Psychological help: seeking help

The first step is to feel confident and welcomed by the chosen healthcare professional. This is the time to discuss with him or her the goals of care, the type of therapy envisaged, the number of sessions required and the cost of treatment. Consultations with a psychiatrist are reimbursed in part by the health insurance system, depending on the doctor's area of practice (1 or 2). Sessions with a psychologist registered with the monpsy. sante.gouv.fr scheme may be reimbursed up to a maximum of eight sessions. Outside this scheme, sessions are not reimbursed by social security. It is also possible to consult an approved center, such as a hospital or CMP (Centre médico-psychologique). It's a good idea to check what is covered by your mutual insurance company, if you have one.

Whatever therapy we choose, it must be delivered by a healthcare professional with an ADELI number (for psychologists and psychotherapists) or an RPPS number (for doctors). These are unique professional identifiers that attest to the seriousness of the person's training. In addition, it is strongly recommended that the professional be specifically trained in the therapy he or she applies. You need to be vigilant and find out about his or her training and background. Finally, a professional does not need to have been exposed to a traumatic event to be competent.

These therapies postulate that emotions and behaviors are determined more by people's interpretation of an event than by the event itself. They are based on the principle that, with practice, new ways of behaving, feeling, sensing and thinking are possible. To achieve this, they use a variety of psychotherapeutic strategies to help people question their thoughts and beliefs, and change them when they cause suffering (cognitive restructuring), assess the way they adapt to their environment, appreciate the consequences and possibly develop new, more effective skills (role-playing with the therapist, focusing on coping strategies), regulate their emotions (breath control or relaxation), confront their fears and overcome their avoidance behaviours (exposure in imagination or in vivo).

In this field, TECCs have been specially designed to treat PTSD. These are trauma-focused therapies. These are brief therapies (between 10 and 15 sessions). Sessions last one hour and are delivered at a rate of atleast one per week. They cost between 45 and 60 euros per session, and may be covered by certain mutual and supplementary insurance companies. Today, three protocols are recognized for their psychotherapeutic efficacy:

• Prolonged exposure therapy: this protocol helps people to emotionally digest their traumatic experience by inviting them to repeatedly revisit their traumatic memories using an imaginative exposure technique, and to overcome the distress they feel in the presence of clues evocative of the trauma (a place, a situation, a smell, etc.) using an in vivo exposure technique. Gradually, traumatic memories are transformed into memories we can live with, and avoidance behaviors fade and disappear.

• Cognitive processing therapy: this protocol helps people to analyze and deconstruct the negative thoughts and beliefs they may have held since the traumatic event. Through cognitive restructuring, they learn to analyze the thoughts and beliefs that disrupt their view of the world, others and themselves, and hinder their recovery, and then reshape them. Gradually, a more balanced system of thoughts and beliefs develops, enabling us to enjoy a better quality of life.

• Cognitive therapy: this protocol combines and develops the therapeutic strategies of the two previous protocols. Cognitive restructuring focuses on the notions of danger/safety, personal competence/incompetence, self-image and trust in others. On the exposure side, imaginative exposure to traumatic memories induces a modification of the content of the memories to make them more tolerable, while in vivo exposure remains unchanged.

EMDR stands for Eye Movement Desensitization and Reprocessing. During an EMDR session, the healthcare professional asks us to think about the hottest or most traumatic moment, letting our emotions rise to the surface. He then asks us to follow his finger with our eyes, moving it in front of him from left to right for around ten seconds. Then we express our emotions and sensations again. These steps are repeated several times during the session. Gradually, the intensity of the emotion provoked by the memory of the traumatic event diminishes until it disappears.

In general, an EMDR session lasts 60 to 90 minutes for an adult, 60 minutes for a child or teenager. Prices range from 80 to 150 euros. Sessions should be held weekly. Some mutual insurance companies and supplementary insurances cover EMDR.

For the time being, science has not yet come to a conclusion as to the effectiveness of these therapies. This is not to say that they don't work, but rather that research is still ongoing to assess their effectiveness. These psychotherapies do not treat the disorder, but rather the whole person. They are inspired by the concepts of psychoanalysis, largely developed by Freud and Lacan, for whom the discovery and understanding of the unconscious causes of our difficulties enable us to free ourselves from them. They are based on talking, analysis and self-reflection, accompanied by listening and intervention on the part of the therapist. These psychotherapies can be useful in both the short and medium term. They focus on our main problems. They are suitable provided we are ready to reflect on ourselves.

These therapies can be short (10 to 20 sessions) or longer. Sessions last from 30 to 45 minutes. Prices vary from 30 to 100 euros.