[Ethical considerations for children living with their imprisoned mothers]. / Réflexions éthiques autour des enfants vivant auprès de leurs mères incarcérées.

In France, pregnant women or women with children under the age of 18 months, and in exceptional cases 24 months, can serve their prison sentences in specially equipped nurseries or mother-child cells. This situation is likely to have a negative impact on the child's health, and on the quality of the bond with the mother over the longer or shorter term. The benefits of maintaining this bond are indisputable, whatever the setting. Improvements to this system could be considered and implemented.

How parents experience their adolescent's disclosure of previous sexual abuse: a qualitative study.

INTRODUCTION: Parents whom adolescents disclose sexual abuse face both a personal traumatic experience, and the need to support their child who is going through a grueling period and needs them. Many quantitative studies exploring the psychological impact of disclosure on parents have been conducted, but few have used qualitative methods. The objective of this study is to explore parents' experiences of their adolescent's disclosure of sexual abuse during psychiatric care, identify the possible beneficial factors and shortcomings, share this knowledge, and improve interventions for these families. METHODS: We conducted semi structured interviews with parents whose children disclosed sexual abuse during their psychiatric care in Paris and analyzed these interviews using a phenomenological framework (interpretative phenomenological analysis). RESULTS: This study analyzed 13 semi structured interviews of 9 mothers and 4 fathers whose children were then aged 14 to 17 years. Qualitative analysis uncovered three themes: (1) Parents: alerts and search for support; (2) Between parents and adolescents: a disruption in relationships linked to the disclosure and its legal consequences; (3) Disclosure at the family level: the possible reactivation of a traumatic past and the search for a new equilibrium. CONCLUSIONS: Considering the parental experience is essential in caring for adolescent patients after they disclose sexual abuse. The need for parental or family psychological support should be systematically assessed. Possible resurgence of parental trauma requires psychiatrists' careful consideration.

Asserting a Functional Neurological Symptom Disorder with a Complementary Diagnostic Approach: A Brief Report.

INTRODUCTION: Functional neurological symptom disorder (FNSD) is a common diagnosis among adolescents. However, we feel it is a difficult diagnosis to assess because of the diversity of its clinical manifestations, the rapid changes in its nosography over the years, and its common imbrication with established somatic diagnoses. We would like to illustrate this hypothesis through a case presentation and the original diagnostic process that emerged from it. METHODS: We chose to present our diagnosis approach through the case of an 11-year-old boy who showed a progressive loss of motor and sensory function to the point of total dependency, and then suddenly switched between this state and a "normal" physical presentation, while deliriously claiming to be an angel. RESULTS: All possible infectious, autoimmune, metabolic, and toxic disorders were ruled out. After the successive therapeutic failures of antidepressants and neuroleptics, FNSD was diagnosed. CONCLUSION: The DSM-5-TR classification was insufficient to explain the full clinical picture and a complementary approach (biblical, psychoanalytical, and historical) was used to analyze the cause of this atypical presentation.

Resources and Obstacles of a Maternity Staff Facing Intimate Partner Violence during Pregnancy-A Qualitative Study.

INTRODUCTION: Intimate partner violence occurring during pregnancy has a similar prevalence as usual obstetrical disorders that are routinely screened for. Referenced publications insist on the importance of adequate screening, but the proper course of action has yet to be defined. AIM OF STUDY: We qualitatively explored the different resources and concepts that emerge from the discourse of maternity staff across professions. MATERIAL AND METHODS: We led a semi structured interview with professionals, which included following their involvement with preselected patients. Nine professionals provided a sample of 19 interviews. The data was analysed using IPA methodology. Results We highlight the investigative importance of navigating the patient's initial demand or lack thereof and the baby's importance within, while identifying mechanisms of maternal disqualification. Creating an atmosphere prone to patient empowerment was the final theme to emerge from the study as the most beneficial tactic both in the short and long term. CONCLUSIONS: HCPs need to enable patients' trust on a personal and an institutional level, as well as empowering the patient in the moment and respecting their values and choices. HCPs also convey the stability of the institution that has become a reference of refuge and assistance for patients from their pregnancy onwards.

Three-level containment model of hospitalized adolescents with borderline pathology: a holistic therapeutic perspective.

Borderline personality disorders account for 50% of adolescent hospitalization cases in psychiatry. The severity and psychopathological complexity of these symptoms indicate the need for inclusive models of understanding. Adopting a holistic approach allows for the consideration of not only the patient's environment, but also their position within that environment and their life history. In this article, a model based on the concept of therapeutic containment at three levels is presented. Global containment refers to the mindset and organization of the institution that provides care, which is itself a part of society at a specific time. Local containment focuses on understanding and therapeutic interventions within the immediate social environment of the individual. Lastly, individual containment encompasses the development of independent processes during the course of care. These three levels are integrated in the hospital treatment of borderline personality disorders, forming a trans-theoretical approach.

Transcultural skills for early childhood professionals.

Context: Transcultural skills are especially useful for those involved in the perinatal period, when parents and babies must adapt to one another in a setting of migration a long a focus of transcultural clinical practice. Objective: The aim of this article is to provide useful transcultural skills for any health care worker (e.g., psychologists, child psychiatrists, midwives, family doctors, pediatricians, specialized child-care attendants, and social workers) who provide care or support to families during the perinatal period. It highlights the cultural aspects requiring attention in relation to representations of pregnancy, children's needs, obstetric complications, and postnatal problems. Taking into account the impact of culture on clinical evaluation and treatment can enable professionals to distinguish what involves cultural representations of pregnancy, babies, and sometimes of disease from what is associated with interaction disorders or maternal psychopathology. Methods: After explaining the relevance of transcultural clinical practices to provide migrant mothers with better support, we describe 9 themes useful to explore from a transcultural perspective. This choice is based on the transcultural clinical practice in our specialized department. Results: The description of these 9 themes is intended to aid in their pragmatic application and is illustrated with short clinical vignettes for specific concepts. We describe situations that are extreme but often encountered in liaison transcultural clinical practice for maternity wards: perinatal mourning with cultural coding, mediation in refusal of care, cultural misunderstandings, situations of complex trauma and of multiple contextual vulnerabilities, and difficulties associated with acculturation. Discussion: The transcultural levers described here make it possible to limit cultural misunderstandings and to promote the therapeutic alliance. It presupposes the professionals will concomitantly analyze their cultural countertransference and acquire both the knowledge and know-how needed to understand the elements of cultural, political, and social issues needed to develop clinical finesse. Conclusion: This combined theoretical-clinical article is intended to be pedagogical. It provides guidelines for conducting transcultural child psychiatry/psychological interviews in the perinatal period aimed at both assessment and therapy.

Migrant mothers' experiences of Caesarean section: a transcultural qualitative study.

Objectives: Migrant women face an increased risk of adverse obstetrical outcome and Caesarean section. The psychological experience of Caesarean section combines physiological, social, and cultural dimensions. This qualitative study explores the subjective experiences of first-generation migrant women who gave birth by Caesarean section. Methods: Seven qualitative, semi-directed interviews were conducted from January to March 2022 in a Paris maternity hospital, with women in their postpartum period who had had a scheduled or emergency Caesarean section and straightforward obstetrical outcomes. The presence of an interpreter-mediator was systematically offered. Thematic analysis of the interviews was carried out following the Interpretative Phenomenological Analysis (IPA) methodology. Results: Four themes were identified in the thematic analysis relating to the women's experiences of Caesarean section: (1) The shock of the intervention combines disappointment, fear and early separation from the baby, (2) Pregnancy and delivery far from one's family aggravates the psychological suffering caused by isolation and loneliness related to migration, (3) The lack of cultural representations of Caesarean section leads to negative preconceptions and hinders mental preparation, in contrast with traditional or medicalised childbirth, and (4) The women's experiences of the medical follow-up highlights the importance of the continuity of care. Discussion and conclusion: Caesarean section, which is a physical break, re-enacts the symbolic break (cultural, social, familial) that follows on from emigration. Improvements in care include the need for a better preparation for Caesarean section, active efforts for care continuity, and the development of early prevention interviews and groups in maternity units.

[Relevance of the transcultural approach to improve the care relationship in the perinatal period]. / Pertinence de l'approche transculturelle pour améliorer la relation de soins en période périnatale.

The international literature review highlights higher neonatal morbimortality in migrant patients and their babies. The explanatory hypotheses include late pregnancy follow-up with difficulty accessing care, language barriers, and different cultural representation in pregnancy support. On the one hand, we propose to explain the cultural factors that can impact the caring relationship during the perinatal period. On the other hand, we set out tools for anthropological and psychological understanding to enhance the sharing of cultural representations around pregnancy follow-up, the needs of a baby, and obstetrical or postnatal complications. The request for a specialised transcultural opinion needs to be more systematic; the transcultural posture is adaptable to each care professional. This requires the professional to address explicitly the impact of culture in care and consider their own cultural distance. Specialised advice is recommended in certain situations of cumulative vulnerability (complex trauma, perinatal depression with cultural coding of symptoms), blockage or refusal of care for cultural reasons and to avoid cultural misunderstandings. We detail two modalities: mediation and a discussion group around cultural issues set up in the maternity ward. The institutional work we propose within the multidisciplinary team in the maternity ward also allows the acquisition of transcultural competencies.

The Cultural Hybridization of Mothering in French Prison Nurseries: A Qualitative Study.

In France, women can be incarcerated during pregnancy and can keep their babies with them in prison up to the age of 18 months. The small number of nurseries in France and their unequal geographic distribution as well as the high percentage of foreign prisoners often result in women's isolation from their usual cultural environment. Family members and cultural community play a crucial role in the process of mothering. The aim of this study is to explore through these mothers' narratives how they experience the cultural aspects of this process in the prison environment. We conducted semi-structured interviews to collect the experience of 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. Four different themes emerged: prison: repression of cultural practices, prison: a culture of its own, loss of traditional culture, and cultural hybridization. The specific environmental architecture and operating rules in prison nurseries may induce acute repression regarding cultural ways of mothering. Considering both cultural permeability specific to the peripartum period during which women tend to more easily embrace cultural aspects from their environment, and family distance which restrains cultural transmission, these mothers gather multiple factors of vulnerability for full prisonization, as a form of forced assimilation to prison culture. But a sort of specific hybrid prison culture around motherhood seems to emerge instead, in a process similar to creolization.

Multimodal co-therapy for unaccompanied minors: a qualitative study.

BACKGROUND: Unaccompanied refugee minors-or unaccompanied minors-are children and adolescents who have been separated from parents and other relatives and are not being cared for by an adult. Unaccompanied minors are a vulnerable population, with numerous stressors and complex psychiatric symptoms necessitating specialized mental health care. This study explores patients' experiences of a Multimodal Co-Therapy for Unaccompanied Minors (MUCTUM), which encompasses cultural, biological, narrative & institutional approaches to care. METHODS: MUCTUM is a co-therapy program for unaccompanied minors, with a psychiatrist, psychologist, native-language interpreter, and caseworker for each patient. In this qualitative study, we interviewed adolescents about their experiences with MUCTUM and analyzed these semi-structured interviews using a phenomenological framework (Interpretative Phenomenological Analysis). RESULTS: Qualitative analysis of 16 interviews discovered that unaccompanied minors felt misunderstood before participating in MUCTUM, describing a sense of strangeness and loneliness in relation to psychiatric symptoms. Several youths experienced triple stigmatization: of being unaccompanied minors, of suffering from psychotrauma, and of being mental health patients. We further describe three overarching domains that inform on MUCTUM support to unaccompanied minors: (1) A safe space for unaccompanied minors; (2) Helpful interventions during therapy; and (3) Narrating one's story can "set us free" if guided carefully by care providers. CONCLUSION: This study suggests that MUCTUM therapy may efficiently support unaccompanied minors' mental health by acknowledging their hierarchy of needs. Psychotherapeutic strategies include creating a safe place, providing culturally appropriate care and patient-centered therapy, addressing concrete problems, supporting relationships, and making use of limited reparenting in therapy. Delayed and progressive inquiry about traumatic events may be beneficial. Replication of these findings and their field application is warranted.

How Do We Address and Treat the Trauma of a 16-Year-Old Girl, Unaccompanied Minor, and Her Rape-Born Son? A Case Report.

BACKGROUND: The child psychiatry unit of the Cochin Hospital in Paris is specialized in a transcultural clinical approach and treatment of psychotraumatism. The clinical demands addressed to the service often combine several levels of vulnerability: recent migration, repeated and intentional traumas, isolation and breach in family bonds sometimes precarious living conditions. Mastering how to approach trauma content adapting to the person's temporality while taking into account the individual, family and collective dimensions, is a key driver to the clinical intervention (of our approach). OBJECTIVE AND METHOD: We describe a paradigmatic clinical situation articulating its multidimensional complexity: the case of Céline, a 16-year-old Mozambique teenager, unaccompanied minor (UM), who arrived in France three years ago with her 4-year-old child born out of rape. They are both cared for by Paris Child Welfare Bureau. The authors used the CARE guidelines for a rigorous approach to clinical case writing. RESULTS AND DISCUSSION: In the clinical discussion, we highlight the pertinence of transcultural abilities for the treatment of a complex PTSD (post-traumatic stress disorder). We describe the measures taken to adapt the clinical interview framework to the mother's psychic temporality, while negotiating what can be said in attendance of the child. The idea of tranquility is primordial-whether she decides to tell or not tell the child. Removing the pressure to have to tell is an element of treatment. CONCLUSION: Working through a progressive narrative construction, the therapeutical process allowed for the restoration of multiple levels of continuity between times prior to the trauma and following it, as well as prior to migration and following it, to create a continuum from adolescence to adulthood. Restoring narrativity favors the process of becoming a mother and the one of negotiating this new identity. The therapeutic axes also focused on improving the well-being of the UM-mother and preventing the impacts of transgenerational trauma transmission to the child. For women with similar experiences, sharing their emotions and their stories with us makes their choice about telling their child legitimate and comfortable, regardless of the decision they make.

Migrant adolescents' experience of depression as they, their parents, and their health-care professionals describe it: a systematic review and qualitative meta-synthesis.

Migrant youth are vulnerable and face a risk of internalised disorders such as depression. This qualitative meta-synthesis explores migrant adolescents' experience of depression. 14 studies (7 qualitative studies and 7 case reports) were selected after a systematic search of PubMed, Embase, Scopus and PsycInfo. Their quality was assessed with the Critical Appraisal Tool (CASP) for qualitative studies and the Joanna Briggs Institute (JBI) checklist for case reports. The analysis identified six themes describing the experience of depression among migrant adolescents: (1) the vulnerability factors underlying depressive distress, before, during and after migration; (2) the subjective experience of depression, combining symptoms associated with a form of depression common in the West with symptoms more common in other cultures; (3) two types of aetiological hypotheses to make sense of their distress; (4) attitudes adopted in response to distress; (5) experience of care, especially reasons discouraging investment in care; and (6) impairment of identity construction by breaks in cultural transmission and intergenerational conflicts. The threat of losing their connections both at the interpersonal (connection to family, peers and community) and intrapsychic levels (construction of identity) is inherently linked to migrant adolescents' experience of depression. We propose to adapt Brandenberger's 3C model (communication, continuity of care, and confidence) for the care of young migrants to promote a therapeutic alliance, foster construction of a coherent bicultural identity, and support the family.

[The signs of the heart's suffering inscribed on the body]. / Les signes de la souffrance du cœur inscrits sur le corps.

Adolescence is a particular period during which certain buried sufferings can awaken. Psychosomatic pain represents a significant number of the complaints made by adolescents in pediatric services. In these cases, a multidisciplinary care will be proposed to the young person, in order to help him to recognize and to elaborate his psychic suffering, but also to understand what is hidden under the somatic complaints having no organic etiology.

[Talking groups, a time for growing up]. / Les groupes de parole, un temps pour grandir.

During adolescence, hospitalization, which accompanies the process of separation and individuation, is a time for self-reflection. Within the framework of the weekly discussion group for young people hospitalized at the Maison de Solenn-Maison des adolescents of the Cochin Hospital in Paris, the latter were able, thanks to group containment and its dynamics, to think about their care and to take an active part in it.

[Contributions of discussion groups in the therapeutic education of bulimic disorders]. / Apports des groupes de parole dans l'éducation thérapeutique des troubles boulimiques.

The treatment of patients suffering from bulimic disorders requires a multidisciplinary approach combining a somatic approach and a psychiatric approach. The Maison des adolescents of the Cochin Hospital offers a therapeutic education program focused on the management of compulsive binge eating. Its modalities have been modified over the years in order to better adjust to the needs of these patients. Monthly discussion groups have been added to the individual interviews, and have been key points in structuring the treatment.

[Temporality of individual psychotherapy in adolescents with anorexia nervosa]. / Temporalité de la psychothérapie individuelle chez les adolescents souffrant d'anorexie mentale.

The management of patients suffering from anorexia nervosa involves the intervention of several professionals in a complementary manner. Within the framework of the multidisciplinary approach (somatic, psychiatric, dietetic, family, etc.), several factors must be taken into account in the clinical evolution to establish the indication of an individual psychotherapy in the most efficient way possible.

[Mothers, precious allies in the support of adolescents]. / Les mères, alliées précieuses dans l'accompagnement des adolescents.

The Maison des adolescents of the Cochin Hospital in Paris is a multidisciplinary structure with a transcultural sensitivity. It welcomes young people, but also their families, and take into account their unique backgrounds. From the reception of the adolescent by the consultation nurse to the implementation of specific care in a transcultural group, the care pathway sometimes requires the mother-adolescent dyad to be carried along in order to achieve an appeasement of the sufferings of each.

["The temporality of victims of sexual abuse is longer than the legal obligation of the institution."] / « La temporalité des victimes d'abus sexuels est plus longue que celle de l'obligation légale de l'institution ¼.

From her six years of experience as a social worker at the Maison des adolescents de l'hôpital Cochin in Paris, Irène Jarry has developed the know-how to help caregivers report and support adolescents and their families. In recent years, the care team has reported a steady increase in disclosures of sexual abuse. Irène Jarry provides us with tools to best accompany these young people, while taking into account the traumatic context and its consequences, before reminding us of the useful foundations for any professional.