Contenu du sommaire : Familles, soignants et maladie grave

Disease and development of the self: subjective appropriation of the disease by multidimensional therapeutic support of the child and his family. Diseases affect the psychological development of Self in children. The authors propose a therapeutic intervention to help ill children and their families to integrate their disease. A case study of a young patient at the hospital illustrates how a multidimensional encounter with tools that promote symbolization (e.g. drawing, plasticine, collage, mental elaboration) promotes a subjective appropriation of the disease. The authors explain how the framework of interdisciplinary work between somaticians, hypno-therapist and psychologist can stimulate the transformation of traumatic elements related to the disease in representations, and how this therapeutic work gives a meaning to the disease, which facilitates a continuation of the development of the child's Self.

Familial experience in the diagnosis of cancer and familial psychological dynamic
Suffering from the cancer and its diagnosis announcement are both moments that cause an automatic anxiety in the family, and then report a groupal anxious experience. The results of the study show alterations in the mode of operation of the family psychic apparatus of the cancer patient: burglary, weakness, constant anxiety, depressive symptoms, defense mechanisms such as splitting, avoidance, rationalization, pipes reaction etc., that are related to this subjective tested positive diagnosis of the disease by the family. Therefore these results can be exploited in the care of the cancer patient and his family.

The encounter between the patient, family and care providers when a serious illness occurs
When occurs serious illness, resources emerge and fragilities can be amplified. Family relations then reveal their history and density. While relieving and best accompanying the person confronted with the disease, it is important to recognize the mutual adaptations that occur in families and the experience of care providers who revolve in such a force field and contribute to it. The care provider, whether a social worker, psychologist, nurse, doctor or other, acts at the heart of this field of forces. Several guidelines from the systemic approach support us on a daily basis in the exercise of our individual and collective responsibilities. Issues related to family loyalties and to the encounters between patients, families and care providers are prioritized. Short stories inspired by real situations illustrate our paper.

Intersection of systems around serious illness
When a person falls seriously ill, she is not the only one to suffer the consequences of her condition: her family environment – especially her parents, her spouse, her children – will participate in a change of relational habits. New relational triangles will then complicate the experiences: intra-family modifications, but also the introduction of new thirds in a more or less invasive way: the family physician, then professional practitioners (physiotherapists, etc.) and finally nurses, and a whole group of professionals who support and constitute same institutional structures – hospital, revalidation center or Of palliative.

The serious illness and care's systemic approach. What consequences for the professional caregivers
It is question of the “prendre soin”, that's pear the Anglo-Saxon expression “caregiving”. For each serious illness it requires to take a triangle care between the patient, his family and the treaters. Those last should be able to evaluate the intersubjective illness's repercussions. They have also to think about the way they are themselves impacted. It has consequences on the treating system which functionality appears more or less able to answer ill's needs. They can so best develop their internal possibilities that they can rest on the external possibilities procured by professional caregivers able to offer them secure base, individually and collectively.

“Don't say that you are MD”What support and counselling offer up caregivers in the exercise of their missions? Compassion fatigue, vicarious trauma and burnout are often minimized and not enough taken into account. Medical culture seems especially reluctant to recognize any such suffering. The experience of a clinical psychologist evolving in an academic medical hospital is proposed here.

The psychic care through access to the emotions
The author proposes the use of metaphorical objects to encourage the expression of traumatic events. The installation of a safe environment and the choice of creative proposals are both essential in these working arrangements.