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From an ethnographical research on the place of children’s play within the framework of a leisure center, this contribution wishes to question more widely the function of sociocultural community developer and its professionalization. Starting from the observation and the analysis of situations where children’s play and sociocultural community developer’s recreational activities crisscross, not without difficulties, it will be a question of looking for the playful skill of the sociocultural community developer. However, the learning of this singular skill confronts with the process of rationalization of relational jobs, in particular those of social work and sociocultural community development. Through the notion of project and the risks of the technicization of the practices, we shall approach the return of the sensitive part of the act on the sociocultural community development practices resting on the last researches based on the analysis of the activity.

Keywords: animador profesional, professional sociocultural community developer, animateur, play, professionnel, juego, jeu, child, niño, enfant, ocio, leisure, loisir

Over the last few years, a number of programs have been put into place within organizations to help their employees develop mindfulness. In this paper, we shed light on the dangers of the instrumentalization of mindfulness in the workplace, and we regret that these interventions are often established, not to favour the personal growth and quality of life of employees, but rather to optimize employee productivity and motivation. We also propose some courses of action to ensure that these promising programs are taught within organizations in a manner that is more consistent with their original goals.

Keywords: Pleine conscience, bien-être, santé au travail, instrumentalisation, paix économique

Keywords: Violence, transgression, régression

Objectives. Several studies suggest that health professionals show negative attitudes towards people with Borderline Personality Disorder (BPD). Many publications have focused on the attitudes of nurses or other type of clinicians like social workers or psychologists. Few researches concern the attitudes of general physicians towards BPD even if they are the main professionals involved in the evaluation and treatment of these patients. Additionally, patients with BPD frequently consult general physicians and, because of the difficulties interacting with these patients, they do not always receive the treatments required by their condition. This research aims to assess the attitudes of general physicians and family medicine residents regarding patients presenting with this disorder.Method. Forty family medicine residents and thirty-five general physicians were compared to thirty-nine mental health professionals using the Attitudes toward people with BPD Scale (ABPDS; Bouchard, 2001). This measure has two subscales labeled Comfort when interacting with someone who has BPD and Positivesperceptions about BPD. The internal consistency of the scale as well as the two distinct factors are satisfactory. The participants also complete a socio-demographic questionnaire.Means, t tests, ANOVAs and factorial ANOVAs are completed in order to compare the three groups on the ABPDS and explore the influence of variables such as sex, age, years of experience, and professional setting (urban or rural) on the results.Results. The results show that general physicians have similar attitudes than mental health professionals towards people presenting with BPD and that family medicine residents present less positive attitude than the other two groups. In addition, clinicians with less experience tend to have less positive attitudes towards people with BPD and clinicians from urban settings seem to have more positive attitude. It was difficult to determinate which variables influence the results because the years of experience, the professional settings and the title of the participants are extremely related. The factorial ANOVAs show no interaction effect between these three variables.Conclusion. Several studies show that health professionals present negative attitudes toward patients with BPD. This study reveals that general physicians and family medicine residents show respectively similar attitudes or less positive attitudes than other mental health professionals. These results underline the importance of providing specific training about BPD to family medicine residents. Because general physicians guide the evaluations and interventions concerning these patients and mental health professionals interact regularly with BPD, it will be helpful if all the clinicians receive more specific training regarding this disorder.

Keywords: trouble de personnalité limite, attitudes, médecins omnipraticiens, résidents, médecine familiale, Borderline Personality Disorder, attitudes, general physicians, family medicine resident

Objective To propose a theoretical model and clinical approach to sexual minority patients who consult mental health professionalsMethods Clinicians at the McGill University Sexual Identity Center (MUSIC) who have been treating patients from various sexual minorities for more than 15 years present useful theoretical constructs of gender and sexuality as well as guidelines for the evaluation and treatment of patients consulting for discomfort or confusion surrounding their sexual orientation, their gender identity or both, based on both the current literature and their clinical experience.Results The notions of non-binary construction of gender, of social determinism of gender roles and expression, and of gender creativity are presented. Sexual orientation is divided into four most commonly used dimensions (emotional attraction, physical attraction, behaviour and identity); the fluidity of these and their potential non-concordance are described. The fact that attraction to one gender is independent of attraction to another gender is highlighted. An attitude of openness to all forms of gender expression and sexual orientation constellations is encouraged to allow the patient free exploration of the several facets of their sexuality.Various domains to explore in evaluating sexual orientation and gender as well as therapeutic avenues are proposed. Areas to enquire about include: mental, physical and social experiences of gender, eroticism and sexual fantasies towards all genders, emotional attraction towards them, sexual and romantic experiences, comfort and certainty about one's identity and about disclosing it.Psychoeducation can be used to teach about sexual diversity and to assess the risks and benefits of coming out to self, family, friends, co-workers or strangers. Cognitive strategies can be undertaken to debunk homophobic and transphobic myths which may fuel poor self-esteem. Psychodynamic approaches can be used to heal the narcissistic wounds of homophobia that may lead one to be mistrustful of authority figures or to suppress sexual feelings when emotional attachment becomes important. Some of these dynamic patterns are rooted in past reactions to parental homophobia and the compromises sexual minorities made as children in order to preserve their relationships with their parents. For youth coming out in present times, family support is crucial to well-being and can be enhanced through family therapy. In mixed orientation couples, couple therapy can help both spouses adapt to the coming out of one of the partners and find a new partnership. Group therapy is useful for many of the above issues particularly as it provides a sense of community which is often lacking in minority groups, especially when individuals and their families do not share the same minority status.Conclusion With the proposed framework and an attitude of openness to sexual diversity, clinicians should feel competent to treat sexual minority patients.

Keywords: genre, orientation sexuelle, psychothérapie, homophobie, transphobie, gender, sexual orientation, psychotherapy, homophobia, transphobia

Objectives In synthesizing a homosexual or bisexual identity, an individual may go through different stages before coming to a positive healthy identity. It is likely that there will be a period in which homosexual yearnings will be unwanted. Sometimes this distress leads the person to consult a health professional. Conversion therapy has been proven both ineffective and harmful and therefore has been ethically prohibited by all major psychiatric and psychological associations. The responsible clinician will attempt to assist the individual in his acceptance of his sexual minority. Occasionally individuals without homoeroticism consult because of distress related to sexual identity questioning which poses a different problem for clinicians especially if the situation goes unrecognized. The objective of this paper is to describe homosexual obsessive compulsive disorder (HOCD) and distinguish it clinically from the normal process of sexual minority identity formation in western culture.Methods A literature review yielded very few descriptions of homosexual OCD. A retrospective chart review of all patients seen in the last 3 years at the McGill University Sexual Identity Centre was conducted to identify all the cases of OCD. Six cases were found, 4 of which were of HOCD and are presented. Similarities between cases are highlighted.Results All cases were young men with relatively little relationship and sexual experience. Most were rather shy and had some other obsessional history in the past though often at a sub-clinical threshold. Obsessional doubt about their orientation was very distressing and did not abate over time as would normally occur with a homoerotic individual. The four patients who had an obsession of being gay despite little or no homoerotism are presented in detail. They all presented mental compulsions, avoidance and physiological monitoring. Continuous internal debate trying to prove or disprove sexual orientation was a ubiquitous mental compulsion. They all spent a majority of time monitoring their physiological reactions to members of both sexes to check for arousal. They attempted homosexual activity and were disgusted by it, yet this did not end their questioning. They avoided relationships with the opposite sex, being either too anxious to initiate, or too conflicted to maintain them. The obsession with being gay seemed like a horrific thought symptomatic of homophobia, however the level of horror was out of proportion to the patient's overall level of homonegativity suggesting that the horror came mostly from feeling like their core identity was threatened.Conclusion HOCD can present in ways similar to normal homosexual identity formation. A thorough exploration of eroticism towards both sexes as well as prior history of subclinical anxiety should help distinguish the two. Treatment of HOCD should combine education about sexuality and OCD as well as usual OCD treatments such as relaxation techniques, cognitive restructuring, mindfulness training and pharmacology.

Keywords: homosexualité, trouble obsessionnel compulsif, identité, homophobie, obsession, homosexuality, obsessive compulsive disorder, identity, homophobia, obsession

Objectives Among interventions that have been shown to be efficacious in the treatment of depression, behavioural activation (AC) is receiving increasing attention as the evidence supporting its effectiveness continues to accumulate. Although the efficacy of AC for the treatment of depression has been established through numerous randomized controlled trials, studies evaluating the effectiveness of AC when implemented in mental health settings are rare and there is insufficient supportive data. This step is, however, essential to the validity and the generalization of the treatment to the reality of clinical settings. This study focuses on AC applied to take into account the reality of clinical settings and patients seeking treatment. It evaluates the effectiveness of group-based AC for the treatment of severe depression in a clinical setting in a heterogeneous population in terms of diagnosis (unipolar and bipolar depression) and comorbidity (Axis I and II).Methods A sample of 45 participants with severe depression was recruited in a psychiatric hospital. Participants received a 10 sessions group intervention of AC. Questionnaires were administered to obtain pretreatment, post-treatment and four-week post-treatment data. The impact of the intervention was observed on measures of depression, behavioural activation, reinforcement, anxiety, social adjustment and quality of life. Various moderation effects associated with the heterogeneity of the sample were tested on the evolution of depressive symptoms. The integrity of the treatment administered by the therapists and the acceptability of the intervention by participants were also documented.Results Mixed model analyses of variance were performed to assess whether (a) AC caused a significant change at the end of treatment on depressive symptoms, behavioural activation, reinforcement, anxiety, social adjustment and quality of life and whether (b) gains were maintained after four weeks. A significant change was obtained between the pre-post measures on the average score of all these variables, with the exception of a subscale of the quality of life measure. Analyses were also performed to verify various moderating effects on the evolution of depressive symptoms, level of activation and reinforcement. No interaction effects are observed on depression, activation and reinforcement measures. There is no significant difference according to pretreatment severity category, diagnosis (unipolar vs bipolar), presence of comorbidity (other Axis I and/or Axis II disorder) or co-morbidity of Axis II disorder. As for the activation measure in people with bipolar depression versus unipolar depression, it should be noted that the result is at the threshold of statistical significance.Conclusion The results support the effectiveness of group-based AC for the treatment of severe depression in clinical settings in a heterogeneous population, as well as for the maintenance of gains after four weeks. The effectiveness of AC was also observed across all associated psychosocial measures.

Keywords: dépression sévère, activation comportementale, thérapie de groupe, comorbidité, trouble bipolaire, severe depression, behavioural activation, group therapy, comorbidity, bipolar disorder

AbstractThe Paediatric Transcultural Clinic of the Maisonneuve-Rosemont Hospital is unique in the fact that it is part of a General Paediatric Unit. Therefore, the child's symptoms are often the result of a larger problem affecting the whole family. This clinic aims to provide a complete care by addressing physical, emotional and cultural issues. The clinic's professionals among the most often use the concepts of filiation and affiliation and the authors attempt to explain and illustrate them with two clinical cases. Their analysis raises an important question: how resilient can children be in an immigration context when dealing with issues of filiation and affiliation?