Cláudio Laks Eizirik

ON THE THERAPEUTIC ACTION OF PSYCHOANALYSIS

The author discusses therapeutic action as addressed in contributions by Klein, the post-Kleinians, and Willy and Madeleine Baranger. He highlights the roles played by psychoanalytic listening and psychoanalytic neutrality in therapeutic action, and presents a detailed clinical vignette to illustrate his points.

Associação entre trauma por perda na infância e depressão na vida adulta

Observacoes clinicas efetuadas por psicanalistas sugerem que psicopatologias da idade adulta podem ter sido originadas na infância. Estudos publicados na ultima decada identificaram associacao entre trauma na infância e depressao na vida adulta. Vivencias traumaticas na infância, como a perda de vinculos afetivos devido a morte de pais ou de irmaos ou, ainda, a privacao de um ou de ambos os pais por separacao ou abandono constituem importantes fatores associados a depressao na vida adulta. O objetivo do presente artigo e revisar a literatura dos ultimos dez anos, considerando os fatores associados a depressao, particularmente aqueles relacionados aos estressores presentes na infância. A metodologia utilizada foi de busca on-line nas bases de dados Medline, PsycINFO, Cochrane e Lilacs, referentes ao periodo de maio de 1991 a maio de 2001. A maioria dos estudos incluidos nesta revisao encontrou uma associacao significativa entre trauma por perdas na infância e depressao na vida adulta, com variacao na intensidade das associacoes observadas.

Psicoterapia psicodinâmica em grupo para fobia social generalizada

OBJECTIVES: The aim of this study is to assess the effectiveness of psychodynamic group therapy in patients with generalized social phobia. METHODS: Thirty patients were included in a randomized single-blind clinical trial comparing psychodynamic group treatment (PGT) with a credible placebo control group (CPC). PGT was carried out within a 12-session psychodynamically-oriented group psychotherapy. Control patients received a treatment package of lecture-discussion and support group for 12 weeks which was compared to PGT. Each participant completed the Liebowitz Social Anxiety Scale (LSAS), the Hamilton Anxiety Scale (HAS) and the Clinical Global Impression Scale(CGI) at pretreatment assessment and after 12 weeks of treatment. Data analysis was carried out using a repeated measures ANOVA. Patients were excluded if they were under any kind of pharmacotherapy or psychotherapic treatment. RESULTS: Both groups demonstrated significant pretreatment-to-posttreatment change on most measures. On the LSAS, PGT patients were rated as more improved than controls at posttest assessment (F1,28=4.84, p=0.036). Baseline data of completers did not show differences between both groups in the demographic variables and outcome variables used. CONCLUSIONS: The present study showed that PGT was superior to a credible placebo control group in the treatment of generalized social phobia, in a 12-week randomized single-blind clinical trial.

Predictors of Normal and Successful Aging Among Urban-Dwelling Elderly Brazilians

The association of successful aging with demographic, socioeconomic, and medical characteristics in healthy community-dwelling Brazilian individuals aged 60 years and older (N = 345) was investigated. Participants were classified as successful (n = 214, 62%) or normal (n = 131, 38%) agers. Successful agers participated in significantly more leisure activities (34%) than did normal agers (21%). Multivariate logistic regression analysis revealed that the number of living children was a risk factor, whereas confidants and family income were protective factors for successful aging.

A pilot study of clonazepam versus psychodynamic group therapy plus clonazepam in the treatment of generalized social anxiety disorder.

BACKGROUND Both psychodynamic group therapy (PGT) and clonazepam are used as treatment strategies in reducing symptoms of generalized social anxiety disorder (GSAD). However, many individuals remain symptomatic after treatment with PGT or clonazepam. METHOD Fifty-eight adult outpatients with a diagnosis of GSAD according to DSM-IV were randomized to 12 weeks PGT plus clonazepam or clonazepam. The Clinical Global Impression-Improvement (CGI-I) Scale was the primary efficacy measure. Secondary efficacy measures included the Liebowitz Social Anxiety Scale (LSAS) total score, the World Health Organization Instrument to Assess Quality of Life-Brief (WHOQOL-Bref) Scale and the Beck Depression Inventory (BDI). RESULTS CGI-I data from 57 patients (intent-to-treat population) showed that patients who received PGT plus clonazepam presented significantly greater improvement than those who received clonazepam (P=0.033). There were no significant differences between the two groups in the secondary efficacy measures. CONCLUSIONS Our study suggests that the combination of PGT with clonazepam may be a promising strategy for the treatment of GSAD, regarding gains in the global functioning. However the present study failed to detect more specific changes in social anxiety symptomatology between the two groups.

Elaboração da versão em português do Psychotherapy Process Q-Set

INTRODUCTION: In Brazil, psychotherapy research is in its early development; there are no systematic studies of the therapeutic process, and there are few available measurement instruments for researchers interested in this field. OBJECTIVE: To develop a Portuguese version of the Psychotherapy Process Q-Set. METHOD: The development of a Portuguese version of the Psychotherapy Process Q-Set involved four stages: translation, back translation, evaluation of semantic equivalence and discussion of the results by the authors. Five raters were trained to apply the instrument. During the training, a field diary was used to record difficulties identified in task execution and to subsidize complementary data. Thereafter, the Psychotherapy Process Q-Set was applied to seven sessions of a short-term psychodynamic psychotherapy to examine agreement between referees. RESULTS: The Portuguese version of the Psychotherapy Process Q-Set presented good semantic equivalence with the original. The assessment of interrater reliability had a satisfactory result. It is worth stressing that applying the Psychotherapy Process Q-Set requires study, time and reflection. The discussion with raters pointed to the need of reviewing the application manual concerning the clinical examples. This will be performed in the near future to minimize the discrepancies observed in the understanding of some concepts and to better adjust them to the Brazilian reality. CONCLUSION: This study provides a Portuguese version of the Psychotherapy Process Q-Set, a versatile instrument that can be used in different contexts to quantitatively describe the therapeutic process of different psychotherapies in clinically significant terms.

First- and last-year medical students: is there a difference in the prevalence and intensity of anxiety and depressive symptoms?

OBJECTIVE Medical training is considered a significant stress factor. We sought to assess the prevalence and intensity of anxiety and depressive symptoms in medical students and compare samples of first-year and sixth-year students. METHOD This was a cross-sectional study of first- and sixth-year medical students who attended classes regularly. The study instruments were a sociodemographic questionnaire, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). RESULTS A total of 232 students (110 first-year, 122 sixth-year) completed the questionnaires, for a response rate of 67.4%. Overall 50.4% of respondents were male (56.4% of first-year and 45.1% of sixth-year students). Anxiety symptoms were reported by 30.8% of first-year students and 9.4% of sixth-year students (p < 0.001). Female students were more affected by anxiety. There were no significant between-group differences in depressive symptoms. CONCLUSION A higher prevalence of anxiety symptoms was found in first-year medical students as compared with sixth-year students. Strategies should be developed to help medical students, particularly female students, manage these symptoms at the beginning of their medical training.

The process of change in brief psychotherapy: Effects of psychodynamic and cognitive–behavioral prototypes

Abstract A brief psychodynamic psychotherapy was assessed using the Brazilian Portuguese version of the Psychotherapy Process Q-Set (PQS). Each session was scored for its adherence to expert psychodynamic therapy (PDT) and cognitive–behavioral therapy (CBT) prototypes derived from the PQS. Results revealed that the therapy process adhered more closely to prototypical CBT than prototypical PDT. Bivariate time-series analyses showed that prototype components capturing the clients adherence to ideal CBT behaviors and collaboration between therapist and client on ideal PDT and CBT behaviors predicted therapy progress. In addition, specific client symptoms influenced whether the therapist adhered to prototypical PDT or CBT behaviors.

Gender differences in the associations between childhood trauma and parental bonding in panic disorder

OBJECTIVE The aim of this study is to evaluate the association between childhood trauma and the quality of parental bonding in panic disorder compared to non-clinical controls. METHOD 123 patients and 123 paired controls were evaluated with the Mini International Neuropsychiatric Interview, the Childhood Trauma Questionnaire and the Parental Bonding Instrument. RESULTS The Parental Bonding Instrument and the Childhood Trauma Questionnaire were highly correlated. Panic disorder patients presented higher rates of emotional abuse (OR = 2.54, p = 0.001), mother overprotection (OR = 1.98, p = 0.024) and father overprotection (OR = 1.84, p = 0.041) as compared to controls. Among men with panic disorder, only mother overprotection remained independently associated with panic disorder (OR = 3.28, p = 0.032). On the other hand, higher father overprotection (OR = 2.2, p = 0.017) and less father warmth (OR = 0.48, p = 0.039) were independently associated with panic disorder among female patients. CONCLUSION Higher rates of different types of trauma, especially emotional abuse, are described in panic disorder patients as compared to controls. The differences regarding gender and parental bonding could be explained in the light of the psychodynamic theory.

Approaching countertransference in psychoanalytical supervision: a qualitative investigation.

A recent examination of the literature concerning countertransference and its developments reveals its clinical usefulness in different psychoanalytical cultures. Nevertheless, a shortage of publications is apparent with respect to its approach in supervision. The authors aim in this study was to examine the concepts of transference and countertransference and how countertransference is approached in supervision, in the training of candidates, at an institute of psychoanalysis belonging to a society affiliated to the International Psychoanalytical Association (IPA). Qualitative research was carried out, interviewing supervisors and supervisees. Through analysis of the material acquired, the authors classifi ed the data into initial, intermediate and fi nal categories. The principal fi ndings were subdivided into three categories: the concepts of transference and countertransference, psychoanalytical listening and the complementarity of the phenomena, and the approach to countertransference. The concepts of transference and countertransference predominantly used by those interviewed are based on the totalistic outlook. Countertransference in supervision has been approached in a more direct and objective way when compared with the previous period, although great care is taken to delimit the boundaries between supervision and personal analysis. The main aim of supervision is to broaden comprehension and to deepen the interpretations directed towards the patient. These fi ndings suggest that the evolution of the concept of countertransference in different psychoanalytical cultures and developments in the analytical fi eld are contributing to this change.