Thérapies avec médiations, ou la thérapeutique par surcroît : comment et quand poser l’indication d’un projet de soins « paradoxal » ?

Abstract

First seen as a way to sustain an insufficient verbal expression to meet the requirements of talking therapies, mediated therapies are tending to become an unexpected effective psychotherapeutic alternative. Various practices have increased. They are often developed on empirical basis by caregivers, who commit themselves at the service of their young patients. They do it with passion, according to their taste and field of competence. This kind of alchemy operates through the material used in the therapy. Thus, this shared creativity seems to ease an intersubjective meeting or even a revival of thought processes. A relaxation of the symptoms, a well-being and a relational openness are often assessed afterwards. This, obviously, encourages caregivers to innovate and to dare to set up tailored action. These must be diverse enough to meet children's latent expectations and to better adjust to their operating constraints. In the last years, many publications tried to understand the concept of mediated therapies and to hypothesize about what is “therapeutic in addition,” despite not in the typical cure framework. Group mediated therapies in child and adolescent psychiatry show a benefit. It invites to interest to group dynamics that contribute to everybody's progress. But whatever the will to describe precisely the framework and content of workshops, to settle them in the institutional set-up and to establish precisely the indications for them, whatever the attempts to formalisation, the essential role is played by all these “little nothings that change everything”: openness to the unattended, chance encounters, atmosphere of the talks, humour, the way emotion spreads and circulates, and the way achievement is taken into account. In spite of all these shadows, indications keep growing. This could testify fewer neurotic organizations and an increase of limit and narcissistic pathologies, which can’t stand especially in adolescence in face-to-face therapy. In such a context, mediated therapies could be indicated to create a Winnicott inspired shared play field, an intersubjective space able to sustain the subjectification process. Maternal qualities such as malleability and solidity cannot be eruditely prescribed but must be found among those involved caregivers and need to refer to the regulatory institutional supporting and thinking bodies.