L'efficacité de la remédiation cognitive assistée par ordinateur (RCAO) n'a pas été démontrée jusqu’ici dans le traitement des dépressions, la notion d’efficacité étant ici à évaluer non seulement sur le plan neurocognitif mais aussi sur le plan du retentissement fonctionnel et relationnel des troubles. En particulier, les facteurs favorisant le transfert des compétences cognitives vers la vie quotidienne du sujet sont à identifier afin de potentialiser l’effet de ce soin.Nous avons réalisé trois études :- La première a vérifié l’efficacité de la RCAO dans le traitement des dépressions et a précisé le rôle du thérapeute dans ce dispositif. Elle a montré l’importance de la motivation et de la métacognition pour en potentialiser les effets.- Notre seconde étude a adapté en français, et a débuté la validation, d’un outil anglophone d’auto-évaluation de la métacognition, le MCQ-30.- Notre troisième étude a testé, chez des personnes dépressives, un nouveau dispositif de soins alliant RCAO et développement métacognitif. Nos résultats confirment que la RCAO a une efficacité dans le traitement de la dépression sur les plans neuropsychologiques, cliniques et fonctionnels. Ils montrent aussi l'importance des aspects métacognitifs et motivationnels dont la prise en compte est nécessaire à une efficacité optimale dans des contextes différenciés. En particulier, une relation thérapeutique développant ces aspects renforce la diminution du retentissement fonctionnel et l’amélioration de la qualité de vie. La RCAO doit ainsi être utilisée comme support et médiation d’une relation psychothérapique nouvelle, tenant compte du profil éminemment singulier de chaque patient / The effectiveness of Computer-assisted cognitive remediation (CACR) hadn’t been proven so far in the treatment of depression, the notion of effectiveness having to be evaluated here not only on the neurocognitive level, but also on the level of the functional and relational impacts of the disorder. The factors favouring the transfer of cognitive skills towards the daily life of the subject in particular are to be identified in order to potentiate the effect of that care.We have conducted three studies:-The first one has verified the effectiveness of CACR in the treatment of depressions and specified the role of the therapist in this plan. It has proven the importance of motivation and metacognition to potentiate their effects.- Our second study has adapted in french, and started to validate, an english questionnaire for auto-evaluation of the metacognition, the MCQ-30.- Our third study has tested on depressive people a new set of cares combining CACR and metacognitive development.Our results confirm that CACR is effective in the treatment of depression on the neuropsychological, clinical and functional levels. They also demonstrate the importance of the metacognitive and motivational aspects, that have to be taken into account for an optimal effectiveness in differencial contexts. A therapeutic relationship developing these aspects in particular reinforces the diminution of functional impact and the improvement of the quality of life. The CACR thus has to be used as support and mediation of a new therapeutic relationship, taking into account the eminently singular profile of each patient.

Inledning: Olika terapimetoder erbjuder olika sätt att hjälpa patienterna. ISTDP utmärker sig genom att vara offensiv och som i alla metoder tillskrivs alliansen en viktig roll. Det är terapeuter som ska jobba med alliansen men hur de upplever den, vilka likheter och olikheter de ser i de metoderna de jobbar med har knappast uppmärksammats. Studiens syfte är att belysa psykodynamiska psykoterapeuters syn på alliansen i både ISTDP och klassisk psykodynamisk psykoterapi. Frågeställningar: Hur ser kliniskt verksamma psykodynamiska psykoterapeuter på den terapeutiska alliansen i både klassisk psykodynamisk psykoterapi och ISTDP ser? Vilka är de skillnader och likheter i hur de skapar och upprätthåller den? Metod: Sex legitimerade psykodynamisk utbildade psykoterapeuter som är utbildade i ISTDP har intervjuats. Data samlades in genom semistrukturerade intervjuer. Grundad teori användes som metod för bearbetning och analys och materialet. Resultat: Skillnaderna finns i behovet av ram och kontrakt samt metodiken. En könsskillnad finns i synen på möjligheten att engagera sig, i tillskrivning av interventionernas betydelse för alliansskapandet och hur begrepp allians, anknytning och emotionell kontakt används. Likheter gäller betydelsen av terapeutens engagemang, kompetens och patientens problematik. Diskussion: Resultatet diskuterats utifrån terapeutens syn på alliansen. Terapeutens engagemang och patientens problematik samt hur metodiken påverkar alliansutvecklingen har diskuterats. Upplevelsen av att kunna skapa och upprätthålla alliansen har diskuterats utifrån tydlighet och ett könsperspektiv. / Introduction: Different therapy methods provide different help. ISTDP is distinguished by being more intensive and, as in all methods, also here alliance is important. Therapists are the one who are working with the alliance but how they experienced it, what similarities and differences there are in the different methods they work with, has rarely been investigated. The goal with the study is to illustrate psychodynamic psychotherapists view on alliance in both ISTDP and classic psychodynamic psychotherapy. Questions: How do clinically effective psychodynamic psychotherapists see the therapeutic alliance in both classic psychotherapy and ISTDP? What are the differences and similarities in how they create and maintain it? Method: Six licensed psychodynamic psychotherapists who also are educated in ISTDP have been interviewed. The research is based on grounded theory. Result: Differences that are found are the need for contract and frame and how the method is applied. A gender difference is in the therapist's view of the possibility of engagement, in ascribing signification to the interventions that bring about alliance and in the way alliance, attachment and emotional contact has been used. Similarities are regarding the importance of therapist's engagement, competence and patient's problems. Discussion: The result was discussed on base of the therapist's view upon alliance. Therapist's engagement and patient's problems as well as how the method has an impact on creating the alliance has been discussed. Therapist's experience of being able to create and maintain the alliance has been discussed from a gender perspective and legibility.

Utgångspunkten i studien var relationens betydelse och fokus i studien har varit att undersöka vad skolkuratorer anser vara förutsättningar för att bygga en relation med ungdomar. För att möjliggöra det har sex semistrukturerade intervjuer genomförts med skolkuratorer i tre kommuner i Sverige. Det empiriska materialet har analyserats genom en tematisk analysmetod där huvudtemat Relationens betydelse framkom, vidare har fyra centrala teman som förutsätter relationsskapande analyserats fram. Respektive tema har ett undertema för att möjliggöra en fördjupning. Följande centrala teman och underteman var; Att finnas där och att lyssna, Att använda sin kunskap och att möta ungdomen där den är, Att vara människokännare och att vara flexibel, Att vara människa och att göra det lilla extra. Resultatet diskuteras utifrån tidigare forskning och Carl Rogers teori om den personcentrerade terapin samt Rogers tankar om den terapeutiska relationen. Studiens huvudsakliga slutsats var att relationen är A och O. / The starting point in this study was the importance of the relationship. The investigation examines school counselors experiences of creating conditions for relationships with young people. Six semi-structured interviews were conducted with school counselors in three Swedish municipalities. A thematic analysis was used to analyze the empirical material were the main theme the importance of the relationship was found. Four key themes of relationship creating conditions were also discovered. The central themes have subthemes to deepen the analysis. These central themes and subthemes were; To be there and to listen, To use the knowledge and to meet the youths perspective, To know people and to be flexible, To be a human being and to do more than required. The results have been discussed in relation to past research and the theory of Carl Rogers on person centered therapy and Rogers thoughts on the therapeutic relationship. The mail conclusion of the study was that the relationship is the key.

Made available in DSpace on 2016-04-28T20:40:19Z (GMT). No. of bitstreams: 1 Leticia Lo Duca.pdf: 2179548 bytes, checksum: f02b1bb1c10d1b8094430631870fb4c8 (MD5) Previous issue date: 2010-05-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of the present research is to study the psychologist s countertransference in the clinic with women in situation of conjugal violence. We believe that the identification and the recognition of countertransference can facilitate for the therapists to elaborate their own feelings, which can benefit the evolution of clinical process and also the maintenance of these professional s psychic health. In a wider context, the study intends to contribute to the conscience of the wounds provoked by masculine violence perpetrated in patriarchal order. The work starts with the therapeutic entailment with the concepts of transference and countertransference. Then, it presents the concepts of vicarious trauma and secondary traumatic stress, like professionals possible symptoms, reactive to the treatment of the trauma. It debates the partner violence phenomenon and the recent changes in Brazilian legislation in behalf of attacked woman. The research was done with ten psychologists that work specifically with the clinical treatment of woman which are victims of violence, in public service, in a big Brazilian city. The instruments used were: semi directed interview with the psychologists and semi structured register of a clinic case, described by the psychologist right after one attendance. The data was analyzed using a qualitative method in the light of analytical psychology. The results disclose that the violence against woman is still a theme poorly explored and valued. It found that in the treatment of these women emerge intense contents, connected to the wounded feminine on the psychologist personal psyche. Most of them seem to present symptoms of secondary traumatic stress. Some countertransference feelings were ignored by psychotherapists; witch can obscure the therapeutic contact. Concluding, this study emphasizes the necessity of the caring of the psychologist. It also emphasizes the necessity of the psychologists to use their perception, discrimination and capacities to work with clear limits, to facilitate the recognition, the elaboration and the analytical work of countertransference reaction in behalf of the therapeutic dynamic / A pesquisa visa observar a contratransferência de psicólogas na clínica com mulheres em situação de violência conjugal. Espera-se que a identificação e o reconhecimento da contratransferência possa facilitar às psicólogas a elaboração de seus sentimentos. Isso tudo pode beneficiar a evolução do atendimento e também a manutenção da saúde psíquica dessas profissionais. Partindo para um contexto mais amplo, o estudo pretende contribuir na conscientização das feridas provocadas pela violência masculina perpetrada na ordem patriarcal. Discute-se, primeiramente, o vínculo terapêutico com os conceitos de transferência e contratransferência. Apresentam-se, em seguida, os conceitos de trauma vicário e estresse secundário traumático, como possíveis sintomas, dos profissionais, reativos à clínica do trauma. Debate-se o fenômeno da violência conjugal e apresentam-se as atuais mudanças na legislação brasileira em favor da mulher agredida. A pesquisa foi realizada com dez psicólogas que trabalham especificamente com a clínica de violência contra a mulher, no serviço público, em uma metrópole brasileira. Foram utilizados entrevista semidirigida com as psicólogas e registro semiestruturado de um caso clínico, descrito pelas psicólogas logo após um atendimento. Os dados foram analisados através do método qualitativo à luz da psicologia analítica. Os resultados revelam que a violência contra a mulher ainda é assunto pouco explorado e pouco valorizado. Revelam, ainda, que essa clínica faz emergir conteúdos intensos, com questões ligadas ao feminino ferido as quais fazem parte do universo pessoal das psicólogas. A maioria delas pareceu apresentar sintomas de estresse secundário traumático. Alguns sentimentos contratransferenciais foram ignorados pelas psicólogas, o que pode obscurecer o contato terapêutico. Concluindo, esse estudo ressalta a necessidade de cuidado direcionado às psicólogas. Ressalta também a necessidade das psicólogas resgatarem suas capacidades de percepção, discriminação e de colocação de limites, a fim de facilitar o reconhecimento, a elaboração e o trabalho analítico das reações contratransferenciais em favor da dinâmica terapêutica

Bakgrund: Humor som inslag i mänsklig kultur går att identifiera så långt tillbaka som det finns skriftliga källor. Humor påverkar social interaktion, används för att känna social samhörighet, skapa band människor emellan och stärka relationer. Traditionellt har sjuksköterskans roll haft begränsat medicinskt fokus. Rollen har breddats och innebär nu personligt relationsskapande präglat av engagemang och att se hela människan – en personcentrerad vård.   Syfte: Att beskriva hur humor används i vården och hur detta upplevs ur ett patient- och sjuksköterskeperspektiv. Metod: En litteraturöversikt med datainsamling från databaserna CINAHL Complete, PubMed och Ageline. Resultat: Sjuksköterskeperspektivet beskriver hur sjuksköterskor använder humor i vården för att främja en terapeutisk relation till patienten, bevara patientens identitet samt skapa trygghet och tillit och även som strategi för att klara av sjuksköterskearbetet och för att stärka teamarbetet. Patientperspektivet beskriver hur patienter avsiktligt använder humor för att få bättre vård och underlätta för sjuksköterskan. I vården är humorn oftast patientinitierad och används av patienten som skydd och för att lätta upp i svåra situationer. Både patienter och sjuksköterskor ansåg att det finns situationer då humor är opassande. Diskussion: Resultatet diskuteras utifrån Katie Erikssons omvårdnadsteori och relateras till konsensusbegreppet hälsa. Humor spelar en central roll i vårdandet och tycks ha effekter på psykiskt välmående. Humorn är dock oftast patientinitierad och för att ge personcentrerad vård borde sjuksköterskor i högre grad använda humor som ett verktyg i den dagliga professionen. / Background: As far back as there are written sources there is possible to identify humour elements in human culture. Humour affects social interactions, is used to show appreciation, create feelings of social connectedness, form bonds between people and maintain and strengthen relationships. Traditionally the nurse’s role has been relatively limited and the focus has been strictly medical. The nurse’s role has expanded and involves personal relationship building characterized by commitment and to see the whole person – a person-centered care. Aim: To describe how humour is used in health care and how it is perceived, from a patient and nurse perspective. Method: A literature review of data collection from databases CINAHL Complete, PubMed and Ageline. Results: The Nurse Perspective describes how nurses use humour in healthcare to promote a therapeutic relationship with the patient and preserve the patients' identity and create a sense of security and trust. Further, humour was used as a strategy to cope with the heavy work the nurse carries out and to improve teamwork. The Patient Perspective describes how patients deliberately use humour to receive better care and to aid the nurse. Mostly, humour in health care was patient initiated and is also used by patients as protection and to lighten up difficult situations. Both patients and nurses believed that humour is inappropriate in some situations. Discussion: The results are discussed on the basis of Katie Eriksson nursing theory and was related to the consensus concept health. Humour plays a central role in nursing and to deepen the nurse-patient relationship. It seems to have effects on psychological well-being. Despite this, humour is usually patient initiated and in order to provide person-centered care nurses should make greater use of humour as a tool used in their profession.

No / Starting from the premise that people are essentially narrative beings, I argue that the onset of severe mental illness compromises the narrative enterprise of being able to construct one's Self and one's relationships inmeaningful and coherent ways. This is due to both the curtailment of opportunities for narrative engagement and the dispossession of those whose narratives do not conform to the current conceptualization of narrative and narrativity. In these circumstances, supporting the narrative enterprise is an ethical endeavour that requires that we examine not only which narratives we construct, but also how we construct them. This requires a re-thinking of what might constitute narrative and how we might facilitate or enhance the narrativity of people with severe mental illness. Following this, I suggest four means to support the narrativity of people with severe mental illness: through maintaining narrative continuity, maintaining narrative agency, countering master narratives and attention to small stories.

English :Between 1870 and 1930, medicine on the heels of the Pastorian revolution underwent profound changes while the hospital – a charitable institution traditionally dedicated to the care of the poor – was fast becoming one of the central sites of Western health care. Yet, it was still decades away from the advent of "patient rights" and the rise to prominence of the ethics of patient autonomy. What moral culture, then, prevailed inside hospitals and shaped the encounter between patients and health care professionals? What logics underlay interactions between the former and the latter? These are the questions that this thesis aims to answer. Drawing from the archives of two public hospitals in Brussels as well as from a series of deontological, literary, religious and jurisprudential sources, this work sits at the intersection of the social history of medicine, the history of authoritarian institutions, the history of patients and the history of medical ethics. It offers an examination of therapeutics interactions that primarily focuses on the day-to-day practices of various groups of historical actors (patients, doctors, interns, catholic nuns, priests, administrators, etc.). With an eye on the larger social context, it attempts to give a new historical depth to topics borrowed from the field of medical ethics, such as medical authority, care relationships, experimentation, religious healing, truth and benevolent lies, etc. By mining a rich collection of letters written by patients and their family members to the hospital administration, this thesis also sheds light on the views and actions of hospital users. Ultimately, it reveals the hospital as structured by a complex moral economy that is the expression of the deep paternalistic outlook of western societies. In this economy, therapeutic interactions rest on an ambiguous system of moral reciprocity that encourages the simultaneous performance of charitable love and social domination, of docility and rebellion.------------Français :Entre 1870 et 1930, la médecine, enrichie par les nouvelles possibilités de l’anesthésie, exultant devant le miracle antiseptique et les promesses de la révolution pastorienne, subit une transformation profonde. L’hôpital public, institution charitable traditionnellement dédiée au soin des populations pauvres, est en passe de devenir un des sites centraux de la thérapeutique occidentale. Pourtant, cette période de formation décisive de la médecine moderne est encore à des décennies de l’avènement des « droits des patients » et de ce bouleversement majeur qui verra, au milieu du 20ème siècle, l’éthique médicale entièrement reformulée autour de la notion d’autonomie du malade. Quelle culture morale prévaut alors à l’intérieur des institutions hospitalières et détermine les formes de la rencontre entre les patients et les soignants? Quels logiques sous-tendent l’agir des premiers et des seconds, dans le cadre de toutes ces activités qui amènent ceux-ci à interagir ensemble ?Ce sont les questions auxquelles cette thèse a l’ambition de répondre. Le contexte hospitalier lui-même est abordé ici comme un révélateur des dynamiques sociales structurant plus largement non seulement la médecine de l’époque, mais aussi les sociétés occidentales avant la Seconde Guerre mondiale.Les archives des hôpitaux bruxellois St-Jean et St-Pierre, supplémentées par une série de sources déontologiques, littéraires, religieuses et jurisprudentielles, constituent le terrain d’étude à partir duquel s’élaborent les propositions nombreuses de cette thèse. L’objet central de celle-ci – les interactions en milieu hospitalier – se situe à la croisée de quatre courants historiographiques :l’histoire sociale de la médecine, le récit interactionniste des institutions autoritaires, l’histoire des patients et l’histoire de l’éthique médicale. Prêtant une attention particulière aux pratiques des acteurs historiques, Guérir, travailler, désobéir se structure autour de six chapitres. Ceux-ci abordent des thématiques aussi variées que l’autorité des acteurs hospitaliers, la communication entre patients et soignants, ou encore la relation soignante. La thèse interroge aussi la dimension « utilitaire » de la rencontre thérapeutique dans un contexte de médecine publique (usage des corps de malades pauvres pour la science, l’enseignement, etc), les pratiques de détournement de l’institution hospitalière par les malades, et la nature du dialogue mettant en lien ces mêmes malades et l’administration hospitalière en cas de plainte. Au final, ce travail de recherche met à jour une économie morale complexe, expression du paternalisme profond des sociétés occidentales, qui fait reposer les interactions thérapeutiques sur un système ambigu de réciprocité morale. / Doctorat en Histoire, histoire de l'art et archéologie / info:eu-repo/semantics/nonPublished