Tous les traumatisés psychiques ne viennent pas demander une psychothérapie. L’angoisse alors les amène à ne vouloir rien savoir de ce qui leur est arrivé. Aussi, dans un premier temps peut-il être judicieux de ne pas leur demander leur avis et de favoriser leur entrée dans le transfert. La névrose traumatique porte bien son nom, contrairement à ce que pensent les rédacteurs du DSM : le traitement passe par la mise en pause de la névrose qui a permis l’incrustation de la scène traumatique. L’entrée dans le transfert a lieu à l’occasion des soins immédiats ou post-immédiats (les debriefings). Le cours de la psychothérapie prend schématiquement deux directions. La première : le récit de l’événement est ressassé mais subit peu à peu des modifications qui signent le travail de l’inconscient sur les images de l’effraction. Dans la deuxième, rapidement il n’est plus question de l’événement traumatique, mais sur la base de sa culpabilité névrotique, le sujet s’extrait peu à peu de l’orbe du trauma. Il fait alors souvent appel à ces figures d’identification mises en situation œdipienne : horrible fusion dans un espace « maternel » et/ou meurtre du père. Dans l’un et l’autre cas, on voit disparaître soit progressivement, soit sans même que le sujet et le thérapeute en soient avertis, le syndrome de répétition.

Traumatic neuroses are a clinical entity which manifests and develops as a result of psychological trauma. Since their first description by Oppenheim in 1889, they have posed a problem with the specificity of care they required. The answer to that question, that of treatment depended primarily on the concept with which the author had already of psychic trauma. Shell shock considered primarily as a stress disorder, was first described by the British military psychiatrists at the time of the First World War. It was this psychophysiological concept that prevailed in this line of thought which led to the diagnosis of “post-traumatic stress disorder” (PTSD). The proposed treatments aimed to reduce or to eradicate the symptoms by acting directly on them by cognitive-behavioral techniques, hypnosis, “EMDR”, etc. At the same time, another school of thought, initiated by Freud and his students, defended the idea that the psychological trauma resulted from an encounter with the “reality of death”. Freud's successors clarified that the traumatic event took place when the Ego of the subject was completely absorbed by his efforts of repression. (“Fenichel”), that is to say, presented neurosis transference, hysterical or obsessive. This corresponds to what we learned from clinical and psychotherapies which we had brought to patients presenting with a traumatic neurosis. These psychotherapies are not “cure types of psychoanalysis” but they use the concepts of psychoanalysis in particular on the issue of transference. We will use the metaphorical schemas of the psychic apparatus proposed by Freud to try to understand the link between the traumatic image which broke in and what Freud calls “the lost object”. This “lost object” is a myth constituted over the early days of the nursling's life: there would be an object capable to fully satisfy the subject, appearing to show nothing missing. More the structure of the subject is neurotic, that is to say, the more it is dissatisfied with the objects of his desire, stronger the longing for the mythical lost object will be. And it is in this place that comes to lodge the traumatic image purveyor of a paradoxical enjoyment even if it pays a fear of annihilation as infants. In biogenic law, with the acquisition of language, the fear of annihilation and pleasure suffer repression (primal repression). We understand more now that there may be a therapeutic effect on the neurotic structure grace of transference. In transferring, the patient sends a message towards a subject (the therapist) seemingly to know. That is to say, he has the desire to inform the therapist of his thoughts with as little censorship as possible, and in doing so, he informs himself, consciously and unconsciously in its own psychic content conscious and unconscious. The motor of this work is the unconscious guilt resulting from having faced the real of death, which is the subject of an anthropological censure. Oedipal guilt pre-conscious or conscious is induced by the previous primary conviction. At the end of this journey that involves the data of the Oedipus complex, the mythical lost object loses its appeal. The traumatic image will possibly disappear, the traumatic event is no longer something that is repeated but a more memory, the subject feels relieved of the trauma as well as the lost object. Three progress-reports of psychotherapy illustrate the theoretical points.