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RÊGO, Mariana Oliveira do. As particularidades da transferência na neurose obsessiva. 2012. 111f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-graduação em Psicologia, Fortaleza (CE), 2012. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2013-11-26T12:47:52Z No. of bitstreams: 1 2012-DIS-MOREGO.pdf: 580501 bytes, checksum: d862a7a494cc0f12bc941547fd585b32 (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2013-11-26T14:32:40Z (GMT) No. of bitstreams: 1 2012-DIS-MOREGO.pdf: 580501 bytes, checksum: d862a7a494cc0f12bc941547fd585b32 (MD5) / Made available in DSpace on 2013-11-26T14:32:40Z (GMT). No. of bitstreams: 1 2012-DIS-MOREGO.pdf: 580501 bytes, checksum: d862a7a494cc0f12bc941547fd585b32 (MD5) Previous issue date: 2012 / The transference in obsessional neurosis has many characteristics that can become difficulties in the course of treatment. We intend to analyze the particularities of this transference and relate them to the obsessional neurosis itself. These difficulties in the handle of the obsessional neurosis´s transference emerged from our clinical activity, from which we delimitated our subject. In despite of this, the clinical case that we assisted lacked elements to base a study. We decided then to approach the transference and the obsessional neurosis from a metapshychological point of view, emphasizing the dynamic and economic aspects. Then, we correlated the founded data to the difficulties faced by Freud in his main clinical cases of obsessional neurosis and to the difficulties we faced in the course of the treatment that instigated this study. We concluded that the obsessional neurosis particular form of the repression (the displacement) causes most part of the particularities of this neurosis, like rationalization and ritualistic behavior. The most visible effects of the displacement in the transferencial context are the rationalizations and the resistance to associate freely. These manifestations have relation with the ambivalent type present in obsessive patients. These resistances, as the same time seem to be inoffensive, are very disadvantageous to the treatment, since they prevent the patient of engage the treatment. We concluded that, being an artificial neurosis, the transference should be comprehended in relation of the characteristics of the neurosis in question, since that characteristics are responsible for the transference form and manifestation. / A transferência na neurose obsessiva apresenta muitas características que podem se transformar em dificuldades no decorrer do tratamento analítico. Visamos, neste estudo, a analisar tais particularidades e a associá-las à estrutura da própria neurose obsessiva. Essas dificuldades no manejo da transferência do obsessivo se manifestaram para nós na realidade da clínica, da qual extraímos nossa temática, mas, apesar disso, o caso atendido não possuía elementos suficientes para embasar uma pesquisa. Optamos, pois, por abordar a neurose obsessiva e a transferência a partir de um ponto de vista metapsicológico, enfatizando os aspectos dinâmicos e econômicos referentes a cada um desses conceitos. Feito isso, correlacionamos os dados encontrados às dificuldades enfrentadas por Freud em seus principais casos de neurose obsessiva e, ainda, aos percalços por nós encontrados no caso clínico que motivou a pesquisa. Concluímos que o modo particular através do qual o recalque se manifesta na neurose obsessiva (o deslocamento) é responsável por muitos predicados dessa neurose, como a tendência às racionalizações e a formação de comportamentos ritualísticos. Na transferência, os efeitos mais visíveis do deslocamento são as racionalizações constantes e a resistência em associar livremente. Essas manifestações se relacionam também ao caráter ambivalente tão presente nos obsessivos. Com dificuldades em conseguir um destino adequado para as pulsões de amor e ódio, igualmente intensas, o obsessivo adota formações de compromisso como tais resistências, que, ao mesmo tempo em que parecem inócuas, entravam a análise por não fazerem com que o sujeito nela se implique. Concluímos que, sendo a transferência uma neurose artificial, é imprescindível que compreendamos as características da neurose em questão, pois estas são responsáveis por dar o tom da transferência.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A transferÃncia na neurose obsessiva apresenta muitas caracterÃsticas que podem se transformar em dificuldades no decorrer do tratamento analÃtico. Visamos, neste estudo, a analisar tais particularidades e a associÃ-las à estrutura da prÃpria neurose obsessiva. Essas dificuldades no manejo da transferÃncia do obsessivo se manifestaram para nÃs na realidade da clÃnica, da qual extraÃmos nossa temÃtica, mas, apesar disso, o caso atendido nÃo possuÃa elementos suficientes para embasar uma pesquisa. Optamos, pois, por abordar a neurose obsessiva e a transferÃncia a partir de um ponto de vista metapsicolÃgico, enfatizando os aspectos dinÃmicos e econÃmicos referentes a cada um desses conceitos. Feito isso, correlacionamos os dados encontrados Ãs dificuldades enfrentadas por Freud em seus principais casos de neurose obsessiva e, ainda, aos percalÃos por nÃs encontrados no caso clÃnico que motivou a pesquisa. ConcluÃmos que o modo particular atravÃs do qual o recalque se manifesta na neurose obsessiva (o deslocamento) à responsÃvel por muitos predicados dessa neurose, como a tendÃncia Ãs racionalizaÃÃes e a formaÃÃo de comportamentos ritualÃsticos. Na transferÃncia, os efeitos mais visÃveis do deslocamento sÃo as racionalizaÃÃes constantes e a resistÃncia em associar livremente. Essas manifestaÃÃes se relacionam tambÃm ao carÃter ambivalente tÃo presente nos obsessivos. Com dificuldades em conseguir um destino adequado para as pulsÃes de amor e Ãdio, igualmente intensas, o obsessivo adota formaÃÃes de compromisso como tais resistÃncias, que, ao mesmo tempo em que parecem inÃcuas, entravam a anÃlise por nÃo fazerem com que o sujeito nela se implique. ConcluÃmos que, sendo a transferÃncia uma neurose artificial, à imprescindÃvel que compreendamos as caracterÃsticas da neurose em questÃo, pois estas sÃo responsÃveis por dar o tom da transferÃncia. / The transference in obsessional neurosis has many characteristics that can become difficulties in the course of treatment. We intend to analyze the particularities of this transference and relate them to the obsessional neurosis itself. These difficulties in the handle of the obsessional neurosisÂs transference emerged from our clinical activity, from which we delimitated our subject. In despite of this, the clinical case that we assisted lacked elements to base a study. We decided then to approach the transference and the obsessional neurosis from a metapshychological point of view, emphasizing the dynamic and economic aspects. Then, we correlated the founded data to the difficulties faced by Freud in his main clinical cases of obsessional neurosis and to the difficulties we faced in the course of the treatment that instigated this study. We concluded that the obsessional neurosis particular form of the repression (the displacement) causes most part of the particularities of this neurosis, like rationalization and ritualistic behavior. The most visible effects of the displacement in the transferencial context are the rationalizations and the resistance to associate freely. These manifestations have relation with the ambivalent type present in obsessive patients. These resistances, as the same time seem to be inoffensive, are very disadvantageous to the treatment, since they prevent the patient of engage the treatment. We concluded that, being an artificial neurosis, the transference should be comprehended in relation of the characteristics of the neurosis in question, since that characteristics are responsible for the transference form and manifestation.

O presente trabalho, situado na linha de Psicologia e Educação, trata-se de uma revisão de literatura, cuja finalidade inicial foi a sistematização dos conhecimentos produzidos acerca do que se convencionou chamar, primeiramente sob o viés psicanalítico, de neurose obsessiva e, posteriormente, a partir do ponto de vista científico, de transtorno obsessivo compulsivo (TOC). Num segundo momento, teve como objetivo analisar os discursos produzidos sobre o tema, tendo em vista as diferentes áreas de conhecimento que dele se ocuparam, bem como as divergentes concepções teóricas. Porém, mais do que os saberes que têm sido produzidos, interessou-nos analisar as práticas que estão implicadas na produção e no funcionamento desses saberes, isto é, quais os efeitos dos discursos das áreas de radical psi - compreendidas aqui pela psiquiatria, psicologia e psicanálise na produção de um tipo bem determinado de sujeito e qual o papel da educação nesse contexto. Para tanto, lançamos mão de alguns estudos de intelectuais de lastro foucaultiano, que nos permitiram compreender a verdade como invenção - e não como descoberta, tal como sugerem muitos cientistas daí a necessidade de desnaturalizá-las; e o discurso como um conjunto de enunciados, vinculado a jogos de poder, que fazem circulam determinados regimes de verdade, através dos quais, realidade e sujeitos são produzidos. Nesse sentido, se a invenção se dá na/pela linguagem, podemos afirmar que, a invenção da neurose obsessiva - ou TOC - e de sua clínica, ganha status de verdade e de realidade na medida em que começa a ser produzida nas narrativas, quando começa a circular em diferentes discursos, quando começa a ganhar força em estudos que visam compreendê-la, explicá-la, enfim, quando começa a produzir saberes geradores de novas práticas e, de modo circular, práticas que convocam novos saberes. Do estudo, também foi possível depreender que os discursos psi são importantes dispositivos de poder, que funcionam no sentido de apagar toda e qualquer diferença, com vistas à adequação dos sujeitos aos padrões normativos. Nesse sentido, a escola, entendida como instituição disciplinar por excelência, onde discursos psi e pedagógicos se fundem e, por vezes, se confundem, é o lugar privilegiado para o exercício do poder e, portanto, das práticas de governo de todos e de si ao mesmo tempo. / This work, situated in the line of search of Psychology and Education, is a literature review, whose initial purpose was the systematization of knowledge produced about what is termed, primarily under the psychoanalytical view, obsessional neurosis, subsequently, from the scientific point of view, obsessive compulsive disorders (OCD). In a second moment, aimed to analyze the speeches produced about the subject, in view of, the different areas of knowledge that gets occupied by it, as well as the divergent theoretical conceptions. However, more than the knowledge that have been produced, interested to us, examining the practices that are involved in the production and operation of such knowledge, that is, what effects the speeches of the radical psy areas - understood here by psychiatry, psychology and psychoanalysis in the production of a determined type of subject and the role of education in that context. For both, in support in some studies of foucaultian approach, which allowed us understand the truth as invention - and not as discovery, as suggest many scientists hence the need for denaturalize them; and the discourse as a set of statements, entailed with power games, which are moving certain truth regimes, through which, reality and subject are produced. Then, if the invention is in/on the language, we can affirm that, the invention of obsessional neurosis - or OCD - and its clinical, get status of truth and reality in so far as it begins to be produced in narratives, when it begins to circulate in various speeches, when it begins to gain strength in studies that aim to understand and explain it, finally, when it begins to produce new knowledge-generating practices and, in a circular way, practices that summon new knowledge. From the study, it was also possible to conclude that the psy speeches are important power devices, which work in order to erase any distinction, to the suitability of the subject to normative standards. Therefore, the school, understood as disciplinary institution par excellence, where psy and educational speeches merge, and sometimes, are confused, is the privileged place for the exercise of power, and consequently, of the rules practices of every and of itself at the same time.

O presente trabalho, situado na linha de Psicologia e Educação, trata-se de uma revisão de literatura, cuja finalidade inicial foi a sistematização dos conhecimentos produzidos acerca do que se convencionou chamar, primeiramente sob o viés psicanalítico, de neurose obsessiva e, posteriormente, a partir do ponto de vista científico, de transtorno obsessivo compulsivo (TOC). Num segundo momento, teve como objetivo analisar os discursos produzidos sobre o tema, tendo em vista as diferentes áreas de conhecimento que dele se ocuparam, bem como as divergentes concepções teóricas. Porém, mais do que os saberes que têm sido produzidos, interessou-nos analisar as práticas que estão implicadas na produção e no funcionamento desses saberes, isto é, quais os efeitos dos discursos das áreas de radical psi - compreendidas aqui pela psiquiatria, psicologia e psicanálise na produção de um tipo bem determinado de sujeito e qual o papel da educação nesse contexto. Para tanto, lançamos mão de alguns estudos de intelectuais de lastro foucaultiano, que nos permitiram compreender a verdade como invenção - e não como descoberta, tal como sugerem muitos cientistas daí a necessidade de desnaturalizá-las; e o discurso como um conjunto de enunciados, vinculado a jogos de poder, que fazem circulam determinados regimes de verdade, através dos quais, realidade e sujeitos são produzidos. Nesse sentido, se a invenção se dá na/pela linguagem, podemos afirmar que, a invenção da neurose obsessiva - ou TOC - e de sua clínica, ganha status de verdade e de realidade na medida em que começa a ser produzida nas narrativas, quando começa a circular em diferentes discursos, quando começa a ganhar força em estudos que visam compreendê-la, explicá-la, enfim, quando começa a produzir saberes geradores de novas práticas e, de modo circular, práticas que convocam novos saberes. Do estudo, também foi possível depreender que os discursos psi são importantes dispositivos de poder, que funcionam no sentido de apagar toda e qualquer diferença, com vistas à adequação dos sujeitos aos padrões normativos. Nesse sentido, a escola, entendida como instituição disciplinar por excelência, onde discursos psi e pedagógicos se fundem e, por vezes, se confundem, é o lugar privilegiado para o exercício do poder e, portanto, das práticas de governo de todos e de si ao mesmo tempo. / This work, situated in the line of search of Psychology and Education, is a literature review, whose initial purpose was the systematization of knowledge produced about what is termed, primarily under the psychoanalytical view, obsessional neurosis, subsequently, from the scientific point of view, obsessive compulsive disorders (OCD). In a second moment, aimed to analyze the speeches produced about the subject, in view of, the different areas of knowledge that gets occupied by it, as well as the divergent theoretical conceptions. However, more than the knowledge that have been produced, interested to us, examining the practices that are involved in the production and operation of such knowledge, that is, what effects the speeches of the radical psy areas - understood here by psychiatry, psychology and psychoanalysis in the production of a determined type of subject and the role of education in that context. For both, in support in some studies of foucaultian approach, which allowed us understand the truth as invention - and not as discovery, as suggest many scientists hence the need for denaturalize them; and the discourse as a set of statements, entailed with power games, which are moving certain truth regimes, through which, reality and subject are produced. Then, if the invention is in/on the language, we can affirm that, the invention of obsessional neurosis - or OCD - and its clinical, get status of truth and reality in so far as it begins to be produced in narratives, when it begins to circulate in various speeches, when it begins to gain strength in studies that aim to understand and explain it, finally, when it begins to produce new knowledge-generating practices and, in a circular way, practices that summon new knowledge. From the study, it was also possible to conclude that the psy speeches are important power devices, which work in order to erase any distinction, to the suitability of the subject to normative standards. Therefore, the school, understood as disciplinary institution par excellence, where psy and educational speeches merge, and sometimes, are confused, is the privileged place for the exercise of power, and consequently, of the rules practices of every and of itself at the same time.

L’approche cognitive du trouble obsessionnel-compulsif (TOC) propose un lien bidirectionnel entre les émotions et les cognitions. Cependant, même si des études montrent une association entre les émotions et le TOC, aucune étude ne s’est attardée à la relation entre les émotions, les cognitions et les comportements au cours d’une thérapie cognitive. La présente étude a pour but d’examiner la relation entre les processus cognitif, béhavioral et émotionnel au cours d’une thérapie basée sur les inférences (TBI) chez des personnes souffrant du TOC. Plus précisément, nous avons observé comment les émotions et les symptômes du TOC s’influencent et comment ils s’influencent à travers le temps. Les patients ont rempli un journal de bord tout au long du processus thérapeutique, notant (de 0 à 100) des émotions clés, ainsi que les croyances et les comportements ciblés durant la thérapie. Des analyses à mesures répétées ont été utilisées afin de maximiser le potentiel des données longitudinales. Les résultats montrent que l’anxiété, la tristesse et la joie ont des trajectoires similaires aux croyances et aux comportements au cours de la thérapie. Les forces et limites de l’étude sont discutées. Les implications des résultats pour le traitement des émotions et des pensées à différents moments de la thérapie sont aussi discutées. / Cognitive approach of obsessive-compulsive disorder (OCD) has suggested a bidirectional link between emotions and cognitions. Few studies have looked at a link between those two components. Although some studies tend to show a relationship between emotions and OCD, no study has looked into the relationship between emotions, cognitions and behaviours over the course of a cognitive therapy. The present case series examines the relationship between cognitive, behavioural and emotional processes over the course of an inference-based therapy (IBT) in OCD clients. More precisely, we looked at how emotions and OCD symptoms influence each other and how they influence each other over time (through therapy). Clients filled in daily diaries rating key emotions, behaviours and beliefs over the course of treatment. A longitudinal analysis based on an event-based approach was used to maximize the potential of longitudinal data. Results showed that anxiety, sadness and joy share similar trajectories with beliefs and behaviours over the course of therapy. Strengths and limitations of the study are noted. Implications for targeting emotions and thoughts at different stages of therapy are also discussed.

L’approche cognitive du trouble obsessionnel-compulsif (TOC) propose un lien bidirectionnel entre les émotions et les cognitions. Cependant, même si des études montrent une association entre les émotions et le TOC, aucune étude ne s’est attardée à la relation entre les émotions, les cognitions et les comportements au cours d’une thérapie cognitive. La présente étude a pour but d’examiner la relation entre les processus cognitif, béhavioral et émotionnel au cours d’une thérapie basée sur les inférences (TBI) chez des personnes souffrant du TOC. Plus précisément, nous avons observé comment les émotions et les symptômes du TOC s’influencent et comment ils s’influencent à travers le temps. Les patients ont rempli un journal de bord tout au long du processus thérapeutique, notant (de 0 à 100) des émotions clés, ainsi que les croyances et les comportements ciblés durant la thérapie. Des analyses à mesures répétées ont été utilisées afin de maximiser le potentiel des données longitudinales. Les résultats montrent que l’anxiété, la tristesse et la joie ont des trajectoires similaires aux croyances et aux comportements au cours de la thérapie. Les forces et limites de l’étude sont discutées. Les implications des résultats pour le traitement des émotions et des pensées à différents moments de la thérapie sont aussi discutées. / Cognitive approach of obsessive-compulsive disorder (OCD) has suggested a bidirectional link between emotions and cognitions. Few studies have looked at a link between those two components. Although some studies tend to show a relationship between emotions and OCD, no study has looked into the relationship between emotions, cognitions and behaviours over the course of a cognitive therapy. The present case series examines the relationship between cognitive, behavioural and emotional processes over the course of an inference-based therapy (IBT) in OCD clients. More precisely, we looked at how emotions and OCD symptoms influence each other and how they influence each other over time (through therapy). Clients filled in daily diaries rating key emotions, behaviours and beliefs over the course of treatment. A longitudinal analysis based on an event-based approach was used to maximize the potential of longitudinal data. Results showed that anxiety, sadness and joy share similar trajectories with beliefs and behaviours over the course of therapy. Strengths and limitations of the study are noted. Implications for targeting emotions and thoughts at different stages of therapy are also discussed.

Le syndrome de Gilles de la Tourette (SGT), le trouble obsessionnel compulsif (TOC) et les comportements répétitifs centrés sur le corps (CRCC) sont trois troubles qui présentent de nombreuses similarités, autant d’ordre phénoménologique que neuroanatomique et fonctionnel. Toutefois, malgré une recension des écrits pointant vers un possible spectre incluant ces trois troubles, les études qui ont contrasté ceux-ci se font peu nombreuses. Étudier les processus cognitifs affectés dans chacune de ces conditions cliniques permettrait alors d’offrir une meilleure compréhension des différences et des similarités entre celles-ci. D’ailleurs, l’utilisation des potentiels évoqués comme technique d’imagerie cérébrale offre l’avantage de mesurer l’activité cérébrale avec une excellente résolution temporelle. Les composantes de potentiels évoqués permettent alors de refléter certains processus cognitifs, notamment les processus attentionnels et mnésiques, qui sont connus comme étant potentiellement affectés dans ces trois troubles. Notre objectif était donc de comparer l’amplitude de trois composantes (P200, N200 et P300) entre des groupes de participants atteints du SGT (n=24), du TOC (n=18) et des CRCC (n=16), qui ont tous été appariés à un groupe contrôle (n=59) dans une tâche de oddball visuelle cognitive. Nos résultats n’ont d’abord montré aucune différence intergroupe pour la P200 et la N200 lorsqu’on contrôle pour les symptômes anxio-dépressifs, ce qui laisse présager que les processus cognitifs reflétés par ces composantes sont intacts dans ces populations cliniques. En ce qui a trait à la composante P300, nos résultats ont montré une diminution de l’effet oddball P300 pour les groupes SGT et TOC comparativement au groupe contrôle, alors qu’un effet oddball intact a été observé pour le groupe CRCC. Les analyses de localisation de sources ont révélé des activations dans le gyrus lingual et le gyrus occipital moyen pour le groupe TOC, ce qui le distingue des deux autres groupes cliniques et du groupe contrôle. En effet, ceux-ci ont plutôt montré des activations dans le cortex cingulaire pour la génération de cet effet oddball. Ainsi, il semblerait que les groupes SGT et TOC présentent des déficits dans la mémoire de travail, tels que dégagés par les altérations de la composante P300, mais que des régions cérébrales différentes soient impliquées dans la génération de ces activations anormales. / Tourette Syndrome (TS), Obsessive-Compulsive Disorder (OCD) and Body-Focused Repetitive Behaviors (BFRB) are three disorders that share many similarities in terms of phenomenology, neuroanatomy and functionality. However, despite a literature review pointing towards a possible spectrum including these three disorders, only a few studies compared them in the same context. Studying the cognitive processes affected by these clinical conditions would provide a better understanding of their differences and similarities. Moreover, using EventRelated Potentials (ERP) as a brain imaging technique offers the advantage of measuring brain activity with excellent temporal resolution. The ERP components can then reflect specific cognitive processes, notably attentional and memory processes, which are known to be potentially affected in these three disorders. Our aim was, therefore, to compare the amplitude of three ERP components (P200, N200, and P300) across groups of participants with TS (n=24), OCD (n=18), and BFRB (n=16), all of whom were matched to a control group (n=59), in a cognitive visual oddball task. Our results initially showed no group differences for the P200 and N200 when controlling for anxiety and depressive symptoms, suggesting that the cognitive processes reflected by these components are intact in these clinical populations. Concerning the P300 component, our results showed a decrease in the P300 oddball effect for the SGT and OCD groups compared to the control group, whereas an intact oddball effect was observed for the BFRB group. Furthermore, source localization analyses revealed activations in the lingual and middle occipital gyrus for the OCD group, distinguishing it from the other two clinical groups and the control group. Indeed, these groups showed activations in the cingulate cortex to generate this oddball effect. Thus, it seems that the TS and OCD groups show deficits in working memory, as revealed by alterations in the P300 component, but those different brain regions are involved in generating these distinct activations.