L’écoute dans le travail social clinique en santé mentale : l'impact d'une parole délirante sur l'idéal

Stigma and marginalization associated with mental health issues are proven phenomena. Even with the progress of pharmacotherapy, social integration of people struggling with Schizophrenia or Bipolar diagnostics is still an issue. Furthermore, the clinical encounter with people labeled schizophrenic or bipolar, is a relationship that could reproduce the social stigma. More specifically, we submit individuals labeled as delusional to coercive control measures, such as obligation of treatment and forced hospitalization.  Our relationship with someone’s verbal occurrence, plays an important role in the evaluation of perceived dangerousness towards oneself or others. In this process, delusions are significant to assess mental stability. By focusing on listening during the practice of clinical social work with individuals labeled delusional or schizophrenic, this research aims to explore a dimension of counselling that is most likely minimized and even shrouded by the importance of “saying” and “doing”. Listening to delusions could then appear as an exercise defined by specific discursive ideals and social constraints, formatted to appease a desire of security and efficiency. Moreover, different ideologies uphold clinical social work in mental health that could possibly have an impact on listening. As part of the many different help professions, the need to deepen the theoretical framework of the practices related to social work could help redefine its specificity. This qualitative study, carried out with eleven social workers practicing in Quebec, wishes to explore the dispositive of listening in the clinical relationship; its definition as well as its practical use. More precisely, the interviews explored the learning process behind listening, the different criteria associated to good listening and their impact in the encounter with an individual qualified as delusional. Finally, we tried to define the blueprint of what would be considered “social work listening”. The results of our phenomenological analysis allowed us to cast a different light on the process of listening, a fundamental dimension of social work but maintained in an implicit position. Also, the encounter with a speech labeled delusional, as an extreme listening situation, allowed us to uncover different control apparatus used by social workers to compensate the particularities related to this form of verbal speech. Using three levels of analysis (intrapersonal, interpersonal and sociocultural), we discuss some of the consequences related to listening to delusions, such as the confrontation to the social worker idealized role and to the type of service offered. Finally, we suggest different pathways to relocate listening as a core practice in social work. By adjoining ethics to listening, by redefining the idealistic viewpoint fostered by social discourses on listening and by taking in consideration different levels of complexity related to its practice, listening could possibly resume its efficiency, more particularly with individuals labeled as delusional.

Keyphrases: listening, delusions, ethics, social work, psychosis, ideology