La honte d’être soi. De l’intérêt de la psychothérapie à médiation artistique pour la réhabilitation des personnes en situation d’exclusion sociale

Abstract

In the context of a multi-annual research project, aiming at exploring the relations between traumatic biographic events since childhood and the structural functioning of personality at adult age, the results of a prospective longitudinal study will be analyzed. Context of the studyFollowing an exploratory study with n=206 people suffering from exclusion and marginalization and a confirmatory study with a new sample of n=195 people, the third stage of the research project was focused on the assessment of arts psychotherapeutic interventions. We present a longitudinal study on the efficiency of arts psychotherapies with n=34 people living in great precariousness and suffering from severe posttraumatic syndromes. The research population was encountered in shelters for homeless people. Clinical and experimental resultsThe clients assisted weekly group sessions during six months to one year. The sessions were directed by experienced psychologists (Master in clinical and health psychology) who had acquired a second Master degree in arts psychotherapies. The exploration of the therapeutic process is based on original rating scales allowing using the pictorial and literary production as a tool of research and computing correlations between psychometric scales, projective tests and expressive tests. In a previous study, 96 % of the pictures drawn during arts psychotherapeutic sessions by people suffering from exclusion and marginalization could be classified into the following typology: (1) type 1: Desire for the Lost Paradise; (2) type 2: Fascination by Evil and Death; (3) type 3: Graphics and Ornamentation; (4) type 4: Description and Banalization; (5) type 5: Fragmentation and Dislocation of Forms. The inspection of the table of frequencies showed a similar distribution of types in the sample of the present study. The analysis of this distribution allowed making a meaningful psychological interpretation at the light of current clinical literature. In order to explore the parallel evolution in the pictorial and literary expression during the psychotherapeutic sessions, rank correlations (Spearman's Rho) were computed between the delta values (post-test–pretest) of the rating scales for the pictures and for the stories written under musical induction. The matrix of correlations indicated a parallel evolution on formal and content values in the two kinds of artistic expressions, pointing towards a progress in the underlying capacity of imaginary and symbolic elaboration. Four representative clinical vignettes are meant to illustrate the peculiar being-in-the world and the existential anxiety of people who feel marginalized, discriminated and uprooted and whose self-esteem is very low. Discussion and conclusionThe discussion is focused on the pertinence of the results of this study in the context of the current literature related to psycho-trauma, great precariousness, and discrimination, as well as to the possibility to draw from the evolution of the artistic production some indications related to a resumption of the blocked process of subjectivation. The limits of arts therapies and arts psychotherapies with this kind of population are linked, among others, to the irreversible effects of long term psychological stress on the hippocampal area of the brain, as well as to the toxic effects of inveterated alcohol and drug addiction.