The development of the therapeutic alliance during the first five hypnotherapy sessions.

The therapeutic alliance is a principal element that allows the dynamics and effects of psychotherapy to be analyzed. In the past half-century, many studies have explored various psychotherapeutic approaches, including psychoanalytic, cognitive-behavioral and systemic psychotherapy, but hypnotherapy has not been addressed. This article presents the first analysis using current methods of verifying and understanding the dynamics of change in hypnotherapy, regarding to the therapeutic alliance. Luborsky et al.'s (1996) revised Helping Alliance Questionnaire (HAq-II) was administered to 59 patients in treatment with psychologists and psychiatrists using Ericksonian hypnosis. Our results suggest that the dynamics of the alliance in the first sessions of hypnotherapy involve factors related more to the therapist's adjustment to the patient than to the progress the patient makes in these initial sessions.

Clinical Perspectives on the Notion of Presence.

This article explores the theme of presence of the psychotherapist, a concept that has been of particular interest in humanistic and existential approaches. Presence was first associated with the humanistic attitudes of the practitioner and the way he or she embodies these attitudes in the here and now of the encounter. Since the publication in 2002 of Geller and Greenberg's model of therapeutic presence, several quantitative studies have explored the relationship between the therapist's perception of presence and other dimensions of the therapeutic process. However, qualitative explorations still seem necessary to account for the complexity of the therapist's presence and its role in the therapeutic process. Centered on the therapist's perspective, we use an idiographic methodology and refer to lived clinical experience to highlight the dimension of sensory contact that, through the body, actualize a connection to a virtual space of the therapeutic relationship. We so describe how a therapist can achieve an embodied processing to clinical material from what we describe as "traces of presence" of the other. From this point of view, the patient's presence incorporates itself into the therapist's experience and the therapist can perceive aspects of this presence in a tangible, concrete, and useful way. The therapist's presence thus takes on a meaning that is not reduced to what the patient will perceive and interpret of his or her attitude. It becomes the main material from which the therapist orients his or her clinical interventions.

Interest of a standardized hypnotic message for the reduction of pain and anxiety in cancer patients treated by capsaicin patch for neuropathic pain: a randomized controlled trial.

BACKGROUND: Neuropathic pain is characterized by spontaneous painful symptoms. Medical therapies include the use of a capsaicin 8% patch (Qutenza®, Grünenthal Gmbh, Germany), and patients may experience a sharp burning sensation at application and removal of the patch. This study aimed to evaluate the impact of playing a standardized hypnosis recording during application, on the pain and anxiety induced by capsaicin treatment. METHODS: In a randomized, controlled trial, we assessed the benefits of the intervention firstly on pain and secondly on anxiety, as measured using numerical rating scales. All patients had application of the capsaicin patch, including the possibility for the patient to apply a cold patch. Participants were randomly assigned to one of 3 groups, namely the "Standard group" (no intervention), "Hypnosis group", in which a standardized hypnotic message was played during application, or the "Music group" in which relaxing music was played during application of the patch. RESULTS: Sixty-nine patients were included. Overall, there was no significant difference in pain scores between groups (p = 0.355). Compared to standard application, anxiety was significantly lower in the hypnosis group after application (p = 0.007), with no significant difference between the standard and music arms (p = 0.271), or between the hypnosis and music arms (p = 0.423). CONCLUSIONS: Listening to a standardized hypnotic message during application of a capsaicin patch was found to significantly lower anxiety. These findings indicate that the use of a hypnotic message can reduce discomfort and warrant its evaluation in other indications of pain or anxiety during treatment procedures. TRIAL REGISTRATION: NCT02822625 .

Early Hypnotic Intervention After Traumatic Events in Children.

Post-traumatic stress disorder is a debilitating condition that can develop after exposure to any potentially traumatic event (natural disaster, physical assault, and car accident). This study focused on four pediatric patients presenting with an early stress response after a motor vehicle accident who were offered early therapeutic and a preventive management by hypnotherapy shortly after exposure to the traumatic event. All patients improved after one or several sessions of hypnosis. The results indicate that hypnotherapy can immediately help patients during the early period following a traumatic event.

The Suitability of a Transcultural Clinical Approach to Psychosomatic Disturbances in Reunion Island / A Pertinência de uma Abordagem Clínica Transcultural a Distúrbios Psicossomáticos na ilha Réunion

Abstract Cultural foundations, beliefs and associated ritual practices delimit the relation to and the representation and lived experience of the body in specific ways. Language is the means through which the cultural specificity of both individual and shared mental content can be explored and worked with in therapy. This article presents beliefs about the body in a patient's religion of origin and takes up the question of the role of the cultural dimension in psychosomatic phenomena. A case report gives indications of a novel therapeutic approach to this theme and highlights the intrinsic connection between cultural belonging and embodiment. Both the two-year long clinical intervention and analysis are grounded in transcultural and psychodynamic theories. The analysis shows how important it is to be aware of the patients' cultural background and the resonance of history in the patients' civilization.

Resumo Bases culturais, crenças e práticas rituais associadas delimitam a relação, a representação e a experiência vivida do corpo de formas específicas. A linguagem é o meio através do qual a especificidade cultural dos conteúdos mentais individuais e partilhados podem ser explorados e trabalhados em terapia. Este artigo apresenta as crenças sobre o corpo segundo a religião de origem de um paciente e levanta a questão do papel da dimensão cultural no fenômeno psicossomático. Um relato de caso dá indicações de uma nova abordagem terapêutica para esse tema e destaca a conexão intrínseca entre pertencimento cultural e corporificação. Tanto a intervenção clínica, que durou dois anos, como a análise fundamentaram-se nas teorias transcultural e psicodinâmica. A análise demonstra como é importante estar ciente sobre o contexto cultural dos pacientes e sobre a ressonância da história na civilização dos pacientes.

[Adaptation strategies faced with chronic pain]. / Stratégies d'adaptation face à la douleur chronique.

Chronic pain constitutes a challenge for patients. It makes them uneasy with regard to their personality, their corporality and their life balance, and leaves long-lasting effects on their experience as a patient. The development of adaptation strategies and resources to deal with chronic pain is therefore essential.

Psychological experience of patients 3 months after a stay in the intensive care unit: A descriptive and qualitative study.

PURPOSE: The purpose was to describe psychological experiences of patients 3 months after a stay in the intensive care unit (ICU) using qualitative methods. METHODS: Twenty patients underwent clinical interview lasting 1 hour and completed the Impact of Event Scale-Revised and Hospital Anxiety and Depression questionnaires. All interviews were recorded and coded using thematic analysis. RESULTS: All patients (100%) reported that they could not remember their ICU stay; half reported confused memories (50%) or disorientation (50%). Negatives memories were also reported (20%-45%), namely, pain, distress, sleep difficulties, noise, fear, feeling of abandonment; 20% reported positive memories. At 3 months, for 10 (50%) of 20 patients, their ICU experience was characterized by anxiety; 3 (15%) of 20 presented posttraumatic stress disorder; 7 (35%) of 20 reported a feeling of well-being with positive life changes. Well-being seems to be associated with use of coping strategies, such as active coping, positive reframing, optimism, humor, acceptance, leisure activities, and family support. CONCLUSION: Our study highlights the need to investigate patients' memories of ICU and the coping strategies used by patients to improve their ICU experience. Our findings suggest that a systematic follow-up consultation after ICU discharge would be useful for monitoring of post-ICU psychological outcomes.

Error in intensive care: psychological repercussions and defense mechanisms among health professionals.

OBJECTIVE: To identify the psychological repercussions of an error on professionals in intensive care and to understand their evolution. To identify the psychological defense mechanisms used by professionals to cope with error. DESIGN: Qualitative study with clinical interviews. We transcribed recordings and analysed the data using an interpretative phenomenological analysis. SETTING: Two ICUs in the teaching hospitals of Besançon and Dijon (France). SUBJECTS: Fourteen professionals in intensive care (20 physicians and 20 nurses). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We conducted 40 individual semistructured interviews. The participants were invited to speak about the experience of error in ICU. The interviews were transcribed and analyzed thematically by three experts. In the month following the error, the professionals described feelings of guilt (53.8%) and shame (42.5%). These feelings were associated with anxiety states with rumination (37.5%) and fear for the patient (23%); a loss of confidence (32.5%); an inability to verbalize one's error (22.5%); questioning oneself at a professional level (20%); and anger toward the team (15%). In the long term, the error remains fixed in memory for many of the subjects (80%); on one hand, for 72.5%, it was associated with an increase in vigilance and verifications in their professional practice, and on the other hand, for three professionals, it was associated with a loss of confidence. Finally, three professionals felt guilt which still persisted at the time of the interview. We also observed different defense mechanisms implemented by the professional to fight against the emotional load inherent in the error: verbalization (70%), developing skills and knowledge (43%), rejecting responsibility (32.5%), and avoidance (23%). We also observed a minimization (60%) of the error during the interviews. CONCLUSIONS: It is important to take into account the psychological experience of error and the defense mechanisms developed following an error because they appear to determine the professional's capacity to acknowledge and disclose his/her error and to learn from it.

[Hypnosis and pain: current and perspective knowledge]. / Hypnose et douleur: connaissances actuelles et perspectives.

After further controversies, the definition of hypnosis is to be at the same time a modified state of consciousness and a particular intersubjective relation between a practitioner and his patient. In a synthetic way, we can say that mechanisms of hypnosis on acute pain are now well known, and its efficiency is particularly proved in the pain provoked by the care. On the other hand, the knowledge concerning the action of the hypnosis on chronic pain is much more complex to understand. If the hypnosis allows connoting differently pain and to decrease its implication in patient's life, otherWise the long-term reorganizations of hypnosis on chronic pain are still for the study. In practice, the field which his particularly in development is the analogical processes of the speech, because they are particularly present in pain medicine, and easy to use in hypnotic method.

[Hypnosis and touch-massage to relieve pain at the end of life]. / L'hypnose et le Toucher-Massage pour soulager la douleur en fin de vie.

The treatment of pain in palliative care requires specific expertise. "Complementary" methods, such as hypnosis or "Toucher-Massage", for example, not only have an effect on the prevention and treatment of pain, but also contribute to the overall support of the patient.

Hypnosis and pain in children.

The development of studies on neuroimaging applied to hypnosis and to the study of pain not only helps to validate the existence of a hypnotic state but also to ratify its therapeutic effects. These studies also enable us to understand how hypnosis is effective on the cortical level. It also helps us see, from another perspective, the mechanisms of pain leading perhaps to a different definition of pain. This article develops the latest knowledge in the domain of hypnosis and pain, and approaches the clinical practices and their applications in the management of pain in children.