Psychothérapie institutionnelle : ambiances de transferts

IF 0.6 4区医学 Q4 PSYCHIATRY

Evolution Psychiatrique Pub Date : 2024-05-17 DOI:10.1016/j.evopsy.2024.04.004

Matthieu Braun (psychiatre, chef de clinique des universités, assistant des hôpitaux de région) , Christophe Chaperot (psychiatre, chef de pôle)

{"title":"Psychothérapie institutionnelle : ambiances de transferts","authors":"Matthieu Braun (psychiatre, chef de clinique des universités, assistant des hôpitaux de région) , Christophe Chaperot (psychiatre, chef de pôle)","doi":"10.1016/j.evopsy.2024.04.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by “skilled” caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to “heal the hospital so that it can heal”, in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work.</div></div><div><h3>Method</h3><div>We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects.</div></div><div><h3>Results</h3><div>Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors.</div></div><div><h3>Discussion</h3><div>Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice.</div></div><div><h3>Conclusion</h3><div>Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them.</div></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 625-638"},"PeriodicalIF":0.6000,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Evolution Psychiatrique","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0014385524000628","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PSYCHIATRY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Public hospitals are necessary for patients with the most severe psychological suffering. Within an institution, the symptoms of some have an impact on the way the group functions, with counter-attitudes, scissionary projections, and so on. Ever since Jean-Étienne Esquirol, we have known that hospitals can be healing in themselves, if they are staffed by “skilled” caregivers. At a time when public hospitals are being restructured, can tools from the field of institutional psychotherapy help to “heal the hospital so that it can heal”, in Hermann Simon's aphorism? We articulate psychopathological knowledge with institutional concepts, in order to reflect on how to care for singularities through collective work.

Method

We present a theoretical-clinical elaboration based on clinical vignettes that attempt to capture the day-to-day practice of a public psychiatric department oriented towards institutional psychotherapy, and the psychotherapeutic care possible, in an institution, for psychotic subjects.

Results

Concepts derived from institutional psychotherapy are based on psychoanalytical and phenomenological psychopathologies that are tested in clinical practice: in particular, questions of space, atmosphere, and transference, at the heart of psychopathology. These concepts can be discussed and refined in the light of current research and practice, and support creative care approaches based on the logic of geographical sectors.

Discussion

Institutional tools seem to support caregiving teams in their response to psychological suffering. If they are not the subject of dogmatic positioning, they encourage a therapeutic alliance that is as close as possible to the subjectivity of the players involved, and enable a performative theorization of daily practice.

Conclusion

Joint attention to psychopathology and institutional clinical practice helps to provide individualized care and support for the singularity and subjectivity of the most fragile patients and the teams who work with them.

查看原文本刊更多论文

机构心理治疗：转移环境

目的：对于心理痛苦最严重的病人来说，公立医院是必要的。在一个机构中，一些人的症状会影响到整个群体的运作方式，如反面态度、任务投射等。自让-艾蒂安-埃斯基罗尔（Jean-Étienne Esquirol）以来，我们就知道，如果医院配备了 "熟练 "的护理人员，那么医院本身就能起到治疗作用。在公立医院进行重组之际，机构心理治疗领域的工具是否可以帮助赫尔曼-西蒙（Hermann Simon）所说的 "治愈医院，使其能够治愈"？我们将精神病理学知识与机构概念相结合，以反思如何通过集体工作来照顾特殊性。方法我们以临床案例为基础，进行了理论-临床阐述，试图捕捉以机构心理治疗为导向的公立精神科的日常实践，以及在机构中对精神病患者可能提供的心理治疗护理。结果从机构心理治疗中得出的概念是基于精神分析和现象学的精神病理学，并在临床实践中得到检验：特别是空间、氛围和移情问题，这些都是精神病理学的核心。这些概念可以根据当前的研究和实践进行讨论和完善，并支持基于地理区域逻辑的创造性护理方法。如果这些工具不是教条式定位的主题，那么它们就会鼓励治疗联盟尽可能地贴近相关参与者的主观性，并使日常实践的表演理论化成为可能。结论对心理病理学和机构临床实践的联合关注有助于提供个性化护理，并为最脆弱的病人和与他们合作的团队的独特性和主观性提供支持。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Evolution Psychiatrique PSYCHIATRY-

CiteScore

0.70

自引率

50.00%

发文量

期刊介绍： Une revue de référence pour le praticien, le chercheur et le étudiant en sciences humaines Cahiers de psychologie clinique et de psychopathologie générale fondés en 1925, Évolution psychiatrique est restée fidèle à sa mission de ouverture de la psychiatrie à tous les courants de pensée scientifique et philosophique, la recherche clinique et les réflexions critiques dans son champ comme dans les domaines connexes. Attentive à histoire de la psychiatrie autant aux dernières avancées de la recherche en biologie, en psychanalyse et en sciences sociales, la revue constitue un outil de information et une source de référence pour les praticiens, les chercheurs et les étudiants.