Psicoterapia Psicodinâmica de Crianças e Gravidez da Terapeuta: Estudo de Caso Sistemático

Schmidt, Fernanda Munhoz Driemeier; Gastaud, Marina Bento; Ramires, Vera Regina Röhnelt

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Sumário

Psychology of Health • Paidéia (Ribeirão Preto) 28 • 2018 • https://doi.org/10.1590/1982-4327e2836 copiar

Psicoterapia Psicodinâmica de Crianças e Gravidez da Terapeuta: Estudo de Caso Sistemático

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

O presente estudo buscou descrever as características do processo psicoterápico psicodinâmico de uma criança com uma terapeuta grávida e identificar possíveis repercussões dessa gravidez no tratamento. Realizou-se um estudo descritivo, longitudinal, baseado no procedimento de estudo de caso único sistemático. Participaram uma menina de oito anos de idade e sua terapeuta que engravidou durante o tratamento. Foram analisadas 40 sessões da psicoterapia por meio do Child Psychotherapy Q-Set. O processo terapêutico foi dividido em quatro períodos de acordo com a gravidez da terapeuta: (1) terapeuta não estava grávida; (2) terapeuta sabia de sua gestação, mas o assunto não havia sido verbalizado; (3) assunto foi tratado no setting terapêutico; (4) retorno da licença maternidade. Os resultados demonstraram uma diminuição da neutralidade e da colocação de limites, discussão de pausas e interrupções no tratamento. Concluiu-se que a gravidez da terapeuta influencia o setting terapêutico de forma acentuada.

Palavras-chave:
psicoterapia psicanalítica; psicoterapia da criança; processo psicoterapêutico

Items	Overall average	Average time 1	Average time 2	Average time 3	Average time 4
Most characteristic items
31 - T asks for more information or elaboration.	8.28	8.25	8.20	8.32	8,36
6 - T is sensitive to C’s feelings.	8.20	8.08	8.20	8.26	8.29
28 - T accurately perceives the therapeutic process.	8.06	7.67	7.95	8.18	8.14
3 - T’s remarks are aimed at encouraging C’s speech.	7.70	8.17	7.95	7.65	7.07
88 - Material of the hour is meaningful and relevant to C’s conflicts.	7.56	7.58	7.20	7.79	7.50
76 - T makes links between C’s feelings and experience.	7.45	7.17	7.75	7.32	7.57
77 - T’s interaction with C is sensitive to the C’s level of development.	7.35	7.42	7.65	7.35	-
23 - Therapy session has a specific focus or theme.	7.25	7.25	7.10	7.26	7.43
86 - T is confident, self-assured [vs; uncertain or unsure].	7.25	7.92	7.35	7.03	-
82 - T helps C manage feelings.	7.16	7.00	7.50	7.18	-
38 - T and C demonstrate a shared vocabulary or understanding when referring to events or feelings.	7.15	-	7.30	7.09	7.36
67 - T interprets warded-off or unconscious wishes, feelings, or ideas.	7.10	-	7.30	7.38	7.36
97 - T emphasizes verbalization of internal states and affects.	7.10	7.33	-	7.18	-
64 - C draws T into play.	7.07	6.92	7.40	7.15	-
69 - C’s current or recent life situation is emphasized.	7.06	8.17	-	-	7.36
81 - T emphasizes feelings to help C experience them more deeply.	-	7.25	-	-	-
65 - T clarifies, restates, or rephrases C’s communication.	-	7.08	-	-	-
62 - T points out a recurrent theme in the C’s experience or conduct.	-	-	7.30	-	7.07
78 - C is compliant.	-	-	6.90	-	-
72 - C is active.	-	-	-	7.03	7.36
75 - Interruptions, breaks in the treatment, or termination of therapy are discussed.	-	-	-	-	7.93
46 - T interprets the meaning of C’s play.	-	-	-	-	7.07
53 - C conveys awareness of own internal difficulties	-	-	-	-	7.50
Least characteristic items
1 - C expresses negative feelings (e.g., criticism, hostility) towards T [vs. express approval or admiration].	2.86	2.92	2.50	-	-
20 - C is provocative; challenges the T or rules and boundaries of the therapy hour.	2.85	2.83	2.80	2.91	2.79
89 - T acts to strengthen existing defenses.	2.65	-	2.55	2.59	2.64
49 - C conveys or expresses mixed or conflicted feelings about the T.	2.62	2.17	2.40	2.85	2.79
95 - C’s play lacks spontaneity.	2.45	2.50	2.35	2.50	2.43
58 - C appears unwilling to examine thoughts, reactions, or motivations related to problems.	2.43	2.50	2.65	2.38	2.21
42 - C ignores or rejects T’s comments and observations.	2.15	2.33	2.25	2.12	1.93
26 - C is socially misattuned or inappropriate.	2.02	2.25	2.10	2.03	1.71
17 - T actively exerts control over the interaction (e.g., structuring, introducing new topics).	1.97	2.25	1.90	1.91	2.00
56 - C is distant from his or her feelings.	1.91	1.58	2.10	1.94	1.86
18 - T is judgmental and conveys lack of acceptance.	1.77	1.67	1.70	1.68	2.21
5 - C has difficulty understanding the T’s comments.	1.73	1.75	1.70	1.76	-
40 - C communicates without affect.	1.72	1.75	1.65	1.71	1.86
41 - C does not feel understood by T.	1.62	1.58	1.55	1.68	1.64
9 - T is nonresponsive [vs; affectively engaged].	1.12	1.25	1.15	1.09	1.07
57 - T attempts to modify distortions in C’s beliefs.	-	2.92	-	-	-
37 - T behaves in a didactic manner.	-	-	-	2.79	2.36
5 - C has difficulty understanding the T’s comments.	-	-	-	-	1.71

Item	Item description	Manova	Tukey
Item	Item description	F	Times	Difference of averages between periods	Item direction
4	There is discussion of why C is in therapy.	6.64**	1-2	1.66*	↓
			1-3	1.59 *	↓
			2-4	-1.68*	↑
			3-4	-1.60*	↑
32	C achieves a new understanding or insight.	3.95*	1-4	-2.71*	↑
35	C’s self-image is a theme.	3.64*	1-4	-1.52*	↑
43	T suggests the meaning of the behavior of others.	3.60*	2-4	-.79*	↑
43	T suggests the meaning of the behavior of others.	3.60*	3-4	-.67*	↑
46	T interprets the meaning of C’s play.	3.91*	3-4	-1.27*	↑
48	T sets limits.	4.81**	1-3	.72 **	↓
48	T sets limits.	4.81**	1-4	.82**	↓
54	C is clear and organized in verbal expression.	2.94*	1-4	.90*	↓
61	C feels shy and embarrassed [vs; un-self-conscious and assured].	4.25*	1-4	2.08*	↓
61		4.25*	2-4	1.60*	↓
67	T interprets warded-off or unconscious wishes, feelings, or ideas.	3.83*	1-2	-1.63*	↑
			1-3	-1.76*	↑
			1-4	-1.69*	↑
69	C’s current or recent life situation is emphasized.	3.08*	1-3	1.40*	↓
75	Interruptions, breaks in the treatment, or termination of therapy are discussed.	7.12**	1-4	-2.51**	↑
			2-4	-2.38**	↑
			3-4	-2.19**	↑
87	T informs C of the potential impact of his or her behavior on others (not including T).	3.03*	2-3	-.70*	↑
93	T is neutral.	3.66*	1-3	1.34*	↓
94	C feels sad or depressed [vs. cheerful and joyous].	3.64*	1-3	.96*	↓

Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 Ribeirão Preto - São Paulo - Brasil, Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br

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[1] Correspondence address: Fernanda Munhoz Driemeier Schmidt. Universidade do Vale do Rio dos Sinos. São Leopoldo-RS, Brazil. CEP 93.022-000. E-mail: fernandadriemeier@hotmail.com