Esta tese teve como objetivo geral analisar o fenômeno do abandono em psicoterapia psicanalítica (PP) através de metodologia qualitativa. Para tanto, três artigos foram realizados identificando características de inicio e término de tratamento de pacientes adultos classificados por seus psicoterapeutas como pacientes que abandonaram a PP, em um serviço de atendimento da cidade de Porto Alegre/Brasil, cujo objetivo principal é a formação de especialistas em PP. Foi utilizado em todos os estudos o método de Bardin (1995) para analisar o conteúdo das entrevistas iniciais de tratamento, encontradas no arquivo do serviço de atendimento, e das entrevistas pós-tratamento realizadas pela autora da tese. O primeiro artigo apresenta a análise do tratamento de seis mulheres que abandonaram a PP. Objetivos pouco claros de tratamento, fraca disposição para mudar, sinais precoces de transferência negativa e resistência, e ausência de reconhecimento da própria participação nos problemas são fatores que surgiram no início da psicoterapia. Ganhos terapêuticos, insatisfação e resistência durante o processo psicoterapêutico pareceram estar associados ao abandono. O segundo artigo revela os achados dos tratamentos de cinco pacientes que abandonaram a PP e de cinco que a completaram. Pacientes que abandonaram a PP apresentaram no início do tratamento: objetivos e expectativas focalizadas, fraca disposição para mudar, capacidade de insight diminuída, percepção negativa dos tratamentos anteriores, e manifestações significativas de transferência negativa e resistência. Por outro lado, pacientes que completaram a PP possuíam metas e expectativas de psicoterapia relacionada com aspectos mais amplos da vida, foram menos resistentes para começar o tratamento, apresentaram maior disposição de mudar, transferência mais positiva, e níveis mais elevados de percepção e de satisfação com o tratamento anterior. Durante o tratamento, pacientes que completaram a PP foram menos resistentes e estavam mais satisfeitos com a psicoterapia, referiram benefícios mais eficazes e alcançaram maior capacidade de continuar trabalhando em problemas psicológicos, em comparação com os pacientes que abandonaram a PP. E o terceiro artigo, mostra os dados encontrados nos tratamentos de pacientes que abandonaram a PP em diferentes momentos da psicoterapia. Sete pacientes de tempo de abandono médio (AM- dois a 11 meses após o início da psicoterapia) comparados com sete pacientes de tempo de abandono tardio (AT- mais de um ano após o início) foram identificados como aqueles que iniciaram o tratamento mais por indicação de terceiros do que por conta própria, apresentando maior resistência, com expectativas de mais apoio, menor transferência positiva, mais queixas depressivas e experiências negativas com tratamentos anteriores. Na entrevista pós-tratamento revelaram mais resistência durante o processo de psicoterapia. Abandonaram a psicoterapia com menor capacidade de insight, avaliaram mais negativamente o tratamento tanto nos aspectos gerais como nos específicos. Embora distinções tenham sido observadas, entende-se que a diferenciação das características dos grupos de AM e AT é tênue e necessita de mais investigações. Esta tese oferece algumas hipóteses ou explicações para o complexo fenômeno do abandono da PP. Sugere que as decisões de iniciar, abandonar ou completar a psicoterapia dependem de múltiplos fatores, tais como: definição de metas e objetivos estabelecidos em conjunto pela dupla paciente/psicoterapeuta, disposição para empreender mudanças, capacidade de insight que implica em reconhecimento da condição psíquica e da participação nos problemas, resistência, transferência e experiência vivenciada em tratamento anterior. Os resultados obtidos nesta tese são exploratórios necessitando mais estudos nessa área. / This thesis had as general objective to analyze the phenomenon of dropout in psychoanalytic psychotherapy (PP) through qualitative methodology. To do so, three articles were written identifying characteristics of beginning and end of treatment of adult patients who were classified by their psychotherapists as patients who dropped out the PP, in a service of attendance in the city of Porto Alegre/Brazil, whose main objective is the formation of specialists in PP. The Bardin’s method (1995) was used in all the studies to analyze the content of the initial interviews of treatment, which were found in the file of the attendance service, and of the post-treatment interviews accomplished by the authoress of the thesis. The first article presents the analysis of treatment of six women who dropped out the PP. Factors that came up in the beginning of the psychotherapy were: unclear objectives of the treatment, weak readiness to change, precocious signs of negative transference and resistance and absence of recognition about the own participation in the problems. Therapeutic gains, dissatisfaction and resistance during the therapeutic process seemed to be associated to the dropout. The second article reveals the findings of the treatments of five patients who dropped out the PP and other five who completed it. Patients who dropped out the PP presented in the beginning of the treatment: focalized objectives and expectations, weak disposition to change, decreased capacity for insight, negative perception of the previous treatments and meaningful manifestations of negative transference and resistance. On the other hand, patients who completed the PP had goals and expectations of psychotherapy related to wider aspects of life, were less resistant to begin the treatment, presented a bigger disposition to change, more positive transference and higher levels of perception and satisfaction concerning the previous treatment. During the treatment, patients who completed the PP were less resistant and were more satisfied about the psychotherapy, referred more effective benefits and reached a bigger capacity to continue working in psychological problems if compared to patients who dropped out the PP. And the third article shows the data found in treatments of patients who dropped out the PP in different moments of the therapy. Seven patients of medium time of dropout (MD - two to eleven months after the beginning of the psychotherapy) compared to seven patients of late time of dropout (LD - more than one year after the beginning) were identified as the ones who started the treatment by indication of others more than by their own, presenting more resistance, with expectations of more support, less positive transference, more depressive complains and negative experiences about the previous treatments. In the post-treatment interview they revealed more resistance during the process of psychotherapy. They dropped out the psychotherapy with minor capacity of insight, evaluated the treatment in a more negative way concerning its general aspects as well as the specific ones. Although distinctions have been observed, it is understood that the differentiation of the characteristics of the groups of MD and LD is tenuous and it needs more investigation. This thesis offers some hypothesis or explanations for the complex phenomenon of dropout of PP. It suggests that the decisions about initiate, dropping out, or completing the psychotherapy depend on multiple factors, such as: definition of marks and objectives established in partnership (patient/psychotherapist), disposition to undertake changes, capacity of insight which implies in recognition of the psychic condition and the participation of problems, resistance, transference and experience that were experienced in previous treatment. The results which were obtained in this thesis are exploratory and it is necessary to study more in this area.

Esta tese teve como objetivo geral analisar o fenômeno do abandono em psicoterapia psicanalítica (PP) através de metodologia qualitativa. Para tanto, três artigos foram realizados identificando características de inicio e término de tratamento de pacientes adultos classificados por seus psicoterapeutas como pacientes que abandonaram a PP, em um serviço de atendimento da cidade de Porto Alegre/Brasil, cujo objetivo principal é a formação de especialistas em PP. Foi utilizado em todos os estudos o método de Bardin (1995) para analisar o conteúdo das entrevistas iniciais de tratamento, encontradas no arquivo do serviço de atendimento, e das entrevistas pós-tratamento realizadas pela autora da tese. O primeiro artigo apresenta a análise do tratamento de seis mulheres que abandonaram a PP. Objetivos pouco claros de tratamento, fraca disposição para mudar, sinais precoces de transferência negativa e resistência, e ausência de reconhecimento da própria participação nos problemas são fatores que surgiram no início da psicoterapia. Ganhos terapêuticos, insatisfação e resistência durante o processo psicoterapêutico pareceram estar associados ao abandono. O segundo artigo revela os achados dos tratamentos de cinco pacientes que abandonaram a PP e de cinco que a completaram. Pacientes que abandonaram a PP apresentaram no início do tratamento: objetivos e expectativas focalizadas, fraca disposição para mudar, capacidade de insight diminuída, percepção negativa dos tratamentos anteriores, e manifestações significativas de transferência negativa e resistência. Por outro lado, pacientes que completaram a PP possuíam metas e expectativas de psicoterapia relacionada com aspectos mais amplos da vida, foram menos resistentes para começar o tratamento, apresentaram maior disposição de mudar, transferência mais positiva, e níveis mais elevados de percepção e de satisfação com o tratamento anterior. Durante o tratamento, pacientes que completaram a PP foram menos resistentes e estavam mais satisfeitos com a psicoterapia, referiram benefícios mais eficazes e alcançaram maior capacidade de continuar trabalhando em problemas psicológicos, em comparação com os pacientes que abandonaram a PP. E o terceiro artigo, mostra os dados encontrados nos tratamentos de pacientes que abandonaram a PP em diferentes momentos da psicoterapia. Sete pacientes de tempo de abandono médio (AM- dois a 11 meses após o início da psicoterapia) comparados com sete pacientes de tempo de abandono tardio (AT- mais de um ano após o início) foram identificados como aqueles que iniciaram o tratamento mais por indicação de terceiros do que por conta própria, apresentando maior resistência, com expectativas de mais apoio, menor transferência positiva, mais queixas depressivas e experiências negativas com tratamentos anteriores. Na entrevista pós-tratamento revelaram mais resistência durante o processo de psicoterapia. Abandonaram a psicoterapia com menor capacidade de insight, avaliaram mais negativamente o tratamento tanto nos aspectos gerais como nos específicos. Embora distinções tenham sido observadas, entende-se que a diferenciação das características dos grupos de AM e AT é tênue e necessita de mais investigações. Esta tese oferece algumas hipóteses ou explicações para o complexo fenômeno do abandono da PP. Sugere que as decisões de iniciar, abandonar ou completar a psicoterapia dependem de múltiplos fatores, tais como: definição de metas e objetivos estabelecidos em conjunto pela dupla paciente/psicoterapeuta, disposição para empreender mudanças, capacidade de insight que implica em reconhecimento da condição psíquica e da participação nos problemas, resistência, transferência e experiência vivenciada em tratamento anterior. Os resultados obtidos nesta tese são exploratórios necessitando mais estudos nessa área. / This thesis had as general objective to analyze the phenomenon of dropout in psychoanalytic psychotherapy (PP) through qualitative methodology. To do so, three articles were written identifying characteristics of beginning and end of treatment of adult patients who were classified by their psychotherapists as patients who dropped out the PP, in a service of attendance in the city of Porto Alegre/Brazil, whose main objective is the formation of specialists in PP. The Bardin’s method (1995) was used in all the studies to analyze the content of the initial interviews of treatment, which were found in the file of the attendance service, and of the post-treatment interviews accomplished by the authoress of the thesis. The first article presents the analysis of treatment of six women who dropped out the PP. Factors that came up in the beginning of the psychotherapy were: unclear objectives of the treatment, weak readiness to change, precocious signs of negative transference and resistance and absence of recognition about the own participation in the problems. Therapeutic gains, dissatisfaction and resistance during the therapeutic process seemed to be associated to the dropout. The second article reveals the findings of the treatments of five patients who dropped out the PP and other five who completed it. Patients who dropped out the PP presented in the beginning of the treatment: focalized objectives and expectations, weak disposition to change, decreased capacity for insight, negative perception of the previous treatments and meaningful manifestations of negative transference and resistance. On the other hand, patients who completed the PP had goals and expectations of psychotherapy related to wider aspects of life, were less resistant to begin the treatment, presented a bigger disposition to change, more positive transference and higher levels of perception and satisfaction concerning the previous treatment. During the treatment, patients who completed the PP were less resistant and were more satisfied about the psychotherapy, referred more effective benefits and reached a bigger capacity to continue working in psychological problems if compared to patients who dropped out the PP. And the third article shows the data found in treatments of patients who dropped out the PP in different moments of the therapy. Seven patients of medium time of dropout (MD - two to eleven months after the beginning of the psychotherapy) compared to seven patients of late time of dropout (LD - more than one year after the beginning) were identified as the ones who started the treatment by indication of others more than by their own, presenting more resistance, with expectations of more support, less positive transference, more depressive complains and negative experiences about the previous treatments. In the post-treatment interview they revealed more resistance during the process of psychotherapy. They dropped out the psychotherapy with minor capacity of insight, evaluated the treatment in a more negative way concerning its general aspects as well as the specific ones. Although distinctions have been observed, it is understood that the differentiation of the characteristics of the groups of MD and LD is tenuous and it needs more investigation. This thesis offers some hypothesis or explanations for the complex phenomenon of dropout of PP. It suggests that the decisions about initiate, dropping out, or completing the psychotherapy depend on multiple factors, such as: definition of marks and objectives established in partnership (patient/psychotherapist), disposition to undertake changes, capacity of insight which implies in recognition of the psychic condition and the participation of problems, resistance, transference and experience that were experienced in previous treatment. The results which were obtained in this thesis are exploratory and it is necessary to study more in this area.

L’expression des gènes est un ensemble hautement régulé de mécanismes ayant pour objectifs de synthétiser les protéines fonctionnelles dont la cellule a besoin à partir des codes inscrits dans l’ADN. Pour contrôler la quantité de signal utilisé et pour que ce message puisse physiquement traverser la cellule, celle-ci utilise la transcription des ARN messagers comme intermédiaire. Pour assurer la qualité de ce signal et pour contrôler son niveau d’expression, plusieurs mécanismes de dégradation des ARNm se coordonnent dans les organismes en fonction de leurs spécificités propres. La littérature a depuis longtemps démontré les liens entre les machineries de synthèse des ARNm et celles de leur dégradation en identifiant comment ceux-ci travaillent ensemble pour assurer une bonne régulation génique. Un de ces mécanismes induit une terminaison dans la région non-codante en 3’ de certains gènes à partir d’un clivage par la ribonucléase III. Dans ce mémoire, nous voulons démontrer qu’un mécanisme similaire dépendant de la ribonucléase III peut induire une terminaison prémature de la transcription à l’intérieur même de séquences codantes. Ce mécanisme semble être indépendant du promoteur et du terminateur des gènes, préférant réguler sa sélectivité à partir de la structure liée au clivage de l’ARNm. Plusieurs séquences et structures sous forme de tige-boucles d’ARNm peuvent être reconnues par la ribonucléase III. Cependant, il existe des différences fonctionnelles entre les différentes tige-boucles et toutes n’induisent pas un mécanisme de terminaison prématurée. Comme ce type de mécanisme doit être inductible et/ou permissible afin de ne pas empêcher complètement l’expression des gènes cibles, nous pouvons potentiellement faire affaire à un nouveau modèle de régulation génique. / Abstract : Gene expression is a highly regulated coordination of processes with the objective of producing functional proteins from the DNA code of the cell. To control the amount of proteins produced, cells use messenger RNAs as an intermediate to permit genomic information to move across the cell. To assure the quality of this signal and to control the level of gene expression, many RNA degradation mechanisms coordinate together according to their own specificities. Scientific literature has demonstrated long ago the existing interactions between RNA synthesis and RNA degradation pathways and how they closely work together to achieve viable gene expression regulation. One of those mechanisms induces transcription termination in the 3’ untranscribed region of coding genes initiated with a RNA cleavage from a ribonuclease III. In this master thesis, we show that a similar RNase III dependent mechanism can induce premature transcription termination inside the coding sequence. This mechanism seems promotor and terminator independent and depends mostly on the sequence coding for a stem-loop structure in the mRNA. Different sequences can induce a stem-loop structure recognizable by RNase III. However, there are some functional differences between stem-loop structures and not all of them can induce premature transcription termination. Since this mechanism must not happen every time and somehow must be inducible to permit gene expression when needed, this could possibly lead to a new gene regulation model.

No description available.

The peroxisome is a subcellular organelle that carries out a diverse range of metabolic functions, including the b-oxidation of very long chain fatty acids, the breakdown of peroxide and the a-oxidation of fatty acids. Disruption of peroxisome metabolic functions leads to severe disease in humans. These diseases can be broadly grouped into two categories: those in which a single enzyme is defective, and those known as the peroxisome biogenesis disorders (PBDs), which result from a generalised failure to import peroxisomal matrix proteins (and consequently result in disruption of multiple metabolic pathways). The PBDs result from mutations in PEX genes, which encode protein products called peroxins, required for the normal biogenesis of the peroxisome. PEX1 encodes an AAA ATPase that is essential for peroxisome biogenesis, and mutations in PEX1 are the most common cause of PBDs worldwide. This study focused on the identification of mutations in PEX1 in an Australasian cohort of PBD patients, and the impact of these mutations on PEX1 function. As a result of the studies presented in this thesis, twelve mutations in PEX1 were identified in the Australasian cohort of patients. The identified mutations can be broadly grouped into three categories: missense mutations, mutations directly introducing a premature termination codon (PTC) and mutations that interrupt the reading frame of PEX1. The missense mutations that were identified were R798G, G843D, I989T and R998Q; all of these mutations affect amino acid residues located in the AAA domains of the PEX1 protein. Two mutations that directly introduce PTCs into the PEX1 transcript (R790X and R998X), and four frameshift mutations (A302fs, I370fs, I700fs and S797fs) were identified. There was also one mutation found in an intronic region (IVS22-19A>G) that is presumed to affect splicing of the PEX1 mRNA. Three of these mutations, G843D, I700fs and G973fs, were found at high frequency in this patient cohort. At the commencement of these studies, it was hypothesised that missense mutations would result in attenuation of PEX1 function, but mutations that introduced PTCs, either directly or indirectly, would have a deleterious effect on PEX1 function. Mutations introducing PTCs are thought to cause mRNA to be degraded by the nonsense-mediated decay of mRNA (NMD) pathway, and thus result in a decrease in PEX1 protein levels. The studies on the cellular impact of the identified PEX1 mutations were consistent with these hypotheses. Missense mutations were found to reduce peroxisomal protein import and PEX1 protein levels, but a residual level of function remained. PTC-generating mutations were found to have a major impact on PEX1 function, with PEX1 mRNA and protein levels being drastically reduced, and peroxisomal protein import capability abolished. Patients with two missense mutations showed the least impact on PEX1 function, patients with two PTC-generating mutations had a severe defect in PEX1 function, and patients carrying a combination of a missense mutation and a PTC-generating mutation showed levels of PEX1 function that were intermediate between these extremes. Thus, a correlation between PEX1 genotype and phenotype was defined for the Australasian cohort of patients investigated in these studies. For a number of patients, mutations in the coding sequence of one PEX1 allele could not be identified. Analysis of the 5' UTR of this gene was therefore pursued for potential novel mutations. The initial analyses demonstrated that the 5' end of PEX1 extended further than previously reported. Two co-segregating polymorphisms were also identified, termed –137 T>C and –53C>G. The -137T>C polymorphism resided in an upstream, in-frame ATG (termed ATG1), and the possibility that the additional sequence represented PEX1 coding sequence was examined. While both ATGs were found to be functional by virtue of in vitro and in vivo expression investigations, Western blot analysis of the PEX1 protein in patient and control cell extracts indicated that physiological translation of PEX1 was from the second ATG only. Using a luciferase reporter approach, the additional sequence was found to exhibit promoter activity. When examined alone the -137T>C polymorphism exerted a detrimental effect on PEX1 promoter activity, reducing activity to half that of wild-type levels, and the -53C>G polymorphism increased PEX1 promoter activity by 25%. When co-expressed (mimicking the physiological condition) these polymorphisms compensated for each other to bring PEX1 promoter activity to near wild-type levels. The PEX1 mutations identified in this study have been utilised by collaborators at the National Referral Laboratory for Lysosomal, Peroxisomal and Related Genetic Disorders (based at the Women's and Children's Hospital, Adelaide), in prenatal diagnosis of the PBDs. In addition, the identification of three common mutations in Australasian PBD patients has led to the implementation of screening for these mutations in newly referred patients, often enabling a precise diagnosis of a PBD to be made. Finally, the strong correlation between genotype and phenotype for the patient cohort investigated as part of these studies has generated a basis for the assessment of newly identified mutations in PEX1.

The chimpanzee is humankind’s closest living relative and the two species diverged ~6 million years ago. Comparative studies of the human and chimpanzee genomes and transcriptomes are of great interest to understand the molecular mechanisms of speciation and the development of species-specific traits. The aim of this thesis is to characterize differences between the two species with regard to their genome sequences and the resulting transcript profiles. The first two papers focus on indel divergence and in particular, indels causing premature termination codons (PTCs) in 8% of the chimpanzee genes. The density of PTC genes is correlated with both the distance to the telomere and the indel divergence. Many PTC genes have several associated transcripts and since not all are affected by the PTC we propose that PTCs may affect the pattern of expressed isoforms. In the third paper, we investigate the transcriptome divergence in cerebellum, heart and liver, using high-density exon arrays. The results show that gene expression differs more between tissues than between species. Approximately 15% of the genes are differentially expressed between species, and half of the genes show different splicing patterns. We identify 28 cassette exons which are only included in one of the species, often in a tissue-specific manner. In the fourth paper, we use massive parallel sequencing to study the chimpanzee transcriptome in frontal cortex and liver. We estimate gene expression and search for novel transcribed regions (TRs). The majority of TRs are located close to genes and possibly extend the annotations. A subset of TRs are not found in the human genome. The brain transcriptome differs substantially from that of the liver and we identify a subset of genes enriched with TRs in frontal cortex. In conclusion, this thesis provides evidence of extensive genomic and transcriptomic variability between human and chimpanzee. The findings provide a basis for further studies of the underlying differences affecting phenotypic divergence between human and chimpanzee.

No description available.

Exploration of factors that lead to early termination of therapeutic services to sexually abused children at TygerBear Unit. Some children referred to TygerBear Unit because of sexual abuse did not complete their therapeutic intervention programmes and possibly did not receive sufficient time to work through the trauma of sexual abuse. The purpose of this qualitative study was to explore and describe the factors that result in the early termination of sexually abused children’s therapeutic services at TygerBear Unit. Applied research that is exploratory and descriptive in nature, with the case study method as strategy, was followed. Data were collected through telephonic and/or one-on-one semi-structured interviews, in addition to the use of notes in personal records. Respondents included parents and/or caregivers of children whose therapy was terminated early, as well as social workers involved with play therapeutic service delivery to these children. Information was analysed with reference to the Field Theory, Ecological Theory and the relevant literature. Several factors that influenced parents and/or caregivers to terminate therapeutic services early were identified. / Die verkenning van faktore wat lei tot voortydige terminering van terapeutiese dienslewering aan seksueel-mishandelde kinders by TygerBeer Eenheid. Sommige kinders wat na TygerBeer Eenheid verwys word weens seksuele mishandeling, voltooi nie hul terapeutiese intervensieprogramme nie. Die kinders is moontlik nie genoeg tyd gegun om deur die trauma van seksuele mishandeling te werk nie. Die doel van hierdie kwalitatiewe studie was om faktore te verken en te beskryf wat lei tot die voortydige terminering van terapeutiese dienslewering aan seksueel-mishandelde kinders by die TygerBeer Eenheid. Toegepaste navorsing van 'n verkennende en beskrywende aard is gebruik, met die gevallestudiemetode as strategie. Data is versamel deur middel van telefoniese en/of een-tot-een semi-gestruktureerde onderhoude en persoonlike rekords. Respondente het bestaan uit ouers en/of versorgers wat hul kinders of voogde se terapie voortydig termineer het, asook maatskaplike werkers betrokke by spelterapeutiese dienslewering aan kinders. lnligting is ontleed met verwysing na die Veldteorie en Ekologiese Teorie, asook die relevante literatuur. Verskeie faktore is geidentifiseer wat ouers en/of versorgers noodsaak om terapeutiese dienste voortydig te termineer. / Social Work / M. Diac. (Play Therapy)

Exploration of factors that lead to early termination of therapeutic services to sexually abused children at TygerBear Unit. Some children referred to TygerBear Unit because of sexual abuse did not complete their therapeutic intervention programmes and possibly did not receive sufficient time to work through the trauma of sexual abuse. The purpose of this qualitative study was to explore and describe the factors that result in the early termination of sexually abused children’s therapeutic services at TygerBear Unit. Applied research that is exploratory and descriptive in nature, with the case study method as strategy, was followed. Data were collected through telephonic and/or one-on-one semi-structured interviews, in addition to the use of notes in personal records. Respondents included parents and/or caregivers of children whose therapy was terminated early, as well as social workers involved with play therapeutic service delivery to these children. Information was analysed with reference to the Field Theory, Ecological Theory and the relevant literature. Several factors that influenced parents and/or caregivers to terminate therapeutic services early were identified. / Die verkenning van faktore wat lei tot voortydige terminering van terapeutiese dienslewering aan seksueel-mishandelde kinders by TygerBeer Eenheid. Sommige kinders wat na TygerBeer Eenheid verwys word weens seksuele mishandeling, voltooi nie hul terapeutiese intervensieprogramme nie. Die kinders is moontlik nie genoeg tyd gegun om deur die trauma van seksuele mishandeling te werk nie. Die doel van hierdie kwalitatiewe studie was om faktore te verken en te beskryf wat lei tot die voortydige terminering van terapeutiese dienslewering aan seksueel-mishandelde kinders by die TygerBeer Eenheid. Toegepaste navorsing van 'n verkennende en beskrywende aard is gebruik, met die gevallestudiemetode as strategie. Data is versamel deur middel van telefoniese en/of een-tot-een semi-gestruktureerde onderhoude en persoonlike rekords. Respondente het bestaan uit ouers en/of versorgers wat hul kinders of voogde se terapie voortydig termineer het, asook maatskaplike werkers betrokke by spelterapeutiese dienslewering aan kinders. lnligting is ontleed met verwysing na die Veldteorie en Ekologiese Teorie, asook die relevante literatuur. Verskeie faktore is geidentifiseer wat ouers en/of versorgers noodsaak om terapeutiese dienste voortydig te termineer. / Social Work / M. Diac. (Play Therapy)

Il presente lavoro di tesi si colloca all’interno della tradizione di ricerca nota come Empirically Supported Therapy Relationships, un modello d’indagine centrato sulla natura e sulla funzione della relazione al di là della contrapposizione tra ricerca sugli esiti e ricerca sul processo. I tre studi in cui si articola il lavoro assumono come focus d'indagine porzioni progressive del trattamento: la prima seduta, le prime due sedute, l’intero percorso. Nel primo studio sono messi a confronto differenti esiti terapeutici per verificare se le ricadute sul piano clinico del metodo interpretativo siano riconducibili ad un criterio di presenza/assenza o da ricercare nell’intreccio con altri fattori caratterizzanti il percorso di cura. Il secondo studio si propone di affrontare casi di interruzione prematura del trattamento, differenziati in funzione del raggiungimento o meno della stipulazione di un contratto terapeutico: l’obiettivo è quello di evidenziare le caratteristiche connesse alla diversa fase di abbandono del contesto di cura. Infine il terzo studio, nella forma del single-case study, è incentrato sui momenti di frattura dell’alleanza terapeutica lungo un intero processo terapeutico di quaranta sedute. / The present dissertation refers to the theoretical background known in the literature as Empirically Supported Therapy Relationships, a research tradition focused on the relationship and its nature, beyond the outcome and process research opposition. The three studies included in this work focused on different portions of treatment: respectively the initial intake session, the first two sessions, and the overall treatment. In the first study different outcomes were compared in order to examine if the effects of interpretations were connected to specific factors of psychotherapeutic process. The second study aimed to assess clinical cases of premature termination, differentiated on the basis of the contract attainment: the purpose was to depict specificities due to the different phase of dropping out. Finally, the third study was a single-case research examining alliance ruptures within an entire clinical process of forty sessions.