[pt] Este estudo tem por objetivo investigar de que forma a inserção da psicoterapia mediada pelo computador, no Brasil, repercute no meio profissional e como os psicólogos clínicos de diferentes tendências se posicionam em face dessa modalidade. Através de um conjunto de entrevistas realizadas com dois grupos de psicoterapeutas - que atuam tanto em consultório quanto por meio da Internet -, constatou-se que as opiniões se dividem em relação aos diferentes aspectos pesquisados: a viabilidade de transposição do seu trabalho do consultório para o computador, a percepção sobre a clientela virtual e o seu interesse e motivação para atuar na rede mundial de computadores. Ao discutir o assunto, busca-se compreender o que rege as opiniões favoráveis e desfavoráveis relacionadas à difusão dessa inusitada modalidade de atendimento psicológico no país. / [en] This study investigates how computer psychotherapy is accepted and adopted in brazilian professional psychological clinic and how different approaches see this practice. Planned interviews were applied to two groups of psychotherapists, concerning those who work directly with patients and those who work with computer in their clinic practice. This study aims to detected how is the perception of their virtual clients; the adequacy of this modality to their clinical work and their interest and motivation using this kind of therapy. Discussing the results we intend to better understand their opinions related to the diffusing of online psychotherapy at the present moment in our brazilian reality.

[pt] O corpo tem sido alvo de observações psicanalíticas desde os primeiros trabalhos freudianos. Partindo dos impasses da clínica contemporânea, procuramos nesse estudo refletir sobre os limites da representação e as atuações no corpo como tentativa extrema de inscrição de vivências de violência. São as marcas corporais que entram em cena, tais como cortes, fraturas, queimaduras, entre outras cicatrizes que nos fazem pensar em intensos afetos que permanecem fora do circuito associativo. Estas características nos remetem à clínica das origens cujo enfoque está nas experiências anteriores à aquisição da linguagem. É contemplada a importância do outro na formação do psiquismo e na constituição de um corpo representado. Visamos entender de que maneira o contato corporal mãe-filho é responsável por reunir o corpo do bebê, propiciando condições favoráveis para que a psique possa realizar o trabalho de elaboração das funções e sensações corporais. Assim, traçamos uma distinção entre o corpo representado da histeria e o corpo apresentado, lugar do excesso, da pulsão desligada que se encontra fora do campo simbólico. / [en] The body has been subject of psychoanalytic observation since Freud’s early works. Based on the impasses of contemporary clinic, this study tries to reflect upon the limits of representation and the acting-out on the body as an extreme effort to inscribe experiences of violence. Body marks such as cuts, fractures, burns and other scars come into play suggesting intense feelings that remain outside the associative circuit. These characteristics seem related to early experiences and to a clinical practice that focus on sensations and perceptions prior to language acquisition. The importance of the Other in the constitution of the psyche and of a body representation is contemplated. The paper`s main objective is to understand how the mother-infant body contact is responsible for giving the baby a sensation of body unification that, in turn, creates a favorable condition for the beginning of the psychical function of representation and elaboration of bodily sensations. Thus, a distinction is made between the hysteria s represented body and the body which is shown, site of excess, of the disconnected instinct that is outside the symbolic field.

Made available in DSpace on 2017-06-01T18:08:31Z (GMT). No. of bitstreams: 1 veridiana costa.pdf: 821261 bytes, checksum: c7ba3ea596fac5b42e3b610d55299d0d (MD5) Previous issue date: 2005-04-08 / The current context presents changes in the subjectives organization ways. Inside this, the redefinitions from the man and woman roles, the new filiation forms, as the new familiar configurations, have brought to a references crisis that reaches different sections from the human life. Among others aspects, this has been implied on redimensionment of the father s place, traditionally conceived as representing from the symbolic law. The father social role is so questioned and, many times, confused with the decline from the paternal function, but, is there is a decline, it is from the patriarchal power, and not of its function, that stays as structural. Fundamental to the structuring of human being and to the social coexistence, the law presents itself like a way of symbolic support. In front of this, we question how stays the reference from the symbolic law, that in the current panorama, it seems leave important blanks in its duties. Inefficient in the limit and interdiction function, the law fails, as well the advantages that should assure of her. No more interdicted, the subject sees himself summoned to the excess and, paradoxally, without references, unsupported. The human condition of unssuporting constituent of the subject due to the life circumstances of people have been exacerbated, what reveals a constant unssuporting situation in which live the nowadays subjects. This leave them to new psychic disorganization forms and makes emerge new symptomatologic configurations, in which expression forms are linked to specific contexts. Among them, the panic disorder highlights as a illustration of the unssuporting more often evocated in the contemporary times, due to the fragility which the law presents itself / O contexto atual apresenta mudanças nos modos de organização subjetiva. Em meio a isso, as redefinições dos papéis do homem e da mulher, as novas formas de filiação, assim como as novas configurações familiares têm levado a uma crise de referências que atinge diferentes setores da vida humana. Dentre outros aspectos, isso tem implicado o redimensionamento do lugar do pai, tradicionalmente concebido como representante da lei simbólica. O papel social do pai passou a ser questionado e, muitas vezes, confundido com o declínio da função paterna, porém, se há um declínio, é do poder do patriarcado, e não de sua função, que permanece como estrutural. Fundamental à estruturação do humano e à convivência social, a lei se apresenta como um modo de amparo simbólico. Diante de tal quadro, questionamos como fica a referência à lei simbólica, que, no panorama atual, parece deixar lacunas importantes em seu exercício. Ineficiente na função de interdição e limite, a lei falha, como falham também as vantagens que ela deveria assegurar. Não mais interditado, o sujeito se vê convocado ao excesso e, paradoxalmente, sem referências, desamparado. A condição humana de desamparo constituinte do sujeito , em razão das circunstâncias de vida das pessoas, vem sendo exacerbada, o que revela a constante situação de desamparo na qual vivem os sujeitos atuais. Isso os leva a novas formas de desorganização psíquica e faz emergir novas configurações sintomatológicas, cujas formas de expressão estão vinculadas a contextos específicos. Dentre elas, o transtorno de pânico se destaca como uma ilustração do desamparo mais freqüentemente evocado na contemporaneidade, promovido pela fragilidade com que a lei se apresenta

Made available in DSpace on 2017-06-01T18:08:43Z (GMT). No. of bitstreams: 1 maria stella.pdf: 221138 bytes, checksum: 4768ae13c43f17e5657f2fc68b79ea06 (MD5) Previous issue date: 2001-03-27 / Human experience s complexity and plurality, which demands questionning on possible articulations of contemporary clinical psychology and other areas of knowledge, builds up this work s scenary which aims to get acquainted with and transmit the psychologist/artists experience. Based on her own experience as a singer and as a psychology therapist, the researcer runs over other psychologists/artists narratives to through them investigate some possible articulationns between these two practices . In order to reach the proposed objectives, the author circumscribes both experiencing and transmission, by means of the narratives, in Gendlin s and Benjamin s works, in search of a theoretical basis needed to validate them as knowledge s production and transmission elements. Then she gives a brief description of the role of narratives in psychotherapy according to Goolishian s and Anderson s postmodern view. Finally, after presenting the psychologists/artists s narratives, she deepens her initial questionning by going through a dialog between her understanding of the research participants experience and the theoretical references which guide her final appreciation / A pluralidade e a complexidade da experiência humana, demandando indagações acerca de articulações possíveis entre a psicologia clínica na contemporaneidade e outros campos do conhecimento, constituem o cenário deste trabalho que busca conhecer e transmitir a experiência de psicólogos/artistas. Partindo da sua própria experiência de cantora e psicóloga clínica, a pesquisadora recorre aos depoimentos de outros psicólogos/artistas para, através deles, investigar algumas articulações possíveis entre esses fazeres. Para alcançar o objetivo proposto, a autora situa a experiência e a sua transmissão, via narrativa, nos trabalhos de Gendlin e Benjamin, a fim de obter o embasamento teórico necessário para validá-las como elemento de produção e transmissão de saber. A seguir, faz um breve relato do papel da narrativa em psicoterapia, na visão pós-moderna apresentada pelos autores Goolishian e Anderson. E, finalmente, após apresentar os depoimentos dos psicólogos/artistas colaboradores, a pesquisadora aprofunda o seu questionamento inicial, correndo ao diálogo entre sua compreensão da experiência dos depoentes e as referências teóricas que lhe auxiliam a encaminhar suas considerações

Made available in DSpace on 2017-06-01T18:09:02Z (GMT). No. of bitstreams: 1 Clarissa Barros.pdf: 4060942 bytes, checksum: 9c83e264410bc78fa296b142c7730311 (MD5) Previous issue date: 2006-04-07 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research project, referred into psycho-analytical theory, departs from the questioning of what takes a youth to intentionally mark his/her skin with tattoos and similar signs. On the side of the culture inscription with its productions of belonging, the research project will formulate a theorical and investigative systematization about the psychic reality of the youths that have themselves tattooed. The body conception will be contemplated in the study, in meanings through the differents cientific views and its meanings. However it is the psychic representation that will be the problematic in the field of the psycho-analytical theory. Its proper to question the conception of the subject and the language, taking into consideration the language´s dimension steped on the body through phrases and symbols exposed to the other´s eyes. The mark on the skin will be also emphasized in relation to the exclusivity of the maternal love through frequent cases of youths that have themselves tattooed with sentences written in their skin invoking that real love just the mother´s. It´s proper to question about the quality of this relation, trying to confront the factual and mythical character in the subject´s relation with his/her mother. From 7 youths, between 16 and 18 years old, will be listened through the depositions collected form free. These youths are of underpriviledged back-ground and belonged to institutions that develop program of social inclusion, as will as those designated by the state to the minors integral protection in accordance with the brazilian children and adolescent statue. The psychic mechanisms related to the act of making a mark on the body reveals an important way to the comprehension of the subject in the face of questions that cannot be separated of human existence. Being in a social risk situation and make marks on his/her skin, cames up a frontier, an edge, that makes the speeches that testifies the condition to existence of and that appeals for protection circulate / A presente pesquisa em psicanálise parte da indagação sobre o que leva um jovem a se marcar intencionalmente na pele, através de tatuagens. Ao lado da inscrição cultural com suas produções de pertencimento, a pesquisa formulará uma sistematização teórica e investigativa sobre a realidade psíquica dos jovens que se tatuam. A concepção do corpo, seus significados através de alguns discursos científicos estará contemplado no estudo. No entanto, é a representação psíquica que será problematizada no âmbito da teoria psicanalítica. A escritura na pele será enfatizada também em relação à exclusividade do amor materno através de freqüentes casos de jovens que se tatuam com frases escritas na pele invocando o amor só de mãe . Cabe a indagação sobre a qualidade desta relação, tentando confrontar o caráter factual e mítico na relação do sujeito com a mãe. Através da escuta, a partir de depoimentos colhidos de forma livre, foram entrevistados 7 jovens, entre 16 e 18 anos, originados de classe social baixa e pertencentes a instituições não governamentais que desenvolvem programa de inclusão social, e governamentais destinadas a vigilância da proteção integral do jovem em conformidade com o Estatuto da Criança e do Adolescente. O mecanismo psíquico subjacente ao ato de marcar o corpo revela um importante caminho para compreensão do sujeito frente a questões indissociáveis da existência humana. Entre estar em situação de risco social e produzir riscos na pele, surge uma fronteira, borda, que faz circular os discursos atestando a condição de existência do desamparo e o apelo de uma proteção

Questa tesi descrive una modalità parsimoniosa di organizzare l'ampia evidenza prodotta in questi ultimi anni nel campo della salute mentale digitale. A tal fine, viene presentato il framework DIU (D per diffusione, I per miglioramento e U per comprensione). Questo quadro teorico è applicato al campo specifico della regolazione delle emozioni (ER) per i disturbi emotivi. L’obbiettivo è quello di fornire una descrizione dell'attuale cambiamento della psicopatologia e evidenziare il ruolo della ER come meccanismo di cambiamento transdiagnostico e transteorico. A tal fine, viene fornita una revisione di tutti gli sviluppi esistenti in ciascuna delle categorie del quadro DIU. Ogni sezione propone nuovi risultati empirici che mostrano come le terapie digitali possano aiutare a migliorare l'ER nei disturbi emotivi. Per realizzare tali contributi empirici, sono stati utilizzati svariati disegni di ricerca e diverse soluzioni statistiche a seconda dei diversi contesti in cui gli studi sono stati condotti. Nel complesso, questa tesi stimola la discussione su alcuni degli attuali dibattiti nell’area della psicologia clinica e suggerisce risposte teoriche ed empiriche al fine di migliorare il campo. / This dissertation describes a way of organising parsimoniously the ample existing evidence that has been produced along these years in the field of digital mental health. For that purpose the DIU framework is presented. That is, D for dissemination, I for improvement and U for understanding. This framework is applied to the specific field of emotion regulation in emotional disorders. In that sense, it presents a description of the current psychopathological transformation in order to outline the role of emotion regulation (ER) as a transdiagnostic and transtheorical mechanism of change. A review of all the existing developments in each of the categories of the DIU framework are described. Each section presents novel empirical results that show how digital interventions may serve to improve ER in emotional disorders. These empirical contributions used a variety of research designs and statistical solutions depending on the different contexts in which the studies were conducted. Overall, this dissertation boosts the discussion concerning some of the current debates in clinical psychology and suggests theoretical and empirical answers in order to improve the field.

IL LAVORO TRATTA IL TEMA DELLA VALUTAZIONE E DELL’INTERVENTO CON VIDEOFEEDBACK A FAVORE DI GENITORI DI BAMBINI CON GRAVE DISABILITA’ NEUROEVOLUTIVA. LA PRIMA PARTE PRESENTA PICCOLO, UN MODELLO DI VALUTAZIONE DEL FUNZIONAMENTO INTERATTIVO GENITORIALE CHE, PER LE CARATTERISTICHE CHE VENGONO DISCUSSE, E’ INDICATO PER ESSERE IMPLEMENTATO ALL’INTERNO DI INTERVENTI DI SUPPORTO AI GENITORI DI BAMBINI CON GRAVE DISABILITA’ NEUROEVOLUTIVA. DOPO UNA PANORAMICA DELLO STRUMENTO E DELLE SUE CARATTERISTICHE E’ PRESENTATO LO STUDIO DI ADATTAMENTO E VALIDAZIONE DI PICCOLO AL CONTESTO ITALIANO. 181 DIADI MADRE-BAMBINO SONO STATE RECLUTATE PER LA SOMMINISTRAZIONE DEL PROTOCOLLO OSSERVAZIONALE; I FILMATI DELLE INTERAZIONI SONO STATI CODIFICATI DA RICERCATORI FORMATI SOTTO LA SUPERVISIONE DEGLI AUTORI ORIGINALI DI PICCOLO. SI PRESENTANO LA TRADUZIONE ITALIANA, LE NORMATIVE DI RIFERIMENTO E I RISULTATI DELLE ANALISI CIRCA LE PROPRIETA’ PSICOMETRICHE. L’ADATTAMENTO ITALIANO DI PICCOLO SI DIMOSTRA ATTENDIBILE E VALIDO, PUR CON QUALCHE FRAGILITA’ NELLA SUA STRUTTURA DIMENSIONALE. LA SECONDA PARTE DEL LAVORO TRATTA IL TEMA DELL’INTERVENTO CON VIDEOFEEDBACK. COME DESCRITTO, TALE TECNICA HA DELLE POTENZIALITA’ PER ESSERE APPLICATA AL CONTESTO DELLA GRAVE DISABILITA’ PRECOCE, IN QUANTO EFFICACE CON ALTRE POPOLAZIONI DI BAMBINI A RISCHIO NEL MIGLIORARE I COMPORTAMENTI GENITORIALI E INDIRETTAMENTE GLI ESITI DI SVILUPPO DEL BAMBINO. SI PRESENTA UNA REVISIONE SISTEMATICA DELLA LETTERATURA FINALIZZATA A DESCRIVERE LO STATO DELL’ARTE DELL’APPLICAZIONE DI TALE METODLOGIA DI INTEVENTO A POPOLAZIONI DI BAMBINI CON DISABILITA’. SONO DISCUSSE LE DIVERSE IMPOSTAZIONI METODOLOGICHE E PRESENTATI I RISULTATI DELLE RICERCHE IN TERMINI DI EFFICACIA NEL MODIFICARE I COMPORTAMENTI PARENTALI E, INDIRETTAMENTE, LO SVILUPPO DEL BAMBINO. INFINE, VIENE PRESENTATO IL METAMODELLO ABC-D, OVVERO UN MODELLO CONCETTUALE PER SUPPORTARE GLI OPERATORI CHE INCONTRANO I GENITORI DI BAMBINI CON DISABILITA’ NEUROEVOLUTIVA, GUIDANDOLI NEL COMPRENDERE I BISOGNI DI SUPPORTO PSICOLOGICO PREVALENTI E NEL PIANIFICARE L’INTERVENTO. IL MODELLO DISTINGUE QUATTRO DOMINI DA INDAGARE (AFFETTI/EMOZIONI, COMPORTAMENTI INTERATTIVI, RAPPRESENTAZIONI MENTALI E COGNIZIONI + DISABILITA’), DA CUI DISCENDONO SCELTE CIRCA GLI OBIETTIVI E LE METODOLOGIE DI INTERVENTO A FAVORE DEI GENITORI. / PARENTING INTERACTIVE BEHAVIORS ASSESSMENT AND VIDEOFEEDBACK INTERVENTION ARE HERE DISCUSSED IN RELATION TO CHILDREN WITH NEURODEVELOPMENTAL DISABILITY. THE FIRST CHAPTER IS A PRESENTATION OF THE PICCOLO, A OBSERVATIONAL EMPIRICALLY VALIDATED TOOL TO EVALUATE PARENTING INTERACTIVE BEHAVIORS IN THE FIRST YEARS OF CHILDREN. SUCH INSTRUMENT APPEARS FITTED TO BE IMPLEMENTED WITH PARENTS OF CHILDREN WITH NEURODEVELOPMENTAL DISABILITY IN A HOSPITAL OR HOME SETTING. THE SECOND CHAPTER IS THE ITALIAN ADAPATION OF PICCOLO IMPLEMENTED WITH 181 MOTHER-INFANTS DYADS. THE SAMPLE HAS BEEN RECRUITED IN DIFFERENT PART OF ITALY AND THE MOTHERS WERE ASKED TO INTERACT FOR 10 MINUTES WITH THE CHILD- THE RECORDING HAS BEEN CODED FOLLOWING THE INSTRUMENTS MANUAL AND AFTER A TRAINING IN CONNECTION WITH AMERICAN ORIGINAL AUTHORS. THE RESULTS SHOWS SOM WEAKNESS IN PSYCHOMETRIC VALUES FOR ITALIAN ADAPTATION. THE THIRD CHAPTER PRESENTS A SYSTEMATIC REVIEW INVESTIGATING THE USE OF VIDEOFEEBACK INTERVENTION WITH PARENTS OF CHILDREN WITH NEURODEVELOPMENTAL DISABILITY. THE STATE OF ART OF SUCH METHOD IMPLMENTATION ARE DISCUSSED, AND THE DIFFERENT METHODOLOGIES ARE PRESENTED. FINALLY, THE ABC-D MODEL, A META THEORY TO GUIDE PARENTAL PSYCHOLOGICAL INTERVENTIONS IN THE CONTEXT OF NEURODEVELOPMTAL DISABILITY, IS DISCUSSED. THE ABC-D MODEL HAS BEEN CONCEPTUALIZED AS COMPOSED BY FOUR DIMENSIONS: AFFECT, BEHAVIOR, COGNITION, AND DISABILITY. IMPLICATIONS FOR PRACTICTIONERS AND RESEARCHERS ARE PRESENTED.

Despite a large body of research has investigated child attachment during middle childhood, only a limited number of studies has focused on children with Autism Spectrum Disorder. Additionally. The few studies available on this topic have exclusively used self-reported measures to assess quality of attachment, overlooking the role of internal representations, which are considered to play a fundamental role since attachment is internalized. Therefore, no studies examined the way in which child attachment representations are associated with child diagnosis, parenting and caregiving environment in ASD. In the first study, we assessed attachment representations in children with ASD, Learning Disabilities (LD) and Typical development (TD). In particular, we investigated possible group differences on perceived attachment to parents, self-protective strategies and quality of attachment implicit representations using the Dynamic Maturational Model of Attachment and Adaptation (DMM). The Study 2 focused on the caregiving environment and its influence on child attachment implicit representations. To this aim, we assessed parenting stress and parental style in mothers and fathers of children with ASD and TD, examining whether parents of children with ASD differ from those of matched TD group. Secondly, we examined which caregiving environment dimensions contribute significantly in predicting at-risk attachment representations, assessing separately the contribution of maternal and paternal parenting stress and parental interactive social style. In the third study maternal and paternal attachment style were assessed to test the hypothesis of attachment continuity across generations. Firstly, we investigated whether parents of children of ASD reported higher level of attachment-related avoidance/anxiety compared to their TD counterpart. Next, the associations between attachment style of both mothers and fathers and quality of child attachment representations was tested, by examining the moderation effect of child ASD diagnosis. The Study 4 investigated the role of other potential child attachment predictors. Due higher co-occurrence of ASD and difficulties in identifying, describing and distinguishing one’s own feelings, the predictive effect of alexithymia on child explicit attachment representations was tested. Moreover, we also examined whether children with ASD reported higher level of alexithymia compared to controls. The Study 1 showed that children with ASD are able to develop secure and coherent attachment implicit representations, albeit with a lesser extent compared to typically developing children. They were able to engage the attachment interview, confirming the suitability of this method in this clinical sample. Importantly, children with ASD showed high-risk attachment implicit representations and greater presence of unresolved trauma and modifiers, despite no differences emerged on perceived attachment to parents. The lack of group difference on perceived attachment suggested that implicit and explicit attachment representations of children with ASD originate from different sources of information. It is plausible that low reflective functioning, impaired metacognition as well as altered psychobiological processes of children with ASD contributed to attachment maladaptive information processing. Secondly, we replicated the well-established finding of higher parenting distress in parents of children with ASD compared to controls also in fathers. Moreover, the Study 2 documented less didactic and limit/setting style in parents of children with ASD. In accordance to a bidirectional perspective, these parenting behaviors were interpreted as parental functional responses to adapt to child unusual social-communication. Interestingly, data revealed a significant effect of maternal parenting stress and social exchange style on child attachment implicit representations. Thus, the study supports the coexistence of both child-driven and parent-driven effects in the context of parent-child relationship in ASD. Similarly, the Study 3 documented that children with ASD who have an insecurely attached primary caregiver showed at-risk attachment implicit representations. In other words, the continuity of attachment security across generations revealed a clear effect in ASD, suggesting that these children may be more susceptible to this mechanism compared to controls. In addition, parents of children with ASD reported higher attachment-related avoidance in comparison to their TD counterpart. This difference could be associated to the significant couple adjustment associated to the impact of rear a child with ASD. In addition, the Study 4 showed that alexithymia, but not ASD predicts perceived attachment to parents highlighting the different nature of attachment explicit and implicit representation. Moreover, our results confirmed higher co-occurrence of alexithymia and ASD also in school-age, extending literature on adulthood. Our findings pointed out that children with ASD (without intellectual disability) showed higher rates of at-risk self-protective strategies (attachment pattern). These results may be related to several factors associated with ASD symptoms, such as the more frequent disruptions of interpersonal exchanges with the caregiver across development, the difficulties in social information processing and reflective functioning. The higher exposure to adverse childhood experience (e.g. bullying), may explained the higher occurrence of unresolved trauma in these children. Up to date, to the best of our knowledge, these are the first studies on group differences and parental predictors of attachment implicit representations in school-age children with ASD. Therefore, these studies brought initial data to ASD literature on attachment representations, suggesting that these children are at increased risk of developing maladaptive information processing. Limitations of the studies and clinical implications are discussed.

L’obiettivo generale del progetto di ricerca è valutare la percezione della qualità dei servizi offerti in due RSA del Nord Italia e proporre interventi di miglioramento. Nel primo capitolo della tesi sono stati descritti i principali modelli teorici della qualità dei servizi. La letteratura riconosce la mancanza di scale validate che esplorano la percezione della qualità dei servizi nelle RSA Italiane. Per questo motivo, è stato realizzato uno studio di validazione e adattamento della versione italiana della scala SERVQUAL. Nel secondo capitolo della tesi è stato presentato uno studio qualitativo retrospettivo. Partendo dagli eventi critici che si sono verificati nella RSA, sono stati analizzati i principali episodi positivi e negativi ricordati dai famigliari degli anziani. I risultati sono stati utilizzati per ipotizzare nuovi percorsi di intervento e per fornire strategie organizzative per migliorare la gestione degli eventi problematici. La letteratura riconosce l’importanza del coinvolgimento dei famigliari per il benessere degli anziani. Per questo motivo, in questo progetto di ricerca sono state delineate le basi concettuali per l’applicazione di un modello collaborativo di assessment all’interno delle RSA. Nello specifico, il terzo capitolo della tesi ha esplorato l'efficacia dell’Assessment Terapeutico attraverso una meta-analisi multilivello e nell'ultimo capitolo della tesi è stata applicata una componente del modello di Assessment Collaborativo e Terapeutico nelle RSA. / The general aim of the present research project was to broaden the knowledge and understanding of the ways in which elderly’s family members perceive the quality of service and propose interventions to improve services. To lay the ground for discussion about the quality of services offered by nursing homes, Chapter 1 provides a historical overview of the models of the quality of services. Given the lack of validated measures of the quality of services in Italian nursing homes, I presented data regarding the validation and adaptation of the Italian version of the SERVQUAL Scale. Chapter 2 introduced a retrospective qualitative study. Starting from critical events that occurred in nursing homes, I analyzed family members’ observations of the incidents. The results were used to generate new paths for interventions to improve the family members’ evaluation of services and to provide organizational strategies to improve the management of problematic events. Given the effect of family involvement on elder people’s well-being, I presented the conceptual underpinnings and the applicability of a collaborative model of assessment in nursing homes. Chapter 3 explored the effectiveness of the Therapeutic Assessment model through a multilevel meta-analytic study. From these results, a component of the Collaborative and Therapeutic Assessment model was applied in nursing homes, as described in the last chapter.

Made available in DSpace on 2016-04-28T20:39:05Z (GMT). No. of bitstreams: 1 Alberto Jose de Camargo.pdf: 516677 bytes, checksum: 70bc526c520eaf01d1b8dd5d2a9a33f6 (MD5) Previous issue date: 2015-05-29 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This paper is based on the report of a case of Asperger Syndrome (A.S.) with a late diagnosis and on some remarks on classic biomedical and clinical psychology assessment and treatment of the Asperger Syndrome. The therapist and also a researcher, transforms the assistance of A.S. based in a classic biomedical framework into a social - historical clinic psychology practice, related to the assumptions of Vigotsky s Works (1924) of Mediation and Proximal Developmental Zone (PDZ). The patient of this case study has extreme difficulties in interpersonal relationship, in affect expressions, and over all, extreme difficulties in starting affective affairs with girls, despite his very good performance in academic and professional tasks. Nevertheless, his difficulties use to lead him to unemploymente menace and to learning déficits in his academic life. He never dares to make any questions to his teachers and colleagues. Aiming diagnosis purposes of difficulties and not deseases, the therapist brings important changes in the classic clinical setting , making therapy in outside environment, by introducing the patient s family and community into the clinical work. This new framework of therapy has the purpose of bringing emotional and dramatical experiences of life to the clinical work, like Veresov (2004) assumptions of the relationship between learning and development in a dialectic way of qualitative steps as a result of intensive emotional and cognitive experiences. The expected effects are the development of new habilities and potentialities as a result of some kind of compensation from the Asperger patient s level of difficulties. Participation of family and community are fundamental to the therapy goals. Aiming new potentialities and development of new habilities for the patient s growing goals, the therapist made a list of steps related to his clinical new approach directed to another therapists: a) Diagnosis of difficulties and potentialities, instead of deseases diagnosis; b) Life story of the patient his family and community; c) Widening up the subjective universe; d) Widening up the therapist and researcher role; e) Multiple mediators proposal; f) Sistemic studies of the patient s contexto of life; g) Therpeutic actions directed toward the Human Rights / Este trabalho é originário de um questionamento de práticas clássicas em psicologia clínica na assistência à Síndrome de Asperger com diagnóstico tardio. O terapeuta, que no seu percurso de atendimento clinico e de pesquisa, acumula formação inicial em psicologia social de orientação marxista e formação psicanalítica posterior, transforma seu atendimento a um caso de Síndrome de Asperger baseado num modelo biomédico clássico, em uma prática clínica fundamentada e orientada pela Psicologia Sócio Histórica e especialmente pela obra de Vigotsky (1998, 1983, 1979), por meio das categorias de Mediação e Zona de Desenvolvimento Proximal. O sujeito assistido apresenta as dificuldades nos relacionamentos interpessoais, na manifestação e expressão de afetos, na extrema dificuldade de iniciar um namoro, ao mesmo tempo que apresenta bom desempenho acadêmico e profissional. Suas dificuldades, no entanto, trazem enorme Prejuizo, com ameaça de perda de emprego e acumulo de dependências na faculdade de engenharia, dada sua extrema dificuldade de fazer perguntas a professores e colegas. Com proposta alternativa de diagnóstico de dificuldades e não de doenças , tal como é desenvolvido por Vigotsky em sua obra sobre Defectologia (1924), o terapeuta promove mudanças no setting clássico de atendimento, levando o trabalho terapêutico para situações extra consultório com o envolvimento da família e da comunidade em que vive o sujeito. Nas ações mediadoras e proximais de desenvolvimento foram construídas situações para o livre acontecimento das emoções de todos os participantes, o que foi fundamental para a vivencia de dramaticidade que Veresov (2004) aponta como crucial para que haja saltos qualitativos na relação desenvolvimento e aprendizagem, e neste caso clínico, para o desenvolvimento de novas habilidades e potencias que configuram a transformação nas dificuldades relativas a Asperger , sendo fundamental a participação da comunidade e da família. Visando o desenvolvimento de novas potencias e de protagonismo para o sujeito em atendimento, o terapeuta elenca as etapas de sua proposta clínica: a) Diagnóstico de dificuldades e potências; b) História de vida do sujeito, de sua família e de sua comunidade; c) Ampliação do universo de subjetivação; d) Ampliação do papel do terapeuta e pesquisador; e) Proposição de múltiplas mediações; f) Leitura crítica e sistemática da realidade e do contexto de vida do sujeito; g) Ação terapêutica conhecedora dos Direitos Humanos e orientada pelos mesmos