L’objectif de ce travail de thèse est d’amener des éléments de réflexions méthodologiques autour du Napping®. Le premier chapitre de ce manuscrit rappelle aux lecteurs ce qu’est le Napping®, à travers une description de la tâche et des données qu’elle fournit, telles qu’elles ont été imaginées initialement par Jérôme Pagès (2005). C’est dans ce même chapitre que le lecteur peut réaliser à quel point il est important de prendre en compte le comportement du sujet lors de la tâche, tant pour la compréhension des données que pour leur traitement. Le deuxième chapitre de ce manuscrit propose un modèle du comportement du sujet dans le cas où le nombre de stimuli est relativement élevé, une situation couramment rencontrée en pratique.Ce modèle et ses limites amènent le lecteur au chapitre 3, dans lequel il est présenté une méthode originale de recueil de données de Napping® appelée digit-tracking. Cette méthode permet d’observer le comportement du sujet au cours du temps par l’enregistrement du positionnement relatif des stimuli tout au long de la tâche et non plus seulement lors de l’étape finale. Enfin le dernier chapitre du manuscrit présente l’outil qui a été développé au cours de cette thèse et qui permet de recueillir des données de Napping® au cours du temps. Cet outil est une plateforme collaborative, appelée Holos, couplée à un logiciel de recueil de données sur tablette tactile, qui permet aux chercheurs de partager une partie ou l’ensemble de leurs résultats. / The objective of this dissertation aims to bring the methodological reflection elements around the Napping® method. Chapter 1 provides the concept of Napping® via a description of its procedure and data format, as it was originally conceived by Jérôme Pagès (2005). This chapter also discussed the importance of taking into account the subject's behaviour during the task for a better understanding of the data collected and their analysis. Chapter 2 proposes a model of the subject's behaviour in which the number of stimuli is relatively high, a situation commonly encountered in practice. This model and its limitations lead to Chapter 3, where a new technique for collecting Napping® data, named digit-tracking, is presented.This new technique of data collection allows to observe the subject’s behaviour over time by recording the relative positioning of all stimuli throughout the task rather than solely her/his final configuration. Finally, Chapter 4 presents a tool devoted to collecting Napping® data over time. This tool is a collaborative platform that works together with an android application for collecting data on tactile tablet devices – Holos environment, which enables researchers to share totally or partially their study resources.

À partir de la distinction opérée par G. Canguilhem (1966) entre la maladie du malade et celle du médecin, nous avons considéré les récits, constructions personnelles et représentations des patients relatifs à leur maladie cancéreuse et coexistants avec les théories scientifiques médicales. Ces éléments représentent un travail psychique d’élaboration qui peut donner naissance à un « roman de la maladie » (Gori, Del Volgo & Poinso, 1994). Cette quête de sens, que nous considérons comme un fondamental de l'existence, peut être mise à mal lorsque l’événement-maladie fait trauma pour le psychisme du patient, entravant alors l'historicisation de son vécu. Mais quid de cette quête à l'approche de la fin de vie ? Comment envisager et donner un sens à l'innommable, l'irreprésentable de sa propre mort (Freud, 1915)? Notre recherche vise à explorer l’évolution des processus d’élaboration en lien avec une mise en sens de l’événement-maladie, des représentations du cancer et de la mort et des processus défensifs mis à l’œuvre pour faire face à ce vécu effractant, entre deux groupes de patients, respectivement en phases curative et palliative de leurs traitements. Une première partie quantitative de notre travail a pour but d’objectiver sur le plan statistique, à l’aide d’outils psychométriques (IPQ-R et DSQ-40), des différences entre les deux groupes (composés de quarante-cinq patients chacun). La seconde partie, qualitative, consiste en une étude clinique et projective (Rorschach et T.A.T.), à partir de la rencontre avec dix patients (cinq de chaque groupe), des processus psychiques à l’œuvre face à la maladie somatique grave et à sa potentielle évolution létale. Notre questionnement touche ainsi à l'étude du « roman de la maladie » après le diagnostic et éventuellement au moment de l'approche de la fin de vie. La maladie grave peut sidérer l'appareil psychique et faire trauma dans certains cas, laissant dans certains autres des possibilités d'élaboration, malgré les représentations de cette pathologie associées socialement à la mort. Mais qu'en est-il lorsque la mort n'est plus affaire de représentation et prend valeur de réalité inéluctable (au sens d'une impossibilité de maintenir cette réalité inconsciente) ? / Starting with the distinction made by G. Canguilhem (1966) between the illness of the patient and the illness of the medical doctor, we have considered the narratives, patients’ personal constructions and representations regarding their cancer, co-existing with the medical and scientific theory. These elements are a psychical work of elaboration that can give birth to “a novel of the illness” (Gori, Del Volgo & Poinso, 1994). This quest for meaning, which we consider fundamental to any existence, can be tested when the illness-event creates a trauma in the psyche of the patient, hindering the elaboration of its history. What about this quest as the end of life approaches? The inconceivable of one’s own death (Freud, 1915) ?Our research explores the evolution of the elaborative processes linked to the quest of meaning of the illness-event, of the representations of cancer, of death and the defenses in place to deal with this frightening experience, comparing two groups of patients, respectively in curative and palliative phases of their treatment. Firstly, a quantitative part of our work is objectified statistically with psychometric tools (IPQ-R and DSQ-40), showing differences between the two groups (each group containing 45 patients). The second part is qualitative with clinical and projective data (Rorschach and T.A.T.) issued from 10 patients (5 of each group), showing the psychical processes of patients facing severe somatic illness and its potential lethal evolution. Our research investigates the “novel of the illness” after diagnosis and at the eventual approach of the end of life. Severe illness can freeze the psyche and be traumatic at times, leaving in certain cases elaborative capabilities, despite the social representation of the pathology associated with death. But what when death is no longer a matter of representation and becomes an undeniable fact (when it is impossible of maintaining this reality unconscious) ?

The Fairy Tale Test (FTT) is a projective personality test designed for children aged 6 to 12 years. FTT is based on the association between fairy tales and unconscious processes. Its goal is to assess the child's personality profile and to offer information not only about single personality traits but also their interrelations. It is possible it effectively employed as a method to assess eventual personality changes over time or as a tool in clinical or cross-cultural research as well. The Fairy Tale Test was standardized in five countries of the world Greece, Russia, China, India and Turkey, at the present time we effort to set up standard specification also in the Czech Republic. This diploma paper should also contribute to the standardization with administrating FTT and its evaluation to the selected sample of six and seven-years old children. Key words Fairy tales, interpretation of the fairy tales, projective tests, the Fairy Tale Test, younger school age.

INTRODUÇÃO: Os pacientes com distúrbios do desenvolvimento sexual (DDS) constituem um desafio para os profissionais que se empenham no seu tratamento e acompanhamento. São raros os estudos na área psicológica com acompanhamento destes pacientes a longo prazo. Este estudo tem por objetivo avaliar os aspectos psicossociais e sexuais em relação ao diagnóstico etiológico, avaliar a influência de diversas variáveis na manutenção ou mudança da identidade de gênero nos pacientes que atingiram a idade adulta e a qualidade de vida numa grande coorte de pacientes com DDS 46,XY e 46,XX acompanhados em um mesmo serviço a longo prazo. MÉTODOS: O estudo teve caráter principalmente retrospectivo e foi realizado em pacientes com DDS de ambos os sexos acompanhados até o período pós-puberal ou idade adulta, num total de 151 pacientes maiores de 15 anos; destes, 55 pacientes apresentavam cariótipo 46,XX e 96 cariótipo 46,XY, tendo sido incluído neste ultimo grupo 6 pacientes que apresentavam cariótipo 46,XY em mosaicismo com a linhagem 45,X. O diagnóstico etiológico do DDS foi estabelecido pela avaliação clínica, citogenética, hormonal e por imagem em todos os casos e na maioria deles complementada pelo diagnóstico molecular. Todos os pacientes foram submetidos a tratamento clinico, psicológico e cirúrgico. Os instrumentos utilizados para a avaliação psicológica foram: a entrevista semi-estruturada com aplicação de um questionário específico com 192 questões, desenvolvido para avaliar os aspectos sociais, profissionais e sexuais, o teste projetivo do HTP para auxiliar na identificação da identidade de gênero e o questionário Whoqol-Bref para avaliar a qualidade de vida. RESULTADOS: A atribuição do sexo social feminino foi predominante em ambos os grupos com DDS. Houve mudança do sexo social em 20% dos pacientes com DDS 46,XY e em 14% dos pacientes com DDS 46,XX. Houve associação significativa da mudança para o gênero masculino nos pacientes do grupo DDS 46,XY por deficiência de 5-redutase 2 quando comparados ao grupo de pacientes com DDS 46,XY por deficiência da produção ou ação da testosterona. Foi encontrada uma maior frequencia de pacientes com orientação homo ou bissexual nas pacientes com sexo social feminino com maior prevalência em pacientes com hiperplasia adrenal virilizante. Nas pacientes com DDS 46,XX por deficiência da 21 hidroxilase não houve influência do número de repetições CAG nos estádios de Prader e na mudança da identidade de gênero. Observamos disforia de gênero em 8 pacientes com DDS 46,XX por deficiência da 21 hidroxilase, sendo que 5 deles mudaram para o sexo social masculino. Todos haviam sido tratados de maneira irregular, apresentaram virilização importante e provinham de famílias de baixa renda, indicando o papel da exposição dos andrógenos e do meio ambiente sobre a identidade de gênero. Três variáveis na análise univariada foram significativamente associadas com a mudança de sexo social para o masculino nos pacientes com DDS 46,XY e DDS 46,XX: brincadeiras masculinas ou neutras na infância, tarefas domiciliares tipicamente masculinas e auto-percepção da aparência física como masculina ou ambígua na infância. Houve associação significativa entre os aspectos da identidade de gênero inicial e o sexo social final no teste do HTP, mostrando ser este um instrumento útil para avaliação dos pacientes com DDS. A qualidade de vida, avaliada pelo teste Whoqol Bref, das pacientes com sexo social feminino foi melhor nas pacientes com DDS 46,XX em comparação com as pacientes com DDS 46,XY. A qualidade de vida dos pacientes com DDS 46,XY registrados no sexo social feminino que mudaram para o sexo social masculino, foi semelhante a daqueles registrados no sexo social masculino. Por outro lado, os pacientes com sexo social final masculino tiveram melhor qualidade de vida quando comparados aos pacientes com sexo social final feminino. O diagnóstico etiológico não teve influência sobre o grau de satisfação pessoal, atribuição do sexo e relacionamento amoroso. CONCLUSÃO: A atribuição do sexo social feminino foi predominante em ambos os grupos. A variável brincadeiras masculinas ou neutras na infância teve valor preditivo para a mudança de sexo social para o masculino nos pacientes com DDS 46,XY e 46,XX educados no sexo social feminino. O teste HTP foi útil na avaliação dos pacientes com DDS. A qualidade de vida dos pacientes 46,XY com sexo social final masculino foi melhor do que a dos pacientes com sexo social final feminino. A maioria dos pacientes referiu elevado índice de satisfação com o tratamento, mostrando a importância de uma equipe multidisciplinar no tratamento dos distúrbios do desenvolvimento sexual. / INTRODUCTION: Patients with disorders of sex development (DSD) constitute a challenge for professionals working in their treatment and follow-up. Studies of patients with DSD have been focused on dissatisfaction in adulthood with sex assigned at birth. However, other parameters, such as psychosocial adjustment, sexual function, psychological health, social integration and the quality of life are rarely described. This study aims to evaluate the professional and psychosocial aspects, in order to identify the variables involved in gender identity and sexual orientation of a large cohort of patients with DSD 46 XY and, 46, XX and also assess the quality of life of patients in adulthood. METHODS: The study was mainly retrospective and was conducted in patients with DSD of both sexes followed until puberty or adulthood, a total of 151 patients older than 15 years; of these, 55 patients had 46, XX karyotype and 96 of them 46,XY karyotype, having been included in the latter group 6 patients who had 46, XY karyotype in mosaicism with the 45, X lineage. Etiological diagnosis of DSD was established by clinical evaluation, cytogenetics, hormonal and image studies in all cases and most of them complemented by molecular diagnosis. All patients underwent surgical and psychological treatment. Instruments used for psychological evaluation were: a semi-structured interview with application of a specific questionnaire with 192 questions developed to assess the social, professional and sexual aspects. The projective HTP test was used to assess gender identity and the Whoqol-Bref questionnaire to evaluate the quality of life. RESULTS: The female social sex assignment was prevalent in both groups with DSD. A change of assigned sex was found in 20% of the 46, XY DSD patients and in 14% of the 46,XX DSD patients. There was a significant association between the change to male social sex with DSD 46, XY due to 5 alpha-RD2 deficiency when compared with DSD 46,XY group due to defects in testosterone secretion or action. A greater frequency of homo or bisexual orientation was found in the patients with female social sex with higher prevalence in patients with virilizing congenital adrenal hyperplasia. In these patients the number of CAG repeats and Prader stage did not influence sexual orientation. We observe gender dysphoria in 8 patients with 46, XX DSD due to 21- hydroxylase deficiency, and 5 of them have changed to the male social sex. All of these patients had been treated irregularly, showed significant virilization and derived from low-income families indicating the role of exposure of androgens and environment on gender identity. Three variables in univariate analysis were significantly associated with change to male social sex in patients with 46, XY DSD and 46, XX DSD educated on female social sex: male or neutral plays in childhood, typically masculine household tasks and self perception of physical appearance as male or ambiguous in childhood but the male or neutral toys in childhood presented the best predictive value of male gender identity in adulthood. There was significant association between aspects of initial gender identity and final gender social sex in HTP test, showing that this is a useful tool for evaluation of patients with DSD. The quality of life of patients with 46,XX DSD was similar to patients with 46, XY DSD however patients with male social sex showed better quality of life than those with female social sex. Similarly, the quality of life of patients with 46, XY DSD the female register social sex who had switched to the male sex social was similar to those assigned in sex male indicating a good social adaptation of patients to new social sex. However, among the patients with female social sex, those with 46,XY DDS showed lower quality of life than 46, XX DSD patients. Male patients with 46,XY DDS had better quality of life than the 46,XY DSD patients with female gender. DDS patients who underwent masculinizing surgery showed better quality of life than the group which underwent feminizing surgery and both groups with DDS showed lower quality of life of patients than patients who undergone to kidney transplantation. The etiological diagnosis had no influence on the assignment of sex and the degree of personal satisfaction. CONCLUSION: Patients with 46,XY and 46, XX DDS showed good social, professional and sexual integration at adulthood. The variable male or neutral plays in childhood had better predictive value of male gender identity in adulthood in patients with 46,X and 46,XX DDS reared in the female social sex. The HTP projective test was useful in the overall assessment of patients with DSD. The quality of life of the patients with male social was better than those with female social sex. Most DSD patients expressed high satisfaction with treatment, showing the importance of a multidisciplinary team in the treatment of the disorders of sex development.

L’objectif de ce travail de recherche est de concevoir une nouvelle méthode de cotation et d’interprétation de l’épreuve projective CAT (Children’s Apperception Test). Cette nouvelle méthode que nous avons appelé « méthode des trois axes » est fondée sur les connaissances et techniques des épreuves thématiques de la méthode projective francophone (Ecole de Paris). Elle est basée en partie sur les considérations théoriques de Roussillon (1995, 1997) concernant la métapsychologie projective des processus qui modélise le trajet psychique allant de la perception du stimulus de la planche à la verbalisation de la réponse projective (processus de symbolisation). Elle est constituée de 3 axes, 16 catégories de cotation et d’un total de 83 procédés de cotation. La méthode des trois axes a été appliquée à 500 protocoles d’enfants répartis en deux groupes distincts : un groupe d’enfants dit « tout-venant » rencontré en milieu scolaire (n=380) et un groupe d’enfants dit « consultant » rencontré en institution de soin (n=120). Les données ont été analysées selon une approche descriptive et une approche comparative basée sur trois groupes d’âge : 3 ans, 4-6 ans et 6-12 ans. Nous avons également réalisé une comparaison inter-juges portant sur la cotation avec la méthode actuellement utilisée (méthode de Boekholt) et la méthode des trois axes que nous proposons. A partir des résultats, nous proposons une théorie de la méthode CAT qui comporte trois parties : le dispositif de la passation, le manuel de cotation des procédés et le manuel d’interprétation des données qui comprendra des repères normatifs. Cette théorie de la méthode doit permettre aux psychologues cliniciens utilisateurs de cet outil d’évaluer plus précisément le fonctionnement psychique de l’enfant. / The aim of this research is to develop a new method of rating and interpreting the Children’s Apperception Test (CAT). This new method wich we have called “la méthode des trois axes” is built on techniques from the academic “Ecole de Paris” for projective methods. It is based in part on the theory of Roussillon (1995, 1997) concerning the projective metapsychology of processes which describes the psychic path from the perception of the stimulus of the plate to the verbalization of the response. This grid is built with 3 axis of description, including 16 categories of rating and 83 items used to rate the responses in application to the ten plates of CAT. “La méthode des trois axes” was applied to 500 children in two groups : a group of “all-comers” met in school (n=380) and a group of patients in care institution (n=120). The data was analyzed using a descriptive approach based on three age groups : 3 years old, 4-6 years old and 6-12 years old. We also performed the assessment of inter-rater reliability on the rating with the method curently used (Boekholt’s method) and “la méthode des 3 axes” that we propose. On the basis of the results, we propose a theory of the CAT method, which consists of three parts: the test administration, the process rating manual and the interpretation manual which include normative references. This method will enable clinicians psychologists who use this tool to more accurately assess the psychic functioning of the child.

INTRODUÇÃO: Os pacientes com distúrbios do desenvolvimento sexual (DDS) constituem um desafio para os profissionais que se empenham no seu tratamento e acompanhamento. São raros os estudos na área psicológica com acompanhamento destes pacientes a longo prazo. Este estudo tem por objetivo avaliar os aspectos psicossociais e sexuais em relação ao diagnóstico etiológico, avaliar a influência de diversas variáveis na manutenção ou mudança da identidade de gênero nos pacientes que atingiram a idade adulta e a qualidade de vida numa grande coorte de pacientes com DDS 46,XY e 46,XX acompanhados em um mesmo serviço a longo prazo. MÉTODOS: O estudo teve caráter principalmente retrospectivo e foi realizado em pacientes com DDS de ambos os sexos acompanhados até o período pós-puberal ou idade adulta, num total de 151 pacientes maiores de 15 anos; destes, 55 pacientes apresentavam cariótipo 46,XX e 96 cariótipo 46,XY, tendo sido incluído neste ultimo grupo 6 pacientes que apresentavam cariótipo 46,XY em mosaicismo com a linhagem 45,X. O diagnóstico etiológico do DDS foi estabelecido pela avaliação clínica, citogenética, hormonal e por imagem em todos os casos e na maioria deles complementada pelo diagnóstico molecular. Todos os pacientes foram submetidos a tratamento clinico, psicológico e cirúrgico. Os instrumentos utilizados para a avaliação psicológica foram: a entrevista semi-estruturada com aplicação de um questionário específico com 192 questões, desenvolvido para avaliar os aspectos sociais, profissionais e sexuais, o teste projetivo do HTP para auxiliar na identificação da identidade de gênero e o questionário Whoqol-Bref para avaliar a qualidade de vida. RESULTADOS: A atribuição do sexo social feminino foi predominante em ambos os grupos com DDS. Houve mudança do sexo social em 20% dos pacientes com DDS 46,XY e em 14% dos pacientes com DDS 46,XX. Houve associação significativa da mudança para o gênero masculino nos pacientes do grupo DDS 46,XY por deficiência de 5-redutase 2 quando comparados ao grupo de pacientes com DDS 46,XY por deficiência da produção ou ação da testosterona. Foi encontrada uma maior frequencia de pacientes com orientação homo ou bissexual nas pacientes com sexo social feminino com maior prevalência em pacientes com hiperplasia adrenal virilizante. Nas pacientes com DDS 46,XX por deficiência da 21 hidroxilase não houve influência do número de repetições CAG nos estádios de Prader e na mudança da identidade de gênero. Observamos disforia de gênero em 8 pacientes com DDS 46,XX por deficiência da 21 hidroxilase, sendo que 5 deles mudaram para o sexo social masculino. Todos haviam sido tratados de maneira irregular, apresentaram virilização importante e provinham de famílias de baixa renda, indicando o papel da exposição dos andrógenos e do meio ambiente sobre a identidade de gênero. Três variáveis na análise univariada foram significativamente associadas com a mudança de sexo social para o masculino nos pacientes com DDS 46,XY e DDS 46,XX: brincadeiras masculinas ou neutras na infância, tarefas domiciliares tipicamente masculinas e auto-percepção da aparência física como masculina ou ambígua na infância. Houve associação significativa entre os aspectos da identidade de gênero inicial e o sexo social final no teste do HTP, mostrando ser este um instrumento útil para avaliação dos pacientes com DDS. A qualidade de vida, avaliada pelo teste Whoqol Bref, das pacientes com sexo social feminino foi melhor nas pacientes com DDS 46,XX em comparação com as pacientes com DDS 46,XY. A qualidade de vida dos pacientes com DDS 46,XY registrados no sexo social feminino que mudaram para o sexo social masculino, foi semelhante a daqueles registrados no sexo social masculino. Por outro lado, os pacientes com sexo social final masculino tiveram melhor qualidade de vida quando comparados aos pacientes com sexo social final feminino. O diagnóstico etiológico não teve influência sobre o grau de satisfação pessoal, atribuição do sexo e relacionamento amoroso. CONCLUSÃO: A atribuição do sexo social feminino foi predominante em ambos os grupos. A variável brincadeiras masculinas ou neutras na infância teve valor preditivo para a mudança de sexo social para o masculino nos pacientes com DDS 46,XY e 46,XX educados no sexo social feminino. O teste HTP foi útil na avaliação dos pacientes com DDS. A qualidade de vida dos pacientes 46,XY com sexo social final masculino foi melhor do que a dos pacientes com sexo social final feminino. A maioria dos pacientes referiu elevado índice de satisfação com o tratamento, mostrando a importância de uma equipe multidisciplinar no tratamento dos distúrbios do desenvolvimento sexual. / INTRODUCTION: Patients with disorders of sex development (DSD) constitute a challenge for professionals working in their treatment and follow-up. Studies of patients with DSD have been focused on dissatisfaction in adulthood with sex assigned at birth. However, other parameters, such as psychosocial adjustment, sexual function, psychological health, social integration and the quality of life are rarely described. This study aims to evaluate the professional and psychosocial aspects, in order to identify the variables involved in gender identity and sexual orientation of a large cohort of patients with DSD 46 XY and, 46, XX and also assess the quality of life of patients in adulthood. METHODS: The study was mainly retrospective and was conducted in patients with DSD of both sexes followed until puberty or adulthood, a total of 151 patients older than 15 years; of these, 55 patients had 46, XX karyotype and 96 of them 46,XY karyotype, having been included in the latter group 6 patients who had 46, XY karyotype in mosaicism with the 45, X lineage. Etiological diagnosis of DSD was established by clinical evaluation, cytogenetics, hormonal and image studies in all cases and most of them complemented by molecular diagnosis. All patients underwent surgical and psychological treatment. Instruments used for psychological evaluation were: a semi-structured interview with application of a specific questionnaire with 192 questions developed to assess the social, professional and sexual aspects. The projective HTP test was used to assess gender identity and the Whoqol-Bref questionnaire to evaluate the quality of life. RESULTS: The female social sex assignment was prevalent in both groups with DSD. A change of assigned sex was found in 20% of the 46, XY DSD patients and in 14% of the 46,XX DSD patients. There was a significant association between the change to male social sex with DSD 46, XY due to 5 alpha-RD2 deficiency when compared with DSD 46,XY group due to defects in testosterone secretion or action. A greater frequency of homo or bisexual orientation was found in the patients with female social sex with higher prevalence in patients with virilizing congenital adrenal hyperplasia. In these patients the number of CAG repeats and Prader stage did not influence sexual orientation. We observe gender dysphoria in 8 patients with 46, XX DSD due to 21- hydroxylase deficiency, and 5 of them have changed to the male social sex. All of these patients had been treated irregularly, showed significant virilization and derived from low-income families indicating the role of exposure of androgens and environment on gender identity. Three variables in univariate analysis were significantly associated with change to male social sex in patients with 46, XY DSD and 46, XX DSD educated on female social sex: male or neutral plays in childhood, typically masculine household tasks and self perception of physical appearance as male or ambiguous in childhood but the male or neutral toys in childhood presented the best predictive value of male gender identity in adulthood. There was significant association between aspects of initial gender identity and final gender social sex in HTP test, showing that this is a useful tool for evaluation of patients with DSD. The quality of life of patients with 46,XX DSD was similar to patients with 46, XY DSD however patients with male social sex showed better quality of life than those with female social sex. Similarly, the quality of life of patients with 46, XY DSD the female register social sex who had switched to the male sex social was similar to those assigned in sex male indicating a good social adaptation of patients to new social sex. However, among the patients with female social sex, those with 46,XY DDS showed lower quality of life than 46, XX DSD patients. Male patients with 46,XY DDS had better quality of life than the 46,XY DSD patients with female gender. DDS patients who underwent masculinizing surgery showed better quality of life than the group which underwent feminizing surgery and both groups with DDS showed lower quality of life of patients than patients who undergone to kidney transplantation. The etiological diagnosis had no influence on the assignment of sex and the degree of personal satisfaction. CONCLUSION: Patients with 46,XY and 46, XX DDS showed good social, professional and sexual integration at adulthood. The variable male or neutral plays in childhood had better predictive value of male gender identity in adulthood in patients with 46,X and 46,XX DDS reared in the female social sex. The HTP projective test was useful in the overall assessment of patients with DSD. The quality of life of the patients with male social was better than those with female social sex. Most DSD patients expressed high satisfaction with treatment, showing the importance of a multidisciplinary team in the treatment of the disorders of sex development.

La maternité des femmes dépendantes aux substances psychoactives est aujourd'hui une question de santé publique. Notre recherche porte sur la prédictivité potentielle des remaniements psychiques observés pendant la grossesse de femmes toxicomanes sur la qualité du processus de maternalité et l'investissement de l'enfant. Elle correspond ainsi à une étude clinique et projective psychodynamique de l’évolution du fonctionnement psychique et des représentations liées à l’enfant de la femme toxicomane et/ou substituée devenant mère. Pour ce faire, nous nous appuyons sur l’analyse d’entretiens semi-directifs et de tests projectifs de femmes consommatrices d’opiacés et/ou sous traitement de substitution aux opiacés et de femmes non toxicomanes, entre le dernier trimestre de grossesse et les un an de l’enfant. Un second versant de cette étude propose un état des lieux des modalités d’accompagnement des femmes enceintes et mères consommatrices de drogues illicites sur le territoire Ouest-Normand ainsi qu’un projet d’accompagnement spécifique et pluridisciplinaire de cette population, élaboré au sein d’un CSAPA (Centre de Soins, d’Accompagnement et de Prévention en Addictologie). / Motherhood among women addicted to psychoactive substances is a public health concern. Our research concerns the predictive potential of the psychic reorganizations observed during pregnancy on the quality of motherhood process and of investment of the child. It is thus a psychodynamic clinical and projective study of the evolution of the psychic functioning and the representations bound to the child of drug addict woman and/or woman receiving opiate substitution treatments becoming a mother. In order to do this, we rely on the analysis of semi-directive interviews and projective tests of women opiate users and\or women receiving opiate substitution treatments and of non-addicted women, between the last quarter of pregnancy and on one year old of the child. A second part of this study proposes a state of play of welfare measures for pregnant addicted women and addicted mothers on West-Norman territory. It also proposes a project of specific and multidisciplinary accompaniment of this population which is developed within a CSAPA (Center of addiction care, support and prevention).

During her theoretical training as an educational psychologist, the researcher was intrigued and fascinated by the expositions on the functioning of the self. With this study she pursued her goal to gain a clearer understanding of the formation and development of the self in a child, with the focus on the child in middle childhood (6 -12 years). In this study, she mainly focused on understanding the connection between the three crucial components of the self, self-concept and self-esteem. Her passion for art inspired her to be inventive and apply artistic creative methods of drawing, painting and clay human modelling as projective means to access the child’s unconscious mind, revealing pivotal experiences and emotions, revealing how the child relates to his or her self. According to this qualitative arts-based research study, the DAP (Draw a Person) and variations of PAP (Paint a Person) and CAP (Create a Person) with the use of appropriate DAP, PAP and CAP questionnaires, seem relevant therapeutic projective measures to assist in educational psychology in exploring the child’s self. / Further Teacher Education / M. Ed. (Guidance and Counselling)

During her theoretical training as an educational psychologist, the researcher was intrigued and fascinated by the expositions on the functioning of the self. With this study she pursued her goal to gain a clearer understanding of the formation and development of the self in a child, with the focus on the child in middle childhood (6 -12 years). In this study, she mainly focused on understanding the connection between the three crucial components of the self, self-concept and self-esteem. Her passion for art inspired her to be inventive and apply artistic creative methods of drawing, painting and clay human modelling as projective means to access the child’s unconscious mind, revealing pivotal experiences and emotions, revealing how the child relates to his or her self. According to this qualitative arts-based research study, the DAP (Draw a Person) and variations of PAP (Paint a Person) and CAP (Create a Person) with the use of appropriate DAP, PAP and CAP questionnaires, seem relevant therapeutic projective measures to assist in educational psychology in exploring the child’s self. / Further Teacher Education / M. Ed. (Guidance and Counselling)