Elaborar, compartilhar, narrar: uma análise narrativa de três abordagens de comunicação em Saúde / Elaborar, compartir, narrar: un análisis narrativo de tres abordajes de comunicación en salud / Elaborating, sharing, narrating: a narrative analysis of three approaches to health communication

Resumo A comunicação, a despeito de ser considerada um aspecto primordial no exercício da prática médica, não ganhou tanta proeminência na literatura e formação médica quanto os aspectos tecnológicos e biomédicos. Em resposta a esse contexto, surgiram campos de conhecimento que se propõem a refletir e fortalecer aspectos da comunicação entre o médico e o paciente. No presente artigo, realizamos uma análise narrativa da literatura de três abordagens de comunicação em Saúde: Grupos Balint, Método Clínico Centrado na Pessoa e Medicina Baseada em Narrativa. Foram destacados aproximações e distanciamentos entre tais abordagens, com o reconhecimento da potência própria de cada uma delas nos diversos contextos da prática médica.

Resumen La comunicación, a pesar de considerarse un aspecto primordial en el ejercicio de la práctica médica, no obtuvo tanto destaque en la literatura y en la formación médica como el que tuvieron los aspectos tecnológicos y biomédicos. Como respuesta a ese contexto, surgieron campos de conocimiento cuya propuesta es reflejar y fortalecer aspectos de la comunicación entre el médico y el paciente. En este artículo, realizamos un análisis narrativo de la literatura de tres abordajes de comunicación en salud: Grupos Balint, Método Clínico Centrado en la Persona y Medicina Basada en la Narrativa. Se destacaron aproximaciones y distanciamientos entre tales abordajes, con el reconocimiento de la potencia propia de cada una de ellas en los diversos contextos de la práctica médica.

Abstract Communication, despite being considered a key aspect in medical practice, has not received the corresponding attention both on literature and medical training as has the technological and biomedical aspects. As a reaction to this context emerged fields of knowledge proposing to reflect and strengthen aspects of communication between the physician and the patient. In this article, we perform a narrative analysis of the literature of three of such approaches to communication in health: the Balint Groups, the Patient Centered Care and Narrative-Based Medicine. The study highlights the approximations and distances between these approaches, along with the recognition of the potency of each of them in the different contexts of medical practice.

Application of the "Balint group" in the doctor-patient communication skills training for standardized residency training of internal medicine / 中华医学教育探索杂志

Objective:To explore the application of Balint group activities in the doctor-patient communication skills training for standardized residency training of internal medicine.Methods:The students from Batch 2018 and some from Batch 2019 participating in the standardized residency training in Renmin Hospital of Wuhan University were selected as the research subjects. SPSS 22.0 was used to perform paired t test for comparison before and after training, and the SEGUE scale was used to evaluate the doctor-patient communication ability of the physicians before and after the training of the Balint group. A questionnaire survey was performed to collect their understanding of doctor-patient communication status and evaluate the training activities. Results:All the residents recognized the importance of doctor-patient communication and clarified the main reasons for the communication of doctors and patients. After receiving the training of doctor-patient communication focusing on group activities, the total score of SEGUE scale increased from (15.40±5.65) to (19.84±1.92), and the residents significantly improved their ability in such five dimensions as stopping inquiry, understanding patients, passing information, collecting information and ready to start ( P<0.001), with a satisfaction rate of 92.00% (69/75) for training methods and contents. Conclusion:The doctor-patient communication ability of the residents needs to be further improved. Balint group activities have enriched the form of doctor-patient communication training, which is helpful for doctors to strengthen their professional confidence and build a harmonious doctor-patient relationship.

A falha básica: alguns aspectos sobre a teoria da técnica em Michael Balint / La falla básica: algunos aspectos de la teoría de la técnica en Michael Balint

O artigo aborda alguns pontos teóricos sobre a técnica, pontos estes relacionados aos pacientes que funcionam de forma ao nível da falha básica, como descreve o psicanalista Michael Balint. O objetivo é trazer reflexões para o atendimento dos pacientes que apresentam quadros regressivos, no sentido de permitir a vivência do novo começo. O texto discute algumas ideias da teoria balintiana sobre a questão da regressão em psicanálise (Au)

The article addresses some theoretical points about the technique related to patients who function more at the level of basic failure, as described by psychoanalyst Michael Balint. The objective is to bring reflections for the care of patients who present regressive conditions in order to allow the experience of the new beginning. The text discusses some ideas of the Balintian theory on the issue of regression in psychoanalysis.

El artículo aborda algunos puntos teóricos sobre la técnica, puntos que se relacionan con pacientes que funcionan en el nivel de falla básica, como lo describe el psicoanalista Michael Balint. El objetivo es traer reflexiones para el cuidado de los pacientes que presentan condiciones regresivas, a fin de permitir la experiencia de un nuevo comienzo. El texto analiza algunas ideas de la teoría balintiana sobre el tema de la regresión en psicoanálisis

Contribuições de Ferenczi, Balint e Winnicott à questão do prazer / Contributions from Ferenczi, Balint and Winnicott on the pleasure issue / Contribuciones de Ferenczi, Balint y Winnicott a la cuestión del placer / La contribution de Ferenczi, de Balint et de Winnicott à la question du plaisir

Neste artigo a autora se propõe a examinar o desenvolvimento do conceito de prazer a partir do trabalho de Ferenczi, Balint e Winnicott. Com base em pontos-chave tratados por cada um dos autores, busca estudar uma modalidade de prazer que, diferente do proposto pela psicanálise clássica, não se encontra necessariamente referida a uma economia psíquica ou à ideia de descarga.

In this article the author proposes a study on the development of the concept of pleasure from the work of Ferenczi, Balint and Winnicott. Based on key points worked by each of the authors, she seeks to study a pleasure category that, different from that proposed by classical psychoanalysis, is not necessarily related to a psychic economy or the idea of discharge.

En este artículo la autora propone examinar el desarrollo del concepto de placer a partir del trabajo de Ferenczi, Balint y Winnicott. Desde puntos clave trabajados por cada uno de los autores, busca estudiar una modalidad de placer que, a diferencia de la propuesta por el psicoanálisis clásico, no esté necesariamente relacionada con una economía psíquica o la idea de descarga.

Dans cet article, l'auteur propose d'examiner le développement du concept de plaisir à partir des travaux de Ferenczi, Balint et Winnicott. Du point de vue des éléments clés travaillés par chacun des auteurs, nous cherchons à étudier une modalité de plaisir qui - différemment de celle proposée par la psychanalyse classique - n'est pas nécessairement liée à une économie psychique ou à l'idée de décharge.

Simultanagnosia as a cause of visual disturbance following Posterior Reversible Encephalopathy Syndrome (PRES): A case report

Simultanagnosia resulting from dorsal stream dysfunction is an under recognized condition. In this case report we describe the case of a young woman who developed posterior reversible encephalopathy syndrome (PRES), and who recovered visual acuities of 20/20 in each eye, along with normal visual fields and contrast sensitivities, yet experienced persistent symptoms of perceptual dysfunction. Detailed and systematic history taking revealed consistent visual difficulties typical of dorsal stream dysfunction. After a detailed explanation of her symptomatology and training in a range of strategies to cope, the patient experienced a great improvement in her day-to-day functioning.

Do Burnout à Estratégia de Grupo na Perspectiva Balint: Experiência com Residentes de Pediatria de um Hospital Terciário / From Burnout to the "Balint Group" Strategy: Experience with Pediatric Residents of a Tertiary Care Hospital

RESUMO A síndrome de burnout (esgotamento) atinge mais de 70% dos médicos residentes em todo o mundo. Apesar dos dados alarmantes, ainda podemos caracterizá-la como uma doença negligenciada. Alguns trabalhos descrevem estratégias de enfrentamento do problema, porém poucos serviços as adotam na prática. Objetivo Determinar a prevalência da síndrome entre residentes de Pediatria de um hospital terciário brasileiro e descrever a estratégia de grupo psicodinâmico implementada localmente com base nos resultados. Metodologia Estudo de prevalência transversal com aplicação da escala Maslach Burnout Inventory aos residentes, seguida de planejamento e execução de um projeto piloto de intervenção, de grupo, na perspectiva Balint. Resultados De 23 residentes de primeiro e segundo ano de Pediatria em dezembro de 2016, 95% eram do sexo feminino, a média de idade era de 27 anos, e a média da carga horária trabalhada era de 75 horas semanais, sendo que apenas três residentes se dedicavam exclusivamente à residência médica. Encontramos uma prevalência de 87% de residentes que apresentavam critérios para síndrome de burnout, sendo 74% com exaustão, 57% com baixa realização profissional e 39% despersonalizados. O grupo de intervenção ocorreu entre maio e dezembro de 2017 com outros seis residentes de primeiro ano que atendiam no Ambulatório Geral de Pediatria às sextas-feiras. A periodicidade foi de uma hora a cada 15 dias. A participação foi voluntária, e os encontros aconteciam segundo o conceito de "espaço protegido". As discussões eram baseadas em casos clínicos e abordavam também a relação médico-família e as dinâmicas hospitalares. Conclusão A elevada prevalência da síndrome de burnout deste trabalho não foi uma novidade frente aos dados da literatura nacional e internacional. Estabelecemos, porém, uma discussão local que resultou numa estratégia que visa ao bem-estar dos residentes e proporciona oportunidade de aprendizado do reconhecimento das reações pessoais, dos pacientes e de toda a equipe de saúde. Entendemos que os benefícios se dão, finalmente, na qualidade da assistência oferecida aos pacientes.

ABSTRACT Burnout syndrome affects more than 70% of resident physicians worldwide. Despite his alarming statistic, it can still be characterized as a neglected disease. Some studies have described coping strategies, but few services adopt them in practice. The aims of this study were to determine the prevalence of Burnout syndrome among pediatric residents of a Brazilian tertiary hospital, and to describe a psychodynamic group strategy that was implemented locally, based on the results. Methodology a cross-sectional prevalence study using the Maslach Burnout Inventory scale, followed by the planning and execution of a pilot intervention group, from the Balint perspective. Results of 23 first and second year pediatric residents in December 2016, 95% were female; the mean age was 27 years, and the average workload was 75 hours per week. Only 3 residents were exclusively dedicated to the medical residency. The prevalence of burnout syndrome was 87%, with exhaustion in 74%, low professional achievement in 57%, and depersonalization in 39%. The intervention group took place between May and December 2017, with six other first-year residents attending the General Pediatric Outpatient Clinic on Fridays. Meetings of the group took place every 15 days, lasted one hour, and adhered to the concept of "protected space". Participation in the meetings was voluntary. The discussions were based on clinical cases, also addressing the doctor-family relationship and the hospital dynamics. Conclusion The high prevalence of burnout syndrome found in this study was comparable to data from national and international literature. However, our study established a local discussion that resulted in a strategy aimed at the well-being of residents and provided an opportunity to learn to recognize personal reactions, as well as those of patients and the whole healthcare team. We also hope this study will bring benefits for the quality of care provided to patients.

Effects of Balint group intervention on occupational burnout of primary care physicians / 中华行为医学与脑科学杂志

Objective To examine the effects of participating in Balint group ( PBG) for reducing occupational burnout among primary care physicians (PCPs). Methods In this randomized controlled trial, 240 PCPs were randomly assigned to PBG (n=70) and control group (n=240) in propotion of 1 ∶ 2. Sub-jects of PBG received Balint group intervention for one year,while control group received natural observation. Maslach Burnout Inventory ( MBI) was used to assess the severity of occupational burnout. Results At baseline all three subscales of MBI had no significant difference between PBG and cotrol group(P>0. 05). After the intervention,PBG had statistically lower subscale scores in emotional exhaustion ((20. 1±8. 3) vs (22. 6±8. 7),t=1. 993,P=0. 048) and depersonalization (( 6. 8± 4. 9) vs ( 10. 8 ± 5. 2),t=5. 355,P<0. 001) than the control group, while had statistically higher score in personal accomplishment subscale ((38. 3±7. 5) vs (34. 6±7. 7),t=3. 311,P=0. 001) than the control group. Conclusions PBG is effective in reducing occupational burnout among PCPs.

Dynamic Interactions in the Primary Care Consultation, and an Introduction to Balint Groups

@#Physicians in the primary care setting, such as General Practitioners and doctors working in polyclinics, will encounter patients with varying expectations of the consultation process, especially with regards to their emotional needs. These interactions, shaped by transference and counter-transference, will often induce varying emotional reactions in the physicians, both positive and negative. Understanding the dynamics which drive these interactions, and reflecting upon the physician's own emotional responses, can often lead to a more holistic appreciation of the patient and the therapeutic relationship, and consequently in improved patient care, and enhanced satisfaction for both the patient and physician. This article highlights the above dynamic interactions, and introduces the Balint Group, a platform whereby such themes and processes can be further explored. The processes of the Balint Group, and its benefit for attending members, are discussed.

Effect of the Balint group on improving the empathy and doctor-patient communication skills among medical students inclinical practice / 中华医学教育探索杂志

Objectives Toexplorethe effect of the Balint group on improving the empathy and doctorpatient communication skills among medical students in clinical practice.Methods We investigated 500 clinicalmedicalstudentsin fourth grade by JSE-HP and SEGUE framework scalein Shanghai Jiao Tong university school of medicine between July 2016 and December 2016.60 students with insufficientempathy and doctor-patient communication skills were selected randomly.These students were thanrandomly divided into the Balint group (experimental group) and the routine clinical practice group(control group).The experimental group participated inthe Balint group activitiesin addition to routine clinical practice,whilethe control group only participated in routine clinical practice.After 20 weeks of the Balintgroup intervention,the two groups were invited to assess theempathy and doctor-patient communication skills again to analyze the effect of the Balintgroup on improving the empathy and doctor-patient communication ability among intern students.The evaluation result was analyzed by SPSS 22.0 software.Data comparison was conducted using pair t test,independent sample t test and x2 testing.Results There were no statistically significant differences in age,sex,whether only child or class leader and previous year theoretical exam scoresbetween the two groups (all P＞0.05).For empathy,there was no statistically significant difference in terms of opinion,emotional care,empathy,and total scorebefore the routine clinical practicebetween the two groups (P＞0.05) and they all improvedsignificantly after the routine clinical practice (all P＜0.05).But the experimental group had higher scoresin all above scalesthan the control group (all P＜0.05).For communication skills with patients,there were no statistically significant differencesbetween the two groupsin communication initiation,information collection,understanding of patients,information giving,end questioning,and SEGUE scoresbefore the routine clinical practice (all P＞0.05),and they allimprovedsignificantly in all above 5 scales after the routine clinical practice (all P＜0.05).While except for understanding of patients,the experimental group had higher gains in other scales than the control group (all P＜0.05).Conclusion Use of the Barring group activities on the basis of routine clinical practice canimprove the empathy andthedoctor-patientcommunication skills in medical students.

Um capítulo húngaro da história da psicanálise: as contribuições de Ferenczi, Spitz e Balint para o estudo das formas passivas de adoecimento psíquico / A Hungarian chapter of the history of psychoanalysis: The contributions of Ferenczi, Spitz, and Balint to the study of passive forms of mental illness / Un capítulo húngaro de la historia de psicoanálisis: las contribuciones de Ferenczi, Spitz y Balint para el estudio de las formas pasivas de enfermedad psíquica / Un chapitre hongrois de l'histoire de la psychanalyse: les contributions de Ferenczi, Spitz et Balint pour l'étude des formes passives de maladie psychique

Na história da psicanálise, podem ser reconhecidas descrições de algumas formas de adoecimento psíquico que ganham a capacidade de enrijecer e crescer, gerando verdadeiras interrupções nos processos de saúde, com regressões intensas e desorganizações psíquicas graves. Constituem-se, desse modo, adoecimentos psíquicos marcados por descontinuidades severas nos processos de saúde. Em alguns casos, tais interrupções ocorrem de forma muito radical e bem no início da vida, isolando uma área do psiquismo, deixando-a deserta. Não será difícil reconhecer nessa argumentação as bases do pensamento de Ferenczi (mas também de Spitz e Balint) sobre o traumatismo precoce e sua descrição clínica das defesas passivas, com sensações de estar afundando e morrendo.

In the history of psychoanalysis, one may recognize some forms of psychic disorders which can stiffen and worsen. As such, they interrupt health processes by causing intense regressions and severe mental disorganization. Therefore, it leads to the development of mental illnesses, which will be marked by severe interruptions in health processes. In some cases, extremely radical interruptions may happen very early in life. As a result, an area of the psyche will be isolated and become desert. In this paper, the reader will have no problem in recognizing the foundation of Ferenczi's thinking on the early trauma and his clinical description of passive defenses, with sensations of sinking and dying. Spitz's and Balint's ideas have also inspired this study.

En la historia del psicoanálisis pueden ser reconocidas descripciones de algunas formas de adicción psíquica que tienen la capacidad de endurecer y crecer, generando verdaderas interrupciones en los procesos de salud, con regresiones intensas y desorganizaciones psíquicas graves. Se constituyen, de este modo, enfermedades psíquicas marcadas por discontinuidades severas en los procesos de salud. En algunos casos tales interrupciones ocurren de forma muy radical y bien al inicio de la vida, aislando un área del psiquismo, dejándola desierta. No será difícil reconocer en esta argumentación las bases del pensamiento de Ferenczi (pero también de Spitz y Balint) sobre el traumatismo precoz y su descripción clínica de las defensas pasivas, con sensaciones de estar hundiéndose y muriendo.

Dans l'histoire de la psychanalyse on peut reconnaitre des descriptions de certaines formes de maladie psychique qui acquièrent la capacité de s'endurcir et de s'accroître, générant des véritables interruptions dans les processus de santé, avec des régressions intenses et des perturbations psychologiques graves. Des maladies psychiques se constituent donc, marquées par de graves discontinuités dans les processus de santé. Dans certains cas, ces interruptions se produisent de forme très radicale et dans les premières années de la vie, en isolant une zone de la psyché, la laissant déserte. Ce ne sera pas difficile de reconnaître dans cet raisonnement le fondement de la pensée de Ferenczi (mais aussi celle de Spitz et de Balint) sur le traumatisme précoce et sa description clinique des défenses passives, avec sensations de naufrage et de mort.

A matriz ferencziana de adoecimento psíquico e seus ecos: Balint e Winnicott / La matriz ferencziana de la enfermedad psíquica y sus ecos: Balint y Winnicott / The Ferenczian matrix of psychic illness and its echoes: Balint and Winnicott / La matrice ferenczienne de ce qui entraine une maladie psychique et ses échos chez Balint et Winnicott

A partir d'une comparaison proposée par Robert Hinshelwood parmi des concepts formulés par Bion et Winnicott, je suggère que les divergences indiquées par l'analyste anglais se doivent à la présence chez ces deux psychanalystes de deux matrices distinctes de ce qui entraine une maladie psychique: la matrice freudienne-kleinienne domine la pensée de Bion, tandis que telle matrice, bien que présente, n'est ni exclusive ni prédominante chez Winnicott ou chez Balint. Chez ceux-ci il y a une forte présence de la matrice ferenczienne pour la compréhension des processus qui entrainent une maladie. Le texte, en acceptant une suggestion d'André Green, cherche à caractériser les deux matrices et à démontrer que la matrice ferenczienne crée un langage clinique sous-jacent aux pensées de Balint et de Winnicott. Bien que ce langage supplée la matrice freudienne-kleinienne sans la remplacer, il ouvre un nouvel horizon pour penser la psychopathologie.

The author starts from Robert Hinshelwood's comparison between some of Bion's and Winnicott's similar concepts. The author suggests that the differences the English analyst has pointed out are regarding two different matrices of psychic illness, which are respectively found in Bion's and Winnicott's thinking. While the Freudian-Kleinian matrix has dominated Bion's thinking, this matrix, even being also present, has been neither exclusive nor dominant in Winnicott's and Balint's thinking. In these authors' work, the Ferenczian matrix has been widely used for understanding processes of illness. This paper, by following André Green's suggestion, attempts to characterize the two already mentioned matrices as well as to demonstrate that the Ferenczian matrix has created a clinical legacy. This legacy underlies Balint's and Winnicott's thinking. Despite supplementing the Freudian- -Kleinian matrix without replacing it, the Ferenczian matrix opens a new horizon to think about psychoanalytic psychopathology.

A partir de una comparación que Robert Hinshelwood propone entre conceptos formulados por Bion y Winnicott, sugiero que las divergencias señaladas por el analista inglés se deben a la presencia en estos dos psicoanalistas de dos matrices diferentes para pensar el proceso de la enfermedad psíquica: la matriz freudo-kleiniana domina el pensamiento de Bion, mientras que tal matriz, a pesar de estar presente, no es ni exclusiva ni dominante en Winnicott y en Balint. Estos comprenden el proceso de la enfermedad a partir de una fuerte presencia de la matriz ferencziana. El texto, aceptando una sugerencia de André Green, trata de caracterizar las dos matrices y mostrar que la matriz ferencziana crea un linaje clínico que es subyacente a los pensamientos de Balint y de Winnicott. Aunque suplemente la matriz freudo-kleiniana sin sustituirla, abre un nuevo horizonte para pensar la psicopatología.

A partir de uma comparação proposta por Robert Hinshelwood entre conceitos formulados por Bion e Winnicott, sugiro que as divergências apontadas pelo analista inglês devem-se à presença, nesses dois psicanalistas, de duas matrizes distintas de adoecimento psíquico: a matriz freudo-kleiniana domina o pensamento de Bion, e, embora presente, não é nem exclusiva nem dominante em Winnicott e Balint. Nestes há uma forte presença da matriz ferencziana na compreensão dos processos de adoecimento. O texto, aceitando uma sugestão de André Green, procura caracterizar as duas matrizes e mostrar que a matriz ferencziana cria uma linhagem clínica que subjaz aos pensamentos de Balint e Winnicott. Ainda que ela suplemente a matriz freudo-kleiniana sem substituí-la, abre um novo horizonte para pensar a psicopatologia.

Study on Balint Groups in the View of Doctor-patient Relationship / 中国医学伦理学

Poor communication between medical staff and patients is the main cause of medical disputes,and the clear emotional recognition and reasonable response of the patient needs psychology training and practice.Balint groups can create a good support environment and is an effective way to improve the communication ability and professional growth for medical staff.

Progress in posterior cortical atrophy research / 复旦学报（医学版）

Posterior cortical atrophy (PCA) is a kind of neurodegenerative dementia,which is characterized by the progressive decline of visuoperceptual,visuospatial,reading and writing ability and praxic skills.Neuroimaging usually shows atrophy or metabolic decrease in posterior brain regions.The most common neuropathologic changes of PCA are amyloid plaques deposition and neurofibrillary tangles in posterior cortex.In general,PCA is considered as a variant form of Alzheimer's disease.

Intervention study of compassion fatigue of oncology nurses in Balint group activities / 中华劳动卫生职业病杂志

Objective@#To explore the effectiveness of Balint group on compassion fatigue among oncology nurses.@*Methods@#From January to December 2016, 35 oncology nurses from one general hospital were enrolled. 18 cases were allocated in the observation group and 17 cases in the control group by computer randomization. Nurses in the observation group were received a total of 8 times Balint Group activities, with 2 times a month and 1.5 hours each time, which is aiming to discuss difficult cases encountered in the clinic to help nurses have a deeper experience and a better understanding of the emotions and behaviors, fantasies and needs between nurse-patient interaction. Nurses in the control group without intervention. All the Participants were requested to complete the survey of the Professional Quality of Life (ProQOL) , the Jefferson Scale of Empathy-Health Professionals (JSE-HP) , and the General Health Questionnaire (GHQ) at pre and post intervention.@*Results@#Before intervention, two group of nurses in age, working years, marriage, and education were not statistically significant (P>0.05). There was no difference in the scores of empathy, compassion satisfaction, secondary traumatic stress, and General health (P>0.05). After intervention, the scores of JSE-HP and its three dimensions of perspective taking, emotional care, and trans-positional consideration in the observation group had significantly higher than the control group (P<0.05). The level of compassion satisfaction in the observation group was higher, and the general health status was lower (P<0.05). There was no statistically difference in the level of burnout and secondary traumatic stress between two groups (P>0.05) .@*Conclusion@#Balint group has a positive role in promoting nurses’empathetic skills, compassion satisfaction and mental health.

Application of Balint special group training in the training of humanistic care for junior nurses / 现代临床护理

Objective To explore the effect of Balint group training on the humanistic caring ability of junior nurses. Methods About 96 junior nurses from the department of oncology were randomly assigned to an intervention group and a control group equally.Balint group training was given to the intervention group every 2 weeks in a year.The control group completed the humanistic care training according to the regular procedure in the department of the hospital.At the beginning of the study and at the end of the study,the nursing staff from the two groups and the patients under their continuous nursing care for more than 3 days were surveyed by the care efficiency scale,nursing care behavior scale and patient care perception questionnaire.Results Before the intervention,there was no significant difference between the groups in the care performance and behavior of nursing staff and the patients'care perception (P>0.05).After the intervention there was significant difference in the care performance and behavior of nursing staff and the patients' care perception (P<0.05). Conclusions Balint group training can improve the caring performance of junior nurses.Their ability to express care and establish the caring nurse-patient relationship can be improved by this group training.They become more voluntary to integrate caring behavior into the daily care and their caring behaviors can be more likely to be felt and recognize by the patients.

O Manejo Clínico de "Casos Difíceis": Herança e Atualidade de Sándor Ferenczi nas Abordagens de Winnicott e Balint / The Clinical Handling of "Difficult Cases": Heritage and Relevance of Sándor Ferenczi in the Approaches of Winnicott and Balint / El Manejo Clínico de los "Casos Difíciles": El Patrimonio y la Relevancia de Sandor Ferenczi en los Enfoques de Winnicott y Balint / La Prise en Charge Clinique des Cas «Difficiles¼: Le Patrimoine et la Pertinence de Sándor Ferenczi dans les Approches de Winnicott et Balint

O presente trabalho tem como objetivo central explicitar como os remanejamentos teóricos e reformulações técnicas de Ferenczi, que foram, posteriormente, ampliados por Michael Balint e Donald Winnicott, podem ser tomados como norteadores para pensarmos os impasses da clínica contemporânea. Nesse sentido, buscaremos destacar como a ênfase que esses autores conferem à regressão em análise e a uma postura mais empática e acolhedora do analista constituem importantes balizas para o manejo clínico com os pacientes cujo sofrimento psíquico não está referido ao modelo da neurose.

The aim of this article is to discuss how Ferenczi's theoretical changes and technique reformulations, which were amplified by Michael Balint and Donald Winnicott, can be taken as a possible guide to think the difficulties in contemporary clinic. In this sense, we will seek to highlight the emphasis that these authors give to regression in analysis and in a more empathetic and welcoming attitude of the analyst as an important boundary for handling with patients whose psychic suffering is not referred to the neurosis model.

Este trabajo está dirigido principalmente a explicar cómo las reformulaciones técnicas y teóricas de Ferenczi, que posteriormente fueron ampliados por Michael Balint y Donald Winnicott, pueden tomarse como una guía para pensar los impasses de la clínica contemporánea. En este sentido, vamos a tratar de poner énfasis en la importancia que estos autores dan a la regresión en análisis y a una actitud más empática y acogedor del analista pensándolas como coordenadas importantes para el manejo clínico de los pacientes cuyo sufrimiento psíquico no hace referencia al modelo de la neurosis.

Ce travail vise essentiellement à expliquer comment les reformulations théoriques et de la techinique de Ferenczi, qui ont été plus tard étendu par Michael Balint et Donald Winnicott, peuvent être considérées comme un guide pour penser les impasses de la clinique contemporaine. En ce sens, nous chercherons à mettre en évidence la façon dont l'accent que ces auteurs donnent à la regression dans l'espace analytique, à une attitude plus sympathique et accueillant de l'analyste, sont des directions très importants pour la prise en charge clinique des patients dont la souffrance psychique se distingue du modèle de la nevrose.

Atenção ao vínculo em neonatologia: Grupos Balint-Paideia - uma estratégia para lidar com a dor e a incerteza em situações-limite / Attention to bond in neonatology: Groups Balint-Paideia - a strategy to deal with the pain and uncertainty in extreme situations / Atención al vínculo en neonatología: Grupos Balint-Paideia - una estrategia para lidiar con el dolor y la incertidumbre en situaciones extremas

As equipes das UTIs Neonatais lidam diariamente com situações de grave sofrimento e risco que se intensificam pela fragilidade da vida dos recém-nascidos e o contato direto com a dor dos pais. Este cenário abriga desde o impacto do nascimento prematuro ou dos diagnósticos de malformações aos efeitos adversos dos próprios tratamentos ou da falta de acesso aos serviços e precariedade de recursos disponíveis. A formação da equipe intensivista é regulada por protocolos rigorosos que dificultam a escuta dos familiares e a busca de decisões compartilhadas. As tensões da equipe também afetam os profissionais pelo confronto de saberes e poderes, pela difícil aceitação de seus limites e pela fragmentação do cuidado. Os Grupos Balint-Paidéia aliam recursos da psicanálise e de metodologias democráticas de gestão para uma experiência compartilhada de análise das relações, focada na atenção ao vínculo, com os recém-nascidos e seus familiares, assim como entre a equipe e desta com a gestão institucional. A experiência favorece a mudança de paradigma, acolhendo a singularidade das experiências subjetivas e enriquecendo formas possíveis de vida e de trabalho.

The teams of the Neonatal Intensive Care Units deal everyday with situations of great suffering and risk which are intensified because of the fragility of the newborn lives and direct contact with parental pain. This scenario may englobe the impact of premature birth or diagnosis of malformation, the adverse effects of required treatments or the inaccessibility to services and precariousness of available resources. The formation of the Intensive Care team is regulated by rigorous protocols which do not facilitate listening to families with the aim to search for shared decisions. The team tension also affect the professionals by the confrontation of knowledge and power, by the difficult acceptance of their limits and by the fragmentation of care. The Balint-Paideia Groups combine resources of psychoanalysis and democratic management methodologies to a shared experience of analysis of the relationship focused on attention to bond with newborns and their families, as well as amoung team members and institutional management. This experience favors the change in paradigms, embracing the uniqueness of subjective experiences and enriching possible ways of living and working.

Los equipos de las Unidades de Cuidados Intensivos Neonatales tratan a diario con situaciones de grave sufrimiento y riesgo que son intensificadas por la fragilidad de la vida de los recién nacidos y el contacto directo con el dolor de los padres. Este escenario incluye desde el impacto de los nacimientos prematuros o de malformaciones fetales a los efectos adversos de los propios tratamientos o de la falta de acceso a los servicios y de la escasez de recursos disponibles. La formación del equipo intensivista se rige por estrictos protocolos que hacen difícil la escucha de la familia y la búsqueda de decisiones compartidas. Las tensiones en el equipo también afectan a los profesionales por la confrontación de saberes y poderes, la difícil aceptación de sus límites y la fragmentación de la atención. Los Grupos Balint-Paideia combinan los recursos del psicoanálisis con métodos democráticos de gestión en favor de una experiencia compartida de análisis de las relaciones centrada en la atención al vínculo, de los profesionales con los recién nacidos, así como entre los profesionales del equipo y de estos con la gestión institucional. La experiencia favorece el cambio de paradigmas incluyendo la singularidad de las experiencias subjetivas para enriquecer formas posibles de vida y de trabajo.

De Ferenczi a Balint: o desenvolvimento da questão da análise didática / From Ferenczi to Balint: the development of the question of the training analysis

Este trabalho trata das formulações de Ferenczi e Balint sobre a análise pessoal para o psicanalista em formação. Ao propor a chamada "técnica ativa", Ferenczi lança novas exigências ao trabalho do psicanalista. Observa-se que essas exigências, concernentes aos atributos pessoais do psicanalista, engendraram o aumento das ambições relativas à análise com fns de formação, que, segundo Ferenczi, deveriam avançar para além da remissão dos sintomas, chegando até o esgotamento das fantasias inconscientes. Balint, por sua vez, rompeu a barreira de silêncio que pairava sobre a chamada "análise didática" desde sua adoção pela IPA como requisito para a formação do psicanalista. Destaca-se aqui a crítica do autor às formas assumidas pela análise didática no interior das instituições afliadas à IPA e sua abordagem do desenvolvimento da questão da análise de formação no movimento psicanalítico, da chegada dos primeiros psicanalistas até o início da década de cinqüenta do século XX.

This work deals with postulations by Ferenczi and Balint related to personal analysis of the training psychoanalyst. By proposing the so-called "active technique", Ferenczi launched new requirements for the psychoanalyst's function. It is observed that those requirements concerning personal abilities presented by the psychoanalyst engendered an increase in ambitions related to analysis aimed at formation which, according to Ferenczi, should extend beyond remission of symptoms until unconscious fantasies become exhausted. In his turn, Balint flew over the silence barrier that impeded application of the so-called "training analysis" since its adoption by IPA as a requirement for the formation of the psychoanalyst. One is to highlight here the author's critical appraisal of forms assumed by training analysis within institutions affliated with IPA and his approach to the development of the issue concerning formation analysis in the psychoanalytical movement since arrival of the frst psychoanalysts up to the beginning of the 50's decade in the XX century.

Qualitative study of Balint group cases in teaching hospital / 中华行为医学与脑科学杂志

Objective To analyze the negative experience from medical practice of medical students by Balint group case study,and to explore new approach for training doctor-patient communication skills.Methods 10 times of Balint group activities were held in Zhongshan Hospital of Fudan University,with one case each time.Grounded theory approach were applied for analyzing discussion record.Results The cases were occurred in doctor-patient interaction,teamwork,conflict between one's personal life and vocational development planning.Trigger events involved doctor-patient conflict,conflict of values,decision making problem while conffronted with incurable patients,role ambiguity,unfair treatment.Topics of discussion included emotional experience with patients,career development orientation,medical teamwork,clinical education of medical student.Conclusion Through practice of Balint group,medical students in teaching hospital can improve their awareness of complicating psycho-social problem of patients and themselves,as well as handling it.And it can improve the professional identity,professional growth and professional self-identity.

Betty Joseph em contexto / Betty Joseph in context / Betty Joseph en contexto

A contribuição de Betty Joseph é examinada à luz do conceito de intertextualidade (Octavio Paz) e dentro do contexto dos desenvolvimentos clínicos da cultura psicanalítica da Sociedade Britânica de Psicanálise. Os autores buscam relacionar dialeticamente as ideias dela com as contribuições de Klein, Balint, Rycroft, Bion, Rosenfeld, Segal e outros. Betty Joseph focava sua abordagem no que estava ocorrendo no aqui e agora da sessão, e procurava discernir os convites inconscientes que o paciente fazia ao analista (por meio de identificações projetivas) para atuar certos papéis ou sentir certos sentimentos, com vistas a manter seu equilíbrio psíquico inalterado e dessa forma impedir qualquer mudança psíquica de ocorrer. Estas projeções e a resposta do analista a elas podem ou não produzir uma mudança psíquica que desafia seu estado atual de equilíbrio psíquico, o que por sua vez nos permite observar como o passado é vivido no presente, reafirmando o caráter imediato da verdade psíquica. As primeiras contribuições publicadas de Betty Joseph datam do fim dos anos de 1950, mas pensamos que ela atinge o pico de sua singularidade na década de 1970.

The contribution of Betty Joseph is examined in light of the concept of intertextuality (Octavio Paz) and within the context of the clinical developments of the psychoanalytic culture of the British Psychoanalytical Society. The authors try to dialectically relate her ideas to the contributions of Klein, Balint, Rycroft, Bion, Rosenfeld and Segal, among others. Betty Joseph would focus her approach on what was happening in the here and now of the session and would seek to identify the unconscious invitations which the patient would offer the analyst (through projective identifications) to play certain parts or feel certain feelings, in view of maintaining its psychic balance unaltered, therefore stopping any psychic change from occurring. These projections, and the analyst's response to them, may or may not produce a psychic change that challenges its current state of mental balance, which, in turn, allows us to observe how the past is lived in the present, reaffirming the immediacy of psychic truth. The first published contributions of Betty Joseph date from the late 1950s, but we believe that she reaches the peak of her singularity in the 1970s.

La contribución de Betty Joseph se examina a la luz del concepto de intertextualidad (Octavio Paz) y dentro del contexto de los desarrollos clínicos de la cultura psicoanalítica de la Sociedad Psicoanalítica Británica. Los autores tratan de relacionar dialécticamente las ideas de ella con las contribuciones de Klein, Balint, Rycroft, Bion, Rosenfeld, Segal y otros. Betty Joseph se basaba en lo que estaba ocurriendo en el aquí y ahora de la sesión e intentaba identificar las invitaciones inconscientes que el paciente hacía al analista (a través de las identificaciones proyectivas) para actuar ciertos papeles o sentir ciertos sentimientos, con el objetivo de mantener su equilibrio psíquico inalterado y de esa forma impedir cualquier cambio psíquico. Estas proyecciones y la respuesta del analista a ellas pueden o no producir un cambio psíquico que desafía a su actual estado de equilibrio mental, lo que a su vez nos permite observar cómo el pasado es vivido en el presente, reafirmando la inmediatez de la verdad psíquica. Las primeras contribuciones publicadas de Betty Joseph datan de finales de los cincuenta, pero sus ideas llegan a la cumbre de su singularidad en los años setenta.