Therapeutic framework

This post is also available in: Français Português

To lay the foundations for future communications in this blog, I have chosen to write a short article on the therapeutic framework, in the sense of the organisation put in place around this idea of video games in therapy.

Other aspects of the therapeutic framework will regularly be addressed directly or referred to in the articles that will feed this blog.

1. Material organisation

The practice is organised into separate ‘therapeutic spaces’, each with a separate function: the verbalisation space with two armchairs facing each other, the construction / simulation games area, the drawing / logic and card games area, and the video game area.

Of course, the invests as much or as little as he or she wishes in the therapeutic space. This functional organisation has first of all a descriptive purpose to realise the physical place that video games occupy in the midst of the usual equipment.

It is the latter space that concerns us here: it is an open room inside the therapeutic consulting room, separate enough to be apart and ‘closed’ enough to be containing.

This space arouses a very special curiosity because on entering you can see out of the corner of your eye on the right a desk with a screen and speaker on each side, two game controllers and two large armchairs in front.

When questioned, the client or parent refer to the incongruity of these objects in a psychotherapeutic practice.

Since starting my practice with video games and the appearance of this ‘gaming room’, two and a half years have elapsed, a period of time during which the clients and their parents have started to get used to the subject. ‘Video games’ are discussed in this practice.

However, a real turning point was taken when this piece appeared: for some it was seen as proof of legitimacy because it had become concrete, real and ‘therefore serious’. This reality indisputably grounds the use of video games in this practice, perhaps also grounding the personality of the therapist whose position is still perceived as questionable in French society in 2015. Obviously, this piece probably also helped me to assert my legitimacy in inviting video games into the therapeutic context, making it a cohesive whole.

To shed more light on this point, here is what Philippe Gutton says in the book ‘The teenager and his psychologist, new therapeutic approaches in psychoanalysis’ to which he contributed: ‘Outside if a sufficiently good agreement between childhood and puberty (does a stable neurotic organisation exist at puberty?), we must invent a specific practice, question our theory of technique. We must not give up by asserting that psychoanalysis does not concern the adolescent as a recent congress in Paris on 7/02/09 pugnaciously suggests by the title, ‘Does the adolescent clinic exist?… Clinically and in theory’ “). We defend, after Pierre Mâle, the idea that one should not hesitate to question the mechanisms of the treatment in order to work on the epistemological turn that the adolescent imposes, when he or she refuses to be known (D.W. Winnicott) and wishes first (and sometimes only) to be ‘recognised’ in his or her desolation.’

2. Therapeutic organisation

The video game is employed in the therapeutic space just like other mediators are employed in the practice. I usually start the sessions with a face-to-face verbal exchange, even if this lasts only 5 minutes, to catch up with each other by both the look and words, and to ground ourselves in the therapeutic setting coming in from the tumultuous exterior and before diving into the intensity of the therapy.

This exchange time, which is not just verbal, strongly conditions the choice of video game; I ask the client at the very beginning of the session what he or she would like to do and depending on this preliminary exchange, its intensity and the particularity of the topic addressed, it sometimes happens that the choice of video game is no longer the same. The client will then choose the mediator best suited to the message he or she wants to convey to the therapist during this session, and appropriate it in a very particular way compared to usual, to which we will be all the more attentive.

Once all this is established, we move together to the computer where the two of us sit, side by side.

The time for the game to load is an interesting discussion time, more focused on the domain of the game, what the client plans to do during this session. Then afterwards we see if the client has followed his or her desire, or what has prevented him or her from doing so, what the client says about it, how he or she experienced it and the outcome at the end of the session.


This post is also available in: Français Português

About Bruno BERTHIER

Psychologue Clinicien en libéral Diplômé en 2001 de l'Ecole de Psychologue Praticiens

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