Atuação clínica junto a familiares em luto antecipatório em contexto domiciliar: uma proposta a partir do ponto de vista da psicologia analítica, com contribuições de Winnicott

Abstract

The illness of an individual due to chronic-degenerative disease takes family members and their surroundings into contact with an announced death, experiencing anticipatory grief at some level. In severe cases, patients can be assisted by multiprofessional teams at home. Psychologists focus on both the patient and family members. However, there is still a lack of studies regarding the understanding of the anticipatory grief phenomenon of family members in this context and a lack of technical tools for proper management. The general objective of this research was to develop, first, an understanding on anticipatory grief experience of these family members, based on the theoretical framework of Jung and successors added to some contributions by the psychoanalyst Winnicott; second, from this elaboration, formulate technical guidelines that would contribute to the psychological practice with these family members. The method used was a structural-conceptual study of the constructs of Analytical Psychology and the search for relevant concepts developed by Winnicott. As a result, we have that, from the Jung, the grieving process is experienced, in health, in an oscillatory way between the point of view of the ego, with several ambivalences and, also, from the point of view of the self, allowing the feelings of peace, joy and confidence in bereaved ones. The grieving process is an adaptation dynamic in which psychic energy regressions and progressions can occur, and various processes such as tension, polarization, integration, transformation. Jung recommends that human beings should also access death in its symbolic aspect, and that images from the unconscious, be used to expand resources for such coping. The anticipatory grief process can, therefore, bring a power of transformation, regeneration and encounter with the other and oneself in the individuation process. From Winnicott, respecting the paradigmatic differences, it was added that the human development, the ability to have "faith in ...", the experience with unthinkable anxieties and the experience of the first death can have a significant contribution in dealing with the second death. Another result of the research was the construction of technical considerations for the clinical practice with the family group. Here, guidance is given on the peculiarities of work in the home setting, the importance of a good-enough holding within the group, the position of the therapist, attention to individual processes and collective family, the use of symbolic listening and the use of expressive techniques that help in coping with grief. This said, the management should provide an opportunity for the process of individuation and disinhibition of intrafamily communication, building the experience of anticipatory grief as a rite of passage. This set of analyzes and developments contributes to fill gaps regarding the clinical and theoretical knowledge that until then have been produced by Psychology. However, further studies are needed to complement this playing field.