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L'actualisation de soi, telle que définie par le Personal Orientation Inventory (P.O.I.) est mesurée chez 49 sujets avant et à la suite d’un traitement psychothérapique. Un groupe contrôle a été apparié selon trois variables démographiques; le test leur a été administré aux mêmes moments. Les résultats obtenus indiquent une augmentation significative du niveau del'actualisation de soi chez les sujets du groupe traitement aux variables: -Orienté selon ses principes, -Vivre de façon existentielle, Estime de soi, et -Capacité de contact intime. Cette recherche renforce les conclusions de nombreuses autres qui ont témoigné de la valeur de la psychothérapie pour rehausser l’actualisation de soi.

AbstractAmongst the many modifications and applications of Interpersonal Psychotherapy (IPT), its utilisation in the treatment of psychological trauma is amongst the most complex. Psychological trauma is usually defined as Post Traumatic Stress Disorder (PTSD) in the Anglo-American literature. Despite the focus of the scientific literature on PTSD, psychological trauma engenders profound disturbances of mood, affect regulation, self-concept, interpersonal adjustment and a profound existential crisis in the lives of those afflicted. In the light of this, no one psychological therapy is positioned to ‘treat'all aspects of psychological traumatic stress. Through its focus upon the individual and his or her experience of their interpersonal world, IPT provides scope for a psychological intervention which, whilst aiming at relief of distress, approaches issues not usually addressed in symptom focussed treatments. In this paper, I will attempt to outline the rationale for the use of IPT in psychological trauma and PTSD and then provide some evidence of its utility in the clinical setting.

The Center for Psychoanalysis and Psychotherapy É. and J. Kestemberg proposes exceptional psychoanalytic treatment conditions for patients with psychotic functioning, who can rely on objectified third parties to cope with their threats of intrusion. The psychoanalytic consultation at the Center with a schizophrenic patient subsequently followed in individual psychoanalytic psychodrama illustrates the complementarity between psychoanalytic and psychiatric approaches in the treatment of these difficult patients.

Keywords: centre psychanalytique, personnage tiers, fonctionnement psychotique, consultation psychanalytique, tiers institutionnel, psychoanalytic center, third character, psychotic functioning, psychoanalytic consultation, institutional third party

Les relations entre la force de l'alliance telle que mesurée lors de la première entrevue et l'abandon prématuré de la psychothérapie ont été examinées. Les participants sont 60 patients d'un service de consultation universitaire servant de lieu de formation aux étudiants post-gradués en psychologie. Trente de ces sujets ont abandonné la psychothérapie à l'intérieur de cinq entrevues et trente l'ont menée à terme. L'alliance a été évaluée par des observateurs indépendants à l'aide du California Psychotherapy Alliance Scales (Marmar & Gaston, 1988). Le degré de fonctionnement global des sujets a été contrôlé (Global Assessment of Functionning Scale,DSM-111-R). Le niveau d'Engagement du Patient et le degré de Consensus sur les Stratégies de Travail (deux échelles du CALPAS) sont reliés au type de terminaison. Il est suggéré …

Which mechanisms underlie a positive outcome in psychotherapy? Recent conceptual and empirical developments of the mentalization-based therapy emphasize the specific and common factors that contribute to the therapeutic outcome, integrating the concept of epistemic trust as critical to the generalization of therapeutic effects. Epistemic trust rekindles one's capacity to learn from experience, by opening one's mind to other minds. These conceptual developments bear consequences in the way to apprehend the mechanisms underlying therapeutic benefits. In the current article, we propose to delineate the three systems of therapeutic communication, which may foster positive outcomes in psychotherapy.

Keywords: mentalisation, confiance épistémique, effet psychothérapeutique, mentalization, epistemic trust, psychotherapy outcome

Objective The field of psychotherapy is growing and is offering more and more types of treatments. The objective of this paper is to go through many clinical researches and experiences from psychotherapists with several psychotherapies in universities in Montreal and Lausanne, especially in the Institute for Mental Diseases in Montreal (IUSMM).

Keywords: amorçage préconscient, priming, écoute préconsciente, psychothérapie, anxiété, phobie sociale, priming, preconscious listening, psychotherapy, anxiety, social phobia

This essay attempts to describe and discuss the major changes in values and fundamental beliefs related to clinical practice within the Département de psychiatrie de l'Université de Montréal since its creation fifty years ago.Being an essay, the methods include shared recollections, discussions with colleagues, especially between the co-authors, and the study of some documents related to the practice of psychiatry 40 to 50 years ago.Five major axes of change are proposed: 1- From psychoanalysis to brain diseases, 2- From “Can a non-physician practice psychoanalysis?” to “Can a psychiatrist still perform psychotherapy?” 3- From continuity of care to episodes of treatment, 4- From treatment first to repeated assessments of patients, 5- From love that can heal and repair to a taboo of love.Finally it is suggested that the increasing emphasis on psychopharmacology and on DSM classifications has contributed to a shift from attempts to understand the intimate nature of symptoms and suffering to a priority given to rather mechanical clinical assessments in search of “objective” criteria.

Keywords: Université de Montréal, valeurs, certitudes, psychiatrie, University of Montreal, values, beliefs, psychiatry

The work of supervision shows that more and more clinicians have troubling doubts about the relevance of their profession. A combination of experiences (eg. fatigue, doubts, perplexity), which we have dubbed clinical futility, can culminate in a professional identity crisis, prompting a request for clinical supervision. This paper proposes a reflection on the contributions of the scientific-professional model which prevails in clinical training, and its impact on therapeutic practice. In particular, the implicit notion that only empirical facts are of value as sources of information leads to a reassuring quest for certainty. This way of thinking is perpetuated in health care settings, particularly public ones, through the notion of evidence-based practices. The intolerance of uncertainty, and its counterpart, the conviction of certainty, at both organizational and individual levels, has a deleterious impact on the clinician's psychic functioning. Unwittingly, the latter is grappling with the weight of what s/he imagines s/he should know. Paradoxically, the search for mastery through knowledge of the facts leads to an impoverishment of the capacity to think creatively, both for and with the patient.

Keywords: désoeuvrement clinique, empirisme, données probantes, supervision, clinical impoverishment, empiricism, evidence-based practices, supervision