The Innate Capacity for Representing Subjective Experience: The Infant's Mind is Neither Primitive nor Prerepresentational.

The author cites the prominence of theories that locate serious adult psychopathology in the preverbal infant's inability to formulate or represent traumatic experience. The work of two such authors, H. Levine and D. B. Stern, is briefly considered. The frame of reference for this investigation is that clinical and academic research findings are highly relevant to psychoanalytic theorizing. It is argued that when such findings are considered, a view of the infant with "primordial and unrepresented" states of mind has little evidence to support it. In fact, research findings summarized herein point to an opposite view: that of the "competent infant," one with highly accurate perceptual discrimination capacities and an innate ability to register and represent subjective experience in both procedural and declarative memory, even prenatally. Given the infant's competencies, it seems implausible to hold that representational deficits are at the heart of serious adult psychopathology, which is instead seen to be the result of defensive maneuvers against unknowable and unspeakable truth rather than the absence of a preverbal representational capacity. Current research findings seem to pose a significant challenge for psychoanalytic theories that espouse "primitive mental states"; "unrepresented," "unformulated," or "unsymbolized" experience; or "nonconscious" states.

Dramatic storytelling and naming subjective experiences in psychodynamic treatments of depressed women-An exploratory study of assimilative functions of narrating.

Objective: The present study aims to demonstrate how assimilation processes indicated by formal aspects of in-session narratives change in the course of psychodynamic therapy and how this differs by therapy outcome. Method: Two sessions each from the initial, the middle, and the termination phase of six successful and six unsuccessful psychodynamic treatments were compared. All narratives were identified and coded for dramatic narrating and naming of emotions and mental verbs. Results: Good outcome cases peaked in the use of direct speech and naming negative emotions in the middle phase of treatment. Poorer treatment outcome was associated with a high amount of narrating and a tendency to more dramatic narrating in the termination phase and with a use of more narrative clauses throughout treatment. Conclusions: Emotional remembering and naming of emotional states in the middle phase could provide partial support for the role of assimilation processes in good outcome cases. Narrative characteristics of less successful treatments are discussed.

Measuring multivariate phase synchronization with symbolization and permutation.

Phase synchronization is an important mechanism for the information processing of neurons in the brain. Most of the current phase synchronization measures are bivariate and focus on the synchronization between pairs of time series. However, these methods do not provide a full picture of global interactions in neural systems. Considering the prevalence and importance of multivariate neural signal analysis, there is an urgent need to quantify global phase synchronization (GPS) in neural networks. Therefore, we propose a new measure named symbolic phase difference and permutation entropy (SPDPE), which symbolizes the phase difference in multivariate neural signals and estimates GPS according to the permutation patterns of the symbolic sequences. The performance of SPDPE was evaluated using simulated data generated by Kuramoto and Rössler model. The results demonstrate that SPDPE exhibits low sensitivity to data length and outperforms existing methods in accurately characterizing GPS and effectively resisting noise. Moreover, to validate the method with real data, it was applied to classify seizures and non-seizures by calculating the GPS of stereoelectroencephalography (SEEG) data recorded from the onset zones of ten epilepsy patients. We believe that SPDPE will improve the estimation of GPS in many applications, such as EEG-based brain-computer interfaces, brain modeling, and simultaneous EEG-fMRI analysis.

[Eating Disorders: An Outline of Postmodern Psychodynamics]. / Essstörungen: Aufriss postmoderner Psychodynamik.

The dazzling characteristics of postmodernity in the form of social flexibility, economization and virtualization can be understood as an expression of a cultural configuration that is by no means natural and irreversible, but is particularly media-related. Bulimia seems, more than Anorexia, a prime example of this.With regard to the historicity of symptoms in their various forms and disorders over time, consideration is given to how anorexic and bulimic symptoms position themselves in it. If the development toward postmodernity is to be understood as the pathology of modernity, in the course of the social pervasion of visual media there is a sociocultural turnabout to the fragile self, in which the theoretical polarity of conflict and structure can no longer be displayed.

How and When Perpetrators Reflect on and Respond to Their Workplace Ostracism Behavior: A Moral Cleansing Lens.

Purpose: This study investigates the association between the previous workplace ostracism of employees and their subsequent helping behavior by drawing on moral cleansing theory in the Chinese context, exploring the mediating roles of employees' guilt and perceived loss of moral credit and the moderating role of their moral identity symbolization. Sample and Method: The data were collected from a two-stage time-lagged survey of 284 Chinese employees. Regression analysis and the bootstrapping method are used in this article to examine the theoretical hypotheses. Results: The results indicate that employees' previous ostracism behaviors positively affected their guilt experience and perceived loss of moral credit. Subsequently, the relationship between employees' workplace ostracism and their helping behavior is mediated by guilt experience and perceived loss of moral credit. Furthermore, moral identity symbolization positively moderated the indirect "workplace ostracism-helping behavior" linkage via guilt and perceived loss of moral credits; in other words, for employees who have a higher degree of moral identity symbolization, the mediating effect is more significant, and vice versa. Conclusion: This study does not merely clarify the theoretical relationship between perpetrators' workplace ostracism and their helping behavior, which enriches the explanatory logic of related research on workplace ostracism and the cause of helping behavior, but also expand the application scope of moral cleansing theory. Further, we aim practically to bring enlightenment to human resource management reform, corporate culture construction, and positive behavior management.

A função fóbica como elemento originário do pensamento: uma leitura do brincar em Hans / Phobic function as an element originating from thought: a reading of play in Hans / A fonction phobique comme élément issu de la pensée: une lecture du jeu dans le cas Hans / La función fóbica como elemento original del pensamiento: una lectura del juego en Hans

O artigo busca identificar a função fóbica como elemento originário do pensamento e do processo de simbolização a partir da leitura do brincar no caso Hans. O trabalho retoma a história da fobia na nosografia psicanalítica e analisa seus desdobramentos no âmbito da antropologia, da cultura e da educação que marcaram os ensaios freudianos posteriores ao caso Hans e reposicionaram a fobia, para além de uma entidade nosológica, como uma função estruturante do processo de simbolização.

The article discusses the phobic function as an element originating from thought and the symbolization process by presenting a reading of play in the Hans case. It resumes the history of phobia in psychoanalytic nosography and analyzes its developments within anthropology, culture, and education that marked the Freudian essays after the Hans case and repositioned the phobia as a structuring function of symbolization, beyond the nosological entity.

L'article traite de la fonction phobique comme un élément issu de la pensée et du processus de symbolisation en présentant une lecture du jeu dans le cas de Hans. L'article reprend l'histoire de la phobie dans la nosographie psychanalytique et analyse ses développements au sein de l'anthropologie, de la culture et de l'éducation qui ont marqué les essais freudiens après le cas de Hans et repositionné la phobie comme une fonction structurante de la symbolisation, au-delà de l'entité nosologique.

Este artículo busca identificar la función fóbica como elemento proveniente del pensamiento y del proceso de simbolización a partir de la lectura del juego en el caso Hans. Se retoma la historia de la fobia en la nosografía psicoanalítica y se analiza sus desarrollos en el ámbito de la Antropología, la cultura y la educación, que marcaron los ensayos freudianos tras el caso Hans y reposicionaron la fobia como función estructurante del proceso de simbolización más allá de la entidad nosológica.

Searching for Bedrocks: Gender, Biology, and the Question of Ontology.

This paper argues that a conceptual conflation between biology and ontology has had a pervasive influence on psychoanalytic thinking about gender, particularly transgender phenomena. This has made it difficult to think about gender's relationship to the body outside of essentializing fantasies. The origins of the modern term gender and Freud's biological emphasis are addressed, followed by a more extensive engagement with contemporary psychoanalytic scholarship on trans. Finally, the paper proposes a framework for attending to gender's relationship to the body with greater nuance, turning to Freud's late drive theory to help us think in this complex area.

Psychoanalytic psychotherapies and the free energy principle.

In this paper I propose a model of the fundamental components of psychoanalytic psychotherapies that I try to explicate with contemporary theories of the Bayesian brain and the Free Energy Principle (FEP). I first show that psychoanalytic therapies require a setting (made up of several envelopes), a particular psychic state and specific processes (transference, free association, dreaming, play, reflexivity and narrativity) in order to induce psychic transformations. I then analyze how these processes of transformations operate and how they can be enlightened by the FEP. I first underline the fact that psychoanalytic therapies imply non-linear processes taking time to unfold and require a setting containing high entropy processes. More precisely, these processes are characterized by an interplay between extension and reduction of free energy. This interplay also favors the emergence of new orders of subjective experience, which occur following states of disorder, according to a certain energetic threshold allowing the modification and improvement of mental functioning. These high entropy states are also characterized by random functioning and psychic malleability which favors the exploration of subjective experience in an original manner. Overall, the approach proposed in this paper support the dialogue between psychoanalysis and other fields of research while underlining how psychoanalytical theoretical and conceptual constructs can also be useful to other disciplines, in particular the neurosciences of subjectivity.

Psychological and Behavioral Outcomes From the Perspective of Moral Culture: A Study of College Students.

Although the issue of moral identity and morality is under investigation for the last many years, there is still a need to investigate its role in how it promotes behavior. This study tends to extend this string of literature and attempted to investigate the mediating role of moral reasoning among the elements of moral culture, prosocial behavior, and psychological wellbeing. For this purpose, college students were selected as participants in this study. For this purpose, a two-wave strategy was followed to collect data. In the first wave of questionnaire distribution, 600 college students were contacted to complete the response. A hidden secret code was allotted to each questionnaire to trace the respondent for the second wave. From the distributed 600 questionnaires, 507 questionnaires were received back. At this stage, demographic characteristics and questions related to both the independent variables were asked from the respondents. While in the next wave, 448 questionnaires were received back from the redistributed questionnaires in the second wave. After discarding the incomplete and partially filled questionnaires (17 questionnaires) there were left 431 useable responses. These responses were used to run the tests through structural equation modeling (SEM) through assessment of measurement and structural model. Results indicate that symbolization promotes positive changes in the psychological wellbeing of the students and prosocial behavior of the college students. Moreover, internalization can promote psychological wellbeing. However, the impact of internalization on the prosocial behavior of college students has not been found statistically significant. Moreover, it can be safely concluded that moral reasoning has the potency to mediate the relationship of symbolization and psychological wellbeing as well as prosocial behavior. Moral reasoning also mediates the relationship between internalization and psychological well-being and prosocial behavior.

The sources of the concept of extension in the work of W. R. Bion.

Bion frequently resorts to mathematical thought in his use of abstractions that account for "elements of psychoanalysis"; among these, the concept of extension plays a central role. The author's hypothesis is that Bion borrowed the concept of extension from Alfred North Whitehead, whose book An Introduction to Mathematics, published in 1911, Bion read. The examples that both Bion and Whitehead use to illustrate the process of extension are almost the same. It is on the basis of this concept of extension that Bion accounts for the psychic growth of each individual, and for the analytic process in terms of transference interpretations in three registers - the senses, the personal myth of the patient, and passion. Bion's description of extension in the psychoanalytical field helps to make explicit some aspects of the psychoanalytic process, with an emphasis on the intuition of the analyst. The author's argument is illustrated with clinical material from the analysis of an autistic child.

"PLAYING WITH REALITY" IN A NAZI CONCENTRATION CAMP.

This paper explores the function of play under traumatic circumstances, focusing on playing with the reality of a Nazi concentration camp. The goal of playing was to enhance life forces, which was achieved by active mastery of the passive trauma, re-establishment of inner equilibrium, transformation of internal reality into a more bearable one, recovery of symbolic functioning. The analysis of the movie "Life is Beautiful" is used for illustrating this theme.

A Moral Cleansing Process: How and When Does Unethical Pro-organizational Behavior Increase Prohibitive and Promotive Voice.

In this study, we draw on moral cleansing theory to investigate the consequence of unethical pro-organizational behavior (UPB) from the perspective of the actors. Specifically, we hypothesize that after conducting UPB, people may feel guilty and tend to cleanse their wrongdoings by providing suggestions or identifying problems at work (i.e., prohibitive and promotive voice). We further hypothesize that the above relationship is moderated by the actor's moral identity symbolization. We conducted three studies, including experiment and surveys, to test our hypotheses. Results of these studies show consistent support to our hypotheses. In particular, individuals reported more felt guilt after conducting UPB, and they tended to compensate with more prohibitive and promotive voice subsequently. In addition, the indirect relationship from UPB acting to both voice behaviors via felt guilt was stronger for people with a high level of moral identity symbolization. Theoretical and practical implications are discussed.

Desdobramentos psicopatológicos da identificação projetiva na parte bebê do self / Psychopathological evolution of projective identification in the baby part of the self

RESUMO: Discutiremos os desdobramentos psicopatológicos na zona arcaica da subjetividade quando a identificação projetiva perde sua dimensão de comunicação primitiva, assumindo um caráter radical de evacuação e prejudicando a rêverie materna. Estudaremos as experiências precoces do psiquismo englobadas na parte bebê do self, fundamentais aos processos de simbolização primária. Suas falhas se manifestam na clínica através de intensos sofrimentos capitaneados por angústias primitivas, como as de abandono e de separação, que acarretam respostas radicais, tais como a fragmentação e a despersonalização. Apresentaremos um fragmento clínico para ilustrar a forma de desorganização psíquica própria às falhas na parte bebê do self.

Abstract: We will discuss the psychopathological evolution in the archaic zone of subjectivity when the projective identification loses its primitive communication dimension, assuming a radical role of evacuation and damaging the maternal rêverie. We will study the early experiences of the psyche embedded in the baby part of the self, fundamental to the processes of primary symbolization. Their failures are manifested in the clinic through intense sufferings captained by primitive anxieties, such as abandonment and separation, which lead to severe responses such as fragmentation and depersonalization. We will present a clinical fragment to illustrate the archaic forms of psychic disorganization proper to failures in the baby part of the self.

Em busca de um lugar de onde falar: uso do meio e maleabilidade do enquadre na clínica dos sofrimentos narcísico-identitários / In search of a place to speak from: use of the medium and malleability of the frame in the clinic of narcissistic-identity sufferings

RESUMO: Partindo de uma discussão acerca das qualidades das relações de base imprescindíveis ao desenvolvimento da capacidade simbólica e, nesse âmbito, em especial, sobre o funcionamento do ambiente enquanto um meio maleável, o artigo busca apontar o papel da situação analisante como condição da transformação clínica de sofrimentos decorrentes de falhas primárias na comunicação com o ambiente. Com a construção de um caso clínico, procuramos ilustrar o modo com que experiências não simbolizadas precisam ser materializadas em um meio, descondensadas graças à sua transferência para ele para, só depois, serem refletidas, tornando-se apreensíveis pelo sujeito.

Abstract: In search of a place from where to speak: the use of the medium and malleability of the setting clinic of narcissistic-identitarian sufferings. Starting from a discussion about the qualities of the essential relationships required to the development of symbolic capacity and, in particular, about the functioning of the environment as a malleable medium, the article seeks to point out the role of analyzing situation as a condition to the clinical transformation of suffering derived from primary failure of communication with the environment. With the construction of a clinical case, we intend to illustrate the way in which un-symbolized experiences need to be materialized in a medium, transfered to it, so that it can later be reflected, becoming apprehensible by the subject.

O terceiro analítico supervisório: o processo supervisório, o campo supervisório e a transformação contínua / The supervisory analytic third: supervisory process, supervisory field, and the continuous transformation / El tercer analítico de supervisión: el proceso de supervisión, el campo de supervisión y la transformación continua / Le tiers analytique de supervision: processus de supervision, champ de supervision et transformation continue

As autoras propõem a hipótese da existência de um fenômeno que ocorre no processo de supervisão e que nomeiam como o terceiro analítico supervisório. Partem da ideia de que algumas representações sem representação simbólica do aparelho psíquico do paciente - que se mantêm nesse estado durante a sessão de análise - poderiam sofrer algum tipo de transformação durante o processo de supervisão. Fenômenos perceptivos que acontecem no aparelho psíquico do sujeito e no campo analítico, como o trabalho de figurabilidade e a simbolização primária, também podem acontecer numa sessão de supervisão. As autoras mostram que esse processo incide tanto na mente do supervisionando quanto na do supervisor e sucede em três tempos: 1) sessão de análise, 2) sessão de supervisão, e 3) reflexão e narrativa. Começam com uma breve revisão teórica dos conceitos de Darstellbarkeit, figurabilidade psíquica e simbolização primária. Depois, descrevem como se dá a apreensão de representações sem representação simbólica, ou seja, representações não simbolizadas, através do processo supervisório, e então propõem a ideia do terceiro analítico supervisório. Por fim, apresentam alguns exemplos clínicos.

This study proposes the hypothesis on the existence of a phenomenon that occurs in the supervisory process, and that will be named as the supervisory analytic third. It begins with the idea that some representations without symbolic representation of the patient's psychic apparatus, who remains in this state during the analysis session, could suffer some kind of transformation during the supervision process. Perceptive phenomena that occur in the subject's psychic apparatus and in the analytic field, such as the figurability work and primary symbolization, can also occur in a supervision session. The authors show that this process focuses on both the supervisee's and supervisor's minds, and takes place in three moments: 1) analysis session, 2) supervision session, and 3) reflection and intelligibility. The text begins with a brief theoretical review of the concepts of Darstellbarkeit, psychic figurability, and primary symbolization. The second part describes how the representations without symbolic representations, that is, representations that are not symbolized, are apprehended; through the supervisory process, and then proposes the idea of the supervisory analytic third. Finally, some clinical examples are presented.

El artículo propone la hipótesis de la existencia de un fenómeno que se produce en el proceso de supervisión y que se denominará tercer analítico de supervisión. Se parte de la idea de que algunas representaciones sin representación-simbólica del aparato psíquico del paciente - que permanece en este estado durante la sesión de análisis- podrían sufrir algún tipo de transformación durante el proceso de supervisión. Los fenómenos perceptivos que se producen en el aparato psíquico del sujeto y en el campo analítico, como el trabajo de figuración y simbolización primaria, también pueden producirse en una sesión de supervisión. Las autoras muestran que este proceso se centra tanto en la mente del supervisor como en la del supervisando y tiene lugar en tres tiempos: 1) sesión de análisis, 2) sesión de supervisión y 3) reflexión e inteligibilidad. El texto comienza con un breve repaso teórico de los conceptos de Darstellbarkeit, figurabilidad psíquica y simbolización primaria. La segunda parte describe cómo se produce la aprehensión de las representaciones sin representación-simbólica, es decir, de las representaciones no simbolizadas a través del proceso de supervisión y, a continuación, propone la idea del tercero analítico de supervisión. Por último, se presentan algunos ejemplos clínicos.

L'article propose, en tant qu'hypothèse, l'existence d'un phénomène qui a lieu dans le processus de supervision et qui sera nommé le tiers analytique de supervision. Il part de l'idée que certaines représentations sans représentation symbolique de l'appareil psychique du patient - lequel reste dans cet état pendant la séance d'analyse, - pourraient subir quelque type de transformation au cours du processus de supervision. Les phénomènes perceptifs qui se produisent dans l'appareil psychique du sujet et dans le champ analytique, tels que le travail de figurabilité et la symbolisation primaire, peuvent également avoir lieu lors d'une séance de supervision. Les autrices démontrent que ce processus affecte aussi bien la psyché de la personne en supervision que celle du superviseur et se déroule en trois étapes : 1) la séance d'analyse, 2) la séance de supervision et 3) les réflexions et l'intelligibilité. L'article débute par une brève révision théorique des concepts de Darstelbarkeit, de figurabilité psychique et de symbolisation primaire. Dans la deuxième partie on décrit comment l'appréhension des représentations sans représentation-symboliques se déroule-t-elle, c'est-à-dire, les représentations non-symboliques, par l'intermédiaire du processus de supervision, et on propose ensuite l'idée du tiers analytique de supervision. Pour finir, quelques exemples cliniques sont présentés.

Meaning, metaphor, and metabolization: the case of eating disorders.

Eating disorders mark deficits in the ability to be nourished and to symbolize embodied experience. Such deficits can be traced to difficulties in early relationships that inhibit the development of self-regulatory functions and the progressive differentiation of self from other. Often, we find mothers who are insufficiently developed, leaving the child either austerely avoiding intrusion or struggling to digest maternal provisions without becoming lost in them. Explorations that link anorexia to deficits in symbolization are in line with psychoanalytic theorizing that marks the concretization of meanings in anorexia. Bulimia, in contrast, has been linked to deficits in self-regulatory capacities that are not necessarily tied to deficits in mentalization. Clinical experience suggests that people with bulimia are often "failed anorexics" who have achieved higher levels of self-development. Case examples explore some of the dynamics underlying such difficulties and how metaphors aid the work with those for whom embodied experience remains largely unsymbolized.

Moral Identity and Subjective Well-Being: The Mediating Role of Identity Commitment Quality.

Moral identity is associated with people's subjective well-being; however, little is known about how an individual with moral identity relates to one's subjective well-being. Based on the eudaimonic identity theory, the current study proposed that identity commitment quality is a critical mechanism that links moral identity (two dimensions: internalization and symbolization) and subjective well-being. We examined our hypotheses in 419 college students, who completed the Self-importance of Moral Identity Questionnaire, Satisfaction with Life Scale, Scale of Positive and Negative Experience, and Questionnaire for Eudaimonic Well-being. Results confirmed significant positive correlations among moral identity, identity commitment quality, and subjective well-being; findings also suggested that both the internalization and symbolization dimensions of moral identity predicted subjective well-being through identity commitment quality, and identity commitment quality fully mediated the pathway relationship between moral identity and subjective well-being. We discussed these findings with respect to implications and proposed research suggestions for future studies.

Estranhezas no campo analítico / Strange things in the field of analysis / Extrañezas en el campo analítico / Étrangeté dans le champ analytique

O autor discute fatos clínicos que se manifestam como estranhos "acidentes" no campo analítico. O analista se assusta com o surgimento abrupto de descargas, atos, sintomas, imagens e situações que o deixam perplexo e estranho. Tem a impressão de que está participando de situações que correspondem ao estranho inquietante descrito por Freud. Através de material clínico, o autor propõe que esses acidentes indicam a substituição do conhecido, do familiar, pelo não familiar. Mas o desconhecido não é inteiramente desconhecido, porque se refere a experiências primitivas que não foram suficientemente simbolizadas. Essa ambiguidade se manifesta na desorientação do analista, que não sabe se sua função analítica está intacta ou perturbada. É demonstrado que ambas as situações estão de fato presentes. Aspectos teóricos são discutidos.

The author writes about clinical facts that happen as strange "incidents" in the field of analysis. The analyst is astonished by the abrupt rise of release, actions, symptoms, images and situations that made him feel perplexed and strange. He has that impression he is part of situations related to Freud's uncanny theory. Through clinical material, the author proposes these incidents are about replacing the familiar for the unfamiliar. What is not familiar is not completely unknown, though. It is related to primitive experiences that haven't been signified enough. This ambiguity manifests in making the analyst disoriented, not sure if his analytical role is intact or disturbed. It is shown that both situations are actually present. Theoretical aspects are discussed.

El autor discute datos clínicos que se manifiestan como extraños "accidentes" en el campo analítico. El analista se asusta con el surgimiento abrupto de descargas, actos, síntomas, imágenes y situaciones que le dejan perplejo. Tiene la impresión de que está participando de situaciones que corresponden al extraño inquietante descrito por Freud. A través de material clínico, el autor propone que esos accidentes indican la sustitución del conocido, del familiar, por el no familiar. Pero lo desconocido no es totalmente desconocido, porque se refiere a experiencias primitivas que no fueron simbolizadas lo suficiente. Esa ambigüedad se manifiesta en la desorientación del analista, que no sabe si su función analítica está intacta o alterada. Está demostrado que ambas situaciones de hecho están presentes. Aspectos teóricos son discutidos.

L'auteur discute des faits cliniques qui se manifestent comme des « accidents ¼ étranges dans le champ analytique. L'analyste s'étonne du surgissement abrupt de décharges, d'actes, de symptômes, d'images et de situations qui le laissent perplexe et étrange. Il a la sensation qu'il participe à des situations qui correspondent à l'étrange inquiétant décrit par Freud. Au moyen d'un matériel clinique, l'auteur propose que ces accidents indiquent le remplacement du connu, du familier, par le non familier. Mais l'inconnu n'est pas tout à fait inconnu, car il fait référence à des expériences primitives qui n'ont pas été suffisamment symbolisées. Cette ambiguïté se manifeste dans la désorientation de l'analyste qui ne sait pas si sa fonction analytique était intacte ou perturbée. On démontre que les deux situations sont vraiment présentes. On discute des aspects théoriques.

Setting interno em revisão: configurações analíticas no trabalho com adolescentes / Internal setting under review: analytical configurations while working with adolescents / Setting interno en revisión: configuraciones analíticas en el trabajo con adolescentes / Le cadre interne à l'étude: configurations analytiques dans le travail avec les adolescents

O artigo centra-se no trabalho analítico com adolescentes, em busca da constituição do setting interno da dupla, em dois momentos: no consultório e no encontro online. Diante dos modelos relativos a espaços, a autora insere a questão do público e do privado, avaliados em graus, e dos impasses para criar, simbolicamente, limites nesse contexto. As reflexões abrem caminho para os próximos passos.

This article focuses on the analytical work with adolescents, in search of the constitution of the duo's internal setting, in two moments: in the office and in the online meeting. In the presence of models related to spaces, the issue of public and private, evaluated in degrees, and the issue of impasses to symbolically create limits in this context are inserted. The reflections pave the way for the next steps.

El artículo se centra en el trabajo analítico con adolescentes, en busca de la constitución del setting interno del dúo, en dos momentos, en la oficina y en la reunión online (modelo virtual). En vista de los modelos relacionados con los espacios, se incluye el tema de lo público y lo privado, evaluados en grados, y los obstáculos para crear, simbólicamente, límites en este contexto. Las reflexiones allanan el camino para los próximos pasos.

Cet article est centré sur le travail analytique auprès des adolescents, recherchant la constitution du cadre interne de deux personnes, à deux moments, dans le cabinet ou en ligne. En face des modèles relatifs aux espaces, on pose la question de ce qui est public et ce qui est privé, évalués à différents degrés, et celle des impasses pour créer symboliquement les limites dans ce contexte. Les réflexions ouvrent la voie aux prochains pas.

Impairment of Cardiac Autonomic Nerve Function in Pre-school Children With Intractable Epilepsy.

Objective: Intractable epilepsy and uncontrolled seizures could affect cardiac function and the autonomic nerve system with a negative impact on children's growth. The aim of this study was to investigate the variability and complexity of cardiac autonomic function in pre-school children with pediatric intractable epilepsy (PIE). Methods: Twenty four-hour Holter electrocardiograms (ECGs) from 93 patients and 46 healthy control subjects aged 3-6 years were analyzed by the methods of traditional heart rate variability (HRV), multiscale entropy (MSE), and Kurths-Wessel symbolization entropy (KWSE). Receiver operating characteristic (ROC) curve analysis was used to estimate the overall discrimination ability. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) models were also analyzed. Results: Pre-school children with PIE had significantly lower HRV measurements than healthy controls in time (Mean_RR, SDRR, RMSSD, pNN50) and frequency (VLF, LF, HF, LF/HF, TP) domains. For the MSE analysis, area 1_5 in awake state was lower, and areas 6_15 and 6_20 in sleep state were higher in PIE with a significant statistical difference. KWSE in the PIE group was also inferior to that in healthy controls. In ROC curve analysis, pNN50 had the greatest discriminatory power for PIE. Based on both NRI and IDI models, the combination of MSE indices (wake: area1_5 and sleep: area6_20) and KWSE (m = 2, τ = 1, α = 0.16) with traditional HRV measures had greater discriminatory power than any of the single HRV measures. Significance: Impaired HRV and complexity were found in pre-school children with PIE. HRV, MSE, and KWSE could discriminate patients with PIE from subjects with normal cardiac complexity. These findings suggested that the MSE and KWSE methods may be helpful for assessing and understanding heart rate dynamics in younger children with epilepsy.