<p>Diss. (sammanfattning) Umeå : Umeå universitet, 1998, Härtill 4 uppsatser.</p> / digitalisering@umu

This master thesis deals with the subjective view of middle aged and older Czech women on problematic of old age and aging. In connection of old age and aging they focus more on the aging of the whole society or relation between the generations, but not on a subjective perception and experience of this life stage and process. The aim of this work is to find out what women consider as the key elements of old age and aging and also to create a comprehensive view of aging from the women perspective. It is also essential to the thesis to determine the differences and similarities in the perception of aging in terms of age and life stage. In this thesis is used a method of qualitative research, which is grounded in the phenomenological approach and data collection is carried out using the ZMET research method. This projective technique of data collection, whose theory and practice is described in the work, is based on the idea that people do not think verbally but in images. Powered by TCPDF (www.tcpdf.org)

Avanços tecnológicos e sociais elevaram acentuadamente a expectativa de vida dos indivíduos, favorecendo considerável envelhecimento populacional e aumento de instituições de longa permanência para idosos (ILPI). O impacto da institucionalização no funcionamento psicológico dessa faixa etária ainda é pouco investigado no Brasil. Nesse estudo, objetivou-se caracterizar e comparar vivências afetivas em idosos institucionalizados e não institucionalizados, a partir de instrumentos padronizados de avaliação psicológica. Participaram do estudo idosos com mais de 60 anos, de ambos os sexos, compondo dois grupos: a) Grupo 1 (G1, n=25): residentes em ILPIs há pelo menos seis meses; b) Grupo 2 (G2, n=25): residentes em seus lares. Os grupos foram balanceados em termos de sexo, faixa etária e escolaridade, embora não tenham sido selecionados por essas variáveis, compondo amostra de conveniência. Foram individualmente avaliados por questionário sociodemográfico e Critério de Classificação Econômica Brasil, Escala de Autoestima de Rosenberg (EAR), Escala de Afetos (EA), Escala de Afetos Positivos e Negativos (PANAS) e Teste das Pirâmides Coloridas de Pfister (TPC). Os dados foram sistematizados conforme respectivos manuais técnicos e normativos, analisados de modo descritivo e inferencial, comparando-se médias de G1 e G2 (teste t de Student, p0,05) e tamanho do efeito (d de Cohen) nas variáveis numéricas, ou análise comparativa da distribuição dos casos (qui-quadrado, p0,05), com tamanho do efeito (V de Cramer) nas variáveis categóricas. Houve diferenças estatisticamente significativas entre G1 e G2 na autoestima (EAR), nos afetos negativos (EA) e indicadores do funcionamento lógico (TPC). Na PANAS não houve indicadores específicos para os grupos avaliados. Os idosos institucionalizados sinalizaram menor autoestima (média EAR menor), mais afetos negativos (somatória maior nos afetos negativos EA) e maior amplitude emocional (fórmula cromática ampla em todos os casos), sugerindo marcadores específicos em sua dinâmica afetiva. Em termos lógicos evidenciaram maior necessidade de tempo de trabalho para atividades (maior média no tempo total TPC) e menor elaboração abstrata dos estímulos (mais tapetes no TPC). A comparação dos atuais achados com expectativas normativas para idosos da comunidade mostrou que idosos de G1 e G2 tiveram resultados inferiores em termos de autoestima e similares nos afetos positivos e negativos, predominando afetividade positiva. No TPC os idosos de G2 acompanharam os referenciais normativos, mas G1 evidenciou diferenças em cinco das 10 cores (azul, violeta, amarelo, marrom e cinza) e síndromes cromáticas (estímulo e incolor), sinalizando maior retraimento e ansiedade. Esses achados apontaram especificidades no funcionamento cognitivo e emocional de idosos institucionalizados, atestando empiricamente a relevância das condições de moradia e suporte social na organização psíquica nessa fase do desenvolvimento. Investigações adicionais sobre a complexa rede de variáveis associadas a essas particularidades fazem-se necessárias diante do crescente aumento de idosos na população e em ILPIs / Technological and social advances have markedly lifted the life expectancy of individuals, favoring considerable population aging and an increase in long-stay institutions for the elderly. The impact of institutionalization on the psychological functioning of this age group is still little investigated in Brazil. In this study, the objective was to characterize and compare affective experiences in institutionalized and non-institutionalized elderly, using standardized psychological assessment instruments. Indicators from the use of psychological assessment tools were sought in elderly people over 60 years of age. Participants were sought in two housing conditions: a) Residents in Long-Term Institutions for the Elderly; b) residents in their homes. The institutionalized formed Group 1 (G1, n = 25), while elderly people living in their homes (G2, n = 25) formed Group 2 (comparison group), assessed by the following materials: sociodemographic questionnaire and Brazil\'s Economic Classification Criteria, Rosenberg Self-esteem Scale (RSS), Affect Scale (AS), Positive and Negative Affect Schedule (PANAS), and Pfister\'s Colored Pyramids Test (PCPT). The instrument data were systematized according to the respective technical manuals. Descriptive and inferential analyzes were performed, comparing the means and effect size calculation (Student\'s t test, p0.05; Cohen\'s d) of G1 and G2 in numerical variables, or comparative analysis of the distribution of cases (chi-square, p0.05) and effect size (Cramers V). There were statistically significant differences between G1 and G2 in self-esteem (RSS), negative affects (affect scale) and indicators of logical functioning (PCPT). At PANAS there were no specific indicators for the groups evaluated. The institutionalized elderly showed lower self-esteem (mean RSS less), more negative affections (greater sum in negative emotions on affect scale) and greater emotional amplitude (wide chromatic formula in all cases on PCPT), suggesting specific markers in their affective dynamics. In logical terms, G1 needed more working time for activities (higher mean in total PCPT) and less abstract elaboration of stimuli (more carpets in PCPT). The comparison of the current findings with normative expectations for the elderly in the community showed that G1 and G2 elderly had lower results in terms of self-esteem and similar in positive and negative affections, predominating positive affectivity. In the PCPT the G2 elderly followed the normative references, but G1 showed differences in five of the 10 colors (blue, violet, yellow, brown and gray) and chromatic syndromes (stimulus and colorless), signaling greater withdrawal and anxiety. These findings pointed out specificities in the cognitive and emotional functioning of institutionalized elders, empirically attesting the relevance of housing conditions and social support in psychic organization at this stage of development. Further research on the complex network of variables associated with these particularities is necessary in the face of increasing numbers of elderly people in the population and in institutionalization

O Método de Rorschach é internacionalmente utilizado e reconhecido como instrumento de avaliação psicológica em processos de investigação da personalidade. Para embasar seu adequado uso no contexto do Brasil, contínuos estudos sobre suas evidências psicométricas fazem-se necessários, sobretudo sobre seus indicadores de validade, precisão e referenciais normativos. Nesse contexto, este trabalho objetivou: a) verificar indicadores de precisão e validade do Rorschach (Escola Francesa ou de Paris), por meio da reavaliação de adultos não pacientes do estudo normativo de Pasian (1998), para checagem da estabilidade temporal (estrutural e funcional) das características de personalidade examinadas pelo método (ESTUDO 1); b) revisar e atualizar padrões normativos e atlas da Escola Francesa do Rorschach em adultos, avaliando-se eventuais especificidades de produção associadas ao sexo, à idade e à escolaridade (ESTUDO 2). No primeiro estudo foram reavaliados 88 adultos do estudo de Pasian (1998), com idade entre 34 a 69 anos, de ambos os sexos e de diferentes níveis de escolaridade (baixa, média e alta). No segundo estudo compôs-se nova amostra com 102 adultos, entre 18 e 65 anos, com sinais de desenvolvimento típico, distribuídos equitativamente em relação ao sexo e com diferentes graus de escolaridade (baixa, média e alta). Para elaboração dos dados normativos foram incluídos 66 adultos do Estudo 1, totalizando 168 casos nessa nova amostra (86 mulheres e 82 homens). Os participantes residiam no interior do Estado de São Paulo e foram avaliados, individualmente, por: a) instrumento de rastreamento de saúde mental (SRQ-20) - no estudo 1, utilizado para caracterização da amostra e no estudo 2 como critério de seleção dos participantes; b) instrumento de avaliação intelectual (Teste de Inteligência Não Verbal - INV, forma C - apenas no Estudo 2) para controle cognitivo da amostra; c) critério de classificação econômica Brasil (ABEP) e d) Método de Rorschach (Escola de Paris). Cada instrumento de avaliação psicológica foi aplicado, codificado e sistematizado conforme seus respectivos manuais técnicos. Especificamente o Método de Rorschach foi avaliado pelas diretrizes da Escola Francesa, sendo cada protocolo (de cada um dos dois estudos) examinado independentemente por dois avaliadores, chegando-se a uma classificação final dos casos. Calculou-se o índice de concordância entre examinadores pelo coeficiente Kappa para as quatro categorias de classificação das respostas do Rorschach (localização, determinante/qualidade formal, conteúdo e banalidades). Os resultados foram sistematizados inicialmente em termos descritivos (média, desvio-padrão, mediana, valor mínimo e máximo), realizando-se análises inferenciais específicas para as amostras de cada estudo em função de seus objetivos centrais. No Estudo 1, os achados relativos aos índices de correlação entre as duas avaliações dos 88 voluntários variaram entre 0,72 a -0,005, evidenciando estabilidade em um conjunto das características de personalidade dos adultos examinados após 15 anos, configurando evidências empíricas de precisão e de validade de método projetivo. Houve variáveis do Rorschach que não apresentaram resultados estáveis entre os dois momentos avaliativos (fórmulas vivenciais), sugerindo se tratarem de indicadores técnicos relativos ao funcionamento da personalidade, mais do que componentes estruturais. As análises do Estudo 2 apontaram reduzida influência dos fatores relacionados ao sexo, à escolaridade e à idade sobre as variáveis do Rorschach, não indicando a necessidade de normas específicas para grupos em termos desses fatores. Por fim, foi elaborado novo atlas de referência do Método de Rorschach (Escola de Paris) no contexto brasileiro, seguindo-se as diretrizes técnicocientíficas nacionais e internacionais da área. Os dados fortalecem a relevância dos estudos de natureza psicométrica para embasar adequadas análises interpretativas desse instrumento de avaliação psicológica (FAPESP e CAPES/PDSE). / The Rorschach Method is internationally used and known as a psychological assessment instrument in personality research. To support its proper use in the Brazilian context, studies about its psychometric evidence are required, particularly the ones that provide indicators of reliability, validity and normative references. This study aimed: a) to verify indicators of reliability and validity of the Rorschach (French School or School of Paris), through the revaluation of non-patient adults from Pasian\'s normative study (1998), to check the temporal stability (structural and functional) of personality traits examined by the Rorschach Inkblot Method (STUDY 1); b) to review and update the norms - the formal quality tables and the location tables of Rorschach (French School) in adults, evaluating any specific production associated with sex, age and education (STUDY 2). Study 1 reassessed 88 adults from Pasian\'s study (1998), ages ranging between 34-69 years, of both sexes and of different educational levels (low, medium and high). Study 2 assessed a new sample of 102 adults, between 18 and 65 years, with typical development indicators, equally distributed regarding sex and with different educational levels (low, medium and high). For the elaboration of the norms, 66 adults from Study 1 were added to the new sample resulting in a sample of 168 cases. Participants are from cities in the State of São Paulo and were evaluated individually using: a) the Mental Health Screening Questionnaire (SRQ-20), in Study 1 to characterize the mental health of adults and in Study 2 as selection criterion of participants; b) Non Verbal Intelligence Test (INV, form C - just in Study 2) for the cognitive control sample; c) Economic classification criteria Brazil (ABEP) and d) Rorschach Method (School of Paris). Each psychological assessment tool was applied, coded and systematized according to their respective manuals. Specifically the Rorschach Inkblot Method was evaluated by the guidelines of the School of Paris, each protocol (of each study) was examined by two independent judges, coming up to a final classification of the cases. The inter-rater reliability was calculated and a Kappa coefficient was obtained for the four categories of classification of Rorschach responses (location, determining/formal quality, content and banality). The results were examined by descriptive (mean, standard deviation, median, minimum and maximum) and inferencial statistical analyses for both samples, according to their main objectives. In Study 1, the correlation ratios between the test-retest of 88 volunteers ranged from 0.72 to -0.005, indicating stability in a set of personality traits of adults evaluated after 15 years, and empirically evidencencing the reliability and validity of this projective method. Some Rorschach variables did not show stable results between the test-retest (Rorschach Personality Styles), suggesting that they can be indicators of personality functioning rather than structural components of personality. In Study 2, regarding the effects of sex, education and age, the analyses showed statistically significant differences in a small number of variables for this projective method. Rorschach French School norms were elaborated for adults aged 18-65 years of both sexes, with different levels of education. Formal quality tables and location tables of this specific method were reviewed and updated according to new data. These procedures were performed in the Brazilian context in accordance with national and international scientific guidelines for the area. Our findings strengthen the relevance of psychometric studies to support appropriate interpretative analysis of the Rorschach School of Paris (FAPESP e CAPES/PDSE).

O diagnóstico de neoplasia em crianças e adolescentes, bem como os cuidados oncológicos necessários, impõem aos pacientes e a suas famílias o convívio cotidiano com múltiplos eventos adversos ao desenvolvimento, que podem ser de natureza biológica, psíquica, social e econômica. Essa complexa realidade exigirá recursos e estratégias pessoais e familiares para positivo desfecho, superando situações de vulnerabilidade. Até o momento, apesar do crescente número de casos de câncer, encontra-se reduzida produção científica sistematizada no campo da Psico-oncologia Pediátrica sobre quais variáveis seriam as mais relevantes em termos de efeitos no desenvolvimento infantojuvenil, embora se reconheça importância dos recursos pessoais (incluindo características de personalidade), sócio-familiares e dos serviços de saúde. Nesse contexto, este trabalho objetivou avaliar longitudinalmente possíveis efeitos da vivência de adoecimento e cuidado oncológico sobre recursos pessoais, familiares e características de personalidade de crianças e adolescentes com câncer. Trata-se de estudo longitudinal, de natureza quantitativa, descritivo-comparativo e interpretativo, a partir de instrumentos de avaliação psicológica. Foram compostos dois de crianças e adolescentes, de sete a 17 anos, de ambos os sexos, bem como seus respectivos pais/responsáveis, compondo amostra de conveniência. O Grupo Clínico (G1, n=30, crianças/adolescentes com diagnóstico de neoplasia há pelo menos um mês) foi retirado de pacientes do Setor de Oncologia e Hematologia Pediátrica de um hospital-escola público, considerado serviço de referência na área. O Grupo de Comparação (G2, n=20, crianças/adolescentes com desenvolvimento típico), foi constituído de modo a ser balanceado em relação a idade, sexo e origem escolar (particular ou pública) a G1. Todos os voluntários (crianças/adolescentes e seus pais/responsáveis) responderam, individualmente e em ambiente adequado para avaliação psicológica, a uma bateria de instrumentos avaliativos, aplicados em dois momentos, nomeados nesse estudo como Fase 1 (recorte transversal) e Fase 2 (recorte longitudinal, após intervalo mínimo de seis meses da primeira avaliação). Os pais/responsáveis responderam a: Critério de Classificação Econômica Brasil, Questionário de Capacidades e Dificuldades (SDQ), Inventário de Recursos do Ambiente Familiar (RAF), Escala de Eventos Adversos (EEA), Escala de Adversidades Crônicas (EAC) e Inventário de Percepção do Suporte Familiar (IPSF). Na criança/adolescente foram administrados: Matrizes Progressivas de Raven (Coloridas ou Escala Geral), Método de Rorschach (Escola Francesa) e Teste das Pirâmides Coloridas de Pfister. A aplicação e a avaliação dos instrumentos seguiram seus respectivos padrões técnico-científicos, realizando-se análises descritivas e comparativas de G1 e G2 (Teste t de Student ou Teste de Wilcoxon, p0,05%), nas duas fases do estudo. Os resultados apontaram, como síntese das duas fases avaliativas, sinais de preservação dos recursos familiares e cognitivo/afetivos das crianças/adolescentes com câncer, com manutenção do funcionamento adaptativo, embora com impacto negativo na percepção de si e de sua identificação com o humano, tendendo a maior mobilização emocional, com tensão e ansiedade em seus esforços adaptativos, identificados pelos pais/responsáveis como indicadores de dificuldades em termos de saúde mental, comparativamente ao Grupo de Comparação. O Grupo Clínico tendeu a recorrer mais a estratégias defensivas baseadas em mecanismos repressivos e de racionalização, inibindo expressões afetivas no ambiente, favorecendo-lhes adaptação ao contexto de vida. Estes achados empíricos evidenciaram, numa perspectiva longitudinal, os recursos e os esforços adaptativos de crianças/adolescentes que convivem com o diagnóstico oncológico, bem como suas famílias. Foi possível apontar a relevância da sistemática avaliação e reavaliação da complexa rede de variáveis envolvidas nesses processos, atestando a contribuição dos métodos projetivos no campo da Psico-Oncologia Pediátrica. / The neoplasia diagnosis in children and adolescentes, as well as the oncological care needed, impose to patients and their families the daily living with multiple adverse events to the development, that may be of biological, psychic, social and economic nature. This complex reality will demand personal and family resources and strategies for a positive outcome, overcoming situations of vulnerability. To date, despite the growing number of cancer cases, there is a reduced systematized scientific production in the field of Pediatric Psycho-Oncology about what variables would be the most relevant in terms of effects on child and adolescent development, although the importance of personal resources (including personality characteristics), socio-family and health services is recognized. In this contexto, this study aimed to longitudinally assess possible effects of the experience of illness and cancer care on personal, family and personality characteristics of children and adolescents with cancer. This is a longitudinal study, of a quantitative, descriptive-comparative and interpretative nature, based on psychological assessment instruments. The were composed two groups of children and adolescents, from seven to 17 years of age, of both sexes, as well as their respective parents/guardians, composing a convenience sample. The Clinical Group (G1, n=30, children/adolescents with diagnosis of neoplasia for at least one month) was composed from patients of the Oncology and Pediatric Hematology Sector of a public school hospital, considered a reference service in the area. The Comparison Group (G2, n=20, children/adolescents with typical development) was constituted in order to be balanced against age, gender and school origin (private or public) to G1. All volunteers (children/adolescents and their parents/guardians) responded, individually and in a suitable environment for psychological assessment, to a battery of assessment instruments, applied in two moments, named in this study as Phase 1 (transversal cut) and Phase 2 (longitudinal cut, after a minimum interval of six months of the first assessment). Parents/guardians responded to: Brazil\'s Economic Classification Criteria, Capacities and Difficulties Questionnaire (SDQ), Family Environment Resource Inventory (RAF), Adverse Event Scale (EEA), Chronic Adversity Scale (EAC), and Inventory of Perception of Family Support (IPSF). In the child/adolescent were administered: Progressive Matrices of Raven (Colored or General Scale), Method of Rorschach (French School) and Test of Colored Pyramids of Pfister. The application and assessment of the instruments followed their respective technical-scientific standards. Descriptive and comparative analyzes of G1 and G2 (Student\'s t test or Wilcoxon test, p0.05%) were carried out in both phases of the study. The results showed, as a synthesis of the two evaluative phases, signs of preservation of the family and cognitive/affective resources of the children/adolescents with cancer, with maintenance of the adaptative functioning, although with a negative impact on the perception of self and its identification with the human, tending to greater emotional mobilization, with tension and anxiety in their adaptive efforts, identified by parents/guardians as indicators of difficulties in terms of mental health, compared to the Comparison Group. The Clinical Group tended to resort more to defensive strategies based on repressive mechanisms and rationalization, inhibiting affective expressions in the environment, favoring adaptation to the context of life. These empirical findings have evidenced, from a longitudinal perspective, the resources and the adaptive efforts of children/adolescents living with cancer diagnosis, as well as their families. It was possible to point out the relevance of systematic assessment and re-assessment of the complex network of variables involved in these processes, attesting the contribution of projective methods in the field of Pediatric Psycho-Oncology.

O diagnóstico de neoplasia em crianças e adolescentes, bem como os cuidados oncológicos necessários, impõem aos pacientes e a suas famílias o convívio cotidiano com múltiplos eventos adversos ao desenvolvimento, que podem ser de natureza biológica, psíquica, social e econômica. Essa complexa realidade exigirá recursos e estratégias pessoais e familiares para positivo desfecho, superando situações de vulnerabilidade. Até o momento, apesar do crescente número de casos de câncer, encontra-se reduzida produção científica sistematizada no campo da Psico-oncologia Pediátrica sobre quais variáveis seriam as mais relevantes em termos de efeitos no desenvolvimento infantojuvenil, embora se reconheça importância dos recursos pessoais (incluindo características de personalidade), sócio-familiares e dos serviços de saúde. Nesse contexto, este trabalho objetivou avaliar longitudinalmente possíveis efeitos da vivência de adoecimento e cuidado oncológico sobre recursos pessoais, familiares e características de personalidade de crianças e adolescentes com câncer. Trata-se de estudo longitudinal, de natureza quantitativa, descritivo-comparativo e interpretativo, a partir de instrumentos de avaliação psicológica. Foram compostos dois de crianças e adolescentes, de sete a 17 anos, de ambos os sexos, bem como seus respectivos pais/responsáveis, compondo amostra de conveniência. O Grupo Clínico (G1, n=30, crianças/adolescentes com diagnóstico de neoplasia há pelo menos um mês) foi retirado de pacientes do Setor de Oncologia e Hematologia Pediátrica de um hospital-escola público, considerado serviço de referência na área. O Grupo de Comparação (G2, n=20, crianças/adolescentes com desenvolvimento típico), foi constituído de modo a ser balanceado em relação a idade, sexo e origem escolar (particular ou pública) a G1. Todos os voluntários (crianças/adolescentes e seus pais/responsáveis) responderam, individualmente e em ambiente adequado para avaliação psicológica, a uma bateria de instrumentos avaliativos, aplicados em dois momentos, nomeados nesse estudo como Fase 1 (recorte transversal) e Fase 2 (recorte longitudinal, após intervalo mínimo de seis meses da primeira avaliação). Os pais/responsáveis responderam a: Critério de Classificação Econômica Brasil, Questionário de Capacidades e Dificuldades (SDQ), Inventário de Recursos do Ambiente Familiar (RAF), Escala de Eventos Adversos (EEA), Escala de Adversidades Crônicas (EAC) e Inventário de Percepção do Suporte Familiar (IPSF). Na criança/adolescente foram administrados: Matrizes Progressivas de Raven (Coloridas ou Escala Geral), Método de Rorschach (Escola Francesa) e Teste das Pirâmides Coloridas de Pfister. A aplicação e a avaliação dos instrumentos seguiram seus respectivos padrões técnico-científicos, realizando-se análises descritivas e comparativas de G1 e G2 (Teste t de Student ou Teste de Wilcoxon, p0,05%), nas duas fases do estudo. Os resultados apontaram, como síntese das duas fases avaliativas, sinais de preservação dos recursos familiares e cognitivo/afetivos das crianças/adolescentes com câncer, com manutenção do funcionamento adaptativo, embora com impacto negativo na percepção de si e de sua identificação com o humano, tendendo a maior mobilização emocional, com tensão e ansiedade em seus esforços adaptativos, identificados pelos pais/responsáveis como indicadores de dificuldades em termos de saúde mental, comparativamente ao Grupo de Comparação. O Grupo Clínico tendeu a recorrer mais a estratégias defensivas baseadas em mecanismos repressivos e de racionalização, inibindo expressões afetivas no ambiente, favorecendo-lhes adaptação ao contexto de vida. Estes achados empíricos evidenciaram, numa perspectiva longitudinal, os recursos e os esforços adaptativos de crianças/adolescentes que convivem com o diagnóstico oncológico, bem como suas famílias. Foi possível apontar a relevância da sistemática avaliação e reavaliação da complexa rede de variáveis envolvidas nesses processos, atestando a contribuição dos métodos projetivos no campo da Psico-Oncologia Pediátrica. / The neoplasia diagnosis in children and adolescentes, as well as the oncological care needed, impose to patients and their families the daily living with multiple adverse events to the development, that may be of biological, psychic, social and economic nature. This complex reality will demand personal and family resources and strategies for a positive outcome, overcoming situations of vulnerability. To date, despite the growing number of cancer cases, there is a reduced systematized scientific production in the field of Pediatric Psycho-Oncology about what variables would be the most relevant in terms of effects on child and adolescent development, although the importance of personal resources (including personality characteristics), socio-family and health services is recognized. In this contexto, this study aimed to longitudinally assess possible effects of the experience of illness and cancer care on personal, family and personality characteristics of children and adolescents with cancer. This is a longitudinal study, of a quantitative, descriptive-comparative and interpretative nature, based on psychological assessment instruments. The were composed two groups of children and adolescents, from seven to 17 years of age, of both sexes, as well as their respective parents/guardians, composing a convenience sample. The Clinical Group (G1, n=30, children/adolescents with diagnosis of neoplasia for at least one month) was composed from patients of the Oncology and Pediatric Hematology Sector of a public school hospital, considered a reference service in the area. The Comparison Group (G2, n=20, children/adolescents with typical development) was constituted in order to be balanced against age, gender and school origin (private or public) to G1. All volunteers (children/adolescents and their parents/guardians) responded, individually and in a suitable environment for psychological assessment, to a battery of assessment instruments, applied in two moments, named in this study as Phase 1 (transversal cut) and Phase 2 (longitudinal cut, after a minimum interval of six months of the first assessment). Parents/guardians responded to: Brazil\'s Economic Classification Criteria, Capacities and Difficulties Questionnaire (SDQ), Family Environment Resource Inventory (RAF), Adverse Event Scale (EEA), Chronic Adversity Scale (EAC), and Inventory of Perception of Family Support (IPSF). In the child/adolescent were administered: Progressive Matrices of Raven (Colored or General Scale), Method of Rorschach (French School) and Test of Colored Pyramids of Pfister. The application and assessment of the instruments followed their respective technical-scientific standards. Descriptive and comparative analyzes of G1 and G2 (Student\'s t test or Wilcoxon test, p0.05%) were carried out in both phases of the study. The results showed, as a synthesis of the two evaluative phases, signs of preservation of the family and cognitive/affective resources of the children/adolescents with cancer, with maintenance of the adaptative functioning, although with a negative impact on the perception of self and its identification with the human, tending to greater emotional mobilization, with tension and anxiety in their adaptive efforts, identified by parents/guardians as indicators of difficulties in terms of mental health, compared to the Comparison Group. The Clinical Group tended to resort more to defensive strategies based on repressive mechanisms and rationalization, inhibiting affective expressions in the environment, favoring adaptation to the context of life. These empirical findings have evidenced, from a longitudinal perspective, the resources and the adaptive efforts of children/adolescents living with cancer diagnosis, as well as their families. It was possible to point out the relevance of systematic assessment and re-assessment of the complex network of variables involved in these processes, attesting the contribution of projective methods in the field of Pediatric Psycho-Oncology.

Résumé confidentiel / Résumé confidentiel

L’insuffisance rénale est une maladie chronique, qui, parvenue à un certain stade, nécessite au patient qui en est atteint, d’avoir recours à un traitement de suppléance permettant de pallier les défaillances de la fonction du rein. Une de ces techniques, l’hémodialyse, comprend trois étapes importantes dans le parcours de la personne malade: l’annonce de la maladie, la création d’un abord vasculaire, le passage au traitement. L’annonce de l’insuffisance rénale a souvent lieu quelques années avant l’intervention de la fistule artério-veineuse et donc bien en amont de la mise en dialyse. Une étude longitudinale aurait permis de procéder au suivi complet de la personne insuffisante rénale à partir de la découverte de la maladie mais les contraintes de temps m’ont conduit à me limiter aux effets après coup de l’annonce et à me concentrer sur les retentissements du traumatisme au moment de la première effraction (création de la fistule artério-veineuse) et de seconde effraction (la mise en dialyse). Au regard des théories psychanalytiques du traumatisme, j’ai cherché à mettre en évidence la portée des effractions corporelles sur l’unité psychosomatique de la personne atteinte d’insuffisance rénale qui se différencie de celle de l’effraction psychique du traumatisme excluant une blessure physique. J’ai repris l’hypothèse de Freud concernant les névroses de guerre qui stipule que l’atteinte physique protège de la névrose traumatique, mais j’ai proposé de modifier la teneur de ses propos en les adaptant à la situation de maladie grave. Par conséquent, la visée de cette recherche est d'étudier le parcours de l'insuffisant rénal à trois temps traumatiques de la maladie dans ses dimensions à la fois psychique et somatique. Afin d'éprouver mes hypothèses, un entretien clinique est proposé lors de la première entrevue, puis des tests projectifs (TAT et Rorschach) accompagnés d'un entretien clinique sont proposés lors de la seconde rencontre. Ma population se compose de huit patients âgés de 22 à 60 ans que j’ai rencontré une première fois lors de la création de la fistule artério veineuse, un moment durant lequel j’ai pu relever que l'annonce de l'insuffisance rénale n’avait pas joué le rôle d'une angoisse signal d'alarme dans l'économie psychique. Car en effet, à l’arrivée de ce nouveau corps étranger, un débordement pulsionnel affleure mettant à jour une fantasmatique de type traumatique. La seconde phase se situe au début des séances de dialyse lors desquelles la sensorialité et les sensations sont mises au service d'une « détresse somato-psychique » convoquant un sentiment d'inquiétante étrangeté et une difficulté de délimitation des frontières corporelles.D’une part, l’analyse au cas par cas des résultats dévoile que la valeur préventive de l’annonce de la maladie quelques années avant l’intervention a été amoindrie par la violence des effractions corporelles D’autre part, l’analyse des tendances générales a mis en évidence une fragilisation de l’investissement narcissique et des repères objectaux à trois niveaux : sensoriel, sensuel, de la représentation. Plusieurs réponses ou couples de réponses face à l’évènement traumatique pouvant appartenir aux dimension régrédiente et/ou progrédiente s’inscrivant dans une histoire singulière et s’exprimant au travers d’un fonctionnement psychique propre à chacun, ont pu être dégagées comme : l’inhibition de la pensée, la rationalisation et l’intellectualisation, le masochisme (mortifère ou gardien de vie), le déni et le clivage non structurel du Moi, les processus névrotiques, les solutions opératoires (répression affective) et les solutions inadaptées.Enfin, l’examen du fonctionnement psychique aux tests projectifs ne permet pas d’établir de lien direct entre l’organisation mentale et les potentialités de réorganisation suite à l’impact du traumatisme comprenant une atteinte physique. / The renal insufficiency is a chronic disease, which, reached certain stage requires to the patient who is affected, to resort to a treatment of substitution allowing to mitigate the failures of the function of the kidney. One of these techniques, the hemodialysis, includes three important stages in the route of the sick person: the announcement of the disease, the creation of a vascular access, the passage in the treatment. The announcement of the renal insufficiency often takes place some years before the intervention of the artério-venous fistula and thus good upstream to the stake in dialysis. A longitudinal study would have allowed to proceed to the complete follow-up of the renal insufficient person from the discovery of the disease but the constraints of time drove me to limit me to the effects afterward of the announcement and to concentrate on the echoes of the trauma at the time of the first burglary (creation of the artério-venous fistula) and of second burglary (the stake in dialysis). Towards the psychoanalytical theories of the trauma, I tried to bring to light the impact of the physical burglaries on the psychosomatic unity of the person affected by renal insufficiency which differs from that of the psychic burglary of the trauma excluding a physical wound. I took back the hypothesis of Freud concerning the war neurosises which stipulates that the physical achievement protects from the traumatic neurosis, but I suggested modifying the content of its comments by adapting them to the situation of serious illness. Consequently, the aim of this research is to study the cours) of insufficient renal in three time traumatic of the disease in its at once psychic and somatic dimensions. To feel my hypotheses, a clinical consultation is proposed during the first interview, then projective tests (TAT and Rorschach) accompanied with a clinical consultation are proposed during the second meeting. My population consists of eight patients from 22 to 60 years old that I met first time during the creation of the fistula venous artério, one moment in the course of which I was able to raise that the announcement of the renal insufficiency had not played the role of an anxiety alarm in the psychic economy. Because indeed, upon the arrival of this new foreign body, an impulsive overflowing appears updating a fantastical of traumatic chap. The second phase is situated at the beginning of the sessions of dialysis when the sensoriality and the sensations are put in the service of a "somato-psychic distress " a feeling of disturbing strangeness and a difficulty of demarcation of the physical borders. On one hand, the individual analysis of the results reveals that the preventive value of the announcement of the disease some years before the intervention was decreased by the violence of the physical burglaries. On the other hand, the analysis of the general tendencies brought to light an embrittlement of the narcissistic investment and the objectals marks at three levels: sensory, sensual, of the representation. Several answers or couples of answers in front of the traumatic event which can belong in regredient and\or progredient dimensions joining a singular story and expressing himself through a psychic functioning appropriatefor each, were able to be brought out as: the inhibition of the thought, the rationalization and the intellectualization, the masochism (mortiferous or guard of life), the denial and the not structural split(cleavage) of the Me, the neurotic operating processes, the solutions ( emotional repression) and the unsuitable solutions.Finally, the examination of the psychic functioning in the projective tests does not allow to establish of direct link between the mental organization and the potentialities of reorganization further to the impact of the trauma understanding a physical achievement

This thesis deals with the evaluation of social and emotional competencies in 7 - 10 years old children and with comparison of different techniques of their measurement. The aim of the study is to evaluate these competencies by using Intelligence and Development Scale for Children (IDS) and to compare them with the social and emotional level of the same sample proven in the selected apperception technique (the Child's World of Michal's projective interview evaluated with SCORS technique). It is therefore a question of comparison of performance-based intelligence test and apperception technique. The focus of this study is to identify whether there is a relationship between the social-emotional scales of IDS and the selected scales of SCORS. This comparison is grounded in the assumption that both methods evaluate similar psychological constructs and therefore their results should correspond. The theoretical section deals with the development of emotional and social competencies in children and their specifics in a younger school age, then the introducing of apperception techniques and intelligence development scales with emphasis on the methods chosen for the present study. The empirical section provides analysis of data obtained from both diagnostic methods. Item analysis and reliability estimates...

A partir d’une clinique constituée de 15 sujets bourreaux et victimes, cette étude porte sur « Les logiques de survie des réfugiés de guerre », en se servant du Rorschach et du TAT comme «dispositifs à symboliser» (Roussillon, 2003 ; Roman, 2005 ; Dérivois, 2004). Comment les réfugiés se reconstruisent-ils dans un pays d’asile ? A quel niveau topique les traumatismes vécus se seraient-ils enkystés ? A quelles stratégies de survie recourent-ils ? Quels mécanismes de défense mettent-ils en œuvre ? Comment les traumatismes subis, les éventuels (ré) aménagements s’expriment-ils au Rorschach et au TAT ? Enfin, l’établissement des indices d’une « personnalité traumatique » est-elle possible au Rorschach et au TAT ?Il existerait un lien entre les traumatismes subis, les troubles référés à l’identité dans le pays d’asile et les différentes modalités de reconstruction psychiques. Les logiques de survie se déclinent en victimisation et logiques victimaires ; bourreaux et boucs-émissaires ; triomphalismes et engagements ; honte et culpabilité ; errance ; silence ; recherche et création. La somatisation constitue une autre déclinaison.Les effets du traumatique sont souvent pensés sous le primat de la négativité. L’hypothèse du traumatisme-moteur a été envisagée. Enfin, un appareil psychique des liens inter-institutionnels a été modélisé. / From a clinical subjects consisting of 15 executioners and victims, this study focuses on "survival strategies of refugees from war, "using the Rorschach and the TAT as "devices to symbolize" (Roussillon, 2003; Roman 2005; Dérivois, 2004).How do they rebuild refugees in asylum countries? At what level topical traumas would they encysted? Which coping strategies do they use? What defenses are they implemented? How trauma, the possible (re) development they are expressed on the Rorschach and the TAT? Finally, Compiling a "personality disorder" is it possible the Rorschach and the TAT? There is a link between trauma, disorders referred to identity in the country of asylum and the various methods of psychological reconstruction. The logic of survival and victimization are divided into logical victimizers; executioners and scapegoats; triumphalism and commitments; shame and guilt, wander; silence, research and creation. Somatization is another variation. The effects of trauma are often designed under the primacy of negativity. The hypothesis of trauma-engine was considered. Finally, a psychic apparatus of inter-institutional linkages have been modeled.