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The practices of psychologists and teachers present similarities and differences, with a common commitment to promote individuals’ progress. The interactions between the patient and their psychologist, as well as between the learner or class group and their teacher, imply a relationship likely to promote-or not-the objectives of the care or the learning. How do the professions of psychologists and teachers approach the singularity of the user and the group? What training is offered for this purpose and what work does this involve on the part of these professionals? How can we consider the therapeutic alliance and the quality of the educational relationship as supports for the commitment of the psychologist and the teacher or trainer in a scientific and professional research process allowing the relationship to be thought about? [ABSTRACT FROM AUTHOR]

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Changing behavior to improve health has become a public health issue. Motivational interviewing (MI) is a scientifically proven relational approach derived from Rogerian psychology. Its aim is to increase patients' motivation to undertake a change that will benefit their health. MI has proven its effectiveness in a wide range of fields, including addiction, chronic illness, prison, education, and sports performance. Its practice requires an expertise that is itself initiated by specific training. MI has many similarities with therapeutic patient education (TPE), not only in its theoretical foundations but also in its practice. Empathy, empowerment, a positive outlook on patients' skills and future, shared hope... belong to both MI and TPE. Thus, MI and TPE are complementary and, when practiced together, can improve the effectiveness of TPE programs, notably by increasing patients' motivation to commit to and remain in these programs. Joint training courses in MI and TPE should be offered to caregivers, to ensure that patients' difficulties are dealt with as effectively as possible. [ABSTRACT FROM AUTHOR]

Attachment theory has found renewed interest among psychotherapy researchers in last decades. There is growing evidence for the role of adult attachment as a predictor of treatment process and outcome. Attachment styles are hypothesized to remain stable over time, however, research also shows that internal models of self and others can be revised through interpersonal experiences that diverge significantly from the primary attachment figure. More recently a new concept has appeared and allows a better understanding of the nature of the bond between the patient and his therapist from attachment theory perspective, it is the concept of patient's attachment of the to the therapist. At first this article reviews the empirical evidence on the link between adult attachment styles, patient's attachment to therapist, therapeutic alliance, and outcome. Secondly, we will present results of an empirical study conducted in Algeria which aimed to examine the links between the patient's attachment to the therapist, the patient's adult attachment styles and the therapeutic alliance, to finally end with a discussion on the interest of the variable of the patient's attachment to the therapist for psychotherapy research and clinical intervention. [ABSTRACT FROM AUTHOR]

Introduction: The development of psychotherapies has been accompanied by assiduous research concerning the evaluation of their effectiveness. Since the major psychotherapeutic models have demonstrated their effectiveness, the focus has shifted to understanding this effectiveness and to identifying factors common to the therapies, such as the therapeutic alliance, which would be predictive of effectiveness (Castonguay, 1993; Norcross & Lambert, 2019; Wampold, 2017). Method: We propose here a review of the literature in order to establish the state of research concerning this new paradigm of common factors that offers an innovative understanding of the therapeutic evolution process. Results and discussion: The therapeutic alliance is defined by the affective bond that develops between the therapist and the patient, as well as the collaboration between the two partners on the definition of the goals and tasks of therapy (Bordin, 1979). This conceptualization of the alliance seems the most relevant, because it positions psychotherapy as a professional act according to a specific methodology (Brennstuhl & Marteau-Chasserieau, 2021). Certain characteristics of the therapist and the patient also have a significant influence on the level of alliance and the outcome of the therapy (Wampold & Brown, 2005). Some therapists are reported to be more effective than their peers and have better outcomes regardless of the therapeutic model used (Baldwin et al., 2007; Wampold, 2001). The common factor paradigm for exploring the processes at work within psycho therapies seems promising and offers a great opportunity for collaboration between clinicians and researchers to understand the effectiveness of psychotherapies. [ABSTRACT FROM AUTHOR]

This article introduces the Change Process Research paradigm. In 1966, Kiesler laid the foundations for this new paradigm by insisting on the interpersonal relationship and the complementarity of the patient's responses to the therapist's interventions. Continuing this work, Greenberg (1986) is interested not only in the singularity of the therapy but also in the singularity of the different episodes of the therapy. By considering the context and asking the participants (therapist and patient) for their point of view, he proposes a method to conduct task analysis for significant events in such a way as to better identify, describe, explain and predict the change processes. We will illustrate this Change Process Research paradigm by studying an episode in family therapy using the patients' perspective to identify the significant event. The method allows to reduce the gap between practice and research because the clinician can rely on this analysis when it is done during the therapy to better adjust to the patients during the following sessions in a self-supervision practice. [ABSTRACT FROM AUTHOR]

Researchers and clinicians live in increasingly separate worlds, precipitating psychotherapy into a crisis of legitimacy. This paper hypothesizes that the therapeutic alliance, as an integrative variable, is an element capable of reducing this gap, considering in particular that the alliance between researcher and clinician is based on the same principles as the working alliance between patient and therapist. A few examples of empirical research allow us to address three conflicting aspects of our current knowledge about the alliance: as a common factor or as a specific agent, as useful to the researcher or useful to the clinician, and finally the distinction between the trait-component and the state-component of the alliance. The time has come to strengthen this vital alliance between research and clinical practice. [ABSTRACT FROM AUTHOR]

Background: Therapeutic alliance represents a rarely studied object when it relates to nurses and care provided by a nursing team in acute care hospitalization.Objective: The objective was to study how factors might influence the therapeutic alliance built between nurses and aides and adult inpatients in an acute care unit of sectorial general psychiatry.Method: This is a prospective, observational and cross-sectional study using a therapeutic alliance measurement scale. Therapeutic alliance (TA) score was measured with a STAR-P scale in a sample of 240 patients.Results: The median score found is 33.4 (±7.8) out of a maximum theoretical score of 48. The global score of TA in patients aged 60 years old or more is significantly higher than the score of patients between 18 and 29 years old (p=0.021). The lack of external follow-up in the three months after hospital release is not associated with TA global score (p=0.73). If inpatients, no matter what their diseases or types of care are, under legal obligation or not, consider their TA is rather good after their hospital stay. Only sociodemographic factors like age, housing conditions (insecure or sustainable), having a job or not, living alone or with a partner affect TA and follow-up.Conclusion: Results evoke concepts of anomie and attachment, that seem to play an important role in the lack of follow-up after hospital stay, and indicate the mandatory global approach to care and an involvement of health professionals as well as social beings, where empathy must find its place. [ABSTRACT FROM AUTHOR]

In this article, we present two psychotherapeutic interventions aimed at helping the patient to regulate certain self-defeating behaviors. We use them occasionally and on a part-time basis with patients older than 15-16 years, including them in larger and more traditional therapies where attentive listening plays a major role. The first intervention is to encourage the patient to overtly fight, with appropriate exercises, self-defeating symptoms such as anxious ruminations. The second is to subtly challenge the patient to acknowledge the absurdity of his symptoms, for example through judicious use of humor. Both aim to put the patient back in the position of actor, by making him aware of his potential to regulate these counter-productive ways of thinking and behaviors, by triggering a reaction of healthy rebellion against them and by reactivating his creativity. The indications are discussed according to various parameters specific to the patient and clinical diagnosis. [ABSTRACT FROM AUTHOR]

Aditi, 18 years old, is hospitalized in psychiatry for eating disorders. We met her in the context of psychomotor therapy. This care, correlated with psychological, psychiatric, nursing and dietetic follow-ups, allowed this young woman to externalize her emotions and to accept a less anxious future. This article traces some of the steps of regression that were useful to Aditi in allowing herself to accept behaviors that she considered shameful. She accepts her majority and her role as a woman in a singular way, far from the paralyzing societal injunctions. The co-created therapeutic alliance is part of the transferential psychiatry where care is not only technicality but where it is elaborated around a joint adaptation and an understanding of non verbalized needs. [ABSTRACT FROM AUTHOR]

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Depuis plusieurs années, la République Démocratique du Congo est le théâtre de grèves menées par les médecins du pays. Les revendications des grévistes en question sont essentiellement financières et statutaires, et visent à faire pression sur le gouvernement. Dans ce pays, comme c’est le cas presque partout dans le monde, les grèves médicales sont autorisées. Tout travailleur a le droit de dénoncer par la grève des conditions de travail jugées inacceptables. Mais les médecins sont-ils des travailleurs comme les autres? N’ont-ils pas des obligations morales particulières liées aux spécificités de leur profession? Pour éclairer ces questions, les auteurs de cet article proposent trois repères moraux essentiels généralisables à des situations de grèves médicales ailleurs dans le monde. Le premier porte sur la reconnaissance du droit de grève pour les médecins, y compris pour des motifs strictement financiers. On ne peut demander à des professionnels de santé d’exercer leur métier dans des conditions de travail inhumaines ou sans un salaire permettant de faire vivre leur famille. Le deuxième repère estime que l’on ne peut pas accepter que ce droit de grève s’exerce en sacrifiant les patients les plus fragiles et en niant ainsi l’essence même de la profession médicale. Un troisième repère vient complexifier la réflexion en rappelant que l’extrême délabrement du système de santé congolais rend impossible l’organisation d’un service minimum de qualité en cas de grève. Pour sortir de ces difficultés, nous proposons une alliance thérapeutique nationale entre les médecins et les citoyens pour replacer les patients au centre des préoccupations du système de santé.

Addictions are invading our daily lives. Eating and body image have become major preoccupations. Anorexia nervosa and bulimia nervosa are eating disorders with a high risk of chronicity and death. Curing them and preventing their recurrence requires a solid therapeutic alliance that aims to work around individual symptoms. The low self-esteem associated with these disorders may contribute to their maintenance, despite their negative impact on quality of life. One of the challenges of treating these disorders is to help patients find the motivation to seek treatment., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

An heurisitc of the multiple therapeutic alliance's construction during the first hospitalisation of a psychotic emergent episode is developped. The proposition of a multiple therapeutic alliance model is based on empirical researchs and clinical observation. The model describes how multiple therapeutic alliance is created and maintain in four domains: adolescent/young adult, parents, family, outpatients and inpatients psychiatrics teams. The model seeks to describe the evolution of case coordination through three steps: multiple therapeutic alliance's creation during consultation andpre hospitalisation, working the multiple therapeutic alliance during hospitalization, and working with the post hospitalization multiple therapeutic alliance. [ABSTRACT FROM AUTHOR]

The author describes the reflection of the multidisciplinary group on the therapeutic alliance between health care teams and families during a first hospitalization for a psychotic episode. This therapeutic alliance emerges and develops within the framework of the "therapeutic system" constituted by the meeting of two groups: the family group and the "therapeutic team" group gathered around this singular situation, emotionally charged with a psychotic decompensation and the hospitalization of a young person. From this point of view, it is thus a question of moving from the individual logic of medicine to a group logic, from a purely medical reading to a pluriaxial reading. Then, medical knowledge and profane knowledge of the family can be expressed and articulated instead of being opposed. Finally, in this process, temporality, stages and interactivity make it possible to manage the part of diagnostic and prognostic uncertainty that characterizes these situations. This working in alliance makes it possible to avoid disruptions in care and optimizes the therapeutic capacities of the teams and preserves the future. [ABSTRACT FROM AUTHOR]

The article presents the introduction of a dossier that summarizes the questions raised by a multidisciplinary working group, working with the family during the first hospitalization for a psychotic episode. In fact, for the past four years, we have worked out, under the aegis of the French Federation of Psychiatry following a parent's letter, commission work in partnership with UNAFAM. This multidisciplinary working group brought together child and adolescent psychiatrists, adult psychiatrists, psychologists of various backgrounds and working in different care contexts, nurses, general practitioner and a regular member of UNAFAM. We are pleased to present the first results of this work initiated by Dr. Roche-Rabreau whose article appears in this dossier. We would like this work to allow the development of recommendations for good practice, such as those developed in different aspects of psychiatric practice. In the appendix, we have set out a summary of the recommendations worked out in committee, and presented during various psychiatric manifestations as well as to the French Federation of Psychiatry. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Social Work Review / Revue Canadienne de Service Social is the property of Canadian Association for Social Work Education 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.)

Résumé Le soin est indissociable de la relation de confiance et de la mobilisation de la capacité du patient à exprimer librement ses choix et de participer aux décisions le concernant, aptitude centrale dans la relation de soins. Si les objectifs d’accès aux soins et de protection des droits du patient sont clairement posés, la question de la liberté de choix du malade mental reste sujette à caution, notamment dans le contexte de la sectorisation psychiatrique. En France, les textes législatifs ne définissent pas de claire délimitation entre l’incapacité à consentir aux soins, le refus de soins et l’adhésion à ces derniers. Il revient par conséquent au médecin de déterminer dans chaque situation si le patient est en état de consentir et d’en apporter la preuve. Le consentement, valorisé par notre moderne démocratie sanitaire, est contesté par le besoin de sécurité mentale, mais conforté par la recherche d’alliance thérapeutique. La permanence d’une telle situation conflictuelle rend compte d’un affrontement entre la défense des droits de l’homme, ici et maintenant, et l’affirmation du « libre choix » de la société. We cannot separate a relationship's care based on trust from the raising of patient's ability to freely express his decisions, the core capability of health relationships. If the goals in access of care and patient's rights protection are clearly laid down, the issue about the freedom of choice of the mentally ill person is still subject to caution, particularly in the context of the psychiatric division into sectors. The French legislative texts do not specify a clear boundary about the inability to consent to the care and it is up to the doctor to approve of its validity. The consent, valued by modern sanitary democracy, is disputed by the need for mental security but is consolidated by the search for a therapeutic alliance. The permanence of a conflicting situation explains the confrontation between a defense of the human Rights, hic and nunc, and a free choice assertion by the society. [ABSTRACT FROM AUTHOR]

Résumé Les directives anticipées sont des documents écrits permettant à une personne consciente de formuler à l’avance ses demandes concernant les soins médicaux futurs, pour le cas où elle serait dans l’incapacité de donner son consentement. Les directives anticipées appliquées à la prise en charge des troubles psychiatriques revêtent des caractéristiques bien spécifiques. Proches de concepts récents tels que l’ empowerment et le rétablissement, elles permettent au patient d’exprimer ses demandes de prise en charge en cas de rechute. Elles ont pour objectif de favoriser l’implication du patient dans ses soins et valorisent son autonomie. Les directives anticipées psychiatriques constituent une intervention complexe, dont les données de la littérature reconnaissent l’intérêt, mais dont la mise en place se heurte à des obstacles pratiques. En s’appuyant sur les résultats existants, notre équipe propose un modèle de directives anticipées psychiatriques appelé Plan Souhaité d‘Organisation des Soins (Plan SOS), appliqué à la prise en charge de patients atteints de pathologies psychotiques chroniques et intégrés aux soins de secteur. Il s’inspire du Joint Cris Plan développé au Royaume-Uni et a la particularité d’associer l’équipe de soins, les proches ainsi qu’un médiateur extérieur à la prise en charge à la rédaction du document avec le patient. Actuellement développé dans le cadre d’un protocole de recherche national multicentrique, les données concernant l’efficacité clinique du Plan SOS sont à venir. Objectives Psychiatric advance directives (PAD) are written documents which are used for patients to notify in advance their preferences for psychiatric treatment for a future situation of relapse when they are unable to give their consent. It contains his or her treatment preferences for any future psychiatric emergency, when he or she may be too unwell to express clear views. The hypothesis is that such active involvement by the patient in the process of crisis planning will increase the likelihood of averting major relapse and the need for compulsory detention. Materials and methods This article reviews the current state of knowledge on use of PAD and then explains the propositions for developing a new model of PAD in France. Results Many studies show a real interest for PAD, regarding user's autonomy, therapeutic alliance and diminution of coercion. PAD may contain information about medication, symptoms, non pharmaceutical demands, name of a proxy decision maker. Different types of PAD exist, depending on the number of stakeholders involved in their completion. Despite a lot of promises, implementation of PAD remains difficult. We define the Plan SOS as a new model of PAD, inspired by the Joint Crisis Plan. It's based on the completion with the user, his medical team, his family and the presence of a facilitator, of an advance care planning. Conclusion Plan SOS is so far a research intervention and a current study is taking place to explore effect of Plans SOS on number of hospitalisations, clinical state, and therapeutic alliance. [ABSTRACT FROM AUTHOR]

Résumé L’observance du traitement antipsychotique est souvent faible. Ainsi, deux tiers des participants arrêtent le traitement dans les protocoles d’évaluation clinique en raison de problèmes de tolérance ou d’efficacité. Dans les années 1980, des études ont montré l’intérêt et les limites des méthodes alternatives au traitement antipsychotique de maintien comme le traitement intermittent ou le traitement prophylactique avec des doses minimales. Néanmoins, ces alternatives ont été largement délaissées en raison de leur efficacité relative, ce qui tend à limiter les choix thérapeutiques au maintien d’un traitement antipsychotique aux doses utilisées en phase aiguë. Cette attitude peut interférer avec la relation thérapeutique et nuire à l’appropriation du traitement par les patients. Le but de cet article est de discuter la recherche d’un dosage minimal comme méthode psychiatrique et psychothérapeutique pour améliorer l’ insight , l’observance du traitement et l’alliance thérapeutique, ainsi que de favoriser le rétablissement, la gestion autonome de la santé et la réduction des effets secondaires tout en évitant les conséquences négatives du risque de rechute. La recherche d’un dosage antipsychotique minimal reste controversée, mais repose sur des bases scientifiques telles que les notions de saillance aberrante ou de taux d’occupation des récepteurs dopaminergiques D2 et bénéficie d’un regain d’intérêt, en particulier pour les premiers épisodes psychotiques. Objectives Antipsychotic medication compliance is low. In the 1980s, studies have shown the value and limitations of alternative methods to continuous standard antipsychotic treatment as intermittent medication or low doses. However, these alternatives were largely abandoned because of their controversial efficacy. Having only one option for maintenance treatment limits treatment choices and constrains therapist's attitude toward maintenance medication at the dosage, which was necessary in the acute phase. This may cause symmetrical relationships with patients, and limits shared decision-making, working alliance and patients’ empowerment to manage medication. The purpose of this article is to discuss the search for a minimal dosage as a psychiatric and psychotherapeutic intervention to improve insight, treatment adherence and therapeutic alliance and to promote recovery, self-management of health, while reducing side effects and avoiding the negative consequences of relapse. Material and methods Development of intervention was based on a literature review focused on shared decision-making, relapse prevention and alternatives to maintenance antipsychotic medication. A clinical vignette illustrates the intervention. Results The recovery process needs patient's hope and taking his/her own responsibilities over the management of disease. This is not possible into a compliance paradigm that implies obedience to medical orders. Working alliance, which is one of the best predictors of outcome in psychotherapy, must also become a goal in psychiatric treatment. Moreover, without treatment choices, there is no room for shared decision-making for both patient and therapist. There is thus a need to shift paradigm in order to open choices for antipsychotic treatment beyond continuous maintenance at standard dosage. A new paradigm may be based on several rational arguments. First, a different conception of relapse is necessary. Linear vision of recovery does not match the experience of individuals: knowledge and mastery of disorders often go through the experience of relapse. While relapses may indeed have harmful consequences when they lead the person into a vicious circle of failure, trauma and rejection of treatment, a well-controlled relapse before a full psychotic episode may be an opportunity to know more about the early signs and management of the disorder in a virtuous circle. Second, recommendations of maintenance treatment for several years are based RCTs, which are limited by on short-term follow-up and high rates of discontinuation due to both efficacy and tolerability problems. Third, several studies showed that patients receiving half standard dosage (about 300 mg EQ CPZ) had no more relapse, less side effects, and better social outcomes. Forth, even if maintenance treatment is the best way to prevent relapse for most individuals, the burden of this treatment remains high for individuals. There is therefore a need to detect those who could remain stable with low dosage, very low prophylactic dosage, intermittent treatment or without treatment. A recent meta-analysis shows that relapse is 2.5 times more frequent in the intermittent treatment with respect to continuous treatment. The discontinuous treatment may also cause sensitization and increase the risk of tardive dyskinesia. These observations led in general not to propose alternatives to continuous treatment in clinical recommendations. However, intermittent treatment remains significantly more effective than placebo, with three times fewer relapses at medium-term. The population of people diagnosed as having schizophrenia is heterogeneous and in some studies, 20%–40% of patients could benefit from a full stop of medication without relapse. In early psychosis, intermittent treatment can detect 20% of patients who can stop the antipsychotic treatment without relapse. Even for those who relapse, the process could have a long-term positive effect on social functioning. Patient adherence to treatment was also higher during intermittent therapy, and the cumulative dose of antipsychotic lower. At last, neuroscience issues such as aberrant salience and dopamine D(2) receptor occupancy give a biological theoretical background to the search of an optimal dosage of antipsychotics. Finally, the therapeutic relationship should go beyond mere prescription of drug, when some patients and therapists confuse “withdrawal of antipsychotic medication” with “discontinuation of treatment”. On the contrary, in view of the search of a minimal dosage, the desire to stop antipsychotic treatment is rather a psychotherapeutic opportunity to develop insight, the ability to identify early signs relapse and to enhance working alliance in a shared decision-making process. Conclusions The search for a minimal dosage of antipsychotics in psychosis remains controversial but feasible, scientifically sound and especially recommended for first-episode psychosis. It assumes that the doses needed for prevention of relapse are lower than in the treatment of an acute episode. Process should be considered with caution and at a slow pace, particularly when the desired dosage reaches 300 mg CPZ EQ or leads to a complete interruption of treatment. The counter-indications include non-stabilized symptoms, dangerousness, a history of severe social consequences or a lack of cooperation with the patient and relatives. The potential consequences of relapse must be carefully examined with the person and family. A short delay between the early signs and full psychotic episode is a relative contraindication, especially if previous episodes have significant risks for the person or to others or had serious social consequences. Further studies should determine more precisely who could benefit from such an approach beyond first psychotic episode, in order to offer other choices to individuals than stopping medication against their therapist's advice. [ABSTRACT FROM AUTHOR]

Résumé Dans le monde anglo-saxon, de nombreuses formations supérieures en psychologie ont été pensées et conçues sur le mode de la réflexion-en-action. La mise en pratique vient alors rapidement étayer le développement des capacités réflexives des futurs professionnels. Les travaux autour des facteurs communs en psychothérapie ont mis en évidence l’importance de la dimension relationnelle entre patient et psychothérapeute, et notamment de l’alliance thérapeutique comme ingrédient majeur du processus de changement. La réflexion-en-action est ici envisagée pour permettre aux psychothérapeutes de développer leurs capacités à identifier les ruptures de l’alliance thérapeutique, et à aider le patient à en faire sens. Ces ruptures d’alliance peuvent précipiter l’abandon ou l’impasse thérapeutique. Toutefois, identifiées et utilisées d’une manière pertinente, elles sont susceptibles de favoriser l’ insight et le changement chez le patient. Alors, quel modèle de formation envisager pour étayer la réflexivité des psychothérapeutes, et favoriser le développement des postures et des interventions relationnelles pertinentes en psychothérapie ? In the Anglo-Saxon world, many higher education programs in psychology have been designed and developed on the mode of reflection-in-action. Practice quickly supports the development of reflective abilities of future professionals. Work on common factors in psychotherapy have highlighted the importance of the relational dimension between patient and psychotherapist, including therapeutic alliance as a major ingredient in the change process. Reflection-in-action is here considered to allow psychotherapists to develop their capacity to identify ruptures of the therapeutic alliance, and to help the patient make sense with them. These alliance ruptures can precipitate abandonment or therapeutic impasse. However, identified and used in a relevant way, they are likely to promote insight and change in the patient. What training model should be then considered to support psychotherapists’ reflexivity, and to promote the development of relevant postures and relational interventions in psychotherapy? [ABSTRACT FROM AUTHOR]

The REVHEPAT network designed an outpatient therapeutic education program (TEP) for patients with chronic hepatitis B and or C to optimize their care pathway. This program is part of the 3 stages of the life of the patient and his relatives before, during and after the treatment, on the basis of collective workshop. This is an innovative approach to chronic liver disease with 562 patients. The collective workshop is a space to understand the subjective experience of illness. It allows resorting to listening, what is seen and felt to overcome the difficulties in communicating about the disease and combining the complex and the intimate. The therapeutic alliance is improved thanks to a newposture of caregivers increasing their knowledge (do/be), for better prevention. The coordination of actions between therapeutic hepatologist and the general practitioner or care structure is reinforced by the TEP team. The collective workshop brings added value to patients. It is a real level that patients can seize to take care of their health, learning how to act on comorbidities and associated risk factors. Thereby, 69 collective workshops have been conducted in 2015. It is a key and a supportive 'tool' with a collective dimension at the person's service (not only focused on the liver). [ABSTRACT FROM AUTHOR]

Only 11 per cent of chronically sick adolescents have a good adherence at all aspects of their treatment. What sense takes the medication for the adolescent? What meanings can have certain behaviors of young people about their treatment? What role for parents in the prescription to the adolescent? In these issues, which place for the child psychiatrist? Especially in adolescence, adherence refers to paradoxical attitudes that are a consequence of the complex issues of mental maturation at this age. The therapeutic alliance, with both the adolescent and his parents, seems to be a prerequisite for good adherence, which is always a compromise between medical logic and logic of the subject. Situations of rupture and adherence or, conversely, of excessive adherence, should always alert and it is important to decode the meaning of these behaviors. Rather than seeking the perfect observance, it is preferred the establishment of a care relationship in which the adherence can be addressed calmly and openly with both the adolescent and his parents. [ABSTRACT FROM AUTHOR]

Résumé Le recueil sémiologique en psychiatrie nécessite : un cadre conceptuel dans lequel les termes sémiologiques sont recueillis et organisés d’une manière cohérente et une pratique clinique permettant d’acquérir les compétences nécessaires au cours de l’entretien avec un patient. Les symptômes concernent différentes dimensions de l’expérience vécue et des conduites du patient. Les symptômes sont donc particulièrement liés à la situation dans laquelle le sujet vit. Ainsi le médecin, pour recueillir ces symptômes, devra s’intéresser de manière attentive à cette situation de vie afin de recueillir une sémiologie valide. Cet intérêt et attention ne s’improvisent pas. Un ensemble de compétences relationnelles sont nécessaires au cours de l’entretien afin d’obtenir la confiance du sujet. La mise en confiance du patient passera par un processus appelé « engagement ». Ce processus d’engagement conduit à ce qui est traditionnellement appelé une alliance (qui est donc le résultat du processus d’engagement). Afin de réussir le processus d’engagement, le médecin devra essayer de répondre à quatre questions que le patient pourrait se poser : ce médecin me comprend-il ? Ce médecin me juge-t-il ? Ce médecin est-il sympathique ? Ce médecin est-il compétent ? À chacune de ces questions correspond une compétence relationnelle de la part du médecin : l’empathie, le sentiment de sécurité, l’authenticité, la compétence. Cet article présentera ces quatre éléments dans le cadre d’un modèle médical pratique permettant un recueil sémiologique valide. The semiologic collection requires in psychiatry: a conceptual framework in which the semiologic terms are collected and organized in a consistent way and a clinical practice to acquire the necessary skills during the interview with a patient. Symptoms affect different dimensions of the patient's experience and behavior. The symptoms are particularly associated with the situation in which the subject lives. Thus, to collect valid symptoms, the physician should be attentively interested to this situation of life. This interest cannot be improvised. A set of interpersonal skills is required during the interview to obtain the confidence of the subject. The building of patient confidence is a process called “engagement”. This engagement process leads to what is traditionally called an alliance (which is the result of the engagement process). In order to succeed the engagement process, the physician will try to answer 4 questions that the patient might ask: does this doctor understand me? Does this doctor judge me? Is this doctor friendly? Is this doctor competent? Each of these issues is a relational competence of the physician: empathy, sense of security, authenticity, and competence. This article will introduce these four elements as part of a practical medical model to a valid semiologic psychiatric collection. [ABSTRACT FROM AUTHOR]

Résumé Principalement abordés sous l’angle médical et physiologique, les traitements de l’obésité et l’embonpoint ne permettent pas de faire état de toute la complexité de ces problématiques. Les recherches dans le domaine de la perte de poids ont montré une relation significative entre l’obésité et certaines variables psychologiques. Ces facteurs psychologiques, dont le lien avec l’obésité et l’influence sur la perte de poids ont été démontrés, semblent être liés à l’alliance thérapeutique, une variable très étudiée dans les recherches portant sur le processus et les résultats thérapeutiques. Dans le domaine des traitements pour la perte de poids, peu d’études ont porté sur cette question. Au moyen de modélisation par équations structurelles multiniveau (MESM), la présente étude a examiné les changements dans l’interaction entre l’alliance thérapeutique, l’état de préparation psychologique et le poids. L’étude a été conduite auprès de 105 sujets âgés de 20 à 65 ans avec un indice de masse corporelle (IMC) d’au moins 25 kg/m 2 . Les résultats indiquent que l’alliance thérapeutique agit sur la perte de poids à travers des effets interactifs, alors que le changement de l’état de préparation psychologique prédit la perte de poids. Les limites et les contributions de cette recherche sont discutées. Objectives The study of factors involved in the process of weight loss is of great interest to researchers. Specialists in the domain of weight management encourage the reduction of calorie intake by the change of eating habits, physical exercise and in certain cases of morbid obesity, by bariatric surgery. Most often the treatment of weight loss is perceived and addressed mainly from the medical and physiological perspective; obesity and overweight are considered in terms of surplus fat that may increase the risk of harmful health consequences. However, considering the problem of excessive weight and its treatment as only a biological issue fails to grasp the complexity of the issues. Research in the field of obesity has shown a significant relationship between obesity and psychological difficulties. These psychological factors appear to be related to a variable that has been extensively studied in research on psychotherapy process and outcome, namely the therapeutic alliance. However, in the field of weight management, few studies have addressed this issue. Thus, the present study aimed to investigate the interaction between development of the therapeutic alliance over the course of weight loss treatment, along with changes in psychological variables and weight loss. Method The study was conducted among 105 subjects aged between 20 and 65 years (42.94 ± 12.17 years) with a Body Mass Index (BMI) of at least 25 kg/m 2 (31.83 ± 5.44 kg/m 2 ). The French version of the shortened Working Alliance Inventory (WAI) and the Larocque Obesity Questionnaire (LOQ) are the main measuring instruments. Their administration was carried out online after each consultation for the WAI and just before the meeting with the doctor for the LOQ. Results Multilevel structural equation modeling indicated the importance of studying the complex interaction between the therapeutic alliance and psychological variables in the treatment of overweight. Specifically, the results showed that changes in psychological readiness predicted weight loss. However, contrary to predictions the therapeutic alliance did not directly predict improvement in psychological readiness, or weight loss. Therapeutic alliance seemed to act more on weight loss in interaction with psychological readiness. Conclusions These results shed new light on the treatment of obesity and overweight. They pave the way for treatments directed more towards the process of treatment for obesity rather than the simple result of losing the excessive weight through biological means (i.e. diet and exercise prescriptions). They suggest the importance of developing interventions aimed at improving the psychological readiness of patients since lack of readiness could jeopardize the patient's achievement of their objectives. Finally, the results of this study support the need to deepen our understanding of the role of the therapeutic alliance in the treatment of obesity and overweight, since it is strongly and significantly related to psychological variables predicting weight loss. [ABSTRACT FROM AUTHOR]

Résumé La thérapie interpersonnelle est une thérapie brève, limitée dans le temps, développée à la fin des années 1970 et présentée dans un manuel en 1984 par G. Klerman. Elle a fait l’objet de nombreuses validations et elle se trouve dans les recommandations internationales en tant que traitement actif de la dépression. Pourtant, elle reste peu connue. L’une des raisons de cette diffusion limitée pourrait être en lien avec ce manuel qui semble surtout adapté à la recherche. De même, la théorie de l’attachement, qui représente la base conceptuelle de référence pour la thérapie interpersonnelle, n’est pas abordée au niveau du processus thérapeutique. Or, plusieurs études ont démontré que les styles d’attachement sécures expliquent en grande partie la qualité des relations interpersonnelles et le bien-être psychologique que les individus en retirent. En outre, l’attachement est de plus en plus présent dans des approches différentes, aussi bien longues que brèves, dans la mesure où il ouvre des perspectives thérapeutiques très prometteuses. L’objectif de cet article consiste à expliquer en quoi l’intégration du concept bowlbien à la thérapie interpersonnelle classique apporte un éclairage permettant de mieux appréhender les décompensations dépressives en lien avec les dysfonctions interpersonnelles. Dans cette optique, nous proposons de présenter notre modèle basé sur l’attachement comportant une articulation psychopathologique et clinique ainsi qu’une régulation émotionnelle interpersonnelle comme levier thérapeutique. Interpersonal therapy is a time-limited brief therapy, developed in the late 1970s and manualized in 1984 by G. Klerman and his collaborators. Although recognized as one of the theoretical foundations of interpersonal therapy, attachment theory has been under-exploited in practice. The aim of this paper is to present our model based on attachment theory with a psychopathological, clinical and therapeutic integration in line with the needs of a brief approach. Our model relies on the hypothesis that an insecure attachment style is a risk factor for psychiatric disorders. Indeed, Bowlby's model enables for a better understanding of these relationships and proposes a therapeutic approach based on the patient's attachment needs. In practice, the therapy is structured over a period of 12 to 16 weekly sessions. Our contribution to classical interpersonal therapy, during the initial phase, is the evaluation of the patient's attachment style by reviewing the early experiences of attachment, interpersonal and romantic attachment. In parallel, we review all the depressive symptoms and explore life events surrounding their onset in order to identify the interpersonal problem area on which will focus the therapy: Grief, interpersonal disputes, and role transition. In our approach, interpersonal disputes are explored through emotionally charged incidents in connection with avoidance and anxiety dimensions assessed with the Experience in Close Relationships Scale. During the intermediate phase, therapeutic work is to solve the patient's interpersonal problem by helping him to re-evaluate his expectations in terms of attachment through a number of techniques. These are focused on a therapeutic relationship as a secure base, interpersonal emotional regulation and interactional regulation. The final phase closes the therapy and helps the patient to review his progress and to plan the future. It is important to prepare the end of the therapy with the patient, as it can be experienced as abandonment, especially for those with an anxious attachment style. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Cette étude vise à évaluer le rôle du thérapeute dans la remédiation cognitive assistée par ordinateur (RCAO) auprès des personnes souffrant de troubles de l’humeur. Méthodes Nous avons réalisé une étude prospective, contrôlée et randomisée en deux groupes auprès de 34 patients ayant vécu des épisodes dépressifs récurrents, dont un épisode aigu dans les 6 mois précédant l’étude. Les 34 patients ont bénéficié de 7 semaines de RCAO comportant 4 séances hebdomadaires. Parmi eux, un groupe a été accompagné individuellement par un thérapeute à l’hôpital une fois par semaine tandis que le second groupe a reçu un mail d’informations concernant les stratégies cognitives à utiliser dans la RCAO. Afin d’évaluer l’impact de l’accompagnement par un thérapeute dans la RCAO, des évaluations avant et après traitement ont été effectuées. Un taux d’abandon important a eu lieu dans le groupe témoin et témoigne de la nécessité de l’accompagnement thérapeutique pour permettre au patient d’être compliant. Résultats Cette étude est en cours et les résultats quantitatifs ne sont pas encore disponibles. Néanmoins, des résultats préliminaires issus de l’analyse des entretiens post-traitement mettent en évidence des différences entre les groupes. Les patients du groupe thérapeute soulignent l’importance de l’alliance thérapeutique pour la réussite du traitement. Dans le groupe témoin, les résultats sont plus contrastés : les sujets n’ayant pas abandonné témoignent d’une motivation intrinsèque importante et d’un bon niveau de métacognition tandis que certains sujets font part de la difficulté à investir l’outil informatique, à rester motivés et à utiliser les stratégies développées dans leur vie quotidienne. Conclusion Cette expérimentation montre que la RCAO nécessite que le patient s’engage véritablement dans une relation avec l’ordinateur. L’inclusion du numérique dans le soin, s’il présente de nombreux avantages, ne va pas pour autant de soi. Elle requiert une évolution du cadre thérapeutique due à l’implication du tiers numérique : le patient doit pouvoir développer sa confiance dans l’ordinateur et le thérapeute penser une place nouvelle dans cette forme de psychothérapie au sein de laquelle l’établissement d’une alliance thérapeutique efficiente, la motivation au changement et le développement de la métacognition constituent des facteurs indispensables pour la réussite du traitement. Summary Objectives This study aims to evaluate the role of the therapist in the computer-assisted cognitive remediation (CACR) of people with mood disorders. Methods We conducted a prospective, controlled, randomized study in two groups with 34 patients who experienced recurrent depressive episodes, including an episode in the 6 months preceding the study. The 34 patients did 7 weeks of CACR with 4 weekly sessions. Among them, one group was accompanied by a therapist individually to the hospital once a week while the second group received mail information about cognitive strategies to use in CACR. To assess the impact of the support by a therapist in the CACR, evaluations before and after treatment were performed. A significant dropout rate occurred in the control group and demonstrates the need for therapeutic support to enable the patient to be compliant. Results This study is ongoing and the quantitative results are not yet available. However, preliminary results from the analysis of post-treatment interviews highlight the differences between the groups. Patients in the group with a therapist emphasize the importance of the therapeutic alliance for successful treatment. In the control group, the results are more mixed: the subjects who did not give up show evidence of a significant intrinsic motivation and a good level of metacognition while some subjects testify about the difficulty in investing the computer tool, in staying motivated and using the strategies in their daily lives. Conclusion This study shows that the CACR requires that the patient is truly committed to a relationship with the computer. The inclusion of digital technology in the care, if it has many advantages, is not self-evident… It requires a change in the therapeutic setting due to the involvement of the digital third party: the patient must be able to develop confidence in the computer and the therapist must rethink a new place for himself in this form of psychotherapy where the establishment of an efficient treatment alliance, the motivation to change and the development of metacognition are essential factors for the success of the treatment. [ABSTRACT FROM AUTHOR]

In the child psychiatry hospital setting, educational approaches and the therapeutic alliance are fundamental principles on which professionals rely on a daily basis. Therapeutic acts, including the administration of psychotropic drugs, are carried out in a specific care area. What about the child's or adolescent's compliance with medication outside this setting? A booklet dedicated to psychotropic treatments, intended for patients and their relatives, has been designed with an informative objective., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: Therapeutic alliance represents a rarely studied object when it relates to nurses and care provided by a nursing team in acute care hospitalization., Objective: The objective was to study how factors might influence the therapeutic alliance built between nurses and aides and adult inpatients in an acute care unit of sectorial general psychiatry., Method: This is a prospective, observational and cross-sectional study using a therapeutic alliance measurement scale. Therapeutic alliance (TA) score was measured with a STAR-P scale in a sample of 240 patients., Results: The median score found is 33.4 (±7.8) out of a maximum theoretical score of 48. The global score of TA in patients aged 60 years old or more is significantly higher than the score of patients between 18 and 29 years old ( p =0.021). The lack of external follow-up in the three months after hospital release is not associated with TA global score ( p =0.73). If inpatients, no matter what their diseases or types of care are, under legal obligation or not, consider their TA is rather good after their hospital stay. Only sociodemographic factors like age, housing conditions (insecure or sustainable), having a job or not, living alone or with a partner affect TA and follow-up., Conclusion: Results evoke concepts of anomie and attachment, that seem to play an important role in the lack of follow-up after hospital stay, and indicate the mandatory global approach to care and an involvement of health professionals as well as social beings, where empathy must find its place.

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Copyright of Obésité is the property of Lavoisier 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.)

Abstract: The therapeutic alliance defines the mutual collaboration, a partnership, between the patient and the therapist with the aim of achieving the fixed objectives. This concept originated in psychoanalysis, and gave rise to intense debates. We propose a synthesis of these debates, since the first intuitions of Freud until the concept of intersubjectivity. This allows to update the arguments of a question which is not finally cut, but which finds however a way of expression in the researches concerning the analytical brief therapies. Indeed, the confrontation of idea essentially carried around the fact of knowing if the notion of therapeutic alliance was antinomic of the concept of transference. And if it was not, how it was possible to integrate it into analytical follow-ups (in premises or in complementarity with an analysis of transference movements). The question is not concluded, but if we consider that although it arrives, a certain collaboration is established between the patient and his therapist, then an analysis of this collaboration via the notion of therapeutic alliance is possible and can offer a glance on the relational dynamics independently of the question of the analysis of transference. It is this verse which the current researches around the therapeutic alliance from analytical follow-ups. [Copyright &y& Elsevier]

Copyright of Lettre de Medecine Physique et de Readaptation is the property of Springer Nature 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.)

Abstract: In this article we will present our early detection local program of autism and invasive developmental disorders. It is to detect and evaluate children under the age of three, in order to propose proper treatment as quickly as possible. First of all we will present the different aspects of the program working within a network. On one side the collaboration with different structures such as the maternal and infant protection (PMI) and on the other the collaboration with institutions that will specifically take care of these children. The proper evaluation will be then explained and our methods will be further detailed. Secondly, we will share our clinical studies stemmed from our experience and will then consider diagnosis announcement, alliance and therapeutic process. This will then be followed by case studies that will highlight the therapeutic dimension, which already seems to exist in this evaluation phase. [Copyright &y& Elsevier]

Abstract: The ethical questions involved in the treatment of patients who have attempted suicide will be addressed here on the basis of two contradictory positions, which appear in codes of deontology. On one hand, we find individual freedom and protection of the person; on the other, professional secret and shared secret. The reflection, developed along the lines of psychoanalytical theory, is enriched by contributions from crisis management. It is illustrated by means of clinical situations taken from clinical practice in the domain of suicide prevention. What is revealed is the fact that suicide does not correspond, in the case of our patients, to the exercise of freedom and as a consequence, it requires us to intervene. Suicide attempts are often associated with pathologies in which we can find a life history marked by separations, abandonments and trauma, corresponding to a failure of the environment which the treatment must be careful not to reproduce. This implies that, between the contradictory terms evoked above, we make the choice of protection of the person and of shared secret. As concerns the analytically based psychotherapeutic framework, the guidelines of traditional neutrality for the analyst, whose value remains complete, must be redefined toward a more interventionist counter-transferential position. [Copyright &y& Elsevier]

Abstract: Objectives: Psychoeducation contains the risk of a misunderstanding in the effective experiences of recognition. We want to show that group psychotherapy can be a means to reconcile recommendations in disease prevention aimed by psychoeducative measures, the vivid and lively dimension of experience found in phenomenological attitudes and aspects, turned to the community world of therapeutic mediation. Method: To articulate these various domains, we approach the principles of psychoeducation, the risks which this one can contain and the contributions of clinical phenomenology. Phenomenological method is different from what we call collectively clinical intuition which is always implicitly colored by the typical contexts of meanings of what appears (meanings which have a practical and effective reach for example) and stay, in spite of the critical distance which we can put it, stuffed with various emotional and theoretical predicates muddled between them. The phenomenological attitude aims as much as possible to a suspension of these predicates, that these predicates arise from the common sense of everyday life or that they arise from a detailed specialized knowledge, and this to remove the “coats of sense” which settled on the perception. Results: The group, by its multiple interactions, aims at an optimization of the articulation of the self-relationship with relationship socially adapted to the others. The therapist constantly has to attend to dialectical dynamics which reigns between a certain self-dissolution in the group and a return to oneself from the meshing which build up itself within the group. For certain patients, it is particularly difficult to maintain a just balance between the two moments of identity, the one which is peculiar to oneself and the one which emanates from relations with the others towards which we are normally constantly turned. The interest of this psychotherapeutic work in group is here to offer to each of participants the possibility of holding, with a little more confindence, an existential position within a meshing of social links, that is a capacity to seize oneself as existing among the other beings having themselves an own existence. From there, the subjective capacities of each can be better recognized, what can also give place to adjustment of these capacities with individual aspirations. The active implication of patients, so looked for by psychoeducation, is all the more tangible as we were so able to appeal, by the phenomenological attitude, to what feels immediately and without distance as much in an intimate self-relation as in relationship to the others. Conclusions: Phenomenological attitude allows not to get stuck in imaginary expert skills, in rational projects of organization and other methodical constructions of the science. This attitude is particularly interesting for group psychotherapy which privileges the opening rather than a work of elaboration. The stake is so the authenticity of a real therapeutic alliance based on fine regulations of the global situation of co-presence taking into account the interlacing of the implicit and the explicit in the exchanges which weave with the patients. We privilege a fertile step rather than rigorous observance of a method which would lead only to a systematization against the spirit of phenomenology. The clinical experience shows that this psychotherapeutic method allows in particular a regular attendance of the group, what is one of major ingredients of its efficiency. [Copyright &y& Elsevier]