The work of “entours”, an everyday life’s clinic in institutional care


Work daily life in institution is subtle and delicate. The author, recolling a clinical situation and moments of  daily life in a day hospital, tries to illustrate this work of the atmosphere, the “entours” of which Jean Oury speaks.
These little unexpected moments that disturb and surprise us, make us perceive the complexity, the difficulty but also the wealth of what the patients deposit in the interstices of the establishment.

For this the Therapeutic Club, operator of change is a valuable tool. A stimulating opposing-power to the hierarchical functioning of the institution, its movement helps to strive routine and inertia.

About the opportunity of updated sectorised psychiatry


Sectorial organisation of psychiatry and institutional psychotherapy were founded 60 years ago. Sectorial organisation of psychiatry is based on closeness and continuity. It is a matter for a constant presence and availability of health care team, in a centralized place for treatment. This centralized device is especially helped by means of transport. Interlocutor’stability reassure patients suffering of psychics insecurity. We combine to this centralized device with the management of these cognitive remediation therapy measures in groups. This will make metacognitives, neurocognitives and social cognitives functions’s work. We may think and apply these principles with help from institutional psychotherapy paradigm’s and psychanalytic approach of psychosis. So, we help to bring toghether shizophrenic dissociations with the symbolising symbol through a health care team meetings. (cross-sector, dissociated transfert, club function). Sectorial organisation of psychiatry psychosocial reabilitation and cognitive remediation connect themselves in a coherent whole.

How Jean Oury, a giant of psychiatry, can help us to practice a humane psychiatry

Summary :


Jean Oury is one of the main creators and actors of the mouvment of institutinnal therapy. Along his professionnal life, he created many and important conceptions for the practice and theorisation of human psychiatry. Some of his inventions (double alienation, dissociated transferance, transferancial constellation, « collectif »,…)are studied in this paper and give an idea of his importance, on the psychopathological way and also on the societal and politic way.

institutional psychotherapy, a permanent creation

Abstract. This text reflects a long-term practice with psychotic patients and the establishment with them of a system in the city of Reims.
Structure mainly based on the ambulatory by Antonin Artaud Unit, but also hold by 5 therapeutic clubs present in various places of the service.
From a transmission / reinvention where patients but also seniors as Roger Gentis and Jean Oury played a crucial role , the essential concepts of institutional psychotherapy are being revisited and acted in a permanent recreation.
The heterogeneous as a founding principle, but also “the club function” contribute to the setting in motion of the Collective, and help the reconstruction for each of a livable and desirable world.
This also assumes a working gathering conscious of psychic continuity, essential to fight against fragmentation and cleavage.
Putting on an equal footing patients and caregivers will thus allow a instituting praxis, and the creation of an patient association named Humapsy.
Keywords: therapeutic club, club function, “phoric” function, Collective, permanent recreation, heterogeneous, institutional psychotherapy.

The collective in itself

Abstract. Institutional therapy includes a vast and heterogeneous set of practices, ideas, thoughts, writings which are particularly inspiring at this moment in time. This article illustrates thoughts about institutional work in an out-patient hospital receiving adolescents and young adults with symptoms from autistic spectrum.

Psychoanalyst in institution: an impossible neutrality?

Summary. Sometimes the psychoanalyst is requested to intervene in institution in various forms. The reference to the groupal psychoanalysis allows to think institution as a specific group with its history, myths and specific functioning. Through clinical examples, we wonder here about the place that the psychoanalyst can take in a listening of the Unconscious when the external and organizational reality sometimes seems to cover the access to the sense. More than ever, a rigorous training is necessary in this working.

From one group to another : psychic capacities of a team and its slags in intitutional care

Abstract :


This exposé aims at suggesting a few arguments in favour of the therapeutic dimension of institutions and situating the part teamwork plays in such a dimension .Thinking collectively supports two types of distinct process . The former is about transforming the suffering that impacts the prevailing way of working of professionals . The latter comes close to the team script-writing about and dramatizing the very mental moves of the persons in care . A short clinical vignette throws light on the failure of such processes in case of institutional crisis.

The playing area of foundational praxis

Abstract. The institution, in the meaning of the act of instituting, is made possible by the creation of multiple play areas (in oneself, inside the group, inside the society). In the daily clinical work, that introduces a fight against the naturalization of the psychotic processes and the institutional phenomena. To open to the complexity of the human relationships and to the consideration of the weaknesses of institutions and people, to put them into the work, is the stake in the instituent praxis.

Institutional dynamics and groupal process : screenwriting and story-telling

Abstract: The author offers an afterthought on the meeting points between institutional therapy and therapeutic mediations. What are the common inspirations that lead these two points of view to defend a certain idea of caregiving institutions? What are the acquaintances and resemblance between these two ways for institutional caregiving? From the example of an institutional workshop as it is set up within the adolescent inpatient unit of the Villa des Pages Clinic, the author tries to articulate these two approaches of institutional psychological care.

Function of the institution in consultations


How the practice among schizophrenics patients would change the listening  to the neurotic people or other patients ? Experience as a practical institution in consultation is illustrated by the therapeutic work continued with a patient .One could argue that institutional psychotherapy today is a psychotherapy of social link. 

About the need to make intitution for teenagers

Abstract :

The institutional psychotherapy is a necessity in all the psychic care institutions, but it is more a necessity when the institution recieve teenagers. Subjets in construction, the adolescents are build with narcissistics and struturals fragilities, which are to analyse with all the care team, how the transference motions are projections upon the differents subjets of the institutions. These tranferences must be analysed by all the members of the therapic group.

The clinical facts are lightning this necessity, ans try to remake the creative moment of the fondators, by making it in work process for each adolescent subject.