Pub Date : 2025-06-01Epub Date: 2025-03-08DOI: 10.1016/j.evopsy.2025.02.001
Isabelle Hubinet (Psychothérapeute, psychologue du travail)
<div><h3>Goals</h3><div>To explore the scream through its relationship to voice, speech and silence, the link to the Other, and its function in the psychotic subject, the effects in the listener. To place its position in the specific drive circuit and on the silence-speech axis developed by M. Poizat. To present the absence of closure of the invocation drive in a psychotic patient and the possibilities offered by the wet wraps used in packing therapy in the renewal of contact, which is the basis of the transferential relationship.</div></div><div><h3>Method</h3><div>This is the study of a clinical situation in a psychotic patient in a psychiatric institution, whose frequent inconsolable screams and whose tendency to provoke rejection from caregivers led to the use of a therapeutic device of unusual magnitude. The analysis focuses on the patient's manifestations of vocal jouissance produced in different environments and on the effects of packing therapy conducted in a context of institutional psychotherapy.</div></div><div><h3>Results</h3><div>Vocal phenomena in this psychotic patient, such as whispering and aphonia, will appear a few days after the beginning of the packing therapy. I hypothesize that they resemble the patient's frequent unconsolable cries, and I situate them, alongside silence, opposite to speech, thus revealing the structural lack of symbolism. If this patient's unconsolable scream is a life force inscribed in the body, its repetition and its effects align him with something deathly, the risk of automation and rejection by others. The scream, coupled or not with suffocation, would also be a valuable indicator of the anxiety that arises in the passage into a new environment, especially when the latter is made up of a desirous otherness. Thanks to the packing therapy, the therapeutic work invites the patient to speak and leads him to reinvest in the living and institutional collective; and the screams will lessen in intensity. The daily packing program allowed for an increased proximity with caregivers, and with the patient feeling more present, no longer abandoned, and that he is someone. If the restoration of transference is favorable and brings a noticeable improvement quickly, other transferential movements will require therapeutic rearrangement. Important and sensitive points in the course and continuation of the therapy that could not be observed are the analysis of the caregiving team's countertransference and, in counterpoint to work carried out by healthcare professionals, the role of the peers in work with alterity.</div></div><div><h3>Discussion</h3><div>Packing is a therapeutic choice whose benefits are positive for this highly motivated patient, facilitating a reinvestment of speech and a turning away from a deathly horizon to reconnect with life. A system of lesser magnitude in terms of frequency, duration, and personnel would not have allowed such a positive transferential movement, counteracting the psychological a
{"title":"Du cri sans appel à la restauration du transfert","authors":"Isabelle Hubinet (Psychothérapeute, psychologue du travail)","doi":"10.1016/j.evopsy.2025.02.001","DOIUrl":"10.1016/j.evopsy.2025.02.001","url":null,"abstract":"<div><h3>Goals</h3><div>To explore the scream through its relationship to voice, speech and silence, the link to the Other, and its function in the psychotic subject, the effects in the listener. To place its position in the specific drive circuit and on the silence-speech axis developed by M. Poizat. To present the absence of closure of the invocation drive in a psychotic patient and the possibilities offered by the wet wraps used in packing therapy in the renewal of contact, which is the basis of the transferential relationship.</div></div><div><h3>Method</h3><div>This is the study of a clinical situation in a psychotic patient in a psychiatric institution, whose frequent inconsolable screams and whose tendency to provoke rejection from caregivers led to the use of a therapeutic device of unusual magnitude. The analysis focuses on the patient's manifestations of vocal jouissance produced in different environments and on the effects of packing therapy conducted in a context of institutional psychotherapy.</div></div><div><h3>Results</h3><div>Vocal phenomena in this psychotic patient, such as whispering and aphonia, will appear a few days after the beginning of the packing therapy. I hypothesize that they resemble the patient's frequent unconsolable cries, and I situate them, alongside silence, opposite to speech, thus revealing the structural lack of symbolism. If this patient's unconsolable scream is a life force inscribed in the body, its repetition and its effects align him with something deathly, the risk of automation and rejection by others. The scream, coupled or not with suffocation, would also be a valuable indicator of the anxiety that arises in the passage into a new environment, especially when the latter is made up of a desirous otherness. Thanks to the packing therapy, the therapeutic work invites the patient to speak and leads him to reinvest in the living and institutional collective; and the screams will lessen in intensity. The daily packing program allowed for an increased proximity with caregivers, and with the patient feeling more present, no longer abandoned, and that he is someone. If the restoration of transference is favorable and brings a noticeable improvement quickly, other transferential movements will require therapeutic rearrangement. Important and sensitive points in the course and continuation of the therapy that could not be observed are the analysis of the caregiving team's countertransference and, in counterpoint to work carried out by healthcare professionals, the role of the peers in work with alterity.</div></div><div><h3>Discussion</h3><div>Packing is a therapeutic choice whose benefits are positive for this highly motivated patient, facilitating a reinvestment of speech and a turning away from a deathly horizon to reconnect with life. A system of lesser magnitude in terms of frequency, duration, and personnel would not have allowed such a positive transferential movement, counteracting the psychological a","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 233-246"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-03-25DOI: 10.1016/j.evopsy.2025.02.002
Philippe Drweski (Psychologue clinicien, Maître de conférences)
<div><h3>Objectives</h3><div>This article proposes a reflection on the impacts of exile and immigration on therapeutic work with certain patients. I observe that the dynamics of transference, due to often traumatic histories, are marked by a variety of phenomena: projective identification, acting out, and operational thinking. Based on this observation, I propose an adjustment to the framework through the creation of a tool I call a “group in transition.” This initiative integrates several elements, including the sensory dimension and transitional objects that facilitate connections between the present and the past, and between the subject's current location and their country of origin. The objective is to facilitate associative processes that have been disrupted by various life events encountered by these populations through sensory transference.</div></div><div><h3>Method</h3><div>The method employed is participant observation of a group established with immigrant subjects.</div></div><div><h3>Results</h3><div>The results indicate that this type of group facilitates the establishment of a transference dynamic through a series of elements: the multicultural group, sensory mediation, and transitional objects. The multicultural aspect allows for the representation of otherness within the group, facilitating its elaboration. Sensory experiences promote regression, granting access to certain parts of the psyche that are challenging to reach due to trauma. Lastly, the transitional object helps to link temporalities (the past and the present) and spaces (here and elsewhere), which are often split, allowing for entry into the subjects’ histories. Thus, this group acts as a vector for the elaboration of questions of identity. The identity question manifests in several ways: the first corresponds to a nostalgic elaboration signifying a genuine process of disengagement. However, we also observe the presence of narcissistic defenses embodied within the group through splits concerning culture, triggering rejection responses. Lastly, another occurrence corresponds to a form of depressive collapse.</div></div><div><h3>Discussion</h3><div>These results prompt me to question certain elements of the “group in transition,” such as its very brief duration (3 months) and the group dimension itself. It seems that while the group supports the psychic apparatus for some, it can also potentially serve as a source of collective resistances through a number of alliances structured by culture and religion. These defenses appear to obscure the traumatic dimensions, which are markedly absent from the sessions. The question of the group's duration is perhaps worth exploring, as it may hinder certain processes, particularly in relation to the elaboration of loss.</div></div><div><h3>Conclusion</h3><div>The difficulties encountered in the clinical setting lead me to imagine new tools to address the challenges of clinical practice with exiled and migrant populations. The “group
{"title":"Dispositif « groupe de passage » auprès de patients exilés et migrants : intérêts et limites","authors":"Philippe Drweski (Psychologue clinicien, Maître de conférences)","doi":"10.1016/j.evopsy.2025.02.002","DOIUrl":"10.1016/j.evopsy.2025.02.002","url":null,"abstract":"<div><h3>Objectives</h3><div>This article proposes a reflection on the impacts of exile and immigration on therapeutic work with certain patients. I observe that the dynamics of transference, due to often traumatic histories, are marked by a variety of phenomena: projective identification, acting out, and operational thinking. Based on this observation, I propose an adjustment to the framework through the creation of a tool I call a “group in transition.” This initiative integrates several elements, including the sensory dimension and transitional objects that facilitate connections between the present and the past, and between the subject's current location and their country of origin. The objective is to facilitate associative processes that have been disrupted by various life events encountered by these populations through sensory transference.</div></div><div><h3>Method</h3><div>The method employed is participant observation of a group established with immigrant subjects.</div></div><div><h3>Results</h3><div>The results indicate that this type of group facilitates the establishment of a transference dynamic through a series of elements: the multicultural group, sensory mediation, and transitional objects. The multicultural aspect allows for the representation of otherness within the group, facilitating its elaboration. Sensory experiences promote regression, granting access to certain parts of the psyche that are challenging to reach due to trauma. Lastly, the transitional object helps to link temporalities (the past and the present) and spaces (here and elsewhere), which are often split, allowing for entry into the subjects’ histories. Thus, this group acts as a vector for the elaboration of questions of identity. The identity question manifests in several ways: the first corresponds to a nostalgic elaboration signifying a genuine process of disengagement. However, we also observe the presence of narcissistic defenses embodied within the group through splits concerning culture, triggering rejection responses. Lastly, another occurrence corresponds to a form of depressive collapse.</div></div><div><h3>Discussion</h3><div>These results prompt me to question certain elements of the “group in transition,” such as its very brief duration (3 months) and the group dimension itself. It seems that while the group supports the psychic apparatus for some, it can also potentially serve as a source of collective resistances through a number of alliances structured by culture and religion. These defenses appear to obscure the traumatic dimensions, which are markedly absent from the sessions. The question of the group's duration is perhaps worth exploring, as it may hinder certain processes, particularly in relation to the elaboration of loss.</div></div><div><h3>Conclusion</h3><div>The difficulties encountered in the clinical setting lead me to imagine new tools to address the challenges of clinical practice with exiled and migrant populations. The “group","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 219-231"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2024-12-17DOI: 10.1016/j.evopsy.2024.11.005
Michel Caire (Psychiatre hospitalier honoraire, Docteur en histoire à l’E.P.H.E. (Paris-Sorbonne))
{"title":"Aux mânes de Constance Pascal. À propos de… « Constance Pascal. Une pionnière de la psychiatrie française (1877–1937) » de Felicia Gordon","authors":"Michel Caire (Psychiatre hospitalier honoraire, Docteur en histoire à l’E.P.H.E. (Paris-Sorbonne))","doi":"10.1016/j.evopsy.2024.11.005","DOIUrl":"10.1016/j.evopsy.2024.11.005","url":null,"abstract":"","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 362-367"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-02-19DOI: 10.1016/j.evopsy.2025.01.008
Jennifer Mertz (Psychologue clinicienne) , Marie-Frédérique Bacqué (Professeur en psychopathologie)
Objective
The person's wishes at the end of their life bring a variety of relational and psychological issues into question. French law allows for Deep and Continuous Sedation Maintained Until Death (SPCMD) under certain conditions. The question then arises of the accuracy of a medical decision in its deontological and ethical dimensions.
Method
We present the request to die of Ms. M., a patient suffering from bipolar disorder treated for several years and a cancer for which treatments have been stopped. This clinical case study highlights the work of reflection around the question of supporting a person whose refractory existential suffering is associated with mental depression.
Results
The request for SPCMD is not admissible within the framework of the Claeys-Leonetti law, as it does not meet the criterion of a short-term lethal prognosis. We offer psychodynamic supportive psychotherapy to the patient. The psychological support undertaken invites us to read the psychological processes that emerge in the meeting space between Ms. M. and a clinical psychologist with a psychoanalytic orientation.
Discussion
The therapeutic listening device specific to the function of the clinical psychologist allows for a space of speech where it is possible to return to what had not been said until then, in this final time of a final accomplishment of a speech act that strengthens and soothes family ties and Ms. M.’s relationship with herself.
Conclusion
The request to die is thus presented as the unconscious revealer of psychological processes neglected by medical decision-making.
{"title":"Psychothérapie et réflexion éthique d’une équipe de soins palliatifs confrontée à la demande de mourir d’une patiente bipolaire","authors":"Jennifer Mertz (Psychologue clinicienne) , Marie-Frédérique Bacqué (Professeur en psychopathologie)","doi":"10.1016/j.evopsy.2025.01.008","DOIUrl":"10.1016/j.evopsy.2025.01.008","url":null,"abstract":"<div><h3>Objective</h3><div>The person's wishes at the end of their life bring a variety of relational and psychological issues into question. French law allows for Deep and Continuous Sedation Maintained Until Death (SPCMD) under certain conditions. The question then arises of the accuracy of a medical decision in its deontological and ethical dimensions.</div></div><div><h3>Method</h3><div>We present the request to die of Ms. M., a patient suffering from bipolar disorder treated for several years and a cancer for which treatments have been stopped. This clinical case study highlights the work of reflection around the question of supporting a person whose refractory existential suffering is associated with mental depression.</div></div><div><h3>Results</h3><div>The request for SPCMD is not admissible within the framework of the Claeys-Leonetti law, as it does not meet the criterion of a short-term lethal prognosis. We offer psychodynamic supportive psychotherapy to the patient. The psychological support undertaken invites us to read the psychological processes that emerge in the meeting space between Ms. M. and a clinical psychologist with a psychoanalytic orientation.</div></div><div><h3>Discussion</h3><div>The therapeutic listening device specific to the function of the clinical psychologist allows for a space of speech where it is possible to return to what had not been said until then, in this final time of a final accomplishment of a speech act that strengthens and soothes family ties and Ms. M.’s relationship with herself.</div></div><div><h3>Conclusion</h3><div>The request to die is thus presented as the unconscious revealer of psychological processes neglected by medical decision-making.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 290-301"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2024-12-12DOI: 10.1016/j.evopsy.2024.11.004
Emmanuel de Becker (Psychiatre infanto-juvénile, Psychothérapeute)
<div><h3>Objective</h3><div>This contribution proposes to address different aspects of parental posture as regards the decision to seek help (or not) for their child, whether for a physical and/or mental health issue, in order to identify some possible ways of helping the professional. To do this, we will explore different scenarios of the parent's “desire” to consult a medical-psycho-social worker, whose repercussions can result in a situation of child abuse.</div></div><div><h3>Method</h3><div>At the risk of being schematic, we propose to group into seven categories the possible postures used by the parent when consulting, or not consulting, a professional for any reason. We accept the arbitrary nature of this classification. It should be noted that each table presented at the moment of the initial professional/parent(s)/child contact can switch from one category to another according to the evolution of several parameters, whether they are individual, relational, or contextual.</div></div><div><h3>Result</h3><div>We will focus on two specific cases that reflect the adult's massive anxieties towards the child, which can lead to the parent's development of delusions about the child, or a more or less elaborate process of using the state of the young person for a defined purpose. Thus, we will present, on the one hand, situations of parental alienation syndrome (PAS) and, on the other hand, situations in which parents “create” symptoms in their children, whose paradigm is represented by Munchausen syndrome by proxy (MSP).</div></div><div><h3>Discussion</h3><div>Behind the desire to seek professional help and the parent's concern for the child, there are sometimes hidden situations of parental inadequacy that are difficult to identify. Thus, let us keep in mind the hypothesis of child abuse, when we question the ins and outs of a consultation approach that gives rise to puzzlement, to a disconcerting parental concern… Let us also point out that we evoke these entities by taking as paradigmatic the case of a mother calling on the professional; it is obvious that many situations concern fathers, certainly when it comes to processes of alienation. In any event, it seems to me useful, from the point of view of relevant support for the child and his or her entourage, to address as precisely as possible the relational context encountered. Understanding without judgment is usually the first step in any care and support intervention. Otherwise, the professional is threatened with being merely an actor immersed (in)-voluntarily, (un)-consciously, in a hypothetically abusive system. Ultimately, we have to be careful when we consider that a child is being used as a tool, because there are many situations…</div></div><div><h3>Conclusion</h3><div>One of the risks for the professional is to take at face value the parent's primary request without taking the time to explore the ins and outs of the process. The child in this case is the object of a consultation, no
{"title":"Du désir parental de consulter au risque de la maltraitance infanto-juvénile","authors":"Emmanuel de Becker (Psychiatre infanto-juvénile, Psychothérapeute)","doi":"10.1016/j.evopsy.2024.11.004","DOIUrl":"10.1016/j.evopsy.2024.11.004","url":null,"abstract":"<div><h3>Objective</h3><div>This contribution proposes to address different aspects of parental posture as regards the decision to seek help (or not) for their child, whether for a physical and/or mental health issue, in order to identify some possible ways of helping the professional. To do this, we will explore different scenarios of the parent's “desire” to consult a medical-psycho-social worker, whose repercussions can result in a situation of child abuse.</div></div><div><h3>Method</h3><div>At the risk of being schematic, we propose to group into seven categories the possible postures used by the parent when consulting, or not consulting, a professional for any reason. We accept the arbitrary nature of this classification. It should be noted that each table presented at the moment of the initial professional/parent(s)/child contact can switch from one category to another according to the evolution of several parameters, whether they are individual, relational, or contextual.</div></div><div><h3>Result</h3><div>We will focus on two specific cases that reflect the adult's massive anxieties towards the child, which can lead to the parent's development of delusions about the child, or a more or less elaborate process of using the state of the young person for a defined purpose. Thus, we will present, on the one hand, situations of parental alienation syndrome (PAS) and, on the other hand, situations in which parents “create” symptoms in their children, whose paradigm is represented by Munchausen syndrome by proxy (MSP).</div></div><div><h3>Discussion</h3><div>Behind the desire to seek professional help and the parent's concern for the child, there are sometimes hidden situations of parental inadequacy that are difficult to identify. Thus, let us keep in mind the hypothesis of child abuse, when we question the ins and outs of a consultation approach that gives rise to puzzlement, to a disconcerting parental concern… Let us also point out that we evoke these entities by taking as paradigmatic the case of a mother calling on the professional; it is obvious that many situations concern fathers, certainly when it comes to processes of alienation. In any event, it seems to me useful, from the point of view of relevant support for the child and his or her entourage, to address as precisely as possible the relational context encountered. Understanding without judgment is usually the first step in any care and support intervention. Otherwise, the professional is threatened with being merely an actor immersed (in)-voluntarily, (un)-consciously, in a hypothetically abusive system. Ultimately, we have to be careful when we consider that a child is being used as a tool, because there are many situations…</div></div><div><h3>Conclusion</h3><div>One of the risks for the professional is to take at face value the parent's primary request without taking the time to explore the ins and outs of the process. The child in this case is the object of a consultation, no","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 302-320"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-04-25DOI: 10.1016/j.evopsy.2025.01.001
Christophe Chaperot (Psychiatre, Chef de pôle)
Objective
The psychotherapy of psychotic patients is the subject of much debate and discussion, with two underlying factors: firstly, the fear of doing worse than better, and secondly, the need to flush out the underlying ideologies likely to aggravate the implicit discrimination of patients under the mask of benevolence, which in reality is rejectionist. To put it bluntly, there are three main approaches: containment of enjoyment, which allows the patient to elaborate at the same time (with the risk of psychic sclerosis), cognitive remediation, with the risk of ideological normalisation, and finally immersion in the psychotic world (with the risk of supporting delirium and its suffering). In this paper, we will discuss this third possibility, drawing on the thinking of Gaetano Benedetti, and consequently on a psychoanalytical basis. It is neither a question of proselytising Benedetti's thought, nor of ostracising other approaches.
Method
The main principles of Benedetti's thinking will be taken up again, at the same time as we propose clinical illustrations from our own practice. A brief reminder of the difference between psychoanalysis and psychotherapy and psychoanalysis will be offered, as well as the impossibility of psychoanalysis with a psychotic patient, which is why our title indicates ‘psychoanalytic psychotherapy’.
Result
It appears that Benedetti's theses, and the praxis that follows from them, do not concern all psychotic patients or all psychoanalysts; they require a kind of special nature that Freud was already talking about in his day. The crucial point is, on the one hand, ‘positivisation’ (considering that the delusional patient is telling the truth because it is his reality). The other aspect concerns an attitude of ‘partial identification’, i.e. identifying with the patient in his psychosis and working in solidarity with him on the basis of his truth.
Discussion
Psychoanalytic psychotherapy of psychotic patients using (partial) identification can be an interesting way of gaining access to the patient's most intimate psychopathological mechanisms, in order to offer help in the same way as an architect rather than an archaeologist (in Freud's sense of the typical cure).
Conclusion
Benedetti has devised a way of approaching psychosis that may prove useful in a number of cases, while putting the possibility of success into perspective. Success results in the construction of an undecidable structure combining unconscious elements of the patient and others of the analyst as a result of identification effects causing a form of unconscious hybridisation.
{"title":"Gaetano Benedetti's psychoanalytical psychotherapy of psychoses: Illustrations from a number of clinical situations","authors":"Christophe Chaperot (Psychiatre, Chef de pôle)","doi":"10.1016/j.evopsy.2025.01.001","DOIUrl":"10.1016/j.evopsy.2025.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>The psychotherapy of psychotic patients is the subject of much debate and discussion, with two underlying factors: firstly, the fear of doing worse than better, and secondly, the need to flush out the underlying ideologies likely to aggravate the implicit discrimination of patients under the mask of benevolence, which in reality is rejectionist. To put it bluntly, there are three main approaches: containment of enjoyment, which allows the patient to elaborate at the same time (with the risk of psychic sclerosis), cognitive remediation, with the risk of ideological normalisation, and finally immersion in the psychotic world (with the risk of supporting delirium and its suffering). In this paper, we will discuss this third possibility, drawing on the thinking of Gaetano Benedetti, and consequently on a psychoanalytical basis. It is neither a question of proselytising Benedetti's thought, nor of ostracising other approaches.</div></div><div><h3>Method</h3><div>The main principles of Benedetti's thinking will be taken up again, at the same time as we propose clinical illustrations from our own practice. A brief reminder of the difference between psychoanalysis and psychotherapy and psychoanalysis will be offered, as well as the impossibility of psychoanalysis with a psychotic patient, which is why our title indicates ‘psychoanalytic psychotherapy’.</div></div><div><h3>Result</h3><div>It appears that Benedetti's theses, and the praxis that follows from them, do not concern all psychotic patients or all psychoanalysts; they require a kind of special nature that Freud was already talking about in his day. The crucial point is, on the one hand, ‘positivisation’ (considering that the delusional patient is telling the truth because it is his reality). The other aspect concerns an attitude of ‘partial identification’, i.e. identifying with the patient in his psychosis and working in solidarity with him on the basis of his truth.</div></div><div><h3>Discussion</h3><div>Psychoanalytic psychotherapy of psychotic patients using (partial) identification can be an interesting way of gaining access to the patient's most intimate psychopathological mechanisms, in order to offer help in the same way as an architect rather than an archaeologist (in Freud's sense of the typical cure).</div></div><div><h3>Conclusion</h3><div>Benedetti has devised a way of approaching psychosis that may prove useful in a number of cases, while putting the possibility of success into perspective. Success results in the construction of an undecidable structure combining unconscious elements of the patient and others of the analyst as a result of identification effects causing a form of unconscious hybridisation.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 197-206"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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