The Drive For Self-Assertion And The Reality Principle In A Patient With Malignant Pleural Mesothelioma: The History of Giulia.

Life in a contaminated environment is often marked by a cumulative psychological trauma that exhibits a variety of social-environmental aspects. This is why I suggested a psychotherapeutic group intervention for the population of Casale Monferrato, a municipality in Northern Italy that is sadly renowned for asbestos-related events and the high mortality rate of its inhabitants. Groupality appears to show the point of contact between psyche and soma, while also promoting the birth of a more realistic approach to the various levels of suffering and their configuration. The multifamily approach seemed to be the most adequate to elaborate the feelings of rage and fear that are concurrent with the aerial contagion. In the "long wave" of group work we have learned to work with participants as well as with empty chairs, the ghosts of the dead: live traces in the mind. Whereas the mind recovers the possibility of entering into a dialogue with the feelings connected to the trauma, without bypassing them towards actions that are apparently more assertive of one's sense of Ego, the will of conciliation can reactivate a thought that is oriented towards the plane of reality.

Parenting Capacity Assessment for the Court in a Multifamily Group Setting.

Parenting capacity assessment in court evaluations is a particularly complex task, given that it is necessary to consider the vast array of distinct and interrelated aspects and abilities which represent parenting, as well as the elevated number of contextual levels that influence parenting quality. The perspective we want to introduce regards the potentiality of the multifamily group as the elective observational setting in parenting capacity assessment.

Grupo multifamiliar no contexto dos Transtornos Alimentares: a experiência compartilhada / Multifamily group in the context of Eating Disorders: a shared experience / Grupo multifamiliar en el contexto de los Trastornos Alimenticios: la experiencia compartida

Este estudo teve por objetivo explorar a experiência compartilhada por cuidadores que participam de um grupo de apoio para familiares de pessoas diagnosticadas com transtornos alimentares (TAs), buscando identificar os sentimentos vivenciados e as possíveis ressignificações de suas experiências como cuidadores. Foram analisadas cinco sessões do Grupo de Apoio Psicológico aos Familiares, das quais participaram 23 familiares de pacientes cadastrados em um serviço especializado em TAs do interior do estado de São Paulo. Os dados foram submetidos à análise de conteúdo temática e interpretados à luz do referencial psicodinâmico. Os resultados indicam que os familiares buscam compreender as causas do problema, percebem o filho afetado pelo transtorno como emocionalmente imaturo, experimentam sentimento de culpa e déficits de autocuidado, beneficiam-se da presença do pai e de outros familiares que não as mães no cenário do tratamento e tiram proveito do grupo para fortalecer seu papel de cuidadores familiares. Evidenciou-se que o espaço do grupo pode funcionar como alternativa importante na construção de relacionamentos mais saudáveis, induzindo mudanças na dinâmica familiar

This study aimed to explore the experience shared by caregivers who participated in a support group for family members of people who have eating disorders (ED), seeking to identify the feelings experienced and possible reinterpretations of their experiences as caregivers. Five group sessions of Family Support Group, attended by 23 relatives of patients registered in a specialized ED service in the state of São Paulo, Brazil, were analyzed. Data were subjected to thematic content analysis and interpreted in the light of a psychodynamic framework. The results indicate that family members seek to understand the causes of the problem, perceive the son/daughter affected by the disorder as an emotionally immature person, experience feelings of guilt and deficits of self-care, benefit from the presence of the father and other family members other than mothers in the setting of treatment and take advantage of the group to strengthen their role as family caregivers. It was evident that the group can function as an important alternative in building healthier relationships, eliciting changes in family dynamics

Este estudio trata de explorar la experiencia compartida por los cuidadores que participaron en un grupo de apoyo para familiares de personas diagnosticadas con trastornos alimenticios (TA), buscando identificar los sentimientos experimentados y la posible reinterpretación de sus experiencias como cuidadores. Fueron analizadas cinco sesiones del Grupo de Apoyo Psicológico a Familiares, al que asistieron 23 familiares de pacientes registrados en una clínica especializada en TA en el estado de São Paulo, Brasil. Los datos fueron sometidos a análisis de contenido temático e interpretados a la luz de la teoría psicodinámica. Los resultados indican que los miembros de la familia tratan de comprender las causas del problema, perciben el miembro afectado por el trastorno como emocionalmente inmaduro, experimentan sentimientos de culpa y déficits de auto-cuidado, se benefician de la presencia del padre durante el tratamiento y de otros miembros de la familia que no sean las madres, y aprovechan el grupo para reforzar su papel como cuidadores familiares. Se hizo evidente que el grupo puede funcionar como una alternativa importante en la construcción de relaciones más sanas, induciendo cambios en la dinámica familiar

Family Interventions for Schizophrenia and the Psychoses: A Review.

Family psychoeducation as a treatment for schizophrenia was developed 40 years ago almost simultaneously and independently by investigators who at the time were not family therapists. Although the original goal was to decrease high expressed emotion as a means of preventing relapse, later variations have gone beyond to focus on social and role functioning and family well-being. Explicitly disavowing the earlier assumptions that family pathology caused relapse and deterioration, family psychoeducation seeks to engage family members as more sophisticated partners, complementing interventions by clinicians with specialized interactions and coping skills that counter the neurologic deficits inherent to the disorder. It has proved to be one of the most consistently effective treatments available. Reports on outcome studies now number more than 100, while meta-analyses put relapse rate reduction at 50-60% over treatment as usual. The most recent application in first episode and prodromal psychosis, combined with other evidence-based interventions, is yielding perhaps the most promising results yet achieved-substantial return of functioning and avoidance of psychosis altogether. Reviewed here are its scientific, theoretical, and clinical sources, a description of the most commonly applied version-the multifamily group format, selected clinical trials spanning those four decades, international and ethnic adaptations, and studies on mechanisms of efficacy.

Clinical and functional outcomes after 2 years in the early detection and intervention for the prevention of psychosis multisite effectiveness trial.

OBJECTIVE: To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth. METHODS: In a risk-based allocation study design, 337 youth (age 12-25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures. RESULTS: A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025). CONCLUSION: FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis.

Contribuição de um trabalho grupal multi-familiar para as famílias participantes / Contributions of a multifamiliar group work for participating families

Este artigo discute as contribuições de um trabalho grupal multifamiliar para as famílias participantes. Para tanto, utilizamos como modalidade de pesquisa um estudo de caso, através da análise das narrativas dos membros das famílias. Consideramos como base teórica e de discussão o enfoque sistêmico, o construcionismo social e as práticas narrativas. O objetivo foi o de refletir sobre as contribuições que o trabalho grupal multifamiliar proporcionou para as famílias participantes. Algumas das contribuições observadas foram: o resgate de recursos familiares e de ligações intergeracionais, o fortalecimento de vínculos entre pessoas da mesma família e o surgimento de novas formas de pensar. Consideramos o trabalho como uma modalidade que incita inúmeras reflexões e possibilita mudanças significativas na forma de pensar, sentir, agir e vivenciar as situações vividas em família. (AU)

This article discuss the contributions of a multifamiliar group work for the participating families. For this purpose, we used the case study as a means of research by analyzing the narratives of family members, considering as the theoritical basis and discussinon the family systems approach. The social constructionism and the narrative practices. The objective was to reflect on the contribuitions that the group work for families provied for the participating families. Some of the observed contributions were: the rescue of family resource and intergenerational bondings, the strengthening of bonds between members of the same family and the appearance of new ways of thinking. We considered this work as a modality that encourages countless reflections and allows significant changes in thinking, feeling, acting and experiencing the situations lived within the family. (AU)

O grupo multifamiliar como recurso no tratamento dos transtornos alimentares / Multifamily group therapy for patients diagnosed with eating disorders

INTRODUÇÃO: O presente artigo é resultado do trabalho sistemático dos autores com grupos multifamiliares de pacientes com diagnóstico de transtorno alimentar (anorexia nervosa, bulimia nervosa e transtorno alimentar não especificado), conjuntamente com seus familiares. As sessões são oferecidas em um hospital público na cidade de Porto Alegre (RS). MÉTODO: Os registros em vídeo de quatro sessões de terapia de grupo multifamiliar foram analisados qualitativamente utilizando-se a técnica de análise de conteúdo. RESULTADOS: Grupos multifamiliares assim constituídos não foram encontrados na revisão da literatura, e sim apenas relatos de grupos multifamiliares com finalidades exclusivamente psicoeducativas, sem a participação dos pacientes identificados. Na avaliação final, a modalidade de atendimento multifamiliar revelou-se como positiva para o atendimento dos casos avaliados. CONCLUSÕES: A pesquisa demonstrou que esse tipo de abordagem, associado ao tratamento unifamiliar e individual, pode tornar-se uma ferramenta eficaz de tratamento para esses pacientes e suas famílias.

INTRODUCTION: This article is the result of the systematic experience of the authors with multifamily group therapy for patients with a diagnosis of eating disorders (anorexia nervosa, bulimia nervosa and not otherwise specified eating disorders) and their families. Sessions are held at a public hospital in the municipality of Porto Alegre, southern Brazil. METHOD: Video recordings of four multifamily group therapy sessions were qualitatively assessed using the content analysis technique. RESULTS: References to similar multifamily group therapy programs were not found in the literature review; rather, only some reports of multifamily group sessions with exclusively psychoeducational purposes were retrieved, however not including direct patient participation. At the final evaluation, multifamily group therapy was considered to have positive therapeutic outcomes for the patients assessed. CONCLUSION: Our study showed that this type of approach, associated with single-family and individual therapy, may become an effective treatment strategy for these patients and their families.

Observando os grupos multifamiliares em uma instituição psiquiátrica / Observing multifamily groups in a psychiatric institution

CONTEXTO: Investigaram-se as diversas práticas que incluem a família em uma instituição psiquiátrica. Destacou-se o grupo multifamiliar, que é um espaço privilegiado de atendimento. OBJETIVO: Buscou-se compreender como as famílias são atendidas, levantando as principais questões observadas em diversos grupos. MÉTODOS: Como método, utilizou-se a observação participante, sendo realizada no setor de atendimento infanto-juvenil, no Hospital-Dia, no Centro de Doença de Alzheimer e outras demências (CDA) e no Programa de Estudos e Assistência ao Uso Indevido de Drogas (PROJAD). RESULTADOS: Observou-se que no grupo multifamiliar a catarse, o relato dos conflitos e o compartilhamento de informações produzem um efeito de rede. Os familiares trabalham juntos e as famílias se engajam em uma conversação que ajuda a construir uma comunidade de apoio. CONCLUSÕES: Em razão das questões apresentadas, considerou-se importante discutir o grupo multifamiliar, relacionando-o à terapia de grupo multifamiliar, aos grupos de psicoeducação e ao trabalho com rede social. Concluiu-se que a rotina da instituição psiquiátrica tem incluído a família, mas é necessário analisar a demanda e sistematizar os atendimentos feitos em grupo.

CONTEXT: Several practices that include the family in a psychiatric institution were investigated. The focus was on the multifamily group, which is a privileged space for assistance. GOAL: There was an attempt to understand how families are assisted, raising the main questions observed in different groups. METHODS: Participant observation was conducted in the child and youth sector, the Day-Hospital, the Center for Alzheimer Disease and other dementia (CDA), and in the Program for Studies and Assistance in Inappropriate Use of Drugs (PROJAD). RESULTS: It was observed that in the multifamily group the catharsis, the account of conflicts and the sharing of information produce a network effect. Family members work together, and families engage in a conversation that helps building a supportive community. DISCUSSION: In the face of the questions raised, it is important to discuss multifamily group, relating it to multifamily group therapy, groups of psychoeducation, and to the work in social networks. It was concluded that the routine in a psychiatric institution has been including the family, but it is necessary to analyze the demands and systematize the assistance conducted with groups.