Thérapie brève de l'insomnie

The type of therapeutic intervention depends on the issues that the clinician arises. If he emphasizes the “why”, he will look for a trigger event and then propose a hermeneutic therapy. If it is the “what for”, he will seek the psychological benefits and then propose a replacement therapy. If it is the “how”, he will look at the vicious circles that self-sustain insomnia: following an initial difficulty, the subject begins to make efforts to sleep better, feeding therefore his insomnia. The “how” gives rise to most treatments: cognitive-behavioral therapy, chronotherapy, relaxotherapies, etc. For my part, I tried to adapt the model of brief therapy from Palo Alto. This model assumes that it is the “attempted solutions” that maintain the problems. When the solution is to cause voluntarily a spontaneous behavior, this behavior becomes impossible. About our subject, it is the paradoxical injunction “Sleep spontaneously!” that generates insomnia. The therapist must then bring the patient to stop to force himself to sleep, which will be done with maximum effectiveness in forcing the patient not to sleep! To the pathogen paradox is thus opposed a therapeutic counter-paradox, prescribing insomnia. The art of the therapist is, of course, to make the patient accept this instruction. The degree of acceptance depends on the adequacy of the explanation that frames the strategic intervention, explanation that must be in harmony with the beliefs of the patient. One must speak the language of the patient, giving this therapy the superiority of the measure over the ready-to-wear.