Fifty Years of Change: A Shared Journey.

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.

Shared Fragility-Contemplating the Impact of Patients' Suicides on Clinicians.

The experience of patient suicide can have a profound impact on clinicians, yet there are limited opportunities for them to express and process their emotional responses. We organized a reflective group session for psychiatrists in Singapore who had encountered patient suicides. Ten psychiatrists participated, with five in the "inner" group (those who had experienced patient suicide) and the remaining five forming the "outer" group. Led by a senior psychiatrist trained in psychodynamic psychotherapy, the inner group shared their reflections on patient suicides, while the outer group provided their insights thereafter. Participants provided written feedback about their session experiences. The session was recorded, transcribed, and analyzed to identify key themes. Three main narrative themes emerged from the analysis. Firstly, there was the acute response to the suicide, involving intense emotional reactions. Secondly, the relationship between clinicians and patients with suicidal thoughts was explored, encompassing countertransferential responses, superego defenses, and resulting anxiety. Lastly, the study examined how clinicians feel about suicidality itself, shedding light on complex attitudes and perceptions. Our findings confirm previous research, indicating that the response to patient suicide is stressful and traumatic for clinicians, who grapple with emotions such as grief, guilt, incompetence, and fear. Moreover, we delve into the intricate connections clinicians have with the concept of suicidality, shaped not only by their own experiences but also by the insights of those who have yet to confront patient suicide. The reflections shared by the participants emphasize the significance of establishing therapeutic spaces for clinicians to process these complex emotions effectively.

The Impact of Patient Suicide on Clinicians.

The experience of patient suicide on clinicians is associated with complex affective states that include grief, guilt, shame, and fear and distressing subjective experiences of incompetence and helplessness. The authors review the literature of the subject and highlight the work of Rajagopalan and colleagues in Singapore, who implemented a one-time reflective group session to help clinicians process the experience of patient suicide to reduce psychological distress and prevent burnout and moral injury.

Franco Battiato's Song "La Cura": A Clinical Reflection.

"La Cura" is one of the tracks in Franco Battiato's L'Imboscata album (1996), the 19th published by the Italian composer and songwriter, who died 3 years ago. In the lyrics several references to psychiatric terminology appear. The purpose of this article is to consider the lyrics of the song from psychodynamic and mental health care perspectives and offer associations that reflect the process of forming a therapeutic alliance with patients.

Liderança no exercício docente no ensino superior: um olhar psicodinâmico / Leadership in teaching in higher education: a psychodynamic perspective / Liderazgo en la enseñanza en la educación superior: una perspectiva psicodinámica

O trabalho docente representa um campo fundamental na sociedade, dada sua importância na formação de futuros profissionais e, especialmente, cidadãos. Dessa forma, a intenção do presente artigo consiste em levantar as questões oriundas do exercício de liderança na atribuição docente e refletir acerca desta liderança no Ensino Superior no que tange à sua importância para o processo formativo, bem como a inspiração que esse ofício pode proporcionar aos educandos, partindo da ideia de que a docência é um exercício de liderança. A proposta metodológica com que analisamos tal exercício, consiste na perspectiva qualitativa de caráter descritivo-analítico. Dois professores foram entrevistados por meio de um roteiro semi-dirigido com vistas a levantar e compreender as experimentações oriundas de suas trajetórias de vida que culminaram no trabalho docente que atualmente exercem. Como fundamentação teórica e metodológica de análise, utilizou-se a Psicodinâmica do Trabalho, por seu olhar quanto aos modos de ser dos sujeitos provocados pelo encontro com o trabalho e as exigências pertinentes aos processos deste. Como resultado, a amostra revelou significativa concordância com os aspectos de liderança na prática docente que exercem, embora reiterassem que existem consideráveis dificuldades nesse ofício. Essa clareza requer uma mobilização por parte dos professores líderes que por vezes se sentem sobrecarregados e redescobrindo meios de não adoecerem. Tais resultados têm potência para que novos estudos sejam elaborados no sentido de ampliar a discussão e contribuir para ações docentes, mas, sobretudo, humanas, melhores e mais afetivas.(AU)

Teaching work represents a fundamental field in society, given its importance in the training of future professionals and, especially, citizens. In this way, the intention of this article is to raise the matters arising from the exercise of leadership in teaching assignments and to reflect on this leadership in Higher Education in terms of its importance for the training process, as well as the inspiration that this craft can provide to students, based on the idea that teaching is an exercise in leadership. The methodological proposal with which we analyze this exercise consists of a qualitative perspective of a descriptive-analytical nature. Two teachers were interviewed through a semi-guided script which intended to raise and understand the experiences arising from their life trajectories that culminated in the teaching work they currently perform. As a theoretical and methodological basis for the analysis, the Psychodynamics of Work was used, due to its view on the subjects' ways of being, provoked by the encounter with work and the demands pertinent to its processes. As a result, the sample revealed significant agreement with the aspects of leadership in their teaching practice, although they reiterated that there are considerable difficulties in this job. This clarity requires mobi-lization on the part of leading teachers who sometimes feel overwhelmed and rediscover ways not to get sick. Such results have the power for new studies to be developed in order to broaden the discussion and contribute to teaching actions, but, above all, human, better and more affective actions. (AU)

El trabajo docente representa un campo fundamental en la sociedad, dada su importancia en la formación de los futuros profesionales y, en especial, de los ciudadanos. De esta forma, la intención de este artículo es plantear las cues-tiones derivadas del ejercicio del liderazgo en la tarea docente y reflexionar sobre este liderazgo en la Educación Superior en cuanto a su importancia para el proceso formativo, así como la inspiración que este oficio puede brindar a los estudiantes, partiendo de la idea de que enseñar es un ejercicio de liderazgo. La propuesta metodológica con la que analizamos este ejercicio consiste en una perspectiva cualitativa de carácter descriptivo-analítico. Se entrevistó a dos docentes a través de un guion semidirigido con miras a plantear y comprender las experiencias surgidas de sus trayectorias de vida que culminaron en la labor docente que desempeñan actualmente. Como base teórica y metodológica para el análisis, se utilizó la Psicodinámica del Trabajo, por su mirada sobre las formas de los sujetos de ser provocados por el encuentro con el trabajo y las exigencias propias de sus procesos. Como resultado, la muestra reveló un acuerdo significativo con los aspectos de liderazgo en su práctica docente, aunque reiteraron que existen dificultades considerables en este trabajo. Esta claridad requiere movilización por parte de los docentes líderes que a veces se sienten abrumados y redescubriendo formas de no enfermarse. Tales resul-tados tienen el poder de que se desarrollen nuevos estudios para ampliar la discusión y contribuir a la acción docente, pero, principalmente, a la acción humana, mejor y más afectiva. (AU)

Eight 'truths' about suicide.

This paper summarises themes that have emerged from 14 years of study of suicide and work with those bereaved. It is based on a talk given in many clinical settings over the past 10 years. I describe my own emotional journey following impactful deaths and summarise personal 'truths' about suicide that have emerged over time. Case studies used for illustration are composites taken from clinical practice; accounts of relatives and other survivors of suicide; and data taken from many sources including suicide audits in mental health organisations, the police and transport services, and from the examination of coroners' records. The intention is to assist open dialogue about the nature of suicide, to contribute to the understanding of the impact on those bereaved and to encourage open-hearted clinical engagement with those who are suicidal.

Freudian robots: Artificial intelligence and psychodynamics.

OBJECTIVE: Artificial intelligence (AI) is rapidly developing, particularly human-interacting and affective AI systems. Psychodynamic concepts important to human development should be considered in the development of AI systems. CONCLUSION: The development of safe and ethical affective artificial intelligence that remains meaningful and flexible should incorporate psychodynamic concepts. Mental health professionals such as psychiatrists and psychotherapists should be involved in the development of AI to provide expert knowledge in the area of psychodynamics.

Clinical Implications of Countertransference in the Treatment of Addictions.

The author provides a historical overview of the psychodynamics of addiction with particular emphasis on countertransference awareness and its relationship with treatment outcomes and prognosis. Countertransferences that frequently occur in the treatment of substance use disorders include shared helplessness, hopelessness, sadness, anxiety, fear, anger, rage, shame, and guilt. These emotional states in clinicians may lead to fatigue, avoidance, and acting out unless therapists are able to ground themselves and disidentify with the projected affective states. Positive emotions may lead to excessive enthusiasm in clinicians and deflect from the therapeutic process, resulting in deviation from established practice guidelines. Coexisting negative and positive affective states may lead to rescue fantasies and transgressions of boundaries. Contemporary psychodynamic clinicians appreciate the quantitative aspect of emotional reactions, where countertransferences accumulate exponentially over time, causing allostatic overload and compassion fatigue. Unanalyzed negative countertransferences are linked to either clinical avoidance or aggression, resulting in withdrawing care, failure of empathy, and dissolution or fragmentation of the therapeutic alliance. The negativism associated with the treatment of addictions may be rooted in unanalyzed countertransferences and psychosocial factors such as internalized negative societal attitudes and stigma. Degrading and dehumanizing attitudes toward people with substance use disorders could stem from internalized negative societal constructs against disenfranchised, minoritized, and stigmatized persons. This editorial introduces the work of Bernardine Han, an addiction psychiatrist who utilizes psychodynamic concepts to guide interventions with people with substance use disorders.

Centralidade do trabalho e saúde mental / Centrality of work for mental health

Partindo da noção de trabalho vivo, Christophe Dejours apresenta a tese da centralidade do trabalho para a subjetividade e a saúde mental. Para tanto, traz à baila a discussão sobre: a atividade, a insuficiência da tarefa e a experiência de fracasso diante do real; bem como a inteligência do corpo e a afetividade, marcando sua transformação à medida que realiza a atividade, em uma relação dinâmica entre o corpo, a subjetividade e a atividade. Não sendo o trabalho algo solipsista, tais elementos se entrecruzam em meio a outrem, o que requisita a cooperação e os aspectos complexos da formulação de regras para a própria atividade e demanda a confiança, a deliberação coletiva. É nesse coletivo, no viver juntos, que pode ocorrer o reconhecimento que, realizado sobre o que é feito, permite a realização de si no campo social, voltando-se para quem o faz, para uma identidade, que é o que protege a saúde mental. Na ausência da convivialidade e reconhecimento, o trabalho produz sofrimento patógeno. Desse modo, Dejours demonstra que nunca há neutralidade do trabalho no que diz respeito à subjetividade e à identidade, possibilitando a realização de si ou sua destruição

Based on the notion of living work, Christophe Dejours presents the thesis of the centrality of work for subjectivity and mental health. To do so, he discusses activity, the insufficiency of the task, the experience of failure in the face of reality, and the intelligence of the body and affectivity, marking its transformation as it performs the activity in a dynamic relationship between the body, subjectivity, and the activity. Rather than configuring a solipsistic text, such elements intersect each other, requiring cooperation and the complex aspects of formulating rules for the activity itself, which requires trust and collective deliberation. It is in this collective, in living together, that recognition can occur, which , based on what is done, enables self-realization in the social field, turning to those who do it and to an identity, which is what protects mental health. In the absence of conviviality and recognition, work produces pathogenic suffering. Thus, the author shows that work is never neutral toward subjectivity and identity, enabling self-realization or its own destruction

O custo da beleza: sofrimento e estratégias defensivas de manicures em salões de beleza do Rio de Janeiro / The cost of beauty: suffering and defensive strategies of manicurists in beauty salons in Rio de Janeiro

Este artigo apresenta parte dos resultados de uma dissertação de mestrado cujo objetivo foi compreender as vivências de sofrimento e as estratégias defensivas desenvolvidas por manicures atuantes em salões de beleza. Nesta pesquisa, de caráter qualitativo, conduziram-se entrevistas em profundidade a partir de roteiro semiestruturado com 12 manicures de nove diferentes salões de beleza localizados no município do Rio de Janeiro. As informações levantadas foram analisadas sob a ótica da análise dos núcleos do sentido. Nos resultados, observou-se o agravamento do sofrimento diretamente relacionado às políticas de remuneração praticadas nos salões, à assimilação do ônus do custeamento dos instrumentos de trabalho e à carência de benefícios sociais e trabalhistas. Como estratégias de defesa, observou-se a predominância de estratégias individuais. A pesquisa buscou contribuir para a redução da invisibilização do trabalho de manicures e, a partir da psicodinâmica do trabalho, desvelar a reciprocidade entre as precárias condições de laborais e os fatores geradores de adoecimento psíquico dessas trabalhadoras

This article presents part of the results of a master's degree whose objective was to understand the experiences of suffering and the defensive strategies experienced by manicurists in beauty salons. In this qualitative research, in-depth interviews were conducted based on a semi-structured script with 12 manicurists from nine different beauty salons located in the municipality of Rio de Janeiro. The data obtained were analyzed from the perspective of the analysis of nuclei of sense. The results showed the worsening of suffering is directly related to the remuneration policies practiced in the salons, the assimilation of the burden of funding work instruments, and the lack of social and labor benefits. As defense strategies, the predominance of individual strategies was observed. This research contributes to reduce the invisibility of manicurists' work and, based on the psychodynamics of work, show the reciprocity between precarious working conditions and the factors that generate these workers' mental illness

The Wounded Pilgrim: A Psychodynamic Perspective on Therapeutic Journeys in Search of Healing.

Traveling in search of healing is quite common in Pakistan, where people gravitate toward large urban tertiary-care centers. In this article the authors explore psychodynamic aspects of the therapeutic journey, with respect to the traveler, the healer, and other symbolic aspects of the doctor-patient relationship in the multicultural nation of Pakistan.

Divisão sexual do trabalho no contexto da Polícia Militar: uma análise no campo da psicodinâmica do trabalho / Sexual division of labor in the context of the Military Police: an analysis in the field of work psychodynamics / División sexual del trabajo en el contexto de la Policía Militar: un análisis en el campo de la psicodinámica del trabajo

Este artigo é uma pesquisa teórica que visa a identificar aspectos da divisão sexual do trabalho na inserção de mulheres à Polícia Militar brasileira, articulando-os ao campo teórico da Psicodinâmica do Trabalho. Para isso, nos pautamos em produções acerca da inserção e do cotidiano de mulheres na Polícia Militar. Compreendemos que a forma com que as mulheres policiais dão sentido as suas experiências laborais podem estar atravessadas por uma ideia de exaltação da virilidade, além de outros atributos que são tidos socialmente como masculinos, visto que as instituições militares brasileiras, historicamente, são compostas por um grande valor social, atrelado a uma concepção de bravura, virilidade, força física, heroísmo, entre outras; características que foram associadas à masculinidade e, contemporaneamente, ainda perpassam nosso meio social. Ressaltamos que as experiências no trabalho estão intima-mente relacionadas à produção de subjetividade, consequentemente, às formas com que os trabalhadores e trabalhadoras se reconhecem enquanto sujeitos em determinado contexto socio-histórico. (AU)

This article is a theoretical study that aims to identify aspects of the sexual division of labor in the incorporation of women into the Brazilian Military Police, linking them to the theoretical field of Work Psychodynamics. To do so, we rely on research on the insertion and daily experiences of women in the Military Police. We understand that the way in which women in the police interpret their work experiences may be shaped by an ideal of exalting virility, as well as other attributes that are socially seen as masculine. This is because Brazilian military institutions, historically, have been associated with values, such as bravery, virility, physical strength, heroism, among others, characteristics that are traditionally associated with masculinity and that continue to influence our social environment. We emphasize that work experiences are closely related to the production of subjectivity, and therefore to the way in which male and female workers recognize themselves as subjects in a particular socio-historical context. (AU)

Este artículo es una investigación teórica que tiene como objetivo identificar aspectos de la división sexual del trabajo en la inserción de las mujeres en la Policía Militar Brasileña, vinculándolas al campo teórico de la Psicodinámica del Trabajo. Para ello, nos guiamos por producciones sobre la inserción y la vida cotidiana de las mujeres en la Policía Militar. Entendemos que la forma en que las mujeres policías dan sentido a sus experiencias laborales puede estar atravesada por una idea de exaltación de la virilidad, además de otros atributos que se consideran socialmente masculinos, ya que las instituciones militares brasileñas, históricamente, están compuestas por una gran valor social, ligado a una concepción de valentía, virilidad, fuerza física, heroísmo, entre otras; características que estaban asociadas con la masculinidad y, al mismo tiempo, aún impregnan nuestro entorno social. Destacamos que las experiencias laborales están estrechamente relacionadas con la producción de subjetividad, en consecuencia, con las formas en que los trabajadores se reconocen a sí mismos como sujetos en un contexto socio-histórico determinado. (AU)

Unconscious system-psychodynamics within a German 4IR engineering company in South Africa.

This article focuses on systems psychodynamics and particularly on the CIBART-model which explores conflict, identity, boundary, authority, role and task and how these phenomena work out on an unconscious level. Therefore, this article presents empirical findings on CIBART in a German multinational engineering organization operating in South Africa. For this study, 16 managers where interviewed on their transformation toward Industry 4.0 with special interest in the interconnection how CIBART aspects play out in the South African context. Findings show that all of the CIBART-phenomena are important during the transformation to more advanced technological levels and restructuring processes. Conclusions are drawn and recommendations are given how to deal with systems-psychodynamic influences within the organization.

A Retrospective Observational Study of Psychosocial Determinants and Psychiatric Diagnoses of Mass Shooters in the United States.

Our aim was to better understand the underlying psychiatric, psychosocial, and psychodynamic aspects of mass shootings in the United States (US). The Mother Jones database of 115 mass shootings from 1982-2019 was used to study retrospectively 55 shooters in the US. After developing a psychiatric-assessment questionnaire, psychiatric researchers gathered multiple psychosocial factors and determined diagnoses and treatment by evaluating the clinical evidence obtained by interviewing forensic psychiatrists, who had assessed the assailant, and/or by reviewing psychiatric evaluations conducted during the judicial proceedings. All 35 surviving-assailant cases were selected. Additionally, 20 cases where the assailant died at the time of the shootings were randomly selected from the remaining 80 cases. The majority of assailants (87.5%) had misdiagnosed and incorrectly treated or undiagnosed and untreated psychiatric illness. Most of the assailants also experienced profound estrangement not only from families, friends, and classmates but most importantly from themselves. Being marginalized and interpersonally shunned rendered them more vulnerable to their untreated psychiatric illness and to radicalization online, which fostered their violence. While there are complex reasons that a person is misdiagnosed or not diagnosed, there remains a vital need to decrease the stigma of mental illness to enable those with severe psychiatric illness to be more respected, less marginalized, and encouraged to receive effective psychotherapeutic and pharmacologic treatments.

Incorporating Brain Explanations in Psychoanalysis: Tennessee Williams as a Case Study.

Despite Tennessee Williams's genius as a playwright who could represent his inner emotional struggles in his art, psychoanalysis was unable to free him from the powerful "blue devils" within him. Williams's inability to engage with psychoanalysis presents an opportunity to discuss ways that contemporary thinking about brain structure and function might guide our understanding and treatment of patients such as Williams. One of the core defensive behaviors that made analysis difficult for Williams was his avoidance of painful emotions through compulsive writing, sex, alcohol, and drug-addictive behaviors. These pre-mentalized reactions became Williams's habitual procedural body response, which occurs below the level of the self-reflective brain. Within a relatively traditional ego psychological frame, Lawrence Kubie, Williams's analyst in 1957, attempted to prohibit the compulsive behaviors to be able to process the underlying painful affects in the analysis. However, given that this level of mind and brain functions was Williams's chief means of regulation, Williams could not engage in the psychoanalytic process and left the treatment after one year. I propose that Williams was operating in brain circuits below the level of "higher" reflection or interpretation-receptive circuits and therefore he was unable to make use of a traditional ego psychological model. A review of these brain circuits seeks to encourage therapists to utilize simplified brain explanations for patients, which can destigmatize the pathologic behaviors and enhance engagement in the treatment process.

[Spirituality of a Catholic nurse in the encounter with care]. / Spiritualité d'une infirmière catholique à la rencontre du prendre soin.

Working in a palliative care unit raises a number of questions for carers relating to suffering and death. This case study of a Catholic nurse investigates the link between spirituality and caregiving by exploring her subjective relationship to the work of caregiving.

Análise do trabalho real em uma emergência psiquiátrica / The multiprofessional team work activity in psychiatric emergency

Este artigo tem como objetivo analisar o trabalho real de profissionais que atuam em uma emergência psiquiátrica. Para tanto, realiza-se, inicialmente, um apanhado histórico contextualizando a Reforma Psiquiátrica Brasileira até o contexto atual. A perspectiva teórica adotada no estudo diz respeito à Psicodinâmica do Trabalho (PDT), pois esta possibilita a compreensão do trabalho enquanto dimensão central para os sujeitos, que por meio de processos de subjetivação, tais como do reconhecimento, de construção de estratégias de defesa, de vivências de prazer e de sofrimento no e pelo trabalho, é passível de implicar em adoecimento e ter reflexo na saúde destes. Trata-se de uma pesquisa qualitativa, de cunho descritivo e exploratório, realizada com 13 profissionais atuantes na emergência. A coleta de dados foi realizada por meio de entrevistas individuais gravadas, guiadas por um roteiro semiestruturado. Os resultados encontrados apontam que uma parte dos profissionais não tinha a atuação na saúde mental como perspectiva de carreira. A segunda categoria encontrada foi das condições de trabalho e das lacunas identificadas no serviço, que refletem diretamente nas práticas profissionais. Os resultados apontam, ainda, que a atividade de trabalho desses profissionais é complexa e repleta de imprevisibilidades.

This article aims to analyze the real work of professionals in a psychiatric emergency. To this end, a historical overview is taken, contextualizing the Brazilian Psychiatric Reform to the current context. The theoretical perspective adopted in the study concerns the Psychodynamics of Work (PDT), as this enables the understanding of work as a central dimension for the subjects, who through subjectivation processes such as recognition, construction of defense strategies, experiences of pleasure and suffering in and through work are likely to imply illness and have a reflection on their health. It is qualitative research of a descriptive and exploratory nature, carried out with 13 professionals working in an emergency. Data collection was carried out through recorded, individual interviews, guided by a semi-structured script. The results indicate that some professionals did not work in mental health from a career perspective. The second category was the working conditions and gaps identified in the service, which directly reflect on professional practices. The results also point out that the work activity of these professionals is complex and full of unpredictability.

Cultural Sensitivity in Preventive Infant Mental Health Care: An Example From the Developmental Guidance Project FIRST STEPS in Belgium.

Preventive developmental guidance programmes have been applied on a large scale for several decades now in many western countries. But how do we adapt these programs to families with very different ethnic backgrounds? How can we concretise the concept of cultural sensitivity into that context? The plea of von Klitzing, the former President of the World Association for Infant Mental Health, for further reflection on the concretization of cultural sensitivity in the context of infant mental health care is the main source of inspiration to this article. von Klitzing speaks out against the point of view in which universal children's rights or conditions that are seen as promoting a child's development all around the globe, are criticized as being only western conceptions and thereby culturally biassed. Following this kind of reasoning, a culturally relativistic stance on what a facilitating environment is, should be adopted. Such a discussion in terms of universalism versus relativism, though, as argues von Klitzing, is an old antagonism that cannot inspire us for the adaptation of early health care practices or developmental guidance programs that are fitting in to the needs of families and their babies that are living in multicultural contexts. Although it could be interesting to think about how certain universal principles of good-enough child care can be formulated or embodied in an intercultural variety of ways, these variable expressions of the worldwide agreed upon principles of good early mental health care will only be culture-specific translations of these universal principles. They can't in any way be seen as an argument against the universality of these principles, as argues von Klitzing, who is describing another way of solving the problem of the cultural relativist criticism on the universality of principles of good infant mental health: culture sensitive infant mental health services. But, to make the principle of cultural sensitivity work in practice, we need to fill it with content. This article is mainly on what it concretely means to work in a culture sensitive way in our preventive practice within the FIRST STEPS program, a Belgian project for immigrant and exiled mothers and their children from zero to three.

[Together in the face of extreme violence: accompanying families after a traumatic event]. / Accompagner les familles après un événement traumatique.

After a traumatic event, families can also be impacted at different levels and require post-immediate or longer-term care. The adaptation of these family care procedures carried out following the attacks of 2015-2016 in France, based on existing clinical arrangements, in a child psychiatry service associated with a medical-psychological emergency unit, is discussed via two clinical examples. These different modalities of follow-up, a family debriefing and a situation of mourning associated with a trauma insist on the necessity to consider the temporality of the follow-up, the use of different theoretical tools, as well as the importance given to rituals and family skills hard hit by the traumatic event.