal function at present and the presence of somatic symptoms of psychic origin, since they are the assaults of panic. This is an effort to realize a contribution to the comprehension of these symptoms, that mother - son is basically conceptualized from the problematics of the díada. For it, it will be described the characteristics of these symptoms and his location in the culture, as well as let's sense beforehand the principal conceptual contributions that have developed from the psychoanalysis for his comprehension. They are, the review of the concept of current neurosis, the abandonment of me, the break of the simbiosis and the short circuit of the symbolic thing. It is the above mentioned, which have led to a deepening on the paternal function. It have been reviewed authors like Green (2009), Castoriadis (2005), Milmaniene (2004) and Dor (2004), to reflect on the relationship that the decline in the paternal function could have in these manifestations of psychopathological symptoms, in which it trumps precisely the symbolic capacity, function directly associated with the father. / Tesis

El extravío espacial surgía con frecuencia como tema en las entrevistas realizadas desde 2007 a pobladores mapuche de los Andes neuquinos. Por una parte, al relatar la memoria familiar o comunitaria eran abundantes las referencias a personas que se habían “perdido” en sus huidas durante la Conquista del Desierto. Por otra, en conversaciones sobre cuestiones actuales, mis consultores daban significados particulares a la noción de “perderse” en su vida cotidiana. La intención que dio origen a esta investigación fue la de historizar los significados de esa noción y su relación con la salud mental. Se hizo evidente así que, insistiendo sobre el fenómeno del extravío espacial de los ancestros que debieron huir de los ataques del ejército, los entrevistados buscaban señalar los profundos padecimientos psíquicos que sobrevinieron a consecuencia de la violencia. Paralelamente, se llevó a cabo en este trabajo una revisión de la documentación oficial – publicada y no publicada– para investigar aquellos episodios y se halló que, cuando los rememoraban, también los ejecutores de las campañas militares habían otorgado un lugar importante al extravío espacial. Padeciéndolo efectivamente, temiéndolo o diciéndolo haber temido en sobremanera, los expedicionarios convirtieron al hecho de “perderse” en uno de los tópicos de sus crónicas. Esta recurrencia abrió una nueva línea de investigación. Se verificó así que estudiando la función narrativa del tópico del extravío era posible revisar a estos discursos castrenses con herramientas desarrolladas por los mitólogos. En las crónicas de sus protagonistas la Conquista fue narrada con recursos tradicionales y con imágenes consagradas desde la antigüedad, que se utilizaron, así mismo, para empujar al combate a la tropa. Confrontando además esas descripciones de los extravíos con los debates científicos que se planteaban en la época a propósito de la orientación espacial y con las discusiones de los psiquiatras desde 1870 sobre distintos tipos de extrañamiento espacial, es posible advertir la dimensión global que asumió el fenómeno en el último cuarto del siglo XIX: en todos los frentes coloniales se reportaban circunstancias comparables descritas en términos similares. Un tipo específico de ansiedad pareció irrumpir entre los conquistadores que constituyeron la avanzada del capitalismo. Su dependencia de guías locales para atravesar los territorios que buscaban conquistar y la incertidumbre geográfica fueron experimentadas con un vértigo que dejó amplia huella documental. En cuanto a la Conquista del Desierto, la revisión de las órdenes tácticas superiores y de los informes labrados desde el propio campo de batalla permite concluir que ese vértigo se convirtió en furor de combate y que existió el objetivo explícito de generar malestares psíquicos en la población atacada. La investigación cuyos resultados se presentan acá contribuye a los debates sobre el carácter genocida de la Conquista aportando pruebas de que 1) los ataques se dirigían con preferencia a la población no combatiente, y de que 2) se buscó deliberadamente generar padecimientos psíquicos entre la población atacada. Mediante herramientas teóricas psicoanalíticas tales como “pánico”, “identificación con el agresor” o “extrañamiento” y con perspectiva de género se contribuye también en este trabajo a indagar en la experiencia histórica de los prisioneros que pasaron a engrosar las filas del ejército. / The subject of being lost in the physical space came up in several interviews conducted on members of the Mapuche community since 2007, in the Andes in the Province of Neuquén, Argentina. On the one hand, when speaking of their family or community memories, they made frequent references to people who had “gotten lost” when escaping the Conquest of the Desert. On the other hand, when speaking of current events, the interviewees gave specific meanings to the notion of “being lost” in their daily lives. It is the intention of this paper to first historicize the meanings allocated to this notion and their relation to mental health. It became evident that, insisting on the phenomenon of their ancestors lost in the physical space escaping the army attacks, the interviewees where trying to draw attention to the deep psychical suffering ensued as a consequence of the violence. A revision of the official documents –published and non-published– was performed in parallel to investigate the events in question, and it was found that, when remembering these events, the officers that had participated in the military campaign had also given a prominent role to being lost in the physical space. Having genuinely suffered, feared or expressed having feared it tremendously, the expeditioners turned the fact of “being lost” into one of the topics of their chronicles. This recurrence opened a new line of investigation. It was soon verified that studying the narrative function of the subject of being lost, the military discourse could be analyzed by means of tools developed by the mythologists. In their chronicles, the people that led the Conquest used traditional resources and consecrated imagery from ancient times to tell their story; said imagery and resources were used as well to lead the troops into battle. Moreover, contrasting these descriptions about being lost with the scientific discussions of the time regarding spatial orientation and with the expert opinions of psychiatrists since 1870 regarding different types of spatial estrangement, it was easy to recognize the global dimension acquired by the phenomenon during the last quarter of the 19th century; all colonial fronts reported comparable circumstances described in similar ways. A specific type of anxiety seemed to take over the conquerors who were leading capitalism forward. The geographical uncertainty and their dependency on local guides to traverse the territories they intended to conquer were undergone with a sense of vertigo that left behind a vast paper trail. Regarding the Conquest of the Desert, the analysis of superior tactical orders and reports drafted in the battlefield lead to the conclusion that this vertigo turned into fury of battle, and that there existed a stated purpose of generating psychological discomfort in the target population. The results of the investigation contribute to the discussions on the genocidal character of the Conquest and put forward evidence that proves that 1) the attacks targeted mainly the non-fighting population, and 2) there was a deliberate intention to cause psychological suffering on the attacked communities. Using theoretical tools of psychoanalysis such as “panic”, “identification with the aggressor” and “estrangement” with a gender perspective, this paper contributes as well to the research into the historical experience of the prisoners taken in the process. / TEXTO PARCIAL en período de teletrabajo

Esta investigación corresponde a un estudio sistemático de caso único de un paciente que presenta ataques de pánico, en un proceso de psicoterapia de orientación psicoanalítica. El estudio tuvo como objetivo describir las capacidades estructurales del funcionamiento mental de un paciente con ataques de pánico, al inicio de un proceso de terapia dinámica interpersonal breve (DIT), utilizando como instrumento de evaluación el Eje IV del OPD- 2. Este instrumento permite evaluar las diferentes Capacidades, Subcapacidades y Dimensiones del funcionamiento estructural del sujeto, a partir del análisis de sus respectivas Dimensiones y sus niveles de integración referidos al Self y los Objetos. Los resultados obtenidos mostraron que el funcionamiento estructural del consultante presentó un nivel de integración Medio para la Capacidad Cognitiva, Capacidad de Manejo y Capacidad de vínculo. En el caso de la Capacidad emocional, el consultante obtuvo un nivel de integración Medio/Bajo. Asimismo, se evidenció que las Dimensiones de Uso de la Fantasía, Self Corporal, Internalización y Desprenderse de vínculos fueron las que presentaron niveles de integración más bajos. Las limitaciones y los alcances de esta investigación son discutidos sobre el final del estudio / This research corresponds to a systematic study of a single case of a patient who presents panic attacks on a process of psychoanalytically oriented psychotherapy. The objective of the study was to describe the structural elements of the mental functioning of a patient with panic attacks, at the beginning of a brief interpersonal dynamic therapy (DIT) process, using Axis IV of the OPD-2 as an evaluation instrument. This instrument allows to evaluate the different Capacities, Sub-capacities and Dimensions of the subject's structural functioning, based on the analysis of their respective Dimensions and their level of integration referred to the Self and the Objects. The results obtained showed that the structural functioning of the consultant presented a Medium level of integration for Cognitive Capacity, Management Capacity and Link Capacity. In the case of Emotional Capacity, the consultant obtained a Medium/Low level of integration. Likewise, it was evidenced that the Dimensions of Use of Fantasy, Bodily Self, Internalization and Letting go of ties were the ones that presented the lowest levels of integration. The limitations and scope of this research are discussed at the end of the study.

El objetivo de esta investigación es mostrar la relación que existe entre el papel de la función paterna en la actualidad y la presencia de síntomas somáticos de origen psíquico, como son los ataques de pánico. Se intenta con ello, realizar un aporte a la comprensión de estos síntomas, que se encuentra básicamente conceptualizada desde la problemática de la díada madre-hijo. Para ello, se describen las características de estos síntomas y su ubicación en la cultura, así como se presentan los principales aportes conceptuales que se han desarrollado desde el psicoanálisis para su comprensión. Ellos son: la revisión del concepto de neurosis actual, el desamparo del Yo, la ruptura de la simbiosis y el cortocircuito de lo simbólico. Es esto último, lo que condujo la investigación hacia una profundización sobre la inclusión de la función paterna en esta problemática. Se revisan autores como Green (2009), Castoriadis (2005), Milmaniene (2004) y Dor (2004), para reflexionar sobre la relación que el declive en la función paterna podría tener en la manifestación de estos síntomas psicopatológicos, en los que falla precisamente la capacidad simbólica, función directamente asociada al padre / The aim of this investigation is to show the relation that exists between the paper of the paternal function at present and the presence of somatic symptoms of psychic origin, since they are the assaults of panic. This is an effort to realize a contribution to the comprehension of these symptoms, that mother - son is basically conceptualized from the problematics of the díada. For it, it will be described the characteristics of these symptoms and his location in the culture, as well as let's sense beforehand the principal conceptual contributions that have developed from the psychoanalysis for his comprehension. They are, the review of the concept of current neurosis, the abandonment of me, the break of the simbiosis and the short circuit of the symbolic thing. It is the above mentioned, which have led to a deepening on the paternal function. It have been reviewed authors like Green (2009), Castoriadis (2005), Milmaniene (2004) and Dor (2004), to reflect on the relationship that the decline in the paternal function could have in these manifestations of psychopathological symptoms, in which it trumps precisely the symbolic capacity, function directly associated with the father.

La siguiente investigación es un estudio cualitativo de caso único que busca comprender cómo operan los mecanismos de defensa en las configuraciones relacionales de un paciente con ataques de pánico en las tres primeras sesiones dentro de una psicoterapia psicoanalítica breve basada en la Terapia Dinámica Interpersonal. Para ello, se usó el CCRT-LU-S para determinar los episodios relacionales y el Defense Mechanism Rating Scale (DMRS) para identificar los mecanismos de defensa en la narrativa del paciente. Se establecieron cuatro configuraciones relacionales y se tomaron en cuenta los mecanismos de defensa que se encontraron dentro de dichas configuraciones. En las configuraciones centradas en la vivencia del cuerpo, donde el cuerpo es tomado como un objeto, se identificaron mecanismos de defensa como la disociación, represión, anulación, racionalización, hipocondría y aislamiento. El mecanismo de idealización se hace presente cuando se trata de preservar el vínculo, así como la anulación y la formación reactiva para protegerse de la ira y de su propia fragilidad. En una misma configuración se ha podido observar distintos movimientos defensivos, como la negación, racionalización y anulación cuando se trata de la figura paterna, y el uso de mecanismos más inmaduros, como la agresión pasiva y la identificación proyectiva cuando se trata de figuras maternas. Sólo se encontró dos mecanismos de un nivel más elevado, altruismo y afiliación. Se pudo observar que los episodios relacionales contenían mecanismos defensas, y con ello, poner en evidencia que los mecanismos de defensa se despliegan dentro de una dinámica relacional y no sólo como una respuesta a conflictos psíquicos internos. / The following research is a qualitative single case study that seeks to understand how defense mechanisms operate in the relational configurations of a patient with panic attacks within a brief psychoanalytic psychotherapy based on Dynamic Interpersonal Therapy. For this, the CCRT-LUS was used to determine the relational episodes and the Defense Mechanism Rating Scale (DMRS) to identify the defense mechanisms in the patient's narrative. Four relational configurations were established and the defense mechanisms found within these configurations were taken into account. In configurations centered on the experience of the body, where the body is taken as an object, defense mechanisms such as dissociation, repression, undoing, rationalization, hypochondria and isolation were identified. The idealization mechanism is present when it comes to preserving the attachment, as well as undoing and reaction formation training to protect yourself from anger and your own fragility. In the same configuration it has been possible to observe different defensive movements, such as denial, rationalization and undoing when it comes to his father figure, and the use of more immature mechanisms, such as passive aggression and projective identification when it comes to maternal figures. Only two mechanisms of a higher level were found, altruism and affiliation. It was possible to observe that the relational episodes contained defense mechanisms, and thus, show that defense mechanisms are deployed within a relational dynamic and not only as a response to internal psychic conflicts.

El estudio tiene el propósito de analizar y comprender el cambio en el patrón relacional de un paciente con sintomatología ansiosa entre la fase inicial y final de un proceso de psicoterapia breve de orientación psicoanalítica. Se utilizó el CCRT-LU-S para la delimitación de los episodios relacionales de las tres primeras y últimas sesiones; y a partir de ellos, se procedió a utilizar el Eje II Relación del OPD-2. Correspondiente a la fase inicial, se encontró que los ítems que conformaban el patrón relacional del consultante eran de carácter disfuncional, siendo la necesidad de aferrarse al otro y tomar distancia las temáticas centrales en su problemática. Se pudo obsevar que este patrón maladaptativo provocaba en el consultante sentimientos de soledad y abandono por parte de los otros, lo que provocaba que éste tome distancia de ellos y así, que el patrón se repita. Se encontró también que el patrón relacional provocaba y mantenía la sintomatología ansiosa, ya que los sentimientos de abandono y soledad en el consultante funcionaban como gatillos para sus ataques de pánico. Respecto a la fase final, los resultados evidenciaron un cambio en el patrón relacional del consultante, donde se observó una mayor apertura a recibir ayuda, así como mantener distancias adecuadas en la relación con los otros, lo que finalmente tuvo un impacto en la reducción de la sintomatología ansiosa del consultante. / The purpose of this study is to analyze and comprehend the change in the relational patterns of a patient with anxious symptomatology between the initial and final phase of a brief psychoanalytic psychotherapy. The CCRT-LU-S was used to delimit the relational episodes of the first and last three sessions; and then, we proceeded to use the Axis II Relation of the OPD-2. Corresponding to the initial phase, it was found that the items that made up the consultant’s relational pattern were mainly dysfunctional, with the need to cling to others and take distance being the central themes in this pattern. It was observed that this maladaptive pattern provoked in the consultant feelings of loneliness and being abandoned by others, which caused him to distance himself from them and thus, the pattern repeats itself. It was also found that the relational pattern provoked and maintained the anxious symptomatology, since the feelings of abandonment and loneliness in the consultant acted as triggers for his panic attacks. Regarding the final phase, the results showed a change in the relational pattern of the consultant, where a greater openness to receiving help was observed, as well as maintaining adequate distances in the relationship with others, which overall had an impact on the reduction of the anxious symptomatology of the consultant.

El objetivo de la presente investigación fue describir los deseos, necesidades y demandas relacionales más frecuentes de un consultante con crisis de pánico en interacción con sus figuras significativas. Esta investigación es un estudio sistemático de caso único que utilizó como material las transcripciones literales de las tres primeras sesiones efectivas al interior de un proceso terapéutico breve de enfoque dinámico. Esta investigación utilizó como instrumento de análisis el método CCRT en base al manual de Espinosa y Valdés (2012). A partir de la data obtenida se realizó un análisis temático cualitativo de la naturaleza explícita e implícita, así como los objetos de interacción y su respectiva direccionalidad. Se encontró que los deseos, necesidades y demandas del consultante tenían una prevalencia hacia su madre con deseos que contenían fundamentalmente su necesidad de cercanía. El análisis de los deseos coincide con teoría que explica el trastorno de pánico, el apego y la angustia de separación. / The aim of the present research was to describe the most frequent relational wishes, needs and demands of a consultant with panic attacks in interaction with his significant figures. This research is a systematic single case study that used the verbatim transcripts of the first three effective sessions within a brief therapeutic process with a dynamic approach. This study used the CCRT method as an instrument of analysis based on the manual by Espinosa and Valdés (2012). From the data obtained, a qualitative thematic analysis of the explicit and implicit nature of the wishes was carried out, as well as the objects of interaction and their respective directionality. It was found that the wishes, needs and demands of the consultant had a prevalence towards his mother with wishes that fundamentally contained his need for closeness. The analysis of the wishes has a correspondence with theory that explains panic disorder, attachment and separation anxiety

La presente investigación busca profundizar en la comprensión del ataque de pánico y el trastorno de pánico desde la perspectiva psicoanalítica, manteniendo interés en el acercamiento a las dinámicas vinculares. Se tiene como objetivo identificar los episodios relacionales y describir las configuraciones relacionales presentes en las tres primeras sesiones de un proceso de psicoterapia psicoanalítica breve con un paciente adulto joven que presenta trastorno de pánico. Se identificaron los episodios relacionales mediante los criterios flexibilizados del CCRT Lu S y se empleó el método de análisis cualitativo temático para el análisis de las configuraciones relacionales halladas. Los resultados confirman los hallazgos empíricos sobre los rasgos característicos de relación presentes en los sujetos que padecen de ataques de pánico, manteniendo a su vez coherencia con las postulaciones desde la teoría psicoanalítica. / The present research seeks to deepen the understanding of panic attack and panic disorder from a psychoanalytic perspective, maintaining an interest in the approach to bond dynamics. The aim is to identify the relational episodes and to describe the relational configurations present in the first three sessions of a brief psychoanalytic psychotherapy process with a young adult patient presenting panic disorder. The relational episodes were identified using the CCRT Lu S flexibilized criteria and the qualitative thematic analysis method was used for the analysis of the relational configurations found. The results confirm the empirical findings on the characteristic relational features present in subjects suffering from panic attacks, while maintaining coherence with the postulations from psychoanalytic theory.

The present doctoral thesis arises from my own experience working within the juvenile justice system. It was in this context where I met minors who had assaulted their parents. The attempt to explain the rapid development of this type of violence and to analyze the interpretations that were emerging lays the groundwork for this work. Therefore, the origin of this work is not disconnected from professional practice and the contact with these minors and their families. The term child to parent violence (CPV) refers to aggressions that parents experience, perpetrated by their children. This concept is specifically used to refer to aggressions by young children, therefore, it is different from the violence suffered by elderly people. In the case of Spain, on occasions it is limited to the age of criminal responsibility, which comprises the ages from 14 to 17 years old. Nonetheless, there are also investigations interested as well for this violence in aggressors younger than 14 years old or young adults. The interest on CPV has been experiencing a meaningful increase over the last two decades; particularly significant in Spain. This type of violence has rapidly evolved from being practically unknown and absent from reference works on family violence to expanding its relevance to varied ambits. Therefore, the works presented next illustrate the approach to CPV from its impact on the academic ambit, the influence on the public system of intervention with the families and the minors, where the child protection service and the juvenile justice system take place, and, lastly, the public ambit. In this last section, the works included have investigated the reaction from the traditional media and the population of Twitter users, among who can be found professionals, institutions and population, in general. The number of academic publications on this type of aggression towards parents escalated simultaneously with the concern of the public institutions that dealt with the minors and their families. During the last years of the first decade in this century, the statistics provided by the Juvenile Prosecution service reflected a significant increment on the amount of minors diverted to the juvenile justice system by cause of assaults towards their progenitors. This rise became significant in a brief period of time, less than a decade. This phenomenon triggered a social reaction that involved both academic and socio-legal ambits, and the public opinion. The following dissertation articulates an interpretation from a sociological perspective to understand the origin of this violence and its social reaction. To achieve this, it proposes a paradigmatic change in the approach of the study of this violence, detaching itself from a positivist perspective centered on the minor’s characteristics. Instead, it focuses on the need for a constructivist comprehension of the minor as an aggressor. At the same time, it adopts a critical position as it incorporates to the analysis the institution’s role in the future of this social phenomenon. The methods used to understand the CPV include the comparison of the data obtained from different sources, both official and obtained from social studies, due to the particularity of the official data, and that this type of data encounters to reflect the real tendency of certain criminal forms. In this context, it is understood the evolution of the figures provided by the public institutions in the action and political decisions reflected in the legal reforms of the juvenile justice system. In addition to this, an analysis on content and critical discourse analysis (CDA) have been done with the data obtained from Twitter, to explore the public opinion on this issue. Adopting a critical posture has endured identifying the main agents and subjects from that discourse, as well as its relationship with the underlying ideology and the social practices associated with it. Therefore, it can be possible to explain the causes behind the rise of these cases of violence and their diversion to the juvenile justice system. The conclusions of this dissertation offer a new interpretation of the development of the CPV in Spain and the social reaction that reveals the influence of the process of legal reform and the subsequent judicialization of certain behaviors. Along with the modification of the criminal legislation of the minors, a social reaction emerges; where the interest of a certain group of social agents that have controlled the discourse on this matter, have priority. The most recent data provided by the Juvenile Prosecution service reflect a drop of the figures, while the numerous publications on the recurrence of this violence do not allow us to conclude that it is rising. Moreover, numerous investigations expose the presence of other forms of family violence previous to the CPV and that oppose stigmatizing conceptions of these minors that had been formed due to some publications. The key question that guides the dissertation is : What has happened in Spain so that in less than a decade, the CPV has evolved from being unknown to generating social concern, and that institutions with so much influence and status such as the Juvenile Prosecution service refer to the lack of social values and the incapacity of families to educate their children? The works included next answer this question from different perspectives under the conception of it being an evaded question until this moment and that, however, it is considered fundamental to be able to understand the characteristics of this violence. Consequently, it is considered that these works add a complementary vision that enriches the perspectives approached until nowadays.