Factores de riesgo/resiliencia en familias con hijos con autismo. Asociación con la evolución en la adolescencia / Risk/resilience factors in families with children with autism. Association with evolution in adolescence

Resumen La influencia del estrés de los padres y el efecto moderador de las estrategias de afrontamiento y apoyo social en niños con autismo están bien documentados. El número de trabajos con un di seño transversal contrasta con la escasez de estudios con diseño longitudinal que permitirían profundizar en las relaciones entre las características del contexto familiar y la evolución del trastorno. El presente trabajo de seguimiento está dedicado al análisis de esas relaciones en el tiempo transcurrido desde la infancia (T1) a la adolescencia (T2), valorando además los resultados en diferentes dominios del desarrollo. Participaron 45 adolescentes con TEA divididos en dos grupos en función del ambiente familiar, de alto riesgo (AR; N= 18) y de bajo riesgo (BR; N=27). Los resultados confirman y extienden los que han aportado trabajos transversales, evidenciando la influencia negativa de un ambiente familiar de riesgo en la severidad del TEA y en el desarrollo de habilidades socio-adaptativas. La psicoeducación, la terapia cognitivo-conductual y el mindfulness han de mostrado que pueden disminuir el estrés de los padres y aumentar el sentimiento de auto-eficacia.

Abstract The influence of parental stress and the moderating effect of coping strategies and social support in children with autism is well documented. The number of works with a cross-sectional design contrasts with the scarcity of studies with a longitudinal design that would allow to deepen in the relationships between characteristics of the family context and the evolution of the disorder. The present follow-up study is devoted to the analysis of these relationships over time from childhood (T1) to adolescence (T2), also assessing the results in different developmental domains. Forty-five adolescents with ASD participated, divided into two groups according to family environment, high risk (HR; N=18) and low risk (LR; N=27). The results confirm and extend those obtained in cross-sectional work, showing the negative influence of a risky family environment on the severity of ASD and the development of socio-adaptive skills. Psychoeducation, cognitive-behavioural therapy and mindfulness have been shown to decrease parental stress and increase feelings of self-efficacy.

Importância do acompanhamento psicológico em mulher mastectomizada: artigo de revisão / Importance of counseling in women with mastectomies: review article

O papel do acompanhamento psicológico em pacientes mastectomizadas nas últimas décadas tem sido foco de diversas discussões, especialmente no que se refere ao tipo de atuação deste profissional. Neste contexto este estudo tem como tecer considerações em relação ao papel do acompanhamento psicológico em tais pacientes. Para alcançar o objetivo supracitado foi realizada, uma revisão dos principais estudos acerca do assunto. Sendo assim, este trabalho trata-se de uma pesquisa analítica, também conhecida como bibliografia. O trabalho foi conduzido a partir de registros disponíveis e decorrentes de trabalhos científicos anteriores, documentados por meio de livros, revistas científicas, monografias, teses e dissertações. A busca foi realizada por meio dos buscadores: Google acadêmico, Periódicos Capes e Scielo. O psicólogo deve abordar os contextos e relações nas quais a paciente esteja inserida e manifestando comportamentos 'desajustados', em decorrência dos efeitos da cirurgia. Desajustamentos comumente são observados em isolamento social, abandono de atividades sociais e de lazer, dificuldade de comunicar as pessoas com quem convive sobre seu estado de saúde. Assim, o psicólogo deve orientar a mulher a perceber as reações emocionais que ela tem manifestado frente à cirurgia, bem como os comportamentos não adaptativos que ela tem adotado como resposta a essas emoções. Em outra frente de atuação, está a família e seus entes queridos, com grande importância ao parceiro. As considerações finais destacam que o acompanhamento poderá intervir nos conflitos acarretados pelos efeitos da mastectomia, auxiliando significativamente a enfrentar os procedimentos e oferecendo suporte necessário as novas demandas e trajetórias a serem percorridas.

The role of counseling in mastectomy patients in recent decades has been the focus of many discussions, especially as regards the type of performance of this professional. In this context this study is to make considerations about the role of counseling in such patients. To achieve the above objective was conducted a review of major studies on the subject. Thus, this work it is an analytical research, also known as bibliography. The study was conducted from available records and related to previous scientific work, documented in books, journals, monographs, theses and dissertations. The search was performed using search engine: Google Scholar, Capes journals and Scielo. The psychologist must address the contexts and relationships in which the patient is inserted and expressing 'misfits' behavior, due to the effects of surgery. Inconsistencies are commonly observed in social isolation, abandonment of social and leisure activities, difficulty communicating people with whom they live on their health. Thus, the psychologist must guide the woman to understand the emotional reactions she has expressed against the surgery, as well as maladaptive behaviors that it has adopted in response to these emotions. In another front of work, it is the family and loved ones, with great importance to the partner. The final considerations highlight that monitoring can intervene in conflicts posed by the effects of mastectomy, significantly helping to address the procedures and providing necessary support new demands and paths to be covered.

A Influência do contexto familiar nas decisões judiciais a respeito de atos infracionais de adolescentes: o intervencionismo familiar ainda se faz presente? / The influence of the family context in judicial decisions regarding offenses committed by adolescents: is the practice of family interventionism still present?

Este artigo analisa, a partir de uma análise qualitativa de jurisprudência, se a situação familiar de um adolescente acusado de cometer ato infracional é considerada, pelo Poder Judiciário, como um fator relevante na decisão da medida socioeducativa a ser aplicada. Objetiva-se problematizar a influência do contexto familiar no tratamento penal dos adolescentes, tendo em mente os preconceitos a respeito de estruturas familiares existentes nas sociedades contemporâneas e a histórica presença de práticas de intervencionismo familiar nas políticas públicas brasileiras. Embora a atual legislação de Direito Penal Juvenil adote um paradigma de responsabilização penal individual do adolescente perante um sistema especialmente pensado para essa faixa etária, observa-se que a real implementação desse modelo enfrenta dificuldades no Brasil, permanecendo, em paralelo, antigas práticas discordantes da doutrina atual, como a de basear o tratamento direcionado a crianças e adolescentes em suas condições sociais e familiares.

This article aims to ascertain, by means of a qualitative analysis of jurisprudence, if the family status of an adolescent accused of committing an offense is considered, by the Judiciary, as a relevant factor in the decision of the socio-educative measure to be applied. The objective is to discuss the influence of the family context in the penal treatment of adolescents, bearing in mind the prejudices regarding family structures that exist in contemporary societies and the historic presence of family interventionism practices in Brazil's public policies. Although the current juvenile penal law adopts a paradigm in which the adolescent is individually criminally liable before a system specifically designed for this age group, it is observed that the effective implantation of such model faces difficulties in Brazil, leading to the endurance of old practices that are in discordance with the current doctrine, such as basing the treatment directed at children and adolescents on their social and family conditions.

Construcción de una escala para evaluar el contexto familiar desde la perspectiva de los padres / Construction of a scale for assessing family context from the perspective of parents

Se presenta la construcción y validación de una escala que mide el contexto familiar desde la perspectiva de los padres, teniendo en cuenta la estimulación temprana que recibe el niño, y que Galvez (2007) define como la actividad de contacto con el bebé, que propicie sus potencialidades. Dentro de la línea ecológica sistémica de Bronfenbrenner (1987), Rodrigo y Palacios (1998) proponen tres aspectos del contexto familiar que afectan el desarrollo del niño: ideas y cogniciones de los padres con respecto al desarrollo, estilo de socialización y escenario e interacción educativa. Una versión preliminar con 73 ítemes fue administrada a una muestra de 229 sujetos para estudiar sus propiedades psicométricas. Se examinó el poder discriminativo de los ítemes, mediante la prueba t de diferencias de medias, resultando discriminativos 59 ítemes. Estos últimos fueron analizados factorialmente para determinar el número y la naturaleza de las dimensiones subyacentes. El análisis factorial exploratorio indicó la presencia de cuatro factores: ambiente familiar en relación a la estimulación personal, ambiente familiar con objetos estimulantes, ideas y creencias y prácticas de crianza. Los ítemes se agruparon guardando coherencia teórica con el planteo inicial. Se estudió la confiabilidad como consistencia interna, mediante el coeficiente Alpha de Cronbach obteniéndose un valor satisfactorio igual a .838. A partir de los cuatro factores hallados se seleccionaron los 16 ítemes (cuatro por factor) con mayor pesaje, que conformaron la escala definitiva de tipo Likert que presentó buenos indicadores de fiabilidad, poder discriminativo de los ítemes y validez de constructo.

The purpose of this work is to present the construction and validation of a scale about ideas and beliefs that parents have respect the cognitive development of their children, the kind of breed adopted and the quality of the family context. Among the different aspects that can be considered in what we call early relations, it is found the early stimulation that Galvez (2007) defines as the contact activity or play with a baby or child that propitiates, strengthens and develops appropriately its potentialities. The family plays a fundamental role in the evolutional development of the child. Different models of family organization agreed in the recognition of its importance (Richaud de Minzi, 2005). It also greatly influences the organization of structural and material processes of the home, the planning of activities taking place there and how parents interact with the child (Muñoz Silva, 2005). This organization is determined in part by the parents´ ideas and beliefs on the process of development of children and on the breeding practices (Siegel, McGillicuddy-Delisi & Goodnow, 1992). Taking into account an ecological systemic perspective, Bronfenbrenner's model (1987) shows the individual experience as a set of nearby structures, each inside the next, being the family the closest to the individual and which will offer the first stimulation experiences. From the point of view of the ecological theory of the individual's development, Rodrigo and Palacios (1998) have defined three family context aspects that will affect the child's development and have been taken as indicators for the construction of this instrument. These are the parents' ideas and beliefs regarding their children's cognitive development, the parenting style adopted by them and the quality of the family context. The items proposed by the authors were selected and reformulated taking into account the direct observation of Argentine parents and presented in a Likert format. The preliminary scale remained constituted by 73 items presented in a Likert scale of three points. No agreement, Moderately agree, and Highly agree. Questions referred to the level of education of the parents, age, and quantity of offspring was also incorporated. The preliminary scale was administered to 229 families of children attending four schools in the city of Buenos Aires (Argentina). To study the psychometric fitness of the scale it was first examine the discriminative capacity of the items using t test of mean differences or the contrasting group's method. The test was performed for the original 73 items, founding that 14 of them were no discriminatory. The preliminary scale was then reduced to 59 items. Factorial analysis of these 59 items was done, as a exploratory mode, to determine the number and nature of the dimensions present in the instrument. This test indicated the presence of four factors: (a) family environment related to personal stimulation, (b) family environment which includes stimulating objects, (c) ideas and beliefs, and (d) breeding practices. The items were grouped in coherence with the initial theoretical hypothesis. Based on factorial analysis the four heavier items in each factor (> .40) that they were not factorially complex were taken into account to constitute the final version of the scale. The factorization of the final 16 items clearly showed the items grouping in the four factors observed before (see Figure 2). These four factors explain 60.39% of variance (see Table 1). Reliability as internal consistence of the scale of 16 reactive through the Cronbach Alpha was analyzed and a coefficient of .738 was obtained. The scale here presented enables us to evaluate ideas and beliefs that parents have with respect to the evolving development of the child and how these materialize in its conduct related to the style of breeding as well as to the patterns of action and their interaction. The scale presents good psychometric properties, specially referring to the factorial structure being its reliability as its internal moderate consistency.

Contexto familiar y consumo de sustancias psicoactivas en niños entre 8 y 12 años / Family Context and Consumption of Psychoactive Substances in Children between 8 and 12 Years Old

Se presentan resultados de una investigación que indaga el consumo de sustancias psicoactivas en una población clínica de niños entre 8 y 12 años que recibe asistencia psicológica en un servicio comunitario, dependiente de la Segunda Cátedra de Psicoanálisis: Escuela Inglesa de la Facultad de Psicología de la Universidad de Buenos Aires, Argentina. Asimismo se indaga el consumo de sustancias psicoactivas en los adultos responsables que acompañan a los niños a la consulta. Las muestras están conformadas por 55 niños (17 niñas y 38 niños) y 55 adultos responsables (47 mujeres y 8 varones). Se administró el cuestionario CORIN (Conductas de riesgo en niños), un cuestionario para padres o adultos responsables y un protocolo de datos sociodemográficos. Resultados: se registró la presencia del consumo ocasional de alcohol en el 33% de los niños y una alta proporción de prevalencia de consumo de alcohol en la vida, año y mes por parte de los adultos. A su vez, entre los adultos se registraron situaciones de consumo abusivo. Se infiere que el consumo ocasional de alcohol por parte de niños se asocia a las características de su contexto familiar y a los hábitos de consumo de sus adultos responsables.

The paper presents the results of an investigation Project UBACYT (Programming 2010/12) "Consumption of psychoactive substances and expectancies towards alcohol in school children between 8 and 12 years old". The paper studies a clinical sample that receives psychological assistance in a Child Clinical Psychology Unit that depends on Segunda Cátedra de Psicoanálisis: Escuela Inglesa, Facultad de Psicología, Universidad de Buenos Aires, Argentina. It investigates the consumption of these substances in children and their responsible adults. The samples are composed of 55 children (17 girls and 38 boys) and 55 responsible adults (47 women and 8 men). The CORIN (Children Risk Behavior) was administrated to the children, it evaluates risk situations regarding to the use of psychoactive substances in school children; a questionnaire that inquires consumption habits was administrated to parents or responsible adults of these children. Also, a protocol of sociodemographic information was used in order to gather and systematize the information of the medical history. Results and conclusions: the presence of occasional alcohol consumption in the 33% of the children sample was recorded. The existence of alcohol consumption in previous ages than the ones studied by governmental agencies. It must be mentioned that the children have consumed alcohol in festive situations and in company of their responsible adults. Regarding to the responsible adults of these children, important proportions of lifetime, year and month prevalence of occasional alcohol and tobacco consumption were recorded; also the abusive consumption of these substances. The registered proportions of the consumption of illegal substances are much lower. The study shows an increase in the occasional consumption of alcohol in children when the responsible adult made an abusive use of alcohol and tobacco during the last year and in less extent when the adult used more than one illegal substance (cocaine and marihuana). The consumption of alcohol in children increased significantly when the responsible adults had made abusive use of alcohol in the last month. It is inferred that the occasional consumption of alcohol in children of the age range studied, is associated with the characteristics of their family background and the consumption habits of the responsible adults.

Família, adolescência e estilos parentais / Family, teenagers and parenting styles

O objetivo principal deste trabalho foi identificar os estilos parentais característicos de famílias provenientes de contextos de alta vulnerabilidade social. A amostra foi composta por 62 adolescentes, com idade entre 12 e 17 anos, de ambos os sexos, e suas respectivas famílias. Para a coleta de dados, utilizou-se uma escala de exigência e responsividade, aplicada de forma coletiva nos adolescentes, além da análise de documentos constantes nos prontuários das famílias. Os resultados principais indicaram que as famílias eram geralmente numerosas, com estruturas diversas, e que os adolescentes percebiam seus pais mais como autoritativos do que como negligentes.

The goal of this research was to identify parenting styles among families from contexts of high social vulnerability. We therefore interviewed 62 teenagers of both sexes between the ages of 12 and 17 and their respective families. Research tools employed a scale of demandingness and responsiveness applied collectively to the teenagers and an analysis was undertaken of documents from the families' files. The main findings showed that such families were normally large and varied in structure and that the teenagers perceived their parents to be more authoritative than negligent.

Consumo de sustancias psicoactivas y contexto familiar en una población clínica de niños entre 8 y 12 años: Resultados preliminares / Consumption of psychoactive substances and family context in a clinical sample of children between 8 and 12 years old: Preliminary results

El trabajo expone resultados preliminares de un proyecto de investigación UBACYT (Programación 2010/12) "Consumo de sustancias psicoactivas y expectativas hacia el alcohol en niños escolarizados entre 8 y 12 años", Director: Marcelo Grigoravicius. Se estudia una población clínica que recibe asistencia psicológica en un Servicio de atención clínica de niños, dependiente de la Segunda Cátedra de Psicoanálisis: Escuela Inglesa de la Facultad de Psicología de la Universidad de Buenos Aires, ubicado en un par tido del sur del conurbano bonaerense. Se indaga acerca del consumo y las actitudes, valores y creencias de los niños sobre el uso de estas sustancias. Se realizan las mismas indagaciones a los adultos responsables a cargo de estos niños. La muestra está conformada por 22 niños y los 22 adultos responsables. Se administró el CORIN (Conductas de riesgo en niños), un cuestionario para padres o adultos responsables y un protocolo de datos sociodemográficos.

The paper presents preliminary results of an investigation Project UBACYT (Programming 2010/12) "Consumption of psychoactive substances and expectancies towards alcohol in school children between 8 and 12 years old", Director: Marcelo Grigoravicius. The paper studies a clinical sample that recieves psychological asistance in a Child Clinical Psychology Unit that depends on Segunda Cátedra de Psicoanálisis: Escuela Inglesa ,Facultad de Psicología, UBA, situated in a location of the conurbano bonaerense. It investigates the consumption, and the attitudes, values and believes the children have towards the use of these substances. Adults in charge of these children are inquired on the same subjects. The sample is composed of 22 children and their 22 adults in charge. The CORIN (Children Risk Behaviour), a questionnaire for parents or responsible adults and a protocol of sociodemographic information were administrated.

Fortalecimientoeemocional de las familias en siuación de pobreza: una propuestta de intervención desde el contexto sccolar / Emotinal strengtthening in the family: intervention from the school context

Las secuelas psicológicas de los patrones relacionales caracterizados por carencias afectivas y mal manejo interaccional entre los miembros de una familia, pueden inhibir u obstruir el intento de los miembros por alcanzar su pleno potencial para un desarrollo psicosocial saludable. En este sentido, el fortalecimiento emocional de las familias se tornaría una condición fundamental para superar estos patrones disfuncionales. El propósito de este trabajo consiste en exponer por qué la educación y la estimulación emocional pueden resultar particularmente útiles en los contextos de riesgo psicosocial y presentar algunas estrategias para abordar dicha tarea desde el ámbito escolar. Esta propuesta se centra particularmente en el fortalecimiento de los recursos emocionales de los padres o cuidadores primarios, logrando impactar directamente sobre el desarrollo emocional de los niños.

The psychological consequences from relational styles characterized by lack of affection and interactional mismanagement between family members can inhibit or block the attempt by members to achieve their full potential for healthy psychosocial development. In this context, emotional strengthening families would become a key condition for overcoming these dysfunctional patterns. The aim of this work is to show why psychoeducation and emotional stimulation can be particularly useful in the context of psychosocial risk due to poverty and present some strategies to approach such goal from the school environment. This approach is mainly focused on the strengthening of emotional resources in parents and primary caregivers to achieve a direct impact on the children's emotional development.

Relaciones entre el clima social familiar y el desempeño en habilidades sociales en niños y niñas entre dos y tres años de edad / The relationship between social family climate and social skills performance in boys and girls between two and three years of age / Relação entre clima social familiar e desempenho nas habilidades sociais em crianças entre dois e três anos de idade

Esta investigación tuvo como objetivo estudiar el clima social de un grupo de familias y su relación con el desempeño en habilidades sociales de 108 niños y niñas entre dos y tres años de edad. Se evaluó el clima social desde tres dimensiones: relaciones, desarrollo y estabilidad, y el desarrollo social mediante seis repertorios conductuales. La investigación fue de tipo descriptivo correlacional. Para evaluar el clima social familiar se utilizó la Escala de clima social, y para evaluar las habilidades sociales, el Cuestionario de habilidades sociales. Se encontró que las familias cohesionadas, es decir, aquéllas que presentan una tendencia democrática caracterizada por espacios de comunicación, expresiones de afecto y un manejo de normas claras, son generadoras de un repertorio amplio de habilidades sociales; mientras que las familias con una estructura disciplinada, caracterizada por acciones autoritarias de los padres, se asocian con un nivel más bajo de desempeño social en los niños y niñas. Una situación similar se pudo evidenciar en las familias con una estructura sin orientación, caracterizada por el poco manejo de normas claras y una gran manifestación de afecto y satisfacción de los deseos de sus hijos e hijas.

This research aimed to study the social climate of a group of families and its relationship with social skills performance of 108 children between the ages of two and three. Social climate was assessed from three dimensions: relationships, development and stability; and social development through six social codes. The research was descriptive correlational. In order to assess the family social climate, the Social Climate Scale was used; and to assess social skills, the Social Skills Questionnaire was administered. Results showed that cohesive families, those with a democratic trend characterized by allowing communication spaces, using expressions of affection and managing clear standards generate a wide repertoire of social skills; whereas families with a disciplined structure, characterized by authoritarian actions of the parents, are associated with lower levels of social performance in boys and girls. A similar situation was evidenced in families with a structure without orientation, characterized by the limited amount of clear standards and a high expression of affection and satisfaction of their sons and daughters' desires.

O objetivo desta pesquisa descritiva correlacional é estudar o clima social de um grupo de famílias e sua relação com o desempenho em habilidades sociais de 108 crianças entre dois e três anos de idade. Estabeleceram-se três dimensões para avaliar o clima social: relacionamentos, desenvolvimento e estabilidade. No desenvolvimento social se observaram seis repertórios comportamentais. Para avaliar o clima social familiar se aplicou a Escala de clima social; para avaliar as habilidades sociais, o Questionário de habilidades sociais. Verificou-se que as famílias coesas, ou seja, mostrando uma tendência caracterizada por espaços democráticos de comunicação, expressões de afeto e aplicação de regras claras geram um amplo repertório de habilidades sociais. Enquanto as famílias com uma estrutura disciplinada caracterizada por ações autoritárias dos pais estão associadas a crianças com menor nível de desempenho social. Uma situação semelhante foi evidente em famílias sem orientação, caracterizada pela aplicação limitada de regras claras e uma grande demonstração de afeto e satisfação dos desejos de seus filhos.

Obediência infantil: conceituação, medidas comportamentais e resultados de pesquisas / Child compliance: definitions, behavioral measurement and research results

A obediência infantil a instruções parentais é um tema amplamente abordado na literatura clínica comportamental. No entanto, há poucos estudos que quantifiquem níveis de obediência em crianças de idades específicas, dificultando o trabalho dos clínicos quanto ao estabelecimento de critérios para definir quais frequências de obediência são "normais" em relação a uma população específica. Este artigo discute as definições do termo obediência, algumas medidas que se mostraram úteis à mensuração desse comportamento, e alguns resultados de pesquisa que apresentam as frequências de obediência em crianças clínicas e não clínicas.

Child compliance with parental instructions is an extensively discussed issue on clinical behavioral literature. However, there are few studies that quantify compliance levels in children of specific ages, making it difficult for clinicians to establish criteria in defining normal frequencies of compliance in a specific population. This paper presents some definitions of the term "compliance", some instruments and measurements that are useful in measuring this behavior, and some research results that present compliance frequencies in clinical and non-clinical children.

A mudança do setting terapêutico como modelo facilitador para promover a estabilidade do vínculo frente às modificações do contexto familiar / The change of therapeutical setting as a facilitator model to promote the stability of the link in the face of the modifications of the familiar context / El cambio del setting terapéutico como modelo facilitador para promover la estabilidad del vínculo frente a las modificaciones del contexto familiar

Neste estudo destacamos a possibilidade de uma criança transitar em contextos familiares diferentes, ao invés de permanecer na família de origem. Ao propormos atendimento psicoterápico nestas condições, defrontamo-nos com desafios que vão além do trabalho com a subjetividade, incluindo questões relativas ao modelo de atendimento mais adequado, especialmente ao setting terapêutico utilizado. Objetivamos discutir a permanência do vínculo terapêutico em oposição a mudanças ambientais. Utilizamos o caso de uma criança em processo de psicoterapia, ao longo do qual ocorreram modificações na estrutura familiar que exigiram alterações no setting terapêutico. Estas possibilitaram manter o vínculo terapêutico, ajudando a paciente vivenciar fases de instabilidade externa com menor turbulência e importantes ganhos emocionais. O estabelecimento de um setting psíquico sólido garantiu a continuidade do trabalho e favoreceu o desenvolvimento emocional da paciente. Baseamo-nos no referencial winnicottiano, no qual o manuseio do setting é um recurso importante para a criação do ambiente de holding, a partir do qual um espaço potencial pode ser concebido. Consideramos esta perspectiva importante na elaboração de propostas interventivas em psicologia clínica comunitária e preventiva.

In this study we highlight the possibility of a child to transit in different family contexts, instead of staying with the original family. When we propose psychotherapeutic treatment in these conditions, we face challenges that are beyond the work with subjectivity, including questions on the best consulting model, specially about the therapeutic setting to be used. We aim to discuss the maintenance of the therapeutic link against environmental changes. We present the case of a child in psychotherapeutic process, in which the changes in the family structure demanded changes in the psychotherapeutic setting. This changes enabled the stability and continuity of the therapeutic link, helping the patient experience external instability with less stress and greater emotional gain. The establishment of a solid psychic setting guaranteed the continuation of the work and favored the emotional development. We were based on Winnicott´s referential, where the handling of the setting is important to create a holding environment, from which a potential space can be conceived. We consider this perspective important to elaborate interventional proposals in community and preventive clinical psychology.

En este estudio destacamos la posibilidad de un niño transitar en diversos contextos familiares, en vez de permanecer en la familia original. Al proponermos tratamiento psicoterápico en estas condiciones, hacemos frente a los desafíos que van más allá del trabajo con la subjetividad, incluyendo preguntas relativas al modelo de tratamiento más adecuado , especialmente a el setting terapêutico utilizado. Tenemos el objetivo de discutir la permanencia del vínvulo terapéutico en oposición a los cambios ambientales. Utilizamos el caso de una niña en proceso psicoterápico, en el cual sucedieron modificaciones en la estructura familiar que demandaran cambios en el setting terapéutico. Estos cambios posibilitaran mantener el vínculo terapéutico, ayudando la paciente a vivir fases de inestabilidad externa con poca turbulencia y beneficios emocionales importantes. El establecimiento de un sólido setting psíquico garantizó la continuidad del trabajo y favoreció el desarrollo emocional de la paciente. Nos basamos en el referencial winnicottiano, en cuál el direccionamiento del setting és un importante recurso para la creación del ambiente de holding, a partir del cual puede ser concebido un espacio potencial. Consideramos esta perspectiva importante en la elaboración de prácticas interventivas en psicología clínica comunitaria y preventiva.