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)
{"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}
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)
{"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}
Romuald Jean-Dit-Pannel (Psychologue clinicien-psychothérapeute, Professeur des universités)
{"title":"Armature-opératoire et tristesse fluide chez des sujets transgenres : d’une seconde peau à un Moi-peau corsets","authors":"Romuald Jean-Dit-Pannel (Psychologue clinicien-psychothérapeute, Professeur des universités)","doi":"10.1016/j.evopsy.2024.07.003","DOIUrl":"10.1016/j.evopsy.2024.07.003","url":null,"abstract":"<div><h3>Goals</h3><p>I develop my hypothesis of a two different corsets, the second skin and the ego-skin corset, which respectively prevent or deploy according to the psychic reappropriations of the subjects, specially transgender subjects.</p></div><div><h3>Method</h3><p>My practice as a clinical psychologist-psychotherapist and my research with transgender subjects led me to wonder about a metapsychology of the corset. I expose here two clinical cases.</p></div><div><h3>Results</h3><p>Two cases in particular led me to think about an authentic depressive capacity that I call here sadness-fluid or fluidity of sadness by analogy to gender-fluid, the fluidity of gender.</p></div><div><h3>Discussion</h3><p>Also, I reflect on the operative armature that can impose itself throughout the transition process, by the diversity of experiences, stories, and resources found in the subject's different environments.</p></div><div><h3>Conclusion</h3><p>The therapeutic needs of trans subjects in their journeys and their reflections lead us to consider the needs to loosen, to untie certain ties. This uncorsetting favors a reflexive fluidity, so that the subject can evolve in an authentic ego-skin corset where it belongs to itself.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 497-507"},"PeriodicalIF":0.6,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141839190","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}
{"title":"Le livret militaire, le dossier étudiant et la carrière médicale de Lacan","authors":"David Monnier (Enseignant-chercheur)","doi":"10.1016/j.evopsy.2024.05.007","DOIUrl":"10.1016/j.evopsy.2024.05.007","url":null,"abstract":"<div><h3>Objectives</h3><div>After having studied the conditions of Lacan's doctoral dissertation in a previous article, I turn to uncovering his academic studies and his medical career to place it in its context.</div></div><div><h3>Materials and methods</h3><div>Search for references to the thesis of Lacan, confrontation of historical data, textual analysis and commentary. I first reread Lacan to pick out biographical references that might be judicious in the context of this study. I then carried out a literature review. This is not enough to establish a detailed chronology of the facts. After that, I visited a number of libraries and other archive sites. I collected material data: Lacan's unpublished student file; his unpublished administrative service records; the military recruitment register where he appears; his military record, some rare, unused, or unpublished photos of Lacan as a student; various little-known elements about his various lodgings during this period. I examined these different documents and compared them with other sources and various information in order to clarify his professional career in medicine.</div></div><div><h3>Results</h3><div>I found several medical internships Lacan completed before psychiatry. From March 1921 to February 1922, he did a one-year internship in Paul Hallopeau's surgical department at Trousseau hospital. From March 1922 to October 1922, he did a seven-month internship in the dermatology department of Edouard Jeanselme at Saint-Louis hospital. From October 1922 to February 1923, he did a five-month internship in the childhood illnesses department of Edmond Lesné at Trousseau hospital. From March 1923 to February 29, 1924, he did a one-year internship in Paul Ribierre's cardiology department at Necker hospital. From June 1924 to February 1925, he did a nine-month internship under Marie-Paul Claisse's supervision at Laënnec hospital. From March 1925 to October 1925, he did an internship of approximately seven and a half months in the Lenormand department at Saint-Louis hospital. From October 1925 to February 1926, he did an internship of approximately four and a half months in the neurology department of Georges Guillain at Salpêtrière hospital. From March 1926 to January 1927, he did an internship of approximately ten and a half months in Octave Crouzon's neurology department of the Salpêtrière. This journey highlights an aspect of Lacan that is not ignored, unrecognized, or underestimated but on the contrary appears with the clarity of evidence as soon as it is said: a portrait of Lacan as a worker with children. Indeed, his first job, from November 1932 until October 1933, was in a child neuropsychiatry clinic. It is enough to briefly recall some milestones of his later work to see that this area of childhood is significant and that Lacan's contribution is substantial. And although Lacan certainly did not have a university hospital career in the strict sense, since he left the hospital environme","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"90 1","pages":"Pages 135-144"},"PeriodicalIF":0.6,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthieu Braun (psychiatrist, head of a university clinic - regional hospital assistant) , Christophe Chaperot (psychiatrist, head of department)
{"title":"Institutional psychotherapy put to the test by the health crisis. Clinical reflection at the heart of a public psychiatric service","authors":"Matthieu Braun (psychiatrist, head of a university clinic - regional hospital assistant) , Christophe Chaperot (psychiatrist, head of department)","doi":"10.1016/j.evopsy.2024.07.002","DOIUrl":"10.1016/j.evopsy.2024.07.002","url":null,"abstract":"<div><h3>Objective</h3><p>Patients suffering from complex psychiatric pathologies require multi-disciplinary care and, in the event of decompensation, may need to be hospitalized. Institutional psychotherapy approaches psychotic, existential and institutional crises as opportunities for clinical elaboration and the deployment of creativity. The health crisis linked to the Covid-19 pandemic has prompted us to rethink its effectiveness and its place within plural contemporary practices. It also offered the opportunity for an unprecedented anthropological reading. In this context, is institutional psychotherapy still a machine for producing “innovation”, for creating, or at least revealing, crises in order to overcome them?</p></div><div><h3>Method</h3><p>Key concepts from the field of institutional psychotherapy can be reexamined in the wake of the health crisis. In the aftermath of the pandemic, we propose an elaboration of what the pandemic has taught us about day-to-day practice, in a public psychiatric department oriented towards institutional psychotherapy. We will draw on a re-reading of clinical vignettes, interviews with caregivers and patients, and notes taken at department meetings during the pandemic.</p></div><div><h3>Results</h3><p>The major concepts of institutional psychotherapy may have some limitations, but they can be reinvented by the caregiver-client collective. During a crisis, collective failings and individual symptoms seem to reveal each other. The therapeutic club represents a stage on which to unfold and elaborate both group and individual issues.</p></div><div><h3>Discussion</h3><p>In this context, the symbolic framework, collectively instituted, and the culture of a service can present operative points of support for continuing care. They “put in crisis” the prejudices and implicit theories of the actors, and support new narratives and new ways of making sense.</p></div><div><h3>Conclusion</h3><p>In the aftermath of a crisis, the therapeutic club remains a space of conflict and intrigue, at the crossroads of collective and individual health crises.</p></div>","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages e49-e60"},"PeriodicalIF":0.6,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852274","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}
Gabriela Patiño-Lakatos (Psychologue clinicienne, post-doctorante (2019–2023) pour le projet de recherche ANR Staccato 2019, membre associé UTRPP, psychologue au CMP, la source) , Cristina Lindenmeyer (Psychanalyste, professeur de psychopathologie, membre titulaire UTRPP) , Sophie Bergheimer (Psychologue clinicienne, chercheure contractuelle (2019–2023) pour le projet de recherche ANR Staccato 2019, ATER (2023–2024))
{"title":"La situation projective du modelage comme instrument clinique dans une recherche sur un dispositif de médiation sensorielle","authors":"Gabriela Patiño-Lakatos (Psychologue clinicienne, post-doctorante (2019–2023) pour le projet de recherche ANR Staccato 2019, membre associé UTRPP, psychologue au CMP, la source) , Cristina Lindenmeyer (Psychanalyste, professeur de psychopathologie, membre titulaire UTRPP) , Sophie Bergheimer (Psychologue clinicienne, chercheure contractuelle (2019–2023) pour le projet de recherche ANR Staccato 2019, ATER (2023–2024))","doi":"10.1016/j.evopsy.2024.05.005","DOIUrl":"10.1016/j.evopsy.2024.05.005","url":null,"abstract":"<div><h3>Objectives</h3><div>This article examines the use of clay modeling as an instrument for clinical analysis of the relation to one's own body and to the object. While modeling is a widely-used medium in therapeutic work, we present here the use of the modeled self-portrait as a projective method in a research situation involving sensorial mediation using touch. The aim is to understand how the subject invests and engages a relation with this object, based on the way s/he invests and represents her/his body and sensations.</div></div><div><h3>Method</h3><div>The modeling situation was proposed individually to 19 participants at the first of six meetings. The choice of the modeled self-portrait in this research project is inspired by a psychoanalytical epistemology that enables us to understand the unconscious psychic dimensions of body image and the relation to the object, as well as the concepts of mediation, the projective situation, and transference. In the absence of a pre-existing reference to a systematized methodology for analyzing the self-portrait with modeling clay, we referred to psychoanalytic work on projective tests to construct a qualitative analysis grid based on the material collected.</div></div><div><h3>Results</h3><div>The modeled self-portrait enabled us to take into consideration, from an economic, dynamic, and topical point of view, on the one hand, the content that emerged in the modeling and in the verbalizations that accompanied it, and, on the other hand, the characteristics of the modeling process itself. The modeling situation gave rise to regressive and projective movements, leading the participants to express key elements of their personal history, their sensory situation, and the areas of the body invested or disinvested, as well as their psychic behaviors in relation to the object in the present of this research encounter. We identified four ways in which participants related to modeling, depending on their subjectivity and their position in the research process. The form given to the modeling, its structure, and the parts represented or not provided us with indications of certain features of the participants’ body image and the way in which they were able to express it in the space-time of this encounter. We hypothesize that through its connections with the subject's body image, the three-dimensional self-portrait expresses the way in which participants invest their bodies, and sometimes body zones linked to the senses, such as touch, through the modeling activity itself, but also other senses through the elements represented or not, verbalized or not, about the created-modeled object.</div></div><div><h3>Discussion</h3><div>We present some considerations on the complex connections between the relationship to modeling, to the object of sensory mediation through touch, and to autobiographical speech in the interview situation, considering the participants’ verbal and non-verbal productions during the process","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 4","pages":"Pages 829-848"},"PeriodicalIF":0.6,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142721927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Repenser la génétique de la schizophrénie à l’ère de la crise de la reproduction. À propos de… « Schizophrenia and Genetics: The End of An Illusion » de Jay Joseph","authors":"Sebur Kapu (Doctorant)","doi":"10.1016/j.evopsy.2024.06.001","DOIUrl":"10.1016/j.evopsy.2024.06.001","url":null,"abstract":"","PeriodicalId":45007,"journal":{"name":"Evolution Psychiatrique","volume":"89 3","pages":"Pages 583-591"},"PeriodicalIF":0.6,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047791","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}