O manejo clínico psicanalítico das psicoses: desafios, limites e possibilidades

Abstract

This is a qualitative and descriptive research which aims to understand the main aspects of the psychoanalytic clinic of psychoses and the role of delusion in this context. The research was divided into two studies. In both, individual semi-structured interviews were conducted with psychoanalysts, medical doctors and/or psychologists who work in the psychoanalytic therapy approach, with experience on individual clinical care of patients with psychotic structure. In study 1, the goal was to understand the main characteristics of psychoanalytic clinical management of psychoses. Answers given by respondents about their experiences of performances in this context were analyzed from Freudian, Bionian and Lacanian theories. In Study 2, the objective was to understand the role of delusion in the psychoanalytic clinic of psychoses, according to the Lacanian approach. Study 1 revealed that psychoanalytical clinical management of psychoses requires specific strategies from the analyst, such as the valorization of manifestations of the patient that overcome lags in its structure and indicate its development, the use of a concrete language and access to the patient through distinct ways from the symbolic field, personal and continued professional training under personal analysis and supervision, the ability to be creative and flexible during sessions, the recognition of own limits, the creation of collaborative treatment networks, and the formation of a mental space to receive the different that is evidenced in psychosis. Study 2 demonstrated that delusion is not only fundamental for the Lacanian psychoanalytic clinic of psychoses, but it is also essential for the psychic life of the subject with psychotic structure. It allows the subject's articulation with the world, expression of his history and experiences, relief from anxiety and torment that could completely drive him mad and even lead him to disastrous acts, among many other possibilities. When clinical management is practiced by the analyst with competence and responsibility, the legitimization of the delusional statement as a discourse that holds values of meaning and truth can direct the psychoanalytic intervention and ensure the value of its use in the intervention with psychoses The research revealed that psychoanalytic theory and technique are valuable and have effective tools in the clinical context of psychoses, but this is only valid if the psychoanalyst recognizes the variations in his theory and technique when applied to this context, recognizing distinct specificities on it different from those of the neuroses and being willing to adopt a specific praxis.