Une zone de création commune avec le traumatisme psychique

RésuméDans le tableau clinique du syndrome psychotraumatique, le sujet vit l’effraction psycho-corporelle du traumatisme dans l’effroi et la sidération. La perte du recours des proches, de l’environnement, contribue à figer le sujet dans une temporalité traumatique. Une latence traumatique peut alors se développer, établir un gel du jeu psychique, une fixation du sujet à la scène traumatique ; la reviviscence persistante de cette dernière met en évidence l’échec du refoulement névrotique. Un clivage post-traumatique (clivage autotomique, dissociation) est souvent un recours mais au prix d’un enkystement du vécu traumatique hors des possibilités de symbolisation. La psychothérapie psychanalytique peut permettre une reprise du jeu psychique par ses dynamiques transférentielles et contre-transférentielles. La séance est alors comprise comme un médium malléable après l’établissement d’un cadre contenant et un étayage pour le psychisme du sujet. Cet étayage permet de retrouver une possibilité de réalimentation du désir et des déplacements libidinaux par l’intermédiaire d’une zone de création commune.

ObjectivesDeveloping psychotherapeutic methods for sideration and panic due to Post-traumatic stress disorder and trauma revival. By means of psychoanalysis using flexible medium when needed. In the clinical picture of Post-Traumatic Stress Disorder, the individual living an experience of traumatic event is overwhelmed by dread and sideration, but also by the loss of help from relatives and their environment. These factors contribute to settle the individual in a traumatic temporality. Our objective is to illustrate how we came to an hypothesis of a traumatic latency that overtakes the role of usual latency work, settling a freeze of psychic play and a fixation of the subject to traumatic experience. We are also discussing some ways for the therapist to solve a situation with a patient overwhelmed by a strong access of panic. What can he do when unsettled by the encounter and feeling sideration or archaic angst? What kind of shared creativity can we build?PatientsWe are working with patients who had to live extremely traumatic events in their lives (aggressions potentially lethal, rape, genocide, torture) and who are coming to see us because they cannot find a way back in their normal life. They are suffering all symptoms of the PTSD or Psychotraumatic Syndrome as we say in France. They sometimes feel as though the events were happening again; which is referred to as “flashbacks”. We have learnt about these feelings a long time ago in psychopathology, but we want to underline how they contribute to compromise the process of nevrotic repression; in fact those flashbacks are illustrating the failure of repression. A post-traumatic dissociation (divide) can often be unconsciously considered by the individual to defend himself against such flashbacks but with high costs in term of automutilation of possibilities of symbolization. The psyche is then taken in a traumatic latency. This special latency does not allow the habitual symbolisation process to transform the experience, not the habitual neurotic process of differed action. Psychic play is overwhelmed by the experience. We are focusing, in this work, on the encounter of a patient that came in France as an exile after having lived traumatic experiences in his country. This patient, suffering from a permanent angst and multiple somatic pains alongside depression made us try to find an unusual use of a medium to help free association, symbolization process and recovering the desire to live.ResultsThrough containment and anaclisis the psychoanalytic psychotherapy, and its transference and counter-transference dynamics allow the psychic to recover some dynamic play. But this recovery has also necessitated the use of a pliable medium when the patient got overwhelmed by panic after a revival provoked by a scream coming from the waiting room. The clay proposed by the psychotherapist surprised the patient. The surprise here has had a great importance as it has allowed a quick exit out of the sheer panic. But the patient was not disposed in sculpting that clay, seeing that the psychotherapist has decided to start sculpting a bit of the clay. That move decided the patient to sculpt the clay, and the way the setting has been reconfigured illustrate that the whole experience allowed the patient and the psychotherapist to find a way together out of the sheer panic. Hence they have shared a moment of creativity, like when playing a squiggle. The patient felt better, and he could put in words what he had materialized with the clay. As the psychotherapy went along the patient managed to find some work and a new taste for life.ConclusionsThe usual psychoanalytic setting favors and cultivates the transference and counter-transference dynamics, even face to face, but sometimes, especially with the clinic of post-trauma, something different needs to be done. That different thing does not need to be done outside of the setting, and it underlines the need for the psychotherapist to work on his counter-transference in front of that special clinic. The setting just needs sometimes to be reconfigured and can thus be understood as a flexible medium and, metaphorically, as an extension of the clay materially used as a medium. When words and the usual settings do not seem to be enough in the case of revival of a traumatic experience, new medium to work with can be suggested by the psychotherapist to allow a new encounter between the two participants of the psychoanalytical work. Words and free association can then recover their utility after the untold traumatic experience had been materialized with the clay. With the recovery of the stream of symbolization and psychic play, the patient also recovered a possibility of desire revival and its libidinal investments to others and future projects in life.