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Dementia pathologies essentially create two victims: the person afflicted with the illness and a member of the family, a spouse or child, who, in the capacity of principle caretaker or tutor, shares the daily drama of the illness and essentially assumes the brunt of the responsibilities with dedication and courage. In its advanced stages, dementia serves as an image of psychic death, which appears as a harbinger of the physical death to come. The degenerative and irreversible character of dementia can bring about a psychic upheaval for the child whose parent is touched by such an illness, notably through a reversal of the relational functioning and a reactivation of the oedipal positions, ending in an advanced type of mourning, called “deuil blanc” in children, forcing the child into an affective distancing to reduce both suffering and anguish.

Keywords: démence, famille, parent, enfant, deuil, dementia, family, parent, child, mourning

Objectives People with borderline personality disorder experience significant health challenges, both in terms of their mental and physical health, resulting in significant functional repercussions. In Quebec and elsewhere in the world, it is reported that the services in place are often poorly adapted or inaccessible. The purpose of this study was to document the current situation in the different regions of Quebec for clients with borderline personality disorder, to describe the main challenges associated with the implementation of services for this clientele, and to identify possible recommendations to meet the needs of this clientele applicable in different practice settings.

Keywords: interventions probantes, organisation des services, trouble de personnalité limite, borderline personality disorder, evidence-based treatments, service organization

La théorie des systèmes autopoïétiques, lancée par les biologistes Humberto Maturana et Francisco J. Varela, permet de décrire scientifiquement les principes organisationnels communs à tous les êtres vivants. Les principes autopoïétiques s’appliquent aussi, à l’état formel, à la vie psychique et à la vie sociale, comme le sociologue Niklas Luhmann a pu le montrer. Puisque la psychanalyse et la psychothérapie analytique se situent au carrefour du psychique et du relationnel, nous cherchons à expliciter les principes autopoïétiques qui sous-tendent leur théorie et leur pratique. En ce sens, la thèse est une comparaison critique des aspects essentiels de la psychothérapie analytique avec les principes généraux du vivant. Le travail se divise en trois chapitres, présentés sous forme d’articles scientifiques théoriques. Dans le premier chapitre, nous montrons …

Our article analyzes the adaptations to the support framework for individuals in “absolute precarity,” based on clinical experience in an addiction care facility with accommodation. After distinguishing between precarity and poverty, we describe the dimensions of precarity and the link between psychological precarity and social symptoms (homelessness, addictions), creating vicious cycles. We demonstrate how the institution adjusts its framework, occasionally adopting a reparative aid model, and analyze the consequences of this approach, marked by an aggressive institutional countertransference. Finally, we discuss the role of psychological care, arguing that absolute precarity is a way of defending oneself, rather than merely a psychological consequence.

Keywords: précarité, addiction, institution, contre-transfert, precarity, addiction, institution, counter-transference

CBT, effective in the treatment of anxiety disorders, helps people treated for anxiety improve their quality of life without reaching the level of the people without anxiety. Solution-focused brief therapy (SFBT) could increase quality of life. This research aims to describe the process of using SFBT for the treatment of anxiety. This qualitative exploratory research uses praxeology and grounded theory. It was conducted with eight patients at the Anxiety Disorders Clinic of the Douglas Mental Health University Institute. The results of this research identify the technical and experiential processes that describe the use of SFBT in the treatment of anxiety.

Keywords: anxiété, thérapie orientée vers les solutions, praxéologie, théorisation ancrée, anxiety, solution-focused therapy, praxeology, grounded theory

Since 2016, nearly 400 social workers have been redeployed from CLSCs to family medicine groups (FMGs). Initially against their will, this move effectively distanced them from the large organizations comprising the integrated health and social services centres (CISSS). This article explores the relationship between this distancing and the observed improvement in workplace well-being among these social workers at FMGs. Using qualitative methods such as interviews and observations, we demonstrate that, despite the operational challenges involved, this distancing appears to be a prerequisite for enhancing the professional autonomy and workplace well-being of these social workers.

Keywords: travail social, soins primaires, organisation des services, bien-être au travail, social work, primary care, service organization, workplace well-being

Objectives Disasters are increasing in frequency and intensity worldwide. Individuals exposed to them are at risk of developing post-traumatic stress disorder (PTSD), insomnia or depression. A stepped care approach, in which the first levels offer interventions that are less costly in terms of specialized resources, could help in meeting the mental health needs of disaster-affected populations. A randomized controlled trial involving evacuees of the 2016 Fort McMurray (Alberta, Canada) wildfires with symptoms of PTSD, depression and insomnia demonstrated the efficacy of the RESILIENT self-treatment in reducing these symptoms. However, its impact among people with a probable diagnosis of PTSD has not been examined. This study aimed to evaluate the effectiveness of RESILIENT in reducing symptoms of PTSD, depression and insomnia in people with probable PTSD following a disaster.

Keywords: catastrophe, trouble de stress post-traumatique, dépression, insomnie, autotraitements, disaster, post-traumatic stress disorder, depression, insomnia, self-treatment

SummaryA placebo is a sham treatment such as pill, liquid, injection, devoid of biological activity and used in pharmacology as a control for the activity of a drug. In many cases, this placebo induces biological or psychological effects in the human. Two theories have been proposed to explain the placebo effect : the conditioning theory which states that the placebo effect is a conditioned response, and the mentalistic theory for which the patient expectation is the primary basis of the placebo effect. The mechanisms involved in these processes are beginning to be understood through new techniques of investigation in neuroscience. Dopamine and endorphins have been clearly involved as mediators of the placebo effect. Brain imaging has demonstrated that the placebo effect activates the brain similarly as the active drug and in the same brain area. This is the case for a dopamine placebo in the Parkinson'disease, for analgesic-caffeine- or antidepressor-placebo in the healthy subject. It remains to be understood how conditioning and expectancy are able to activate, in the brain, memory loops that reproduce the expected biological response.