The Faithless Analyst.

In this lecture, I wish to speak about the faithless analyst. This is an analyst without fixed religious notions, without specific preferences with regard to religious faith and practice, without religious commitments or attachments of the kind that would influence the course of the analysis. Is this possible? Analysts like everyone else grow up in specific cultures that are deeply entangled with religious traditions. Can analysts shed this formation when they enter the consulting room? Should they? Values come with religious faith and practice. Should the analyst shed such religiously based values for the sake of absolute neutrality? I want to think about such faithlessness as an impossible ideal for analytical practice and how to work with failures to remain faithless in the presence of different faiths or the absence of faith among patients.

Dans cette conférence, je souhaite parler de l'analyste sans foi. Il s'agit d'un analyste sans notions religieuses fixes, sans préférences spécifiques en ce qui concerne la foi et la pratique religieuses, sans engagements religieux ou attachements du type de ceux qui influenceraient le cours de l'analyse. Est­ce possible? Les analystes, comme tout le monde, grandissent dans des cultures spécifiques qui sont profondément enchevêtrées avec des traditions religieuses. Les analystes peuvent­ils se débarrasser de cela lorsqu'ils entrent dans la salle de consultation? Devraient­ils le faire? Les valeurs viennent avec la foi et la pratique religieuses. L'analyste devrait­il se débarrasser de telles valeurs fondées sur la religion au nom d'une neutralité absolue? Je veux réfléchir à une telle absence de foi religieuse comme un idéal impossible pour la pratique analytique, et à la façon de travailler avec les situations où l'on ne parvient pas à rester sans foi en présence de fois différentes ou de l'absence de foi chez les patients.

En esta conferencia quiero hablar del analista sin fe. Se trata de un analista sin nociones religiosas fijas, sin preferencias específicas con respecto a la fe y la práctica religiosas, sin compromisos religiosos ni apegos del tipo que influirían en el curso del análisis. ¿Es esto posible? Los analistas, como todo el mundo, crecen en culturas específicas profundamente vinculadas a tradiciones religiosas. ¿Pueden los analistas desprenderse de esta formación cuando entran en la consulta? ¿Deberían hacerlo? Los valores vienen con la fe y la práctica religiosas. ¿Debería el analista desprenderse de esos valores basados en la religión en búsqueda de una neutralidad absoluta? Quiero reflexionar sobre esta falta de fe como un ideal imposible para la práctica analítica y sobre cómo trabajar con los fracasos para permanecer sin fe en presencia de diferentes credos o de la ausencia de fe entre los pacientes.

Case report: Hybrid reconstruction of quadriceps function after sarcoma resection using a reinnervated free flap and tendon transfer.

We describe a case of a leiomyosarcoma of the thigh, the resection of all the anterior muscular compartment, and the reanimation of knee extension, using a latissimus dorsi (LD) free flap and tendon transfer. Surgical technique and postoperative care management are described. Functional results, neuropathic pain, and range of motion (ROM) were assessed at 3 months and 12 months after discharge. A complete excision (R0) was carried out and rapid wound healing was obtained despite developing a seroma infection. The patient was able to walk without technical support nor limping at 3 months post-surgery. The patient was still in remission at 12 months follow-up, with Medical Research Council (MRC) scale assessed at 4/5 and ROM rated at 5-105°. In case of total quadriceps resection, knee extension reconstruction can be obtained with tendon transfers and reinnervated free muscular flaps. Combining these techniques could be a good strategy for rapid recovery, with optimal scarring and tissue coverage.

[Anatomical cartography of the radial nerve at the elbow level for intraradial nerve transfers for finger extension reconstruction in spastic upper limb - A cadaveric study]. / Cartographie anatomique du nerf radial dans la région du coude pour son application aux transferts nerveux intraradiaux dans la chirurgie de la spasticité.

INTRODUCTION: Upper limb spasticity is a surgical challenge, both in diminishing agonists spasticity and reconstructing antagonist function. Brachioradialis (BR) is often involved in elbow flexors spasticity. Finger extension is often impaired in spastic patients. This study aims to demonstrate the feasibility of BR motor branch to posterior interosseous nerve (PIN) during BR selective neurectomies, and to describe fascicles topography inside the radial nerve to facilitate PIN dissection. MATERIAL AND METHOD: Ten upper limbs from 10 fresh frozen anatomical specimens were dissected. Motor branches to the BR, wrist extensors, supinator, PIN and radial sensory branch were identified. BR to PIN transfer was realized and its feasibility was studies (donor length, tensionless suture). RESULTS: BR to PIN transfer was achievable in 9 out of 10 cases. The position of the sensory branch of the radial nerve was inferior or medial in all cases. The position of the PIN was lateral in 90% of the cases. CONCLUSION: BR to PIN nerve transfer is achievable in most cases (90%). The lateral topography of the PIN and the inferomedial topography of the sensory branch in most cases allows for an easier intraoperative finding of the PIN when stimulation is not possible. LEVEL: IV, feasibility study.

[Clinical outcome after transfer of vitrified blastocysts in relation to freezing indication]. / Devenir clinique après transfert de blastocystes vitrifiés selon l'indication de congélation.

OBJECTIVES: In France, embryo thawing concern 45.8% of attempts at assisted reproductive technologies excluding artificial inseminations. This proportion is constantly increasing for various reasons. The main objective of this study is to compare the live birth rate following frozen blastocyst transfer (FBT) according to the initial indication for freezing. METHODS: This is a retrospective study including patients who underwent FBT between 01/01/2020 and 06/30/2022 at the Regional University Hospital Center of Tours. The results were compared (univariate and multivariate analyses) between the three main indications for freezing: freezing of the complete cohort of blastocysts for risk of ovarian hyperstimulation (=OHS), freezing of supernumerary blastocysts after fresh blastocyst transfer (BT) with pregnancy (=second request) or without pregnancy (=BT failure). Results have also been described for other indications. RESULTS: Among the 963 FBT cycles selected, 28% of live births by thawing were obtained, all indications of freezing combined. A significantly lower rate was identified in the FBT failure group compared to the OHS group. However, after adjustment, the results remained significant for the age of the patient on the freezing cycle but not for the indication for freezing. CONCLUSIONS: The outcome of a FBT does not seem significantly impacted by the indication of freezing considering the confounding factors. The prospective analysis of more data from a multicenter study would be necessary to confirm these results.

[Supporting perinatal professionals]. / L'accompagnement des professionnels en périnatalité.

No professional, no team can be a caregiver if they themselves are not well supported, well "cared for", i.e. if they are not well looked after. Professional support is therefore not a luxury, but a sine qua non of quality care and psychological care. After a few reminders about practice analysis and supervision, the impact of the baby's functioning on that of professionals (an impact to be taken into account in terms of their support) is considered, before tackling the concept of intransitive demand, which is also to be considered in the work of supervision.

The Personal and The Transpersonal Psyche: Human Suffering, the Archetypes and the Clinical Encounter.

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

Alors que le concept jungien d'archétype a eu un attrait et une importance majeure et universelle, ce qui demeure moins évident est de savoir comment ces idées peuvent bénéficier au patient en analyse. En particulier, le thérapeute et/ou le patient peuvent peiner à contenir la tension entre les névroses personnelles du patient et la manière dont les éléments transpersonnels/archétypaux façonnent son expérience. Alors que Jung s'est efforcé de développer un traitement qui s'occupait essentiellement de la psyché objective/archétypale, c'est la psyché personnelle qui est probablement l'intermédiaire par lequel on fait l'expérience des archétypes. Je soutiens que la « discipline ¼ analyse jungienne est issue de la transposition des idées de Jung autour de thèmes transpersonnels, philosophiques et religieux (issus de sa propre auto­analyse), et qu'elle est progressivement devenue un processus psychothérapeutique impliquant deux personnes. Jung fournit peu de descriptions de ses rencontres cliniques et de la manière dont il conduisait ses analyses, ce qui laisse de l'incertitude. Ceci a probablement contribué au fait qu'il y a des divergences dans les approches utilisées aujourd'hui par les psychologues analytiques. Cet article examine les conséquences de ces divergences pour la pratique contemporaine de l'analyse jungienne. Il propose une manière de travailler dans l'esprit jungien c'est­à­dire en maintenant le lien avec le domaine symbolique, mais tout en restant concentré sur les complexités des dynamiques personnelles et relationnelles.

Aunque la noción de arquetipos de Jung ha tenido un atractivo y una relevancia extensa y universal, sigue siendo menos obvio cómo estas ideas pueden beneficiar al paciente analítico. En particular, el terapeuta y/o el paciente pueden tener dificultades para mantener la tensión entre las neurosis personales de este último y el modo en que los elementos transpersonales/arquetípicos informan su experiencia. Aunque Jung se esforzó por desarrollar un tratamiento que se ocupara principalmente de la psique arquetípica/objetiva, la psique personal es el medio a través del cual se experimentan los arquetipos. Sostengo que la "disciplina" del análisis Junguiano evolucionó a partir de una transposición de las ideas de Jung en torno a temas transpersonales, filosóficos y religiosos (surgidos de su propio análisis de sí mismo), en un proceso psicoterapéutico de dos personas. Jung brinda poca descripción de sus encuentros clínicos y de la forma en que llevó a cabo sus análisis, dejando una incerteza que probablemente ha contribuido a la divergencia de abordajes practicados en la actualidad por analistas Junguianos. Este artículo considera la implicancia de estas divergencias para la práctica Junguiana contemporánea y propone una manera de trabajar en el espíritu Junguiano que mantiene una conexión con la dimensión simbólica mientras que al mismo tiempo permanece centrado en las complejidades de las dinámicas personales y relacionales.

Use of autologous adipose tissue in acute burn wound management: A systematic review.

Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in burn wounds and reconstructive surgery. The present systematic review aimed to evaluate the effectiveness of autologous fat transfer for acute burn wound management. A systematic review of the US National Library of Medicine, Cochrane Library, Web of Science, and Embase was conducted on October 15, 2022 (registration number CDR42022369726). A database watch was performed until submission of the manuscript. The review focused on wound healing. All studies reporting fat transfer in adult patients (at least 5 patients reported) with deep 2nd degree burn wounds were included. The database search yielded a total of 720 records and 367 patients were included from 3 studies. A statistically significant improvement in scar texture, scar appearance, and time to healing was reported in one study in the fat transfer group versus control (P<0.001). Similarly, scores for scar color, scar thickness, scar stiffness, and scar regularity increased significantly. The small number of included studies and their heterogeneity did not allow a meta-regression to be performed. This systematic review emphasizes the limited evidence currently available regarding the use of autologous fat transfer to improve burn wound healing in adult patients, even though it seems promising. Future search should focus on randomized controlled trials with a larger number of participants.

[Tracking transfers of resistance-carrying bacteria between animals, humans and the environment]. / Tracking des transferts des bactéries porteuses de résistances entre animal, homme et environnement.

The fight against antibiotic resistance must incorporate the "One Health" concept to be effective. This means having a holistic approach embracing the different ecosystems, human, animal, and environment. Transfers of resistance genes may exist between these three domains and different stresses related to the exposome may influence these transfers. Various targeted or pan-genomic molecular biology techniques can be used to better characterise the dissemination of bacterial clones and to identify exchanges of genes and mobile genetic elements between ecosystems.

La lutte contre la résistance aux antibiotiques doit intégrer le concept «  Une seule santé  ¼ pour être efficace. Ceci consiste à avoir une approche holistique embrassant les différents écosystèmes, homme, animal et environnement. Des transferts de gènes de résistance peuvent exister entre ces trois domaines et différents stress liés à l'exposome peuvent influencer ces transferts. Différentes techniques de biologie moléculaire ciblées ou pan-génomiques peuvent être mises en œuvre pour mieux caractériser les circulations de clones bactériens mais aussi pour identifier les échanges de gènes et d'éléments génétiques mobiles entre écosystèmes.

An alternative method to reconstruct grade-3 hypoplastic thumb by hemi-metacarpal transfer.

We designed a new method using hemi-longitudinal second metacarpal bone to reconstruct grade-3 hypoplastic thumbs. Seven patients were treated in two stages. In the first stage, the second metacarpal was split longitudinally and transferred to reconstruct the first metacarpal. In the second stage, opponensplasty was performed by transferring the FDS tendon. Bone union was achieved in all cases. All patients could oppose to their middle finger at least. They managed to do daily activities such as writing, eating, using smartphones and so on. This is a useful procedure to preserve a 5-digit hand with good function in treating grade-3 hypoplastic thumbs, with no harm to the foot and no need for vascular anastomosis. LEVEL OF EVIDENCE: IV.

[Breast restoration by the lipomodeling technique after breast sequelae following complications of reduction mammoplasty]. / Rattrapage des séquelles esthétiques de réduction mammaire par la technique du lipomodelage.

BACKGROUND: Complications of reduction mammoplasty can lead to aesthetic sequelae, which are known to be difficult and delicate to treat, and only a few articles deal with this subject. PURPOSE: The objective of this article is to present and analyze our experience of lipomodeling for the secondary management of aesthetic sequelae occurring after a complication of reduction mammoplasty. MATERIAL AND METHODS: An uniform and consecutive series of 22 female patients, operated with the lipomodeling technique from December 2003 to March 2019 by the last author, to correct aesthetic sequelae after secondary complications of reduction mammoplasty was studied analyzing the efficiency and the tolerance of this technique. RESULTS: The results showed 86.4% of very good results and 13.6% of good results. Seventeen patients (77.3%) were highly satisfied with the postoperative outcome, and 5 patients were satisfied (22.7%). The number of procedures varied from 1 to 3: 15 patients (68.2%) underwent only one session of lipomodeling, 5 patients (22.7%) underwent two sessions, and 2 patients (9.1%) underwent three sessions. The mean time between two interventions was 4 months (3-12). No patient of this series initiates any medico-legal proceeding towards the first surgeon. CONCLUSION: After this study, lipomodeling, in association with ancillary procedures, seems to be an effective and safe solution to correct aesthetic sequelae following secondary complications of reduction mammoplasty. It should have a key role for the correction of these sequelae. An effective and appropriate care of these patients leads to good results and patients' final satisfaction, and manages to avoid any medico-legal proceeding, always badly lived as much for the patient as for the first surgeon.

Transferência e contratransferência: os efeitos clínicos do observador no trabalho em grupos terapêuticos / Transference and countertransference: the observer's clinical effects in therapeutic groups / Transfert et contre-transfert: les effets cliniques de l'observateur dans les groupes thérapeutiques / Transferencia y contratransferencia: los efectos clínicos del observador en el trabajo con grupos terapéuticos

O propósito deste artigo é refletir sobre os conceitos de transferência e contratransferência, articulando-os com a dimensão clínica do lugar do observador no trabalho em grupos terapêuticos. Inicialmente, será feito um percurso histórico sobre tais conceitos na psicanálise. Posteriormente, a noção de transferência será discutida como um vínculo que pode se manifestar pela via da expressão corporal e sensorialidade, enquanto a contratransferência será analisada a partir do campo da intersubjetividade. Esses aspectos serão ilustrados por duas vinhetas clínicas

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

Cet article reflète aux concepts de transfert et de contre-transfert en articulation avec la dimension clinique de la place de l'observateur dans les groupes thérapeutiques. D'après un aperçu historique de ces concepts en psychanalyse, on discute la notion de transfert en tant que lien qui peut se manifester par l'expression corporelle et la sensorialité. Le contre-transfert, à son tour, sera analysé à partir du domaine de l'intersubjectivité. Ces aspects seront illustrés par deux vignettes cliniques

El propósito de este artículo es reflexionar sobre los conceptos de transferencia y contratransferencia articulándolos con la dimensión clínica del lugar del observador en el trabajo con grupos terapéuticos. Inicialmente, se hará un recorrido histórico sobre tales conceptos en el psicoanálisis. Posteriormente, la noción de transferencia será discutida como vínculo que puede manifestarse por la expresión corporal y la sensorialidad, mientras que la contratransferencia será analizada a partir del campo de la intersubjetividad. Estos aspectos serán ilustrados por dos viñetas clínicas

Transferência e a clínica psicanalítica das psicoses / Transference and the psychoanalytic clinic of the psychosis / La transferencia y la clínica psicoanalítica de las psicosis / Transfert et la clinique psychanalytique des psychotiques

Resumo: Desde o início do desenvolvimento de sua teoria, Freud observara que os psicóticos não respondiam ao tratamento psicanalítico, levando à ideia de que à psicose corresponderia um mecanismo de constituição diferente. Aos poucos, a transferência passou a ser alvo da investigação que conduzisse à descoberta de um modo a lidar com a psicose. Mas as descobertas freudianas foram insuficientes para se estabelecer um laço transferencial satisfatório para os psicóticos. Com Jacques Lacan, alguns conceitos freudianos sofreram modificação, com a criação de operadores próprios, surgindo a erotomania, consequência estrutural e lógica do vínculo entre analista e psicótico. Sendo assim, este artigo busca demonstrar uma clínica possível, sob a perspectiva psicanalítica, para o tratamento da psicose, a partir do estabelecimento do laço transferencial, por meio do manejo apropriado do gozo, que promova estabilização e consiga mitigar o sofrimento, como saída possível para o problema da indicação do tratamento psicanalítico aos psicóticos.

Résumé : Au début de ses développements théoriques, Freud a observé que les psychotiques ne répondaient pas au traitement psychanalytique, indiquant qu'un mécanisme de formation différent correspondrait à la psychose. Progressivement, le transfert est devenu la cible de la découverte d'une manière pour faire face à la psychose. Jacques Lacan a modifié certains concepts freudiens pour crée des opérateurs propres et a inventé l'érotomanie, la conséquence structurelle et logique de la relation entre analyste et psychotique. Cet article propose une clinique possible, dans la perspective psychanalytique, comme solution possible au traitement de la psychose à partir de l'établissement du transfert par le biais du maniement approprié de la jouissance qui conduise à la stabilisation.

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

Resumen: Desde el comienzo del desarrollo de su teoría, Freud observó que los psicóticos no respondían al tratamiento psicoanalítico, lo que dio lugar a la idea de que la psicosis correspondía a un mecanismo de formación diferente. Gradualmente, la transferencia se convirtió en el objetivo de la investigación que podría conducir al descubrimiento de una manera peculiar para hacer frente a la psicosis. En el estudio de Jacques Lacan, algunos conceptos freudianos se han modificado con la creación de operadores propios, y emergió la erotomanía como consecuencia estructural y lógica de la relación entre el analista y el psicótico. Así, este artículo busca demostrar una posible clínica desde una perspectiva psicoanalítica para el tratamiento de la psicosis, basada en el establecimiento del vínculo transferencial, a través del adecuado manejo del goce que promueva la estabilización y logre mitigar el sufrimiento, como una posible salida al problema de indicar tratamiento psicoanalítico a los psicóticos.

[Identification and transfer movements among caregivers in neonatal and pediatric intensive care]. / Les mouvements d'identification et de transfert chez les soignants en réanimation néonatale et pédiatrique.

Acute care in neonatal and pediatric intensive care units calls into play transferential and identificatory movements in caregivers. To combat burnout and protect themselves from this potentially frightening clinic, they implement defense and sublimation mechanisms.

Tendon transfer from a re-innervated triceps to the biceps for restoration of elbow flexion in total brachial plexus palsy.

OBJECTIVES: This study aimed to evaluate the outcomes of the tendon transfer from a reinnervated triceps to biceps in the context of total brachial plexus palsy. METHODS: We conducted a retrospective study. Patients had reinnervation of the triceps either by spontaneous recovery or by nerve transfer. Functional results were assessed by strength and range of motion. The level of patient satisfaction was measured on a scale from 0 to 10. RESULTS: Six patients (6 transfers) were included. Two triceps had spontaneous reinnervation and the other four through neurotization of intercostal nerves. All patients recovered strength to M4 in flexion with an average secondary deficit of 10° (5°-15°). The mean level of satisfaction was measured at 7/10 (6-8). CONCLUSIONS: This tendon transfer is a reliable and simple solution for supportive restoration of elbow flexion. Systematic reinnervation of active extension of the elbow should be proposed for the gain in function that it represents but also for the supportive therapeutic opportunity that it offers should nerve surgery for elbow flexion fail.

[Lipofilling in the management of breast cancer: An update based on a literature review and national and international guidelines]. / Le lipomodelage du sein dans un contexte cancérologique : mise au point à partir d'une revue de littérature actualisée et des référentiels nationaux et internationaux.

BACKGROUND: Lipomodelling (LM) is an increasingly used technique to reconstruct or correct an aesthetic defect linked to a loss of substance. In France, the Haute Autorité de santé (HAS) published recommendations in 2015 and 2020 concerning the conditions of use of LM on the treated and contralateral breast. These appear to be inconsistently followed. METHODS: Twelve members of the Senology Commission of the Collège national des gynécologues-obstétriciens français (French College of Gynecologists and Obstetricians) reviewed the carcinological safety of LM and the clinical and radiological follow-up of patients after breast cancer surgery, based on French and international recommendations and a review of the literature. The bibliographic search was conducted via Medline from 2015 to 2022, selecting articles in French and English and applying PRISMA guidelines. RESULTS: A total of 14 studies on the oncological safety of LM, 5 studies on follow-up and 7 guidelines were retained. The 14 studies (6 retrospective, 2 prospective and 6 meta-analyses) had heterogeneous inclusion criteria and variable follow-up, ranging from 38 to 120 months. Most have shown no increased risk of locoregional or distant recurrence after LM. A retrospective case-control study (464 LMs and 3100 controls) showed, in patients who had no recurrence at 80 months, a subsequent reduction in recurrence-free survival after LM in cases of luminal A cancer, highlighting the number of lost to follow-up (more than 2/3 of luminal A cancers). About follow-up after LM, the 5 series showed the high frequency after LM of clinical mass and radiological images (in » of cases), most often corresponding to cytosteatonecrosis. Most of the guidelines highlighted the uncertainties concerning oncological safety of LM, due to the lack of prospective data and long-term follow-up. DISCUSSION AND PERSPECTIVES: The members of the Senology Commission agree with the conclusions of the HAS working group, in particular by advising against LM "without cautionary periods", excessively, or in cases of high risk of relapse, and recommend clear, detailed information to patients before undergoing LM, and the need for postoperative follow-up. The creation of a national registry could address most questions regarding both the oncological safety of this procedure and the modalities of patient follow-up.

Observing and interpreting clinical process: Methods and findings from 'Layered analysis' of parent-infant psychotherapy.

This paper describes a method for investigating clinical process, Layered Analysis, which combines therapist countertransference reports and multi-faceted microanalytic research approaches. Findings from the application of Layered Analysis to video-recorded micro-events of rupture and repair in four psychoanalytic parent-infant psychotherapy sessions are presented. Layered analysis showed that countertransference and observation are complementary perspectives, which enable concomitant study of interactive events, conscious internal experiences, as well as nonconscious and unconscious elements of therapeutic interaction. Interactional rupture and repair were found to constitute co-constructed micro-events that occurred fleetingly and often implicitly, and differed in the structure, coherence and flow of interactions and in the relationship between verbal and nonverbal communication. Furthermore, interactional ruptures were found to sometimes 'get into' the therapist and transiently disrupt their self-organization, such that the therapist became a locus of disruption for the patient(s), actively contributing to the rupture, which thus became embedded in the therapeutic system. Interactive repair was found to be most often initiated by the therapist and to be underpinned by the therapist re-establishing self-regulation, through metabolizing embodied and verbal aspects of the rupture. Studying such processes can enhance our understanding of clinical process, inform therapist training and clinical supervision, and contribute to clinical outcomes.

Este ensayo describe un método para investigar un proceso clínico, Análisis en Capas, el cual combina los reportes de contratransferencia del terapeuta y los acercamientos investigativos micro analíticos multifacéticos. Se presentan los resultados de aplicar Análisis en Capas a micro eventos, grabados en video, de ruptura y reparación en cuatro sesiones de sicoterapia sicoanalítica de progenitor e infante. Los Análisis en capas mostraron que la contratransferencia y la observación son perspectivas complementarias que, en combinación, permiten el estudio concomitante de eventos interactivos, experiencias internas conscientes, así como elementos no conscientes de la interacción terapéutica. Adicionalmente, los resultados mostraron que la ruptura y la reparación constituyen micro eventos co-construidos que ocurren muy fugazmente y a menudo implícitamente, y que difieren en la estructura, coherencia, flujo de interacciones y en la relación entre la comunicación verbal y no verbal. Es más, rupturas interaccionales pueden 'meterse en' el terapeuta y transitoriamente interrumpir su autoorganización, de manera que el terapeuta se convierte en un punto de interrupción para el paciente y la ruptura pasa a ser parte del sistema terapéutico. La reparación interactiva está sostenida por, y depende de, la metabolización del terapeuta de los aspectos incorporados y verbales de la ruptura. Estudiar tales procesos puede mejorar nuestra comprensión del proceso clínico y ser usado en entrenamiento y supervisión de terapeutas.

Cet article décrit une méthode d'investigation du processus clinique d'Analyse Multidimensionnelle en Couches, qui combine des rapports de contre-transfert du thérapeute et des approches de recherche micro-analytique à facettes multiples. Les résultats de l'application de l'analyse multidimensionnelle en couches à des micro-événements enregistrés à la vidéo de rupture et de réparation dans quatre séances de psychothérapie psychanalytiques parent bébé sont présentés. L'analyse multidimensionnelle en couches a montré que le contre-transfert et l'observation sont des perspectives complémentaires qui, combinés l'un avec l'autre, permettent une étude concomitante d'événements interactifs, d'expériences internes conscientes et d'éléments non-conscients de l'interaction thérapeutique. De plus, les résultats ont montré que la rupture et la réparation constituent des micro-événements co-construits, qui se passent très fugacement et souvent implicitement et diffèrent en structure, cohérence et flux des interactions et dans la relation entre la communication verbale et non verbale. Enfin les ruptures interactionnelles peuvent 'entrer' dans le thérapeute et perturber de façon transitoire leur auto-organisation, de telle manière que le thérapeute devient le locus de la perturbation pour le/la/les patient(e/s) et la rupture s'encastre dans le système thérapeutique. La réparation interactive est étayée par, et elle en dépend également, la métabolisation d'aspects verbaux et incarnés de la rupture du thérapeute. L'étude de tels processus peut améliorer notre compréhension du processus clinique et être utilisée dans la formation et la supervision des thérapeutes.

[Emergency room transfers for residents of the 16th arrondissement of Paris]. / Transferts aux urgences des résidents d'Ehpad du 16e arrondissement de Paris.

Access to care for the population residing in residential facilities for dependent elderly people (Ehpad), i.e. 600,000 people in France in 2019, is a major public health issue. Description of the characteristics and pathways of the residents of Ehpad transferred to the emergency department (SAU) in the Paris 16th district.

[The adventure of speech]. / L'aventure de la parole.

The step of going to a therapist is the fruit of a contingency of life, a painful reality, sometimes hardly noticeable and which becomes repetitive or unbearable. The therapist takes support on this adventure which begins in order to reveal the object which is nestled in the patient's speech. To orientate this work, the transference, the symptom and the part of jouissance are crossed. The adventure of speech thus takes the risk of going towards the intimate, present in what makes suffering. A psychoanalytical point of view is precious to enlighten the stakes of the relational field.

Exploring decision makers' knowledge, attitudes and practices about decentralisation and health resources transfer to local governments in Burkina Faso.

In the health sector, decentralisation mainly consists of the devolution of administrative functions to local governments. Since 2009, Burkina Faso has engaged in a process to transfer health resources to local governments. This study examines the decision-makers' knowledge, attitudes and practices (KAP) about the decentralisation and health resources transfer to local governments in Burkina Faso. We used a qualitative research method. In-depth semi-structured interviews were conducted with key decision-makers. The data collected went through a directed qualitative content analysis. Findings suggest that all respondents are aware of the rationale of the decentralisation and resources transfer to local governments. The vast majority of respondents have a positive opinion towards decentralisation and the main elements that appear to be motivating their attitude, are the expected outcomes from decentralisation. The practical experience was limited to awareness raising, training, supervision, technical assistance and resources mobilisation. Poor collaboration between health districts and local governments, the control of certain resources by the state and the health districts constrain the implementation of health resources and skills transfer policy at grassroots level. Careful attention should be given to the country's political context and institutional design.