Des personnalités évitantes plus évitantes que d’autres : intérêt du test de Rorschach dans la compréhension des facteurs qui s’opposent au processus psychothérapique

Abstract

Avoidant personality disorders are (APD) among the most prevalent personality disorders and a frequent request for consultations. Patients suffering from this disorder describe high levels of distress and low quality of life. Some of the consulting patients benefit from a genuine improvement in psychotherapy while others drop out after the first signs of recovery. The aim of this study is to investigate, from the Rorschach Test, the variables accounting for the treatment response differences in a population of APD. MethodsTwenty Rorschach protocols collected from 20 APD patients, diagnosed as such according to the DSM-IV-TR by their psychiatrist, have been included in a retrospective study and subdivided in 2 groups. The first, AT (n=11), had been composed by patients that completed their psychotherapy (integrative) in agreement with their psychotherapist recommendations, and the second, NAT (n=9) by drop-outs who interrupted their treatment in spite of their psychotherapist recommendations, after a subjective feeling of improvement. The research material has been collected through the Rorschach test (Comprehensive System); the protocols had been scored twice : prior to the therapeutic process and prior to inclusion in the study. Data had been analyzed with descriptive statistics as well as with the Mann Withney and Fisher's exact test. ResultsResults had shown that the patients that drop out prematurely from therapy present, in the Rorschach test (1) narcissistic traits (Fr+rF>N), which are defined as a tendency to overestimate his own value through defense mechanisms such as idealization, externalization and denial; (2) anxiety and chronic stress and (3) cognitive rigidity. DiscussionIf in the early stages of psychotherapy the high level of distress acts as a stout lever for help seeking, when improvement arise, narcissistic traits, chronic distress and rigidity become impediments to treatment adherence. The psychological status of these variables is discussed in the light of the approach/avoidance theory where they act as a coping emotion-focused strategy aiming to prevent the patient from facing guilt, shame or more anxiety stemming from the psychotherapy deepening.