Pragmatique et dispositifs de soin par la parole

Abstract

ObjectivesEven though the precise evaluation of the effectiveness of different types of psychotherapy has proved difficult, the French state has only just committed to recognizing these types of treatment through its funding. Together, with regard to the development of epidemiological knowledge in mental health and the most recent neurobiological conceptions, a new modeling of psychotherapies is taking shape. Here, the models and the evolutions of pragmatics appear both fundamental and difficult, as few psychologists and psychiatrists are familiar with them. MethodIn this interest of didactic clarity, we take up the definitions and the very essence of pragmatics by synthesizing its origins, its applications, and its contemporary uses. ResultsPragmatics is the science of language in action: it aims to model the functions of construction of meaning by the “actants” and “acted” of linguistic behaviors and discourses, by attempting to answer the question: “What is language for?” For communicating, of course, but communicating what? Three dimensions: descriptions of the world, expressions of the speaker's psychological state, and actions. These three functions – respectively referred to as “referential,” “modal,” and “illocutionary” – constitute the operational base of the discipline. In psychopathology, the contributions of pragmatics can be applied to the highlighting of deficits concerning comprehension, as well as to the modeling of communication situations. Finally, the modeling of clinical situations is required to study therapeutic processes. The active principle of any talk therapy consists in the therapist communicating new interpretations to the patient that can account for her/his condition. However, interpreting acts and thoughts amounts either to associating new acts with intentional properties expressed by the patient or to attributing new intentional properties to acts. DiscussionOne might think that the clinician's action stems from a principle of external influence exerted on the patient, which would lead the latter to say what the former expects them to say. However, the goal of the therapeutic enunciative procedure is to make patients aware of parts of themselves that they must conquer in order to escape their torments. It is in so far as patients will recognize the word pronounced by the therapist as being ultimately their own (or the expression of their own words), that they will be able to overcome the representations of themselves and of their social environment that hinder recovery. Such communication is driven by objectives of dissociation and concordance. Dissociation consists of freeing oneself from the domain spontaneously expressed by the patient, the domain of complaint and of problem, in order to direct the communication towards additional, less sensitive and less controlled domains. In talk therapy, concordance represents a matching of the feelings and interpretations of the two protagonists of the dialogue. ConclusionWhat is a true statement? A true statement is present in a word that sets in motion the relationship of self to self that is constituent of an increased self-awareness. We are not what we are because we are not a thing-in-itself. This dichotomy of consciousness that governs its property of being reflective is at the heart of the principle of healing that underlies the actions of psychological care.