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Revista de Psiquiatria do Rio Grande do Sul

Print version ISSN 0101-8108

Rev. psiquiatr. Rio Gd. Sul vol.27 no.1 Porto Alegre Jan./Apr. 2005

http://dx.doi.org/10.1590/S0101-81082005000100013 

BOOK REVIEW

 

Review of the book entitled Psicoterapia de orientação analítica: fundamentos teóricos e clínicos

 

Reseña del libro Psicoterapia de orientação analítica: fundamentos teóricos e clínicos

 

 

José T. Thomé

Psychiatrist and psychotherapist. Founder and professor of the Psychodynamic Psychotherapy Formation Course of Instituto Sedes Sapientiae of São Paulo (1976). Coordinator of the Department of Psychotherapy of the Brazilian Association of Psychiatry. Director of the Brazilian Association of Psychotherapy

Correspondence

 

 

PSICOTERAPIA DE ORIENTAÇÃO ANALÍTICA: FUNDAMENTOS TEÓRICOS E CLÍNICOS

Cláudio L. Eizirik, Rogério W. Aguiar, Sidnei S. Schestatsky et al.
Porto Alegre, Artmed, 2005

 

 

I received the invitation to make this review with a mix of pleasure and uneasiness, because although this is said to be the second edition reviewed, it is, in fact, a new book.

I have opted to start my review by telling my experience with psychotherapy, both as an academic and practical activity, in order to contextualize how important the book has been since its first edition. It is worth reminding the adversities that this clinical procedure underwent due to scientific, socio-cultural, political and economic contexts, especially after the second half of the 20th century, when it was named treatment - and considered as such.

Initially, the psychoanalytical psychotherapy was seen and judged by prejudicial and discriminating eyes. To start practicing the psychotherapy treatment as a clinical act, and find theoretical and scientific basis was not an easy task.

At the end of the 1980s I contacted the book's authors in a search for some interlocution. They were workmates with whom I found some identification because of their formation, clinical practice and teaching experience in psychoanalytical psychotherapy, as they worked with clear-cut definitions and objective orientations.

It must not be forgotten that since the 1950s, Universities and some psychotherapy services were already developing the analytically oriented psychotherapy (AOP) in the state of Rio Grande do Sul, Brazil. As a result of this tradition and of the application of this kind of psychotherapy, the first edition of the book was launched in 1989, written by a group of professors from the Universidade Federal do Rio Grande do Sul (UFRGS). This edition provided psychotherapists from all over Brazil with material to go further on the AOP, knowing it better and being able to systematize it. Soon, the book became an important landmark in the area: a result of its unquestionable quality.

The second edition arrives 15 years after the first, and if this one was a landmark, what could we say about the second?

At a glance, reading the local, national and international author's and collaborator's names, we realize the book is a globalized discussion with up-to-date scientific knowledge about the AOP. In this sense, I understand it as a new book that pragmatically legitimizes this field and therefore, the state-of-the-art.

By analyzing the titles of each session and their respective writers, who are all experts in their areas, we confirm the quality and contemporaneous aspect of the texts. The book is written in clear and objective language, and one of its most outstanding features, as compared to other similar publications, is that it may be useful both for professionals and lay readers.

The first part is entitled Introductory Topics and it contextualizes the reader in the field of psychotherapy. It is a review made by authors that represent today's world psychoanalysis, psychiatry and AOP areas.

Dr. Michael Stone makes a brief review on the psychotherapy history, and claims that its fundamental aspects have existed since long time ago, even before any discipline named "psychiatry". In his conclusion, he says we are in the way towards the consolidation and integration of psychotherapy, as opposed to the strong sectarianism of the 20th century. Chapters 2 and 3 are intended to describe and locate the historical roots of psychoanalysis and AOP (R. S. Wallerstein) up to the present, and to establish relations with science and knowledge (J. L. Ahumada.). Chapter 4 brings R. Bernardi's reflections on the investigation of rational and emotional processes that guide the therapists' preferences and support changes in their theoretical and technical choices.

The second part of the book (Technical and theoretical basis of AOP) is about several authors of the psychoanalysis field (meta-psychology) whose ideas can be applied by the psychoanalytical psychotherapy.

In the axis of psychoanalysis, the chapter starts is Freud's premises (L.C. Mabilde), followed by: the importance of the internal and external traumas both in theory and in practice (Norberto C. Marucco); the concepts of the object relations schools understood (E. M. R. Barros) together with the psychoanalysis object, and their connection with the object of neurosciences (M. Solms); theories about the therapeutic action of AOP and its origins in the ideas of psychoanalysis actions mechanisms, according to the Freud-Klein-Bion axis (V.S. Mondrzak), and the reflection about some trends of evolution in the different approaches about the therapeutic status, which outline the concepts of field and intersubjectivity (P. H. Cavalli); the way how psychotherapy and psychoanalysis work with the internal reality and the psychic reality (D. Widlocher), followed by reflections about the internal world and transformations (J. C. Carlich); and, eventually, psychoanalytical models of the mind, whose objective is to introduce the study of theoretical models (J. C. Carlich.)

The 16 chapters that compose the third part of the book (Fundamentals of the AOP) lead us through deep reflection on the basis, features, and drawbacks of the AOP, providing readers with a wide, update and universal view over some of the most relevant issues in the area. The four initial chapters of this part could be referred to as the "technical axis" of AOP. C. E. Keidan and J. S. Dal Zot begin the chapter inviting the reader to reflect upon how the patient should be evaluated. E. Iankilevich dedicates a chapter to one of the technical singularities of the AOP: psychotherapy planning. In chapter 16, the importance of focus and delimitation in psychotherapy is approached by M. H. G. Valério. N. K. Lucion and L. Knijnik approach the issue of contract e vicissitudes, understanding them as part of the psychotherapy process.

The remaining 11 chapters deal with aspects of the therapeutic relationship. I. Pechansky dedicates the chapter to a discussion about the controvert therapist's neutral attitude. F. G. Gomes writes about how important the establishment of a solid therapeutic alliance (TA) is, characterized as a positive and necessary relation between the therapist and the patient. Chapter 20 analyses the singularities of the AOP under the point of view of some phenomena that determine specific moments of its development. R. Levy draws a historical line of the development of the concept of insight and its use in the psychoanalytical treatment. The two following chapters are inseparable: transference and countertransference. R. Tyson and C. L. Eizirik approached transference, defined as a "universal phenomenon and the most difficult part of the treatment" (Bird). C. L. Eizirik and S. Lewkowicz described critically the different phases of the evolution of the countertransference concept. Chapter 24 was written by G.O.Gabbard, who approached the violation of professional borders in therapeutic relationships, considered as the "margin" or the limit of the psychoanalytic psychotherapist's adequate behavior in the clinical setting. As for acting and enactment in the psychoanalytic treatment, M. Gus reminds us of the importance of both therapist and patient understanding of the psychic reality. A. C. J. Pires approaches the vicissitudes of the psychotherapy treatment, especially the negative therapeutic reaction (NTR) and the development of impasse. P.F.B. Soares analyze how the patients communicate, and how to understand them and intervene in their communication. In chapter 28, J. Guedes Cruz reviews some aspects of origin, structure, functions and clinical use of dreams. Chapter 29 closes the third part with texts by R. Romanowski, J. R. Escobar, R. E. Sordi and M. S. Campos about levels of changes and criteria for assessing improvements in psychotherapy, which should be conceived within possible and acceptable parameters. The fourth part (Special situations) incites us to reflect on the topic. Today, the psychotherapist needs to have a wide, update and universal point of view on emerging questions, in which new scientific, socio-cultural, political and economic paradigms of the contemporaneous world are based.

G. Vollmer Fl. and G. I. Berlim try to establish a link between ethics and psychotherapy, claiming that, behind the psychic symptom and the status of psychic suffering, there is an ethical conflict, determined by the psychic conflict. Chapters 31 (Psychodynamic contributions to supportive psychotherapy) by L. H. F. Ceitlin and G. G. Manfro; 32 (Psychotherapy and psychopharmacology) by C. M. S. Osório and M. P. A. Fleck; and 33 (Study about the effectiveness of psychotherapy) by Peter Fonagy, stress that the psychotherapist should be always update with scientific development. Examples include: the understanding that the group psychotherapy requires knowledge on the entire psychoanalytical construct, and that supportive interventions are present in all modalities of standard psychotherapy and psychoanalysis; the association between psycho pharmacotherapy and psychotherapy in the clinical practice, its indications, complexities and controversies; and the analysis of effectiveness of psychosocial interventions in the main psychiatric status, through the review of studies based on evidence and randomized controlled trials. In "Genre and psychotherapy," by M.S. Araújo, and in "A clinical view of homosexuality", by E.S. Person, we have the possibility of assessing how socio-cultural changes modify the clinical field of psychotherapy, influenced by the binomial transference/countertransference and intersubjective field, as it happened with the homosexuality concept, which was considered a disease some time ago and now it is a normal behavior. J. Zaslavxky and C. L. S. Brito present some theoretical and technical presupposes for teaching POP today.

Part Five (Fundamentals of psychodynamic approaches in specific clinical situations) allows us to go further on the understanding of the AOP clinical practice in the main nosologic entities.

In "What do we treat in psychotherapy", M. H. G. Valério creates an hypothetical clinical example and its possible evolution to indicate which steps can be taken to make patients get in affective contact with their disorders. M. P. Santos, H. O. Fontouro and C. Gari wrote about relevant aspects of character or character traits, as origin and development of their manifestations during treatment. R. Cassorla approaches anxiety and its symptoms, and makes no distinction between psychoanalytic psychotherapy and psychoanalysis, for considering them as a continuum. S. L. P. Machado and S. Schestatsy confirm the theoretical concepts of depression etiology and pathogen. J. A. Nogueira explains the histrionic personality disorder, from Hypocrates up to the arrival of psychoanalysis, describing the psychodynamic point of view. In "Approaching the obsessive patient", J. J. Chachamovich and I. C. Fetter make a historical review on the topic by citing Freud, Klein, Liberman among others. He differentiates between compulsive-obsessive disorder and obsessive-compulsive personality disorder. H. Ferrari approached phobia and their psychoanalytic treatment. Phobia is considered a defensive behavior that prevents the development of anguish and panic attacks. S. Lewkowicz brings some basic contributions to the understanding of narcissism. In chapters 45 and 46, S. S. Schestatsy and O. F. Kemberg discussed the borderline pathology. One refers to the diagnostic and psychodynamic status of the patients and their analyzability, the second approaches the emotional outbursts or "affective storms" of patients with borderline personality organization and severe regression in transference. R. Hartke sets the concept and examines theoretical and technical aspects of perversion as a phenomenon that can manifest in the therapeutic relation. M. Aisenstein focuses his chapter on the psychosomatic unit of the human being. H. L. Persano covers the eating disorders, claiming that the psychoanalytic treatment is useful in the long term, especially if a multidisciplinary and integrating approach is used. R. W. Aguiar and L. Calefi deal with issues related to the approach of patients with chronic pain and the structure they require, such as comprehensive evaluation and development of interdisciplinary treatment. C. Garland shows the importance and the value of a psychotherapy understanding in the impact of trauma over the mental work and personality. M. L. S. Zavaschi, A. M. S. Bassols, D. S. Bergmann and F. M. C. Costa present some fundamentals on the theory and technique of AOP applied to children, based on the Klein's theory. A. B. Lewkowicz and G. Brodacz wrote about the treatment of adolescents within the current socio-cultural context. A. M. Rosa and M. C. Vasconcellos covered the psychodynamic approach of the geriatric patient, taking into consideration the current concept of elder age. C. A. Krieger and A. Cataldo Neto call the attention to the fact that patients who need inpatient care are managed by professionals from different areas. Their psychotherapy treatment should comprise systematic assessment and understanding of the psychoanalytical phenomenon of mechanisms involved. F. Pechansky and L. Luborsky present the treatment that must be provided to patients with chemical dependence.

As a conclusion, we would like to stress that the book remains an update and necessary reference about AOP for all professionals who work in the mental health care area.

 

 

Correspondence to
José T. Thomé
E-mail: jtthome@uol.com.br

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