Libro, diaspora e ri-costruzioni identitarie. Per una storia della tipografia sefardita portoghese nell'Italia del Cinquecento

Il lavoro ripercorre le tracce che gli ebrei portoghesi, esuli dopo il biennio 1496-97, lasciarono nel loro cammino attraverso l'Europa. In particolare, l'interesse si concentra sulla breve parentesi italiana, che grazie all'apertura e alla disponibilità  di alcuni Signori, come i Gonzaga di Mantova, i Medici, i Dogi della Serenissima e gli Este, risulta ricchissima di avvenimenti e personaggi, decisivi anche per la storia culturale del Portogallo. L'analisi parte evidenziando l'importanza che ebbe la tipografia ebraica in Portogallo all'epoca della sua introduzione nel Paese; in secondo luogo ripercorre la strada che, dal biennio del primo decreto di espulsione e del conseguente battesimo di massa, porta alla nascita dell'€™Inquisizione in Portogallo. Il secondo capitolo tenta di fare una ricostruzione, il più possibile completa e coerente, dei movimenti degli esuli, bollati come marrani e legati alle due maggiori famiglie, i Mendes e i Bemveniste, delineando poi il primo nucleo di quella che diventerà  nel Seicento la comunità  sefardita portoghese di Amsterdam, dove nasceranno le personalità  dissidenti di Uriel da Costa e del suo allievo Spinoza. Il terzo capitolo introduce il tema delle opere letterarie, effettuando una rassegna dei maggiori volumi editi dalle officine tipografiche ebraiche stanziatesi in Italia fra il 1551 e il 1558, in modo particolare concentrando l'attenzione sull'€™attività  della tipografia Usque, da cui usciranno numerosi testi di precettistica in lingua ebraica, ma soprattutto opere cruciali come la famosa «Bibbia Ferrarese» in castigliano, la «Consolação às Tribulações de Israel», di Samuel Usque e la raccolta composta dal romanzo cavalleresco «Menina e Moça» di Bernardim Ribeiro e dall'ecloga «Crisfal», di un autore ancora non accertato. L'ultimo capitolo, infine, si propone di operare una disamina di queste ultime tre opere, ritenute fondamentali per ricostruire il contesto letterario e culturale in cui la comunità  giudaica in esilio agiva e proiettava le proprie speranze di futuro. Per quanto le opere appartengano a generi diversi e mostrino diverso carattere, l'€™ipotesi è che siano parte di un unicum filosofico e spirituale, che intendeva sostanzialmente indicare ai confratelli sparsi per l'Europa la direzione da prendere, fornendo un sostegno teoretico, psicologico ed emotivo nelle difficili condizioni di sopravvivenza, soprattutto dell'integrità religiosa, di ciascun membro della comunità.

Psychosoziale Belastung bei Herztransplantationskandidaten

Fragestellung: In der vorliegenden Untersuchung wurde geprüft, ob sich neu gelistete Herztransplantationskandidaten mit ischämischer Herzinsuffizienz (IKMP) und dilatativer Kardiomyopathie (DKMP) nach Kontrolle von Krankheitsschwere und Geschlecht in psychosozialen Variablen unterscheiden. Zudem wurde untersucht, ob psychosoziale Risikofaktoren für IKMP-Patienten stärker mit der 1-Jahres-Mortalität auf der Warteliste assoziiert sind als für DKMP-Patienten. Methode: Im Rahmen der multizentrischen, prospektiv angelegten Studie „Warten auf ein neues Herz“ bearbeiteten 160 DKMP- (16 % Frauen) und 122 IKMP-Patienten (13 % Frauen) kurz nach Aufnahme auf die Warteliste einen Fragebogen, der subjektiven Gesundheitszustand, Angst, Depressivität, soziale Unterstützung, Netzwerkgröße, Ärger, Ärgerausdruck und wartezeitspezifische Belastungen erfasste. Medizinische Daten zum Zeitpunkt der Listung und Veränderungen im Wartelistenstatus im 1-Jahres-Follow-Up wurden von Eurotransplant bereitgestellt. Ergebnisse: IKMP-Patienten waren im Vergleich mit DKMP-Patienten älter, häufiger ehemalige Raucher, hatten häufiger vorherige Herzoperationen erlebt, litten seltener unter einer Erregungsleitungsstörung, wurden seltener mit Aldosteronantagonisten sowie häufiger mit Katecholaminen behandelt. Nach Kontrolle dieser Variablen und unter Einbezug des Geschlechts berichteten nur Männer mit IKMP höhere Angstwerte und mehr Anger-In als Männer mit DKMP. Ein höheres Mortalitätsrisiko für IKMP-Patienten ein Jahr nach Aufnahme auf die Warteliste konnte nicht belegt werden. Auch zeigte sich keine Interaktion zwischen psychosozialer Belastung und Grunderkrankung hinsichtlich der Mortalität. Niedrige emotionale Unterstützung ging unabhängig von der Grunderkrankung mit einem dreifach erhöhten Mortalitätsrisiko einher. Fazit: Männer mit IKMP sind stärker durch negative Emotionen belastet als Männer mit DKMP. Eine weitere Risikogruppe stellen Personen mit niedriger emotionaler Unterstützung dar. Psychosoziale Risikofaktoren sollten daher bereits bei Aufnahme auf die Warteliste erfasst und Betreuungsangebote gezielt auf diese beiden Gruppen abgestimmt werden.

Family satisfaction with critical care: measurements and messages

PURPOSE OF REVIEW: Family satisfaction in the ICU reflects the extent to which perceived needs and expectations of family members of critically ill patients are met by healthcare professionals. Here, we present recently developed tools to assess family satisfaction, with a special focus on their psychometric properties. Assessing family satisfaction, however, is not of much use if it is not followed by interpretation of the results and, if needed, consecutive measures to improve care of the patients and their families, or improvement in communication and decision-making. Accordingly, this review will outline recent findings in this field. Finally, possible areas of future research are addressed. RECENT FINDINGS: To assess family satisfaction in the ICU, several domains deserve attention. They include, among others, care of the patient, counseling and emotional support of family members, information and decision-making. Overall, communication between physicians or nurses and members of the family remains a key topic, and there are many opportunities to improve. They include not only communication style, timing and appropriate wording but also, for example, assessments to see if information was adequately received and also understood. Whether unfulfilled needs of individual members of the family or of the family as a social system result in negative long-term sequels remains an open question. SUMMARY: Assessing and analyzing family satisfaction in the ICU ultimately will support healthcare professionals in their continuing effort to improve care of critically ill patients and their families.

Family satisfaction in the intensive care unit: what makes the difference?

PURPOSE: To assess family satisfaction in the ICU and to identify parameters for improvement. METHODS: Multicenter study in Swiss ICUs. Families were given a questionnaire covering overall satisfaction, satisfaction with care and satisfaction with information/decision-making. Demographic, medical and institutional data were gathered from patients, visitors and ICUs. RESULTS: A total of 996 questionnaires from family members were analyzed. Individual questions were assessed, and summary measures (range 0-100) were calculated, with higher scores indicating greater satisfaction. Summary score was 78 +/- 14 (mean +/- SD) for overall satisfaction, 79 +/- 14 for care and 77 +/- 15 for information/decision-making. In multivariable multilevel linear regression analyses, higher severity of illness was associated with higher satisfaction, while a higher patient:nurse ratio and written admission/discharge criteria were associated with lower overall satisfaction. Using performance-importance plots, items with high impact on overall satisfaction but low satisfaction were identified. They included: emotional support, providing understandable, complete, consistent information and coordination of care. CONCLUSIONS: Overall, proxies were satisfied with care and with information/decision-making. Still, several factors, such as emotional support, coordination of care and communication, are associated with poor satisfaction, suggesting the need for improvement. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00134-009-1611-4) contains supplementary material, which is available to authorized users.

Postpartum depressive symptoms in the first 17 months after childbirth: the impact of an emotionally supportive partnership

OBJECTIVES: This study investigates the impact on different postpartum depressive trajectories (i.e., "non depressive symptoms", "stable depressive symptoms", "deterioration" and "improvement") from 5-17 months after childbirth exerted by emotional support that mothers receive from their partners and emotional support they provide to their partners. METHODS: Postpartum depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale 5 and 17 months after delivery in a sample of 293 mothers. Emotional support received from the partners was assessed among both mothers and partners. RESULTS: The initial level and the change in emotional support that mothers received from their partners were related to different trajectories of postpartum depressive symptoms. Mothers who were living in a partnership with low reciprocal emotional support showed a significantly higher risk of suffering from "stable depressive symptoms" than mothers who were living in a partnership with high reciprocal emotional support. CONCLUSIONS: An increased risk of persistent depressive symptoms beyond the early postpartum period was observed in mothers with poor reciprocal emotional support in the partnership. Further research is needed for a better understanding of the mothers persistent depressive symptoms after childbirth associated with reciprocity of emotional support in the partnership.

Coping resources in a sample of chronic low back pain patients: Evaluation of the questionnaire for back pain

BACKGROUND The coping resources questionnaire for back pain (FBR) uses 12 items to measure the perceived helpfulness of different coping resources (CRs, social emotional support, practical help, knowledge, movement and relaxation, leisure and pleasure, spirituality and cognitive strategies). The aim of the study was to evaluate the instrument in a clinical patient sample assessed in a primary care setting. SAMPLE AND METHODS The study was a secondary evaluation of empirical data from a large cohort study in general practices. The 58 participating primary care practices recruited patients who reported chronic back pain in the consultation. Besides the FBR and a pain sketch, the patients completed scales measuring depression, anxiety, resilience, sociodemographic factors and pain characteristics. To allow computing of retested parameters the FBR was sent to some of the original participants again after 6 months (90% response rate). We calculated consistency and retest reliability coefficients as well as correlations between the FBR subscales and depression, anxiety and resilience scores to account for validity. By means of a cluster analysis groups with different resource profiles were formed. Results. RESULTS For the study 609 complete FBR baseline data sets could be used for statistical analysis. The internal consistency scores ranged fromα=0.58 to α=0.78 and retest reliability scores were between rTT=0.41 and rTT=0.63. Correlation with depression, fear and resilience ranged from r=-0.38 to r=0.42. The cluster analysis resulted in four groups with relatively homogenous intragroup profiles (high CRs, low spirituality, medium CRs, low CRs). The four groups differed significantly in fear and depression (the more inefficient the resources the higher the difference) as well as in resilience (the more inefficient the lower the difference). The group with low CRs also reported permanent pain with no relief. The groups did not otherwise differ. CONCLUSIONS The FBR is an economic instrument that is suitable for practical use e.g. in primary care practices to identify strengths and deficits in the CRs of chronic pain patients that can then be specified in face to face consultation. However, due to the rather low reliability, the use of subscales for profile differentiation and follow-up measurement in individual diagnoses is limited.

It’s all about networking! Empirical investigation of social capital formation on social network sites

As Social Network Sites (SNS) permeate our daily routines, the question whether participation results in value for SNS users becomes particularly acute. This study adopts a 'participation-source-outcome' perspective to explore how distinct uses of SNS generate various types of social capital benefits. Building on existing research, extensive qualitative findings and an empirical study with 253 Facebook users, we uncover the process of social capital formation on SNS. We find that even though active communication is an important prerequisite, it is the diversified network structure and the increased social connectedness that are responsible for the attainment of the four benefits of social capital on SNS: emotional support, networking value, horizon broadening and offline participation. Moreover, we propose and validate scales to measure social capital benefits in the novel context of SNS.

Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study

BACKGROUND The quality and quantity of social relationships are associated with depression but there is less evidence regarding which aspects of social relationship are most predictive. We evaluated the relative magnitude and independence of the association of four social relationship domains with major depressive disorder and depressive symptoms. METHODS We analyzed a cross-sectional telephone interview and postal survey of a probability sample of adults living in Switzerland (N = 12,286). Twelve-month major depressive disorder was assessed via structured interview over the telephone using the Composite International Diagnostic Interview (CIDI). The postal survey assessed depressive symptoms as well as variables representing emotional support, tangible support, social integration, and loneliness. RESULTS Each individual social relationship domain was associated with both outcome measures, but in multivariate models being lonely and perceiving unmet emotional support had the largest and most consistent associations across depression outcomes (incidence rate ratios ranging from 1.55-9.97 for loneliness and from 1.23-1.40 for unmet support, p's < 0.05). All social relationship domains except marital status were independently associated with depressive symptoms whereas only loneliness and unmet support were associated with depressive disorder. CONCLUSIONS Perceived quality and frequency of social relationships are associated with clinical depression and depressive symptoms across a wide adult age spectrum. This study extends prior work linking loneliness to depression by showing that a broad range of social relationship domains are associated with psychological well-being.

Food Insecurity and the Behavioral and Intellectual Development of Children: A Review of the Evidence

Background: Given that an alarming 1 in 5 children in the USA are at risk of hunger (1 in 3 among black and Latino children), and that 3.9 million households with children are food insecure, it is crucial to understand how household food insecurity (HFI) affects the present and future well-being of our children. Purpose: The objectives of this review article are to: (i) examine the association between HFI and child intellectual, behavioral and psycho-emotional development, controlling for socio-economic indicators; (ii) review the hypothesis that HFI is indeed a mediator of the relationship between poverty and poor child development outcomes; (iii) examine if the potential impact of HFI on caregivers’ mental health well-being mediates the relationship between HFI and child development outcomes. Methods: Pubmed search using the key words “food insecurity children.” For articles to be included they had to: (i) be based on studies measuring HFI using an experience-based scale, (ii) be peer reviewed, and (iii) include child intellectual, behavioral and/or socio-emotional development outcomes. Studies were also selected based on backward and forward Pubmed searches, and from the authors’ files. After reviewing the abstracts based on inclusion criteria a total of 26 studies were selected. Results: HFI represents not only a biological but also a psycho-emotional and developmental challenge to children exposed to it. Children exposed to HFI are more likely to internalize or externalize problems, as compared to children not exposed to HFI. This in turn is likely to translate into poor academic/cognitive performance and intellectual achievement later on in life. A pathway through which HFI may affect child development is possibly mediated by caregivers’ mental health status, especially parental stress and depression. Thus, HFI is likely to foster dysfunctional family environments. Conclusion: Findings indicate that food insecure households may require continued food assistance and psycho-emotional support until they transition to a “stable” food secure situation. This approach will require a much better integration of social policies and access to programs offering food assistance and mental health services to those in need. Findings also fully justify increased access of vulnerable children to programs that promote early in life improved nutrition as well as early psycho-social and cognitive stimulation opportunities.

A qualitative and quantitative assessment of cancer patients' perceptions of barriers to treatment

This study examined barriers that cancer patients experience in obtaining treatment. The principal aim of the study was to conduct a comprehensive quantitative and qualitative assessment of barriers to cancer treatment for Texas cancer patients. The three specific aims of the study were to: (1) conduct a review and critique of published and unpublished research on barriers to cancer treatment; (2) conduct focus groups for the qualitative assessment of cancer patients' perceived barriers to cancer treatment; and (3) survey a representative sample of cancer patients regarding perceived barriers to treatment. The study was guided by the Aday and Andersen access framework of predisposing, enabling, and need determinants of care-seeking.^ To address the first specific aim, a total of 732 abstracts were examined, from which 154 articles were selected for review. Of these 154 articles, 57 that related directly to research on barriers to cancer treatment were chosen for subsequent analysis. Criteria were applied to each article to evaluate the strength of the study design, sampling and measurement procedures. The major barriers that were consistently documented to influence whether or not cancer patients sought or continued required treatment included problems with communication between the patient and provider, lack of information on side effects, the cost of treatment and associated difficulties in obtaining and maintaining insurance coverage, and the absence of formal and informal networks of social support. Access barriers were generally greater for older, minority women, and patients of lower socioeconomic status.^ To address the second specific aim, a total of eight focus groups (n = 44) were conducted across the State of Texas with cancer patients identified by the Texas Community Oncology Network, American Cancer Society, and community health centers. One important finding was that cost is the greatest hurdle that patients face. Another finding was that with the health care/insurance crisis, an increasing number of physicians are working with their patients to develop individually-tailored payment plans. For people in rural areas, travel to treatment sites is a major barrier due to the travel costs as well as work time forfeited by patients and their family members. A third major finding was the patients' family and church play important roles in providing social and emotional support for cancer patients.^ To address the third aim, a total of 910 cancer patients were surveyed during October and November, 1993. Approximately 65% of the cancer patients responded to the survey. The findings showed that the major barriers to treatment included costs of medications and diagnostic tests, transportation, lack of social support, problems understanding the written information regarding their disease as well as losing coverage or having higher premiums or copayments once they were diagnosed (particularly among blacks).^ Significant differences in reported barriers were found between racial groups. The minority respondents (i.e., blacks and Hispanics) tended to experience more barriers to treatment compared to the white respondents. More specifically, Hispanics were more likely to report transportation as a barrier to treatment than both white and blacks. Future research is needed to better understand the problems that minority cancer patients experience in receiving treatment. (Abstract shortened by UMI.) ^

Recommendations for dementia caregiver stress interventions based on Intervention Mapping guidelines

Stress can affect a person's psychological and physical health and cause a variety of conditions including depression, immune system changes, and hypertension (Alzheimer's Association, 2010; Aschbacher et al., 2009; Fredman et al., 2010; Long et al., 2004; Mills et al., 2009; von Känel et al., 2008). The severity and consequences of these conditions can vary based on the duration, amount, and sources of stress experienced by the individual (Black & Hyer, 2010; Coen et al., 1997; Conde-Sala et al., 2010; Pinquart & Sörensen, 2007). Caregivers of people with dementia have an elevated risk for stress and its related health problems because they experience more negative interactions with, and provide more emotional support for, their care recipients than other caregivers. ^ This paper uses a systematic program planning process of Intervention Mapping to organize evidence from literature, qualitative research and theory to develop recommendations for a theory- and evidence-based intervention to improve outcomes for caregivers of people with dementia. A needs assessment was conducted to identify specific dementia caregiver stress influences and a logic model of dementia caregiver stress was developed using the PRECEDE Model. Necessary behavior and environmental outcomes are identified for dementia caregiver stress reduction and performance objectives for each were combined with selected determinants to produce change objectives. Planning matrices were then designed to inform effective theory-based methods and practical applications for recommended intervention delivery. Recommendations for program components, their scope and sequence, the completed program materials, and the program protocols are delineated along with ways to insure that the program is adopted and implemented after it is shown to be effective.^

Exploring the Benefits of a Parent Partner Mentoring Program in Child Welfare

Parent partner mentoring programs are an innovative strategy for child welfare agencies to engage families in case planning and service delivery. These programs recruit and train parents who have been involved in the system and have successfully resolved identified child abuse or neglect issues to work with families with current open cases in the child welfare system. Parent partner mentors can provide social and emotional support, advocacy, and practical advice for navigating this challenging system. Insofar as parent partners share similar experiences, and cultural and socioeconomic characteristics of families, they may be more successful in engaging families and building trusting supportive relationships. The current study presents qualitative data from interviews and case studies of families who were matched with a parent partner in a large county in a Midwestern state. Interviews with families, parent partner mentors, child welfare agency staff, and community partners and providers suggest that parent partner programs may be just as beneficial for parent partner mentors as they are for families being mentored. These programs can build professional skills, help improve self-esteem, provide an avenue for social support, and may potentially prevent recidivism. Parent Partner programs also provide a mechanism for amplifying family voice at all levels of the agency.

PERCEPÇÃO DE SUPORTE SOCIAL E CONSUMO DE ÁLCOOL EM DESEMPREGADOS

O desemprego tem sido objeto de preocupação no contexto político, econômico e social, uma vez que a população de trabalhadores desempregados enfrenta dificuldades diárias para a obtenção de trabalho/ou emprego, situação que gera intenso sofrimento psíquico e pode repercutir de modo negativo na saúde do trabalhador. Este estudo teve por objetivo investigar a percepção de suporte social e o consumo de álcool em desempregados. Por meio de estudo epidemiológico, quantitativo e transversal constituímos uma amostra de 300 indivíduos, recrutados em uma agência pública em São Bernardo do Campo SP, que capta vagas no mercado e encaminha trabalhadores para recolocação profissional. A amostra resultou em 54,3% pessoas do gênero masculino, com idade média de 29,30, com mínimo de 18 anos e máximo de 56 anos; 67% tinham ensino médio, sendo 50% solteiros, 52% encontravam-se desempregados de um a seis meses, 37% residiam em imóvel próprio, e 37% possuíam renda familiar de um a dois salários mínimos. Foram utilizados três instrumentos auto-aplicáveis para coleta dos dados: a) Questionário de características sócio-demográficas; b) Escala de Percepção de Suporte Social (EPSS); c) Teste para Identificação de Problemas Relacionados ao Uso de Álcool (AUDIT). Os dados coletados foram submetidos ao programa estatístico SPSS, versão 15.0 para Windows que permitiu fazer as correlações entre as variáveis. Os resultados indicaram correlações significativas entre as variáveis: suporte prático e renda; suporte prático e suporte emocional, com idade. Estas correlações sugeriram que os sujeitos apresentavam melhor percepção de suporte prático na medida em que aumentava a renda familiar, e que quanto maior a idade, menor é a percepção do suporte prático e emocional recebido pela rede social. O AUDIT não apontou correlações significativas entre as variáveis estudadas, e 76% da amostra se situou na zona 1 consumo de baixo risco ou abstinência. Não verificamos correlação entre consumo de álcool e desemprego.(AU)

PERCEPÇÃO DE SUPORTE SOCIAL E CONSUMO DE ÁLCOOL EM DESEMPREGADOS

O desemprego tem sido objeto de preocupação no contexto político, econômico e social, uma vez que a população de trabalhadores desempregados enfrenta dificuldades diárias para a obtenção de trabalho/ou emprego, situação que gera intenso sofrimento psíquico e pode repercutir de modo negativo na saúde do trabalhador. Este estudo teve por objetivo investigar a percepção de suporte social e o consumo de álcool em desempregados. Por meio de estudo epidemiológico, quantitativo e transversal constituímos uma amostra de 300 indivíduos, recrutados em uma agência pública em São Bernardo do Campo SP, que capta vagas no mercado e encaminha trabalhadores para recolocação profissional. A amostra resultou em 54,3% pessoas do gênero masculino, com idade média de 29,30, com mínimo de 18 anos e máximo de 56 anos; 67% tinham ensino médio, sendo 50% solteiros, 52% encontravam-se desempregados de um a seis meses, 37% residiam em imóvel próprio, e 37% possuíam renda familiar de um a dois salários mínimos. Foram utilizados três instrumentos auto-aplicáveis para coleta dos dados: a) Questionário de características sócio-demográficas; b) Escala de Percepção de Suporte Social (EPSS); c) Teste para Identificação de Problemas Relacionados ao Uso de Álcool (AUDIT). Os dados coletados foram submetidos ao programa estatístico SPSS, versão 15.0 para Windows que permitiu fazer as correlações entre as variáveis. Os resultados indicaram correlações significativas entre as variáveis: suporte prático e renda; suporte prático e suporte emocional, com idade. Estas correlações sugeriram que os sujeitos apresentavam melhor percepção de suporte prático na medida em que aumentava a renda familiar, e que quanto maior a idade, menor é a percepção do suporte prático e emocional recebido pela rede social. O AUDIT não apontou correlações significativas entre as variáveis estudadas, e 76% da amostra se situou na zona 1 consumo de baixo risco ou abstinência. Não verificamos correlação entre consumo de álcool e desemprego.(AU)

O LÚDICO VIA FÁBULAS EM ATENDIMENTO PSICOTERAPÊUTICO: UM ESTUDO DE CASO CLÍNICO DE MOBBING

Esta pesquisa verifica a validade da utilização de fábulas em processo psicoterapêutico de paciente de Mobbing acometida de depressão e síndrome de pânico. Desenvolve-se por meio de estudo de caso avaliativo-interventivo evolutivo prolongado, com um total de 116 sessões semanais. Inicialmente realiza o diagnóstico clínico elaborado a partir do desenho da figura humana, extraído do teste projetivo House Tree and Person, de entrevista inicial semi-dirigida, e de coleta de relatos verbais e observações feitas durante os primeiros atendimentos. As sessões são realizadas com utilização ocasional de fábulas, associada ou não a técnicas de relaxamento de Schultz e Jacobson, com interpretação de sonhos e recomendação de filmes. O objetivo é verificar se as fábulas contribuem de forma positiva para o paciente compreender com mais facilidade as interpretações do psicoterapeuta, se diminui sua resistência ao falar dos seus conteúdos e se amplia à consciência simbólica. O primeiro momento interventivo tem a duração de aproximadamente 16 meses, o segundo, de 04 meses, quando é solicitado o segundo desenho e o terceiro processa-se em 09 meses, quando é solicitado o último desenho. No primeiro momento é proporcionado à paciente um ambiente facilitador com sustentação emocional (Holding), buscando resgatar sua ilusão, numa visão winnicottiana. Revela-se uma situação de Mobbing acompanhada de depressão manifesta e síndrome do pânico; com alto nível de exigência pessoal e profissional; grande passividade nos relacionamentos e na dinâmica do casal. Ao final desse momento, já consegue começar a desviar sua auto-agressividade para o meio externo de maneira mais positiva e socialmente aceita. No segundo momento predomina o encontro e aceitação de seu verdadeiro jeito de ser; enxerga o quanto estava se deixando prejudicar; mostra-se mais confiante, comunica-se e enfrenta melhor suas dificuldades afetivas. No terceiro momento demonstra estar segura e feliz. Cuida de sua aparência e sente prazer em ser notada socialmente. Demonstra ter aprendido a se defender em situações de confronto, com maior autonomia e verbaliza estar muito feliz com as mudanças, sorri com freqüência. A análise evolutiva dos desenhos confirmam esta boa evolução. A utilização de fábulas foi muito bem aceita pela paciente, que conseguiu por meio da leitura simbólica contida nas mesmas, aproximar-se de sua problemática e aprender a lidar com ela de forma mais saudável. Os resultados também indicam que a utilização de relaxamento associado à leitura das fábulas contribuiu para sua assimilação mais abrangente e profunda. O estudo ilustra a evolução do caso por meio de 24 vinhetas, devidamente analisadas em relação aos momentos descritos.(AU)