La tarification à l’activité (T2A) : Quelles transformations pour l’activité du personnel infirmier ? Etude exploratoire

This article presents an exploratory study, which attempts to analyse the changes which have occurred in the professional life of nurses in France since the introduction of the system of payment per medical act (T2A). The theoretical background is provided by theories on the activity. The T2A system is intended to provide a means of or ganising nursing care. The main results of qualitative analysis undertaken show above all changes in the way nurses’ work is organised (pace, rhythm, productivity, value for money and turnover). The more intense workload mentioned by the nurses concerns above all an increase in technical and administrative activity rather than any personal interaction with the patients, which appears to have suffered from the changes. The repercessions identified by the nursing staff include frustration, a loss of meaning in their work and a lower standard of nursing care provided.     

Boundary and analytic attitude: reflections on a summer holiday break

The effect of a boundary in analytic work at the summer holiday break is discussed in relation to archetypal experiences of exclusion, loss and limitation. Some attempts by patients to mitigate an analyst's act of separation are reviewed as enactments, and in particular the meanings of a gift made by one patient. Analytic attitude towards enactment from within different schools of practice is sketched, with reference to the effect on the analyst of departing from the received practice of their own allegiance. A theory is adumbrated that the discomfort of ‘contravening the rules’ has a useful effect in sparking the analyst into consciousness, with greater attention to salient features in an individual case. Interpretation as an enactment is briefly considered, along with the possible effects of containing the discomfort of a patient's enactment in contrast to confronting it with interpretation.     

Understanding injuries in sports: Self-reported injury and perceived risk of injury among adolescents

IntroductionAlthough exposure and perceived risk of injury in sports among adolescents is a well-known phenomenon today, their understanding remains poorly explored.ObjectiveThis study examines the relationships between demographics, sport motives, and sport-related characteristics in a sample of French adolescents involved in sports.MethodsThe sample included 394 adolescents involved in sports, between 13 and 19 years old. The adolescents filled out a questionnaire requesting information about their age, sex, sport motives, sport-related characteristics, the number of injuries, and perceived risk of injury in their preferred sport.ResultsThe findings showed that the number of injuries was related to age, sex, type of sport and the participant's motives. The will to play to the limit increased with the exposure to injury. Participation in risky sports and the will to play to the limit were predictors of the adolescents’ risk of exposure to sports injuries. Time devoted to sports appears to be a confounding factor. Moreover, boys exhibited higher number of injuries than girls, and they perceived their preferred sport as riskier.ConclusionExposure to the risk of injury in sports and the exacerbated perception of that risk may provide a means of enhancing one's self-image, procuring an emotional experience, and constructing one's masculinity.     

Unformulated experience,dissociation, and Nachträglichkeit

The paper is divided into two parts. The first part is an interpersonal/relational psychoanalytic account of some relationships between dissociation, time, and unformulated experience. Trauma, and the dissociation to which trauma leads, freezes time, which makes it impossible to formulate certain kinds of new experience. Instead, potential new meanings remain unformulated. The route of clinical access to frozen time is the interpersonal field: to thaw time and allow new experience, the ways in which the interpersonal field is itself frozen need to be addressed. A clinical illustration of these ideas is offered. The second part of the paper presents and explores a point of confluence between the views in Part 1 and certain aspects of French psychoanalysis, with particular reference to the concept of Nachträglichkeit in the work of Jean Laplanche and Haydée Faimberg.     

Residues in the analyst of the patient's symbiotic connection at a somatic level: unrepresented states in the patient and analyst

This paper discusses the residues of a somatic countertransference that revealed its meaning several years after apparently successful analytic work had ended. Psychoanalytic and Jungian analytic ideas on primitive communication, dissociation and enactment are explored in the working through of a shared respiratory symptom between patient and analyst. Growth in the analyst was necessary so that the patient's communication at a somatic level could be understood. Bleger's concept that both the patient's and analyst's body are part of the setting was central in the working through.     

Analytic attitude – focus or embodiment? Subtle communications in the transference/countertransference relationship

The paper considers a ‘befallment’ that occurred in the course of analysis at a time when the focus of work was too much at a conscious level, dissociated from the patient’s embodied and visceral depths. A rigidly held attitude of focal attention is considered as potentially a defence against embodied experiences of overwhelm and vulnerability that may haunt shadowy realms which remain unlit by the narrow beam of conscious awareness. Rather as a dream drifts in from the unconscious, an enactment by the analyst brought neglected aspects of the transference and countertransference relationship into the room. Later, the patient’s own dreaming mind offered images that suggested an underlying dynamic. These subtle communications, alongside the patient’s attitude toward the analyst’s lapse, are considered as factors in the achievement of greater embodied integration. The analyst’s difficulty in arriving at a formulation of such events is discussed, along with the necessity of holding such ‘befallments’ in mind over long periods of time before any explanation can be adumbrated.