Detresses collectives severes et contexte extensif de confiance

In the situations of collective and severe distress one may raise the issue of mental health work. This question was raised for us in 1993, in the refugee's camp of ex-Yugoslavia. We gave up the idea of undertaking to detect the most severe situations, and chose to build our work on an extensive context of trust. Our practice was to disclose the residual relational resources and to support a training programm in family therapy and network practices for local social workers. To disclose the residual relational resources, one needs an extensive screening that enables one to detect the cues of these resources and whether they seem highly unexpectable. Seeking only deficiences or pathologies puts us at the risk of transforming the work of detection into a work of stigmatization, that is, a work that repeats at another level the traumatisms caused by the war and the ethnic purification. Moreover, we have to be very cautious about these risks, as long as all these traumatisms are already perpetuated as consequenCeS of the situation of refugees, i.e., a situation of dramatic exclusion. The significant interpersonal links are the essential resources of the therapeutic process: they form the therapeutic site, they not only define its end, but are the most important means to reach that end. The contextual approach of Boszormenyi-Nagy offers, in that respect, a frame that enables us to acknowledge on the one hand the extent of the harms and on the other hand the residual resources that remain despite the dramatic extent of the destruction and traumatisms.