Contando histórias, construindo histórias: a escuta do psicanalista de crianças / Story-telling, constructing stories: the listening of the child analyst

Cada processo psicanalítico é, em si mesmo, uma história. Que tem a peculiaridade de dedicar-se a encontrar, com o paciente, a história deste desde seu próprio ponto de vista. Na história de cada psicanálise de criança existem algumas peculiaridades, especificidades técnicas impostas pelas condições da faixa etária. Como se constrói na mente do analista a escuta geradora de sentido? Certamente essa é uma questão sem resposta absoluta ou última. Neste trabalho procuro refletir sobre alguns aspectos dessa construção. Sugiro que vivências oriundas das múltiplas fontes do campo da psicanálise de crianças podem ser utilizadas na busca de entendimento da construção dessa escuta tão específica. A partir de vivências clínicas com três crianças busco pensar a escuta psicanalítica que constrói meu entendimento e o que comunico – verbalmente ou não - a meus pacientes. Uma peculiaridade do tratamento de crianças é que trabalhamos com os outros de nossos pacientes não apenas como objetos internos, como é comum na análise de adultos, mas também como objetos presentes no campo. Neste trabalho sugiro que, respeitados os inevitáveis limites de nossa competência, a complexidade de encontros na psicanálise de crianças pode ser inspiradora, contribuindo para a compreensão do paciente, enriquecendo a história do próprio processo, ampliando as interpretações possíveis e podendo nos ensinar sobre a especificidade da escuta que estrutura nosso encontro psicanalítico com os pacientes, seja qual for sua idade.

Each psychoanalytical process is, in itself, a story. Story which has the peculiarity of dedicating itself to find, along with the patient, his/her own story from his/her vantage point. In the story of each child’s psychoanalysis, there are some peculiarities, technical specificities, imposed by the conditions of the age group. How is the listening which generates sense constructed in the mind of the analyst? This is certainly a question with no absolute, ultimate answer. In this paper the author intends to reflect upon some aspects of this construction. The author suggests that experiences from many sources of the field of child psychoanalysis may be used in the search to understand the construction of this listening, which is so peculiar. Using clinical experiences with three children, the author intends to think further the psychoanalytical listening which constructs her understanding and what she communicates – orally or not – to her patients. A peculiarity in treating children is that we work with our patients others not only as internal objects, common in adults analysis, but also as objects present in the field. In this paper, the author suggests that, respected the unavoidable thresholds of our competence, the complexity of encounters in child psychoanalysis may be inspiring, contributing for the understanding of the patient, enriching the story of the process itself, broadening the possible interpretations, and teaching us about the specificity of listening which structures our psychoanalytical encounter with the patients, no matter what age they are.

Cada proceso psicoanalítico es, en sí mismo, una historia. Que tiene la peculiaridad de dedicarse a encontrar, con el paciente, su historia desde su propio punto de vista. En la historia de cada psicoanálisis de niño existen algunas peculiaridades, especificidades técnicas impuestas por las condiciones de la faja de edad. ¿Cómo se construye en la mente del analista la escucha generadora de sentido? Seguramente esa es una pregunta sin respuesta absoluta o última. En este trabajo, busco reflexionar acerca de algunos aspectos de esa construcción. Sugiero que vivencias oriundas de las múltiples fuentes del campo del psicoanálisis de niños se puedan utilizar en la búsqueda de entendimiento de la construcción de esa escucha tan específica. A partir de vivencias clínicas con tres niños, busco pensar la escucha psicoanalítica que construye mi entendimiento y lo que comunico – verbalmente o no – a mis pacientes. Una peculiaridad del tratamiento de niños es que trabajamos con los otros de nuestros pacientes no apenas como objetos internos, como es común en el análisis de adultos, sino como objetos presentes en el campo. En este trabajo sugiero que, respetados los inevitables límites de nuestra competencia, la complejidad de encuentros en el psicoanálisis de niños puede ser inspiradora, contribuyendo a la comprensión del paciente, enriqueciendo la historia del proceso, ampliando las interpretaciones posibles y pudiendo enseñarnos acerca de la especificidad de la escucha que estructura nuestro encuentro psicoanalítico con los pacientes, sea cual fuere su edad.

Feed back of the parents and / or relatives witnessing a squint surgery of their ward in the operation theater.

The aim of the study was to know the response of the relatives attending the squint surgery of their ward. A trained secretary administered an eight item questionnaire by live / telephonic interview. Of the 44 attendees, two left the Operation Theater before completion of the surgery. Mean age of the patients was 7.2 years ± 7.8 and that of the attendees was 36.1 years ± 8.5. Forty patients had a surgery under general anesthesia and four under local anesthesia. Eleven (25%) attendees experienced an increase in anxiety. Thirty-six (82%) attendees reported increased transparency, 38 (86%) reported increased confidence, and 43 (98%) reported increased awareness. None found any disadvantage. Twenty-seven (61%) recommended this practice for all and 16 (36%) recommended the practice selectively. The internal validity of the questionnaire was fair (Cronbach's Alpha = 0.6). It was concluded that the presence of relatives in the Operation Theater during the surgery could bring in more transparency, accountability, confidence, awareness, and trust.

Effect of Parental Presence and Doctor's Conversation in Gastric Acidity and Volume Changes among Non - Crying Pediatric Surgical Patients / 대한마취과학회지

It has been already demonstrated by Cote and his collegues that the values of crying pts gastric pH were higher than those of noncrying pts. We have previously shown that the more patients cried, the higher gastric pH they had, and speculated that this effect may be resulted from the discharged stress through the crying. The present study was performed to examine the hypothesis that parental presence and doctors conversation prior to anesthesia influence the gastric acidity and volume changes. Ninety-one ASA class I or II children, 4 to 13 years of age, were selected randomly excluded 2nd or repeated operation, gastrointestinal operation and history of disease affecting gastric acidity and volume. And divided them into two groups by their status of parental presence and doctors conversation; parents presence (G-l, N=46) or not (G-2, N=45), doctor's comforting words(G-A, N=45) or not (G-B, N=46). These patients were further analyzed by combine factors of parental presence and doctors conversation; parental presence and doctors conversation (G-IA, N=25). parental presence and no conversation (G-1B, N=21), parent not present and conversation(G-2A, N=20) and parent not present and no conversation (G-2B, N=25). Those patients who had comforting words from their doctors were further divided by their response: poor response(G-i), good response(G-ii). All patients were premedicated with glycopyrrolate and hydroxyzine. Gastric samples were obtained through nasogastric tube and measured pH values with TOA pH METER MODEL HM-5ES(TOA Electronics Ltd., Tokyo, Japan) immediately after induction. The results were as follows; 1) Gastric pH; There were no statistical significances between groups(P>0.05) in the changes of the mean pH values. 2) Gastric volume; There were no statistical differences between groups(P>0.05) in the changes of the mean gastric volume(ml/kg). 3) Gastric pH and volume of the response of doctors conversation, There were no statistical difference of gastric pH and volume between good and poor response groups of doctors comfortmg words(P>0.05). From these results, we concluded that parental presence and doctors conversation did not influence the gastric acidity and volume statistically. However, clinically, these results might somehow influence the gastric acidity because the values of gastric pH of G-l(2.32+/-0.69) and G-A(2.38+/-0.64) were higher than of G-2(2.38+/-0.64) and G-B(2.18+/-0.53), and the value of gastric pH of G-IA(2.40+/-0.68) was highest and G-2B(2.15+/-0.43) was lowest.