RESUMO
O presente trabalho apresenta o papel fundamental das instituições de saúde mental, nos casos de psicose, quando se permitem funcionar como objeto subjetivo nos momentos em que os pacientes necessitam regredir à dependência. Segundo a proposição teórico-clínica do psicanalista inglês D. W. Winnicott, entende-se que o paciente psicótico tem a necessidade de depender de um ambiente suficientemente bom para poder integrar-se em uma unidade identitária e assim dar continuidade ao processo de desenvolvimento emocional. Como apoio à linha teórica adotada foi utilizado o caso clínico, atendido por Winnicott, da paciente e psicanalista Margaret Little e sua internação momentânea em um hospital psiquiátrico.
The current work presents the key role that mental health institutions would play in cases of psychosis, when they work as a subjective object at times when patients need regression to dependence. According to the theoretical-clinical proposition of the English psychoanalyst D. W. Winnicott, the psychotic patient should depend on a good enough environment to be able to integrate himself into a single identity unit and then continue his maturational process. The theoretical guideline was based on the clinical procedures handled by Winnicott on the patient and psychoanalyst Margaret Little and her temporary hospitalization in a psychiatric hospital.
El trabajo presenta el rol fundamental de las instituciones de salud mental, en los casos de psicosis, cuando se les permite funcionar como objeto subjetivo en los momentos en que los pacientes necesitan regresar a la dependencia. Según la propuesta teórico-clínica del psicoanalista inglés D. W. Winnicott, se entiende que el paciente psicótico tiene la necesidad de depender de un ambiente suficientemente bueno para poder integrarse en una unidad identitaria y así dar continuidad al proceso de maduración personal. Como guía teórica fue utilizado el caso clínico atendido por Winnicott de la paciente y psicoanalista Margaret Little y su internación momentánea en un hospital psiquiátrico.
Cet article présente le rôle fondamental des institutions de santé mentale dans les cas de psychose, lorsqu'elles sont autorisées à fonctionner comme un objet subjectif à des moments où les patients ont besoin de régresser à la dépendance. Selon la proposition théorico-clinique du psychanalyste anglais D. W. Winnicott, on comprend que le patient psychotique a besoin de dépendre d'un environnement suffisamment bon pour pouvoir s'intégrer dans une unité d'identité et ainsi poursuivre le processus de maturation. Comme ligne théorique, nous avons utilisé le cas clinique suivi par Winnicott de la patiente et psychanalyste Margaret Little et son internement temporaire dans un hôpital psychiatrique.
Assuntos
PsicanáliseRESUMO
O principal objetivo deste artigo é evidenciar a inovação que o conceito de regressão à dependência, formulado por Winnicott, traz para a psicanálise em termos de consequências clínicas. Partindo da comparação com a psicanálise tradicional, evidenciamos a ênfase na terapêutica deste novo modo de trabalhar a "transferência da necessidade". Ademais, através da atenção à necessidade maturacional do paciente, será possível acompanhar como a utilização da regressão à dependência possibilitou terapias bem-sucedidas em pacientes psicóticos, esquizoides e de tipo falso si-mesmo (borderline), tidos como incuráveis pelo método psicanalítico tradicional, cujos pressupostos o impedem de apreender as demandas anteriores à constituição de um EU unitário. Ao atentar para a fase pré-edípica do indivíduo, veremos como Winnicott promove uma verdadeira transformação na prática clínica.
The main objective of this paper is to illustrate the innovation embodied by Winnicott's concept of regression to dependence with regard to psychoanalysis as mirrored by clinical consequences. Comparing with traditional psychoanalysis, the emphasis is on the therapeutic process of this new way of working the transference of need. Through attention to the patient's maturational need, we will see that the use of regression to dependence enabled some successful therapies for psychotic patients, both of schizoid and borderline types, traditionally considered incurable by psychoanalysis, as the latter did not meet requirements prior to the formation of a unitary ME. Thus, Winnicott, when referring to the pre-Oedipal phase of the individual, suggests a true transformation in clinical practice.
RESUMO
Changes in dynamic psychological structures are often a treatment goal in psychotherapy. The present study aimed at creating a typology of self-representations among young women and men in psychoanalytic psychotherapy, to study longitudinal changes in self-representations, and to compare self-representations in the clinical sample with those of a nonclinical group. Twenty-five women and sixteen men were interviewed according to Blatt's Object Relations Inventory pretreatment, at termination, and at a 1.5-year follow-up. In the comparison group, eleven women and nine men were interviewed at baseline, 1.5 years, and three years later. Typologies of the 123 self-descriptions in the clinical group and 60 in the nonclinical group were constructed by means of ideal-type analysis for men and women separately. Clusters of self-representations could be depicted on a two-dimensional matrix with the axes Relatedness-Self-definition and Integration-Nonintegration. In most cases, the self-descriptions changed over time in terms of belonging to different ideal-type clusters. In the clinical group, there was a movement toward increased integration in self-representations, but above all toward a better balance between relatedness and self-definition. The changes continued after termination, paralleled by reduced symptoms, improved functioning, and higher developmental levels of representations. No corresponding tendency could be observed in the nonclinical group.
