CONDIÇÕES GERAIS DO PÉ QUENTE BRADESCO PRIME AMAZONAS SUSTENTÁVEL PM I – INFORMAÇÕES INICIAIS SOCIEDADE DE CAPITALIZAÇÃO: BRADESCO CAPITALIZAÇÃO S/A CNPJ: 33.010.851/0001-74 PÉ QUENTE BRADESCO PRIME AMAZONAS SUSTENTÁVEL PM PLANO PM 60/60 P - MODALIDADE: TRADICIONAL PROCESSO SUSEP Nº: 15414.100141/2012-89 WEB-SITE: www.bradescocapitalizacao.com.br II
Conversely, injection forms, though being painful and needing help of medical personnel for application, help to quickly achieve necessary concentration of preparation in blood buy antibiotics online Antibiotic is usually chosen in an empiric way (at random). But when choosing one is obligatory guided by definite rules.
07_wils 29.33A.N.Z.J. Fam. Ther., 2000, Vol. 21, No. 1, pp 29±33 Specific Cases, Techniques and Approaches Stories provide one way to say the unspeakable. Drawing on systemic, constructionist and narrative ideas, this paper offers a commentary upon the development of a therapeutic story for a seven year old child and her mother.
and Freedman 1990 and 1996; Dwivedi, 1997, Bowen & Robinson, 1999). Stories are ubiquitous in children's Along with some other therapists in recent years (see, for lives, whether through fairytales and/or television pro- example, Zilbach 1986; White and Epston 1995; Larner grams, or through talk in the school playground. Stories 1996; Wachtel 1996; Cattanach 1997; Selekman 1997), this are culturally bound constructions and can be useful in paper attends to the voice and experience of children in bringing new meaning, new thinking and new expres- therapy.The common concern of these practitioners is the sions of experience to the predicaments of children (as wish to make the child's encounter with a therapist atten- well as adults). But how do these stories come to us? If tive to the child's age and stage of development.To do this therapy is a co-constructed enterprise then the therapist effectively means that the therapist is constantly on the must first pay attention to the story told by the other.
lookout for opportunities to make a useful connection The ability to listen attentively is fundamentally impor- with the child's perspective (Stith, Rosens, McCollum, tant since from this listening come the improvisations Coleman, and Herman 1996; Wilson, 1998).
that lead to the creation of a story peculiar to the client's I describe the development of a story which grew out of the exchanges between myself and members of Billie's family. I then offer a commentary on the development of systemically informed therapeutic stories, in an attempt to show how concepts come to mind. The approach avoids too much intentionality by the therapist. Instead I suggest Billie is a seven year old girl who is brought to see me by an approach focused on attentive listening with a systemic Jenny, her mother. Jenny is blind in one eye following a `ear'and an ability to notice the ideas which come alive to terrible assault by her partner nine months earlier. Billie us in our meetings with children in therapy.
was present when her mother was beaten and `cleared up the blood to make it better'. Jenny's partner, Bill, is now in prison but will be released in a year's time.
The mother wants help for Billie, who is fearful and Practitioners have amply documented the use of written bossy and sometimes a very real challenge to her mother's and spoken stories using metaphor and symbolism as effective ways of engaging children in therapy (Combs Jenny has been trying to move house since the most recent (and final) assault, which led to her partner's im- prisonment. She wants to escape. She has begun to make plans for a new future with her daughter in a different *Jim Wilson is a Family Therapist and Training Director at The area. She receives support from a women's refuge volun- Family Institute, Cardiff which is part of Barnardos' work in Wales, UK. Address: 105 Cathedral Road, Cardiff, Wales, CF1 During the initial, nervous consultation Billie plays very quietly and the mother talks rapidly about her situation and her worries for her daughter. Jenny wants hearing more stories of the pain and the panic that they me to help her daughter to get over Billie's witnessing of her father's violence. Slowly, over the first few meetings Jenny and I discussed how best to arrange to read the with the mother and daughter I begin to form a picture of story to her daughter; I emphasised that Jenny would be the history of abuse suffered by Jenny. In Billie's ex- the best judge of the timing of this: she should not feel changes with me she begins to settle more and to talk of obliged to read the story to Billie unless she felt it was her friends, but she does not talk of her father's violence safe enough to do so. This sort of instruction places the parent in a position of active involvement and responsi- The following story comes to mind as a way of con- bility for the telling and hearing of the story. As Penn and necting with Billie about this inexpressible and perhaps Frankfurt (1994) illustrate, this form of reading can lead unthinkable event. The themes which emerge in the fol- to the mother's re-understanding of her own position, lowing story of the two goldfish are based both onJenny's through hearing herself tell the story in this metaphoric play and on my talking with Jenny and Billie together.
form. It speaks to her predicament as well as her The story is an offering, an invention based on my under- standing of the experiences of both mother and daughter.
After Christmas, Jenny and Billie returned and I found Billie has two pet goldfish.The story was offered to Billie that Jenny had decided to read the story in short instal- before Christmas 1998 for the mother to read to her as and ments. It provoked more reflection and discussion between when she judged the time right.When I gave her the story mother and daughter in the next session. The story of the she accepted it as a gift in return for her giving me a toy goldfish became a safe focus; the metaphorical parallels with the family's experience were close enough, without being too threatening to either of them. As with other less direct approaches, it was important for me not to `overwork' the meanings of the story. It is more useful to In giving this story to Billie and her mother, timing was leave these open, avoiding the possibility of imposing crucial. The point of the exchange at Christmas-time one's own biases through the interpretations one makes.
seemed to bring Billie and me together in mutual accept- After nine months, my work with Jenny and Billie is ance and new trust. Billie's play had been so fragmented coming to an end. When I last met with them in their and her mother's worries so preoccupying and frantic that new home, Billie played `house moves' with me as a at times I felt it was difficult to catch my breath before `neighbour'. After a short while her friends called to go A.N.Z.J. Fam. Ther., 2000, Vol. 21, No. 1 `I hope he has gone for good!'said Melissa.`I never want to see him again. He was so bad to you. He should never have bashed you with his tail and hurt you so much. This is our bowl. It has always been our bowl. Why do you think he Melissa was a very pretty young fish indeed. She was a gold- fish. She swam around in her goldfish bowl quite happily, in Samantha couldn't find the words to explain to her daughter.
and out of the pretend seaweed, playing with her mother, She too had found the Silvery Prince someone she once liked Samantha. Samantha was a proud and beautiful goldfish.
very, very much. `How is it possible?', she said to herself in She and Melissa would enjoy swimming around each other, goldfish language,`How is it possible to like someone so very, looking at the world outside from their goldfish bowl. (Have very much and yet he should do such bad things? This is you ever imagined what a goldfish sees when she looks out from a goldfish very confusing.' It made her swim round and round in frantic bowl? She probably sees funny shapes of people and television sets and won- circles trying to make sense of this. Slowly, over the follow- ing goldfish-weeks and months, and even a goldfish year, One day Melissa and her mother were having a bite to Melissa and Samantha began to feel more safe again. But they eat (ants eggs seemed to drop in from the sky as if by magic).
always had one big worry. Do you know what this worry All of a sudden there was an almighty splash! A very hand- was? It was this: would there be a time, sometime in the some new goldfish appeared. He had a black line down his future when there would be a big splash and the Silvery back and silvery fins. After being surprised Samantha and Prince might come back again? This was frightening for Melissa got on very well with this new, handsome Silvery Samantha and for Melissa. (Sometimes when people are frightened Prince (as they decided to call him). They began to like him; they think it is best notto talk aboutthe frightening thing and I can under- he made them laugh and life inside the goldfish bowl was stand that, because we all like to try to forget frightening things.) As Melissa swam around the goldfish bowl she said to But, one day when they were all swimming around, the herself, `I wonder: if I had been nicer to that Silvery Prince Silvery Prince said,`This goldfish bowl is too small and you would he have liked me better and liked my mum better? (pointing to Samantha and Melissa) are taking up too much Maybe I made him do something to hurt my mum, but I can't think what that would have been. Maybe if I had Samantha and Melissa were shocked and frightened.Their shared my food a bit more or let him play a bit more behind goldfish eyes opened very wide and their mouths opened the seaweed. Even though I am angry about what he did, sometimes, just sometimes, I would like to hear how he is, Before Samantha could tell the Silvery Prince that this was and if he is unhappy. I wonder if he is in another goldfish her bowl and belonged to no one else he whacked her so bowl on his own, or if he has a friend? I wonder what he hard with his tail that she flew against the side of the bowl looks like now? I wonder if he still has the silvery gills and and hurt her fins very badly. She lay there and couldn't get that black line on his back? I wonder if I will ever see him up. Melissa was very frightened. (It was the kind of fright where you don't really know whatto say or whatto feel.You just know something Melissa's mum sometimes felt sad about the things that wrong has happened and you don't like it.) had happened. She even thought, `Maybe I have myself to Melissa wanted it to be all better again. She wanted the blame. If only I had kept him away from us. If only I had goldfish bowl to be a happy place once more. She wanted spoken to him a bit more strongly. If only I had seen that the Silvery Prince to be nice again, to be good to her and he wanted to take over this goldfish bowl. Maybe Melissa her mum. She wanted him to like her because deep down wouldn't be so upset.' She wanted to tell Melissa how much inside she liked him very much and he was good fun at she loved her and how much she was sorry that bad things times. But this was a bad thing he had done and she didn't Yet some good things began to happen too: the goldfish Slowly Samantha got up and began to swim again. It took bowl was beginning to look smart again.The water was calm.
a while and she was always frightened about what the Silvery They could breathe through their gills more easily. Samantha Prince might do next. For a long time Samantha and Melissa also made some special plans. She was becoming a stronger said nothing to each other.They just kept themselves hidden goldfish. Melissa liked that. She could see there was a quick- behind the pretend seaweed. The Silvery Prince swam ness now in the way Samantha seemed to patrol the goldfish around like he was the King of the sea.
bowl and slowly, slowly at first, Melissa began to play again.
Melissa and her mum were very unhappy. They showed She began to pick little pebbles up and play with them in the this by keeping very quiet or sometimes getting very very bowl. She began to dart in and out of the pretend seaweed angry and flapping their tails around. But they didn't cry like like she used to do! She began to want to have some more human beings do (maybe, because tears are made from water we can't friends again. She remembered that goldfish actually swim around in big groups called `schools', and when she started Anyway, one day there was another big splash. This time, to think of this she felt good. Her tail would flick a little bit when Melissa and Samantha opened their eyes the Silvery and she would dart around the goldfish bowl. She could see Prince was gone. At first Samantha and Melissa couldn't be- slowly, slowly at first, that things over the last goldfish-year lieve it. They breathed a big sigh of relief through their gills and began to gently and slowly swim out further and further This is the end of this part of the story of Melissaöthere from behind the pretend seaweed, until they began to feel a could be more adventures and things to say but this is little bit more at home again. Samantha said,`I wonder where Melissa's story so far. (What do you think could happen next swimming and I was secretly pleased to be relegated once story. The general attitude is close to the attitude of practitioners involved in reflecting teams and processes (Andersen, 1987 and 1990). The orientation of the writer of the story is one of attempting to appreciate the child's situation rather than judging or offering definitive inter- Our professional theories, as well as our personal experi- pretations of her reality. Perhaps the orientation is best ences, are wells of experience and resourcefulness which considered in the light of the following claim by the can be drawn upon for the benefit of the people we see in therapy. Systemic therapy, informed by narrative and . children are amnesiacs behind enemy lines . Being a social constructionist ideas, draws me towards an appreci- child is largely a flux of bold and furtive guesswork, fixed ation of how the internal experiences of children in ideas continually dislodged by scrambling and tentative therapy can be contextualised and given fuller expression.
revision . All our energy and cunning go into getting our In so doing we may try to introduce more expanded, less bearings without letting on that we are ignorant and lost blameworthy or confining meanings to prior experiences.
I assume that the child's trauma will be associated with central themes and internal responses to these: the loss of her parent through imprisonment and the fearfulness of what had been experienced sit alongside her wish to Creating stories with, and offering them to, children can be in touch in some way with her father. These themes enhance therapeutic potential by employing a child- were only marginally alluded to in the prior sessions with friendly idiom. The active involvement of the therapist Jenny and her daughter but alluded to enough for them in devising, structuring and offering a tailor made story to be included as central themes in the story. The notion to a family may, in itself, enhance rapport and motivation of each story offered containing an inherent systemic within the therapeutic process. Crucial to the stimulation logic (Cecchin, Lane and Ray, 1994) equips the writer of one's imagination is attention to the imagination of with an orientation which helps introduce complexity children in our play and talk with them. This capacity, into the client's account. In essence the story takes the together with a sense of realistic optimism, are necessary shape of a systemic narrative offered to the child and for the emergence of improvised, case specific stories.
The therapist should not feel the need to structure the story as an imposition. Listening to the expressions of children and being educated by their play is often more than enough to trigger story lines in the mind of the There are always options for parents to write their own stories and for children and therapists to embark on a joint writing expedition (Marner, 1995). If the story is written by the therapist, the key idea of applying systemic Andersen,T.,1987.The ReflectingTeam: Dialogue and Meta Dialogue in Clinical Work, Family Process, 26: 415^428.
logic to a child's situation helps a therapist to avoid Andersen,T. (Ed.), 1990.The ReflectingTeam, NY, Norton.
judging the various characters too harshly (for example, Cattanach, A., 1997. Children's Stories in Play Therapy, London, Jessica the father in this case). Characters are neither demonised or sanctified, since this speaks to only one dimension of Cecchin, G., Lane, G. and Ray, W., 1994. The Cybernetics of Prejudice, the significant adults in the child's life. These stories do Combs, G. and Freedman, J.,1990. Symbol,Story&Metaphor, NY, Norton.
not have romantic or `Hollywood' endings, in fact, one Dwivedi, K. N. (Ed.), 1997. TheTherapeutic Use of Stories, London, Rout- important element is that some unspeakable truth may find expression in the telling. The therapist keeps the Freedman, J. and Combs, G., 1996. NarrativeTherapyöThe Social Construc- client's way of talking and the quality of the therapeutic tion of Preferred Realities, NY, Norton.
Killick, S. and Wilson, J., 1999.Weaving Words and Emergent Stories.
relationship uppermost in her/his mind in order to create In B. Bowen and G. Robinson (Eds), Therapeutic Stories, Canterbury, a useful fit between the story, the listener and the teller.
If the story is too hopeful we risk being seen as na|«ve.
Larner, G., 1996. Narrative Child Family Therapy, Family Process, 35: If we become too engrossed in our enthusiasm we can lose sight of the client's scepticism. If we become too Marner, T., 1995. Therapeutic Letters To, From and Between Children in FamilyTherapy, Journal of Social Work Practice, 9, 2: 169^176.
organised by instruction in the story, we risk becoming Moore, L. (Ed.), 1997.The Faber Book of Contemporary Stories about Childhood, moralisers.The therapist has to be careful to sidestep such traps and at the same time, develop a relevant story that Penn, P. and Frankfurt, M., 1994. Creating a Participant Text: Writing, holds within it the capacity for new possibilities to be MultipleVoices, Narrative Multiplicity, Family Process, 33, 3: 217^231.
Selekman, M. D., 1997. Solution Focused Therapy with Children, NY, London, heard by the reader and the listener.
The stories use symbols and metaphors chosen to Stith, S. M., Rosens, K. H., McCollum, E. E., Coleman, J. U. and ignite the child's imagination. Central to all of this en- Herman, S. A., 1996. The Voices of Children: Preadolescent Child- deavour is the therapist's desire to try to see the world, ren's Experiences in Family Therapy, Journal of Marital and Family as far as possible, through the eyes of the child.This form Wachtel, E. F., 1994. Treating Troubled Children and their Families, NY, of systemic empathy helps shape the main themes in the A.N.Z.J. Fam. Ther., 2000, Vol. 21, No. 1 White, M. and Epston, D., 1990. Narrative Means toTherapeutic Ends, NY, Wilson, J., 1998. Child Focused PracticeöACollaborative Systemic Approach, Thank you to Yasmin for the drawing, to colleagues and trainees at The Family Institute, The Newry Family Resource Centre, Diamond Zilbach, J., 1986.Young Children in FamilyTherapy, NY, Brunner/Mazel.
House and others in the Northern Ireland network, for contributing For other articles that focus on children, think of: Seymour, F. W., Bayfield, G., Brock, P. and During, M., 1983. Management of Night-Waking in Young Heins, T., 1988. Relearning Childthink, ANZJFT, 9, 3: 143^149.
Gerrard, J. M., 1991. The Teasing Syndrome in Facially Deformed Children, ANZJFT, 12, 3: 147^154.
Boland, C., 1993: Child Behaviour Management Programs: Avoiding Parental Drop-Out, ANZJFT, 14, 3: If you've missed out on these, consult the editors about the back issues in their shed. Single issues, Volumes 1^17, $5.00 per issue, postage additional, from the editors.
For Volume 18 on, contact Blackwell.
MANAGEMENT AND OPERATION OF ST. CYRIL & METOD HEALTH CENTRE Management Team In order to streamline the management of the hospital it was recently decided that the hospital should be registered as a trust deed under trustees. This was done and the following is the current composition of the caretaker management committee; Lions representatives – 2No Local catholic churc