When the foundations of life have been upset: an integrated clinical and experimental study with people suffering from exclusion and marginalization

IntroductionPeople suffering from exclusion and marginalization can present symptoms of identity disruption and prodromic phases of psychotic disorders. They need a psychotherapeutic approach avoiding interfering too abruptly... [ view full abstract ]

Introduction

People suffering from exclusion and marginalization can present symptoms of identity disruption and prodromic phases of psychotic disorders. They need a psychotherapeutic approach avoiding interfering too abruptly with the defence mechanisms and coping strategies that have been necessary for their  physical and psychical survival  but are blocking their further  evolution. 

Objectives

We explore the links between traumatic biographic events since childhood and the functioning of personality at adult age, with clinical subgroups suffering from exclusion and marginalization (total N= 401). Among others, we are testing the traumatogenic hypothesis of borderline functioning and psychosis. Arts psychotherapy combined with verbal elaboration in the cognitive-psychodynamic tradition may be a promising treatment option for heavily traumatized people.  

Methods

We present the results of a multi-annual research project based on a mixed-methods approach and combining semi-structured interviews, psychometric questionnaires, projective tests and expressive tests. Original rating scales allowed us  using projective and expressive tests as a tool of research, by passing from qualitative analysis to quantification and the use of inferential and multidimensional non parametric statistics. The cross-sectional studies were completed by longitudinal prospective studies exploring the results of arts psychotherapies.

Results

With the help of multidimensional statistics  different personality profiles were extruded,  linked to the effects of multiple traumata since childhood or to the presence of  massive traumata  in late adolescence or adulthood interrupting a regular life course. The exploration of the therapeutic process allowed us gaining new insights into the resumption of the interrupted subjectivation process.

Discussion and conclusion

The theoretical discussion is based on the differences between the categorical, dimensional and structural approaches to psychopathology and on recent neuropsychological insights into the effects of repeated stress.  The results of the study lead to differentiated treatment options, as well as to promising tracks for future research.