Raça e classe na clínica psicológica: concepções de estagiários do interior da amazônia ocidental / Raza y clase en la clínica psicológica: concepciones de pasantes desde el interior de la amazonia occidental / Race and class in the psychological clinic: internship conceptions from western amazon countryside

Resumo Este trabalho resulta de uma pesquisa qualitativa que verificou as percepções de estagiários de Psicologia, através de entrevistas semiestruturadas, sobre questões raciais e de classe social, e como esses fatores se evidenciam na clínica de psicológica. O método de análise das entrevistas foi a Análise de Conteúdo de Bardin. Os resultados indicam: restrito conhecimento temático; dificuldades em relacionar conceitos de forma crítica que abarquem as especificidades desses fenômenos na realidade; escasso repertório teórico-metodológico dos estagiários em identificar tais questões em clínica, limitando-se a utilização de técnicas psicoterapêuticas que não contemplam as especificidades dessas demandas. Por fim, as questões raciais e de classe não são suficientemente discutidas no campo das intervenções clínicas, o que sugere que a formação em Psicologia no interior de Rondônia não contempla aprendizados que habilitem os futuros profissionais à intervenção adequada às questões sócio-raciais.

Resumen Este trabajo es el resultado de una investigación cualitativa que verificó las percepciones de los pasantes de psicología, a través de entrevistas semiestructuradas, sobre temas raciales y de clase social, y cómo estos factores se evidencian en la clínica psicológica. El método de análisis de las entrevistas fue el Análisis de contenido de Bardin. Los resultados indican: conocimiento temático limitado; dificultades para relacionar críticamente conceptos que engloben las especificidades de estos fenómenos en la realidad; escaso repertorio teórico-metodológico de los aprendices para identificar tales cuestiones en la práctica clínica, limitando el uso de técnicas psicoterapéuticas que no abordan la especificidad de estas demandas. Finalmente, las cuestiones raciales raciales y de clase no se discuten suficientemente en el campo de las intervenciones clínicas, lo que sugiere que la formación en Psicología en el interior de Rondônia no incluye un aprendizaje que permita a los futuros profesionales intervenir adecuadamente en cuestiones socio-raciales.

Abstract This work is the result of a qualitative research that verified the perceptions of psychology interns, through semi-structured interviews, about racial and social class issues, and how these factors are evidenced in the Psychology clinic. The method of analysis of the interviews was Bardin's Content Analysis. The results indicate: restricted thematic knowledge; difficulties in critically relating concepts that encompass the specificity of these phenomena in reality; scarce theoretical-methodological repertoire of trainees to identify such issues in clinical practice, limiting the use of psychotherapy techniques that do not address the specificity of these demands. Finally, racial and class issues are not sufficiently discussed in the field of clinical interventions, which suggests that the training in Psychology in the countryside of Rondônia does not include learning that will enable future professionals to intervene appropriately to socio-racial issues.

Interventions to reduce caesarean section rates at government medical college and hospital Aurangabad, India

Background: Caesarean sections are effective in saving maternal and infant lives, but only when they are performed for medically indicated reasons, The Objective of this study was to reduce caesarean Section rate at GMCH, Aurangabad and to improve overall birthing experience with respectful maternity care.Methods: The caesarean sections done at GMCH Aurangabad were audited using Robson`s Ten Group classification system to identify the major contributors to the overall CS rate. The following clinical and non-clinical interventions were applied dynamically to control the caesarean section rates. Clinical Interventions were changes in protocols regarding induction of labour, Intermittent auscultation as opposed to continuous electronic foetal monitoring in low risk cases, use of a partogram, encouragement of different birthing positions, promoting TOLAC to reduce the secondary CS rate. Nonclinical interventions include encouragement of DOULA (birth companion), ante-natal counselling of the expectant mothers, training of healthcare staff for respectful maternity care and use of evidence based clinical practice guidelines with mandatory second opinion for every non recurrent indication of CS. Auditing of caesarean section using Robson classification.Results: In this study there has been steady decline in LSCS rates from 33% to 26.9%. On analysis with Robson classification, group 5 (previous LSCS) made largest contribution of 36.9% followed by Group 1, 2, 10 each contributed 18.01%,13.2% and 11.2% respectively. Group 6 to 10 account for 23%. Various birthing positions lowered use of oxytocics from 33 % to 19% as well lowered episiotomy rates with greater success in vaginal delivery.Conclusions: Modification of induction protocols have reduced the primary LSCS rates and successful VBAC using FLAMM score was helpful in reducing the repeat caesarean Sections. Various birthing positions, DOULA gave greater success in vaginal delivery. LSCS rates in mothers with breech, multiple or oblique/transverse lies were largely unmodifiable. Limiting the CS rate in low-risk pregnancies by individualizing every labour and not to set a time limit as long as mother and baby are closely monitored.

Towards optimizing caesarean section: a five-year review of caesarean sections at a Southern Nigeria hospital

Background: Monitoring caesarean sections at hospital level is essential to reduce unnecessary caesarean sections while still ensuring adequate access to caesarean section. This study was conducted to determine the caesarean section rate and indications for caesarean section at the study centre and provide objective data for institutional interventions towards reducing unnecessary caesarean sections in the centre.Methods: A retrospective descriptive study of patients that had caesarean sections between 1st January 2013 and 31st December 2017 at the Federal Medical Centre, Yenagoa, Nigeria. Data were analyzed using Statistical Package for Social Sciences version 22.Results: There were 5,793 deliveries and 1,654 were by caesarean section. The average caesarean section rate was 28.6%. The leading indications for caesarean section were cephalopelvic disproportion (26.6%), previous cesarean section (18.2%), suspected fetal distress (11.2%), severe preeclampsia/eclampsia (7.9%), obstructed labour (6%), and breech presentation (5.9%).Conclusions: The 28.6% caesarean section rate in this study falls within a widely varied rate across Nigeria at hospital level but is comparable to rates within the south-south geopolitical zone of Nigeria. The leading indications for caesarean section are modifiable, thus there is room for institutional intervention to reduce unnecessary caesarean sections. Collaborative research between institutions is required to assess peculiar regional determinants of caesarean section towards developing suitable interventions to reduce unnecessary caesarean sections regionally.

Sobre el establecimiento de la sintonía en la primera sesión y la defensa del paciente / About the stablishment of attunement during the first session and the patient's defense

Tras definir el concepto de sintonía, describir la muestra (la primera sesión o entrevista inicial de 20 pacientes con sus respectivos terapeutas) y el método (el algoritmo David Liberman, ADL), y presentar el repertorio de las intervenciones prototípicas del terapeuta, el trabajo analiza el establecimiento del vínculo de sintonía entre paciente y terapeuta y sus perturbaciones, así como las defensas del paciente durante la sesión en el momento de establecer la sintonía. Luego el trabajo procura establecer nexos entre los resultados referidos a las dificultades para lograr la sintonía y los resultados de los estudios de las defensas y su estado al intentar sintonizar con el paciente. El trabajo concluye que importa más el estado de la defensa que la severidad clínica que esta ponga de relieve.

After defining the concept of attunement, describing the sample (20 patients having gone through their first session or first interview with their corresponding therapists), defining the method (the David Liberman algorithm, DLA), and presenting the repertoire of the prototypical interventions of therapist, the paper analyzes the establishment of attunement between therapist and patient, the perturbations on the tuning, as well as the defenses used by patients while the attunement is established. Then the paper tries to establish a link between the results regarding difficulties on accomplishing attunement and the results from studying the patients' defenses and the state of defense when the therapist attempts to tune with the patient. The paper concludes that for establishing attunement, it is more relevant the state of the patients' defense rather than the clinical severity of this mechanism.

Conflictos conyugales en la contemporaneidad y transmisión psíquica: investigación e interpretación con parejas / Marital conflicts in contemporaneity and psychic transmission: research and intervention with couples

Hace más de una década hemos direccionado nuestras investigaciones dentro de la clínica psicoanalítica de parejas y familias, tomando cómo referencial teórico básicamente el psicoanálisis vincular argentino y de los autores franceses, en especial Eiguer (1998) y Kães (2011), este último con los conceptos de transmisión psíquica (inter y transgeracional) y pacto denegativo primordialmente. A lo largo del tiempo las investigaciones clínicas fueron siendo asociadas a los estudios psicosociales, en el sentido de complementar la visión y formación del clínico. Fueron incorporados los cambios ocurridos en la familia, en el pasaje del modelo tradicional a las nuevas configuraciones familiares de la actualidad y fueron considerados los nuevos conflictos y patologías en el interior del grupo familiar y en el ambiente social más amplio. Proponemos la creación de una clínica específica de parejas (Gomes, 2007) cuya demanda de atención se centra aún, en algunos casos, en el síntoma del niño. Por medio de la psicoterapia psicoanalítica utilizada con 10 parejas de una clínica-escuela, profundizamos la comprensión de los conflictos conyugales intermediados por la transgeracionalidad, en la interfaz entre conyugalidad y parentalidad. En la mayoría de los casos prevaleció la disposición de las familias reconstituidas, donde el interjuego entre conyugalidad y parentalidad, por ser más complejo, contribuyó más enfáticamente para ese tipo de conflictiva. Sólo 03 casos tuvieron demanda directa para atención de la pareja, sin utilizar lo(s) hijo(s) como depositarios. Sin embargo, la comprensión de los conflictos conyugales, independiente de la demanda, permitió abordar en profundidad el tipo de vínculo o pacto inconsciente establecido por las parejas. En general, se encontraba asociado a contenidos transgeracionales que, una vez venidos a la toma, promovieron posibilidades de cambio y elaboraciones efectivas intra e interpsíquicamente a todos los involucrados.

For more than a decade we have aimed at researching within the psychoanalyticcouple and family clinic, relying basically on the theoretical referential frame ofargentine relational psychoanalysis and of french authors, mainly Eiguer (1998) andKaës (2011), the latter regarding concepts of psychic transmission (inter and trans-generational) and denegative pact mainly. Eventually clinical research broadened itsscope to include psychosocial studies, aiming at complementing the perspective andtraining of the clinician. In the passage from the traditional model to new family configurations, changes occurring within the family were incorporated and new conflicts and pathologies occurring within the house hold and in the broader social environment were considered. We propose the creation of a specific couple clinic (Gomes, 2007) since couple clinics still focus, in some cases, on the symptoms of the child. By means of psychoanalytical psychotherapy applied to 10 couples in a training clinic, we increased the understandingof marital conflict mediated by trans-generationality, at the interface between conjugalityand parenting. In most cases, reconstituted families was the prevailing arrangement, where the interplay between conjugality and parenting being more complex, contributed more emphatically to that type of conflict. Only on 3 cases the demand wasfor couple assistance, without using the child as depositary. However, understanding marital conflict not withstanding the demand enabled in depth consideration of the typeof link or unconscious pact established by the couples. In general, it was associated to trans-generational content, which once manifested, promoted change opportunities and effective elaborations intra and inter-psychically for all those involved.

Los modos de relatar/contar/narrar el abuso sexual sufrido en la infancia por adolescentes en tratamiento psicoanalítico / The ways of telling/relate/narrate the sexual abuse suffered in childhood by teenagers in psychoanalytic treatment

Este artículo se propone presentar algunas consideraciones clínicas acerca de los modos de relatar, contar, narrar el abuso sexual en el contexto de los tratamientos psicoanalíticos y la posición del analista ante ello. En el marco de un diseño exploratorio, se ha trabajado con una muestra finalística conformada por diez adolescentes que han sido abusados sexualmente en la infancia y que realizan o han realizado tratamiento psicoterapéutico. La fuente de datos han sido los materiales clínicos elaborados por los psicoanalistas a cargo del tratamiento de cada adolescente. El procedimiento de análisis ha sido cualitativo, de tipo hermenéutico. Se presenta el análisis de varios fragmentos clínicos a modo de ilustración del trabajo empírico y de interpretación teórica realizado. Como resultados se han categorizado diversas modalidades narrativas y distinguido algunas relaciones con las intervenciones del psicoanalista.

This paper proposes to presents some clinical considerations about the ways of telling, relate, narrate the sexual abuse in psychoanalytic context and the analyst's position to it. As part of an exploratory design, we worked with a finalistic sample composed by ten adolescents who has been sexually abused in childhood and realize or have realized psychoanalytic treatment. The data source has been the clinical materials elaborated by the psychoanalyst in charge of treating of each adolescent. The analysis method has been qualitative, of hermeneutic type. We present the analysis of several clinical fragments as an illustration of the empirical work and theoretical interpretation made. As results we have categorized various narrative modalities and distinguished some relations with the analyst's interventions.

Conflicto psíquico y tratamiento psicopedagógico / Psychic conflict and psycho-pedagogical treatment

El tratamiento psicopedagógico tiene por objeto elaborar restricciones simbólicas de púberes, adolescentes y niños con problemas de aprendizaje, para mejorar y enriquecer sus formas de pensamiento frecuentemente amenazadas por situaciones conflictivas de carácter restrictivo. Los diferentes conflictos que cada sujeto expresa durante su tratamiento psicopedagógico, pueden ser restrictivos o propulsivos. Los de carácter propulsivo, incluyen estrategias de circulación del afecto plásticas y dinámicas que incorporan recursos diversos y heterogéneos asociables a experiencias de aprendizaje satisfactorias. Los restrictivos en cambio, muestran maneras rígidas de resolución de las situaciones problemáticas que el sujeto atraviesa, frecuentemente ligadas a modos característicos de repetición resolutiva que no reportan complejización en términos representacionales ni incorporan gratificaciones complementarias. En estos casos, los pacientes repiten formas de simbolización producidas por intensos trabajos psíquicos que empobrecen sus recursos representacionales y descienden activamente el deseo de búsqueda de oportunidades de mayor complejidad simbólica. Dichos trabajos, al servicio de la restricción, rigidizan la circulación del afecto alrededor de los objetos sociales con los cuales el sujeto interactúa. En la clínica psicopedagógica, conocer las maneras repetitivas de organización simbólica de cada paciente, le permitirá a los terapeutas intervenir alrededor de las mismas para promover su complejización representacional y ductilidad afectiva.

The aim of psycho-pedagogical treatment is to help children and adolescents with learning problems to elaborate symbolic restrictions resulting from conflictive situations which threaten their thinking processes.Different conflicts expressed by subjects along psycho-pedagogical treatment can be restrictive or propulsive.Propulsive conflicts involve plastic and dynamic ways of affect- circulation and representational resources, which can be associated to satisfactory learning experiences. On the other hand, restrictive conflicts show rigid, repetitive ways of solving problematic situations which involve neither more psychic complexity nor other forms of complementary fulfillment. In these cases, patients repeat symbolizations characterized by an impoverishing psychic work, with the decrease of both, representational resources and the active search for new investment opportunities. Affect circulation around the social objects a child interacts with becomes rigid with a consequent loss in psychic complexity. In psycho-pedagogical treatment, knowing repetitive ways in each child ´s symbolic organization, allows therapists to design clinical interventions meant to promote psychic complexity and affective plasticity.