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Article Dans Une Revue Annales Médico-Psychologiques, Revue Psychiatrique Année : 2006

Schémas dépressogènes et espace subjectif

Résumé

The concept of schema used in cognitive psychotherapy is an heuristic tool that has more a metacognitive value than a psychological value: it doesn't involve directly the cognitive processes and the representations in memory. Therefore, the understanding of the therapeutic action is limited and insufficient for a satisfying account of the complex clinical data observed during the course of treatment of resistant depression. To overcome this problem, we propose a conceptual framework that describes a subjective universe as a representational space that is displayed from memory. From this point of view, depression is equivalent to a retraction of the subjective space. This retraction is primed by the reactivation of some past traumatic events. We show the influence of early painful situations on the Home Image, which is an essential area for the unification of the representational space. This conceptual framework allows us to define the representational structures underlying the cognitive model of learned helplesness of Abramson et al. [1]. Two levels of schemas are specified: (1) the symbolic structures that constitute the "web" of the subjective space and correspond to the schemas of the cognitive psychology; (2) the metaschemas that are the constructs of the therapist. The formation of the depressogenic schemas during the personal story is linked to the development of metaschemas of vulnerability, gratitude, and control. A therapeutic block is defined as a closing of the therapeutic space - that is, the intersubjective world constructed between the patient and the therapist. Such a block indicates the necessity of a global restructuration to release the memory from a depressogenic metaschema. In this case, the therapeutic strategy requires a technical adaptation to mobilize the mass of the subjective space. The therapeutic medium needs to resonate with the core of the depressogenic metaschema that is deeply buried in memory. The patient should also actively grasp the processes of the symbolic structuration of his/her subjective space. This conceptual framework allows us to account of the concept of insight as a spatial feeling of unification and widening that is associated to a restructuration. Thus, a cognitive therapy can be analyzed as a succession of phases that mirrors in reverse order the development of the depressogenic metaschemas. A case study confirms the relevance of this approach and we underline the crucial function of the therapist's creativity to overcome the therapeutic blocks. We insist also on the carefulness that is necessary to approach the early painful situations deeply buried in memory.
La notion de schéma utilisée dans les thérapies cognitives est un instrument heuristique mais ne met pas directement en jeu les processus mnésiques, ce qui limite la compréhension de l'action thérapeutique. Afin d'affiner cette compréhension, nous introduisons un cadre conceptuel qui permet de décrire le monde subjectif en tant qu'espace de représentation déployable à partir de la mémoire. La formation des schémas dépressogènes au cours de l'histoire singulière peut alors être précisée. Nous montrons comment redéfinir dans ce cadre les structures de représentation sous-jacentes aux modèles cognitifs de la dépression. Deux niveaux de schémas sont différenciés : 1) les structures symboliques qui forment la trame de l'espace subjectif et correspondent aux schémas de la psychologie cognitive ; 2) les métaschémas qui sont les constructs auxquels le thérapeute se réfère. Ce cadre conceptuel permet de clarifier les notions de blocage thérapeutique, d'insight et de restructuration. Une étude de cas illustre la pertinence de cette approche.

Dates et versions

halshs-00791025 , version 1 (21-02-2013)

Identifiants

Citer

Arnaud Plagnol, Christine Mirabel-Sarron. Schémas dépressogènes et espace subjectif. Annales Médico-Psychologiques, Revue Psychiatrique, 2006, 164 (1), pp.24-33. ⟨10.1016/j.amp.2004.11.014⟩. ⟨halshs-00791025⟩
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