Clinical psychology

This work is dedicated to the development of L.S. Vygotsky’s ideas in clinical psychology and the clarification of some basic points of the cultural-historical concept. The paper presents a thesis about the development of man in ontogeny as the result of his interaction with the cultural environment, which transforms natural mental functions into higher mental functions. This process can be attended by a whole range of psychopathologies. The issues discussed include voluntary regulation of higher mental functions, determination of the involuntariness and “post-voluntariness” of functions, the internalization of actions, the differentiation of affect and emotion (including as higher mental functions), the “cultural” socialization of non-mental functions (sex, sleep, excretion), and the discord between natural and “cultural” entities in a person. The basis for the ontological development of man is the genesis of “subjectness”, like all the forms of higher activity that emerge when encountering cultural restrictions and requirements causing specific mental disorders. The supposition is made that there are no significant restrictions to explaining either mental or non-mental functions with the cultural-historical approach. Recommendations for further research are suggested.

From a Relational-Historical theoretical framework applied to clinical psychological practice, this study examines the data set underlying the personality attributes of different groups of children with behavior problems as demonstrated on the Rorschach Inkblot Test. To define the groups, categories were established from parents’ descriptions of their own children. This procedure allowed for the formation of three major psychological profiles: hyperkinetic, oppositional defiant, and antisocial (Saraiva & Ferreira, 2016). The major goal of this study is data exploration in a clinical setting, in order to investigate whether and in what ways groups of hyperkinetic, oppositional defiant, and antisocial children differ. These profile characteristics are important issues embraced by both psychodiagnosis and psychotherapy. The participants for this study were 39 Portuguese children, who were private clinic clients; there were 24 boys and 15 girls between the ages of 6 and 14. Their personality attributes were measured using the Rorschach Inkblot Test (Rorschach, 1994), and the Comprehensive System developed by Exner (1991, 1993, 2000) was applied, with the support of the clinical interpretation provided by Quintino-Aires (1999; 2009; 2012; 2014). Comparison of the three profiles showed four common aspects of personality structure: a deficit in cognitive perceptual skills, lack of self-control, limited relational skills, and low self-esteem. Differences in the three profiles revealed factors related to the functional characteristics of specific behavior patterns. Children with the hyperkinetic psychological profile show factors of difficulty in controlling their activity, impulsivity, and overlapping emotions about conscious action. Those with the oppositional defiant profile revealed factors of low self-confidence, low trust in others, high pessimism, loneliness, and structural stress. Finally, those with the antisocial profile had factors of a deficit in coping skills, lack of verbalization of affects and emotions, and egotism.

Guided by the principle that scientific knowledge should serve to transform reality and create suitable conditions of life for all, the Portuguese Association for Relational-Historical Psychology (APPRH) founded a school named RITA LEAL (RLS), with a therapeutic purpose based on new perspectives for treating autism — perspectives quite different from instrumental and behavioral learning programs. The Rita Leal School (Leal, 1975/2004, 1997, 2005, 2010) is rooted in the theory that mental development is based on a mutually contingent emotional relationship, while it underwrites Vygotsky’s concept of the Zone of Proximal Development (ZPD) and Mediation (1930/2004, 1934/2009). Learning to read is a complex process which individuals with Autism Spectrum Disorder (ASD) master slowly and with difficulty. We analyzed the process of learning to read of two ASD children accompanied by peers without special educational needs, aiming to pinpoint distinct aspects of their progress. We used the Observer Software Program to collect and analyze observations of their performance, which were understood as data to be classified according to previously specified codes. We believed we could demonstrate that, especially in the case of ASD children, learning is dependent on contingent responses and adequate levels of mediation. The technical team at the RLS has continuous clinical supervision. That is because we believe this supervision is what permits the team to undergo a process of de-centering, becoming more empathic and accessible to the autists. This makes the team’s intervention more efficient, because it becomes more aware of each autist’s individual characteristics, and therefore more available to respond to the autist’s needs.

Low birth weight has a negative impact on psychomotor development, specifically on motor and perceptual functions. In order to prevent this effect, neurodevelopmental diagnosis should be supplemented by an effective therapeutic system. The aim of this work was to test a program for psychomotor development based on A.R. Luria’s concept of three functional brain units or blocks and the necessity of stimulation of the first functional unit in early childhood. Stimulation of subcortical systems associated with psychomotor and cognitive regulation may help to set the basis for positive functioning of the cerebral cortex in the coming years. Vestibular exercises and proprioceptive stimulation were used. All exercises included significant communicative activity as described by Vygotsky and Lisina, which provided positive direct emotional contact between adult and child. Twenty-five babies with low birth weight were included in the study, along with their parents. After 250 days in the program, all the underweight children presented positive functional development. We conclude that positive effects of these programs for correction and psychological development may be achieved during the first year of life. The methods for sensitive diagnosis and correction should be considered by all specialists involved in topics of early development.

This article deals with vital questions of the health and safety of children with intellectual disability (mental disability and mixed specific disorders). Theoretical analysis has demonstrated insufficient study of the problem, both in national and foreign psychological and pedagogical studies, although a number of approaches exist. Researchers agree that development of these children is an important condition for the existence of both individual and society at large. At the contemporary stage of development of our society, the safety of the children is all the more relevant since the degree of their development is an important condition of socialization and normal interaction with the environment. Diagnostic tools to estimate the comprehension and recognition of unsafe situations by children with these disorders are still insufficiently developed.

This paper describes the application of a technique called “Recognition of Unsafe Situations”, which was designed to study the ability of children with intellectual disability to recognize potentially life-threatening situations (handling household appliances, electricity, medicine, hot or sharp objects, behavior at heights and with stray animals) and to predict the consequences of their actions in such situations. The results of this study allow us to determine the differences in recognizing unsafe situations by children with mental disability and children with mixed specific developmental disorders. We show that children with mixed specific developmental disorders have a certain ability to identify potentially unsafe situations, and with support provided by adults, they are able to predict the consequences of their actions. Children with mental disability, however, have insufficient knowledge of safe behavior; but special activities that take into account these children’s ability to compensate enable them to develop the essential skills for behavior in potentially life-threatening situations.