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Les modèles d'intervention médico-psychologique précoce sont actuellement dominés par l'exercice du débriefing dans des conditions de stress exceptionnel tels que les conflits armés. L'intervention doit être rapide et coordonnée pour répondre aux besoins des victimes, en favorisant la verbalisation des émotions et la restauration des liens sociaux. L'origine historique et l'évolution du débriefing depuis les guerres passées jusqu'à son application contemporaine, soulignent son rôle dans une psychiatrie ainsi pensée sur un registre préventif. Les effets du traumatisme psychique sur l'individu et le groupe, impliquent des phénomènes de dissociation délétères nécessitant la restauration d'un cadre sécurisant. Le rôle du débriefing dans la réintégration de l'expérience vécue par l'élaboration d'un récit commun favorise un processus de reliaison, participant de cet effet de sécurisation. Le principe de libération immédiate de la parole des individus traumatisés remet toutefois en question sa conformité aux pratiques habituelles en psychothérapie. Son enseignement, qui n'est pas en soi un acte de soin, est pour autant une occasion d'en approcher les effets, par une même dynamique d'identification chez les stagiaires. Le développement de nouvelles méthodes pédagogiques telles que la simulation s'y applique particulièrement, privilégiant l'acquisition d'un savoir-faire à la transmission de connaissances théoriques. L'enseignement s'effectue selon un prisme comportemental, l'objectif étant d'inscrire le stagiaire dans une pratique qui vise à se parfaire par la répétition d'exercices de mise en situation, avec une transmission des habiletés relationnelles et communicationnelles qui s'en trouve ainsi facilitée. La formation des professionnels de santé militaires, notamment en psychiatrie, est capitale pour faire face aux contraintes spécifiques des opérations militaires. Ces formations, visent à préparer les soignants à intervenir en cas de situations isolées et à gérer des scénarios de crise. Une initiative pédagogique spécifique a été mise en place à l'hôpital militaire Sainte-Anne de Toulon, axée sur la simulation pour enseigner le débriefing médico-psychologique au profit des soignants amenés à partir en mission. L'équipe pédagogique utilise des jeux de rôle pour simuler des situations de crise opérationnelle avec exposition traumatique, offrant ainsi une approche réaliste et interactive aux stagiaires. Cette approche par la simulation permet aux stagiaires de se confronter à des situations imprévues et spécifiques du contexte militaire, tout en développant des compétences pratiques et émotionnelles essentielles dans la prise en charge des troubles psychiques. En outre, cette méthode d'enseignement encourage la pratique réflexive et favorise une approche empathique vis-à-vis des patients, différenciant la posture de l'enseignant dans ce contexte de celle habituellement adoptée en médecine. La simulation sert ainsi de catalyseur pour amorcer des échanges authentiques entre stagiaires et formateurs, au-delà des effets d'éprouvés subjectifs propres à chacun dans l'expérience des jeux de rôle. La simulation diffère ainsi du discours académique en cherchant à créer une expérience engageante et sensorielle pour les stagiaires. Cette approche immersive peut d'ailleurs être comparée à la nature même des événements traumatiques, en impliquant tous deux une expérience sensorielle intense avec une empreinte corporelle ou émotionnelle durable. La singularité de la simulation réside aussi dans sa capacité à se détacher des discours universels pour se rapprocher des questionnements personnels, des doutes et des limites de chaque individu. Cette approche résonne avec les concepts lacaniens de transmission du savoir et met en lumière les effets d'interprétation individuelle et d'interaction entre formateurs et stagiaires, comparables à ceux du transfert en psychothérapie. Tout ceci n'est toutefois possible que par le rôle actif du stagiaire dans ce processus, mais aussi par l'engagement des enseignants, en s'appuyant sur un cadre théorique rigoureux avec une attention particulière portée à la manière dont les émotions influencent l'apprentissage chez les stagiaires. La simulation revêt en définitive un caractère imprévisible par la genèse d'effets d'apprentissages inattendus, tant pour les stagiaires que pour les enseignants, rappelant ainsi la nécessité de rester ouvert aux connaissances nouvelles qui peuvent surgir de cette expérience d'apprentissage. L'apprentissage par la simulation du débriefing offre une approche séduisante aux étudiants par ses effets d'implication subjective, mais remet également en question les méthodes traditionnelles d'enseignement en santé. Bien que ces nouvelles approches pédagogiques enrichissent indéniablement les connaissances des étudiants, elles ne peuvent cependant reproduire l'authenticité de la relation thérapeutique entre le patient et son thérapeute. L'apprentissage clinique reste essentiel, mais il doit intégrer la confrontation à l'inconnu, à la singularité de chaque expérience clinique, tout en tenant compte du décalage indéfectible entre les connaissances acquises et la réalité de la pratique. 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. 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. 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 each in the role-playing experience. Simulation thus differs from academic discourse by seeking to create an engaging and sensory experience for trainees. This immersive approach can also be compared to the very nature of traumatic events, both involving an intense sensory experience with a lasting physical or emotional imprint. The uniqueness of the simulation also lies in its ability to detach itself from universal discourse and draw closer to the personal questions, doubts, and limits of each individual. This approach resonates with Lacanian concepts of the transmission of knowledge and highlights the effects of individual interpretation and interaction between trainers and trainees, comparable to those of transference in psychotherapy. All of this is only possible, however, if the trainee plays an active role in the process, but also if the teachers are committed to it, based on a rigorous theoretical framework with particular attention paid to the way in which emotions influence learning in trainees. In the final analysis, simulation is unpredictable in that it generates unexpected learning effects for both trainees and teachers, reminding us of the need to remain open to the new knowledge that may emerge from this learning experience. Learning through debriefing simulation offers an approach that is attractive to students because of its subjective involvement effects, but it also challenges traditional health teaching methods. Although these new teaching approaches undeniably enrich students' knowledge, they cannot reproduce the authenticity of the therapeutic relationship between patient and therapist. Clinical learning is still essential, but it must include confrontation with the unknown, with the singularity of each clinical experience, while taking into account the indefectible gap between the knowledge acquired and the reality of practice. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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 of this research. Finally, we present the limits of the collection and analysis of results in the context of this research and the present article. The use of the modeled self-portrait has brought out elements that enable us to better understand the psychological underpinnings of the different relations to the mediating object that the participants expressed in this research. Insofar as self-portrait calls upon unconscious elements of both body image and relation to the object, it encounters resistance and defensive modalities in the subject's own psychic functioning. [ABSTRACT FROM AUTHOR]

L'hôpital public est nécessaire aux patients présentant les souffrances psychiques les plus graves. Au sein d'une institution, les symptômes des uns impactent le fonctionnement collectif, entre contre-attitudes, projections scissionnelles, etc. Nous savons depuis Jean-Étienne Esquirol que l'hôpital peut être soignant en lui-même, s'il est investi par des soignants « habiles ». À l'heure d'une restructuration de l'hôpital public, les outils issus du champ de la psychothérapie institutionnelle peuvent-ils participer à « soigner l'hôpital pour qu'il devienne soignant », selon l'aphorisme d'Hermann Simon ? Nous proposons d'articuler des savoirs psychopathologiques aux concepts institutionnels, afin de questionner un possible soin des singularités via le travail collectif. Nous présentons une élaboration théorico-clinique à partir de vignettes cliniques qui tentent de rendre compte de la pratique quotidienne d'un service de psychiatrie publique orienté par la psychothérapie institutionnelle et du soin psychothérapique possible, en institution, de sujets psychotiques. Les concepts issus de la psychothérapie institutionnelle s'appuient sur des psychopathologies psychanalytiques et phénoménologiques qui font l'épreuve de la clinique : notamment les questions d'espace, d'ambiance et de transfert, au cœur de la psychopathologie des psychoses. Ces concepts peuvent être discutés et affinés au regard de l'actualité de la recherche et des pratiques et soutiennent des prises en soins créatives adossées à la logique de secteur. Les outils institutionnels semblent soutenir les équipes soignantes dans leurs accueils de la souffrance psychique. S'ils ne font pas l'objet de positionnements dogmatiques, ils favorisent une alliance thérapeutique au plus près de la subjectivité des acteurs, et permettent une théorisation performative de la pratique quotidienne. Une attention conjointe portée à la psychopathologie et à la clinique institutionnelle contribue à proposer des prises en soin individualisées et à soutenir la singularité et de la subjectivité des patients les plus fragiles et des équipes qui les accompagnent. 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. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

Context: Patient handovers without any structured checklist may omit essential information that might have undesirable consequences for patients. Aim: We sought to determine the effectiveness of a structured postanesthesia care handover (PACH) checklist in the postanesthesia care unit (PACU) to reduce adverse clinical outcomes. Setting and Design: A single-center, prospective, pre–postimplementation study was conducted. Materials and Methods: Moreover, post-PACH checklist implementation data were collected from 130 participants (n = 65 in each group) by an independent observer. Data analysis was performed using the SPSS (25.0) version (IBM SPSS statistics). The Chi-square test was used to compare the dichotomous response. Results: A statistically significant reduction in hypoxemia (21.5% vs. 0; P < 0.001) was observed in the postimplementation group. There were significant improvements in patient information (P < 0.01), reduction in variations in hemodynamic parameters (P < 0.01), and improvement in the quality of information transferred concerning surgical procedures (P < 0.01). The number of phone calls to consultants was significantly lower in the PACH group. Conclusion: Implementation of the PACH checklist was associated with no hypoxemic events in PACU by improving the quality of communication. The implementation of a structured checklist in PACU should be mandatory in the postoperative intensive care unit. [ABSTRACT FROM AUTHOR]

Dans la continuité de nos recherches sur la médiation par le jeu de rôle, nous nous questionnons sur les modalités d'expression du transfert, compte tenu des caractéristiques de ce médium qui mêle activité de jeu et narration collective. À cet égard, nous faisons l'hypothèse qu'il mobilise une forme spécifique de transfert, à l'origine de mouvements thérapeutiques particuliers. Nous avons rencontré deux groupes d'adolescents (7 au total) dans le cadre d'une médiation thérapeutique par le jeu de rôle, menée par un psychologue et un éducateur dans une institution de scolarisation adaptée. Nous avons conçu une grille de repérage des mouvements transférentiels permettant de caractériser la nature de ces mouvements et de différencier leur scène d'émergence, entre groupe et narration. Nous avons étudié les retranscriptions de l'intégralité des séances d'atelier pour mettre en évidence les processus émergents et leur évolution de manière longitudinale. Nos résultats mettent en évidence un déploiement du transfert d'abord généralisé et marqué par des tendances massives à l'expression de l'agressivité, du déni ou du rejet de l'autre et du groupe. Au fil du temps, le mode de relation à l'objet semble évoluer, en s'appuyant sur le transfert qui s'engage avec les co-thérapeutes, et par l'intrication de ces relations aux plans actuels et narratifs. Le jeu de rôle se révèle comme un lieu de projection de la dynamique relationnelle entretenue avec l'objet, et des représentations de la relation à l'autre. Le médium révèle alors les impasses de la création du lien et de la reconnaissance de la place de l'objet, les angoisses sous-jacentes, mais il devient également un transformateur des relations, parce qu'il permet l'émergence d'un transfert d'abord diffracté dans l'enveloppe narrative, qui autorise secondairement un mouvement de reprise et un apaisement des relations de groupe. Le jeu de rôle offre des espaces de projection qui rendent compte de la souffrance liée à la situation de rencontre avec le groupe. Il est également le lieu d'où peuvent se déployer des dynamiques relationnelles protégées de la destructivité agie grâce au prisme de la narration et d'un transfert en trois temps qui contribue au processus d'historicisation, de mise en lien. Following on from our research into mediation through role-playing games, we are investigating the ways in which transference is expressed given the characteristics of this medium which combines game activity and collective narrations. From this perspective, we hypothesize that it mobilises a specific form of transference at the origin of particular therapeutic movements. We met with two groups of adolescents (7 adolescents altogether) in a therapeutic mediation through role-playing games, conducted by a psychologist and an educator in an adapted educational institution. We proposed a grid for identifying transference movements, making it possible to characterize the nature of these movements and to differentiate their scene of emergence between group and narrative. We studied the transcripts of all the workshop sessions to highlight the emerging processes and their evolution. Our results showed that the transference was initially generalised and marked by massive tendencies to express aggression, denial or rejection of the other and the group. Over time, the mode of relationship to the object seemed to evolve, drawing on the transference enabled by the psychologist and the educator and by the link between relationships at the actual and narrative levels. The role-playing game reveals itself as a place of projection of the relational dynamics and representations of the relationships. The medium then reveals the pitfall in the creation of a bond and the recognition of the object's place, and the underlying anxieties. However, it also becomes a transformer of relationships because it allows the emergence of a transference that is first diffracted in the narrative envelope, which secondly authorizes a movement of recovery and a relief of group relationships. The role-playing game offers spaces for projection that takes account of the suffering linked to the situation of encounter within the group. It is also a place where relational dynamics can unfold, protected from the destructiveness of acting through the prism of narrative and a three-stage transfer that contributes to the process of historicization. [ABSTRACT FROM AUTHOR]

Psychose, névrose et perversion ont structuré la clinique à l'âge d'or de la psychanalyse. Si la psychose et la névrose font toujours partie intégrante de notre vocabulaire médical, la perversion s'avère au contraire être devenue un concept peu évoqué voire quelque peu oublié de notre nosographie classique. Pourtant, les processus d'interactions de certains patients et plus particulièrement certains passages à l'acte suicidaires semblent s'y rapporter grandement. Dans cet article, à partir des questions suscitées par le cas clinique abordé, nous soulignerons l'importance de nous ré-intéresser à ce concept. L'objet de cet article consistera en l'étude de certains mécanismes de la perversion dans la clinique du passage à l'acte suicidaire et tentera d'en établir une définition non exhaustive, historique et actuelle afin de répondre au questionnement suivant : « le passage à l'acte suicidaire peut-il être pensé comme un acte pervers dans son adresse au thérapeute ? » Les apports théoriques seront soutenus par une illustration clinique préalable portant sur le suivi hospitalier et ambulatoire d'un jeune patient. Lorsque le passage à l'acte revêt, dans la clinique du suicide, une symbolique particulière adressée au thérapeute et confère au sujet une prise de pouvoir dans la relation thérapeutique, nous pouvons y lire les caractéristiques de la perversion. Il convient de faire preuve de prudence concernant cette proposition et de ne pas associer sans nuance tout acte suicidaire à la clinique de la perversion. De même, il revient au thérapeute de prendre conscience des mécanismes développés par le patient au sein de la relation thérapeutique et d'en faire un objet de travail commun. L'article suivant propose au lecteur une approche théorique et clinique du passage à l'acte suicidaire dans la clinique de la perversion. Il permet d'envisager la distinction entre la clinique du suicide adressée et non adressée, de détacher le passage à l'acte d'une éventuelle pathologie, de prendre connaissance des difficultés cliniques qui en découlent et de dégager des pistes de réflexions concernant le suivi post-passage à l'acte. The notions of psychosis, neurosis, and perversion structured clinical thought during the golden age of psychoanalysis. But, even if psychosis and neurosis are still an integral part of our medical vocabulary, perversion, on the other hand, has become a forgotten or even obsolete concept. However, some mechanisms of interaction between patients and more precisely some suicide attempts seem to be significantly related to it. In this article, we offer the reader a second look at this clinical perversion. This article aims to study some perverse mechanisms that are present in clinical work with suicidal patients and to establish a current, historical, and non-exhaustive definition that will answer the following question: "can a suicide attempt be thought of as a perverse act in its address to the therapist?" The theoretical input will be supported by a preliminary clinical illustration about the hospital and ambulatory monitoring of a young patient. When suicidal acting out takes on a special meaning addressed to the therapist and allows the patient to seize power in the therapeutic relationship, we can clearly see the characteristics of perversion. A cautious approach should be adopted about this proposition: not all suicidal acts are to be associated without nuance with perversion. Similarly, it is up to the therapist to understand the mechanisms developed by the patient in the therapeutic relationship and to make them the object of shared therapeutic work. This article offers the reader a theoretical and clinical approach to the suicidal act in patients whose psychic structure can be considered perverse. It allows us to: differentiate between addressed and un-addressed suicidal acts, acknowledge the resulting clinical difficulties, and explore avenues about the monitoring of patients after a suicide attempt. [ABSTRACT FROM AUTHOR]

While Jung's notion of archetypes has had far‐reaching universal appeal and significance, it remains less obvious how these ideas might benefit the analytic patient. In particular, the therapist and/or patient may struggle to hold the tension between the latter's personal neuroses and how transpersonal/archetypal elements inform his/her experience. While Jung strove to develop a treatment that dealt primarily with the archetypal/objective psyche, the personal psyche is arguably the medium through which the archetypes are experienced. I contend that the "discipline" of Jungian analysis evolved from a transposition of Jung's ideas around transpersonal, philosophical and religious themes (borne out of his own self‐analysis), into a two‐person psychotherapeutic process. Jung provides little description of his clinical encounters and the way in which he conducted his analyses leaving an uncertainty that has likely contributed to the divergence of approaches practised today by analytical psychologists. This article considers the implication of these divergences for contemporary Jungian practice and proposes a way of working in the Jungian spirit that maintains a connection to the symbolic realm while at the same time remaining focused on the complexities of personal and relational dynamics. [ABSTRACT FROM AUTHOR]

Collusion designates a specific type of transference-countertransference interaction between two or more persons, linked by an unconscious and shared unresolved issue, which they avoid on an intrapsychic level by externalizing it in the interpersonal space. To find a way to identify collusion and to delineate it from other transference-countertransference interactions. We conducted this study based on a case series approach. The study material consisted of audiotaped clinicians-centered supervisions with oncologists. The case series methodology involved the systematic examination of a purposive sample of supervisions, with the aim to understand how and why they differ from one another with respect to the relational dynamic between the physician and his/her patient. Four cases/supervisions were selected as they allowed to situate collusion on the spectrum of transference-countertransference interactions. We report on it by describing a countertransference reaction, two transference-countertransference interactions, and a collusion. The study reveals the challenges and pitfalls of research on collusion. The results allow to confirm the criteria of our working definition of collusion and to delineate collusion from other transference-countertransference interactions, which represents a first step for the empirical investigation of collusion. [ABSTRACT FROM AUTHOR]

Le constat de la traversée analytique de la lettre, dont Lacan s’est saisi pour mettre en lumière les modalités de manifestation de l’inconscient, incite à nous pencher sur ses apports, plus spécifiquement dans le champ d’une clinique à l’épreuve du trauma et du transfert. C’est à partir de deux experiences cliniques, celle avec Fatah, enfant mutique, et M. U., souffrant d’une névrose dite “traumatique”, que nous aborderons les modalités d’évolution d’une lettre qui, via le transfert, tente de retrouver son inscription symbolique. Nous verrons que de ces rencontres advient la possibilité d’une réarticulation de la lettre, cette dernière fonctionnant comme mise en bouche d’une parole à advenir, une trace qui engage la dimension du réel et du corps organique, dans leur dialogue impossible et à jamais inachevé avec le langage.

Quel est le sujet de la psychiatrie ? Professionnelles du service de psychiatrie de l'hôpital d'instruction des armées Sainte-Anne à Toulon, nous avons eu l'idée de formuler une première réflexion à trois, entre psychomotricienne, psychologue et psychiatre, autour du soin en psychiatrie, en supportant les nuances voire les divergences de nos pratiques. Notre présent travail ne prétend pas mener à une pensée univoque ; il s'impose d'une volonté de soutenir la nécessité d'une continuité des soins, du travail en commun, du décloisonnement des différents espaces où est entendu le sujet, devant la discontinuité qui touche aujourd'hui la psychiatrie en France. Notre fil rouge sera le transfert comme instrument nécessaire pour que puisse se produire dans la rencontre une parole inédite. What is psychiatry about? As professionals in the Department of Psychiatry of the Sainte-Anne Army Hospital in Toulon, we decided to formulate an initial three-way discussion between psycho-motor specialists, psychologists and psychiatrists on the subject of psychiatric care, bearing in mind the nuances and even the divergences in our practices. Our current work does not claim to lead to unequivocal thinking; it is based on a desire to support the need for continuity of care, for working together, and for decompartmentalizing the different areas where the subject of psychiatry is relevant, especially in light of the discontinuity that is present in the practice of psychiatry in France today. Our common thread will be transference as a necessary element so that this encounter can develop an unprecedented form of expression. [ABSTRACT FROM AUTHOR]

The author, a psychoanalytic-oriented psychologist, relates how witnessing children's play on a seashore, between sand and sea, inspired thoughts about the potential space in child psychoanalytic psychotherapy. From the metaphor of the seashore, clinical examples, and references to psychoanalysts and philosophers' theories, she introduces the idea of the seashore as a physical space that could represent a favourable psychic space for the establishment of symbolic play, potential source of both creativity and transformation. She suggests certain theoretical-clinical avenues in order to promote these processes--transitional, transferential, and symbolic--in child psychoanalytic psychotherapy. [ABSTRACT FROM AUTHOR]

In a new study on hysteria, the author seeks what can be revealed in relation to the classic model of neurosis. It is from clinical experience that the emergence of projection leads us to think about its unique place and role within psychic functioning furthermore supported by repression and internal conflict. The bodily ailments so characteristic of hysterical symptoms arise then from a displacement of the same order when words fail. In certain situations, projection reverses this dominant tendency by the externalization of instinctual movements and the fantasies attached to them. [ABSTRACT FROM AUTHOR]

Early in his theoretical developments, Freud noticed that psychotics did not respond to the psychoanalytic treatment, suggesting that psychosis would correspond to a different constitution mechanism. Gradually, transference became the target of investigation for discovering a way to tackle psychosis. However, Freud's findings were insufficient to solve the issue of establishing a satisfactory transference bond with psychotics. Jacques Lacan modified some Freudian concepts to create his own operators and coined erotomania, the structural and logical consequence of the bond between analyst and psychotic. This article proposes a possible clinic, from a psychoanalytic perspective, as a possible treatment route for psychosis by establishing a transference bond via the appropriate management of jouissance, which promotes stabilization. [ABSTRACT FROM AUTHOR]

This paper reflects on the concepts of transference and countertransference in articulation with the clinical dimension of the observer's place in therapeutic groups. After a brief historical overview of these concepts in psychoanalysis, the notion of transference is discussed as a link that can manifest itself via bodily and sensorially. Countertransference, in turn, will be analyzed based on intersubjectivity. These aspects will be illustrated by two clinical vignettes. [ABSTRACT FROM AUTHOR]

A reflection on one of Kernberg's last articles, which deals with the transference characteristics of various pathologies, and on some of the most important aspects of his Kleinian relational thought, on the theory of the mind and on the technique, particulary of the borderline and psychotic patients. After emphasizing the significant differences between the Kleinian theory of development and the one by the British independents, which A.S.P. - Associazione di Studi Psicoanalitici and the School1 refer to, with particular regard to Balint's concept of primary love and mutuality between mother and infant, the author proposes a model of the Self not with a representational character but with an organizational and systemic one. This model tends to integrate the first Freudian topic with the structural theory, taking into account Bucci's, Panksepp's and Biven's contributions to the theme. Finally, the article deals with the difference between Kernberg's approach to severe patients, which, contrary to Searles' symbiotic view, tries to distinguish early the patient's feelings from the therapist's, and the intersubjective approach which integrates the mutual share of affection between the two partners with the employment, as soon as possible, of the preinterpretative and interpretative activity on the resistances. [ABSTRACT FROM AUTHOR]

The dream is discussed as a herald announcing the issues and conflicts that will be deployed in the cure. The account given by the patient first serves the analyst's attention before ensuring the relevance of the interpretation. The dream narrative is compared to the various processes of imagery or remote sensing in the wave spectrum insofar as it anticipates the work to come in the treatment, at the three levels of external life, infantile sources, and transferential actualizations. Some shifts in the use of dreams in treatment are presented to illustrate the difficulty linked to a concern centered too exclusively on interpretation. [ABSTRACT FROM AUTHOR]

The paper analyzes the relationship between interpretation and construction, underlining the conjectural value of constructions. The author traces the Freudian conceptualization of interpretation and construction in relation to dreams, transference and resistance, which must be taken into consideration as a priority. The vision of the Kleinian school is also critically explored, specifically regarding the emphasis on the need to provide systematic transference interpretations, which tends to excessively personalize the transference, overriding its value of repetition of the past. Starting from the vision of the French school and Winnicott, it is underlined how the main task of the analytical work is to facilitate the transformation of instinctual impulses into representations to subsequently make them accessible to interpretation. Starting from the difference between interpretation and construction, emphasis is also placed on their different use in neurotic and non-neurotic structures. [ABSTRACT FROM AUTHOR]

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(i) Retracer la genèse des consultations thérapeutiques parents/bébé et en pointer les carrefours épistémologiques ; (ii) Présenter les résultats principaux d'une recherche effectuée à l'hôpital Necker dans une consultation parents/bébés ; (iii) Montrer que la consultation thérapeutique parents/bébé est un marqueur pertinent de l'évolution permanente de la psychanalyse qui maintient vivante son dynamisme en relevant le défi clinique d'envisager des territoires cliniques jusque-là inédits. Les auteurs mettent en perspective les différents modèles de cadre et pointent les thématiques de recherches cliniques prévalentes. Pour les praticiens de cette consultation périnatale l'engagement simultané dans la recherche et l'enseignement s'impose comme une condition de sa fécondité épistémologique. Pour les praticiens de la consultation parents-bébé, l'engagement simultané dans la recherche clinique et l'enseignement sont les deux conditions de sa fécondité épistémologique. La consultation thérapeutique parents/bébé est un marqueur pertinent du dynamisme d'une psychanalyse vivante grâce à sa confrontation à des défis cliniques inédits. (i) To trace the genesis of therapeutic parent/baby consultations and to point out the epistemological crossroads; (ii) To present the main results of a research project carried out at the Necker Hospital in a parent/baby consultation; (iii) To show that the therapeutic parent/baby consultation is a relevant marker of the permanent evolution of psychoanalysis, which remains dynamic by taking up the clinical challenge of envisaging hitherto unseen clinical territories. The authors put into perspective the different framework models and point out the prevalent clinical research themes. For the practitioners of this perinatal consultation, the simultaneous engagement in research and teaching is essential as two conditions of its epistemological fecundity. For practitioners of parent/baby consultations, the simultaneous engagement in clinical research and teaching are the two conditions of its epistemological fecundity. The therapeutic parent/baby consultation is a relevant marker of the dynamism of a living psychoanalysis thanks to its confrontation with new clinical challenges. [ABSTRACT FROM AUTHOR]

Étudier le processus de parentification à partir du matériel issu d'une psychothérapie chez une patiente suivie en Centre Médico-Psychologique (CMP). Le matériel clinique fait l'objet d'une analyse thématique, une analyse de la dynamique du transfert et du contre-transfert étayée par une réflexion théorique. L'histoire infantile de la patiente est marquée par un renversement générationnel, des imagos parentales envahissantes, des dynamiques identificatoires narcissiques, des relations familiales incestuelles, un couple parental et conjugal dysfonctionnel, une dynamique fraternelle où la parentification de l'aîné (notre patiente) est au premier plan, ainsi qu'une possible transmission intergénérationnelle ou transgénérationnelle de la parentification. Son choix professionnel s'oriente vers un métier de soin. La psychothérapie psychanalytique a permis un meilleur insight, des changements au niveau des imagos parentales et des changements dans la relation aux autres (conjoint, enfants, fratrie, collègues). L'analyse clinique de différents thèmes, l'exploration tridimensionnelle du processus de parentification (intrapsychique, intersubjectif et transubjectif), ainsi que celle de la dynamique transféro-contre-transférentielle nous ont permis de montrer des changements au niveau du fonctionnement psychique de la patiente, de mettre en évidence la nature de l'empreinte de la parentification, ainsi que son élaboration dans la thérapie. La psychothérapie psychanalytique a été utilisée comme méthode d'investigation (des processus conscients et inconscients et d'évaluation du processus de parentification) et également comme méthode de traitement psychothérapeutique. Cette recherche expose la reconstruction de ce qui s'est passé au décours d'une psychothérapie psychanalytique, en ayant comme fil conducteur la problématique de la parentification et de son élaboration, mettant en évidence les éléments cliniques dégagés grâce à l'analyse de la dynamique transféro-contre-transférentielle. The 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. After 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. We 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. For 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. We underscore the contribution of the clinical elements revealed by the analysis of the transfer/counter-transference dynamics in the process of deparentification. [ABSTRACT FROM AUTHOR]

By appropriating the tradition of the presentation of a patient, which historically legitimised psychiatric knowledge and validated nosographic classification, Lacan subverts it by tying it to analytic practice. It becomes a clinical presentation that is no longer a demonstration of the knowledge of the master. In fact, the analyst in this transference relation starts from the saying of the patient and in that way submits himself to its unconscious logic. If the patient’s knowledge thus takes centre stage, a certain number of biases should nevertheless be questioned, which could limit or even nullify the relevance of such a dispositive. [ABSTRACT FROM AUTHOR]

The brief apologue of the mustard pots introduced by Lacan in his seminar The Ethics of Psychoanalysis allows us to approach the specificity of the psychoanalytic clinic in a clear way. It opens up the logical operations of the constitution of the subject and of desire and leads to specifying the effectiveness of the analytic operation. On this path, two ternaries are to be tied: demand-identification-transference and indetermination-deception-certainty. [ABSTRACT FROM AUTHOR]

Clearly, the syntagm, “psychoanalytic clinic” has been established in psychoanalytic literature. However, it is far from being indifferent to speak of The psychoanalytic clinic or of a clinic, at the risk of confusing psychoanalytic practice, psychoanalytic experience or the so-called “psychoanalytic clinic”. Moreover, whether we speak of “Freudian clinic”, of “Kleinian clinic” or of “Lacanian clinic” or of others, sufficiently indicates the link, not always thought through, between “clinical observation”, “construction of clinical cases”, doctrine or theory, and concern for transmission and training. Hence the question that this article wishes to address: is there a psychoanalytic clinic?. [ABSTRACT FROM AUTHOR]

This study compared the differential effects of focused and comprehensive written corrective feedback (WCF) on the accuracy of revision and new pieces of writing. It also examined whether the effects depended on feedback sub-types. Data were collected from 87 Grade 6 students in an intensive English program over seven sessions. Students were first divided into three groups: two treatment groups and one control group. The treatment groups were then divided into three subgroups based on three feedback sub-types (i.e., direct, indirect underline, and indirect metalinguistic cues). Students produced three pieces of writing, revised them, and produced new writings. Findings revealed that both focused and comprehensive feedback types improved learners' accuracy of revision and subsequent writings, and focused feedback was more effective than comprehensive feedback. The effect of both feedback types, however, varied across writing sessions. Additionally, an interaction of comprehensive feedback and feedback subtypes was found on the accuracy of revision. [ABSTRACT FROM AUTHOR]

Silence is a mysterious psychic experience: what is there in silence? Words have mysterious character because they carries multi-faceted meanings with evocative and symbolic power. But silence maintains an additional aura of darkness: while with words it is possible to start an evocative activity through images, thoughts, ideas, considerations that arise in the therapeutic encounter, in silence everyone remains trapped in their own world. What is expressed and what is satisfied in a person who is simultaneously silent and in relationship with the analyst? Another way to articulate this question is to ask what is the drive (libidinal-aggressive) that fuels silence and what kind of defense is at work. Many considerations arise from the experience of silence during a psychotherapy with a young man. [ABSTRACT FROM AUTHOR]

As there is a lack of regulations on pesticide levels in crude oils, this study aimed to evaluate transfer factors for extrapolating concentration limits established for maize kernels to the crude oils extracted from their germs. Maize kernels were spiked with 4 organophosphates insecticides (chlorpyriphos, chlorpyriphos-methyl, fenitrothion, pirimiphos-methyl), 2 pyrethroids (cypermethrin and deltamethrin) and a pyrethroid synergist, piperonyl butoxide (PB) targeting a dose of 1 mg/kg grain. The kernels were transformed in a pilot starch-mill to separate the germs (wet-milling) then these germs underwent an oil extraction process in a mini-pilot comprising a thermal conditioning stage, a mechanical extraction followed by a solvent extraction and a desolventization-toasting stage for the meal. Analyses were carried out by gas chromatography coupled to MS/MS detector. The pesticides content was measured on kernels, spiked kernels, germ, crude oil and meal. Surprisingly, a significant difference in behavior was observed between organophosphates and pyrethroids in the transition from grain to germ. For the former, the applied pesticides were recovered at levels between 48% and 81% in the germ, compared to only 9–11% for the latter and 31% for PB. It has been shown by means of acetonitrile washing on spiked seeds that the pyrethroids remained bound to the hydrophobic cuticle of the grains. On the other hand, from the germ to the oil, the initial hypothesis of an almost total transfer of the pesticides in the fat fraction of the material was confirmed. The germ to meal concentration ratios were on average 0.019, 0.065 and 0.109 for organophosphates, PB and pyrethroids respectively. In the same order, the concentration ratios between germ and crude oil were 1.87, 1.98 and 2.17. Grain to final oil transfer factors ranged from 7.4 to 12.7 for organophosphates, 4.8 for PB and 1.4 and 1.7 for cypermethrin and deltamethrin respectively. [ABSTRACT FROM AUTHOR]

The paper attempts to reflect on the value and meaning of psychoanalysis as well as the very fact of what to be a psychoanalyst means. Psychoanalysis is seen as a path towards the possibility of obtaining greater degrees of freedom in life, within the limits of what is possible, by facing the desires, difficulties and fears that growing up entails, such as the need and the fear of needing other, or the very fantasy of being able to find ourselves deprived of the protection that our chains offer us. We don’t grow up alone, but benefiting from our family, as well as from friends and colleagues, from our own analysts and masters who have supported us in our training, searching for our own personal identity in which past experiences can be given new meaning in a new authenticity. A fragment of a clinical experience is presented in which analyst and patient meet, with their mutual personal histories, motivations, and desires, as people with different roles who decide to have a common intention. [ABSTRACT FROM AUTHOR]

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Copyright of Estilos da Clínica is the property of FEUSP - Faculdade de Educacao da USP - Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The birth of a new sibling can create a state of inner chaos for the first born. Conflict, aggression and regression often occur as the replaced child adjusts to his loss of exclusivity. This paper describes a short analytic sandplay case of a 5-year-old boy manifesting anger and anxiety as the birth of his new sibling approached. Throughout this individuation process, a fluid back and forth movement occurred from regression to progression, and from deintegration to reintegration (Fordham 1988), as he advanced from the regressed Uroboric phase of development, forward to the age-appropriate phase of the Patriarche (Neumann 1990). As he grieved the loss of his exclusive status, Roy worked with his aggressive feelings towards his mother and the new baby, as well as with his feelings of despair. This process developed in the context of a positive maternal transference which allowed for both moments of deep resonance, states of participation mystique, and moments of projected rage and aggression towards the 'abandoning mother'. His work in analysis resulted in an opening of the ego-Self axis, a solidifying of the depressive position, and a movement forward in development. At the end of treatment, an initiatory process into the realm of the 'Father' was activated. Roy's symptoms had diminished and he was ready to leave the regressive pull of the Great Mother and move out into the world of peers, with a strengthened ego and an expanded sense of self. [ABSTRACT FROM AUTHOR]

This paper takes its cue from those given at the conference Psychotherapy and Healthy Masculinity. These prompted the author to reflect on how he experienced masculinity as a psychotherapist working with families within NHS England's CAMHS. The difficulties in children leading to their referral demonstrated a problematic parenting in which the diminished role of the father was causal. Beliefs about masculinity held within the family matrix were largely ones that functioned to fill epistemic lacunae. Such filling represents a double injustice. Not only is there very little empirically based thinking about fathers in our western culture for families to draw upon to make sense of their experiences. Instead, this dearth is often falsely compensated through ideologically derived pejorative concepts, that invariably do not relate to experience. The paper discusses the perniciousness of relying upon ideological perceptions of masculinity through focusing upon how easily they are acquired and work against the mental health of children and their families. [ABSTRACT FROM AUTHOR]

Résumé: En oncologie, l'antalgie est un enjeu majeur de la prise en charge du patient. La « Patient-controlled analgesia » est une méthode permettant au patient de gérer lui-même sa douleur, mais elle n'est pas toujours applicable en cas de transfert des patients. L'objectif de ce travail a été de valider l'utilisation d'un dispositif portable d'intérêt permettant de mimer l'action de pompes électriques pour deux molécules : morphine et oxycodone. Des études de stabilités ainsi que la vérification de la conformité des spécificités vis-à-vis du débit ont été étudiées, en parallèle une réflexion sur le circuit de dispensation a été menée. Les deux molécules sont stables sur une durée d'au moins 30 heures. Une conformité de la valeur des débits a pu être montrée. Le circuit « prescription – dispensation – administration » a été définit et sécurisé. Ceci a pu permettre de valider et de mettre en place l'utilisation de ce dispositif. In oncology, analgesia is a major issue in patient management. "Patient-controlled analgesia" (PCA) is a method that allows patients to manage their own pain, but it is not always applicable when patients are transferred. The objective of this work was to validate the use of a portable device allowing to mimic the action of electric pumps use for PCA. For this purpose, two drugs were studied and analyzed. Stability studies, as well as the verification of the conformity of the specificities with regard to the flow rate were studied, in parallel a reflection on the dispensing circuit was carried out. Both molecules are stable for at least 30 hours. Compliance of the flow rates was demonstrated. The "prescription – dispensation – administration" circuit was defined and secured. These tests allowed us to "validate" this device and to use it in real life. [ABSTRACT FROM AUTHOR]

The end of professional education in alternating (France) or dual structures (Germany) cleary consists in professionalising the learners by offering knowledge, developing competences and in enabling them to get integrated into the communities of practice. This aim is realised in professional schools and at the workplace, from which arises the question -- discussed in this field of research for decades -- on the nature of the relationship between the learning in academic and working contexts. There have been given quite a number of answers to this also in the French speaking discourses. This paper, however, will concentrate on additional answers as suggested by research of Anglo-Saxon origin (connectivity theory, by Guile and Griffith) and by German origin (Komplementaritatstheorie der Bildung, by Jongebloed and Bank). The discussion of the different theoretical approaches leads to a hypothesis, in accordance to which the nexus between the learning of theory and the learning of practical tasks is realised by transfer learning. This hypothesis is first tested in a pilot study that has been carried out in interviewing some of the persons involved: the apprentice-students. The end of professional education in alternating (France) or dual structures (Germany) clearly consists in professionalising the learners by offering knowledge, developing competences and in enabling them to get integrated into the communities of practice. This aim is realised in professional schools and at the workplace, from which arises the question -- discussed in this field of research for decades -- on the nature of the relationship between the learning in academic and working contexts. There have been given quite a number of answers to this also in the French speaking discourses. This paper, however, will concentrate on additional answers as suggested by research of Anglo-Saxon origin (connectivity theory, by Guile and Griffith) and by German origin (Komplementaritatstheorie der Bildung, by Jongebloed and Bank). The discussion of the different theoretical approaches leads to a hypothesis, in accordance to which the nexus between the learning of theory and the learning of practical tasks is realised by transfer learning. This hypothesis is first tested in a pilot study that has been carried out in interviewing some of the persons involved: the apprentice-students. [ABSTRACT FROM AUTHOR]

This paper aims to represent the synthesis of the clinical experience of Dr. Antonino Lo Cascio, a pupil of Bernhardt and co-founder of AIPA, with respect to the analytical clinic technique. The text is built on an interview structure, in which the authors? Antonino Lo Cascio and Cristina Brunialti? define the stages of the analytic path. Unexplored aspects of the technique are deepened, according to a particular perspective that the Authors define autodafè. The reader will find food for thought between the reference to the technique and Lo Cascio's biographical narrative. The interviewer Cristina Brunialti, a pupil and friend of Lo Cascio, "has fun" with him to give shape to a conversational and spontaneous dialogue that deals with complex issues still debated in the psychoanalytic field. [ABSTRACT FROM AUTHOR]

The text is based on data coming from doctoral research on the possible lessons learned about the difficulties adhering the treatment by adolescent drug users and that boost the work of the teams at the Child and Adolescent Psychosocial Care Center (CASPi), which is part of the Psychosocial Care Network of Brazil. The purpose of the study is, from one of the five cases studied, employing the single case method in Freud and Lacan, to focus on one of them which exemplifies the importance of the effects of transference in the clinic, considering the radical abandonment reflected in criminality and drug abuse. Besides, the study allows us to think about the possibilities for the treatment in these institutions ruled by a psychosocial mandate. [ABSTRACT FROM AUTHOR]

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Copyright of Studii şi Cercetări de Onomastică şi Lexicologie is the property of University of Craiova, Faculty of Letters and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article discusses four different positions of fictional truth derived from Sabina Berman's play, Feliz Nuevo Siglo Doktor Freud, on Dora's clinical case. The staging inherent to the hysteric structure reveals the fantasies of prostitution, of the seduction of the father, of the instauration of femininity and of the textual diversity of (counter) transference. The play takes clinical work to a dimension of critical debate in which Freud finds himself divided between the different formulations of his sexual theory and the breakthroughs brought about by the testimony of the singular experience. It reveals not only the background of social and historical conditions that frame the clinical exercise of the word and subjectivity, but also the conditions that determine complex relations between sexes and imaginary-ideological schemes that influence Freud's thinking. [ABSTRACT FROM AUTHOR]

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Cet article interroge le mode d'entrée en lice du diagnostic d'état-limite, originairement borderline, dans la nosographie de l'époque. Nous nous appuyons sur la littérature psychanalytique qui de 1938 à nos jours, fait état de l'état-limite, dans une opposition entre pertinence et inconsistance selon que l'on soit pro ou anti-état-limite. L'état-limite, qu'il s'agisse des patients diagnostiqués comme tels ou du concept, s'est affirmé sur un mode que nous qualifions d'insolent. Ces patients chahutent le cadre de la cure analytique tandis que le concept bouscule la nomenclature théorique en place (psychose, névrose et perversion). Des auteurs font l'hypothèse que les théoriciens de l'état-limite sont animés par le désir (conscient ou inconscient) de renverser la nosographie classique et au-delà, de mettre à bas les fondations sur lesquelles le Père de la psychanalyse, Sigmund Freud, s'est lui-même appuyé. La pugnacité des théoriciens de l'état-limite traduirait un désir de détrôner la figure paternelle. La discussion porte sur les conséquences de ce passage en force de l'état-limite au point de vue clinique. Quelle peut être l'intention sous-jacente de son inventeur (Adolph Stern) et des théoriciens qui lui font suite dans l'élaboration des principes organisateurs de ce concept. Le succès du concept d'état-limite est incontestable, en premier lieu parce qu'il est un diagnostic pratique et aisé à poser. Son spectre, devenu extrêmement large nuit largement à son éventuelle pertinence clinique. Toutefois, ce concept a le mérite de relancer la recherche sur une question tombée un temps dans les oubliettes; la question du trauma survenu très précocement dans la vie des sujets. This article questions the way in which the "borderline" diagnosis made its way into various nosographies of the 20th and 21st centuries. I examine the psychoanalytical literature from 1938 to the present day that refers to the borderline entity, in an opposition between relevance and inconsistency depending on whether one is pro- or anti-borderline. The borderline state, whether it is a question of patients diagnosed as such or of the concept, has asserted itself in a way that I describe as insolent. These patients disturb the framework of the analytical treatment while the concept upsets the theoretical nomenclature in place (psychosis, neurosis, and perversion). Some authors hypothesize that the theorists of the borderline state are driven by the desire (conscious or unconscious) to overthrow the classical nosography and, beyond that, to tear down the foundations on which the Father of psychoanalysis, Sigmund Freud, himself relied. The pugnacity of the theorists of the borderline state would thus translate their desire to dethrone the father figure. The discussion focuses on the consequences of the forceful appearance of the borderline state from a clinical point of view. What might be the underlying intention of its inventor (Adolph Stern) and of the theorists who followed him in the elaboration of its organizing principles? The success of the concept of the borderline state is indisputable, in large part because it is a practical and easy diagnosis to make. Its spectrum, which has become extremely broad, undermines its possible clinical relevance. However, this concept has the merit of reviving research on a question that had been temporarily fallen out of fashion: the question of trauma that occurred very early in the life of subjects. [ABSTRACT FROM AUTHOR]

The work of supervision in psychomotricity is the place of the psychic élaboration of clinical exercice. It is based on the listening and the enlightening of an experienced psychomotrician psychoanalyst or at least oriented in psychoanalysis, amongst a group of peers or by oneself. It allows one to take distance, and grasp bodily and verbal transfers and counter-transfers specific to the patients's care. It supports the professionnal in the affirmation of his or her identity and in refining his or her personal style. To the professional, supervision is a posture of observation of his or her engagement as much as of the engagement of the patient, his family and the institution. A posture that the professionnal acquires and appropriates. [ABSTRACT FROM AUTHOR]

Cet article est la traduction et l'adaptation en français d'un article de Jonathan Shedler, psychologue clinicien et universitaire américain connu pour ses travaux sur les psychothérapies psychanalytiques. Shedler propose dans cet écrit une introduction aux psychothérapies psychanalytiques (ou psychodynamiques) rédigée initialement à destination des étudiants et des néophytes en la matière. Un propos préliminaire replace ce texte dans son contexte actuel. Les préjugés habituels à l'égard de la psychanalyse, une description de ce que n'est pas la psychanalyse ainsi que des précisions terminologiques sont proposés. Plusieurs notions fondamentales de l'approche psychanalytique sont ensuite présentées : la vie psychique inconsciente, la conflictualité, le rôle des expériences passées, le transfert, les mécanismes de défense, la causalité psychique, l'association libre et la place du travail personnel. Ces différentes notions, illustrées par de nombreux exemples cliniques, mettent en évidence l'intérêt et les particularités de l'approche psychanalytique dans le domaine du soin psychique. Cet article se termine par un épilogue dans lequel Shedler décrit son parcours et ses désillusions face à une psychologie universitaire américaine jugée déshumanisée et souvent éloignée des préoccupations des étudiants et de la pratique clinique. This paper is the translation and adaptation in French of a paper written by Jonathan Shedler, a clinical psychologist and American scholar known for his work on psychoanalytic psychotherapies. Shedler offers an introduction to psychoanalytic (or psychodynamic) psychotherapies, initially written for students and clinicians trained in other treatment approaches. A preliminary statement also describes the context of this writing. The usual biases towards psychoanalysis, a description of what psychoanalysis is not , and some comments about terminology are offered in an introduction. Fundamental concepts of the psychoanalytic approach are then presented: unconscious mental life, psychological conflicts, the role of past experiences, transference, defense mechanisms, psychological causation, free association, and the importance of the clinician's personal psychotherapy. These notions, illustrated by several clinical examples, highlight the interest and particularities of the psychoanalytical approach in the field of psychotherapy. This article concludes with an epilogue in which Shedler describes his journey and his disillusionment with academic psychology in the United States due to its disconnect from the fundamental concerns of students and from clinical practice. [ABSTRACT FROM AUTHOR]

The oak barrel maturation step is nowadays strongly rooted in the production of quality wines. Two main physico‑chemical phenomena contribute to the modification and improvement of wine: the solubilisation of volatile and non-volatile wood compounds concomitant with the dissolution of oxygen from the air into the wine. Indeed, wood is a porous material and gas transfer (especially oxygen transfer, expressed as oxygen transfer rate or OTR) through oak barrels, is an intrinsic parameter which ensures wine oxygen supply during maturation. Due to its oenological impact, it has been actively studied over recent decades using several approaches based on the same principle: the monitoring of oxygen in a model wine solution in the barrel. This project aimed at assaying barrel OTR by using a new tool based on the theoretical knowledge of gas transfer through porous materials. An oxygen concentration gradient was created on each side of a barrel kept in an airtight stainless-steel tank. The concentration of the oxygen in the atmosphere around the barrel was monitored in order to quantify oxygen transfer, thus the avoiding common drawbacks of interactions between dissolved oxygen ingress kinetics and the consumption of oxygen in the liquid phase by wood components. This study reports for the first time, the diffusion coefficient of entire oak barrels (Q. sessilis) to be between 10-10 and 10-9 m²/s, and it contributes to increasing knowledge on the complex phenomena driving oxygen ingress during the maturation of wine in barrels kept in cellar conditions. The results highlight the important role of wood moisture content in oxygen transfer, and provides a simple and reliable parameter to monitor it: the weight of the barrel. Following methodology developed by the authors, the OTR of a new oak barrel was found to be 11.4 mg/L per year. Taking into account the oxygen released through the wood pores, a new barrel will contribute 14.4 mg/L per year of oxygen to the wine, of which 46 % in the first three months of aging.

In this interview, Andreina Navone talks about herself and retraces the long road that led her to be a Jungian analyst, starting from her first steps as a teacher, discovering, through her work with children, the power of the image and its therapeutic value. During the conversation, Navone also dwells on some important theoretical principles, such as transference and countertransference, in particular in the Sandplay method, on spirituality and on the work with adopted children, which she has long dealt with. In the story we find also the encounter with various analysts and with Dora Kalff, whose student and friend she was. [ABSTRACT FROM AUTHOR]

Cet article propose une réflexion sur les fondements, les principes, les modalités et les limites des utilisations du jeu vidéo en psychothérapie d'inspiration psychanalytique. Nous commençons par une revue de la littérature concernant l'utilisation du jeu vidéo au sein de cadres-dispositifs thérapeutiques d'orientation psychanalytique en France. Puis, nous rappelons les fondements et principes directeurs de l'approche psycho-dynamique de la médiation thérapeutique développée par « l'Ecole lyonnaise ». Enfin, nous proposons une analyse des publications consultées. Cela nous permet de dégager les fondements, les principes, les modalités et les limites des médiations numériques et de discuter les rapprochements et divergences avec le modèle de la médiation thérapeutique. La médiation numérique est présentée avec un style démonstratif, voire didactique. La présentation du jeu vidéo occupe une place significative, tandis que le cadre et la méthodologie sont présentés de manière variable. Le matériel clinique, parfois dense et amené tardivement, est utilisé à des fins informatives ou illustratives ou pour confirmer un point de vue, ce qui n'est pas propice à l'analyse et à la discussion. Ade rares exceptions, il n'y a pas de contre-argumentation et les rares autocritiques sont peu étoffées. Le jeu vidéo est présenté comme un objet de parole et un support de projection de la vie psychique facilitant l'expression des conflits inconscients, mais aussi comme un objet culturel, proche des jeunes générations, ce qui en ferait un objet approprié à la thérapie. En médiation, il est pensé comme un prétexte à la rencontre et comme une solution face à l'impasse thérapeutique. Les publications se réfèrent aux écrits des psychanalystes anglo-saxons, à ceux d'Anzieu, ainsi qu'aux apports de la psychologie cognitive et de la psychologie du développement. Le jeu vidéo est alors pensé comme un objet de contenance et de transformation et d'intégration de l'angoisse, en légitimant l'expression de la vie pulsionnelle sans risque de représailles. Il est un support de symbolisation plurielle, un vecteur d'apprentissage et de subjectivation par l'action dont l'utilisation et les propriétés réflexives permettent de révéler les « compétences » et les « ressources » du patient. Les médiations numériques sont des « techniques » visant à aider le patient à « mentaliser » ses conflits et traumatismes, à restaurer sa capacité de jeu, à le « renarcissiser », à « restaurer de l'estime de soi » ou à soutenir la « capacité d'être seul en présence d'un autre ». Elles s'opèrent par l'actualisation des expériences de partage et d'accordage mère-bébé. Le transfert s'effectue alors sur le thérapeute, par diffraction s'il s'agit d'un groupe, mais aussi dans le jeu vidéo, sur les figures numériques, notamment l'avatar que le joueur contrôle. En médiation thérapeutique, le jeu vidéo serait un accélérateur de la relation transférentielle. Le style, la place importante allouée au jeu vidéo par rapport à la méthodologie, la manière d'utiliser le matériel clinique et l'absence de contre-argumentation contribuent à une approche en apparence psychanalytique ainsi qu'à une certaine imprécision, ce qui ne permet pas de discuter des spécificités, des limites et zones d'ombres des médiations numériques. Le recours au jeu vidéo est justifié par son statut d'objet culturel et de prétexte à la rencontre plutôt que par l'adéquation entre sa matérialité et la problématique du patient. Outre l'écueil consistant à surinvestir la verbalisation et la dynamique groupale au détriment de la matérialité de l'objet, se pose la question du désir du thérapeute et du sens de cette médiation. Nous retrouvons des références communes avec le modèle de la médiation thérapeutique. Cependant, nous repérons un risque de fétichisation du modèle du jeu ainsi que l'écueil consistant à se focaliser sur la sensori-motricité et sur les propriétés de l'objet médiateur, au détriment de la prise en compte des enjeux intersubjectifs. La référence aux travaux d'Anzieu en médiation numérique invite à plusieurs remarques. Elle peut conduire à un glissement métonymique consistant à prendre l'écran comme un équivalent de la peau. De plus, cette théorisation peut servir d'écran pour éviter de penser les enjeux sous-jacents à l'expérience vidéo-ludique. Les pratiques rapportées révèlent une certaine variabilité et des points de divergence avec le modèle de la médiation thérapeutique notamment au travers de la focalisation sur des objectifs et sur la manière de penser et de poser le cadre, mais aussi avec certains emprunts à des modèles non-psychanalytiques. Cela soulève des questions sur les effets de ces choix, sur le positionnement du thérapeute et sur l'absence de modalités d'évaluation consensuelles. Nous remarquons une tendance à réduire le transfert à ce qui se joue à l'écran, notamment avec l'avatar, ce qui pose la question d'une mise à l'écart de la relation intersubjective et de certaines formes de la négativité tout comme des éléments pré-figuratifs qui constituent les formes primaires de symbolisation. De plus, le transfert négatif est très peu abordé et non-analysé. Enfin, l'« accélération de la relation transférentielle » rappelle la problématique de l'hypnose avec un contournement temporaire des défenses avant leur rétablissement après le jeu vidéo. Le contre-transfert n'est pratiquement pas évoqué, et encore moins ses manifestations corporelles. Plusieurs éléments pourraient constituer des indices du contre-transfert mais ils ne sont majoritairement ni repérés, ni analysés, ni discutés. Excepté dans quelques écrits, l'analyse de la dynamique transféro-contre-transférentielle reste très succincte. Ces éléments nous invitent à interroger les écarts avec le modèle de la médiation thérapeutique. Le parcours de la littérature révèle une diversité dans les pratiques, ce qui nous conduit à discuter de la pertinence du modèle de la médiation thérapeutique pour ce travail d'analyse. Nous proposons plusieurs points qui permettraient d'accroître l'intérêt pour l'approche psycho-dynamique de la médiation thérapeutique par le jeu vidéo. Tout d'abord, le cadre et la méthodologie pourraient être présentés de manière plus détaillée. Ensuite, l'initiative d'une telle médiation thérapeutique gagnerait en qualité si les auteurs précisaient comment ils ont réfléchi au lien entre la problématique du patient et la matérialité de l'objet médiateur. Enfin, la référence à la psychanalyse implique que le travail du clinicien se centre davantage sur la dynamique transféro-contre-transférentielle, plutôt que sur la présentation du logiciel et le récit de ce qui se passe à l'écran. This article offers a reflection on the foundations, principles, modalities, and limits of the uses of video games in psychoanalytically inspired psychotherapy. We begin with a review of the literature concerning the use of video games within psychoanalytic-oriented therapeutic settings in France. Then, we recall the foundations and guiding principles of the psychodynamic approach to therapeutic mediation developed by the "Lyon School." Finally, we provide an analysis of the publications consulted. This allows us to identify the foundations, principles, modalities, and limits of digital mediations and to discuss the parallels and divergences with the model of therapeutic mediation. Digital mediation is presented with a demonstrative, even didactic style. The presentation of the video game occupies a significant place, while the setting and methodology are presented in varying ways. The clinical material, sometimes dense and brought in late, is used for informational or illustrative purposes or to confirm a point of view, which is not conducive to analysis and discussion. With rare exceptions, there is no counter-argument and self-criticisms are sparse. The video game is presented as an object of speech and a support for the projection of psychic life facilitating the expression of unconscious conflicts, but also as a cultural object, close to the younger generations, which would make it an appropriate object for therapy. In mediation, it is thought of as a pretext for a therapeutic encounter and as a solution to the therapeutic impasse. The publications refer to the writings of Anglo-Saxon psychoanalysts, to those of Anzieu, as well as to the contributions of cognitive psychology and developmental psychology. The video game is then thought of as an object that can contain, transform, and integrate anxiety, legitimizing the expression of the life drive without risk of reprisals. It is a support for pluralistic symbolization, a vector of learning and subjectification through action, the use and reflective properties of which reveal the patient's "skills" and "resources." Digital mediations are "techniques" aimed at helping the patient to "mentalize" their conflicts and traumas, to restore their ability to play, to "renarcissize" them, to "restore self-esteem" or to support their "capacity to be alone in the presence of another." They operate by updating the experiences of mother-baby sharing and attunement. There is a transference on the therapist, by diffraction if it is a group, but also on the video game, or on digital figures, in particular the avatar that the player controls. In therapeutic mediation, the video game would be an accelerator of the transferential relationship. The style, the important place allocated to the video game compared to the methodology, the way of using the clinical material and the absence of counter-argumentation contribute to an apparently psychoanalytic approach as well as to a certain imprecision, which does not allow for a discussion of the specificities, the limits, and the gray areas of digital mediations. The use of video games is justified by their status as a cultural object and as a pretext for encounters rather than by the adequacy between their materiality and the patient's problematic. Besides the pitfall consisting in over-investing verbalization and group dynamics to the detriment of the materiality of the object, the question of the therapist's desire and the meaning of this mediation arises. We find common references with the model of therapeutic mediation. However, we identify a risk of fetishization of the game model as well as the pitfall of focusing on the sensorimotor and the properties of the mediating object, to the detriment of intersubjective issues. The reference to Anzieu's work in digital mediation invites several comments. It can lead to a metonymic shift, making the screen an equivalent of the skin. In addition, this theorization can mask the absence of thinking about the issues underlying the video game experience. The practices reported reveal a certain variability and points of divergence with the model of therapeutic mediation, in particular through the focus on objectives and on the way of thinking the setting, but also with certain borrowings from non-psychoanalytic models. This raises questions about the effects of these choices, the positioning of the therapist, and the absence of consensual evaluation methods. We notice a tendency to reduce the transference to what is played out on the screen, in particular with the avatar, which raises the question of a possible marginalization of the intersubjective relationship and of certain forms of negativity, just like pre-figurative elements which constitute the primary forms of symbolization. In addition, the negative transference is very little discussed and not analyzed. Finally, the "acceleration of the transferential relationship" recalls the problematic of hypnosis with a temporary bypassing of the defenses before their recovery after the video game. Countertransference is hardly mentioned, much less its bodily manifestations. Several elements could constitute indications of countertransference, but they are mostly neither identified, nor analyzed, nor discussed. Except in a few writings, the analysis of the transfero-countertransference dynamic remains very succinct. These elements invite us to question the differences with the model of therapeutic mediation. The literature review reveals a diversity in practices, which leads us to discuss the relevance of the therapeutic mediation model for this analytical work. We suggest several points that would increase interest in the psychodynamic approach to therapeutic mediation through video games. First, the setting and methodology could be presented in more detail. Then, the initiative of such therapeutic mediation would gain in quality if the authors specified how they reflected on the link between the patient's problem and the materiality of the mediating object. Finally, the reference to psychoanalysis implies that the clinician's work focuses more on the transfero-countertransferential dynamic, rather than on the presentation of the software and the narration of what is happening on the screen. [ABSTRACT FROM AUTHOR]

The relationship between transference and feminine in psychoanalysis arises from the discovery of transference, in which, in Dora's case, the presence of the feminine is not only because it is a woman but due to the stumbling blocks in the handling of the case, which caused Freud postulated transference precisely in what the method had failed, revealing the erotic dimension present in every treatment. This revelation is made not only by the content worked by Freud in this case but by the mystery of femininity, which placed itself to Dora and Freud himself. Dedicating itself to this first moment, in which the feminine appears in the transference bond, this article investigates the answers given, from Freud to Lacan, to the feminine that poses as a constant interrogation to the limits of the phallic signifier and, without departing from it, reveals a not-all phallic position that can contribute to the management of transference. [ABSTRACT FROM AUTHOR]

Des recommandations spécifiques à la néphrologie ont été rédigées sous l'égide de l'Association internationale de néphrologie pédiatrique en 2011. Ces recommandations préconisent une transition individualisée, débutant entre 12 et 14 ans, avec des informations sur la maladie et les traitements du patient adaptées à l'âge et au niveau intellectuel. Les recommandations insistent sur l'importance d'identifier un référent pédiatre et un référent en service adulte, ainsi qu'une équipe paramédicale et de travailleurs sociaux ; elles insistent également sur l'importance d'associer les aidants (les familles et l'entourage proche, etc.), la nécessité d'un dossier spécifique de transition et d'une visite préalable du service adulte avant le transfert. L' International Pediatric Nephrology Association recommande que le transfert soit réalisé au « bon moment » de la vie du jeune et non à ses 18 ans ; ce « bon moment » étant défini par le moment où le jeune se sent prêt, en période de stabilité aussi bien médicale que familiale, scolaire et sociale. Afin de fournir au jeune des compétences d'autogestion (empowerment) appropriées de sa maladie et de sa vie, dans le cadre de la filière maladies rénales rares (ORKiD), nous avons élaboré un programme avec questionnaire adapté à l'âge en nous inspirant de celui mis en place à Southampton au Royaume-Uni. Ce document présente les outils développés par le groupe de travail de la filière de soins ORKiD. [ABSTRACT FROM AUTHOR]

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