Psychothérapie institutionnelle en situation de confinement : adaptation du cadre en hôpital de jour. Vers une institution mentale virtuelle

Within the context of the SARS-Cov-2 virus epidemic, the Ambulatory Care Unit of the Toulouse University Hospital Center, offering institutional psychotherapeutic care to people with severe and/or disabling psychiatric pathologies, closed its doors to patients on the 16th of March 2020. This article aims to document the necessary adjustments to the care setting during this extraordinary period. As it was, the team had to tell patients to stay at home and to respect rules of social distancing. An inescapable paradox when our work consists precisely in de-confining, connecting, being in contact with each other. Face-to-face meetings, group workshops, the array of our mediations were suspended; the challenge for us was to bring to light what is irreducible or essential in the institutional psychotherapeutic care for psychoses, what must remain active through the confinement. These modifications of the psychotherapeutic setting will be described in terms of constructing a virtual mental institution, based on a setting twisted by the distance but not abolished, telephone consultations opening up to a speculative but not disembodied psychopathological imaginary, and finally a blog as a quasi-materialization of a virtual space. This experience led the team of the Ambulatory Care Unit to radicalize the institution to keep it in its simplest apparatus: a virtual tree structure of the mental institution. The prior interactions between caregivers and patients have been translated (and thus re-created) virtually. As to respect their singular aspects, as well as their fundamental belonging to the collective that supports our institution. This virtual mental institution can therefore maintain the framework that structures our institutional care project, and can link the before and what will be the after of the confinement. For this study, we have conducted an “on-the-spot” analysis of the concrete arrangements of our therapeutic setting from an interdisciplinary perspective: phenomenological, systemic and psychodynamic.