Pratiquer la clinique en « milieu hostile » : quels possibles ?

Abstract

ContextBy imposing techniques, reporting, efficiency, and profitability on hospital practices, New Public Management has considerably altered the role of psychologists in medical departments, as well as their relationship with teams and administrative staff. ObjectiveThe aim of this reflection is to highlight the positions that appear most appropriate for continuing to promote the activity of hospital clinical psychologists in this disrupted context. MethodThe author traces the evolution of the place of psychologists in medical settings, and draws on his own experience in the face of the disruptions encountered to examine what makes it possible to hold one's place as a clinical psychologist in a hospital institution. ResultsPositioning oneself as “carried by” an intention or a meaning, rather than “against” someone or a hierarchy, is necessary for one's clinical practice. By enabling us to continue questioning our subjectivities, the clinical approach has become an “authority” in relationships, transcending hierarchies. While accompanying the interlocutor, it naturally opens the way to joint elaboration. In addition to seminars, supervisions, and affiliations with psychoanalytic schools or groups, psychologists must also join psychologists’ collectives, such as colleges of psychologists or inter-colleges, in order to think about, discuss, and elaborate clinical possibilities. ConclusionThe work of clinical psychologists in hospitals is an act of resistance in itself. However, it is a natural outcome of our activity and should not become a goal in itself. It's about continuing to reflect on the complex situations we deal with, so that the obvious can emerge. Continually focusing on analyzing requests with tact allows us to modernize the authority inherent in the clinical approach itself, and to establish the autonomy of psychologists without them behaving like loose cannons, instead truly asserting their expertise. If valuable qualitative links are thus established with the interlocutors, the approach requires fully accepting the constraint of these links and of the debate which takes place throughout this analysis, whose finality is uncertain.