Novas formas de psicopatologia em um mundo em mudança: um desafio para a psicanálise no século XXI / New forms of psychopathology in a changing world: a challenge for psychoanalysis in the twenty-first century / Nuevas formas psicopatológicas en un mundo que cambia: un desafío para el psicoanálisis del Siglo XXI

O presente artigo tem por objetivo contextualizar as mudanças no setting psicanalítico e na psicoterapia de orientação analítica decorrentes do distanciamento social provocado pela pandemia de Covid-19. São abordadas questões desde as combinações necessárias ao estabelecimento de um novo setting virtual, como o uso de tecnologia de comunicação apropriada e de plataformas on-line, até as implicações transferenciais e as contratransferências no campo analítico. Saliento que as observações sobre o novo setting psicanalítico virtual são ainda preliminares, pois essa modalidade de atendimento encontra-se em construção, uma vez que se trata de um campo ainda a ser mapeado devido ao pouco tempo que tivemos para processar tais transformações com um exercício ético, adequado, capaz de desenvolver um verdadeiro e sólido processo analítico eficaz. Palavras-chaves: Tele psicanálise; Atendimento virtual; Setting virtual; Psicanálise em tempos de pandemia da Covid-19

This paper intends to contextualize the changes arising from the social distancing consequent to the Covid-19 pandemic in the psychoanalytic setting and in analytically-oriented psychotherapy. Issues such as the agreements necessary to establish a new virtual setting, the use of appropriate communication technology and online platforms, transference and countertransfer in the analytical field are addressed. The observations made upon the new virtual psychoanalytic setting are still preliminary, since this modality of care is under construction, as it is a field still to be mapped, due to the short time we had to process such transformations with an ethical, adequate practice, capable of developing a true and solid efficient analytical process (AU)

Este artículo tiene como objetivo contextualizar los cambios en el setting psicoanalítico y la psicoterapia de orientación analítica resultantes del distanciamiento social provocado por la pandemia del Covid-19. Se abordan temas desde los conciertos necesarios para establecer un nuevo setting virtual, como el uso de tecnologías de comunicación adecuadas y plataformas en línea, hasta las implicaciones transferenciales y contratransferencias en el campo analítico. Destaco que las observaciones sobre el nuevo setting psicoanalítico virtual son aún preliminares, pues este tipo de servicio está en construcción, ya que es un campo aún por mapear debido al poco tiempo que tuvimos para procesar tales transformaciones con un ejercicio ético, adecuado, capaz de desarrollar un verdadero y sólido proceso analítico efectivo

Lo interpsíquico: estado normal, patología y las diferencias con lo interpersonal e intersubjetivo / The interpsychic: normal state, pathology and the differences between the interpersonal and the intersubjective

Lo interpsíquico es un nivel funcional pre-subjetivo donde dos personas pueden intercambiar contenidos y experiencias de un modo compartido, a través de la utilización normal de identificaciones proyectivas comunicativas. Tomando como fuente de inspiración situaciones de la vida cotidiana y viñetas clínicas, este trabajo explora el área natural de estos intercambios humanos para poder entender mejor lo que ocurre durante fases importantes del trabajo analítico, cuando éste se desarrolla de un modo suficientemente bueno. Los conceptos de Intrapsíquico/Interpsíquico, Sí mismo/no Sí mismo, Personación/Despersonación y Empatía Psicoanalítica permiten describir, junto con la metáfora de la gatera (chatiere), la complejidad de los intercambios entre las interioridades de dos seres humanos cuento un encuentro real y un contacto interno tienen lugar (AU)

The Interpsychic is a functional, pre-subjective level where two persons can Exchange internal contents and experiences in a shared way, through the utilization of normal communicative projective identifications. Taking inspiration from every day life situations and from clinical vignettes, this paper explores the natural area of these human interchanges, in order to better understand what happens during many important phases of the analytic works well enough. The concepts of Intrapsychic/Interpsychic, Self/No self, Personnation/Despersonnation, and Psychoanalytic Empathy are involved, together with the metaphor of the cat-flow (chatiere), to describe the complexity of the exchange between the interiors of two human beings when a real encounter and internal contact takes place (AU)

The analyst's awkward gift: balancing recognition of sexuality with parental protectiveness.

The author describes the many roles that the analyst is called upon to fulfill in the transference during the course of an analysis. The loving transference is distinguished from the erotic transference and the erotized transference. Repetition is discussed, as is narcissism, especially in the light of clinical situations in which oedipal issues take center stage. Four brief clinical examples are presented.

Em nome de uma psicanálise renovada / En nombre de un psicoanálisis renovado / For a renewal psychoanalysis

O Dr. Stefano Bolognini, abriu um espaço na sua agenda de trabalho de conferências, seminários clínicos e supervisões na SBPSP para conversar com o corpo editorial do Jornal de Psicanálise. Por uma hora e meia pudemos ouvi-lo falando de temas importantes pa a nós, psicanalistas, como: os interesses na investigação psicanaloítica que permeiam seu trabalho hoje, a questão da identidade analítica local, a importância no trabalho clínico da confiança no pré-consciente do analista, a discriminação conceitual necessária entre interpsíquico, intersubjetivo e interpessoal, e sua crítica ao International Journal of Psychoanalysis no que diz respeito a certa parcialidade na eleição de artigos para publicação, entre outros. Através destas reflexões, Dr. Bolognini reafirmou a crença em uma psicanálise viva, renovada permanentemente pelas trocas entre analistas

A família institucional e a fantasmática do analista / The institutional and phantasmal family of the analyst

O autor propõe a existência de intensa interação entre as duas famílias do analista: a histórica, da infância, e a institucional, de sua formação. Para ele, ambas intervêm no trabalho do analista com seu paciente, no plano da fantasia interior, em grau diferente, segundo os diversos momentos de trabalho. Mostra-se que o elemento comum à experiência infantil e a analítica é a imensa oportunidade de profunda introjeção. No percurso do jovem psicanalista, há momentos introjetivos decisivos, que vão fundar e constituir as bases culturais, teóricas e clínicas do seu “Eu de trabalho” (AU)

The author proposes the existence of intense interaction between the analyst’s two families, the historical one of his infancy, and the institutional one, of his psychoanalytic education. In his opinion, they both step in the analyst’s work with his patient, on the level of his inner fantasy, and in different degrees according to the diverse moments of the work. He points out that the common element between the infantile experience and the analytic one is the enormous opportunity of profound introjection. There are important moments that favor introjection in the young analyst’s course, which establish and constitute the cultural, theoretical and clinical foundations of his Working Self (AU)

[Lichtenstein vs. Rutkow-Robbins technique in the treatment of primary inguinal hernia. Analysis of the long term results]. / Tecnica di lichtenstein vs. Rutkow-Robbins nel trattamento dell'ernia inguinale primaria. Analisi dei risultati a distanza.

BACKGROUND: The AA. compared the preliminary results of two different methods of inguinal hernioplasty: one using only the mesh (Lichtenstein) and the other one using both mesh and plug (Rutkow-Robbins). PATIENTS AND METHODS: Seventy consecutive patients were randomly allocated into two groups, 35 patients each one, to receive either a Licthenstein mesh or a Rutkow-Robbins plug and mesh for primary monolateral groin hernia. RESULTS: Follow-up was planned at 1 week, 3 weeks, 3 and 6 months after surgery. The Authors evaluated early and late complications i.e.: the presence of paraesthesia, postoperative pain and the incidence of recurrence. The results were analysed statistically using the Fisher and chi2 tests. CONCLUSIONS: Data parameters did not show statistically significative differences between the two groups (p > 0.05). No recurrences were detected. The Authors concluded that no advantage may derivate by an additional plug to the single mesh hernia repair.

[Thyroid microcarcinoma and multinodular struma. Personal experience and considerations regarding surgical therapy]. / Frequenza di microcarcinoma tiroideo in gozzo multinodulaxe. Esperienza personale e considerazioni sugli aspetti chirurgici.

Thyroid microcarcinoma is a malignant papillary tumour of the thyroid gland measuring < or = 1.0 cm in diameter. Prognosis and treatment are controversial. We report on a personal series of 28 cases of thyroid microcarcinoma observed over the period from 2000 to 2004. From 2000 to 2004, 199 consecutive total thyroidectomies were performed in patients with multinodular struma. The histological diagnosis was made by a pathologist according to the recommendations of the World Health Organization by means of sections of the thyroid gland of no more than 2 mm. At routine histological examination, 28 cases (14.07%) of "incidental" thyroid microcarcinoma were found. The mean tumour size was 4.10 mm (range: 0.12 to 10 mm). The tumours were multifocal in 2 patients, and none presented lymph node metastases. Thyoid microcarcinoma is a malignant tumour associated with a good prognosis. Multifocality should be the main factor considered in selecting the type of thyroid surgery. A total thyroidectomy may be regarded as sufficient treatment.

The profession of ferryman: considerations on the analyst's internal attitude in consultation and in referral.

Psychoanalytic consultation is an interview with a patient who will not be taken in treatment by the consultant analyst, but who will be sent to another, perhaps specifically chosen, colleague after one or more assessment sessions. This practice is becoming increasingly important since, besides traditional private relationships between consultant and patient, it is now common in many specialized centres affiliated to official psychoanalytical institutions. The author explores some fundamental aspects of the analyst's internal attitude in consultation: motivation to know; a 'concave' attitude to listening; responsibility in proposing suitable technical choices and referral to a further specialist; empathy and partial identification; the balance between authentic experience in the consultation and risks of seduction; internal links within the community of colleagues; the technique for sending patients on. He presents a clinical example, specifically aimed at reproducing the internal attitude of the analyst, together with the necessary work that allows a difficult patient to initiate psychoanalytic treatment.

Intrapsychic-interpsychic.

The 'interpsychic' is an extended psychic dimension, regarding the joint functioning and reciprocal influences of two minds. The concepts of 'subjectivity' and 'person' can be included in the 'interpsychic'. They can also overlap with each other, and sometimes all three can overlap together, but they do not necessarily coincide. In the different contemporary perspectives, how can we modify the intrapsychic 'through' (and 'with' and 'by') the interpsychic? Presenting four clinical vignettes, the author progressively moves from the theoretical positions that emphasise the exploration and the elaboration of the intrapsychic mainly through the intrapsychic, to the positions that emphasise the same operations mainly through the interpsychic. The last part of the paper deals with the technical use of the interpsychic dimension: the analytic dialogue, when interpsychically experienced (from inside), gains a new, more specific effectiveness, first in containing and then in symbolising. In an intense mental 'cohabitation' inside the analytic working pair, it is very often clearly experienced as 'true' (as in dreams).

O bar no deserto. Simetria e assimetria no tratamento de adolescentes difíceis / A bar in the desert. Symmetric and assymetric aspects in the treatment of dificult

O autor considera a oportunidade de uma alternância adequada de momentos de simetria e de assimetria na relação analítica (que precisa ser mantida, porém, dentro da moldura clássica de assimetria) para facilitar o trabalho e permitir interpretações com um analisando que, em geral, está assustado com a dependência, é hostil aos representantes superegóicos, tem necessidade de uma contenção não declarada e de uma contribuição de base para a coesão do self, como é o paciente adolescente. A história clínica narrada ilustra esse modo específico de trabalhar, bem diferente do modo comumente adotado na análise de pacientes adultos. O analista precisa ser capaz, por exemplo, às vezes por um longo período, de renunciar a interpretações muito freqüentes ou brilhantes que ressaltariam a superioridade do adulto, coisa que um paciente adolescente dificilmente poderia tolerar.

The analyst at work: two sessions with Alba.

In this paper, the author presents clinical material that relates to two sessions with a patient called Alba. This analytic work, being of a somewhat unusual character, lends itself to discussion, the author feels, since the technical choices made are undoubtedly very personal and he believes many colleagues might have done things differently. The author endeavours to enrich the account of the sessions with his concomitant thoughts, so as to supply colleagues with the elements, atmosphere and developments of his internal workshop.