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La diversité des approches théoriques et des techniques en psychothérapie est une richesse, mais elle peut parfois entraver l'élaboration d'une réflexion commune sur les psychothérapies et leur efficacité. L'objectif de cet article est de montrer que la notion d'alliance thérapeutique permet une compréhension intégrative du processus de soin psychique. Nous proposons une revue narrative sur l'alliance thérapeutique incluant la diversité des théories et des pratiques thérapeutiques. Nous prenons appui sur le modèle contextuel de Wampold (2001) et le modèle d'alliance thérapeutique proposé par Bordin en 1979. Les études que nous présentons portent principalement sur des psychothérapies individuelles auprès d'adultes, et sont majoritairement issues de la littérature internationale des cinquante dernières années. Nous explorons les implications épistémologiques et pratiques de ces études. Un pan de la recherche explore les liens entre alliance et résultats thérapeutiques, tandis qu'un autre explore l'alliance comme processus thérapeutique en soi. L'approche contextuelle et le modèle d'alliance permettent de proposer une définition de la psychothérapie qui est commune aux différents courants de pratique et offrent un cadre pour prodiguer des soins psychiques de qualité. Psychotherapy is an immensely diverse field of practice, in which multiple models and protocols coexist. This diversity can be an asset but can sometimes hinder the path toward a common understanding of what works in psychotherapy. The aim of this article is to show that the therapeutic alliance construct can provide an integrative frame of reference when it comes to understanding the psychotherapeutic process. This narrative review of the therapeutic alliance concept embraces the diversity of theories and practices in psychotherapy. We draw on the contextual model (Wampold, 2001) and the therapeutic alliance model (Bordin, 1979). The reviewed studies mainly focus on individual psychotherapy for adult patients and are drawn from the international literature over the past fifty years. We explore the epistemological and practical implications of these studies. One part of the research explores the links between alliance and psychotherapy outcomes, while another explores alliance as a therapeutic process. The contextual approach and the alliance model can be used to provide a definition of psychotherapy that is common to different schools of thought. These concepts offer a framework for quality psychological care. [ABSTRACT FROM AUTHOR]

Les exilés ont souvent vécu de multiples traumatismes et lorsqu'ils arrivent en France, ils restent en général dans une situation sociale précaire avec un certain nomadisme et un isolement important. L'offre de soins existante pour la santé mentale du public exilé n'est malheureusement pas suffisante actuellement ; aussi, multiplier les moyens et innover dans les prises en charge permettrait de soulager la pression de la demande. La présentation de l'État de Stress Post-Traumatique (ESPT) chez ce public est très fréquemment somatique, avec une errance diagnostique initiale fréquente. À travers trois vignettes cliniques, nous pouvons observer que le médecin généraliste formé, en tant que médecin de premier recours, peut déjà rétablir un lien de confiance qui est souvent rompu, redonner un certain sentiment de sécurité et apporter du soutien, ce qui est la base du soin dans le psychotrauma chez ces patients souvent déshumanisés, isolés et loin de leur environnement soutenant culturel. Il est possible pour le médecin de dépister, orienter, et prendre en charge selon ses compétences ces psychotraumatismes en étant une personne ressource et en utilisant une méthode complémentariste, tout en prenant en compte l'ensemble des symptômes présentés par les patients. Prendre en charge l'ESPT en situation transculturelle nécessite un décentrage indispensable et une prise en charge globale du patient, afin d'obtenir une alliance thérapeutique nécessaire à la qualité des soins. Or le travail en médecine générale est déjà dans cette démarche de raisonnement. Enfin, la continuité des soins dans la durée permet d'éviter les ruptures de soins qui peuvent alors être traumatogènes pour ces patients. Le travail du médecin généraliste permettra alors d'améliorer l'accès aux soins psychiques des exilés et développer des structures spécialisées dans le psychotrauma des personnes migrantes, tout en innovant dans la prise en charge. Exiles have often experienced multiple traumas, and when they arrive in France, they generally find themselves in precarious social situations, often with a certain level of nomadism and significant isolation. Unfortunately, the existing mental health care services available for exiles are currently inadequate, and more resources and innovative approaches to providing care would help alleviate the pressure of demand. The presentation of Post-Traumatic Stress Disorder (PTSD) in this population is often somatic, with frequent initial misdiagnoses. Through the study of three clinical vignettes, we are able to substantiate that a trained general practitioner, as the primary care physician, can readily establish a bond of trust that has often been broken, restore a sense of security, and provide support, which is at the core of trauma care for these patients who are often dehumanized and isolated, far from their supportive cultural environment. The general practitioner can screen, refer, and manage these psycho-traumas according to their competence, serving as a resource person and using a complementary approach while taking into account all the symptoms presented by the patients. Addressing PTSD in a transcultural context requires essential decentralization and comprehensive patient care to establish a therapeutic alliance necessary for quality care. This approach is increasingly being used in general medical practice. Additionally, the continuity of care over time helps prevent breaks in treatment, which can be traumatic for these patients. The treatment provided by the general practitioner will help to improve access to mental healthcare for refugees and to develop structures specialized in treating psychotrauma in migrant populations, while at the same time being innovative in patient care. [ABSTRACT FROM AUTHOR]

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]

The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow‐up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry. [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]

Le concept d'injustice épistémique s'intéresse à la manière dont la capacité d'un sujet à produire du savoir peut être déniée ou minorée. Nous nous proposons ici d'étudier son intérêt en psychiatrie, de la pratique clinique à la nosographie. Après avoir défini les principales injustices épistémiques, nous étudions leur application à la relation médecin-malade. Nous cherchons enfin à comprendre quel pourrait être l'apport de ce concept dans la clinique psychiatrique mais aussi dans la classification des troubles mentaux. Les patients souffrant de troubles mentaux sont particulièrement vulnérables aux injustices épistémiques. Des facteurs prédisposants peuvent être identifiés, certains communs à tous les troubles psychiatriques, d'autres spécifiques à chaque pathologie. Les classifications en psychiatrie reflètent aussi l'existence d'un déséquilibre épistémique entre usagers et communauté scientifique. L'inclusion des usagers dans l'élaboration de la nosographie est de plus en plus consensuelle, car elle pourrait permettre d'améliorer leur validité, avec un impact sur la pratique clinique, sur les questions de stigmatisation ou encore le financement de la recherche. La notion d'injustice épistémique pourrait constituer un cadre conceptuel pour mettre en évidence les situations dans lesquels le discours du patient n'est pas suffisamment pris en compte alors qu'il constitue un savoir pertinent. Il nous semble donc utile dans une approche intégrative visant à mieux articuler savoirs médical et expérientiel, sous réserve du développement d'outils pour mieux recueillir ce savoir expérientiel. The concept of epistemic injustice was developed in 2007 by Miranda Fricker. It designates a specific category of prejudices, where the subject's capacity to produce knowledge is denied or undermined. Several authors have applied this concept to the field of health and argue that people with a medical condition are more vulnerable to epistemic injustices than healthy people. In psychiatry, some authors believe that patients are even more vulnerable to such injustices in clinical practice than patients of other specialties. Some others identify certain forms of epistemic injustice in the classifications of mental disorders, and postulate that it could lead to epistemic losses in classifications, diagnoses and care. In France, this concept is relatively unexplored in psychiatry. The aim of this paper is to identify and summarize the potential contributions of the concept in psychiatry, from the clinical practices to the definition of mental disorders. First, we will define the main types of epistemic injustice described by Fricker. We will then see how these injustices can occur in the field of health. Finally, we will study why patients with a mental disorder are particularly affected by these injustices, the potential impact on psychiatric nosography and the ways to address these epistemic injustices. There are two types of epistemic injustice. In testimonial injustices, a person's speech is unwittingly considered to be of little or no credibility by his interlocutor, because of negative prejudices against him or his community. Hermeneutic injustice occurs when a person fails to convey their experience, due to a lack of hermeneutical resources to interpret and communicate it. In healthcare, the credibility of the patient's testimony can be diminished by several factors and general prejudices. Additionally, there is a lack of interpretive resources to understand and share many aspects of the experience of illness. In addition to this, the epistemic privilege accorded to healthcare professionals, particularly physicians, leads to accentuating the epistemic imbalance. The type of doctor-patient relationship, and its evolution, also impact the respective epistemic positions. In psychiatry, patients are seen as more vulnerable to epistemic injustices. Crichton thus identifies three common factors to all mental disorders, including a general prejudice of irrationality and unreliability. In addition, each pathology has specific factors exposing patients to a weakening of their epistemic capacity. To correct these injustices, several tools have been proposed, such as including the study of epistemic injustice in physician's training or using a phenomenological toolbox. Anke Bueter also suggested the existence of a specific form of testimonial injustice in psychiatric classifications, known as "pre-emptive", which excludes the possibility for ill people and their relatives to testify. However, taking these testimonies into account could act as a corrective mean in the construction of nosography. This nosography is indeed based, in psychiatry, on value judgments, due to the lack of objective data. Several authors, including Bueter, therefore call for a better integration of users in the revisions of classifications, to improve their validity. This could have implications for the clinic, research and its funding, and other issues such as stigmatization. However, how exactly the users' point of view could be integrated still needs to be defined. Several proposals have been found in the literature. We consider that the concept of epistemic injustice is a useful tool towards a better articulation between experiential and medical knowledges. In clinical practice, if the clinician is trained in this concept, he will be able to identify situations at risk of epistemic injustice, attempt to neutralize this imbalance and thus carry out a more exhaustive clinical examination and more appropriate care for the patient. Regarding nosography, strengthening the epistemic position of users and integrating their knowledge could improve the validity of classifications. The question of the validity of psychiatric nosography is a problem that the scientific community has faced for a long time, and it therefore seems interesting to continue this reflection through the concept of Fricker. In both cases, it is necessary to continue developing tools to better define, analyze and integrate this experiential knowledge. [ABSTRACT FROM AUTHOR]

Le dévoilement de soi par les professionnels de la santé est une pratique courante, bien que controversée quant au moment opportun, à l'étendue et au contenu des informations partagées et aux conséquences cliniques. Cette étude qualitative vise à enquêter sur de dévoilement de soi chez les professionnels de la santé et du monde socioéducatif. Treize entretiens approfondis avec les animateurs d'une intervention pour améliorer le plaisir et la motivation dans la schizophrénie. Les entretiens ont fait l'objet d'une analyse thématique. Les professionnels décrivent leurs dévoilements comme un partage authentique d'expériences vécues. Du point de vue du contenu, les professionnels sélectionnent des événements simples de leur vie personnelle ou professionnelle, qu'ils trouvent faciles à partager avec les patients, en groupe. Les critères de sélection de ces expériences concernent principalement la valeur thérapeutique et sont formulés en termes de pertinence du contenu et de l'utilité envisagée pour le patient ainsi que d'authenticité. La révélation de soi génère une redéfinition des places dans l'interaction conduisant à une relation plus égalitaire. Le dévoilement de soi s'avère être un outil pour développer et maintenir la relation thérapeutique. De plus amples études sur le phénomène seraient utiles pour concevoir la formation des professionnels. Health professionals' self-disclosure is a common practice, but there is still controversy regarding when it is appropriate, what the extent and content of self-disclosure should be, and what the clinical consequences are. This qualitative study aimed to investigate self-disclosure in health and social-care professionals. Thirteen in-depth interviews with group leaders of an intervention to improve pleasure and motivation in schizophrenia. The interviews were subjected to thematic analysis. Professionals describe their personal disclosures as authentic sharing of lived experiences. From a content point of view, professionals select simple events from their personal or professional life, which they find easy to share with patients, in a group. The selection criteria for these experiences mainly concern the therapeutic value and are formulated in terms of relevance of the content and the usefulness envisioned for the patient as well as authenticity. Self-disclosure generates a redefinition of the places in interaction and a more egalitarian relationship. Self-disclosure is found to be a tool for developing and maintaining the therapeutic relationship. Further studies of the phenomenon would be useful to design training and supervision for professionals. [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]

Dans le monde, les technologies sont de plus en plus utilisées en psychothérapies, et plus largement dans le domaine de la santé mentale. Parmi ces technologies, les jeux vidéo et les robots ont donnée lieu à un grand nombre de recherches. Pour autant, ces études ne décrivent pas précisément : d'une part, les modalités d'utilisation de ces technologies dans les dispositifs en psychothérapie ; d'autre part, quel niveau de fonctionnement en psychothérapie (explicite ou implicite) est concerné par ces dispositifs. Cette recherche poursuit donc l'objectif de présenter les principales orientations thérapeutiques de ces dispositifs, tout en les croisant aux niveaux de fonctionnement en psychothérapie. Pour conduire cette revue, nous avons utilisé une perspective qualitative et conceptuelle, en suivant trois étapes clés (définition du périmètre de l'étude, recherche documentaire et analyse de la littérature), et consistant en une intégration des publications organisées d'une manière thématique, et regroupées ensuite par orientation en psychothérapie. D'une part, trois orientations thérapeutiques sont distinguées : l'utilisation des technologies comme des objets thérapeutiques en eux-mêmes (à la manière des serious game) ; l'utilisation de ces technologies pour faciliter l'adhésion, l'alliance et la communication thérapeutiques (« médiation relationnelle » soignant-patient ou psychothérapeute-patient) ; l'utilisation des jeux vidéo et des robots comme des cyber-médiations en psychothérapie (« médiation thérapeutique » psychothérapeute-patient). D'autre part, ces trois orientations ne semblent pas occuper le même espace au sein des deux niveaux de fonctionnement en psychothérapie. La différence entre la première et la troisième orientation semble tenir en la présence systématique ou non du psychothérapeute. Les limites de cette recherche sont nombreuses, la démarche étant essentiellement qualitative et conceptuelle. Des études complémentaires devront être entreprises. Par ailleurs, les limites potentielles de ces utilisations sont soulignées : les études contrôlées et randomisées sont rares, et les publications sans données expérimentales sont parmi les plus courantes. De plus, les données longitudinales font défaut, notamment en ce qui concerne le maintien et la généralisation des résultats dans le temps. Technologies are used increasingly today in psychotherapy and especially in the field of mental health. Among these technologies, video games and robots have given rise to a large amount of research. However, these studies don't describe precisely the modalities of use of these technologies in psychotherapeutic settings, or which, level of functioning in psychotherapy (explicit or implicit) is concerned by these devices. The aim of this research is to highlight the main therapeutic orientations of the devices while crossing them at the levels of functioning in psychotherapy. To conduct this review we used a qualitative and conceptual perspective and followed three key steps (definition of the perimeter of the study, documentary research and analysis of the literature). The literature has been organized in a thematic way and researches have been gathered according to their orientation in psychotherapy. Three therapeutic orientations are distinguished: the use of technologies as therapeutic objects in themselves (in the manner of serious games); the use of these technologies to facilitate adherence, alliance and therapeutic communication ("relational mediation" caregiver-patient or psychotherapist-patient); the use of video games and robots as cyber-mediations in psychotherapy ("therapeutic mediation" psychotherapist-patient). On the other hand, these three orientations do not seem to occupy the same space within the two levels of functioning in psychotherapy. The difference between the first and third orientations seems to be the systematic presence or not of the psychotherapist. The limitations of this research are numerous, the approach being essentially qualitative and conceptual. Further studies should be undertaken. Additionally, the potential limitations of these uses are highlighted: randomized controlled studies are rare and publications without experimental data are among the most common. Also longitudinal data are lacking, particularly with respect to the maintenance and generalization of results over time. [ABSTRACT FROM AUTHOR]

On estime que le syndrome de stress post-traumatique (PTSD) reste chronique et sévère pour 25 à 50 % des patients malgré une prise en charge psychothérapeutique. La MDMA (« ecstasy ») possèderait des propriétés psychopharmacologiques qui renforcent l'alliance thérapeutique et permettent au patient de travailler sur le contenu traumatique sans être submergé par la peur et l'anxiété. Les résultats d'essais cliniques de phase II confirment que la MDMA améliore efficacement la prise en charge psychothérapeutique des patients atteints de PTSD sans effets secondaires sérieux. Des essais de phases III sont en cours. La Multidisciplinary Association for Psychedelic Studies (MAPS) a mis en ligne une proposition de méthode et forme des thérapeutes pour mener des psychothérapies assistées par la MDMA. La Food and Drug Administration (FDA) et l' European Medicines Agency (EMA) pourraient autoriser cet outil thérapeutique dans les prochaines années. Posttraumatic stress disorder (PTSD) is estimated to remain chronic and severe for 25–50% of patients despite psychotherapeutic treatment. Part of the reasons is that patients with PTSD can have difficulties in establishing a good therapeutical alliance with the therapist. Moreover, they often fail to re-think the content of the trauma without being overwhelmed by negative emotions and tend to rely on avoidance strategies and/or to abandon the therapy. MDMA ("ecstasy") is a drug classified as an entactogen (en "within", tactus "touch", and gen "produce"), an amphetamine with psychedelic properties that possesses psychopharmacological properties to overcome these issues. Indeed, MDMA triggers the release of oxytocin, which favors the establishment of interpersonal relationship based on kindness and trust. Moreover, MDMA diminishes the activity of the amygdale, allowing patients to work on challenging memories with less fear and anxiety. Finally, MDMA may also provide access to meaningful spiritual experiences, release of tensions and a sense of healing on a non-verbal level that are not completely understood. But are viewed as important by patients. Today, there is no evidence that the use of MDMA in a clinical setting has bad neurologic, psychological or cognitive consequences. Results of phase II trials in the United States and Europe confirm that MDMA favors psychotherapy's outcome without severe adverse effects. Phase III trials are underway. The Multidisciplinary Association for Psychedelic Studies (MAPS) has published online a method proposal and trains therapists in MDMA-assisted psychotherapy. Food and Drug Administration (FDA) and European Medicines Agency (EMA) could approve this therapeutic tool in the coming years. [ABSTRACT FROM AUTHOR]

Les difficultés psychologiques font partie des enjeux de santé publique les plus importants. Pour ces raisons, il est nécessaire de s'interroger sur les effets réels des psychothérapies et sur leurs difficultés à produire, parfois, des résultats tangibles. La psychothérapie est efficace pour des problématiques psychologiques variées, aussi bien dans les études contrôlées que dans les conditions réelles de terrain, et participe à la réduction des coûts de santé. Pourtant, tous les patients ne retirent pas de bénéfices des soins, certains sont à risque de se détériorer et d'abandonner leur traitement et des effets secondaires parfois persistants existent ; les cliniciens surestiment leur efficacité, et leurs performances accusent un déclin au cours de leur carrière. Deux méthodologies prometteuses paraissent associées à de meilleurs résultats : le suivi continu des résultats (SCR) ou Routine Outcome Monitoring (ROM) et l'entraînement spécifique des thérapeutes au développement de leur expertise nommée « Pratique délibérée » (Deliberate Practice). Utiliser le feedback des patients permet d'assurer le suivi des résultats et de mettre en place une « pratique délibérée » en soins courants. La mise en place de la méthode du SCR-ROM devrait être encouragée dans les pays francophones, pour produire des données probantes quant à la délivrance, à l'amélioration de l'efficacité des psychothérapies et au possible remboursement des soins. Psychological difficulties are part of higher stakes health issues. What are the real effects and the difficulties to generate results of psychotherapies? Psychotherapy is efficient for multiple psychological disorders, as well in controlled as in naturalistic studies, and participate in reduction of health expenditure. However, all patients do not get real benefits from care, patients can deteriorate or drop-out treatment, and persistent side effects can occur; clinicians overestimate their efficiency and their performances decline during their career. Two promising methodologies seems to be associated with better outcomes: Routine Outcome Monitoring (ROM) and a specific form of training clinician expertise named "Deliberate Practice". Using client feedback allows to implement ROM and "Deliberate Practice" in routine care. Implementation of Routine Outcome Monitoring should be encouraged in French Speaking countries to produce evidence-informed practice for the delivering, the improvement and the payment for psychotherapy expenditure. [ABSTRACT FROM AUTHOR]

Cet article propose une revue de littérature concernant l'évaluation et l'efficacité des psychothérapies psychanalytiques et de la psychanalyse (PPP). Après avoir proposé une vue d'ensemble de l'évaluation des psychothérapies, nous reprenons les travaux portant sur l'évaluation empirique et quantitative des PPP avant de nous centrer sur leur évaluation qualitative et processuelle. Les résultats des études menées en ce domaine démontrent que les psychothérapies sont efficaces aussi bien sur le court terme que le long terme. Leur efficacité est le plus souvent indépendante de l'obédience théorique du clinicien. En revanche, les facteurs communs comme l'alliance thérapeutique ou les particularités du thérapeute sont des éléments prévalents de même que la durée et la fréquence des psychothérapies. Concernant plus précisément l'évaluation des PPP, celles-ci sont démontrées empiriquement comme étant efficaces pour la plupart des troubles psychiatriques. Plusieurs caractéristiques des PPP sont en outre corrélées de manière significative avec l'efficacité thérapeutique. L'évaluation qualitative et processuelle des PPP apparaît complémentaire à ce premier niveau d'évaluation empirique qui présente plusieurs limites (biais d'allégeance, indistinction des processus, pratiques de recherches questionnables, etc.) mises notamment en évidence par la crise de la reproductibilité. La méthodologie des Essais Contrôlés Randomisés propose une évaluation de surface à laquelle doivent être associées des approches fondées davantage sur la pratique clinique. L'approche du groupe de Boston, l'analyse des processus psychothérapiques par le Psychotherapy Q-Sort (PQS) ainsi que la modélisation du processus de symbolisation par l'École de Lyon sont trois paradigmes de recherche qualitatifs particulièrement riches de ce point de vue. Les PPP sont efficaces pour la plupart des troubles psychiatriques sur le court terme, en fin de thérapie et plusieurs années après celle-ci. Elles engendrent des transformations durables sur le plan des symptômes et de la personnalité. Elles apparaissent souvent plus efficaces que la pharmacothérapie et conduisent à des économies substantielles quand elles sont mises en œuvre dans des services de soin auprès de patients souffrant de pathologies variées. This article proposes a review of the literature concerning the evaluation and the efficacy of psychoanalytic psychotherapy and psychoanalysis (PPP). After proposing a global overview of the evaluation of psychotherapy, we sum up the empirical and quantitative evaluation of PPPs before focusing on their qualitative and process-based evaluation. Psychotherapies are very effective both in the short and in the long term. Their effectiveness is largely independent of the clinician's theoretical affiliation. Common factors such as the therapeutic alliance or the particularities of the therapist are prevalent, as are the duration and the frequency of the session throughout the therapy. Concerning more specifically the evaluation of PPPs, they have been empirically demonstrated to be effective for most psychiatric conditions. Several characteristics of PPPs are also specifically correlated with therapeutic effectiveness. Moreover, they produce long-term therapeutic effects, particularly concerning personality and after the end of the therapy. The qualitative and process-based evaluation of PPPs appears complementary to empirical evaluation, the latter suffering from several limitations (allegiance bias, indistinction of processes, questionable research practices, etc.) highlighted in particular by the recent crisis of reproducibility. The methodology of Randomized Controlled Trials should be associated with research based on clinical material. The approach of the Boston group, the analysis of psychotherapeutic processes with the Psychotherapy Q-Sort (PQS) and the modeling of the symbolization processes by the School of Lyon are three qualitative research paradigms that are particularly rich from this point of view. PPPs are effective for most psychiatric disorders in the short term, at the end of the therapy, and for several years afterwards. They generate lasting transformations in terms of the reduction of symptoms and of personality evolution. They often appear to be more effective than pharmacotherapy and lead to substantial savings when they are implemented in health care facilities for patients suffering from a large variety of pathologies. [ABSTRACT FROM AUTHOR]

Copyright of Sante Mentale au Quebec is the property of Revue Sante Mentale au Quebec 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.)

Copyright of Physiotherapy Canada is the property of University of Toronto Press 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.)

Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the 'online disinhibition effect', the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations. [ABSTRACT FROM AUTHOR]

As research has shown a consistent link between the alliance and the therapeutic success, an alliance-focused supervision was designed to help novice therapists improve their relational and collaborative abilities. Fifteen young therapists participated in the alliance-focused supervision and 15 did not. Therapists' and clients' results at the Working Alliance Inventory showed that the supervision model improved their perceptions concerning the therapist's ability to foster mutual emotional involvement, as well as collaboration. All therapists demonstrated an ability to negotiate emotional alliance with the client. However, when they participated in the alliance-focused supervision, they appeared to improve their capacity to finding an agreement with the client around therapeutic goals, which was not the case when they did not participate. In addition, more independent views on the alliance appeared in clients and therapists when the professional took part in the alliance-focused supervision than when he/she did not. Results on the Difficulties in Emotion Regulation Scale also showed that participating in the alliance-focused supervision had a protective influence on therapists' impulsiveness. Overall, alliance-focused supervision appeared useful in helping therapists improve emotional involvement and collaboration in the alliance. It also seemed to protect them from being impulsive. [ABSTRACT FROM AUTHOR]

L'épidémie du COVID-19 est survenue au Gabon à une période où l'hôpital psychiatrique vit une crise sans précédent du fait d'une baisse des moyens matériels et humains. À partir de l'expérience clinique des soignants, nous présentons les difficultés que rencontrent ces acteurs du soin pour maintenir l'alliance thérapeutique. L'article expose une synthèse de travaux sur le confinement, le COVID-19 et les troubles psychiques. Globalement, on observe une baisse des consultations en ambulatoire. En zone rurale, la crise sanitaire a occasionné une suppression des suivis au domicile des patients ainsi qu'une difficulté d'accès aux médicaments psychotropes onéreux, favorisant l'inobservance du traitement avec comme conséquence des décompensations psychiatriques. Gabonese psychiatry is facing a crisis, which results in a decrease in material and human resources. Hospital beds are closed and consultations are mainly on an out-patient basis. This article shows how health care workers are coping with this pandemic, and the challenges of maintaining the therapeutic alliance. It presents a synthesis of works on confinement, COVID-19 and mental disorders. Clinical observations reveal that the COVID-19 epidemic has strengthened the dysfunctions observed in care. In rural areas, there is a suppression of follow-up at home. In general, this health crisis had an impact on the purchasing power of patients. What caused a difficulty of payment of the psychiatric consultations in liberal, a difficulty of access to the expensive psychotropic drugs, thus favouring a non-observance of the care, and a decompensation of the psychiatric picture. In urban areas, there is a considerable decrease in out-patient consultations. There is still concern about the inter- and post COVID-19 psychiatric care. This pandemic calls on leaders leading to a reorganisation of the psychiatric care system (decentralisation of establishments throughout the country, training of qualified nursing staff, fall in the prices of expensive psychotropic drugs). The establishment of helplines in psychiatric facilities, the opening of hospital beds, COVID-19 devices in public and private facilities for patients with mental disorders are essential. [ABSTRACT FROM AUTHOR]

Digital therapeutic programs are emerging almost daily, offering the potential to reduce healthcare access inequalities by providing more flexible and accessible care options. However, as with traditional healthcare, the issue of patient engagement is fundamental, and the latest research have reported that fewer than 30% of users complete these programs in their entirety. Hence, many authors emphasize the importance of studying the role of therapeutic alliances specifically adapted to digital care. The therapeutic alliance encompasses the collaborative aspects of the relationship between the therapist and the patient. In this context there is a need to reconceptualize the alliance within the context of digital healthcare as it can enhance engagement, adherence, and the effectiveness of such treatments. The objective of this qualitative study was to identify the components of the digital therapeutic alliance. A thematic analysis has identified three major themes that appear to constitute the digital therapeutic alliance among 44 users of an online program: trust in the program, perception of interactions, and feeling of consideration. These results prompted a discussion of the challenges of digital healthcare, including the terminology to use. The term "digital therapeutic adherence" is proposed, thereby opening up a field for research and clarification of this important concept distinct from traditional alliance., (Copyright © 2024 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

In psychotherapy, therapeutic alliance is an integrative factor influencing the effectiveness of treatment. This alliance depends on the bond between therapist and patient. This study investigates patient's psychological variables likely to facilitate or hamper a psychotherapeutic process. We asked 38 clinicians to assess the importance of each domain and facet of the Five-factor model (five domains and thirty facets) supposed to facilitate or hamper therapeutic alliance. Results indicate that high openness, agreeableness and conscientiousness are perceived as favourable to therapeutic alliance. Beyond these results, we preferably focus on facets of the Five-factor model to assess their relevance for the facilitation or hindrance of therapeutic alliance. According to clinicians, 17 facets are supposed to affect positively therapeutic alliance: A2 (straightforwardness), O3 (feelings), C5 (self-discipline), O5 (ideas), O6 (values), C2 (order), O1(fantasy), C1 (competence), E2 (gregariousness), E1 (warmth), A6 (tender-mindedness), N5 (impulsiveness), A3 (altruism), C4 (achievement striving), E4 (activity), N1 (anxiety) and C6 (deliberation). Thirty-eight facets were supposed to have a negative effect on therapeutic alliance: A5 (modesty), A2 (straightforwardness), A1 (trust), C3 (dutifulness), E3 (assertiveness), E1 (warmth), A4 (compliance), O3 (feelings), C4 (achievement striving), N3 (depression), A6 (tender-mindedness), O5 (ideas), A3 (altruism), E5 (excitement-seeking), N5 (impulsiveness), O2 (aesthetics), E2 (gregariousness) and O1 (fantasy). On this basis, we propose three experimental scores investigating the proneness to access therapy based on the Five-Factor Model. [ABSTRACT FROM AUTHOR]

Cette revue de littérature synthétise les résultats des études ayant utilisé une mesure empirique de l'attachement du client au thérapeute en psychothérapie. Une recherche systématique dans les bases de données Medline , Embase , Pubmed , PsycInfo , et Web Of Science a débouché sur 25 études publiées. Une approche méta-analytique a également été utilisée pour examiner la corrélation avec l'alliance thérapeutique (11 études) et l'attachement adulte du client avant la thérapie (11 études). Les résultats montrent que l'attachement du client au thérapeute Sécure est très fortement corrélé à l'alliance thérapeutique, moyennement corrélé aux résultats, et faiblement corrélé négativement aux dimensions d'évitement et d'anxiété de l'attachement adulte. Le style Evitant–Craintif montre des résultats inverse au style Sécure, alors que le style Préoccupé–Fusionnel montre plutôt des corrélations faibles ou nulles, et qui varient suivant les études. Ces résultats sont consistants avec la conception de Bowlby concernant le thérapeute comme base sécure et confirment la pertinence de l'attachement au thérapeute comme prédicteur des résultats et du processus de changement en psychothérapie, pour différentes formes de thérapies et différents types de patients. Attachment theory describes characteristic patterns of relating to close others and has important implications for psychotherapy. Consistent with Bowlby's (1988) secure base conception of attachment in psychotherapy, several instruments have been developed to measure client attachment to therapist. Despite a large number of studies, no review takes into account all published work. The purpose of this systematic review was to compare different measures of client's attachment to therapist, with different groups of client and in different therapeutic contexts. Medline, Embase, Pubmed, PsycInfo, and Web Of Science were searched to identify studies published between 1995 and 2019 reporting on help-seeking client's attachment to therapist. Twenty-five empirical papers met the inclusion criteria. Meta-analyses were conducted for studies that examined client attachment to therapist subscales (Secure, Avoidant–Fearful, Preoccupied–Merger) as correlates of client-rated working alliance (K = 11, 892 clients), and general adult attachment (K = 11, 752 clients). The results show that the client's secure attachment to therapist is strongly correlated with the therapeutic alliance (mean weighted R = 0,71 [95% CI = 0.62–0.79]), moderately correlated with the results, and negatively correlated with the avoidance (mean weighted r = − 0,12 [IC 95% = − 0.06–− 0.21]) and anxiety dimensions (mean weighted R = − 0,11 [IC 95% = − 0.03–− 0.17]) of adult attachment. With the Avoidant–Fearful style, results go in the opposite direction, negatively correlated with the therapeutic alliance (mean weighted R = − 0.55 [IC 95% = − 0.59–− 0.50]), negatively correlated with the results, and correlated with the avoidance dimension of adult attachment (mean weighted R = 0,16 [IC 95% = 0.09–0.23]). The Preoccupied–Merger style shows weak (positive or negative) to zero correlations. In addition, nine studies looked at some dimensions of the psychotherapy process (e.g., resistance, transference, emotions, self-disclosure, and attitude toward psychotherapy), showing that insecurity of attachment to the therapist (both Avoidant–Fearful style and Preoccupied–Merger style) seem to interfere in one way or another with the development of a productive psychotherapy process. Overall, these results are in line with what was expected. They are consistent with Bowlby's conception of a secure base of attachment in psychotherapy. They showed that dysfunction and maladaptive developmental experience interfere with adult's ability needed to establish secure attachments and that psychotherapy may play the role of what has been previously defined as corrective emotional–or intersubjective–experience. In addition, these results do not seem to vary according to the instruments used. Together, the high correlation with therapeutic alliance and the weak correlation with pretherapy adult attachment confirm the relevance of the client's attachment to therapist as a specific variable related to the process of change in psychotherapy. [ABSTRACT FROM AUTHOR]

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]

Pendant longtemps, le psychotraumatisme est resté l'affaire des médecins militaires. Les derniers attentats sur le sol français et le nombre important de personnes ayant développé un trouble de stress post-traumatique ont depuis ouvert la voie à de nouvelles approches dans la prise en charge. Cet article étudie par quels processus et dans quelle mesure un atelier d'art-thérapie par l'argile peut aider les personnes ayant subi un traumatisme. Comment l'argile, en tant que médium malléable, peut-elle contribuer au processus de changement dans un cadre thérapeutique ? Peut-elle favoriser l'élaboration du vécu PTSD ? L'argile permettrait un premier temps une voie cathartique nécessaire, suivi d'un deuxième temps d'élaboration et d'un troisième de transformation. Ces trois étapes sont-elles garantes d'un pronostic positif lors d'un PTSD ? Ce travail prend en compte l'importance de l'alliance thérapeutique entre thérapeute et participant. Cette relation est construite autour d'un cadre contenant et structurant qui permet au processus de création de se mettre en place. The purpose of this paper was to review of the benefits of art therapy in the management of post-traumatic stress disorder (PTSD). Psychotrauma has long been the business of military doctors. However, the latest attacks on French soil have opened the door for new approaches in care. Research in clinical psychology and psychopathology underlines the effectiveness of art therapy in the treatment of PTSD. Our aim is to identify the extent to which and the processes through which clay may be of benefit to people having suffered trauma. As a malleable medium, can clay contribute to the process of change in a therapeutic setting? Can it help the patient confront trauma-related information in a therapeutic manner? Clay is a vehicle that allows for three steps in the therapeutic process. First, clay allows for a cathartic release of emotions. Second, it helps elaborate the traumatic experience. Third, it leads to transformation. Do these three steps guarantee a positive prognosis for PTSD? This work takes into account the importance of the patient-therapist therapeutic alliance. This relationship, built within a structured and containing therapeutic framework, allows the creative process to take place. Art therapy with clay helps reduce anxiety. The act of kneading, smoothing, touching, or moistening the clay, makes artistic creation a pleasant and relaxing activity. This induces relaxation and the reduction of cortisol levels, reducing stress and anxiety. This relaxation is comparable to that achieved through mindfulness. Clay makes the unconscious visible and thus creates possibilities for investigating emotions and cognition. This contributes to cognitive regulation. Varying instructions during the sessions allow the participant to learn to self-regulate through touch, and control physical reactions that trigger the cycle of stress. Work with clay provides distance, improved recall of trauma and easier access to emotions. The setting, instruction, and attitude of the therapist create a safe environment for the conscious expression of emotions and memories. This is similar to exposure, recall, and emotional distancing and allows for better regulation of emotion. Clay facilitates the association of ideas. It helps the patient open up to his therapist and their experience during the process of creating with clay can be deepened through conversation. After identifying and isolating negative thoughts, patients gain new skills on how to counteract them. Clay allows the elaboration of thought and improves the capacity for symbolization and imagination. The results presented in this article provide insight into the effectiveness of clay art therapy in trauma treatment. They highlight the urgent need for further research on art therapy and trauma treatment. [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.)

Les notions d'observance ou d'adhésion ne sont pas les seuls concepts utilisés pour décrire le comportement du patient face à son traitement. Dans la littérature, il est difficile de trouver des définitions consensuelles des notions caractérisant la prise de médicaments ou le suivi des mesures hygiéno-diététiques. La traduction mot à mot peut se révéler dangereuse et amener à des confusions ou des incompréhensions. The notions of compliance or adherence are not the only concepts used to describe the behaviour of patients with regard to their treatment. It is difficult to find, in literature, consensual definitions of notions characterising medication intake or adherence to lifestyle and dietary changes. Word for word translation is dangerous and can lead to confusion and misunderstandings. [ABSTRACT FROM AUTHOR]

Résumé Objectif Explorer la relation médecin-patient dans les études qualitatives traitant de la théorie de l'attachement, qui en apportent une compréhension en médecine générale. Méthode Méta-synthèse : méthode d'analyse secondaire d'études qualitatives. Revue de littérature, analyse thématique, translation et synthèse. Résultats La relation médecin-patient était une relation d'attachement nécessaire au patient pour se sentir apaisé en situation de vulnérabilité. Les stratégies de régulation des émotions négatives du patient et du médecin guidaient les comportements de santé. Le propre style du médecin conditionnait la qualité de la relation. Le médecin, « base sécure », exerçait un effet régulateur des émotions négatives du patient. La confiance mutuelle était thérapeutique dans une approche « liée-patient ». Conclusion La théorie de l'attachement est utile pour l'étude de la relation médecin-patient. Abstract Objectives Explore the physician-patient relationship through the qualitative studies about attachment theory, to allow its understanding in general practice. Materials and methods Meta-synthesis is a method of secondary analysis of qualitative studies. The studies had to be about attachment theory, applied to the framework of the physician-patient relationship in general practice. Studies were identified and selected in MEDLINE, EM Premium, Banque de Données en Santé Publique, PsyclINFO, PsycARTICLES, Web of Science. The quality of the studies was evaluated thanks to the CASP qualitative research checklist. Three researchers performed a thematic analysis and then a reciprocal translation of different themes across studies. A triangulation was performed at every step. The synthesis was written according to the ENTREQ reporting guidelines. Results 14 studies have enabled a lines-of-argument synthesis with 6 master themes. The physician-patient relationship in general practice was an attachment relationship. This relation was necessary for the patient to feel safe in a situation of distress. The physician and his patient had strategies of regulation of negative emotions. These internal working models guided health-behaviours, like the engagement in their relationship and the approach of each of them. The own physician's attachment style on the one hand, and his reflexive function on the other hand, influenced the quality of the relationship with his patient, favoring therapeutic alliance. Being a secure base for the patient involved the regulation of his negative emotions. Patient-centered care could be revisited as informed by adult attachment theory. The approach including a patient's attachment style, but also that of a physician, has been defined as "an approach linked to the patient". The mutual trust in each other was therapeutic. Conclusions General practice could inspire itself from this useful framework to understand interpersonal difficulties and improve care. More research is needed to explore specific components, such as doctor's attachment style, its complementarity with patients' styles, or the reflexive function as a mediator of this relationship. [ABSTRACT FROM AUTHOR]

Résumé Le recours à un interprète lors d'une consultation avec un patient allophone, est une pratique de plus en plus fréquente chez les cliniciens. Cependant, l'impact d'une tierce personne sur la relation de soin, notamment sur la construction de l'alliance thérapeutique, est une question peu évoquée dans la recherche sur la psychothérapie. Or, la présence d'un interprète modifie inévitablement le processus thérapeutique en le complexifiant. Elle implique certains aménagements du cadre physique et matériel, et impacte aussi bien les modalités techniques que les modalités de l'entretien, tout comme le contenu des échanges. Des concepts généraux relatifs à l'approche interculturelle seront d'abord présentés. Puis, la question de l'établissement d'une alliance thérapeutique triadique dans une perspective interactionniste et systémique sera abordée à partir de travaux sur des thérapies de couple et de famille ou des consultations précoces parent-nourrisson. L'application de ces modèles à une meilleure compréhension de l'alliance triadique entre thérapeute-interprète-patient, de ses composantes et dimensions spécifiques, sera finalement discutée. Les implications en termes de directions de recherche visant à optimiser la conduite d'une psychothérapie et, plus largement, d'une consultation avec un interprète seront présentées. Abstract The relevance of the use of an interpreter when receiving an allophone patient seems to be more and more accepted among clinicians. However, the influence of this third person on the therapeutic process, and particularly on the establishment of the therapeutic alliance, has received scarce attention so far. The presence of an interpreter inevitably modifies the therapeutic process and makes it more complex. It requires some adjustments of the physical and material setting. It also influences practical arrangements and the very nature of interactions, as well as their content. General concepts about the intercultural approach will first be presented. Subsequently, the issue of the establishment of a triadic therapeutic alliance during a couple and family therapy or mother infant consultations will be discussed from an interactionnist and systemic perspective. The application of these models to a better understanding of patient-therapist-interpreter alliance and its specific components and dimensions will be discussed. Finally, research directions and some clinical considerations to optimize the conduct of a consultation or a psychotherapy with an interpreter will be stressed. [ABSTRACT FROM AUTHOR]

Objectives: The therapeutic alliance, an essential component of the therapeutic process, has been investigated in adult and child therapy, but studies in the context of parent-infant or parent-toddler therapeutic interventions are scarce. This monocentric study aims to produce a French cross-cultural adaptation of a therapeutic alliance scale for the context of early consultations in a child and psychiatry department., Method: Fifty-five young children aged 3 to 30 months consulting for regulation or behavioral disorders and their mothers were included in the study. The working alliance inventory (WAI) was translated into French by two bilingual translators and adapted to early-age consultations in parent and therapist versions. Assessments of the child's symptoms and the parents' anxiety and depression were carried out at the start and end of therapy. We studied the association of the alliance with the initial clinical characteristics and with the outcome of the child and the mother. An exploratory factor analysis was performed considering the items most associated with expected outcomes., Results: The alliance coded by the mother was lower in case of child behavioral problems and was associated with the mother and child outcome. Short versions of the infant-toddler WAI were developed based on factor analysis, highlighting four factors: positive goals and tasks, bond with the mother, alliance with the child, negative experience of care relationship., Discussion: Results were similar to those found in therapy with adults or older children. The alliance issue in mother-baby therapies was as essential as in other therapy contexts. The short Infant-Toddler WAI resulting from this work must be validated in future studies., (Copyright © 2022 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Résumé Introduction Les lombalgies chroniques ont des répercussions physiques, psychologiques et sociales qui peuvent toutes avoir une incidence sur la sexualité. Objectif Présenter une revue de littérature sur la lombalgie chronique et ses répercussions physiques, psychologiques et sociales sur la sexualité, ainsi que les programmes d'intervention biopsychosociale sur la sexualité en contexte de douleur chronique. Méthodologie Revue de la littérature sur les bases de données PubMed, PsycINFO et Google Scholar en utilisant plusieurs mots clés, dont « chronic low back pain », « chronic pain », « low back pain », « sexuality », « sexual function » et « sexual dysfunction ». Toute publication pertinente, ainsi que leurs références ont été considérées. Résultats Les études montrent que la lombalgie chronique peut entraîner des troubles du désir, de l'excitation, et de l'orgasme, qui peuvent être directement liées à l'étiologie de la douleur, comme dans le cas d'hernies discales, ou aux effets secondaires de médicaments comme les antidépresseurs, les analgésiques, ou opioïdes, ou encore les traitements mécaniques ou chirurgicaux. Les répercussions psychologiques de la lombalgie, comme la dépression, l'anxiété, l'hypervigilance à la douleur, une faible estime de soi et image corporelle, des distorsions cognitives et pensées catastrophisantes et un passé de violence sexuelle, peuvent également contribuer aux dysfonctions sexuelles. Les facteurs sociaux, enfin, peuvent entraîner des changements de rôles de genre qui peuvent altérer l'engagement dans les relations sexuelles ; et peuvent avoir un impact sur le partenaire et la sexualité. Ces facteurs favorisent une prise en charge holistique de type biopsychosocial associant notamment la thérapie cognitivo-comportementale, l'éducation au cycle de la douleur, et l'exercice physique, qui ont montré des résultats encourageants. Conclusion Les programmes multidisciplinaires axés sur un modèle biopsychosocial semblent indiquer pour traiter les divers aspects de la douleur chronique et ses répercussions sur la sexualité. Summary Introduction Chronic low back pain has physical, psychological and social repercussions that can interfere with sexuality. Objective Present a literature review on chronic low back pain and its physical, psychological and social repercussions on sexuality, as well as biopsychosocial intervention programs for sexual dysfunctions in the context of chronic pain. Methods Literature review on PubMed, PsycINFO and Google Scholar using key words such as "chronic low back pain", "chronic pain », "low back pain", "sexuality", "sexual function". Every relevant publication and their references were considered. Results Results indicate that chronic low back pain can be associated with hyposexual desire, arousal difficulties and orgasm disorder, which can be directly related to the aetiology of pain, such as following herniate discs, or side effects of medications such as antidepressives, analgesics, or opioids, or side effects of mechanical or surgical treatments. Psychological repercussions of low back pain, such as depression, anxiety, hypervigilance to pain, low self-esteem and body image, as well as a history of sexual abuse can also contribute to sexual dysfunctions. Social factors, finally, can trigger changes in sexual and social roles, altering the desire to engage in sexuality, or have an impact on the partner. These factors call for holistic biopsychosocial interventions, combining for example cognitivo-behavioral techniques, education on the cycle of pain, and physical exercises, which have shown encouraging results. Conclusion Multidisciplinary programs based on a biopsychosocial model seem best indicated to treat the various aspects of chronic pain and their impact on sexuality. [ABSTRACT FROM AUTHOR]

This study examined how clients' self-image and perception of therapist's behavior are related to the therapeutic alliance, as well as how these variables change in the psychotherapy process in trainee-led psychotherapy. A total of 164 participants (M = 28.9 years) who attended two semesters of treatment at the Psychology Clinic of Umeå University completed the Working Alliance Inventory (WAI) to evaluate their perception of their alliance with the therapist. They also completed two questionnaires based on the Structural Analysis of Social Behavior (SASB) model to give insight into their self-image patterns and to analyze their perceptions of the therapist's behavior. The results show that a positive self-image and positive perceptions of the therapist's actions increased significantly over the course of the therapy, with a corresponding decrease in negative patterns. The alliance scores show that the therapeutic alliance gains significance over time and that it is influenced more by the perception of the therapist's behavior than by the self-image. The self-image becomes relevant after the mid part of therapy, underlining the role of the therapist in co-creating the treatment relationship. The implications of these results are discussed, and so are directions for future research in other trainee-led settings and samples. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Les sujets ayant un trouble de la personnalité borderline sont peu informés sur leur trouble, malgré les recommandations en ce sens. Nous n'avons pas retrouvé de document d'information écrit sur le trouble élaboré en collaboration avec des patients, comme le préconise la Haute Autorité de santé. L'objectif de ce travail a été d'élaborer et d'évaluer un document d'information pour les personnes ayant un trouble de la personnalité borderline, en impliquant des patients. Méthode Nous avons organisé un groupe de travail puis des entretiens individuels avec des patients. L'évaluation a été quantitative et qualitative (analyse thématique). Résultats Une version initiale du document a été élaborée à partir de différentes sources récentes. Le groupe de travail a conduit à 19 modifications du document, dont l'ajout d'une partie « d'autres pistes pour aller mieux » et l'ajout de la notion d'hypersensibilité. Les entretiens individuels ont conduit à 23 modifications, dont la suppression des pourcentages sur l'évolution du trouble (devant leur caractère pessimiste), le développement du critère sur l'instabilité affective (considéré comme central), le développement de la partie « autres pistes pour aller mieux » (avec des conseils de gestion de l'anxiété). Les patients ont évalué le document facile à comprendre, intéressant, et sa lecture a été bien vécue. En revanche, la présentation a été jugée insuffisamment attractive et a été améliorée. Conclusion Ce document a pour objectif d'être utilisé en complément de l'information orale, qui reste indispensable. Il serait intéressant d'évaluer l'impact de l'information orale et écrite sur l'alliance thérapeutique. Abstract Introduction Borderline personality disorder affects 10% of ambulatory patients and 15 to 25% of patients hospitalized in psychiatry. Therapeutic recommendations include informing patients about the characteristics of the disorder, its evolution and the effectiveness of psychotherapies. This information can promote self-understanding, therapeutic alliance and the involvement of the patient in his/her care. Despite these recommendations, people with borderline personality disorder are generally not well-informed about their disorder in France. We find a few written document delivering information about the disorder destined for patients in French, but we did not find it with a detailed elaboration methodology and none developed with patient involvement. The objective of this work was to develop and to evaluate, an information leaflet for patients with Borderline Personality Disorder, involving patients in these two stages. Method We developed and evaluated an information document with a step-by-step approach, similar to that described in the methodological guide of the French High Authority for Health (Haute Autorité de santé). We first designed an initial version, which we then modified with a working group with 4 patients and 2 health professionals. Finally, we evaluated and modified this document through 6 individual interviews with patients. Patients were recruited through psychiatrists and psychologists from the department of Toulouse, who were contacted by email. Concerning the analysis of the data, the answers to the closed questions were quantified. The answers to the open-ended questions were analyzed qualitatively through a thematic analysis, in order to organize in a structured and synthetic way all the subjects covered by the patients during the various interviews. Results The working group led to 19 changes to the original version of the document, including the addition of "other ways to feel better", the addition of the concepts of hypersensitivity and intense emotional crisis, and rewording to simplify the document. Individual interviews led to 23 changes including: the removal of percentages on the evolution of the disorder (in view of their pessimistic nature), the development of the criterion on affective instability (considered as central), the development of the "other ways to get better" section (with a crisis management board through a soothing activity); several rephrasings, reorganizations or deletions. Patients evaluated the document, they judged it as easy to understand, interesting and its reading was well experienced. On the other hand, the presentation was judged to be insufficiently attractive and is being improved by graphists. We can emphasize the particular attention shown by the patients to the document being optimistic. Conclusion We have elaborated with patients an informative document. This document is to be used as a support to oral information, in order to reinforce the patient's knowledge. It cannot replace the oral information that remains essential. Concerning the limitations of this work, it might have been interesting to involve other health professionals in the development of the initial version of the document, such as experts on the disorder. It would be interesting to evaluate the impact of the information approach on the therapeutic alliance or the involvement of patients in care, as well as the impact of the written document on these parameters. [ABSTRACT FROM AUTHOR]

The work with parents has always characterized the institutions that deal with psychological treatment of children. Family therapy has evolved a lot and, differently from the therapy with groups of parents, it has relied on a strong theoretical basis. The groups of parents, instead, work above all as "groups of words" that support the Ego function. In this article, I address questions on the setting and the therapeutic process that is involved in this kind of group through the discussion of a clinical vignette. [ABSTRACT FROM AUTHOR]

Abstract: For some time, it has been clear that psychoanalytic theories are built upon the kind of master narratives Roy Schafer, a New York psychoanalyst, described in 1980. As such, psychoanalytic theories may today have lost some of their initial scientific credibility in that they can no longer be seen as summarizing findings from data collected in a research environment. As aids in participating in their patients’ process of healing, however, narratives continue to be used by practitioners and reflect allegiance to core beliefs and propositions with roots in long‐standing Western thought. In this article, the metaphors in master narratives of Freud and Jung are compared with a conceptual system identified by cognitive linguists as ‘The Great Chain of Being’. Based on this analysis, the article proposes that theoretical formulations have mainly a secondary role to play in achieving good outcomes. The most critical element is the therapist's capacity to access a specific narrative for what transpires throughout each treatment. [ABSTRACT FROM AUTHOR]

Intersections between Grawe’s General Psychotherapy and Prochaska’s Transtheoretical Model were investigated in group therapy in a longitudinal design. It was assumed that general change mechanisms have an impact on patients’ stages of change. Specifically, the main hypotheses were that experiential change mechanisms (ECM; clarification of meaning, problem actuation, emotional bond and group cohesion) should be especially relevant for early stages of change (precontemplation and contemplation), whereas behavioral change mechanisms (BCM; resource activation, mastery/coping and task and goals) should be especially relevant for late stages of change (action and maintenance). Therefore, 140 outpatients attending different types of group therapy, with a typical duration of 8 sessions, were investigated. Patients completed the Form for the Evaluation of Therapeutic Processes in Group Therapy (FEPiG), the University of Rhode Island Change Assessment, short version (URICA-S) and several symptomatology measures (BDI-II, BSCL and IIP-32) at two measuring times. Intersections were analysed through correlational analyses, cross-lagged panels and a path-analytic model, supporting the hypotheses. Specifically, results suggested that experiencing ECM at t1 predicted higher levels of reported contemplation at t2. Patients experiencing higher levels of BCM at t1 reported higher levels of action at t2. Clinical implications of the results are discussed. [ABSTRACT FROM AUTHOR]

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]