La psychothérapie institutionnelle à l’épreuve des crises. Une réflexion clinique au cœur d’un service de psychiatrie publique au décours de la crise sanitaire liée à la COVID-19

Abstract

ObjectivePatients suffering from complex psychiatric pathologies require multi-disciplinary care and, in the event of decompensation, may need to be hospitalized. Institutional psychotherapy approaches psychotic, existential, and institutional crises as opportunities for clinical elaboration and the deployment of creativity. The public health crisis linked to the COVID-19 pandemic has prompted us to rethink its effectiveness and its place within pluralistic contemporary practices. It also offered the opportunity for an unprecedented anthropological reading. In this context, is institutional psychotherapy still a machine for producing “innovation”, for creating, or at least revealing, crises in order to overcome them? MethodKey concepts from the field of institutional psychotherapy can be reexamined in the wake of the public health crisis. In the aftermath of the pandemic, we propose an elaboration of what the pandemic has taught us about day-to-day practice, in a public psychiatric department oriented towards institutional psychotherapy. We will draw on a re-reading of clinical vignettes, interviews with caregivers and patients, and notes taken at department meetings during the pandemic. ResultsThe major concepts of institutional psychotherapy may have some limitations, but they can be reinvented by the caregiver–client collective. During a crisis, collective failings and individual symptoms seem to reveal each other. The therapeutic club represents a stage on which to unfold and elaborate both group and individual issues. DiscussionIn this context, the symbolic framework, collectively instituted, and the culture of a department can present operative points of support for continuing care. They “put in crisis” the prejudices and implicit theories of the actors, and support new narratives and new ways of making sense. ConclusionIn the aftermath of a crisis, the therapeutic club remains a space of conflict and intrigue, at the crossroads of collective and individual health crises.