L’alliance thérapeutique en situation transculturelle. Enquête auprès des psychiatres de l’enfant et de l’adolescent de la Haute-Garonne et perspectives

Abstract

Background

The problem of the therapeutic alliance seems very present and specific in child psychiatry in a transcultural situation. The purpose of this article is to make an inventory of the practices and uses of child psychiatrists in Haute-Garonne when they are confronted with a lack of therapeutic alliance in a transcultural situation. Then, in a second step, to propose avenues for the evolution of practices based on the theoretical developments proposed by the transcultural current developed by Marie Rose Moro, with the aim of improving the therapeutic alliance and therefore the efficiency of care provided to migrant populations.

Method

Twenty-nine psychiatrists out of 58 responded to a questionnaire asking to describe, in a quantitative and qualitative way, the clinical practices with patients from first and second generation migration on the theme of the alliance, its identification, its remediation in the event of default, recourse to interpreters, recourse to specific transcultural or intercultural mechanisms, interest in transcultural concepts, as well as proposals for improving practices.

Results

The results show that the child psychiatrists of Haute-Garonne are generally aware of and interested in the concepts of transcultural psychiatry but that few of them use specific devices which are also few in the territory. The alliance problems encountered are not always related to the cultural particularities of the families. They do not always recognize the importance of interpreters in their functions as “cultural mediators” but more for the translation of the language. Many proposals are emerging to improve practices and resources in the territory.

Conclusions

From these results, avenues for development have emerged at several levels: adapting existing systems through better knowledge and taking into account the cultural specificities of patients, developing knowledge and the use of interpreting as well as to supervisions, set up new specific mechanisms (such as consultation and transcultural mediation) with trained practitioners and organize a network allowing greater clarity and better access to the resources of the territory.