Establishing a therapeutic relationship: An initial stake in psychotherapy with young psychotic adults.

Although psychosis and psychoanalysis have been closely linked since the earliest Freudian theories, the psychoanalytic treatment of psychotic states still presents major difficulties. The establishment of a therapeutic situation allowing the deployment of psychic work is still uncertain. The resumption of the work of S. Freud and DW. Winnicott associated with the development of the theorization of a metapsychology of the process of symbolization by the French school (Green, Roussillon) allows a revival of the reflection on the stakes of the establishment of the therapeutic situation. This theorization of representative processes makes it possible to consider the psychotherapeutic approach to psychoses from the angle of a "psychopathology of the psychic apparatus" and thus to model the psychic dynamics involved in psychotic problems which initially appear in a chaotic form. The apparent failure of the psychic processes, in their linking and transforming activity with which the psychotic states are confronted, can then be thought of as the seat of a particular psychic work that can provide essential support to the therapeutic work. Two cases studies illustrate these processes.

International Health Practices: A Multidisciplinary Approach to Therapeutic Mediations With an Artistic Medium Based on the Model of Play.

This article, corresponding to a part of the restitution of a financed international research project between France, Brazil, Canada, Italy and Belgium, aims to offer a modelisation and qualitative evaluation of mediation care settings based on an original methodological tool that involves identifying the typical games at the foundations of creativity, following a multidisciplinary perspective. Therapeutic mediations are settings or devices organized around a "pliable medium," often artistic, like painting, modeling, writing and theater, which are very widespread in institutional practices, both in France and abroad. The scientific objectives of this research consist in a multi-disciplinary exploration (anthropology, criminology, neuroscience, clinical psychology) of the process of creative symbolization understood as a process of transformation involving play. According to this orientation, play can be defined as a psychic process whereby a subjective experience can be explored with pleasure, and consequently symbolized and appropriated. Our fundamental and original hypothesis is that play is at the source of the creative process, conceived as a work of metabolization by the psyche of playful experiences during the different stages of life. The review of the understanding of play in psychoanalysis, anthropology, criminology and neuroscience emphasizes the richness of this model and the importance of reflecting on the typical games in the field of psychic care. A clinical example of treatment in a pictorial therapeutic mediation setting of a child with psychotic disorders makes it possible to identify a number of typical games as well as the modalities of interpretation of the therapists through play. These multidisciplinary studies lead to the presentation of a general table of typical games, and these first results highlight the richness of identifying typical games in clinical settings. Ultimately, the multidisciplinary approach shows the interest of the model of play in the evaluation of therapeutic mediation settings, with a convergence of the different disciplines emphasizing the pertinence of this model. The scientific impact of this research overlaps with its societal impact, through the development of innovative tools for evaluating therapeutic mediations, in order to take account of the evolution of the different forms of social expression of psychic suffering.