Thierry Baubet

Against the odds: psychomotor development of children under 2 years in a Sudanese orphanage.

Providing abandoned children the necessary medical and psychological care as possible after their institutionalization may minimize developmental delays. We describe psychomotor development in infants admitted to an orphanage in Khartoum, Sudan, assessed at admission and over an 18-month follow-up. Psychological state and psychomotor quotients were determined using a simplified Neonatal Behavior Assessment Scale (NBAS), the Brunet-Lezine and Alarm distress baby (ADBB) scale. From May-September 2005, 151 children were evaluated 2, 4, 9, 12 and 18 months after inclusion. At admission, ~15% of children ≤1 month had a regulation impairment according to the NBAS, and 33.8% presented a distress state (ADBB score >5). More than 85% (129/151) recovered normal psychomotor development. The results of the program reinforce the importance of early detection of psychological disorders followed by rapid implementation of psychological case management to improve the development of young children in similar institutions and circumstances.

Mobilising Social and Symbolic Resources in Transcultural Therapies with Refugees and Asylum Seekers: The Story of Mister Diallo

211 Psychotherapies with refugees and asylum seekers are a challenging task for health professionals. Therapists do not only have to face the difficulties of transcultural communication, they also have to confront the omnipresence of social and administrative problems these patients struggle with. They equally have to adapt their technique to the dynamics appearing in therapeutic work with victims of deliberate violence. In this article, we first propose a brief discussion of these problems, their impact on the psychotherapeutic work and our strategies to deal with them. In the following part, we illustrate our approach by a case study.

Countertransference in Trauma Therapy

Countertransference in Trauma Therapy Background: Trauma is perceived as a highly subjective experience depending on personal resources and resilience. The therapeutic relationship in trauma psychotherapy seems to be a special one due to the powerful, emotional charged process of revealing and working with memories of traumatic experiences. This qualitative study explored the countertransference in trauma therapy by means of applying a special protocol in interviewing therapists from various cultural backgrounds. Methods: Seven trauma therapists were interviewed following a specific in-depth protocol where the method of emergent scenarios was applied. In this method, the therapist describes a client’s traumatic event, thereby triggering various countertransference responses, which are registered and analysed in clusters. Results: Participants indicated the exceptional use of defence mechanisms, such as minimisation of the clients’ traumatic stories and the presence of reactions such as: affective disconnection, absorption by the scene, use of metaphors, being invaded by the scene, identification with specific feelings, blank-out, confusion of feelings, dreaming and emergent scenario’s appearance. The findings indicated that therapists, who have experienced trauma in their life course and/or genealogy, showed stronger countertransference emotions and reactions. Therapists who did not experience trauma and who were still in the beginning of their career, showed relatively low emotional and physical countertransference responses. The therapists indicated the application of self-healing and other coping strategies to deal with the countertransference feelings and reactions. Conclusions: The vivid descriptions of the participants gave deep insights into and highlighted the specificity of the therapeutic relationship in trauma therapy. This was presented in the stories of the therapists, which reflected personal aspects of their life experiences. Several participants mentioned silence surrounding personal trauma posed major challenges in trauma therapy. Moreover, the therapists indicated several measures to deal with countertransference issues, such as supervision, specialization and support.

Impact of migration on explanatory models of illness and addiction severity in patients with drug dependence in a Paris suburb.

Objectives of this study were to assess explanatory models (considering illness experience and meaning), addiction severity among patients with drug dependence, and the role of migration. Adapted Explanatory Model Interview Catalogue interviews were conducted with 70 outpatients in a Paris suburb. Among them, 42 were either first- or second-generation immigrants, most from North Africa. Explanatory models were analyzed qualitatively and quantitatively according to migration status, assessing potential confounders with multivariate linear models. Explanatory models were heterogeneous. Compared with nonmigrants, migrants reported fewer somatic and violence-related symptoms. They attributed the causes of their addiction more frequently to social and magico-religious factors and less to psychological factors. Conversely, no difference in addiction severity was found between migrants and nonmigrants. Considering local patterns of illness experience and meaning of drug dependence is a critical component of culturally sensitive clinical care.

Le miroir pétrifié: Destins du traumatisme psychique dans les familles confrontées à la guerre du Liban

Suite au conflit Libanais de juillet 2006, des prises en charge d’urgence medico-psychologique ont ete proposees des l’accueil des refugies a l’aeroport de Roissy-Charles de Gaulle. Comprenant psychiatres, pedopsychiatres, psychologues et infirmiers, ces interventions precoces ont permis en particulier de reveler l’intensite de la reactivation traumatique chez les parents victimes du precedent conflit et ses consequences sur les enfants de tout âge. Cet article propose une reflexion sur le destin du trauma qui se nourrit de l’evenement lui-meme tout autant de ce qu’il vient reactiver dans l’histoire individuelle et dans l’histoire collective. Nous tenterons egalement de voir comment, au-dela de la realite de la destructivite de ce mal, les sujets peuvent faire de la malediction d’un desastre inflige la chance d’une force creee.