Complementary Therapies in Clinical Practice 21 (2015) 1e6
Contents lists available at ScienceDirect
Complementary Therapies in Clinical Practice
journal homepage: www.elsevier.com/locate/ctcp
The biopsychosocial spiritual model applied to the treatment
of women with breast cancer, through RIME intervention
(relaxation, mental images, spirituality)*
rio Ricci a, b,
Ana Catarina Araújo Elias a, b, *, Marcos Deside
b
rgio Henrique Diaz Rodriguez , Stela Duarte Pinto b, Joel Sales Giglio c, d,
Lo
Edmund Chada Baracat a, b
~o Paulo (FMUSP), Brazil
Department of Obstetrics and Gynecology of the Faculty of Medicine, University of Sa
~o Paulo (ICESP), Brazil
Institute of Cancer of the State of Sa
c
Department of Medical Psychology and Psychiatry of the Faculty of Medical Sciences, State University of Campinas (FCM UNICAMP), Brazil
d
Jungian Association of Brazil (AJB) Linked to the International Association for Analytical Psychology (IAAP)), Brazil
a
b
a b s t r a c t
Keywords:
Spirituality
Brief psychotherapy
Psychosomatic medicine
Imagery (psychotherapy)
Complementary therapy
This postdoctoral study on the application of the RIME intervention in women that had undergone
mastectomy and were in treatment, aimed to promote psychospiritual and social transformations to
improve the quality of life, self-esteem and hope. A total of 28 women participated and were randomized
into two groups. Brief Psychotherapy (PB) (average of six sessions) was administered in the Control
Group, and RIME (three sessions) and BP (average of five sessions) were applied in the RIME Group. The
quantitative results indicated a significant improvement (38.3%) in the Perception of Quality of Life after
RIME according to the WHOQOL, compared both to the BP of the Control Group (12.5%), and the BP of the
RIME Group (16.2%). There was a significant improvement in Self-esteem (Rosenberg) after RIME (14.6%)
compared to the BP of the Control Group (worsened 35.9%), and the BP of the RIME Group (8.3%). The
improvement in well-being, considering the focus worked on (Visual Analog Scale), was significant in the
RIME Group (bad to good), as well as in the Control Group (unpleasant to good). The qualitative results
indicated that RIME promotes creative transformations in the intrapsychic and interpersonal dimensions,
so that new meanings and/or new attitudes emerge into the consciousness. It was observed that RIME
has more strength of psychic structure, ego strengthening and provides a faster transformation that BP,
therefore it can be indicated for crisis treatment in the hospital environment.
© 2015 Elsevier Ltd. All rights reserved.
1. Introduction
From the twentieth century to the present moment the possible
transformation of the biomedical model (focus on the mechanisms
*
Postdoctoral Study by the first author entitled “Resignifying the experience of
being a breast cancer patient by using the RIME intervention for quality of life
promotion”, under the supervision of the sixth author, co-supervised by the second
author, with the collaboration of third, fourth and fifth authors.
Mastology Service of the Gynecology Discipline of the Faculty of Medicine, University of S~
ao Paulo (FMUSP) and Hospital Psychology Service of the Institute of Cancer
~o Paulo. Address: Avenida Doutor Arnaldo, 251 e Cerqueira Ce
sar,
of the state of Sa
S~
ao Paulo e SP, Brazil. CEP: 01246-000.
* Corresponding author. Rua Juquis, 391 ap.62B, Bairro Moema, CEP 04081-010
S~
ao Paulo, SP, Brazil.
E-mail address: [email protected] (A.C.A. Elias).
http://dx.doi.org/10.1016/j.ctcp.2015.01.007
1744-3881/© 2015 Elsevier Ltd. All rights reserved.
of organic disease) into the biopsychosocial model (focus on the
subject, interrelating the biological, psychological and social factors) has been an important study object. Leading researchers
advocate bidirectional dialogue and integration between the two
models [1], i.e., that studies are conducted demonstrating the
benefits and contributions for medical treatments by the inclusion
of sociopsychic factors, however, that the importance of biological
treatment is also observed with the advanced technology of the
biomedical model, for the social and psychological well-being of
the patient.
The findings of the study reported in this article are in accordance with the proposal cited above [1], since it was observed that,
faced with the diagnosis of breast cancer, patients experienced
significant distress and despair, loneliness and anger, however,
such anxieties were minimized by clinical treatment, with
2
A.C.A. Elias et al. / Complementary Therapies in Clinical Practice 21 (2015) 1e6
emphasis on biomedical excellence. This enabled the emergence of
other psychological suffering, which apparently had no connection
with the disease yet influenced the perception of quality of life and
the self-esteem of patients, and that were worked on through the
RIME intervention (Relaxation, Mental Images and Spirituality)
resulting in improved perception of quality of life in general, the
amplification of self-esteem, as well as the promotion of creative
transformations in the intrapsychic and interpersonal dimensions
of these patients, so that new meanings and/or new attitudes
emerged for awareness, thus applying the biopsychosocial and
spiritual model to the treatment.
The integration of the spiritual dimension of the human being to
the biopsychosocial model has been an important object of study in
the academic community. Spirituality is related to the transcendent, to the sacred aspects of the existence and to the universe, and
in a search of the PubMed database, 1109 relevant articles were
found on the clinical application of spirituality for mental health
[2], which corroborates this statement.
The RIME intervention integrates relaxation techniques, guided
imagery and elements of spirituality, with a transpersonal symbolic
approach and was developed in the Master's degree [3e5] of the
first author to resignify the Symbolic Pain of Death (Psychic Pain
and Spiritual Pain) of patients without the possibility of a cure. In
the first author's doctorate [6e8] a training program was developed
for health professionals and both the experience of the professionals, as well as that of the patients, in the application of RIME
were studied. The results suggested that RIME promotes quality of
life, dignity and improved psycho-spiritual well-being in the dying
process, as well as psycho-spiritual benefits to the health professionals that apply it. The benefits achieved with the application
of RIME in patients with Alzheimer's dementia and their carers
were also studied, where improvements in interpersonal communication and in socio-emotional and spiritual aspects were
observed in the caregivers and the patients [9].
This article refers to the postdoctoral research of the first author
who studied the benefits of RIME in patients with the possibility of
a cure, choosing the treatment of breast cancer. This type of cancer
more affects women around the world, both in developing and
developed countries. For Brazil, in 2014, 57,120 new cases of breast
cancer are expected, with an estimated risk of 56.09 cases per
100,000 women [10].
In a systematic literature review [11] factors such as quality of
life, hopelessness and self-esteem were considered important
sources of resilience (ability to emerge from adverse situations
strengthened and transformed for the better), in coping with somatic diseases, and faced with these findings, the authors [11]
concluded that such factors need to be considered and possibly
incorporated into psychological and psychiatric care for physically
ill individuals.
The aim of this study was to apply the RIME intervention with
mastectomized women undergoing breast cancer treatment, with
the possibility of a cure, in order to elicit the transcendent function
[12], i.e., as a facilitator for the establishment of dialogue between
the conscious and unconscious contents, favoring the sociopsycho-spiritual transformation of these patients, with the intention of positively affecting the ‘quality of life’ and psychological
aspects of ‘hopelessness’ and ‘self-esteem’.
2. Methods
This study was approved without restrictions by the Research
Ethics Committee of the Faculty of Medicine, University of S~
ao
Paulo, under process number: 70430, dated: 08/08/2012.
During the year 2013, 34 patients who had undergone mastectomy and were in the breast reconstruction and adjuvant treatment
process, with the possibility of a cure, were referred by the Plastic
~o
Surgery Outpatient Clinic of the Cancer Institute of the state of Sa
Paulo (ICESP). Of these, 28 were screened and randomly divided
into five groups, draw in the presence of the physicians of the
Mastology Outpatient Clinic of ICESP, with each group of patients
divided in two to compose the Control Group, who received up to
twelve sessions of Brief Psychotherapy (PB), from co-author 4, and
the RIME Group, who received three sessions of RIME from the
main author, and up to twelve sessions of BP from co-author 4. The
BP described in this study, in short, is psychotherapy with a defined
focus, over a limited number of sessions, and conducted through
verbal expression. After one year of screening the study was subjected to statistical analysis, considering the sample size required
for the difference between the groups to be longitudinally significant, considering a type one error of 5% and power of 95%. From
this, according to the study aims, it was concluded that the sample
of 28 patients was sufficient, including the withdrawal of three
patients from the RIME Group and three patients from the Control
Group for personal reasons.
A comparative, descriptive, exploratory method was used with a
quantitative-qualitative approach. A qualitative approach was
based on Analytical Psychology [12e16], for the symbolic interpretation of the data, with the processing of the data performed
through thematic content analysis [6e8]. The development of the
qualitative results was performed by consensus analysis, in a group
composed of the principal investigator and co-authors 3, 4 and 5,
with qualified knowledge in Analytical Psychology and Hospital
Psychology. The quantitative analysis was performed by a statisti~o Paulo School of Nursing, through the
cian of the University of Sa
‘mixed effects model’ method. The socio-demographics data of the
RIME Group and Control Group were subjected to Fisher's exact test
and Welch's t test, showing no significant differences, i.e., p values
greater than 0.05, as shown in Table 1.
The instruments for the qualitative data collection were recorded semi-structured interviews and graphical representations,
before the 1st session and after the 3rd session of RIME. The instruments used to collect the quantitative data for the RIME Group
and Control Group were the WHO Quality of Life-Bref instrument/
WHOQOL Bref [17]; Rosenberg's Self-Esteem Scale [18]; Beck's
Hopelessness Scale (BHS) [19]; and the Visual Analog Scale, colored
facial expressions model [6e8], which were applied after the
signing of the TFPIC (RIME and Control Groups), after the 3rd session of RIME (RIME Group), and after the BP (RIME and Control
Groups).
The main theoretical bases used for the development of RIME
were Analytical Psychology [12e16] and Near Death Experiences
[20e24].
The RIME application is initiated by the induction of a state of
mental relaxation through slow, deep breathing and listening to
soft music, previously chosen by the patient; next the visualization
of an image of nature is induced, also chosen by the patient (a
beach, waterfall, garden, field or lake) where a Supreme Spiritual
Being of Light that emanates absolute and unconditional Love,
previously defined by the patient according to their religion, waits
to accompany them in the experience. The Spiritual Being of Light
has a dual representation: in the symbolic, socio-psychic dimension, it represents the Self [14] (internal source) and in the spiritual
dimension it represents the psychic contact of the patient with the
Beings of Light (external source) [20e24], i.e., with Unconditional
Love, the Sacred, represented by the cultural dimension of their
religion.
The RIME intervention is structured through four basic images
of possible archetypal character, related to the alchemical phases
and operations [16] and refers to the Symbols of Transformation
[13]. From the nigredo raw content, the solutio is performed to reach
A.C.A. Elias et al. / Complementary Therapies in Clinical Practice 21 (2015) 1e6
Table 1
Socio-demographic data comparison between the RIME Group and Control Group.
p-Valuea
Group
Control
RIME
N
N
%
%
Religion
Catholic
Protestant
Spiritualist
Other
5
4
1
1
45.5
36.4
9.1
9.1
4
2
3
2
36.4
18.2
27.3
18.2
0.689
Education
Up to elementary
High school
Higher education
7
3
1
63.6
27.3
9.1
3
6
2
27.3
54.5
18.2
Marital status
Single
Married/stable union
Divorced/separated
Widowed
0
4
4
3
0.0
36.4
36.4
27.3
2
6
3
0
18.2
54.5
27.3
0.0
0.355
0.147
Reconstruction
Immediate with expander
Immediate with abdominal flap
Other
Operated breast
Right
Left
Bilateral
Age
a
b
creative potential that emerges from the unconscious and that
should be integrated into the consciousness, developed and experienced [12e16].
On completion of the experience, when the patient symbolically
prepares to return from the star to the place they left (beach,
waterfall, garden, field or lake), down the white staircase, they also
receive a blue cloak, symbolizing protection. The average application time of the experience is 25 min, plus the time required for the
verbal expression before and after the RIME application.
In the RIME Group three sessions of RIME were applied by the
principal investigator with each patient, with an interval of at least
one week between one session and the next, followed by up to
twelve sessions of BP by co-author 4. In the Control Group up to
twelve sessions of BP were applied with each of the patients by coauthor 4. The BP was terminated when the patient and the psychologist felt that the proposed focus had been sufficiently covered.
The average number of BP sessions for the RIME Group was five
sessions and six sessions for the Control Group.
3. Results
0.672
8
2
1
72.7
18.2
9.1
7
1
3
3.1. Quantitative results
63.6
9.1
27.3
0.790
Complication in the reconstruction
Physio/radio/chemo
3
3
3
0
50.0
50.0
0.0
3
5
2
30.0
50.0
20.0
2
11
18.2
100.0
2
10
20.0
100.0
1.000
1.000
Mean
SD
Mean
SD
p-Valueb
52.45
12.23
48.00
8.00
0.326
Fisher's exact test.
Welch's t-test.
the albedo through two images. 1st) Water represented by a
waterfall, beach/ocean or river, where the patient washes and
dissolves their suffering, their shadow content. The suffering
mentioned and chosen by the patient is dissolved. 2nd) Colorful
robes, where the patient experiences them all and then mentally
chooses the color of robe that they prefer, with reference to the
colors of the chakras postulated by Oriental traditions. Symbolically, the movement of progression or regression of the libido [12] is
observed and the transcendent function [12] is elicited. The
induced colors are: red, orange, yellow (warm colors/lower or
terrestrial chakras, suggesting progression of the libido); green, sky
blue, royal blue (cool colors, higher or psychic chakras, suggesting
regression of the libido); pink, violet, white, silver, gold (mixed hot
and cold colors together/spiritual chakras, suggesting that the
transcendent function was elicited). Then, through the third image,
coagulatio is performed to reach citrinitas. The quality chosen by the
patient is coagulated with their well-being and quality of life. 3rd)
In a star, the same color chosen for the robe, reached via a white
staircase, the patient receives golden seeds that are deposited by
the Supreme Spiritual Being of Light that emanates absolute unconditional Love in the forehead, throat, heart, navel, hands and
feet of the patient, to enlighten their thoughts, words, feelings,
emotions, actions and pathway, considering the desired quality.
Finally, through the fourth image, the coniunctio is performed to
reach rubedo. 4th) The Supreme Spiritual Being of Light that emanates absolute, unconditional Love delivers a red box containing a
gift to the patient, as a symbolic reference to a specific aspect of the
According to the statistical analysis shown in Table 2, comparing
the RIME Group with the Control Group, the quantitative results
indicated significant improvement (38.3%) in the Perception of
Quality of Life according to the WHOQOL [17] after RIME compared
to both the BP of the Control Group (12.5%) and the BP of the RIME
Group (16.2%). Significant improvements in Self-esteem (Rosenberg) [18] after RIME (14.6%) compared to the BP of the Control
Group (35.9% worsened) as well as the BP of the RIME Group (8.3%).
The improvements in the BHS (hopelessness) [19] were similar in
both the RIME Group and the Control Group: RIME ¼ 20.1%,
RIME þ PB ¼ 27.1%, BP 11.1%. The improvement in well-being
considering the focus worked (Visual Analog Scale) [6,7] was significant in the RIME Group (bad well-being to good well-being), as
well as in the Control Group (unpleasant well-being to good wellbeing). None of the three treatments, RIME, RIME þ BP, or BP,
presented significant improvements in the domains of the WHOQOL [17] or in the satisfaction with health of the WHOQOL [17].
3.2. Qualitative results
The qualitative analysis was performed in order to comprehend
the process and the meaning of the transformation that occur
through RIME. The categories were developed based on Analytical
Psychology [12e16], for the symbolic interpretation of the data,
with the processing of the data performed through thematic content analysis [6e8]. The development of the categories was performed by consensus analysis, in a group composed of the principal
investigator and co-authors 3, 4 and 5, with qualified knowledge in
Analytical Psychology and Hospital Psychology, based on semistructured interviews before and after each session of RIME.
A) With regard to the FOCUS FOR TRANSFORMATION, i.e., the
behavior, emotion or feeling chosen by the patient to be
worked on and transformed through RIME, two categories
were found:
Category 1) SELF-VALORIZATION to transform the relationships, whether at the marital, family, work, or
spiritual level.
Category 2) SELF-VALORIZATION to transform the
sequelae of the disease.
B) With regard to the analysis of the SYMBOLIC DIMENSION OF
THE SELF three categories were found:
4
A.C.A. Elias et al. / Complementary Therapies in Clinical Practice 21 (2015) 1e6
Table 2
Quantitative results/comparison of the results of the scales in the three phases: 1st phase: after signing the TFPIC (RIME Group and Control Group); 2nd phase: after application
of the three RIME sessions (RIME Group); 3rd phase: after application of up to twelve sessions of Brief Psychotherapy (RIME Group and Control Group).
p-Valuea
Group
Control
Mean
~o da QV
Percepça
Post TCLE
Post RIME
Post PB
~o com a Saúde
Satisfaça
Post TCLE
Post RIME
Post PB
Físico
Post TCLE
Post RIME
Post PB
gico
Psicolo
Post TCLE
Post RIME
Post PB
Social
Post TCLE
Post RIME
Post PB
Meio Ambiente
Post TCLE
Post RIME
Post PB
WHOQOL total
Post TCLE
Post RIME
Post PB
Rosenberg
Post TCLE
Post RIME
Post PB
BHS
Post TCLE
Post RIME
Post PB
EVA
Post TCLE
Post RIME
Post PB
RIME
SD
3.07
1.77
3.45
0.69
3.55
1.21
3.55
0.82
2.90
0.68
3.09
0.61
3.51
0.76
3.47
0.48
3.85
0.62
3.60
0.66
3.97
1.42
3.63
1.30
3.61
0.72
3.46
0.46
8.36
6.17
11.36
4.78
4.91
3.11
4.36
3.47
4.55
2.70
7.09
2.07
Improvement
Mean
SD
12.5%
3.29
4.55
3.82
1.90
0.52
1.40
0.0%
3.55
3.64
3.55
1.44
1.12
1.44
6.3%
3.09
3.59
3.35
0.97
0.87
1.29
1.3%
3.50
3.56
3.42
0.67
0.70
1.27
6.3%
3.54
3.63
3.60
1.05
0.89
1.43
8.6%
3.54
3.73
3.42
0.58
0.64
1.30
4.2%
3.50
3.78
3.52
0.79
0.61
1.28
35.9%
8.73
7.45
8.00
5.52
5.73
5.39
11.1%
4.36
3.45
3.18
3.59
3.30
2.44
56.0%
3.45
6.91
7.82
2.02
2.59
2.89
RIME Control
RIME þ PB Control
RIME RIME þ PB
0.032
0.792
0.010
0.865
1.000
0.810
0.228
0.766
0.198
0.740
0.931
0.555
0.503
0.542
0.932
0.139
0.539
0.214
0.141
0.558
0.203
0.068
0.109
0.735
0.819
0.690
0.809
0.461
0.146
0.300
Improvement
38.3%
16.2%
2.6%
0.0%
16.4%
8.5%
1.7%
2.2%
2.5%
1.7%
5.2%
3.5%
7.8%
0.5%
14.6%
8.3%
20.8%
27.1%
100.0%
126.3%
Bold¼indication of improvement in the perception of quality of life in the RIME Group.Italic¼indication of self-esteem improvement in the RIME Group.
a
Mixed effects model.
Category 1: TRANSFORMATION of the FEMININE representation from absent or devourer to the loving or protective, of the MASCULINE from the intangible, absent or
impotent to the tangible, potent and loving, and of the
DIVINE from the intangible, inaccessible and impersonal
to the close, accessible and loving. Category 2: INTEGRATION into the consciousness of the capacity for selfcare, self-valorization, self-confidence; of the deserving
of the protection of Divine love; of the existence of internal resources; and of new external possibilities for the
expression of the potential.
Category 3: PATHWAY to BREAK PRIMITIVE AND RIGID
DEFENSES, allowing an opening for the development of
repressed conflicts, WITHOUT PSYCHICALLY DISRUPTING
THE PATIENT.
C) With respect to the symbolic comprehension of the COLOR
OF THE ROBE/STAR, one category was found: “There are indications the RIME intervention ELICITS THE TRANSCENDENT FUNCTION, this transcendent function may occur with
movement of regression of the libido, with movement of
progression of the libido, or reciprocating progression/
regression”.
D) With regard to the fourth image/the gift found in the red box,
the SYMBOLS OF TRANSFORMATION that emerged were:
➢ Representations of the mineral world (n ¼ 6): Golden
seeds. Blue “smoke”. Carpet full of stars of all colors.
A.C.A. Elias et al. / Complementary Therapies in Clinical Practice 21 (2015) 1e6
Crown with shiny stones. Crown full of green stones.
Golden crown with emerald stones. Two crystals.
➢ Representations of the vegetable world (n ¼ 3): Red Rose.
Red Roses. Bouquet of flowers. Pink rose. Orange rose.
Tulip.
➢ Representations of the animal world (n ¼ 1): White dove
in white box.
➢ Representations of the human world (n ¼ 8): Sense of
healing. Feeling of Love, of Care/Caring, of Peace. Quality
“courage”. Child/baby. Feeling of emptiness. Shining red
breast. Golden heart. Reassuring message on a paper
drinking straw. Gold pendant with a photo of her
daughter and son together. White Robe. Blue box with
card (ticket) written “Believe, Trust and Forgive”. Very
pretty poster written: “Always Believe”. Photographs of
places and family members, acquaintances, but with
reference to the future and happiness.
The analysis [12e16,25] of these Symbols of Transformation
suggested representations of healing and wholeness, expressed in
the category: “Mediated by the symbols of transformation (presents), the unconscious archetypal potential entered into the consciousness: with the potential for psychic transformation, usually
with energy for its constellation, and representing beacons of light
illuminating the darkness of the unconscious for the expression of
the creative femininity”.
E) The graphical representation aimed to identify feelings, emotions or thoughts faced with cancer at the moment of diagnosis
and at the moment of treatment (in the breast reconstruction
and adjuvant treatment process), and in the consensus analysis
the authors observed that the symbolism of the drawings was
transformed for the better in the drawings of all patients after
the third session of RIME, suggesting that this intervention facilitates the introduction into the consciousness of self-curative
resources and minimizes the traumatic memory.
4. Discussion
The importance of subjective transformations and positive
changes in the lives of cancer survivors, from the perspective of the
biopsychosocial and spiritual model, which goes beyond the event
of sickness, are being reported in the academic literature [26,27].
This study aimed to promote socio-psycho-spiritual transformations through RIME, focusing on the transformation of the
psychological distress chosen by the patient, not necessarily related
to breast cancer, in order to contribute to the quality of life and selfesteem and to minimize the hopelessness of these patients.
Comparing the RIME intervention with the BP applied with the
Control Group, considering the statistical analysis, it was observed
that the RIME had more strength in psychic structuring and ego
strengthening than the BP, even though both caused a significant
improvement in the perceived quality of life and self-esteem of the
patients.
Regarding the promotion of hope and the transformation of the
focus (psychological distress chosen by the patient to be worked
on), the results between RIME and BP were similar, however it was
observed that RIME produced a faster transformation, since three
RIME sessions were performed, compared to an average of six BP
sessions in the Control Group. Although BP is an intervention
consecrated in Psycho-Oncology [27], the results are relevant for
the indication of RIME for psychological treatment in a crisis situation in the hospital context, considering hospitalization, pre- and
post-surgery monitoring, and the outpatient clinic.
5
No significant improvements were related to the BP of the RIME
Group patients, compared to improvements achieved by the RIME
itself, suggesting that three RIME sessions are sufficient to promote
the transformation. It was observed that RIME does not provide a
cognitive, rational solution for the problems and suffering of patients, but facilitates the perception of the strength of their own life
drive to solve the problem, i.e., the ability to recognize one's own
potential and energetic force and the possibility of being able to
construct a better, more integrated life. In summary, the RIME
Intervention promotes the empowerment of the libido [12], as a
constructive force, in women with breast cancer, with the possibility of a cure.
To identify the social and psychological suffering of cancer patients in the medical setting, and to assist them in obtaining
appropriate psychosocial services is an important factor of discussion in the literature [28,29]. The qualitative analysis of the data
indicated that the main suffering, the focus for transformation of
the women with breast cancer of the RIME Group, was the need for
self-valorization, which was also observed in the BP of the Control
Group.
The main psychological transformations found, mediated by the
symbolic elements of the RIME, were the transformation of the
feminine representation from the absent or devourer to the loving
or protector, of the masculine from the intangible, absent or
impotent to the tangible, potent and loving, and of the divine from
the intangible and inaccessible to the close, accessible and loving.
Such representations in women refer to personality structures,
with the feminine representation being related to the main personality, with characteristics related to feelings and intuition (Eros),
and the masculine representation related to a subpersonality called
animus, which operates at an autonomous and less conscious level,
with characteristics related to rationality and objectivity (Logos)
[14]. The Divine representation refers to the connection of the
personality with the sacred [14]. The transformation of these basic
personality structures indicates a healthy and regenerating movement of the libido [12], disassociating from the death drive polarity,
to the life drive polarity, and enabling integration into the consciousness of the capacity for self-care, self-valorization, selfconfidence; of deserving of the protection of Divine love; of the
existence of internal resources; and of new external possibilities for
the expression of the potential.
The aim of this study was for RIME to elicit the transcendent
function [12], that is, to facilitate the integration into the consciousness of the healing and constructive potential of the patients, extending the capabilities of self-valorization and positive
action, and strengthening the personality through the symbolic
union of the opposites [12e16]. This was achieved by observing
the category found in the symbolic analysis of the colors of the
robes and of the gift offered by the Spiritual Being of Light, in the
red box.
There is an important neuroscientific discussion about the mind
brain relationship. In empirical studies by leading researchers
[20e24,30] support is given to the hypothesis that the consciousness (mind, psyche) and brain are separate entities, i.e., consciousness is not produced by the brain but manifested through it,
having characteristics of not being local, and that transformations
in the dynamics of the consciousness can alter the thoughts and
emotions expressed through the brain dynamics. Considering the
results found in this study, working with the transformation of the
personality of the patients through the psychic dynamic, the consciousness, from a symbolic perspective, aligns us with the hypothesis that the mind is not produced by the brain.
Conflicts of interest statement
None declared.
6
A.C.A. Elias et al. / Complementary Therapies in Clinical Practice 21 (2015) 1e6
Acknowledgments
We thank Dr. Eduardo Gustavo Pires de Arruda, Dr. Alexandre
Siqueira Franco Fonseca and Dr. Eduardo Montag for the referral of
the patients of the Plastic Surgery Outpatient Clinic of the Institute
~o Paulo (ICESP).
of Cancer of the state of Sa
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