Résumé
L’étude empirique du devenir à long terme des personnes atteintes de schizophrénie fait apparaître qu’un rétablissement est souvent possible. Ce dernier peut, selon cette littérature, renvoyer à des expériences différentes selon les personnes qui ont présenté pourtant les mêmes troubles psychiatriques. Pour certaines, le rétablissement peut signifier la rémission des symptômes, alors que pour d’autres il peut se traduire par des accomplissements psychosociaux. Pour d’autres encore, cependant, se rétablir peut impliquer des changements subjectifs dans la manière de se sentir sujet de l’action, porteur de sens dans le monde. Pour certaines personnes, se rétablir sera retrouver pleinement le sentiment de soi, un sentiment de soi qui permette de s’engager dans des relations à autrui dotées de sens et d’affronter les rigueurs de la vie quotidienne. Dans cet article, nous examinerons la capacité de la psychothérapie individuelle d’aborder les aspects les plus subjectifs du rétablissement liés au sentiment de soi. Nous recenserons d’abord la littérature sur l’efficacité de la psychothérapie pour les personnes atteintes de schizophrénie. Nous discuterons ensuite les travaux portant sur la question plus large de savoir de quelle manière le déficit en matière de métacognition narrative, peut être sous-jacent à certains des troubles du sentiment de soi observés dans la schizophrénie. Enfin, nous nous centrerons sur la manière dont la psychothérapie pourrait être conçue et adaptée pour contribuer à enrichir l’expérience de soi par la narration et la métacognition. Des perspectives pour des recherches futures seront discutées.
Abstract
Empirical study of long-term outcomes for persons with schizophrenia suggests that recovery is often possible. This literature also emphasizes that recovery may involve different kinds of experiences for different people with the same psychiatric condition. For some, recovery may mean symptom remission while for others it may be reflected by the achievement of psychosocial milestones. For yet others, however, to recover can involve subjective changes in how those persons experience themselves as meaningful agents in the world. For some, to recover could be to reclaim a full sense of self, a sense of self that permits to engage in relationship with others and the rigors of daily life. In this chapter, we review the potential of individual psychotherapy to address the more subjective aspects of recovery related to sense of self. We first review literature on the effectiveness of psychotherapy for persons with schizophrenia. We then discuss literature on the larger issue of how decrement in personal narrative metacognition may underpin some of the disturbance in sense of self observed in schizophrenia. Finally, we focus on how psychotherapy could be conceptualized and adapted to help enrich self-experience by addressing narrative and metacognition. Directions for future research are discussed.
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Article traduit par C. des Moutis et B. Pachoud (bernard.pachoud@gmail.com).
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Lysaker, P., Erickson, M. La psychothérapie individuelle de la schizophrénie: mise en perspective de son histoire, de ses développements récents et de ses orientations nouvelles. Psychiatr Sci Hum Neurosci 8, 187–196 (2010). https://doi.org/10.1007/s11836-010-0149-4
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DOI: https://doi.org/10.1007/s11836-010-0149-4