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The paper considers a 'befallment' that occurred in the course of analysis at a time when the focus of work was too much at a conscious level, dissociated from the patient's embodied and visceral depths. A rigidly held attitude of focal attention is considered as potentially a defence against embodied experiences of overwhelm and vulnerability that may haunt shadowy realms which remain unlit by the narrow beam of conscious awareness. Rather as a dream drifts in from the unconscious, an enactment by the analyst brought neglected aspects of the transference and countertransference relationship into the room. Later, the patient's own dreaming mind offered images that suggested an underlying dynamic. These subtle communications, alongside the patient's attitude toward the analyst's lapse, are considered as factors in the achievement of greater embodied integration. The analyst's difficulty in arriving at a formulation of such events is discussed, along with the necessity of holding such 'befallments' in mind over long periods of time before any explanation can be adumbrated.

L'article examine un « ratage ¼ qui se produisit durant une analyse à une période pendant laquelle l'axe du travail était à un niveau trop conscient, dissocié des profondeurs incarnées et viscérales du patient. Tenir de manière rigide une attitude où l'attention consciente occupe une place centrale est considéré comme étant potentiellement une défense contre des expériences incarnées de débordement et de vulnérabilité. Expériences qui peuvent hanter des régions pleines d'ombres, et que le rayon étroit de la perspective consciente ne parviendra pas à éclairer. Un peu de la même manière que le rêve arrive de l'inconscient par un mouvement qui s'apparente à une dérive ou un glissement, un agir de l'analyste a apporté dans la salle de consultation des aspects négligés de la relation transfert/contretransfert. Plus tard, c'est l'esprit en mesure de rêver du patient qui a offert des images suggérant une dynamique sous-jacente. Ces communications subtiles, ainsi que l'attitude du patient envers la défaillance ou l'écart de l'analyste, sont considérées comme des facteurs facilitant l'accomplissement d'une meilleure intégration, plus incarnée. La difficulté de l'analyste à parvenir à une formulation de tels événements est abordée, ainsi que la nécessité de garder de tels « ratages ¼ en tête pendant de longues périodes avant qu'aucune explication ne puisse être esquissée.

El artículo considera un 'suceso accidental' que ocurrió en el curso de un análisis, en el momento en el que el foco del trabajo se hallaba a un nivel demasiado consciente, disociado de las profundidades viscerales y corporizadas del paciente. Una actitud de atención focalizada rígidamente sostenida es considerada potencialmente como una defensa contra experiencias abrumadoras y de vulnerabilidad encarnadas, que pueden acechar aspectos o dominios en sombra, los cuales permanecen sin ser iluminados por el estrecho haz de luz de la consciencia. Como un sueño que fluye desde el inconsciente, un 'enactment' de la analista trajo al espacio aspectos negados de la relación de transferencia y contratransferencia. Luego, la propia mente soñante del paciente ofreció imágenes que sugirieron la dinámica subyacente. Estas comunicaciones sutiles junto a la actitud del paciente respecto al lapsus de la analista, son considerados como factores en la consecución de una mayor integración corporizada. Se plantea la dificultad de la analista para acceder a una formulación de semejantes eventos, junto con la necesidad de sostener semejantes 'sucesos accidentales' en mente a lo largo de largos períodos de tiempo antes que alguna explicación pueda ser vislumbrada.

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Beginning with the story of Bluebeard, the author considers how traumatic overwhelm can occur in everyday childhood situations of a psychically murderous quality; for example, a nanny's totalitarian regime may be invisible to parents ruled by collective social and cultural norms. A child who is remote from mother and idealises a father embodying a powerful patriarchal system may remain naïvely dependent in marriage and unable to cope with the realities of human aggression. The paper describes analytic work with a woman who had suffered repeated breakdowns and needed to relinquish a fragile, socially constructed identity in order to establish her own true orientation.

Prenant pour point de départ l'histoire de Barbe Bleue, l'auteur examine comment le débordement traumatique peut se produire dans l'enfance dans des situations de tous les jours qui ont une qualité psychique meurtrière. Par exemple, le régime totalitaire d'une assistante maternelle (nourrice) peut être invisible aux yeux de parents régis par des normes collectives sociales et culturelles. Un enfant émotionnellement à distance de sa mère et qui idéalise un père incarnant un système patriarcal puissant peut rester dépendant d'une manière naïve étant marié et incapable de se débrouiller de la réalité de l'agressivité humaine. L'article décrit le travail analytique avec une femme qui a vécu des dépressions à répétition et qui devait renoncer à une identité fragile, construite selon des normes sociales, afin d'établir son orientation personnelle authentique.

Comenzando con la historia de Barba Azul, la autora considera cómo una devastación traumática puede ocurrir en situaciones cotidianas de infancias con cualidades de asesinato psíquico; por ejemplo, el régimen totalitario de una abuelita puede resultar invisible a los padres regulados por normas colectivas sociales y culturales. Un niño controlado por la madre y que idealiza a un padre que representa un sistema profundamente patriarcal, puede permanecer ingenuamente dependiente del matrimonio e incapaz de hacerle frente a las realidades de la agresión humana. El artículo describe el trabajo analítico con una mujer que sufrió repetidas crisis y necesitó renunciar a una frágil identidad, socialmente construida para poder establecer su propia y verdadera orientación.

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The effect of a boundary in analytic work at the summer holiday break is discussed in relation to archetypal experiences of exclusion, loss and limitation. Some attempts by patients to mitigate an analyst's act of separation are reviewed as enactments, and in particular the meanings of a gift made by one patient. Analytic attitude towards enactment from within different schools of practice is sketched, with reference to the effect on the analyst of departing from the received practice of their own allegiance. A theory is adumbrated that the discomfort of 'contravening the rules' has a useful effect in sparking the analyst into consciousness, with greater attention to salient features in an individual case. Interpretation as an enactment is briefly considered, along with the possible effects of containing the discomfort of a patient's enactment in contrast to confronting it with interpretation.

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In Mpumalanga province, more than 45 000 persons with disability receive a disability grant. Although research regarding social grants in general and disability grants specifically had previously been conducted from various perspectives, none has been carried out in Mpumalanga and none to explore the impact of the disability grant on the lives of the recipients. The objective of the study was to gain an understanding of the impact of the disability grant on the lives of recipients living in Mpumalanga. The study was conducted as a contextual, exploratory and qualitative study. The target population was persons with a disability receiving a disability grant. Data gathering was conducted in October 2010 using a semi-structured interview technique. The data were analysed in terms of the social and economic impact of the disability grant in the life of the participant. A combination of three qualitative data analysis methods was used to analyse the data. The qualitative findings indicate that although it is an individual grant, the disability grant was used to support the whole family and was frequently the family's only income. Food, clothes and electricity was most frequently bought with the disability grant. Food often did not last for a month. The families were living precariously and any crisis, for example lapsing of the grant, would result in hunger and desperation as a result of their complete dependence on the disability grant.Without insight in how people live their lives, registered nurses may give health education to patients that they cannot implement, perpetuating the burden of disease in South Africa.

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Pain has been recognized as an important, highly prevalent, and debilitating symptom of HIV and AIDS. In South Africa, many people living with HIV and AIDS utilize primary health clinics for pain management. Primary health clinics are nurse led and face a variety of challenges pertaining to pain management. The purpose of this study was to explore if HIV and AIDS pain is effectively managed in a primary health clinic in Tshwane, South Africa. The study aimed to explore the level and characteristics of HIV- and AIDS-related pain, the pain-related experiences of patients and if pain was managed according to the applicable guidelines of the Department of Health. A quantitative survey was conducted. The target population was HIV and AIDS patients who had been using the primary health clinic for chronic pain management. The sampling method was convenience (n = 500). Data were gathered by means of structured interviews and structured observation. The data were analyzed using the SSPS 15 program and open coding. The study provided evidence that HIV- and AIDS-related pain is not managed effectively. Despite repeated visits to the primary health clinic, the overwhelming majority of patients still experienced pain. Nurses added to the suffering, because they lacked knowledge of pain and pain management. It is recommended that nurses practicing in primary health clinics should be trained and supervised to effectively manage the pain of people living with HIV and AIDS.

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PURPOSE: The purpose of the study was to explore if cervical cancer information presented in a non-stigmatizing manner could promote screening in women living in a resource poor environment in Tshwane, South Africa. METHODS: An exploratory, contextual, quantitative door-to-door survey was conducted. The sampling method was convenience (n = 105). Structured interviews were used to gather self-reported data. Chi-square tests were used for secondary data analyses. RESULTS: The study provided evidence that presenting information on cervical cancer in a non-stigmatizing manner based on the theme of self protection promoted cervical screening. The study further provided evidence that women preferred a cervical cancer message that does not focus on the sexual risk factors of this disease. More than a third of the sample preferring a message introducing cervical cancer as a sexually transmitted infection (n = 32) were of the opinion that this message were stigmatizing, blameful and displayed misunderstanding of their lives. CONCLUSIONS: Cervical cancer screening is indeed not simple. The screening rate not only in South Africa but many other countries serves as proof. It can therefore not be afforded to add to the barriers by presenting information on cervical cancer in a way perceived as stigmatizing and blameful. Presenting information in way that women prefer might not only promote cervical screening, but might motivate them in such a way that they are screened.

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PURPOSE OF THE RESEARCH: The purpose of the study was to explore what women living in Ga-Rankuwa in Tshwane, South Africa know and understand about cancer as well as their health seeking behaviour should they suspect that they might have cancer. METHODS AND SAMPLE: An exploratory, contextual, quantitative door-to-door survey was conducted. The sampling method was convenient (n=565). Data were gathered by means of self-reports using structured interviews. KEY RESULTS: The study provided evidence that, despite all the interventions to teach the community about cancer, women had a low level of knowledge and understanding of cancer. Cancer was seen as something that primarily happens to the breast. There was no link between the perception of cancer and the seriousness of the warning signs. It is doubtful if the woman, except for the possibility of a lump in the breast, would recognize any sign of cancer and consider it to be serious. Women still needed to ask permission to seek health-care and in some instances, the health care provider was chosen for them. Not all women were prepared to spend money of their own health and some would even feel guilty should they do so. CONCLUSIONS: Women's knowledge and understanding of cancer and health seeking behaviour related to cancer do not facilitate early detecting and therefore the possibility to be cured. The fundamental strategy of primary and secondary prevention of cancer, teaching the community, remains a challenge for both nursing practice and nursing research.

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The concepts of home and migration are briefly explored. Reference is made to the reflections of several writers on migration suggesting that migrants may experience alienation, even permanent melancholia. There is discussion of the need to mourn what has been lost and left behind, and of the challenge in analytic work with a migrant to relate to the pain of the individual's core self amid environmental and cultural losses. The paper outlines the history of an individual before her migration from Latin America to London, and tendency to idealize as a new arrival. The symbolization process is discussed and it is suggested that repetitive enactment in the analytic transference may have been needed for her internal reality of estrangement to be confirmed and differentiated from her culturally and socially isolated external life as a migrant. Only then could she mourn losses and symbolize her inner reality. It is suggested that through mourning and symbolization the significance of migration for the patient was worked with and transformed so that, following a second migration, an ordinary, good enough home could be made in a new place.

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In South Africa, in 2005-06, 100% of primary health care clinics in South Africa had health professionals trained to conduct Pap smears, yet the screening rate was only 1.3% and one in 26 women develop cervical cancer during their lifetime. Many women admitted to oncology wards are at such an advanced stage of disease that palliation is the only treatment option left. The purpose of this qualitative study in 2007, using semi-structured interviews with 15 women with advanced cervical cancer, was to understand the routes they followed from first signs and symptoms of disease to receiving treatment. The willingness of the women to be diagnosed was a positive finding of the study. The women did seek treatment, often more than once, and were not solely responsible for presenting late. The average number of months from first contact with a health care professional until diagnosis was 17.3, ranging from 11.8 months for urban participants to 28.4 months for rural participants, and three to seven months from diagnosis to referral for treatment. Lack of knowledge and awareness among health care professionals resulted in a low suspicion of cancer and misdiagnosis. A national cervical cancer strategy, including health education and re-training of health professionals, should be made a priority.

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