Pub Date : 2024-10-24DOI: 10.1016/j.evopsy.2024.10.003
Yann Auxéméry , Sarah Troubé (Psychologue clinicienne, maîtresse de Conférences en psychologie clinique et psychopathologie)
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Pub Date : 2024-10-15DOI: 10.1016/j.evopsy.2024.08.002
Jean-Michel Thurin Ph D sciences cognitives (psychiatre, compétent enfant/adolescent, chercheur associé CESP, resp. pédagogique D.U. psychothérapies : des théories aux pratiques) , Dr en sciences du langage Monique Thurin (psychologue clinicienne) , François Journet (psychiatre) , Huguette Le Guillou (psychologue psychothérapeute) , Marie-Michelle Narzabal (psychologue clinicienne, psychothérapeute) , Sandrine Bonneton (psychiatre, pédopsychiatre) , Luc Surjous (psychiatre, pédopsychiatre) , Michel Botbol (professeur émérite de psychiatrie de l’enfant et de l’adolescent, président de l’Association mondiale de psychiatrie dynamique)
<div><h3>Objective</h3><div>What is psychotherapy today? Why evaluate its therapeutic mechanisms? How can these practices be taught? These are the three essential and complementary questions that the journal <em>L’Évolution Psychiatrique</em> invited us to answer.</div></div><div><h3>Method</h3><div>The elucidation of therapeutic mechanisms, “Why and how does psychotherapy produce effects?” has already been a focal point for questioning practices and theories at the beginning of the twentieth century. Pierre Janet and Sigmund Freud both sought a scientific answer to this question. Janet approached it through a historical study of psychotherapy methods and their results, justified by various mechanisms. Based on 250 cases that he himself treated through hypnotic suggestion, he considered that it was not about creating new resources but rather about using those that the mind already possesses. Freud, during the same period, saw psychotherapy as a process that allows the unconscious to become conscious. He noted that although he had abandoned hypnosis, he rediscovered suggestion in the form of transference. He expressed doubts about the reception that evaluation might receive and predicted the upcoming importance of biology. The elucidation of change processes and their mechanisms became the central question in psychotherapy research in the early 2000s (Kazdin, Kraemer et al.). Developmental psychopathology and methodologies applicable to psychotherapies conducted in natural settings are included. Medical and psychological methodologies for evaluative research are quickly distinguished. Two major developments are noteworthy during this period. The first is the broadening of psychotherapy's scope to include childhood disorders, severe personality disorders, as well as psychotic and psychosomatic disorders. These are revealed to be complex multifactorial disorders. The second is the development of research in biology and then on the brain in relation to the context of reality, including early developmental phases, stress, and trauma. What are the consequences of this evolution on current theories and practices?</div></div><div><h3>Results</h3><div>To answer these questions, we approached this evolution by associating the history of psychotherapy methods (P. Janet) with four major actors in the neuroscientific field who have published on: evolution, development, and consciousness (G.M. Edelman); modern biology and psychoanalysis (E. Kandel); clinical and neurobiological psychotherapy of complex disorders (A.R. Schore); and the socialization of sensorimotor contingencies (A. Lübbert). These five authors have engaged in a multidisciplinary approach open to psychotherapy.</div></div><div><h3>Discussion</h3><div>Their work significantly contributes to understanding the conditions that influence the effects and mechanisms of psychotherapy. They shed light on the changes it produces and help grasp their origin and part of the cause. Biology and psychology wo
{"title":"La psychothérapie à la lumière des neurosciences","authors":"Jean-Michel Thurin Ph D sciences cognitives (psychiatre, compétent enfant/adolescent, chercheur associé CESP, resp. pédagogique D.U. psychothérapies : des théories aux pratiques) , Dr en sciences du langage Monique Thurin (psychologue clinicienne) , François Journet (psychiatre) , Huguette Le Guillou (psychologue psychothérapeute) , Marie-Michelle Narzabal (psychologue clinicienne, psychothérapeute) , Sandrine Bonneton (psychiatre, pédopsychiatre) , Luc Surjous (psychiatre, pédopsychiatre) , Michel Botbol (professeur émérite de psychiatrie de l’enfant et de l’adolescent, président de l’Association mondiale de psychiatrie dynamique)","doi":"10.1016/j.evopsy.2024.08.002","DOIUrl":"10.1016/j.evopsy.2024.08.002","url":null,"abstract":"<div><h3>Objective</h3><div>What is psychotherapy today? Why evaluate its therapeutic mechanisms? How can these practices be taught? These are the three essential and complementary questions that the journal <em>L’Évolution Psychiatrique</em> invited us to answer.</div></div><div><h3>Method</h3><div>The elucidation of therapeutic mechanisms, “Why and how does psychotherapy produce effects?” has already been a focal point for questioning practices and theories at the beginning of the twentieth century. Pierre Janet and Sigmund Freud both sought a scientific answer to this question. Janet approached it through a historical study of psychotherapy methods and their results, justified by various mechanisms. Based on 250 cases that he himself treated through hypnotic suggestion, he considered that it was not about creating new resources but rather about using those that the mind already possesses. Freud, during the same period, saw psychotherapy as a process that allows the unconscious to become conscious. He noted that although he had abandoned hypnosis, he rediscovered suggestion in the form of transference. He expressed doubts about the reception that evaluation might receive and predicted the upcoming importance of biology. The elucidation of change processes and their mechanisms became the central question in psychotherapy research in the early 2000s (Kazdin, Kraemer et al.). Developmental psychopathology and methodologies applicable to psychotherapies conducted in natural settings are included. Medical and psychological methodologies for evaluative research are quickly distinguished. Two major developments are noteworthy during this period. The first is the broadening of psychotherapy's scope to include childhood disorders, severe personality disorders, as well as psychotic and psychosomatic disorders. These are revealed to be complex multifactorial disorders. The second is the development of research in biology and then on the brain in relation to the context of reality, including early developmental phases, stress, and trauma. What are the consequences of this evolution on current theories and practices?</div></div><div><h3>Results</h3><div>To answer these questions, we approached this evolution by associating the history of psychotherapy methods (P. Janet) with four major actors in the neuroscientific field who have published on: evolution, development, and consciousness (G.M. Edelman); modern biology and psychoanalysis (E. Kandel); clinical and neurobiological psychotherapy of complex disorders (A.R. Schore); and the socialization of sensorimotor contingencies (A. Lübbert). These five authors have engaged in a multidisciplinary approach open to psychotherapy.</div></div><div><h3>Discussion</h3><div>Their work significantly contributes to understanding the conditions that influence the effects and mechanisms of psychotherapy. They shed light on the changes it produces and help grasp their origin and part of the cause. Biology and psychology wo","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 713-748"},"PeriodicalIF":0.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721922","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 : 2024-10-10DOI: 10.1016/j.evopsy.2024.09.001
Cécile Gorin (Médecin en Chef, Psychiatre), Célia Breton (Psychologue de Classe normale, Psychologue), Carole Milan (Médecin en Chef, Psychiatre), Charles Gheorghiev (Médecin en Chef, Chef du service de Psychiatrie de l’HIA Sainte Anne)
<div><h3>Objectives</h3><div>Early medical and psychological intervention models are currently dominated by debriefing in conditions of exceptional stress such as armed conflict. Intervention must be rapid and coordinated in order to meet the needs of the victims, by encouraging the verbalization of emotions and the restoration of social links. The historical origins and evolution of debriefing, from past wars to its contemporary application, underline a different, preventive, role in a psychiatry.</div></div><div><h3>Method</h3><div>The effects of psychological trauma on the individual and the group involve deleterious dissociation phenomena requiring the restoration of a reassuring framework. The role of debriefing in reintegrating the experience through the development of a shared narrative encourages a process of reconnection, which contributes to this reassuring effect. However, the principle of immediately encouraging traumatized individuals to express themselves verbally calls into question debriefing's conformity with usual psychotherapy practices. Teaching it, which is not in itself an act of care, is nevertheless an opportunity to approach its effects, through the same dynamic of identification in the trainees. The development of new teaching methods, such as simulation, is particularly relevant here, as it emphasizes the acquisition of know-how rather than the transmission of theoretical knowledge. The teaching is based on a behavioral approach, the aim being to encourage trainees to perfect their skills by repeating role-playing exercises, thereby facilitating the transmission of interpersonal and communication skills.</div></div><div><h3>Results</h3><div>The training of military health professionals, particularly in psychiatry, is vital if they are to cope with the specific constraints of military operations. The aim of this training is to prepare healthcare professionals to intervene in isolated situations and to manage crisis scenarios. A specific educational initiative has been set up at the military hospital Sainte-Anne in Toulon, based on simulation to teach medical-psychological debriefing for the benefit of medical staff who are deployed on missions. The teaching team uses role-playing to simulate operational crisis situations involving traumatic exposure, offering trainees a realistic and interactive approach. This simulation-based approach enables trainees to confront unforeseen situations specific to the military context, while developing the practical and emotional skills that are essential in the management of psychological disorders. In addition, this teaching method encourages reflective practice and promotes an empathetic approach to patients, differentiating the teacher's posture in this context from that which is usually adopted in medicine. In this way, simulation serves as a catalyst for initiating authentic exchanges between trainees and trainers, over and above the effects of subjective experiences specific to ea
{"title":"L’enseignement du débriefing médico-psychologique par la simulation : quand le transfert se loge au cœur des effets de transmission d’un savoir","authors":"Cécile Gorin (Médecin en Chef, Psychiatre), Célia Breton (Psychologue de Classe normale, Psychologue), Carole Milan (Médecin en Chef, Psychiatre), Charles Gheorghiev (Médecin en Chef, Chef du service de Psychiatrie de l’HIA Sainte Anne)","doi":"10.1016/j.evopsy.2024.09.001","DOIUrl":"10.1016/j.evopsy.2024.09.001","url":null,"abstract":"<div><h3>Objectives</h3><div>Early medical and psychological intervention models are currently dominated by debriefing in conditions of exceptional stress such as armed conflict. Intervention must be rapid and coordinated in order to meet the needs of the victims, by encouraging the verbalization of emotions and the restoration of social links. The historical origins and evolution of debriefing, from past wars to its contemporary application, underline a different, preventive, role in a psychiatry.</div></div><div><h3>Method</h3><div>The effects of psychological trauma on the individual and the group involve deleterious dissociation phenomena requiring the restoration of a reassuring framework. The role of debriefing in reintegrating the experience through the development of a shared narrative encourages a process of reconnection, which contributes to this reassuring effect. However, the principle of immediately encouraging traumatized individuals to express themselves verbally calls into question debriefing's conformity with usual psychotherapy practices. Teaching it, which is not in itself an act of care, is nevertheless an opportunity to approach its effects, through the same dynamic of identification in the trainees. The development of new teaching methods, such as simulation, is particularly relevant here, as it emphasizes the acquisition of know-how rather than the transmission of theoretical knowledge. The teaching is based on a behavioral approach, the aim being to encourage trainees to perfect their skills by repeating role-playing exercises, thereby facilitating the transmission of interpersonal and communication skills.</div></div><div><h3>Results</h3><div>The training of military health professionals, particularly in psychiatry, is vital if they are to cope with the specific constraints of military operations. The aim of this training is to prepare healthcare professionals to intervene in isolated situations and to manage crisis scenarios. A specific educational initiative has been set up at the military hospital Sainte-Anne in Toulon, based on simulation to teach medical-psychological debriefing for the benefit of medical staff who are deployed on missions. The teaching team uses role-playing to simulate operational crisis situations involving traumatic exposure, offering trainees a realistic and interactive approach. This simulation-based approach enables trainees to confront unforeseen situations specific to the military context, while developing the practical and emotional skills that are essential in the management of psychological disorders. In addition, this teaching method encourages reflective practice and promotes an empathetic approach to patients, differentiating the teacher's posture in this context from that which is usually adopted in medicine. In this way, simulation serves as a catalyst for initiating authentic exchanges between trainees and trainers, over and above the effects of subjective experiences specific to ea","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 695-711"},"PeriodicalIF":0.6,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722000","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 : 2024-09-26DOI: 10.1016/j.evopsy.2024.08.001
Laura Pralus (étudiante en Master de Psychopathologie Clinique Psychanalytique, Université Lumière Lyon 2) , François-David Camps (professeur de Psychopathologie et de Psychologie Clinique, Centre de Recherche en Psychopathologie et Psychologie Clinique (CRPPC), Université Lumière Lyon 2)
Objectives
Repeated suicide attempts are a particularly difficult clinical problem. Multiple suicide attempts in the same patient often leave caregivers with a feeling of incomprehension and therapeutic powerlessness. Far from being a “raptus,” the act of suicidal recividism is underpinned by complex psychic processes. In particular, we look at the role of the object and the loss of perception of the object in the dynamics of repeated suicidal acts.
Method
We conducted research with three women hospitalized in a psychiatric unit. We offered them a semi-directive interview, followed by the Rorschach and the T.A.T., and finally an open interview. Part of the research process was designed to give the participants the opportunity to express themselves freely, leaving room for imaginative reverie based on the rule of free association. Our methodology is based on an individual case study.
Results
Frédérique, Nora, and Olga all took the projective tests. However, the T.A.T. showed some difficulty in processing the instructions. The protocols as a whole showed little investment of thought, a form of passivity in the face of the material, with a predominance of avoidant maneuvers. Using our data, we will question the quality and capacity of our subjects to summon a sufficiently solid internal object. We will also analyze our patients’ narratives, which are more invested in an anaclitic mode, where relationships, and particularly specular relationships, are at the forefront. The narratives are thus mainly mobilized around the treatment of loss through the excitement it can arouse in our subjects.
Discussion
Object support is particularly invested in a negative function. We thus studied the relational modalities of our subjects with regard to object dependence, the question of loss and the anxiety it can engender, as well as its associated manifestations.
Conclusion
By exploring the unconscious dynamics underlying suicidal acts, and in particular recidivism, we are led to believe that this type of act contains an address to the object, an address that remains unknown to the subject itself and that requires a response from the object for which it is intended. The absence of a response from the object would give rise to an unbearable excitation, for which the subject can imagine no other solution than resorting to a suicidal act. The inevitable return of these unworkable situations would explain suicidal recidivism.
{"title":"Le rôle des angoisses de perte dans la récidive suicidaire","authors":"Laura Pralus (étudiante en Master de Psychopathologie Clinique Psychanalytique, Université Lumière Lyon 2) , François-David Camps (professeur de Psychopathologie et de Psychologie Clinique, Centre de Recherche en Psychopathologie et Psychologie Clinique (CRPPC), Université Lumière Lyon 2)","doi":"10.1016/j.evopsy.2024.08.001","DOIUrl":"10.1016/j.evopsy.2024.08.001","url":null,"abstract":"<div><h3>Objectives</h3><div>Repeated suicide attempts are a particularly difficult clinical problem. Multiple suicide attempts in the same patient often leave caregivers with a feeling of incomprehension and therapeutic powerlessness. Far from being a “raptus,” the act of suicidal recividism is underpinned by complex psychic processes. In particular, we look at the role of the object and the loss of perception of the object in the dynamics of repeated suicidal acts.</div></div><div><h3>Method</h3><div>We conducted research with three women hospitalized in a psychiatric unit. We offered them a semi-directive interview, followed by the Rorschach and the T.A.T., and finally an open interview. Part of the research process was designed to give the participants the opportunity to express themselves freely, leaving room for imaginative reverie based on the rule of free association. Our methodology is based on an individual case study.</div></div><div><h3>Results</h3><div>Frédérique, Nora, and Olga all took the projective tests. However, the T.A.T. showed some difficulty in processing the instructions. The protocols as a whole showed little investment of thought, a form of passivity in the face of the material, with a predominance of avoidant maneuvers. Using our data, we will question the quality and capacity of our subjects to summon a sufficiently solid internal object. We will also analyze our patients’ narratives, which are more invested in an anaclitic mode, where relationships, and particularly specular relationships, are at the forefront. The narratives are thus mainly mobilized around the treatment of loss through the excitement it can arouse in our subjects.</div></div><div><h3>Discussion</h3><div>Object support is particularly invested in a negative function. We thus studied the relational modalities of our subjects with regard to object dependence, the question of loss and the anxiety it can engender, as well as its associated manifestations.</div></div><div><h3>Conclusion</h3><div>By exploring the unconscious dynamics underlying suicidal acts, and in particular recidivism, we are led to believe that this type of act contains an address to the object, an address that remains unknown to the subject itself and that requires a response from the object for which it is intended. The absence of a response from the object would give rise to an unbearable excitation, for which the subject can imagine no other solution than resorting to a suicidal act. The inevitable return of these unworkable situations would explain suicidal recidivism.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 1-11"},"PeriodicalIF":0.6,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158967","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 : 2024-09-14DOI: 10.1016/j.evopsy.2024.05.006
Fernando Landazuri (Psychiatre, patricien hospitalier)
Objective
The author proposes to take up the phenomenological approach to mania, considering that its presently prevalent semiological form is dysphoric, and no longer, as was classically described, euphoric. After having briefly attempted to formulate some hypotheses relating to the occurrence of this semiological modification, it will be a question of seeking the unity of syndromic mania in spite of, or rather through, these modes of semiological presentation that seem a priori to be radically opposed.
Method
Relying mainly on the founding works relating to the study of manic phenomenality (mainly by Binswanger and Ey), but without leaving the heuristic horizon of psychoanalysis, we will endeavor to circumscribe the reductive constraint (epochè) specific to mania, as well as the directions of phenomenological meaning that characterize it most closely.
Result
Manic depersonalization proceeds, as does melancholy, from a radical form of affective neutralization, whose paradoxical inferences in the registers of spatio-temporality and intersubjectivity will need to be clarified. The manic antinomy (Binswanger), dramatically tightening the chiasmatic knot of life and death, engages the emancipation of extreme tensions mixing expansion and retraction of space and time, which can be represented by the image of a leap (vertiginous or soaring), between flight and fall; while in the domain of inter-subjectivity, the lack of apprehension and a “loud-mouth” form of being determine the characteristic misdirection of the encounter with the other by the manic subject.
Discussion
The manic antinomy joins the melancholic agony to a counter-agonic vital leap, which the daseinsanalytical and psychoanalytical approaches help to clarify. The loss of historicization and even the subjective anonymization that characterize mania as well as melancholy, to the point of making them “a-historical psychoses” (Binswanger), nevertheless leave intact the experience of self-belonging of the Ego, in a form of “pure ego distress” (Binswanger), which we will try to specify.
Conclusion
The mood component (euphoric or dysphoric) ultimately appears vicarious in the manic process. Manic phenomenality stems from an eminently singular affective epoch‘e, touching on trans-possibility (Maldiney), the semiological outcome of which seems linked to the emergence of this tension of nonexistence that totalizes the manic experience, or rather, experimentation.
{"title":"Investigation phénoménologique des formes actuelles de la manie : de l’euphorie à la dysphorie","authors":"Fernando Landazuri (Psychiatre, patricien hospitalier)","doi":"10.1016/j.evopsy.2024.05.006","DOIUrl":"10.1016/j.evopsy.2024.05.006","url":null,"abstract":"<div><h3>Objective</h3><div>The author proposes to take up the phenomenological approach to mania, considering that its presently prevalent semiological form is dysphoric, and no longer, as was classically described, euphoric. After having briefly attempted to formulate some hypotheses relating to the occurrence of this semiological modification, it will be a question of seeking the unity of syndromic mania in spite of, or rather through, these modes of semiological presentation that seem a priori to be radically opposed.</div></div><div><h3>Method</h3><div>Relying mainly on the founding works relating to the study of manic phenomenality (mainly by Binswanger and Ey), but without leaving the heuristic horizon of psychoanalysis, we will endeavor to circumscribe the reductive constraint (epochè) specific to mania, as well as the directions of phenomenological meaning that characterize it most closely.</div></div><div><h3>Result</h3><div>Manic depersonalization proceeds, as does melancholy, from a radical form of affective neutralization, whose paradoxical inferences in the registers of spatio-temporality and intersubjectivity will need to be clarified. The manic antinomy (Binswanger), dramatically tightening the chiasmatic knot of life and death, engages the emancipation of extreme tensions mixing expansion and retraction of space and time, which can be represented by the image of a leap (vertiginous or soaring), between flight and fall; while in the domain of inter-subjectivity, the lack of apprehension and a “loud-mouth” form of being determine the characteristic misdirection of the encounter with the other by the manic subject.</div></div><div><h3>Discussion</h3><div>The manic antinomy joins the melancholic agony to a counter-agonic vital leap, which the daseinsanalytical and psychoanalytical approaches help to clarify. The loss of historicization and even the subjective anonymization that characterize mania as well as melancholy, to the point of making them “a-historical psychoses” (Binswanger), nevertheless leave intact the experience of self-belonging of the Ego, in a form of “pure ego distress” (Binswanger), which we will try to specify.</div></div><div><h3>Conclusion</h3><div>The mood component (euphoric or dysphoric) ultimately appears vicarious in the manic process. Manic phenomenality stems from an eminently singular affective epoch‘e, touching on trans-possibility (Maldiney), the semiological outcome of which seems linked to the emergence of this tension of nonexistence that totalizes the manic experience, or rather, experimentation.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 71-83"},"PeriodicalIF":0.6,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143159019","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 : 2024-09-13DOI: 10.1016/j.evopsy.2024.07.005
Clémence Dayan (Maître de conferences en psychopathologie)
Objective
This article reports on a case study from qualitative research into the peer relationships of young children with disabilities.
Method
This qualitative study consisted in observing disabled children's relationships over an 18-month period in three contexts (family, mainstream environment, and special needs environment). Thirty-two children were included, 15 girls and 17 boys, with a mean age of 3 years and 2 months, and with various disabilities (motor disability [n = 8], both intellectual and motor disabilities [n = 16], multiple disabilities [n = 8]). Three kinds of tools were used: a logbook retracing the child's development and life events filled in by the referent psychologist; observation booklets filled in twice by parents and inclusion professionals and the referent psychologist, over two separate 18-month periods; semi-directive interviews carried out by the researchers with the parents and the professionals at the end of the research project. A thematic qualitative analysis was carried out on all the data collected for the 32 cases.
Results
The present article focuses on the case of Myriam, who has had an overall developmental delay since birth. At the beginning, when she arrives at school, she overwhelmingly prefers relationships with adults; is disorganized in her relationships with other children; and cannot seem to bear noise, movement, and groups, which she avoids. Interaction with her is possible, but on the condition that she is able to anticipate and remains in control. Eighteen months later, she reacts better to requests, interacts by imitation and has started a special relationship with another little girl. At the CAMSP, she is surer of herself in the group and is able to contradict adults or be aggressive with her classmates. At the end of the research project, at 6 years old, Myriam is much more self-assured. Even if some interactions remains difficult, they have become possible, without adult mediation.
Discussion
This case, chosen because of its representativeness, enables us to raise issues concerning the specific processes underlying disabled children's construction of peer relationships. Typically, young children initially relate to the adults in their life, and then gradually learn to cope with the presence of other children, first in the family, and then outside the family circle. For Myriam, this process occurred later; our hypothesis is that this time lag is due to the particularly central role of the process of separation–individuation with the mother, as relationships with peers can only be formed once the child's maternal representations have evolved. Initially, she is deeply insecure with other children; still in a context of symbiosis with her mother, Myriam seems too little differentiated from the
{"title":"Myriam à la rencontre des autres enfants : processus psychiques à l’œuvre dans la construction des liens avec les pairs chez une petite fille handicapée","authors":"Clémence Dayan (Maître de conferences en psychopathologie)","doi":"10.1016/j.evopsy.2024.07.005","DOIUrl":"10.1016/j.evopsy.2024.07.005","url":null,"abstract":"<div><h3>Objective</h3><div>This article reports on a case study from qualitative research into the peer relationships of young children with disabilities.</div></div><div><h3>Method</h3><div>This qualitative study consisted in observing disabled children's relationships over an 18-month period in three contexts (family, mainstream environment, and special needs environment). Thirty-two children were included, 15 girls and 17 boys, with a mean age of 3<!--> <!-->years and 2<!--> <!-->months, and with various disabilities (motor disability [<em>n</em> <!-->=<!--> <!-->8], both intellectual and motor disabilities [<em>n</em> <!-->=<!--> <!-->16], multiple disabilities [<em>n</em> <!-->=<!--> <!-->8]). Three kinds of tools were used: a logbook retracing the child's development and life events filled in by the referent psychologist; observation booklets filled in twice by parents and inclusion professionals and the referent psychologist, over two separate 18-month periods; semi-directive interviews carried out by the researchers with the parents and the professionals at the end of the research project. A thematic qualitative analysis was carried out on all the data collected for the 32 cases.</div></div><div><h3>Results</h3><div>The present article focuses on the case of Myriam, who has had an overall developmental delay since birth. At the beginning, when she arrives at school, she overwhelmingly prefers relationships with adults; is disorganized in her relationships with other children; and cannot seem to bear noise, movement, and groups, which she avoids. Interaction with her is possible, but on the condition that she is able to anticipate and remains in control. Eighteen months later, she reacts better to requests, interacts by imitation and has started a special relationship with another little girl. At the CAMSP, she is surer of herself in the group and is able to contradict adults or be aggressive with her classmates. At the end of the research project, at 6<!--> <!-->years old, Myriam is much more self-assured. Even if some interactions remains difficult, they have become possible, without adult mediation.</div></div><div><h3>Discussion</h3><div>This case, chosen because of its representativeness, enables us to raise issues concerning the specific processes underlying disabled children's construction of peer relationships. Typically, young children initially relate to the adults in their life, and then gradually learn to cope with the presence of other children, first in the family, and then outside the family circle. For Myriam, this process occurred later; our hypothesis is that this time lag is due to the particularly central role of the process of separation–individuation with the mother, as relationships with peers can only be formed once the child's maternal representations have evolved. Initially, she is deeply insecure with other children; still in a context of symbiosis with her mother, Myriam seems too little differentiated from the","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 29-43"},"PeriodicalIF":0.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158969","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 : 2024-08-10DOI: 10.1016/j.evopsy.2024.06.003
Stéphane Muths (Psychologue clinicien, Docteur en Psychopathologie et chercheur associé au CRPMS URP 3522, Chargé d’enseignement à la Faculté de psychologie de l’Université de Strasbourg) , Renaud Evrard (Psychologue clinicien, Maître de conférences HDR en Psychologie)
Aims
We examine the alienating and structuring aspects of shame in a psychotherapeutic setting. The aim is to determine its place in the construction of identity from the latency phase through puberty where psychotic movements are present.
Method
We will base our study on the case of Augustin, a ten-year-old whose presentation suggested a form of psychosis, with social withdrawal, psychomotor agitation, social communication disorders, and behavioral problems. We were able to see him for three years in a medical and psychological center for children. We describe the development of symptoms, the family configuration, and the main stages of his treatment. We sketch out the main features of this case, interpreting the particularities of Augustin's contact and his destructive movements as relating to a struggle against psychic invasion by an alienating family logic.
Results
This clinical work led us to identify psychotic manifestations that surpass a simple and exclusive structural distinction. We were able to highlight the family component in the psychopathological expression of Augustin's case, based on the father's paranoid logic. The specific relationship with language is revealed as an instrument of the transferential logic that allows a form of subjectivation of the risk of psychic invasion by shame.
Discussion
The clinical picture required us to move away from the DSM's logic of piling up diagnoses in order to shed light on psychic functioning, revisiting the notion of psychotic disorders in children and adolescents so as not to confine Augustin's case to a single trajectory. It was necessary to avoid the temptation to read into the family configuration the ‘causes’ of the child's disorders, rather than some of their coordinates. By working on the child's experiences and the malleable medium, the individual therapeutic mediations we implemented enabled us to co-construct a therapeutic space that facilitated access to play by taking into account the development of the affect of shame in the transferential relationship.
Conclusion
The aim of the psychotherapeutic process was to create a space that could accommodate the destructive movements of the object and thus offer the possibility of symbolizing the destructive and invasive elements of the family scene, and the fragilities of the ego specific to the psychotic movements in place. On the basis of an analysis of these elements, the psychotherapeutic work enabled the sensations of contamination and invasion of the psyche to be recaptured in order to construct a form of psychic containment that prevented movements of confusion between the self and the other. Augustin's case illustrates the symptomatic modulations specific to psychotic elements, highlighting the fragility of contact in the psychic construction of children and adolescents.
{"title":"Actualisation de la notion de psychoses infantiles dans un dispositif psychothérapique : la place de la honte dans le transfert avec l’enfant aux portes de l’adolescence","authors":"Stéphane Muths (Psychologue clinicien, Docteur en Psychopathologie et chercheur associé au CRPMS URP 3522, Chargé d’enseignement à la Faculté de psychologie de l’Université de Strasbourg) , Renaud Evrard (Psychologue clinicien, Maître de conférences HDR en Psychologie)","doi":"10.1016/j.evopsy.2024.06.003","DOIUrl":"10.1016/j.evopsy.2024.06.003","url":null,"abstract":"<div><h3>Aims</h3><div>We examine the alienating and structuring aspects of shame in a psychotherapeutic setting. The aim is to determine its place in the construction of identity from the latency phase through puberty where psychotic movements are present.</div></div><div><h3>Method</h3><div>We will base our study on the case of Augustin, a ten-year-old whose presentation suggested a form of psychosis, with social withdrawal, psychomotor agitation, social communication disorders, and behavioral problems. We were able to see him for three years in a medical and psychological center for children. We describe the development of symptoms, the family configuration, and the main stages of his treatment. We sketch out the main features of this case, interpreting the particularities of Augustin's contact and his destructive movements as relating to a struggle against psychic invasion by an alienating family logic.</div></div><div><h3>Results</h3><div>This clinical work led us to identify psychotic manifestations that surpass a simple and exclusive structural distinction. We were able to highlight the family component in the psychopathological expression of Augustin's case, based on the father's paranoid logic. The specific relationship with language is revealed as an instrument of the transferential logic that allows a form of subjectivation of the risk of psychic invasion by shame.</div></div><div><h3>Discussion</h3><div>The clinical picture required us to move away from the DSM's logic of piling up diagnoses in order to shed light on psychic functioning, revisiting the notion of psychotic disorders in children and adolescents so as not to confine Augustin's case to a single trajectory. It was necessary to avoid the temptation to read into the family configuration the ‘causes’ of the child's disorders, rather than some of their coordinates. By working on the child's experiences and the malleable medium, the individual therapeutic mediations we implemented enabled us to co-construct a therapeutic space that facilitated access to play by taking into account the development of the affect of shame in the transferential relationship.</div></div><div><h3>Conclusion</h3><div>The aim of the psychotherapeutic process was to create a space that could accommodate the destructive movements of the object and thus offer the possibility of symbolizing the destructive and invasive elements of the family scene, and the fragilities of the ego specific to the psychotic movements in place. On the basis of an analysis of these elements, the psychotherapeutic work enabled the sensations of contamination and invasion of the psyche to be recaptured in order to construct a form of psychic containment that prevented movements of confusion between the self and the other. Augustin's case illustrates the symptomatic modulations specific to psychotic elements, highlighting the fragility of contact in the psychic construction of children and adolescents.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 2","pages":"Pages 247-259"},"PeriodicalIF":0.6,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144090548","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 : 2024-08-08DOI: 10.1016/j.evopsy.2024.06.002
Crystal Tomaszewski (Doctorante) , Dr Aziz Essadek Mcf en psychologie clinique et psychopathologie (Psychologue clinicien) , Héloïse Onumba-Bessonnet (Directrice générale) , Dr Christophe Clesse MSc, MRes, BSc, CPsychol (Lecturer in psychology, Psychologue clinicien) , Dr Rose-Angélique Belot (Professeure de psychologie clinique et psychopathologie, Psychologue clinicienne)
Objectives
Experiences of sexual violence lead to a wide range of psychopathologies, often associated with post-traumatic stress disorder. Mentalization abilities, developed in relation to attachment figures, play a significant role in the development of psychological trauma. We explore the notion that low mentalization capacities, coupled with fearful attachment, hinder the psychological processing of trauma. This article aims to identify the psychological mechanisms at play in our participant and to clinically refine the exploration of our hypothesis, while isolating the relevant role of clinical tools (AAI, RSQ, RFQ, and Rorschach) in shaping the management of patients who have experienced sexual violence.
Method
Theoretical-clinical links are proposed to align the use of these tools with the psychological issues faced by the participant.
Results
The participant exhibits psychological trauma following childhood experiences of sexual violence, a disorganized attachment profile, and a failure in mentalization with a stiffening of mentalization processes.
Discussion
Impairment in mentalization abilities is evident in the Rorschach test, characterized by rigid thinking, difficulties in symbolization, intrusive early childhood experiences, and significant relational avoidance. Due to the risk posed by establishing a new relationship, establishing the therapeutic relationship should be the focus of initial psychotherapeutic work. Subsequently, the work can address experiences of violence and trauma.
Conclusion
This case sheds light on trauma management through the reactivation of mentalization and symbolization processes in an individual with an insecure/fearful attachment profile. In the psychotherapeutic treatment of patients with similar metapsychological characteristics, these elements can inform the development of an appropriate care pathway.
{"title":"Violences sexuelles, traumatismes et mentalisation : étude de la dynamique psychique à partir du cas Hélène","authors":"Crystal Tomaszewski (Doctorante) , Dr Aziz Essadek Mcf en psychologie clinique et psychopathologie (Psychologue clinicien) , Héloïse Onumba-Bessonnet (Directrice générale) , Dr Christophe Clesse MSc, MRes, BSc, CPsychol (Lecturer in psychology, Psychologue clinicien) , Dr Rose-Angélique Belot (Professeure de psychologie clinique et psychopathologie, Psychologue clinicienne)","doi":"10.1016/j.evopsy.2024.06.002","DOIUrl":"10.1016/j.evopsy.2024.06.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Experiences of sexual violence lead to a wide range of psychopathologies, often associated with post-traumatic stress disorder. Mentalization abilities, developed in relation to attachment figures, play a significant role in the development of psychological trauma. We explore the notion that low mentalization capacities, coupled with fearful attachment, hinder the psychological processing of trauma. This article aims to identify the psychological mechanisms at play in our participant and to clinically refine the exploration of our hypothesis, while isolating the relevant role of clinical tools (AAI, RSQ, RFQ, and Rorschach) in shaping the management of patients who have experienced sexual violence.</div></div><div><h3>Method</h3><div>Theoretical-clinical links are proposed to align the use of these tools with the psychological issues faced by the participant.</div></div><div><h3>Results</h3><div>The participant exhibits psychological trauma following childhood experiences of sexual violence, a disorganized attachment profile, and a failure in mentalization with a stiffening of mentalization processes.</div></div><div><h3>Discussion</h3><div>Impairment in mentalization abilities is evident in the Rorschach test, characterized by rigid thinking, difficulties in symbolization, intrusive early childhood experiences, and significant relational avoidance. Due to the risk posed by establishing a new relationship, establishing the therapeutic relationship should be the focus of initial psychotherapeutic work. Subsequently, the work can address experiences of violence and trauma.</div></div><div><h3>Conclusion</h3><div>This case sheds light on trauma management through the reactivation of mentalization and symbolization processes in an individual with an insecure/fearful attachment profile. In the psychotherapeutic treatment of patients with similar metapsychological characteristics, these elements can inform the development of an appropriate care pathway.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 13-28"},"PeriodicalIF":0.6,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143158968","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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