Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100436
A. Chandon-Piazza
Context
The work of the clinical psychologist in pediatric hospitals aims to promote the subjective appropriation of the experience by the child, by ensuring a feeling of continuity and security. It is particularly important to ensure the quality of the relation between subject, entourage, and caregivers. However, a certain amount of violence exists in the relation between caregiver and patient. We suggest that beyond the violence of caregiving itself, there is an “over-violence” (Tomkiewicz, 1991) which risks undermining the patient's feeling of security.
Objectives
We believe that this over-violence arises when caregivers are confronted with intolerable experiences in the face of the vital risk incurred by the patient. This article aims to examine the emergence of this over-violence and its modes of expression.
Method
This work is based on several situations encountered in different pediatric wards, based on three cases of adolescent patients who put their caregivers in difficulty and required the intervention of hospital psychologists to understand the issues at hand.
Results
Through these different clinical cases we identify two mechanisms of over-violence. First, encroachment, in the form of excessive control of patients’ behavior, which echoes the control that exists over the bodies of sick children. second, rejection, as an attempt to evacuate that which is violent, despite the needs of the patient, sometimes justified by the imperative of freeing hospital beds for other patients. We also identify the effects of a paradoxical over-violence in the oscillation between these two poles.
Discussion
Faced with potential death and the anxiety it arouses, caregivers confronted with violent affects deploy unconscious defense mechanisms that can undermine the professional-patient relationship and can produce over-violence in care. Faced with this phenomenon, reflecting together as a team allows for the regulation of affects and promotes temperance in the professional-patient relationship. Psychologists practicing in somatic hospitals are instrumental in the setting up and maintaining of spaces for regulation or analysis of professional practice in services in which psychological care is not the primary task.
{"title":"Empiètement, rejet ou tempérance : l’adolescence en pédiatrie au risque de la surviolence","authors":"A. Chandon-Piazza","doi":"10.1016/j.inan.2024.100436","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100436","url":null,"abstract":"<div><h3>Context</h3><p>The work of the clinical psychologist in pediatric hospitals aims to promote the subjective appropriation of the experience by the child, by ensuring a feeling of continuity and security. It is particularly important to ensure the quality of the relation between subject, entourage, and caregivers. However, a certain amount of violence exists in the relation between caregiver and patient. We suggest that beyond the violence of caregiving itself, there is an “over-violence” (Tomkiewicz, 1991) which risks undermining the patient's feeling of security.</p></div><div><h3>Objectives</h3><p>We believe that this over-violence arises when caregivers are confronted with intolerable experiences in the face of the vital risk incurred by the patient. This article aims to examine the emergence of this over-violence and its modes of expression.</p></div><div><h3>Method</h3><p>This work is based on several situations encountered in different pediatric wards, based on three cases of adolescent patients who put their caregivers in difficulty and required the intervention of hospital psychologists to understand the issues at hand.</p></div><div><h3>Results</h3><p>Through these different clinical cases we identify two mechanisms of over-violence. First, encroachment, in the form of excessive control of patients’ behavior, which echoes the control that exists over the bodies of sick children. second, rejection, as an attempt to evacuate that which is violent, despite the needs of the patient, sometimes justified by the imperative of freeing hospital beds for other patients. We also identify the effects of a paradoxical over-violence in the oscillation between these two poles.</p></div><div><h3>Discussion</h3><p>Faced with potential death and the anxiety it arouses, caregivers confronted with violent affects deploy unconscious defense mechanisms that can undermine the professional-patient relationship and can produce over-violence in care. Faced with this phenomenon, reflecting together as a team allows for the regulation of affects and promotes temperance in the professional-patient relationship. Psychologists practicing in somatic hospitals are instrumental in the setting up and maintaining of spaces for regulation or analysis of professional practice in services in which psychological care is not the primary task.</p></div>","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100436"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140650394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100438
Maria Lívia Tourinho Moretto
{"title":"Commentaire sur l’article « La rencontre clinique entre diagnostic et transfert, identité et identification » de Jean Peuch-Lestrade","authors":"Maria Lívia Tourinho Moretto","doi":"10.1016/j.inan.2024.100438","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100438","url":null,"abstract":"","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100438"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141240884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100429
H. Haliday
Context
The public healthcare system in France is in search of a new “spirit” to address the symptoms of disaffection it currently experiences. Management sciences are exploring how leadership can enhance workplace well-being, emphasizing “salutogenic” approaches and caring leadership. In contrast to previous interpretations of “clinical governance,” often focused on the use of evidence-based clinical data, we investigate the potential use of psychoanalytic theories to shed light on clinical governance practices attentive to the diverse elements contributing to organizational atmosphere.
Objectives
We aim to return to the conceptions and practices of hospital administrators themselves. The demonstration will revolve around identifying the objects of the specific work done by clinical governance, and the actions taken by hospital administrators practicing this way. Our aim is to extend to the healthcare field the path laid out by institutional psychotherapy in psychiatry, ensuring healthcare institutions do not perpetuate, at their highest hierarchical level, the social symptoms of their time.
Method
Our approach is rooted in empirical interpretation sciences and relies on a qualitative analysis methodology that emphasizes proximity to the lived experience of our interviewees. Our field investigation has been ongoing for several years, conducted in collaboration with management teams from institutions of various sizes and regions. The abductive hypothesis of a form of clinical governance gradually emerged while working closely with two well-known hospital administration teams. We engaged in co-thinking with the involved directors to validate our interpretations.
Results
We revisit the concept of “clinical governance” to describe a way of managing hospitals which symbolically and attentively, though sometimes unconsciously, works with a number of identified objects. We define these objects as related to the organization: hierarchy, space, resources, information, the “scope” of action, and time. Others elements are related to the institutional network: speech, the Self, the perception of others, conviviality, and affects. Each of these elements is examined from the perspective of its symbolic significance, beyond its material or practical aspects, with the understanding that their circulation is of particular interest to clinical governance.
Interpretation
Our results call for a renewal of institutional psychotherapy in general hospitals, through the perspective of daily “asepsis” of the milieu as facilitated by clinical governance. This involves a recognition by hospital administrators of the symbolic value of the objects we have listed. Clinical governance enables administrators to interpret the symbols behind the apparent materiality of what healthcare professionals discuss. While our results are partial and exploratory, they pave t
{"title":"La « gouvernance clinique » : sur un mode de travail particulier chez les directeurs d’hôpital","authors":"H. Haliday","doi":"10.1016/j.inan.2024.100429","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100429","url":null,"abstract":"<div><h3>Context</h3><p>The public healthcare system in France is in search of a new “spirit” to address the symptoms of disaffection it currently experiences. Management sciences are exploring how leadership can enhance workplace well-being, emphasizing “salutogenic” approaches and caring leadership. In contrast to previous interpretations of “clinical governance,” often focused on the use of evidence-based clinical data, we investigate the potential use of psychoanalytic theories to shed light on clinical governance practices attentive to the diverse elements contributing to organizational atmosphere.</p></div><div><h3>Objectives</h3><p>We aim to return to the conceptions and practices of hospital administrators themselves. The demonstration will revolve around identifying the objects of the specific work done by clinical governance, and the actions taken by hospital administrators practicing this way. Our aim is to extend to the healthcare field the path laid out by institutional psychotherapy in psychiatry, ensuring healthcare institutions do not perpetuate, at their highest hierarchical level, the social symptoms of their time.</p></div><div><h3>Method</h3><p>Our approach is rooted in empirical interpretation sciences and relies on a qualitative analysis methodology that emphasizes proximity to the lived experience of our interviewees. Our field investigation has been ongoing for several years, conducted in collaboration with management teams from institutions of various sizes and regions. The abductive hypothesis of a form of clinical governance gradually emerged while working closely with two well-known hospital administration teams. We engaged in co-thinking with the involved directors to validate our interpretations.</p></div><div><h3>Results</h3><p>We revisit the concept of “clinical governance” to describe a way of managing hospitals which symbolically and attentively, though sometimes unconsciously, works with a number of identified objects. We define these objects as related to the organization: hierarchy, space, resources, information, the “scope” of action, and time. Others elements are related to the institutional network: speech, the Self, the perception of others, conviviality, and affects. Each of these elements is examined from the perspective of its symbolic significance, beyond its material or practical aspects, with the understanding that their circulation is of particular interest to clinical governance.</p></div><div><h3>Interpretation</h3><p>Our results call for a renewal of institutional psychotherapy in general hospitals, through the perspective of daily “asepsis” of the milieu as facilitated by clinical governance. This involves a recognition by hospital administrators of the symbolic value of the objects we have listed. Clinical governance enables administrators to interpret the symbols behind the apparent materiality of what healthcare professionals discuss. While our results are partial and exploratory, they pave t","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100429"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542360624000064/pdfft?md5=6746dbbc10aff1ec68d0579a253d2424&pid=1-s2.0-S2542360624000064-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100437
K.-L. Schwering
{"title":"La rencontre clinique à l’hôpital : restituer le patient à lui-même","authors":"K.-L. Schwering","doi":"10.1016/j.inan.2024.100437","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100437","url":null,"abstract":"","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100437"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141240886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100430
P. Sauvajon
Context
In the context of increasing chronic disease, and limited resources, the current hospital reform is mobilizing patients towards a positive approach meant to allow everyone to choose for themselves. Health promotion and self-care practices are the main intentions of this change. If this evolution is part of the ongoing history of the hospital, it exists in the current societal environment. This latter is characterized by multitude of choices. The situation of patients struggling to keep up with this change should encourage hospital decision-makers to question this quest for effective care.
Objective
The clinician meets patients who are mobilized by resistance, or even negativity, in a “system” that solicits positive abilities. These patients seem to mobilize the assistance of the healthcare environment, unable to meet them where they are. This article proposes pathways for an articulation of the system with the singularity of the patient-individuals who encounter it.
Method
Returning to the history of the hospital and its current intentions, we question the quest for effective care for all patients. The situation of patients who “resist” the apparatus of positivity could shed light on the stakes of certain changes in the works.
Results
The juxtaposition of the current hospital environment and the story of a patient who is “resistant” to it suggests a mutual influence.
Interpretation
With patients increasingly passing through the hospital, instead of staying, they are encouraged to become autonomous actors of their own care. Those patients who require more support from the hospital put to the test the latter's capacity for care experienced in the register of negativity.
{"title":"Le positif pour l’hôpital, le négatif chez le patient","authors":"P. Sauvajon","doi":"10.1016/j.inan.2024.100430","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100430","url":null,"abstract":"<div><h3>Context</h3><p>In the context of increasing chronic disease, and limited resources, the current hospital reform is mobilizing patients towards a positive approach meant to allow everyone to choose for themselves. Health promotion and self-care practices are the main intentions of this change. If this evolution is part of the ongoing history of the hospital, it exists in the current societal environment. This latter is characterized by multitude of choices. The situation of patients struggling to keep up with this change should encourage hospital decision-makers to question this quest for effective care.</p></div><div><h3>Objective</h3><p>The clinician meets patients who are mobilized by resistance, or even negativity, in a “system” that solicits positive abilities. These patients seem to mobilize the assistance of the healthcare environment, unable to meet them where they are. This article proposes pathways for an articulation of the system with the singularity of the patient-individuals who encounter it.</p></div><div><h3>Method</h3><p>Returning to the history of the hospital and its current intentions, we question the quest for effective care for all patients. The situation of patients who “resist” the apparatus of positivity could shed light on the stakes of certain changes in the works.</p></div><div><h3>Results</h3><p>The juxtaposition of the current hospital environment and the story of a patient who is “resistant” to it suggests a mutual influence.</p></div><div><h3>Interpretation</h3><p>With patients increasingly passing through the hospital, instead of staying, they are encouraged to become autonomous actors of their own care. Those patients who require more support from the hospital put to the test the latter's capacity for care experienced in the register of negativity.</p></div>","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140645975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100431
F. Maréchal
Context
The hospital is in crisis, with many ills and difficulties experienced by caregivers and patients alike. These difficulties are due to the de-subjectivization of caregivers and patients, conveyed by the language of a techno-scientific new management.
Objectives
To show how metapsychology and psychoanalysis can help caregivers and their patients rediscover in their language a space of subjectivity in which to express themselves and bear witness to their realities.
Method
Exploration of the effects of the new managerial and techno-scientific language used and experienced in care by caregivers and their patients.
Results
The language of new hospital management can be seen as a socio-psycho-linguistic virus, weakening caregivers and forcing them to act rather than reflect, because of a lack of words and of space in which to express themselves. Techno-scientific language reifies patients and detaches them from their unique experiences. Caregivers and patients therefore find it difficult to relate to each other in any way other than through their illness. Psychoanalysis and metapsychology create the conditions for deepening and redeploying the caregiver-patient relationship, and through attention to narrativity, they enable us to give importance to the patient's narrative. Systems inspired by institutional psychotherapy give caregivers the space to develop their subjectivity and reduce the suffering associated with caring for patients.
Conclusion
The struggle of languages to which patients and caregivers are subjected is partly responsible for the malaise in hospital culture. It seems to us that working on the language of caregivers and patients, and maintaining spaces for everyone to put themselves into words, could contribute to the development of a culture of care that prevents the actors and subjects of care from talking to each other only about their ills.
{"title":"Encore des mots, toujours des maux, les mêmes maux ?","authors":"F. Maréchal","doi":"10.1016/j.inan.2024.100431","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100431","url":null,"abstract":"<div><h3>Context</h3><p>The hospital is in crisis, with many ills and difficulties experienced by caregivers and patients alike. These difficulties are due to the de-subjectivization of caregivers and patients, conveyed by the language of a techno-scientific new management.</p></div><div><h3>Objectives</h3><p>To show how metapsychology and psychoanalysis can help caregivers and their patients rediscover in their language a space of subjectivity in which to express themselves and bear witness to their realities.</p></div><div><h3>Method</h3><p>Exploration of the effects of the new managerial and techno-scientific language used and experienced in care by caregivers and their patients.</p></div><div><h3>Results</h3><p>The language of new hospital management can be seen as a socio-psycho-linguistic virus, weakening caregivers and forcing them to act rather than reflect, because of a lack of words and of space in which to express themselves. Techno-scientific language reifies patients and detaches them from their unique experiences. Caregivers and patients therefore find it difficult to relate to each other in any way other than through their illness. Psychoanalysis and metapsychology create the conditions for deepening and redeploying the caregiver-patient relationship, and through attention to narrativity, they enable us to give importance to the patient's narrative. Systems inspired by institutional psychotherapy give caregivers the space to develop their subjectivity and reduce the suffering associated with caring for patients.</p></div><div><h3>Conclusion</h3><p>The struggle of languages to which patients and caregivers are subjected is partly responsible for the malaise in hospital culture. It seems to us that working on the language of caregivers and patients, and maintaining spaces for everyone to put themselves into words, could contribute to the development of a culture of care that prevents the actors and subjects of care from talking to each other only about their ills.</p></div>","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100431"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140645974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100425
Audrey Juteau , Adeline Lepine , Nathalie Dumet
Context
This article is based on doctoral research interested in the effects of “médiation culturelle” – the bi-directional interplay and effects of embedding a cultural experience or artistic process – on institutional behavior, environment, daily routine, and corporate culture. The specific focus here is an original institutional experience, entitled “Windows Open to the World,” that examines the effect of embedding an artist and artistic process into the everyday life of a regional rehabilitation center for patients with acquired neurologic disease or traumatic injury. This study was completed in partnership with the Biennale d’Art Contemporain of Lyon, via the Veduta platform and the artist/photographer Karim Kal, as part of the national Culture and Health program.
Method
This is exploratory research. In an institutional clinical setting, we present clinical observations and propose lines of reflection and analysis.
Objectives
This study seeks to analyze the function of art on healthcare institutions (daily routine, corporate culture, environment) and professional practice. This study further explores the modulatory effect of embedding artistic and cultural experiences (“médiation culturelle”) on clinical staff, including the potential to improve providers’ feelings of well-being, renew professional interest and commitment, spark individual and team creativity, improve team cohesion, and reduce burn-out.
Results
As an interventional device, the “médiation culturelle” process created new opportunities at the institutional level: in a dynamic interplay, embedding the artistic process created new common space and spontaneous gatherings; and time spent in discussion promoted collaboration between professionals, allowing new projects to come to life despite the current constraints of the institutional environment. The preparatory work required for any project, often undocumented and hidden from view, is shown by these results to be essential.
These interdisciplinary projects are conducive to group work, prompting a review of and a strengthening of the team's approach to collaborative clinical care. Moreover, through the interactive creative nature of the artistic cultural intervention, these projects serve to generate enduring psychological interactions and emotional experiences between patients, artists, and professionals, ultimately forging more vibrant relationships through these shared experiences. These cultural interventions make it possible to reset and re-ignite the imagination in the institution, in support and advocacy of artistic creativity. Similarly, they rejuvenate the professional staff, stimulating new ideas, fostering creative exchange, and prompting collaboration with natural extensions to their clinical practice. These cultural projects can also serve as a kind of libidinal recharge for professionals, supporting their ability to gene
{"title":"Des fenêtres culturelles à l’hôpital : susciter de nouvelles perspectives cliniques dans les établissements de santé","authors":"Audrey Juteau , Adeline Lepine , Nathalie Dumet","doi":"10.1016/j.inan.2024.100425","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100425","url":null,"abstract":"<div><h3>Context</h3><p>This article is based on doctoral research interested in the effects of “médiation culturelle” – the bi-directional interplay and effects of embedding a cultural experience or artistic process – on institutional behavior, environment, daily routine, and corporate culture. The specific focus here is an original institutional experience, entitled “Windows Open to the World,” that examines the effect of embedding an artist and artistic process into the everyday life of a regional rehabilitation center for patients with acquired neurologic disease or traumatic injury. This study was completed in partnership with the Biennale d’Art Contemporain of Lyon, via the Veduta platform and the artist/photographer Karim Kal, as part of the national Culture and Health program.</p></div><div><h3>Method</h3><p>This is exploratory research. In an institutional clinical setting, we present clinical observations and propose lines of reflection and analysis.</p></div><div><h3>Objectives</h3><p>This study seeks to analyze the function of art on healthcare institutions (daily routine, corporate culture, environment) and professional practice. This study further explores the modulatory effect of embedding artistic and cultural experiences (“médiation culturelle”) on clinical staff, including the potential to improve providers’ feelings of well-being, renew professional interest and commitment, spark individual and team creativity, improve team cohesion, and reduce burn-out.</p></div><div><h3>Results</h3><p>As an interventional device, the “médiation culturelle” process created new opportunities at the institutional level: in a dynamic interplay, embedding the artistic process created new common space and spontaneous gatherings; and time spent in discussion promoted collaboration between professionals, allowing new projects to come to life despite the current constraints of the institutional environment. The preparatory work required for any project, often undocumented and hidden from view, is shown by these results to be essential.</p><p>These interdisciplinary projects are conducive to group work, prompting a review of and a strengthening of the team's approach to collaborative clinical care. Moreover, through the interactive creative nature of the artistic cultural intervention, these projects serve to generate enduring psychological interactions and emotional experiences between patients, artists, and professionals, ultimately forging more vibrant relationships through these shared experiences. These cultural interventions make it possible to reset and re-ignite the imagination in the institution, in support and advocacy of artistic creativity. Similarly, they rejuvenate the professional staff, stimulating new ideas, fostering creative exchange, and prompting collaboration with natural extensions to their clinical practice. These cultural projects can also serve as a kind of libidinal recharge for professionals, supporting their ability to gene","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100425"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542360624000027/pdfft?md5=8f1863893179b83be369c26cd820196f&pid=1-s2.0-S2542360624000027-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140351046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100427
Stéphanie Hertzog
{"title":"La résistance thérapeutique dans la douleur chronique nociplastique : de la relation mère-enfant à la relation médecin-patient. Expériences subjectives de femmes fibromyalgiques","authors":"Stéphanie Hertzog","doi":"10.1016/j.inan.2024.100427","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100427","url":null,"abstract":"","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100427"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140604604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.inan.2024.100435
Anna Kyprianou
Context
This paper illustrates a psychodynamic analysis of the intrapsychic and intersubjective effects of the use of MRI in a Neurovascular Unit (NVU) for elderly post-stroke patients, in mainland France. The sudden onset of the stroke and the shift from independence to dependence are juxtaposed with the reality of normal and pathological aging in the elderly, making the boundaries around these two issues difficult to determine.
Objectives
The aim of this paper is to propose a reflection about the intrapsychic and intersubjective effects of the almost automatic use of the MRI results during the hospitalization of elderly post-stroke patients.
Method
This is a theoretical-clinical elaboration based on clinical cases derived from clinical psychotherapeutic sessions with post-stroke hospitalized patients, institutional observations during staff meetings, and transdisciplinary interviews with the patients and their families.
Results
We can conclude, through the cases studied and the theoretical analysis that a more personalized use of MRI is essential, because it may help the patient to visualize his or her stroke, to organize what has been psychologically and physically disorganized, and to create a link with the healthcare professional. However, an automated and mechanized way of showing these results may lead the patient into a psychological impasse, accentuate the psycho-corporal disorganization, and complexify the relationship with others.
Interpretations
MRI is nowadays the main tool for diagnosing strokes, allowing in vivo exploration of the human brain. Despite its relatively recent appearance, MRI seems to be essential in the treatment and monitoring of stroke patients. However, the use of showing the MRI results to the elderly patients in a stroke unit, their families, and the healthcare professionals does not seem to have been thought through, or at the very least, reflected upon consciously.
{"title":"(In)visibilité dans la clinique de l’AVC du sujet âgé : effets intrapsychiques et intersubjectifs de l’utilisation de l’IRM","authors":"Anna Kyprianou","doi":"10.1016/j.inan.2024.100435","DOIUrl":"https://doi.org/10.1016/j.inan.2024.100435","url":null,"abstract":"<div><h3>Context</h3><p>This paper illustrates a psychodynamic analysis of the intrapsychic and intersubjective effects of the use of MRI in a Neurovascular Unit (NVU) for elderly post-stroke patients, in mainland France. The sudden onset of the stroke and the shift from independence to dependence are juxtaposed with the reality of normal and pathological aging in the elderly, making the boundaries around these two issues difficult to determine.</p></div><div><h3>Objectives</h3><p>The aim of this paper is to propose a reflection about the intrapsychic and intersubjective effects of the almost automatic use of the MRI results during the hospitalization of elderly post-stroke patients.</p></div><div><h3>Method</h3><p>This is a theoretical-clinical elaboration based on clinical cases derived from clinical psychotherapeutic sessions with post-stroke hospitalized patients, institutional observations during staff meetings, and transdisciplinary interviews with the patients and their families.</p></div><div><h3>Results</h3><p>We can conclude, through the cases studied and the theoretical analysis that a more personalized use of MRI is essential, because it may help the patient to visualize his or her stroke, to organize what has been psychologically and physically disorganized, and to create a link with the healthcare professional. However, an automated and mechanized way of showing these results may lead the patient into a psychological impasse, accentuate the psycho-corporal disorganization, and complexify the relationship with others.</p></div><div><h3>Interpretations</h3><p>MRI is nowadays the main tool for diagnosing strokes, allowing in vivo exploration of the human brain. Despite its relatively recent appearance, MRI seems to be essential in the treatment and monitoring of stroke patients. However, the use of showing the MRI results to the elderly patients in a stroke unit, their families, and the healthcare professionals does not seem to have been thought through, or at the very least, reflected upon consciously.</p></div>","PeriodicalId":100661,"journal":{"name":"In Analysis","volume":"8 1","pages":"Article 100435"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140823723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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