Someone is to blame: the impact of suicide on the mind of the bereaved (including clinicians).

This paper presents an emerging understanding of the psychodynamics of suicide loss, derived from over 1500 accounts of suicide bereavement shared by families, friends and clinicians. It identifies clear patterns in the responses of the bereaved, particularly the formation of delusional narratives that often place them at the centre of blame for the death. These narratives have a profound impact on well-being, increase the risk of mental illness and elevate the likelihood of death by suicide. They not only cause harm to the bereaved but also permeate and distort our systemic and societal responses. Understanding why suicide unleashes such painful and dangerous forces helps mitigate the widespread harm and distress that often follows such a death. This knowledge also enables us to effectively and compassionately support those bereaved.

Fifty Years of Change: A Shared Journey.

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.

Mulheres no trabalho militar: uma revisão bibliométrica e crítica / Mujeres en el trabajo militar: una revisión bibliométrica y crítica / Women in military work: a bibliometric and critical review

Resumo: O trabalho militar, historicamente, é uma profissão predominantemente masculina. A crescente inserção das mulheres nas instituições militares tem enfrentado entraves importantes. A presente revisão bibliométrica objetivou mapear e analisar criticamente a literatura indexada sobre gênero no contexto militar, pretendendo especificamente identificar características, tendências e lacunas da produção científica sobre o tema nos últimos 10 anos na psicologia. Além da ausência de estudos brasileiros ou em língua portuguesa, identificou-se predominância de métodos quantitativos e de participantes homens nas pesquisas. O tema mais abordado foi o trauma sexual militar. Aponta-se a necessidade de mais investigações com mulheres militares em contexto brasileiro.

Resumen: El trabajo militar ha sido históricamente una profesión predominantemente masculina. La creciente inserción de la mujer en las instituciones militares ha enfrentado importantes obstáculos. La presente revisión bibliométrica tuvo como objetivo mapear y analizar críticamente la literatura indexada sobre género en el contexto militar, con el objetivo de identificar características, tendencias y vacíos en la producción científica sobre el tema en los últimos 10 años. Además de la ausencia de estudios brasileños o en lengua portuguesa, se identificó predominio de métodos cuantitativos y participantes del sexo masculino en la investigación. El tema más discutido fue el trauma sexual militar. Se destaca la necesidad de más investigaciones con mujeres militares en el contexto brasileño.

Abstract: Military work is, historically, a predominantly male profession. The growing insertion of women in military institutions has faced important obstacles. This bibliometric review aimed to map and critically analyze the indexed literature on gender in the military context, specifically intending to identify characteristics, trends and gaps in scientific production on the topic in the last 10 years. In addition to the absence of Brazilian or Portuguese-language studies, a predominance of quantitative methods and male participants was identified. The most discussed topic was military sexual trauma. The need for more research with military women in the Brazilian context is highlighted.

Shared Fragility-Contemplating the Impact of Patients' Suicides on Clinicians.

The experience of patient suicide can have a profound impact on clinicians, yet there are limited opportunities for them to express and process their emotional responses. We organized a reflective group session for psychiatrists in Singapore who had encountered patient suicides. Ten psychiatrists participated, with five in the "inner" group (those who had experienced patient suicide) and the remaining five forming the "outer" group. Led by a senior psychiatrist trained in psychodynamic psychotherapy, the inner group shared their reflections on patient suicides, while the outer group provided their insights thereafter. Participants provided written feedback about their session experiences. The session was recorded, transcribed, and analyzed to identify key themes. Three main narrative themes emerged from the analysis. Firstly, there was the acute response to the suicide, involving intense emotional reactions. Secondly, the relationship between clinicians and patients with suicidal thoughts was explored, encompassing countertransferential responses, superego defenses, and resulting anxiety. Lastly, the study examined how clinicians feel about suicidality itself, shedding light on complex attitudes and perceptions. Our findings confirm previous research, indicating that the response to patient suicide is stressful and traumatic for clinicians, who grapple with emotions such as grief, guilt, incompetence, and fear. Moreover, we delve into the intricate connections clinicians have with the concept of suicidality, shaped not only by their own experiences but also by the insights of those who have yet to confront patient suicide. The reflections shared by the participants emphasize the significance of establishing therapeutic spaces for clinicians to process these complex emotions effectively.

The Impact of Patient Suicide on Clinicians.

The experience of patient suicide on clinicians is associated with complex affective states that include grief, guilt, shame, and fear and distressing subjective experiences of incompetence and helplessness. The authors review the literature of the subject and highlight the work of Rajagopalan and colleagues in Singapore, who implemented a one-time reflective group session to help clinicians process the experience of patient suicide to reduce psychological distress and prevent burnout and moral injury.

Franco Battiato's Song "La Cura": A Clinical Reflection.

"La Cura" is one of the tracks in Franco Battiato's L'Imboscata album (1996), the 19th published by the Italian composer and songwriter, who died 3 years ago. In the lyrics several references to psychiatric terminology appear. The purpose of this article is to consider the lyrics of the song from psychodynamic and mental health care perspectives and offer associations that reflect the process of forming a therapeutic alliance with patients.

Liderança no exercício docente no ensino superior: um olhar psicodinâmico / Leadership in teaching in higher education: a psychodynamic perspective / Liderazgo en la enseñanza en la educación superior: una perspectiva psicodinámica

O trabalho docente representa um campo fundamental na sociedade, dada sua importância na formação de futuros profissionais e, especialmente, cidadãos. Dessa forma, a intenção do presente artigo consiste em levantar as questões oriundas do exercício de liderança na atribuição docente e refletir acerca desta liderança no Ensino Superior no que tange à sua importância para o processo formativo, bem como a inspiração que esse ofício pode proporcionar aos educandos, partindo da ideia de que a docência é um exercício de liderança. A proposta metodológica com que analisamos tal exercício, consiste na perspectiva qualitativa de caráter descritivo-analítico. Dois professores foram entrevistados por meio de um roteiro semi-dirigido com vistas a levantar e compreender as experimentações oriundas de suas trajetórias de vida que culminaram no trabalho docente que atualmente exercem. Como fundamentação teórica e metodológica de análise, utilizou-se a Psicodinâmica do Trabalho, por seu olhar quanto aos modos de ser dos sujeitos provocados pelo encontro com o trabalho e as exigências pertinentes aos processos deste. Como resultado, a amostra revelou significativa concordância com os aspectos de liderança na prática docente que exercem, embora reiterassem que existem consideráveis dificuldades nesse ofício. Essa clareza requer uma mobilização por parte dos professores líderes que por vezes se sentem sobrecarregados e redescobrindo meios de não adoecerem. Tais resultados têm potência para que novos estudos sejam elaborados no sentido de ampliar a discussão e contribuir para ações docentes, mas, sobretudo, humanas, melhores e mais afetivas.(AU)

Teaching work represents a fundamental field in society, given its importance in the training of future professionals and, especially, citizens. In this way, the intention of this article is to raise the matters arising from the exercise of leadership in teaching assignments and to reflect on this leadership in Higher Education in terms of its importance for the training process, as well as the inspiration that this craft can provide to students, based on the idea that teaching is an exercise in leadership. The methodological proposal with which we analyze this exercise consists of a qualitative perspective of a descriptive-analytical nature. Two teachers were interviewed through a semi-guided script which intended to raise and understand the experiences arising from their life trajectories that culminated in the teaching work they currently perform. As a theoretical and methodological basis for the analysis, the Psychodynamics of Work was used, due to its view on the subjects' ways of being, provoked by the encounter with work and the demands pertinent to its processes. As a result, the sample revealed significant agreement with the aspects of leadership in their teaching practice, although they reiterated that there are considerable difficulties in this job. This clarity requires mobi-lization on the part of leading teachers who sometimes feel overwhelmed and rediscover ways not to get sick. Such results have the power for new studies to be developed in order to broaden the discussion and contribute to teaching actions, but, above all, human, better and more affective actions. (AU)

El trabajo docente representa un campo fundamental en la sociedad, dada su importancia en la formación de los futuros profesionales y, en especial, de los ciudadanos. De esta forma, la intención de este artículo es plantear las cues-tiones derivadas del ejercicio del liderazgo en la tarea docente y reflexionar sobre este liderazgo en la Educación Superior en cuanto a su importancia para el proceso formativo, así como la inspiración que este oficio puede brindar a los estudiantes, partiendo de la idea de que enseñar es un ejercicio de liderazgo. La propuesta metodológica con la que analizamos este ejercicio consiste en una perspectiva cualitativa de carácter descriptivo-analítico. Se entrevistó a dos docentes a través de un guion semidirigido con miras a plantear y comprender las experiencias surgidas de sus trayectorias de vida que culminaron en la labor docente que desempeñan actualmente. Como base teórica y metodológica para el análisis, se utilizó la Psicodinámica del Trabajo, por su mirada sobre las formas de los sujetos de ser provocados por el encuentro con el trabajo y las exigencias propias de sus procesos. Como resultado, la muestra reveló un acuerdo significativo con los aspectos de liderazgo en su práctica docente, aunque reiteraron que existen dificultades considerables en este trabajo. Esta claridad requiere movilización por parte de los docentes líderes que a veces se sienten abrumados y redescubriendo formas de no enfermarse. Tales resul-tados tienen el poder de que se desarrollen nuevos estudios para ampliar la discusión y contribuir a la acción docente, pero, principalmente, a la acción humana, mejor y más afectiva. (AU)

Eight 'truths' about suicide.

This paper summarises themes that have emerged from 14 years of study of suicide and work with those bereaved. It is based on a talk given in many clinical settings over the past 10 years. I describe my own emotional journey following impactful deaths and summarise personal 'truths' about suicide that have emerged over time. Case studies used for illustration are composites taken from clinical practice; accounts of relatives and other survivors of suicide; and data taken from many sources including suicide audits in mental health organisations, the police and transport services, and from the examination of coroners' records. The intention is to assist open dialogue about the nature of suicide, to contribute to the understanding of the impact on those bereaved and to encourage open-hearted clinical engagement with those who are suicidal.

Freudian robots: Artificial intelligence and psychodynamics.

OBJECTIVE: Artificial intelligence (AI) is rapidly developing, particularly human-interacting and affective AI systems. Psychodynamic concepts important to human development should be considered in the development of AI systems. CONCLUSION: The development of safe and ethical affective artificial intelligence that remains meaningful and flexible should incorporate psychodynamic concepts. Mental health professionals such as psychiatrists and psychotherapists should be involved in the development of AI to provide expert knowledge in the area of psychodynamics.

Clinical Implications of Countertransference in the Treatment of Addictions.

The author provides a historical overview of the psychodynamics of addiction with particular emphasis on countertransference awareness and its relationship with treatment outcomes and prognosis. Countertransferences that frequently occur in the treatment of substance use disorders include shared helplessness, hopelessness, sadness, anxiety, fear, anger, rage, shame, and guilt. These emotional states in clinicians may lead to fatigue, avoidance, and acting out unless therapists are able to ground themselves and disidentify with the projected affective states. Positive emotions may lead to excessive enthusiasm in clinicians and deflect from the therapeutic process, resulting in deviation from established practice guidelines. Coexisting negative and positive affective states may lead to rescue fantasies and transgressions of boundaries. Contemporary psychodynamic clinicians appreciate the quantitative aspect of emotional reactions, where countertransferences accumulate exponentially over time, causing allostatic overload and compassion fatigue. Unanalyzed negative countertransferences are linked to either clinical avoidance or aggression, resulting in withdrawing care, failure of empathy, and dissolution or fragmentation of the therapeutic alliance. The negativism associated with the treatment of addictions may be rooted in unanalyzed countertransferences and psychosocial factors such as internalized negative societal attitudes and stigma. Degrading and dehumanizing attitudes toward people with substance use disorders could stem from internalized negative societal constructs against disenfranchised, minoritized, and stigmatized persons. This editorial introduces the work of Bernardine Han, an addiction psychiatrist who utilizes psychodynamic concepts to guide interventions with people with substance use disorders.

Centralidade do trabalho e saúde mental / Centrality of work for mental health

Partindo da noção de trabalho vivo, Christophe Dejours apresenta a tese da centralidade do trabalho para a subjetividade e a saúde mental. Para tanto, traz à baila a discussão sobre: a atividade, a insuficiência da tarefa e a experiência de fracasso diante do real; bem como a inteligência do corpo e a afetividade, marcando sua transformação à medida que realiza a atividade, em uma relação dinâmica entre o corpo, a subjetividade e a atividade. Não sendo o trabalho algo solipsista, tais elementos se entrecruzam em meio a outrem, o que requisita a cooperação e os aspectos complexos da formulação de regras para a própria atividade e demanda a confiança, a deliberação coletiva. É nesse coletivo, no viver juntos, que pode ocorrer o reconhecimento que, realizado sobre o que é feito, permite a realização de si no campo social, voltando-se para quem o faz, para uma identidade, que é o que protege a saúde mental. Na ausência da convivialidade e reconhecimento, o trabalho produz sofrimento patógeno. Desse modo, Dejours demonstra que nunca há neutralidade do trabalho no que diz respeito à subjetividade e à identidade, possibilitando a realização de si ou sua destruição

Based on the notion of living work, Christophe Dejours presents the thesis of the centrality of work for subjectivity and mental health. To do so, he discusses activity, the insufficiency of the task, the experience of failure in the face of reality, and the intelligence of the body and affectivity, marking its transformation as it performs the activity in a dynamic relationship between the body, subjectivity, and the activity. Rather than configuring a solipsistic text, such elements intersect each other, requiring cooperation and the complex aspects of formulating rules for the activity itself, which requires trust and collective deliberation. It is in this collective, in living together, that recognition can occur, which , based on what is done, enables self-realization in the social field, turning to those who do it and to an identity, which is what protects mental health. In the absence of conviviality and recognition, work produces pathogenic suffering. Thus, the author shows that work is never neutral toward subjectivity and identity, enabling self-realization or its own destruction

O custo da beleza: sofrimento e estratégias defensivas de manicures em salões de beleza do Rio de Janeiro / The cost of beauty: suffering and defensive strategies of manicurists in beauty salons in Rio de Janeiro

Este artigo apresenta parte dos resultados de uma dissertação de mestrado cujo objetivo foi compreender as vivências de sofrimento e as estratégias defensivas desenvolvidas por manicures atuantes em salões de beleza. Nesta pesquisa, de caráter qualitativo, conduziram-se entrevistas em profundidade a partir de roteiro semiestruturado com 12 manicures de nove diferentes salões de beleza localizados no município do Rio de Janeiro. As informações levantadas foram analisadas sob a ótica da análise dos núcleos do sentido. Nos resultados, observou-se o agravamento do sofrimento diretamente relacionado às políticas de remuneração praticadas nos salões, à assimilação do ônus do custeamento dos instrumentos de trabalho e à carência de benefícios sociais e trabalhistas. Como estratégias de defesa, observou-se a predominância de estratégias individuais. A pesquisa buscou contribuir para a redução da invisibilização do trabalho de manicures e, a partir da psicodinâmica do trabalho, desvelar a reciprocidade entre as precárias condições de laborais e os fatores geradores de adoecimento psíquico dessas trabalhadoras

This article presents part of the results of a master's degree whose objective was to understand the experiences of suffering and the defensive strategies experienced by manicurists in beauty salons. In this qualitative research, in-depth interviews were conducted based on a semi-structured script with 12 manicurists from nine different beauty salons located in the municipality of Rio de Janeiro. The data obtained were analyzed from the perspective of the analysis of nuclei of sense. The results showed the worsening of suffering is directly related to the remuneration policies practiced in the salons, the assimilation of the burden of funding work instruments, and the lack of social and labor benefits. As defense strategies, the predominance of individual strategies was observed. This research contributes to reduce the invisibility of manicurists' work and, based on the psychodynamics of work, show the reciprocity between precarious working conditions and the factors that generate these workers' mental illness

The Wounded Pilgrim: A Psychodynamic Perspective on Therapeutic Journeys in Search of Healing.

Traveling in search of healing is quite common in Pakistan, where people gravitate toward large urban tertiary-care centers. In this article the authors explore psychodynamic aspects of the therapeutic journey, with respect to the traveler, the healer, and other symbolic aspects of the doctor-patient relationship in the multicultural nation of Pakistan.

Divisão sexual do trabalho no contexto da Polícia Militar: uma análise no campo da psicodinâmica do trabalho / Sexual division of labor in the context of the Military Police: an analysis in the field of work psychodynamics / División sexual del trabajo en el contexto de la Policía Militar: un análisis en el campo de la psicodinámica del trabajo

Este artigo é uma pesquisa teórica que visa a identificar aspectos da divisão sexual do trabalho na inserção de mulheres à Polícia Militar brasileira, articulando-os ao campo teórico da Psicodinâmica do Trabalho. Para isso, nos pautamos em produções acerca da inserção e do cotidiano de mulheres na Polícia Militar. Compreendemos que a forma com que as mulheres policiais dão sentido as suas experiências laborais podem estar atravessadas por uma ideia de exaltação da virilidade, além de outros atributos que são tidos socialmente como masculinos, visto que as instituições militares brasileiras, historicamente, são compostas por um grande valor social, atrelado a uma concepção de bravura, virilidade, força física, heroísmo, entre outras; características que foram associadas à masculinidade e, contemporaneamente, ainda perpassam nosso meio social. Ressaltamos que as experiências no trabalho estão intima-mente relacionadas à produção de subjetividade, consequentemente, às formas com que os trabalhadores e trabalhadoras se reconhecem enquanto sujeitos em determinado contexto socio-histórico. (AU)

This article is a theoretical study that aims to identify aspects of the sexual division of labor in the incorporation of women into the Brazilian Military Police, linking them to the theoretical field of Work Psychodynamics. To do so, we rely on research on the insertion and daily experiences of women in the Military Police. We understand that the way in which women in the police interpret their work experiences may be shaped by an ideal of exalting virility, as well as other attributes that are socially seen as masculine. This is because Brazilian military institutions, historically, have been associated with values, such as bravery, virility, physical strength, heroism, among others, characteristics that are traditionally associated with masculinity and that continue to influence our social environment. We emphasize that work experiences are closely related to the production of subjectivity, and therefore to the way in which male and female workers recognize themselves as subjects in a particular socio-historical context. (AU)

Este artículo es una investigación teórica que tiene como objetivo identificar aspectos de la división sexual del trabajo en la inserción de las mujeres en la Policía Militar Brasileña, vinculándolas al campo teórico de la Psicodinámica del Trabajo. Para ello, nos guiamos por producciones sobre la inserción y la vida cotidiana de las mujeres en la Policía Militar. Entendemos que la forma en que las mujeres policías dan sentido a sus experiencias laborales puede estar atravesada por una idea de exaltación de la virilidad, además de otros atributos que se consideran socialmente masculinos, ya que las instituciones militares brasileñas, históricamente, están compuestas por una gran valor social, ligado a una concepción de valentía, virilidad, fuerza física, heroísmo, entre otras; características que estaban asociadas con la masculinidad y, al mismo tiempo, aún impregnan nuestro entorno social. Destacamos que las experiencias laborales están estrechamente relacionadas con la producción de subjetividad, en consecuencia, con las formas en que los trabajadores se reconocen a sí mismos como sujetos en un contexto socio-histórico determinado. (AU)

Espaço da palavra com trabalhadores em unidade básica de saúde / Word space with workers in basic health unit / Espacio de palabra con trabajadores en unidad básica de salud

Considerando o sofrimento psíquico evidenciado em contextos laborais, este estudo objetiva descrever uma intervenção desenvolvida com 14 trabalhadores de um serviço de saúde pública. A intervenção foi analisada com base na Psicodinâmica do Trabalho de Dejours, viabilizando espaços de discussão sobre as questões ligadas ao trabalho, saúde do trabalhador e sua mobilização subjetiva. O método englobou etapas de investigação, pesquisa e intervenção grupal e a análise qualitativa das falas dos trabalhadores. Os resultados mostraram os mecanismos de funcionamento institucional relacionados com as vivências de sofrimento que englobam a polivalência, competição, adoecimento, defesas e restrições do agir. Os encontros propiciaram um espaço de fala acerca das vivências e modos de subjetivação no trabalho, o que fortaleceu a integração dos coletivos, a ressignificação do processo de adoecimento e a deliberação para algumas transformações do trabalho.

Considering the psychological suffering evidenced in work contexts, this study aims to describe an intervention developed with 14 workers of a public health service. The intervention was analyzed based on Dejours' Psychodynamics of Work, providing spaces for discussion on issues related to work, workers' health and their subjective mobilization. The method included stages of investigation, research and group intervention and qualitative analysis of the workers' statements. The results showed the institutional functioning mechanisms related to the experiences of suffering that encompass polyvalence, competition, illness, defenses and restrictions of acting. The meetings provided a space for speech about the experiences and kinds of subjectivation at work, which strengthened the integration of groups, the redefinition of the illness process and the deliberation for some changes in work. (AU)

Considerando el malestar psicológico evidenciado en contextos laborales, este estudio tiene como objetivo describir una intervención desarrollada con 14 trabajadores de un servicio público de salud. La intervención se analizó a partir de la Psicodinámica del Trabajo de Dejours, proporcionando espacios de discusión sobre temas relacionados con el trabajo, la salud de los trabajadores y su movilización subjetiva. El método incluyó etapas de investigación, investigación e intervención grupal y análisis cualitativo de las declaraciones de los trabajadores. Los resultados mostraron los mecanismos de funcionamiento institucional relacionados con las experiencias de sufrimiento que engloban polivalencia, competencia, enfermedad, defensas y restricciones de actuación. Los encuentros proporcionaron un espacio para el discurso sobre las experiencias y modos de subjetivación en el trabajo, lo que fortaleció la integración de grupos, la redefinición del proceso de la enfermedad y la deliberación por algunas transformaciones laborales. (AU)

A Retrospective Observational Study of Psychosocial Determinants and Psychiatric Diagnoses of Mass Shooters in the United States.

Our aim was to better understand the underlying psychiatric, psychosocial, and psychodynamic aspects of mass shootings in the United States (US). The Mother Jones database of 115 mass shootings from 1982-2019 was used to study retrospectively 55 shooters in the US. After developing a psychiatric-assessment questionnaire, psychiatric researchers gathered multiple psychosocial factors and determined diagnoses and treatment by evaluating the clinical evidence obtained by interviewing forensic psychiatrists, who had assessed the assailant, and/or by reviewing psychiatric evaluations conducted during the judicial proceedings. All 35 surviving-assailant cases were selected. Additionally, 20 cases where the assailant died at the time of the shootings were randomly selected from the remaining 80 cases. The majority of assailants (87.5%) had misdiagnosed and incorrectly treated or undiagnosed and untreated psychiatric illness. Most of the assailants also experienced profound estrangement not only from families, friends, and classmates but most importantly from themselves. Being marginalized and interpersonally shunned rendered them more vulnerable to their untreated psychiatric illness and to radicalization online, which fostered their violence. While there are complex reasons that a person is misdiagnosed or not diagnosed, there remains a vital need to decrease the stigma of mental illness to enable those with severe psychiatric illness to be more respected, less marginalized, and encouraged to receive effective psychotherapeutic and pharmacologic treatments.

Incorporating Brain Explanations in Psychoanalysis: Tennessee Williams as a Case Study.

Despite Tennessee Williams's genius as a playwright who could represent his inner emotional struggles in his art, psychoanalysis was unable to free him from the powerful "blue devils" within him. Williams's inability to engage with psychoanalysis presents an opportunity to discuss ways that contemporary thinking about brain structure and function might guide our understanding and treatment of patients such as Williams. One of the core defensive behaviors that made analysis difficult for Williams was his avoidance of painful emotions through compulsive writing, sex, alcohol, and drug-addictive behaviors. These pre-mentalized reactions became Williams's habitual procedural body response, which occurs below the level of the self-reflective brain. Within a relatively traditional ego psychological frame, Lawrence Kubie, Williams's analyst in 1957, attempted to prohibit the compulsive behaviors to be able to process the underlying painful affects in the analysis. However, given that this level of mind and brain functions was Williams's chief means of regulation, Williams could not engage in the psychoanalytic process and left the treatment after one year. I propose that Williams was operating in brain circuits below the level of "higher" reflection or interpretation-receptive circuits and therefore he was unable to make use of a traditional ego psychological model. A review of these brain circuits seeks to encourage therapists to utilize simplified brain explanations for patients, which can destigmatize the pathologic behaviors and enhance engagement in the treatment process.

Unconscious system-psychodynamics within a German 4IR engineering company in South Africa.

This article focuses on systems psychodynamics and particularly on the CIBART-model which explores conflict, identity, boundary, authority, role and task and how these phenomena work out on an unconscious level. Therefore, this article presents empirical findings on CIBART in a German multinational engineering organization operating in South Africa. For this study, 16 managers where interviewed on their transformation toward Industry 4.0 with special interest in the interconnection how CIBART aspects play out in the South African context. Findings show that all of the CIBART-phenomena are important during the transformation to more advanced technological levels and restructuring processes. Conclusions are drawn and recommendations are given how to deal with systems-psychodynamic influences within the organization.

[Spirituality of a Catholic nurse in the encounter with care]. / Spiritualité d'une infirmière catholique à la rencontre du prendre soin.

Working in a palliative care unit raises a number of questions for carers relating to suffering and death. This case study of a Catholic nurse investigates the link between spirituality and caregiving by exploring her subjective relationship to the work of caregiving.