ABSTRACT
Violence-related post-traumatic stress disorder (PTSD) in the context of war and terrorism has become an increasingly pressing public health issue relevant to refugee children and families. PTSD and related psychopathology in children can adversely affect all domains of development and, in particular, interfere with learning and socialization. When the experience of violent trauma and related loss is shared with the entire family, resulting impairment and distress may prevent caregivers from being psychologically available to process their traumatized children's emotional communication and otherwise meet their children's developmental needs. When children suffer from PTSD, it may be impossible to put their experience and related thoughts and feelings into words, let alone a coherent narrative. The latter difficulty can be even more pronounced when the child displays dissociative symptoms, possibly signaling a dissociative subtype of PTSD. Thus, the narrative within the child's play during psychotherapy becomes all the more important as an indicator of the child's internal world. This case report is an example both of evaluation and of psychotherapy that is both psychodynamic and trauma-informed with a 10-year-old Afghani boy who suffered the violent loss of his father at age of 3 years, leading to his immigration to Switzerland. This paper addresses the question of how the psychotherapist can accompany the child through the elaboration of his trauma and how the therapist can contribute to the co-construction of a coherent narrative of the child's experience and to the restoration of an intersubjective connection between the traumatized child and caregiver.
ABSTRACT
This article presents the construction of a chain of care of perinatal psychiatric situations within the University Service of Child and Adolescent Psychiatry, which evolved within the framework of the departmentalization of this service. This chain of care includes the psychiatry of the liaison, the outpatient clinics as well as and day hospital care and extends from the prenatal period to the child's five years, with a focus on the relationship between child and caregivers, as well as an individual perspective on the child. Herein, we present and describe the different units and their functioning emphasizing the synergies and collaborations put in place that ensure the best possible continuity for patients and their families by promoting as much as possible the therapeutic alliance in this chain of care.
Cet article présente la mise en place d'une filière de soins pour la prise en charge des situations de psychiatrie périnatale au sein du Service universitaire de psychiatrie de l'enfant et de l'adolescent, qui prend place dans le cadre de la départementalisation de ce service. Cette filière de soins comprend des prises en charge de liaison, en ambulatoire et en hôpital de jour, et s'étend de la période prénatale aux 5 ans de l'enfant, en se focalisant sur les aspects relationnels parents-bébé mais également sur l'enfant en tant qu'individu. Les différents lieux de prise en charge sont présentés et chacun de leur mode de fonctionnement est décrit. Cet article insiste sur l'importance capitale d'une articulation et d'une collaboration étroite entre les différents lieux de prise en charge afin d'assurer la meilleure continuité possible des soins pour les patients et leur famille en favorisant au maximum l'alliance thérapeutique.
