Une étude clinique autour de la parentification et de son élaboration dans la psychothérapie psychanalytique

ObjectiveThe purpose of this article is to highlight the imprint of the parentification process in a patient in the context of a four-year psychoanalytic psychotherapy, through the analysis of the parentification process in its intrapsychic, intersubjective, and transsubjective dimensions.MethodAfter the end of the therapy, the psychotherapist returns to the material, which involved a patient who presented a depressive disorder and a parentification process during their childhood. We analyzed different themes related to parentification: infantile history, parental imagos, identifying dynamics, parental couple and conjugality, siblings, family functioning, choice of professional career and the relationship to work, and finally, a possible intergenerational or transgenerational transmission of parentification.ResultsWe observed changes to the patient's subjective suffering: better insight, changes in parental imagos, and also changes in the relationship with others (partner and children) as a consequence of an elaborative process around her parentification. In this case, parentification appears as a response to the traumatic infantile parental perception, as a defensive organization, as a survival solution organized around the symbiotic relationship between the child and the sick parent and, later, in relationships of great dependence with her spouse or her children. Throughout the psychotherapy process we observed: a childhood story marked by a generational reversal, an invasive parental imago, narcissistic identificatory dynamics, a parental couple characterized by dysfunctional conjugality, a special place in her siblings, a familial functioning marked by confusion between roles and generations, a professional choice in the field of care, a potential intergenerational or transgenerational transmission of parentification, and finally a dysfunctional parenthood over several generations. The narcissistic dimension of parentification observed in this patient seems to be linked to the omnipotent position vis-à-vis her “failed” parents, which activates a megalomaniacal narcissism and a heroic masochism.DiscussionFor the psychotherapist, the method of treatment and the method of research overlap. The work of writing this case of psychoanalytical psychotherapy allows for new reflections in its aftermath, other elaborations on the material of the sessions, and a tridimensional exploration of the process of parentification: intrapsychic, intersubjective, and transubjective.ConclusionWe underscore the contribution of the clinical elements revealed by the analysis of the transfer/counter-transference dynamics in the process of deparentification.     

Bases neurales de la décision. Une approche de neurosciences cognitives

Based on neuroscience, the author reviews divers problems related to decision-making: Decision and reason, decision and looks/glances, decision and inhibition, decision and double, decision and anticipation, decision and emotion, decision and interactions, or social norms (competition between emotional cognition, changing one's point of view, sympathy or empathy). He concludes his presentation by underlining that in all these extremely complex and interactive neurophysiological and psychological processes; one must take into account other factors such as interindividual differences linked to age, experience and sex.     

La croissance post-traumatique chez les victimes de violences conjugales : une étude pilote dans la Vienne

ObjectiveThis study aimed to: (1) evaluate posttraumatic growth in survivors of intimate partner violence, (2) compare and characterize this posttraumatic growth with the one measured in survivors of other types of violence, and (3) evaluate post-traumatic stress disorder and its relationship with posttraumatic growth in our clinical population.MethodsWe realized a monocentric pilot study in Poitiers (Vienne, France) recruiting 17 survivors of intimate partner violence and 42 survivors of other types of violence from two medical departments: the Unit of Forensic Medicine, where victims are oriented following complaints, and the Psychotrauma Center. Participants were administrated questionnaires comprising socio-demographics data and specific scales, namely the PTGI and PCL-5.ResultsWe found a higher prevalence of posttraumatic growth in survivors of intimate partner violence (82 %), when compared with survivors of sexual assault and other interpersonal types of violence (52 % and 53 %, respectively). Posttraumatic growth was low to moderate, and faster as it was detected in victims recruited in the Unit of Forensic Medicine. All domains of posttraumatic growth were positively affected, i.e. higher scores from the PTGI were recorded in survivors of intimate partner violence. No difference was found when results were compared between groups from the Psychotrauma Center. We were unable to identify socio-demographic predictors of posttraumatic growth. À posttraumatic stress disorder was found in survivors of intimate partner violence, and negatively related to posttraumatic growth.DiscussionTo our knowledge, this is the first study comparing post-traumatic growth across such conditions and using specific and recognized scales. Our pilot study demonstrated that survivors of intimate partner violence were able to develop low to moderate posttraumatic growth faster than survivors of other types of violence. All domains of posttraumatic growth were affected, demonstrating the ability of survivors to withstand adversity. Scientific data regarding the link between posttraumatic growth and posttraumatic stress disorder is unclear, probably depending on the trauma, the circumstances, the timing of the measurement. In our study, we found a clear negative correlation between the two parameters. Our results underline the necessity to provide overall and rapid intervention in survivors of intimate partner violence, comprising legal, psychological, social and medical approaches, to facilitate the development of posttraumatic growth.     

Vers une meilleure compréhension de la fatigue dans la schizophrénie

Despite being one of the most common complaints of people with schizophrenia, fatigue remains largely unexplored in this population. The lack of knowledge regarding this complex symptom makes it often underdiagnosed and undertreated in schizophrenia. The aim of this brief perspective review is to outline the potential origins (distinguishing primary and secondary fatigue) and consequences of fatigue and to explore some potential treatments in this population. The current literature in schizophrenia has mainly investigated fatigue as a trait, using a self-administered questionnaire. Beyond this observational approach, which does not allow to capture the symptom in real life situations where high levels of fatigue can emerge rapidly, we propose to consider the state level of fatigue, for instance occurring after a prolonged period of cognitive activity (i.e. mental fatigue). We elaborate on the potential relationships between mental fatigue and negative symptoms of schizophrenia and propose some research avenues to test the effects of acute fatigue on effort intentions and behaviours. The consideration of the multidimensional aspects of fatigue will allow to move beyond the sole pharmacological approach to treat fatigue in schizophrenia. Targeting the cognitive as well as the performance components of fatigue through interventions such as concomitant aerobic exercise - mental training offers attractive prospects to reduce fatigue in this population and minimize its functional negative impact.     

Pour une approche psychanalytique de l’intime conviction chez les magistrats dans une affaire d’inceste

In the French law tradition, jurors and magistrates have to use their intimate conviction to judge not only the reality of the act, but also the intention of the author and his/her “spirit”. In addition, an analysis of legal texts on intimate conviction enables to make the hypothesis that they tend to induce, for the juror or the magistrate, a dual conflict: one between trust and distrust regarding one's own representations, and another regarding one's own affective tendencies, which have to be kept away. The general objective of our research is to study the conscious and unconscious processes by which the magistrates build their intimate conviction. The specific objective of this article is to study how the magistrates, subjectively, appropriate or not the conflict induced by legal texts on intimate conviction. We submitted a criminal case to ten magistrates, then analyzed their discourses on three levels: analysis of the psychosocial determinants, analysis of narrativity, and analysis of subjective implication. Our specific objective leads us to find, on a psychoanalytical perspective, two main modes of linking the psychic conflict induced by the practice of intimate conviction. First, “the avoidance of psychic conflict”, by recourse to idealization processes of the plaintiff or, on the other hand, by distrust of the image of the victim. Second, “the crossing of psychic conflict”, which supposes the experience, by the magistrate, of his/her own contradictory tendencies, his/her ambivalence regarding the plaintiff or the defendant, and his/her unique psychic conflicts. Thus a reflection opens itself on the psychic processes around which, subjectively, the link between the magistrate and his/her own beliefs, collective representations of the victims and authors, and the judicial process, is built.     

Les enjeux de la transition dans l’anorexie mentale vus par les professionnels : une étude qualitative

IntroductionAnorexia nervosa (AN) is an eating disorder (ED) that emerges during adolescence and may be lasting several years, or even becoming chronic. For these patients, the transition to adult care is a period of high risk of instability, relapse, symptomatic re-aggravation and increased development of co-morbidities or eventually leading to care drop-out or medical nomadism. Professionals involved in the transition process with AN patients are often challenged with various difficulties, and confronted with the need to plan this care stage. This study sought to understand the pediatricians and (child) psychiatrists experience of this transition step and to identify national practices around the transition process for adolescents and young adults with anorexia nervosa.MethodA qualitative study was carried out on the basis of thirteen recorded individual interviews with physicians specialised in eating disorders working in hospital adolescent medicine units or in adult medicine units. The methodology used was IPA (Interpretative Phenomenological Analysis).ResultsVarious difficulties and obstacles to a successful transition emerged as well as perspectives to improve the transition to adulthood care: early identification of the target population, choice of the most adapted unit to the severity level of the disease, family support during the transition, identification of a coordinating physician and enhanced networking support. The opportunity of a transition program is discussed among physicians, who are consistent on the need for guidelines.ConclusionThis qualitative study allowed us to highlight the difficulties of specialized professionals faced to the transition period with AM patients but also to consider the need for specific tools and guidelines to promote continuity to adulthood care.     

Une analyse des effets de la Mindfulness-Based Cognitive Therapy (MBCT) du champ princeps de la dépression à une pluralité de troubles psychiques : une revue de la littérature

Rooted in the psychotherapies of the third wave which point up the mindfulness concept and the acceptance of life experiences, the MBCT was applied for the first time in 2000 by Teasdale within the framework of a clinical trial designed to explore the key factors of the cognitive vulnerability to recurrent depression. If this princeps study has been replicated on several occasions and is still being deepened at this time, the exploration of the MBCT effects has also been broadened to a plurality of other therapeutic fields. After a brief presentation of its background and basic procedure, we submit an overview of the present state of research based on thirty-seven studies in accordance with the original group format delivery while expressing the main empirical results relating to the efficiency issue of the therapy. The outcomes show evidence of both a proven action in the depression field and a real applicability potential in the other fields explored despite an obvious need of methodological refinement and replication to complement the existing accounts. The outcome analysis will lead us to reflect on the psychotherapeutic drives of the MBCT and to mark the area of its most efficient clinical application modes out.     

La classification de la paranoïa dans la psychiatrie américaine contemporaine : une revue de la littérature

Objective

The main objective of this paper is to undertake a literature review on the classification of the paranoia in contemporary American psychiatry.

Le fonctionnement émotionnel lors de la douleur chronique : état de la question

Pain mobilizes numerous psychological variables, which involve the interaction of cognitions (attention, interpretation of the situation), feelings (fear, anger, anxiety) and behaviors (immobilization, avoidance). These various aspects generally have an adaptive role, necessary for the conservation of the body. However, in chronic pain, these mechanisms can become dysfunctional and cannot answer their initial function, and can even influence the appearance of psychopathologies. In this framework, feelings and emotional processing play an important role in the modulation of the intensity of sensory and emotional aspects of pain. In this particular case, suppression, emotional avoidance and alexithymia are associated with a greater intensity of the sensory or emotional aspects of pain. Although recent studies have employed relatively rigorous methodological devices, sometimes they used many tools which do not yet measure the dysfunction directly. Furthermore, emotional suppression was mainly studied during anger, which constitutes a specific phenomenon that cannot be generalized to all emotions. New studies are to be envisaged which would allow in particular the study of the effect of unregulated (insufficient control of experience or emotional expression) and untreated (arousing intrusive thoughts and the obstinacy of the emotional experience) emotions, defined by Baker et al. (2007), and the use of a tool permitting the differentiation and measurement of all possible dysfunctions. They could also allow for the control of the concomitant presence of various emotional dysfunctions in participants. Ideally, the realization of forward-looking studies could define the nature of the links between emotional dysfunctions and chronic pain.