The purpose of this study was to investigate whether a psycho-educational intervention program could support traumatised people to increase their mental toughness. Mental toughness is a well proven phenomenon in sports psychology as well as in leadership in the corporate world. I wanted to apply the use of mental toughness in trauma. Literature was consulted to understand the phenomena of mental toughness and trauma respectively. The corresponding aspects of mental toughness and trauma were selected for the literature review and many similarities between mental toughness and trauma were discovered. The corresponding aspects included action taking, the importance of the “self”, facing negativity and adversity, the importance of support systems, flexibility and adjustment, dealing with guilt and self-blame, the role of self-talk, people’s perceptions, goal-setting, commitment, helplessness / learned helplessness and dealing with stress. I used the corresponding aspects to compile a psycho-educational intervention programme to support traumatised persons to develop increased mental toughness that will support them to better deal with trauma. A valid and reliable psychometric instrument, the MTQ48 (Mental Toughness Questionnaire 48), has been successfully used to determine people’s mental toughness in sports psychology and in corporate management, but has never been tested before in supporting traumatised people. An action research design was employed, where both qualitative as well as quantitative methods were used. This is also known as a mixed research design. Eight traumatised people took part in the research which was presented weekly, as individual sessions, over eight weeks. Data collection methods included questionnaires, observation and individual therapy. The results of the study indicated that seven of the eight participants’ overall mental toughness increased after the intervention program, and four of the eight participants’ mental toughness components increased. As an additional benefit, all respondents indicated that they could better deal and cope with their trauma after the intervention program. The conclusion could be drawn that the psycho-educational intervention program was successful in supporting the traumatised participants to increase their mental toughness. / Psychology of Education / D. Ed. (Psychology of Education)

Comme les études sur la couverture médiatique ont démontré qu’elle influence pratiquement toute personne qu’elle touche, des consommateurs aux jurés aux témoins, les deux études de cette thèse doctorale ont respectivement examiné l’opinion du public sur l’imposition de restrictions sur les médias dans les palais des justices et l’impact de la couverture médiatique sur la santé mentale des victimes de crime. Le gouvernement québécois a récemment introduit des restrictions sur les médias dans les palais de justice afin de minimiser l’influence des journalistes et des caméramans. Bien que l’affaire a atteint la Cour suprême du Canada, une étude préliminaire a trouvé que le public est largement favorable à ces restrictions (Sabourin, 2006). La première partie de cette thèse doctorale cherchait à approfondir ce sujet avec un échantillon plus représentatif de la population. Deux cent quarante-trois participants comprenant six groupes expérimentaux ont rempli des questionnaires mesurant leur opinion de ces restrictions. Les participants ont été divisé en deux conditions expérimentales où ils ont visionné soit des clips audiovisuels démontrant une atmosphère de débordement dans des palais de justice ou des clips plutôt calmes. Un troisième groupe n’a visionné aucun clip audiovisuel. De plus, il y avait deux versions du questionnaire ayant 20 items où les questions ont été présenté en sens inverse. L’étude a trouvé qu’une grande majorité des participants, soit presque 79 pourcent, ont supporté la restriction des médias dans les palais de justice. Il est intéressant de noter qu’un des groupes n’a pas supporté les restrictions – le groupe contrôle qui a lu les énoncés supportant l’absence des restrictions en premier. La deuxième composante de cette thèse doctorale a examiné l’impact des médias sur les victimes de crime. De nombreuses études expérimentales ont démontré que les victimes de crime sont particulièrement susceptibles à des problèmes de santé mentale. En effet, elles ont trois fois plus de chances de développer un trouble de stress post-traumatique (TSPT) que la population générale. Une étude a confirmé cette conclusion et a trouvé que les victimes de crimes qui avaient une impression plutôt négative de leur couverture médiatique avaient les taux les plus élévés de TSPT (Maercker & Mehr, 2006). Dans l’étude actuelle, vingt-trois victimes de crimes ont été interviewé en utilisant une technique narrative et ont complété deux questionnaires mésurant leur symptômes du TSPT et d’anxiété, respectivement. Une grande proportion des participantes avaient des symptômes de santé mentale et des scores élévés sur une échelle évaluant les symptômes du TSPT. La majorité des narratives des participants étaient négatives. Les thèmes les plus communs incluent dans ces narratives étaient l’autoculpabilisation et une méfiance des autres. La couverture médiatique ne semblaient pas être liée à des symptômes de santé mentale, quoique des facteurs individuels pourraient expliquer pourquoi certains participants ont été favorables envers leur couverture médiatique et d’autres ne l’été pas. Les résultats de ces deux études suggèrent que le public approuve la restriction des médias dans les palais de justice et que des facteurs individuels pourraient expliqués comment la couverture médiatique affecte les victimes de crime. Ces résultats ajoutent à la littérature qui questionne les pratiques actuelles qu’utilisent les médias. / As media coverage has been shown to influence virtually everyone that it reaches, from its consumers to jurors in cases with pretrial publicity to eyewitnesses, the two studies that comprise the present dissertation respectively investigated the public’s opinion on imposing restrictions on the media in courthouses and the impact of media coverage on the mental health of crime victims. The Quebec government recently imposed restrictions on the media in courthouses in order to reduce the interference of journalists and cameramen. While the issue reached the Supreme Court of Canada, the public were found to be largely in favour of these restrictions in a preliminary study (Sabourin, 2006). The first part of this dissertation sought to further investigate this topic with a more representative sample of the population. Two hundred forty-three participants in six experimental groups filled out questionnaires that measured their opinion of these restrictions. There were two conditions with audiovisual clips showing either a media circus-like atmosphere or relatively calm proceedings in Quebec courthouses. A third control group did not view any audiovisual clips. There were also two versions of the twenty-item questionnaire where the questions were presented in reverse order. This study also found overwhelming support for the restrictions; nearly 79 percent of participants supported restricting media presence in courthouses. Interestingly, one experimental group did not – the control group that read statements that supported an absence of restrictions first. The second component of this dissertation examined the impact of the media on crime victims. Crime victims have been shown to be especially susceptible to mental health problems. Indeed, they are three times as likely as the general population to develop Post-traumatic Stress Disorder (PTSD). One study confirmed this finding and found that crime victims who had negative impressions of the media coverage of their cases had the highest rates of PTSD (Maercker & Mehr, 2006). In the present study, twenty-three crime victims were interviewed using a narrative technique and completed two questionnaires that respectively measured their PTSD symptoms and anxiety. A great proportion of participants were found to have mental health symptoms and high scores on the Impact of Events Scale-Revised (IES-R). The majority of the narratives of these participants were negative. The most common themes included in these narratives were self-blame and suspiciousness of others. Media coverage did not appear to be related to any mental health symptoms, although individual factors may explain why some participants were favourable towards the coverage and others were not. The findings of these two studies suggest that the public approves of restricting media presence in courthouses and that individual factors may explain how media coverage impacts crime victims. These results add to the literature that calls current practices used by the media to gain coverage into question.

The purpose of the current study was to examine Dutton's (1992) model of moderating and mediating variables which may impact the relationship of violence from an intimate partner with the development of posttraumatic stress disorder (PTSD) symptoms. This model was tested within three ethnic groups (African American, n = 303, Euro-American, n = 271, and Mexican American, n = 260), of low income, community women in serious, long-term relationships. The importance of the differences and similarities observed are discussed within a framework of the PTSD as well as domestic violence literature.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Dans son ouvrage Shell Shock Cinema, publié en 2009, Anton Kaes se distancie fortement du travail fondateur et classique de Siegfried Kracauer, From Caligari to Hitler, publiée en 1947, et portant sur le cinéma pendant la période de Weimar. Réfutant la thèse de Kracauer selon laquelle un inconscient collectif allemand annonce la montée du nazisme dans le cinéma de l’entre-deux-guerres, Kaes affirme au contraire que le shell shock, héritage de la Première Guerre mondiale, est l’un des moteurs du cinéma weimarien. Les travaux de Kaes s’inscrivent dans une historiographie en renouvellement qui, confrontant également la thèse de Kracauer, met désormais l’accent sur la Première Guerre mondiale, et non sur la Seconde Guerre mondiale, pour mieux comprendre et analyser le cinéma weimarien. Ce mémoire, tout en étudiant de façon détaillée l’historiographie du sujet, tend à approfondir et à réévaluer la thèse d’Anton Kaes en l’exposant à davantage de films représentant des traumatismes personnels, des traumatismes sociaux et des chocs post-traumatiques (CPT). Ces maux sont exacerbés par des tensions sociopolitiques – insurrection de janvier 1919, Traité de Versailles, occupation de la Ruhr, l’inflation de 1923-24, etc. – alimentant à la fois des représentations symboliques et concrètes d’expériences traumatisantes qui caractérisent l’ensemble du cinéma weimarien. / Anton Kaes’ 2009 Shell Shock Cinema made a clear shift from Siegfried Kracauer’s 1947 classic book, From Caligari to Hitler. Refuting Kracauer’s major thesis – which found hints of the rise of Nazism through an analysis of Weimar cinema – Kaes placed shell shock as a primary source of influence on the 1920’s German movies. Recent research takes a new look at Kracauer’s thesis and its significance, emphasizing the First World War, and not the Second World War, as the new cornerstone of studies on Weimar Cinema. This paper, while conducting a thorough review of literature on the subject, seeks to reconsider Kaes’ thesis, expending it to a larger filmography selected for its numerous representations of personal trauma, social trauma and post-traumatic stress disorder (PTSD). These mental troubles are exacerbated by socio-political tensions, – such as the Versailles Peace Treaty, the Ruhr occupation, the January 1919 insurrection and the inflation of 1923-24, – feeding both symbolic and concrete depictions of traumatic experiences throughout the Weimarian cinema.

Today’s military encompasses a wide variety of families who are affected by deployments in multiple and complex ways. Following deployments, families must reconnect in their relationships and reestablish their way of life. Appropriate and effective communication during this time is critical, yet many military couples struggle with this process. Moreover, student service members/veterans and their families are in a unique position. In addition to coping with changes in their marital relationship, student veterans may feel isolated or unsupported on college campuses, often experiencing anxiety, depression, posttraumatic stress, or suicidality. The current study seeks to bridge the gap between the military family literature and the student service member/veteran literature by examining how deployment experiences, mental health issues, and communication patterns influence post-deployment relationship adjustment among student veterans. Analyses tested whether communication style and/or current mental health concerns mediate associations between combat experiences and couples’ relationship adjustment, as well as between experiences in the aftermath of battle and relationship adjustment. Results suggest that although posttraumatic stress is significantly related to deployment experiences among student veterans, participants report no significant negative effects of deployment on relationship adjustment. Communication style, however, was significantly associated with relationship adjustment, and a lack of positive communication was found to correlate with PTSD diagnosis. Research and clinical implications are discussed.

Thesis (Ph.D.(Psychology))--University of the Witwatersrand, Faculty of Humanities, 2013. / The research entailed a comprehensive study of vicarious trauma in short-term insurance claims workers, compared to trauma counsellors and a control group of holiday booking consultants. A well-known, comprehensive model of compassion fatigue/secondary traumatic stress, developed for therapists formed the basis of the study. The research attempted to determine whether this model can be applied more widely to include administrative populations exposed to traumatised clients on a regular basis. To this end, the model was deconstructed into its eleven constituent parts and each element was investigated in addition to other variables of interest to the study. This was done to determine the importance and applicability of each model element and other selected variables to the administrative context. A mixed methods approach was utilised, which combined quantitative and qualitative data. The results yielded by the study were collectively utilised to construct an etic and an emic voice from the research. At the same time, effects from vicarious trauma were considered from an overarching bio-psychosocial stance, systematically gauging effects on various levels of functioning. Scores from quantitative measures on secondary traumatic stress, negative cognitive schemas, empathy, social support and compassion satisfaction were statistically analysed, which revealed significant differences between the worker groups. Widely accepted relationships between the study variables were tested and found to hold true within and across groups. Regression analysis determined the roles of empathy, social support and compassion satisfaction in vicarious trauma, as measured by secondary traumatic stress and negative cognitive schemas. In addition, constructivist selfdevelopment theory was employed to interpret the negative cognitive effects from vicarious traumatisation. Qualitative data were utilised to further elucidate the role and nature of vicarious trauma in each of the worker groups. The themes of exposure to client suffering, detachment, level of empathic engagement, personal trauma history and difficult life demands were unearthed from the qualitative data, which illuminated the importance and role of each of these elements to claims workers. Other areas of interest, being utilisation of sick-leave as a means to cope, work-related illness, attitudes towards professional counselling, feelings evoked by traumatised clients, and the language utilised by workers in response to client traumata were investigated. Further effects on participants as well iv as effects that reach beyond the person were identified and examined. Effects on the social and work contexts were also elucidated. Finally, interesting themes that emerged spontaneously from the data were considered. The consideration of the various model elements and other areas of interest systematically revealed that administrative workers dealing with traumatised clients are also affected by the process of vicarious trauma. Furthermore, the model was found to be largely suitable to the context of claims workers. However, the model was expanded to augment its usability within the more general administrative domain. Finally, the overarching aim was to enrich, contextualise and elaborate on the experiences of claims workers within their unique work context, to facilitate insight and a deeper understanding of vicarious trauma in more administrative populations that have largely been overlooked in research.

INTRODUÇÃO: o Transtorno de Estresse Pós-Traumático (TEPT) se caracteriza pelo desenvolvimento de sintomas específicos após a ocorrência de um evento traumático intenso, envolvendo a participação direta ou não do indivíduo. A prevalência do TEPT na população pode variar entre 1,4% e 11,2% na vida, sendo que mulheres apresentam uma vulnerabilidade maior para o transtorno, apesar dos homens geralmente serem expostos a um número maior de eventos traumáticos. Além de trazer inúmeros prejuízos na vida do sujeito, observam-se altas taxas de comorbidade entre TEPT e Abuso e Dependência de Álcool e Drogas (ADAD), o que por sua vez está associado a níveis mais graves de psicopatologia, maior comprometimento do funcionamento social global, uso mais freqüente de serviços de saúde e pior resposta ao tratamento. OBJETIVOS: 1) examinar a distribuição de eventos traumáticos e a prevalência de TEPT e ADAD de acordo com o gênero dos indivíduos, 2) identificar a prevalência de TEPT por tipo de evento traumático e o risco condicional de TEPT entre homens e mulheres, 3) examinar a existência de comorbidade entre TEPT e ADAD e 4) verificar as associações entre diferentes tipos de eventos traumáticos e ADAD quando são levados em conta no modelo número de traumas, categorias de eventos traumáticos e fatores sócio-demográficos (gênero, idade, anos de escolaridade, estado civil e renda), controlando para o TEPT. MÉTODOS: estudo de corte transversal com uma amostra representativa da região metropolitana de São Paulo (n=2.942). O trabalho é um subprojeto do São Paulo Megacity, parte de uma iniciativa internacional coordenada pela Organização Mundial de Saúde (World Mental Health Survey). As análises utilizaram dados dos módulos de Abuso de Substâncias e Transtorno de Estresse Pós Traumático do Composite International Diagnostic Interview (CIDI) desenhada para produzir diagnósticos do CID-10 e do DSM-IV. A análise estatística utilizou o programa Statistical Analysis System (SAS). Foram aplicados algoritmos às respostas dos módulos clínicos para identificação diagnóstica e as taxas de prevalência foram calculadas em porcentagens, assim como os erros-padrão. Ainda foram levantados os traumas que ocasionaram o TEPT, bem como os riscos condicionais para o desenvolvimento do transtorno. Foram realizadas análises de regressão logística simples para verificar a comorbidade entre TEPT e ADAD e regressões logísticas múltiplas para explorar as associações entre TEPT e ADAD. RESULTADOS: a prevalência de TEPT na vida foi de 3,2% (EP=0,2) e no último ano de 1,6% (EP=0,2). 4,6% das mulheres e 1,6% dos homens desenvolveram o transtorno na vida (OR 3; IC 95% 1,8-4,9); dentre a população com TEPT, o principal fator que desencadeou o transtorno foi morte inesperada de um ente os principais riscos condicionais para o desenvolvimento de TEPT para a população feminina foram agressão sexual e estupro e para a população masculina, sequestro relâmpago e estupro; foi identificada comorbidade entre TEPT e ADAD, porém houve diferença entre homens e mulheres de acordo com o padrão de consumo de substâncias (dependência e abuso) e categoria de substâncias psicoativas (álcool e drogas); o número de traumas é um fator diretamente associado ao ADAD, sendo que a categoria de eventos envolvendo violência intencional mostrou-se associada a todos os padrões de abuso e dependência de álcool e drogas. CONCLUSÕES: foi identificada comorbidade entre TEPT e ADAD, sendo o número de traumas e a categoria de eventos envolvendo violência intencional particularmente importantes na associação com o ADAD. / INTRODUCTION: Post-Traumatic Stress Disorder (PTSD) is characterized by the development of specific symptoms after an intense traumatic event that affects the person directly or indirectly. The lifetime prevalence of PTSD ranges from 1.4% to 11.2%. Women are more vulnerable than men, although men experience more lifetime traumatic events. Other than causing a number of problems in someone´s life, there are high comorbidity rates between PTSD and substance abuse and dependence (SAD), which in turns is associated with worse psychopathological conditions, lower levels of social functioning, more frequent utilization of health care services and worse treatment outcomes. OBJECTIVES: to examine the distribution of traumatic events and the prevalence of PTSD and alcohol/drug abuse and dependence; to examine the distributions of PTSD cases across different types of traumatic events and to investigate the conditional risk of PTSD in females and males; to examine the comorbidity between PTSD and SAD, and to verify the associations between number and different categories traumatic events and SAD when controlling for PTSD. METHODS: cross-sectional study with a probabilistic sample of household residents in the Sao Paulo Metropolitan Area (n=2.942). The study is a subproject of the São Paulo Megacity, a counterpart of an international initiative coordinated by the World Health Organization (World Mental Health Survey). The analysis were based in the substance abuse and PTSD sections of the Composite International Diagnostic Interview (CIDI), created to generate diagnoses of the CID-10 and the DSM-IV. The statistical analyses were calculated by the Statistical Analysis System (SAS) software. Prevalence of the diagnosis and their standard errors were calculated, as well as the traumatic events that led to PTSD cases and the conditional risk of PTSD. A series of simple logistic regressions were performed to examine the comorbidity between PTSD and SAD. Multiple regressions were conducted to examine the associations between number and categories of traumas and SUD after controlling for PTSD. RESULTS: lifetime PTSD prevalence was 3.2% (SE=0.2) and last year´s prevalence was 1.6% (SE=0,2). 4.6% of women versus 1.6% of men had lifetime PTSD prevalence (OR 3,0; CI 95% 1.8-4.9); among the PTSD group, the most frequent traumatic event associated with the disorder was sudden unexpected death of relative or/friend ;in females,sexual assault and rape were associated with the highest conditional risk of PTSD and and rape were associated with the highest conditional risk of PTSD in males; comorbidity between PTSD and SAD was found in the sample, however there were differences between males and females related to the pattern of consumption (dependence and abuse) and type of substance (alcohol and drug); in the multiple regression models, number of traumatic events and interpersonal violence were strongly associated with SAD. CONCLUSIONS: comorbidity between PTSD and SAD was found in the sample, and alcohol abuse and number of traumatic events and well as the category of events involving interpersonal violence were particularly important in the association with PTSD

The study undertook to explore the notion of stuckness within interpersonal and intrapersonal relationship dynamics. Stuckness has different presentations and can pertain to an individual’s’ inability to move beyond a particular challenge, or find resolution to one or more persistent problems. Alternatively, the stymied dynamic could manifest as a person becoming consistently highly activated or triggered. This has negative ramifications, within both interpersonal and intrapersonal relationships. Therapeutically, psychological stuckness is frequently encountered, and a lack of resolution of past trauma, is speculated as being a contributory factor. A qualitative, explorative research study was conducted over a period of one year, to collect data. The research design consisted of five case studies of participants who engaged in approximately one year of therapy. Participants were seen fortnightly, by a clinical psychologist, who is also the researcher of the study. The notes taken in the therapy sessions, as well as other qualitative methods, were utilised to collect the data. The data was analysed for themes formulated by the researcher, which themes correlated with the principles of the two schools of thought applied in the study. Logotherapy and somatic experiencing are the therapeutic interventions, which were included in the research method. These approaches were utilised in an endeavour to explore their efficacy, in resolving stuckness, speculated as being due to unprocessed trauma. Participation in the study was voluntary and boundaries of ethical codes, as well as values of psychotherapeutic therapy adhered to. There was no monetary exchange for the therapy received, and no costs incurred to the participants, in the research study. The presence of a long-standing persistent problem, or issue (stuckness) that had belied resolution, was the main criteria for inclusion in the study. The research explored the possible association between unresolved trauma, as well as various types of interpersonal, and intrapersonal stuckness. Impulsivity, explosive tempers, irrationality, emotionality and bizarre acting out behaviours, are some of the presentations, that the study speculated, as being due to unprocessed traumatic energy. A contribution of this research is that there is an absence of any prior studies conducted which explores stuckness and its correlation with unresolved trauma. In addition, no other research assessing the combined, top-down, and bottom-up efficacy of the therapeutic approaches of logotherapy and somatic experiencing were sourced. Payne, et al. (2015 b) state that they could not find evidence of more than five papers which provided case studies on somatic experiencing as a trauma intervention. The number of studies undertaken on somatic experiencing in general, is also significantly limited (Changaris, 2010; Samardzic, 2010). This adds to the value, meaning and purpose of this research, as it is a unique endeavour, motivated by the researcher’s intention to add more value to individuals’ lives, especially when the presenting problem, appears to be unfathomable stuckness. In an absence of any understanding for the reasons for such stuckness, these people may experience significant distress at being stymied, within the self, or in relation to others, as well as feel at a loss for any possible recourse. This study could prompt other researchers to conduct similar investigations, not only of the combined body-based, and cognitive psychotherapuetic interventions, but also of the link between stymied interpersonal, as well as intrapersonal relationship dynamics, and trauma. The application of a mind, body and soul approach in the study, through the inclusion of logotherapy, is also relevant. In reviewing the direction of psychological fields, one can detect that the trends are towards constructs such as meditation, enlightenment, consciousness, meaning, purpose, mindfulness, presence, and spiritual identity. Individuals are seeking more enlightenment, and want to explore more of the noetic dimension, which I believe psychotherapy has to include, in order to meet the needs of an evolving society. / Psychology / D.Phil. (Psychology)

L’ostéopathie fonctionnelle est connue pour son action mécanique de rééquilibration des différentes structures du corps, action qui vient en renfort d’un processus permanent d’autoréparation de l’organisme. « Retracer la lésion sans irriter » dénoue les tensions myofasciales et produit des effets psychiques moins connus mais capitaux dans la clinique des troubles post-traumatiques. La prise en charge par ostéopathie fonctionnelle de patients « tout-venants » d’un cabinet privé a servi de pré-recherche qualitative pour repérer les mécanismes psychiques à l’œuvre. Puis la recherche quantitative AIVIO (Aide Intensive aux Victimes par Ostéopathie) a permis une prise en charge prospective randomisée sur plusieurs thérapeutes de victimes d’accident de la voie publique (AVP) recrutées dans un hôpital sur critère d’Etat de Stress Post-traumatique (ESPT) et/ou douleur. Cette recherche a montré l’efficacité d’une telle prise en charge par des résultats cliniques satisfaisants et statistiquement significatifs selon divers questionnaires (MOS SF-36, PCLS, DES, PPAG, BECK 21) Les résultats hautement significatifs concernent la douleur, la vie sociale et la santé psychique pour les victimes d’AVP. La taille des cohortes n’a pas permis de conclure sur l’impact du point de vue biologique, notamment sur l’évolution des taux bas de cortisol, pathognomoniques d’ESPT. L’évolution psychosomatique des patients, montrant trois différents destins, confortent les hypothèses de départ : 1/ Certains troubles anxieux post-traumatiques pourraient être soulagés par le soin du corps lui-même. Eliminer le whiplash et autres tensions myofasciales semble parfois réguler l’irritation neurovégétative et les troubles anxieux. 2/ Le cadre du soin ostéopathique produirait, en plus du travail somatique, un retour tridimensionnel (lieu-temps-niveau de conscience) sur la mémoire épisodique du traumatisme et ses affects liés. La part psychique du traumatisme s’éliminerait par réminiscence du traumatisme dans un état dissociatif paisible ou pendant un moment de sommeil. En cas de résistance au relâchement myofascial, induire délicatement ce processus habituellement spontané et inconscient relancerait le processus d’autoréparation psychique et somatique. L’induction ne parviendrait pourtant pas à diminuer les résistances lorsqu’elles reposent sur la colère, l’angoisse d’origine infantile et sur des difficultés affectives ou socio-économiques majeures. 3/ Dans d’autres cas enfin, le traumatisme corporel donnerait une occasion et un support somatique pour exprimer d’autres souffrances psychonévrotiques. Le symptôme douloureux post-traumatique serait alors maintenu par tension myofasciale. L’écoute active serait parfois suffisante pour libérer cette souffrance somatisée, surtout quand on connaît les mécanismes de défense spécifiques des différentes personnalités psychonévrotiques. Sinon l’approche psychothérapeutique conjointe serait conseillée en cas de névrose plus marquée ou de décompensation d’assises narcissiques fragiles. Du point de vue psychosomatique, nous n’avons pas observé de pensée opératoire ni de refoulement de l’imaginaire. Le symptôme étant déterminé par conservation d’énergie mécanique du traumatisme, il n’est pas métaphorique et ne devrait donc pas être interprété.