French psychomotricity

1. Introduction

Version followed: French state-diploma psychomotricity (psychomotricien D.E.) as scoped by the 1988 decree of competence (now in the Code de la santé publique). Relaxation methods follow the Paris (Sainte-Anne / Henri-Rousselle) lineage as taught in the UPMC first-year course (Guiose, 2003–04): Ajuriaguerra's adaptation of Schultz, Jacobson, Wintrebert, Bergès and Dupont. Severe autism work follows the Bullinger sensorimotor approach (Kloeckner et al., 2009). Where only secondary or training sources were reachable, this is marked.

What it is. French psychomotricity is a regulated health profession and clinical discipline, not a single manualised therapy. It works on how tone, movement, sensation, emotion, representation and relationship fit together, across the lifespan. In France it works on medical prescription. The profession was created in 1974 as "psychorééducateur", renamed "psychomotricien" in 1985, given a list of authorised acts in 1988 and written into the Public Health Code in 1995. Its theoretical synthesis comes from Julian de Ajuriaguerra (Sainte-Anne / Henri-Rousselle, Paris, 1937–1959 and after). He drew on Dupré (who introduced the term clinically in 1909), Wallon (emotion as a tonic relation), Piaget, psychoanalysis and phenomenology. [source: SFETD; Thiffault 1978; GHU Paris archives; Universalis/Bernard] The pairing with Giselle Soubiran (co-worker of Ajuriaguerra and founder of the ISRP school) is historically standard, but no Soubiran primary text is drawn on here. [uncertain]

How change is thought to happen. Muscle tone is read as both a neurological state and a relational message: the "dialogue tonico-émotionnel". Disorders are seen as lying between neurology and psychiatry rather than coming from a focal lesion. Change comes from new, shared bodily experience inside a relationship: regulating tone, organising the body in space and time, building the body schema and body image, and then putting that experience into representation and words. In this view, psychic change goes with psychomotor change. [source: SFETD; Universalis/Bernard; Berthoz homage; Thiffault 1978]

Scope warning. This guide is for clinicians. Outside France, the title and the use of touch are regulated differently. Check what your licence and jurisdiction allow before using any touch-based or relaxation-by-touch technique, and get specific training and supervision. [synthesis]

2. Framework

There is no single published phase manual for the discipline. The pathway below is the regulatory and clinical sequence the sources describe. [source: Decree 1988; SFETD; Onconormandie slides; Kloeckner et al. 2009]

Phase 0: Referral. A medical prescription is required (decree: "sur prescription médicale"), after a medical/neuropsychological examination. Goal: a clear request and medical clearance. Move on once there is a prescription and you have clarified who is asking for what (patient, parent, school, team). [source: Decree 1988; SFETD]

Phase 1: Intake and psychomotor assessment (bilan psychomoteur). Typically 1–3 sessions [uncertain: the number is not given in the sources]. Goals: anamnesis, then assessment of psychomotor development, tonic-emotional regulation, dynamic and fine coordination, balance, laterality, spatio-temporal organisation, body schema and body image. In pain or somatic settings, also cover the history of the pain and its emotional, behavioural, cognitive and sensory dimensions. Move on when you have a psychomotor diagnosis and have sent a written report with care proposals to the prescriber, who validates the plan. [source: SFETD; Thiffault 1978]

Phase 2: Therapeutic project. Choose goals, the mediation(s), individual or group format and the frame (fixed day, time, room). The frame should be stable and rhythmic. [source: SFETD; Onconormandie slides]

Phase 3: Treatment course. The format depends on the method:

Bergès children's relaxation: weekly, individual or group, for 6 months to 1 year. [source: Guiose 2003; Elsevier/Bergès-Bounes et al. 2011]
Wintrebert relaxation: weekly, for at least one school year, after a preliminary interview. [source: Guiose 2003]
Schultz lower cycle: each standard exercise takes about 15 days. Sessions grow from about 20–30 seconds at first, to 5–15 minutes by week 4–6, to up to about 30 minutes by month 3. [source: Guiose 2003]
Jacobson relaxation: from several months to years. [source: Guiose 2003]
Graphomotor re-education (non-psychomotor graphotherapy source): typically 3–10 sessions, then follow-ups every 3–4 weeks. [source: Cheynel, secondary]
Other mediations: no standard session count was found. In practice, weekly sessions of about 45 minutes over months are common. [uncertain]

Phase 4: Reassessment and ending. Reassess regularly (in the Bullinger approach, a yearly sensorimotor assessment) and adjust the project. Criteria for ending (all [synthesis] beyond the reassessment requirement): the goals set at the bilan are met on reassessment; the patient carries regulation into daily life (Jacobson's "differential relaxation" and Wintrebert's final "re-adaptation to daily life" are the method-specific markers); and the patient no longer needs the therapist's tone or touch to regulate. [source: SFETD; Kloeckner et al. 2009; Guiose 2003]

Within-session structure. The sources do not give a standard sequence for a whole session. The relaxation methods have their own sequences (see section 4), each ending with a "reprise" (a wake-up and return step) and a spoken exchange. For play and movement sessions, a common working shape is: a welcome ritual, then body or activity time, then a quieter time of representation (talk, drawing or modelling), then a goodbye ritual. [synthesis]

3. Guiding principles

Tone is communication (tonic-emotional dialogue). Read the client's tone, posture and breathing as messages, and treat your own tone, holding and voice as part of the reply. [source: SFETD; Universalis/Bernard; Kloeckner et al. 2009]
Disorders are not focal lesions. Ajuriaguerra held that psychomotor disorders "ne répondent pas à une lésion en foyer". Assess and treat the whole person-in-relation, not an isolated motor skill. [source: Berthoz homage]
Several bodies. Ajuriaguerra distinguished the perceived, known, represented and lived body. Name which level you are working on: sensation, knowledge of body parts, the drawn or spoken body, or the felt and emotional body. [source: Berthoz homage]
Psychomotricity as a way of being in the world. Ajuriaguerra called it "une certaine façon d'être au monde". Gestures and attitudes toward others are clinical material, not just performance. [source: Thiffault 1978]
Emotion is observed throughout, not tested. Note ease or discomfort in the body across every task. [source: Thiffault 1978]
Technique serves the relationship. Mediations are supports for the relationship. The therapist may start a movement or follow the client's own. [source: SFETD]
Regulation, not minimum tone. The aim is adaptable tone, not maximal slackness. [source: Guiose 2003 on Dupont]
The client's words feed the method. In relaxation, fold the client's own descriptions back into later inductions, and hold a spoken exchange after each exercise. [source: Guiose 2003]
The client controls stimulus intensity. In sensory work, prefer active tasks in which the client controls the intensity. Approach from the side rather than head-on, and give stable supports and a background ("appuis", "arrière-fond"). [source: Kloeckner et al. 2009]
A stable, rhythmic frame. Keep the same day, time, room and rituals. Predictability is part of the treatment. [source: Onconormandie slides]
Pleasure in the body. One stated aim is to restore a "corps plaisir": help the client make sense of sensations and build their own coping tools. [source: SFETD]
Prescription, team and reporting. Work on medical prescription, report back to the prescriber, coordinate with the team and family, and reassess. [source: Decree 1988; SFETD; Onconormandie slides]
Stay in scope. Graphomotor work is in scope; teaching written language is not (decree). Refer psychological issues beyond your remit. [source: Decree 1988; synthesis]
Prevention and development first. Before formal learning, a child needs a usable body for movement, space, time and communication. Educational and preventive work is part of the role. [source: Thiffault 1978; Decree 1988]

4. Intervention inventory

The decree lists the authorised therapeutic means as: dynamic relaxation, gestural education, bodily or plastic (visual-art) expression, and rhythm, play, balance and coordination activities. It also authorises early education and psychomotor stimulation, and a "body-approach contribution" to the care of intellectual disability, personality disorders, emotional and relational regulation disorders and body-image disorders. [source: Decree 1988] The entries below give the concrete procedures found for each. Where the sources name a mediation without describing it, the steps are marked [synthesis].

Touch: general rule for every technique below that uses it. None of the sources gives explicit consent steps. All the following are [synthesis], following current good practice:

Before the first session, explain what touch is used, where, and why.
Ask for agreement every time, and for a child also get the parent's agreement.
Offer a no-touch alternative: your verbal naming only, the client's own hand, or an object such as a ball or cushion.
Agree a stop signal (a word, or a raised hand for non-speaking clients) and respect it at once.
Check in during the exercise and afterwards.
Touch only clothed, non-intimate areas: hands, forearms, shoulders, upper back, feet and lower legs, the head only if agreed. Never genital, breast or buttock areas.
Record consent in the notes.

Touch-based work needs specific training and supervision, and a check of what your licence allows.

4.1 Intake and psychomotor assessment (bilan psychomoteur)

Purpose / when: At the start and at each reassessment. It produces the psychomotor diagnosis and the report to the prescriber. [source: SFETD; Decree 1988]
Steps:
1. Clarify the request and who is making it. Take the history: pregnancy and birth, motor milestones, laterality, sleep, school, family, illness and pain history. [source: SFETD]
2. Assess, in play-like or standardised tasks, each of the following [source: SFETD; Thiffault 1978]:
  - tone: passive extensibility, ability to relax voluntarily, and tonic-emotional reactions
  - balance and dynamic coordination: Thiffault cites Ozeretski-type balance items
  - fine coordination, praxis and sequencing
  - laterality: the Auzias laterality test for ages 4–12 (2003) is one named instrument [source: GHU Paris archives]
  - spatio-temporal organisation and rhythm
  - body schema: naming, showing and imitating
  - body image: for example, drawing a person and how the client talks about their body
  - graphomotor skill: the Ajuriaguerra writing scale is a named instrument [source: Cheynel, secondary]
3. Observe throughout: posture, tone, over- or under-investment of body zones, signs of psychic breach or trauma, anxiety, withdrawal, depression, sleep, breathing and how the client relates to you. [source: SFETD]
4. Score standardised tests by their manuals. The licensed tests (for example, Bergès-Lézine imitation of gestures, NP-MOT, M-ABC) are not reproduced here [uncertain: these instruments].
5. Write the psychomotor diagnosis and care proposals, and send them to the prescriber. [source: SFETD]
Example language (illustrative): "Today we'll play some movement games so I can see how your body likes to work, what's easy and what's hard. There are no wrong answers."
Watch for: Performance anxiety distorting the scores. Fatigue (split the bilan across sessions). The difference between motor clumsiness and inhibition. Emotional reactions to being touched during tone testing: ask first, and name each passive mobilisation before doing it. [synthesis]

4.2 Sensorimotor assessment (Bullinger approach, severe autism / polyhandicap)

Purpose / when: For non-verbal or severely impaired clients. Done yearly, to set goals. [source: Kloeckner et al. 2009]
Steps: Observe each channel [source: Kloeckner et al. 2009]:
- Oral: grasping with the mouth, exploration, chewing, swallowing, and tolerance of toothbrushing.
- Postural: dominance of extension, arched back, arms raised "en chandelier" (like a candelabrum), and "pneumatic" tone.
- Visual: gaze alignment, smooth pursuit of a horizontally moving object, and reaction to small moving light spots.
- Tactile: withdrawal or defensiveness, versus fine finger exploration.
- Auditory: response to their name or a beep, and whether being alerted leads on to orienting and exploring.
- Lower body: foot exploration, plantar roll, hip laxity, and all-or-nothing leg tone.
Example language (illustrative): with the parent: "I'm going to watch how she uses her mouth, eyes, hands and feet, and how her posture changes when something new happens."
Watch for: Approach from the side, not head-on. Note whether alerting moves on to orientation and exploration, or to withdrawal or stereotypy. [source: Kloeckner et al. 2009]

4.3 Ajuriaguerra's relaxation (psychotonic re-education)

Purpose / when: A relaxation system based on psychophysiological training, combining elements of Schultz and Jacobson, within a relationship read through psychoanalysis. Its Paris lineage also grounds Auzias's relaxation-based writing re-education. [source: OQLF; Thiffault 1978; GHU Paris archives]
Steps: Ajuriaguerra's own step sequence was not found in the sources used. [uncertain] In practice, conduct it as the Schultz lower cycle (4.4), with the Jacobson-style contrast work (4.5) where the client cannot yet feel release, and with a post-exercise spoken exchange that treats the transference and the client's associations as material. [synthesis, based on OQLF and Thiffault 1978]
Watch for: See the contraindications under 4.4 and section 5.

4.4 Schultz autogenic training, lower cycle (as taught in psychomotricity)

Purpose / when: Self-induced relaxation for anxiety, stress, insomnia, tension headache, stuttering, writer's cramp, and as an adjunct in psychosomatic presentations. Use from about age 10. It requires the client's agreement. [source: Guiose 2003]
Contraindications named: young children, intellectual disability, psychosis, severe neurosis. Classic relaxation contraindications also apply: secondary gain from illness, "eroticising" the treatment, schizoid functioning, and organic tremor or tics. [source: Guiose 2003] Add: severe dissociation, untreated trauma with intrusions, and active suicidality until stabilised. [synthesis]
Setting: A quiet room at moderate temperature, in half-light. The client sits in an armchair, sits on a chair in the "coachman" posture (slumped forward, forearms on thighs), or lies on their back. [source: Guiose 2003]
Steps:
1. The client closes their eyes and gives themself one calm-inducing phrase ("I am completely calm").
2. Heaviness: "my (dominant) arm is heavy", repeated 5–6 times, until heaviness spreads to the other limbs.
3. Warmth: "my arm is warm".
4. Heart: a calm, strong heartbeat.
5. Breathing: "I breathe calmly". The client lets breathing happen rather than steering it.
6. Solar plexus warmth: the therapist may place a hand on the abdomen, between the navel and the lower tip of the breastbone (with consent; see the touch rule). The client's own hand later replaces the therapist's.
7. Forehead: a light, passing coolness.
8. Add each new stage after about 15 days, and say the earlier formulas as a chain before it.
9. Reprise (ending): a vigorous bend of the forearms, a deep breath, then open the eyes.
10. Talk the session through. Fold the client's own words for sensations into later formulas. [source: Guiose 2003]
Duration: about 20–30 seconds at first, 5–15 minutes after 4–6 weeks, up to about 30 minutes after about 3 months. Daily home practice. [source: Guiose 2003]
Example language (illustrative): "Let the arm rest. Just notice what's there: heavy, light, nothing in particular. All are fine. What words would you use?"
Watch for: Paradoxical anxiety, a feeling of losing control, depersonalisation, intrusive images. If they appear, stop, do the reprise, sit the client up and orient them. [synthesis] Skip the heart formula for clients with cardiac anxiety, and the solar plexus touch for clients sensitive to abdominal touch. [synthesis] It is working when the client reports heaviness and warmth spreading, and can self-induce relaxation without you.

4.5 Jacobson progressive relaxation and differential relaxation

Purpose / when: For clients who cannot yet feel the difference between tension and release, and for transferring low-effort tone into activities. [source: Guiose 2003]
Steps:
1. The client lies on their back after 5–10 minutes of rest.
2. For each muscle group: tense it, observe the tension, release it, and observe the release.
3. Order: arms, legs, trunk, face, then imagined exercises.
  - Arms: bend the wrist back or forward; bend the elbow; stiffen the arm with progressively weaker contractions.
  - Legs: toes pulled up or pointed; leg lifted from the knee; leg pressed down.
  - Trunk: draw in the belly, arch the back, breathe in deeply, draw the shoulders back or up, tilt the neck.
  - Face: forehead, brows, eyelids, eyes, jaw, lips, tongue; then counting aloud and then silently.
4. Leave rest periods of 5–10 minutes between groups, about 30 minutes without instruction in a roughly one-hour session.
5. Differential relaxation: use only the minimum contraction an action needs, progressing from lying, to sitting, to reading or writing, to daily activities. [source: Guiose 2003]
Example language (illustrative): "Bend the hand back just a little. Notice where you feel it. Now let it go, and notice what changes."
Watch for: Over-strong contractions (ask for less). Pain or cramp (stop). Breath-holding during tension. It is working when the client finds tension on their own in daily tasks and lowers it.

4.6 Wintrebert active-passive relaxation (children)

Purpose / when: For young children, from about age 2 and mostly ages 4–6, where physical contact and passive movement are central. [source: Guiose 2003] Indication lists differ between sources. Unstable, agitated children are the classic indication [uncertain].
Format: Weekly, for at least one school year, after a preliminary interview with the parents. [source: Guiose 2003]
Steps:
1. Observation session: a metronome is used, and when the beat stops the child must move. Note anticipation and how steady the child's posture is while waiting.
2. Stage 1, passive mobilisation: the child lies down. You slowly, regularly and monotonously move a limb (for example, lifting and lowering the forearm, or rolling the leg) until the child neither resists nor helps.
3. Stage 2, immobility: light touch on a named body part, with suggestions such as thinking of the hand as calm and relaxed, or the forehead as smooth.
4. Stage 3: the child makes movements with pauses: raising and lowering, holding postures, contract-release, plus breathing exercises.
5. Final stage: carry the movements over into everyday actions. [source: Guiose 2003]
Touch consent: Follow the touch rule above. A non-touch option is for the child to move their own limb slowly to your counting. [synthesis]
Example language (illustrative): "I'm going to move your arm very slowly, like a sleepy pendulum. You don't need to help. If you want me to stop, say 'stop'."
Watch for: The child "helping" (active participation) or bracing (resistance). Both are information, not failure. It is working when the limb goes heavy and passive and waiting becomes calmer.

4.7 Bergès therapeutic relaxation (children; Sainte-Anne method)

Purpose / when: From about age 5. Indications: psychomotor disorders (instability or hyperactivity, dyspraxia), learning disorders, somatic-expression disorders (migraine, sleep problems), psychic-expression disorders, reactive and traumatic disorders, and support for children with somatic illness or pain. It is not a treatment for the illness itself. [source: Elsevier/Bergès-Bounes et al. 2011; Guiose 2003]
Format: Weekly, individual or group, for 6 months to 1 year. It combines mental concentration, muscle relaxation, touch and naming, inside the relationship with the therapist. [source: Elsevier; Guiose 2003]
Steps:
1. Concentration: the child, lying down, calls up a calm memory or pictures a calm postcard. You repeat the instruction three times.
2. Body awareness: you name and touch body parts in sequence: shoulder, arm, forearm, and so on.
3. Neuromuscular relaxation: the child thinks of each part resting, then you move it passively. This also helps the child place their body in space.
4. Suggestion: for example, the body felt heavy, sinking toward the floor.
5. Reprise: stretch, breathe, open the eyes, sit up.
6. Afterwards: the child says what they felt. The book's emphasis on "corps, langage, sujet" makes this naming central. Whether a drawing is routinely added was not confirmed. [uncertain] [source: Guiose 2003; Elsevier]
Touch consent: Follow the touch rule above. A no-touch version is to name each part while the child places their own hand on it. [synthesis]
Example language (illustrative): "Think of a quiet picture, a place where you feel calm... Now I'm going to touch your shoulder and name it: your shoulder."
Watch for: Giggling, eye-opening or agitation in the first sessions (common; keep the frame). Silences or distress linked to particular body parts (note them and talk about them afterwards). It is working when the child names sensations more precisely over the sessions and carries calm into daily life.

4.8 Dupont dynamic psychomotor relaxation

Purpose / when: Tonic regulation through slow movement rather than stillness. Useful for clients who cannot tolerate lying still. It matches the decree's "relaxation dynamique". [source: Guiose 2003; Decree 1988]
Contraindications named (because of the mild hyperventilation it produces): epilepsy, cardiovascular disorders, psychosis, hallucinations, delirium, depersonalisation or derealisation. [source: Guiose 2003] Add: pregnancy, asthma or COPD, panic disorder, recent surgery or injury, active suicidality, and recent trauma without stabilisation. [synthesis]
Steps:
1. Describe each gesture before it is done, then narrate it while the client does it.
2. Do series of slow, repetitive gestures, 10–20 repetitions per series, for example raising and lowering the arms or rotating the trunk [synthesis: the example movements].
3. Do not correct form at first.
4. Synchronise the start and end of the movement across muscle groups, and coordinate breathing with the gesture: mostly abdominal, an active, long, slow in-breath and a free, long out-breath.
5. After each series, rest and have the client take an inventory of the limbs that worked, using open suggestions (for example, perhaps the right arm feels heavier).
6. Keep the setting safe and reassuring. [source: Guiose 2003]
Example language (illustrative): "Breathe in slowly as the arms rise... and let the breath go as they come down, as long as it wants."
Watch for: Dizziness, tingling or lightheadedness, which are signs of over-breathing. If they appear, slow down, shorten the in-breath and sit the client down. [synthesis] It is working when movements become smoother and better synchronised and the client notices a difference between the limbs that worked and those that did not.

4.9 Eutonie (Gerda Alexander), as used in psychomotor training

Purpose / when: Tonic adaptation to daily stress, and prevention. Often done in groups or in pairs. [source: Guiose 2003]
Steps: A dynamic, gymnastic-like movement phase, followed by a still phase lying on the back, exploring body sensations (contact with the floor, volume, skin). [source: Guiose 2003] Eutonie has its own formal training; the detailed sequence is not drawn on. [uncertain]
Example language (illustrative): "Notice where your body meets the floor... where the contact is clear, and where it's vague."
Watch for: Pair work involves touch between clients. Set rules and get consent from each participant. [synthesis]

4.10 EMG biofeedback

Purpose / when: Making tension visible for clients who cannot feel it. [source: Guiose 2003]
Steps: Attach EMG sensors to the target muscle (for example, forehead or forearm). The device signals tension. The client tries strategies (breathing out, Jacobson release, imagery) to lower the signal. Then fade the device out. [source: Guiose 2003; fading: synthesis]
Watch for: Over-effort or frustration when "trying to relax". Reframe the goal as noticing rather than winning. [synthesis]

4.11 Relaxation combined with systematic desensitisation

Purpose / when: Phobic or anticipatory anxiety. [source: Guiose 2003]
Steps: Teach relaxation first. Build a graded list of imagined situations with the client. Present each in imagination while the client is relaxed. When anxiety breaks the relaxation, stop the image and help the client relax again before going on. [source: Guiose 2003]
Safety and consent [synthesis]: Agree the hierarchy and a stop signal. Do not start trauma-memory exposure without stabilisation, and only within your competence. Screen for dissociation and suicidality.
Watch for: It is working when distress drops for each item across presentations.

4.12 Gestural education: coordination, balance and praxis (sensorimotor circuits)

Purpose / when: Dyspraxia and motor clumsiness, coordination and balance disorders, developmental delay. [source: Decree 1988; SFETD; Onconormandie slides]
Steps (the sources name the means, so the concrete sequence is [synthesis]):
1. Set up a circuit in the room: things to step over, a balance beam or line, cushions to cross, a tunnel, a target to throw at.
2. Demonstrate, then have the child plan the route aloud.
3. Grade the difficulty one variable at a time: speed, surface, eyes open or closed, carrying an object, two-handed tasks.
4. Break complex gestures into sequences and chain them.
5. Close with a still moment and a short talk or drawing of the route.
Example language (illustrative): "Tell me your plan first: what comes after the tunnel?"
Watch for: Repeated failure feeding inhibition. Keep a success rate the child can sustain. It is working when the child plans and adjusts without needing to be shown. [synthesis]

4.13 Body schema and laterality work

Purpose / when: Body-schema and laterality disorders, poor body awareness, body-image disorders of psychic or physical origin. [source: Decree 1988; SFETD]
Steps [synthesis, building on the body-part naming in Bergès, 4.7]:
1. Name and point to body parts: on yourself, on the child, on a doll, and in a mirror. Use a mirror carefully with clients with body-image disorders.
2. Imitate postures, facing and then side by side.
3. Trace the body outline on paper, then fill it in and talk about it.
4. Do right-left tasks on self, then on others, then in space.
5. Match touch to naming (with consent).
Example language (illustrative): "Show me your elbow... now the elbow of the doll... now draw where it goes."
Watch for: Distress at the mirror or at being drawn, a sign of a body-image injury. Slow down and talk about what is happening. [synthesis]

4.14 Spatio-temporal organisation and rhythm activities

Purpose / when: Spatio-temporal organisation disorders, instability, prerequisites for learning. [source: Decree 1988; Thiffault 1978]
Steps: Clap or tap rhythms with the child repeating them back. Walk to a beat. Stop when the sound stops (compare the metronome waiting task in Wintrebert, 4.6). Use orientation games (in front of, behind, between). Lay out and then recall sequences in space. Progress from body, to objects, to paper. [steps: synthesis; metronome: Guiose 2003]
Example language (illustrative): "Listen first, then give me back the same rhythm."
Watch for: Anticipating the beat (impulsivity) versus freezing (inhibition). It is working when the child keeps a steady tempo and can wait.

4.15 Graphomotor re-education (Auzias lineage)

Purpose / when: Graphomotor disorders (dysgraphia, tense or slow writing). Re-education of written language itself is out of scope for psychomotricians. [source: Decree 1988] At Sainte-Anne, Marguerite Auzias founded a school of graphomotor therapy based on Schultz relaxation as adapted by Ajuriaguerra. Its foundations date from 1957–58 with Hélène de Gobineau. [source: GHU Paris archives] The Auzias step sequence is not drawn on. [uncertain] The steps below come from a graphotherapy source. [source: Cheynel, secondary]
Steps:
1. Assess posture, grip, paper tilt, arm support and tension. Use the Ajuriaguerra writing scale against age norms.
2. Set up posture: table height so the elbows are not raised and the back not hunched; tilted paper; left-handers seated on the left.
3. Work toward a tripod or vertical semi-palmar grip, with the thumb in line with the arm.
4. Free up the fingers with finger games.
5. Pick one basic gesture to work on, explain it with shared words, and anchor it with stories.
6. Progress from a board, to blank paper, to lined paper. Reduce size and loosen the movement. Work from the shoulder first and finish with the fingers.
7. Set short daily home practice. Add a relaxation step (4.4 or 4.5, focused on the arm and shoulder) before graphic work, in keeping with the Auzias lineage. [synthesis]
Example language (illustrative): "First let the shoulder go soft... now let the loop come from the shoulder, big on the board."
Watch for: Pain, a crushed grip, breath-holding. Compare before-and-after samples. It is working when lines are steadier, letters better proportioned and writing more fluid.

4.16 Expressive mediations: body expression, rhythm, visual art and play

Purpose / when: Emotional, relational and behavioural difficulties, inhibition, instability, and personality disorders as supportive work. [source: Decree 1988; SFETD]
Steps [synthesis]:
1. Offer a mediation suited to the client: free movement to music, mime, modelling, painting, or symbolic play with cushions, fabrics and balls.
2. Follow the client's movement or start it yourself.
3. Mirror their tone and tempo and then gently vary it (an application of the tonic-dialogue principle).
4. Close with a time of representation (talk, drawing). [following: SFETD]
Example language (illustrative): "Show me with your body how the storm is today... and how it might calm down."
Watch for: Escalating excitement. Mark limits with clear rituals. It is working when play gains in narrative and the client can move from acting to saying. [synthesis]

4.17 Therapeutic touch and gentle massage

Purpose / when: Relaxation, body awareness, a sense of a body envelope. Used in pain, palliative care and somatic illness as support, not as disease treatment. [source: SFETD; Onconormandie slides] The sources name the technique but do not describe it. [uncertain]
Steps [synthesis]:
1. Use the full touch-consent procedure above.
2. The client sits or lies clothed, with a stop signal agreed.
3. Use slow, even, enveloping pressure on hands, forearms, shoulders, back or feet, using the whole palm and keeping contact continuous.
4. Name the area before you touch it.
5. Sessions are short (a few minutes per area).
6. Close by keeping a still hand, then lifting it slowly, then talking it through.
7. Avoid recent surgical sites, injuries, lines or drains, inflamed or fragile skin, and areas of thrombosis risk. Check medical clearance. Never use deep-tissue pressure.
Example language (illustrative): "I'm going to place my hand on your shoulder now. Is that all right?"
Watch for: Freezing, holding the breath, flushing or dissociative signs. Stop and orient the client. Clients with trauma histories may comply without consenting; offer the no-touch option again. [synthesis]

4.18 Containing experiences and wrapping (enveloppements)

Purpose / when: To give a felt body boundary in severe autism, polyhandicap, self-injury and psychotic disorganisation. [source: SFETD; Kloeckner et al. 2009]
Steps: Bullinger describes carrying in a cloth or hammock, sound envelopes, vibration, and enclosed spaces with clear edges (a floor area or a cabin), all within a relationship. [source: Kloeckner et al. 2009] A dry version [synthesis]: the client, consenting, lies on a mat. You fold a large sheet or blanket around the body, not the face, with arms in or out as the client chooses. Leave it loose enough to move freely and get out at once. Stay present and in view, speak, and keep it brief. Unwrap slowly and talk about it afterwards.
Risk flag: Kloeckner et al. (2009) cite packing (cold wet wrapping) as a containing experience for self-injury. French health authorities (HAS/ANESM, 2012) are widely reported to have formally opposed packing in autism outside research protocols. That document is not drawn on. [uncertain] Do not use cold wet wrapping or any restraint-like wrapping. Never wrap without consent, never immobilise, and never cover the face. [synthesis]
Watch for: Panic, struggling, or a drop in responsiveness. Unwrap at once. [synthesis]

4.19 Water mediation (pool, paddling pool, hydrotherapy)

Purpose / when: Buoyancy and water resistance give sensory envelopment, pleasure and motor freedom. [source: Kloeckner et al. 2009; SFETD; Onconormandie slides]
Steps [synthesis]: Make a medical and safety check (epilepsy, skin, infection, wounds). Keep one-to-one supervision within arm's reach. Enter gradually. Offer floating, splashing and pouring games. Let the client control contact with the water. Keep water temperature comfortable. End with drying and wrapping in a towel, which also gives an envelope.
Watch for: Fear, hypothermia, seizures. Have pool safety procedures in place. [synthesis]

4.20 Postural supports and tone regulation (Bullinger)

Purpose / when: Extensor dominance, arching, poor postural availability. [source: Kloeckner et al. 2009]
Steps: Offer large balls, barrels, floor support and rolled-up (flexed) postures to reduce extensor tone. Seat the client on a large ball. Use ride-on toys to avoid extensor reactions. Bring the client upright gradually. Use mirrors to allow indirect eye contact. Start with relaxation to reach the best postural availability. [source: Kloeckner et al. 2009]
Watch for: Hip laxity and falls. Approach from the side. It is working when the posture is more available and the hands and eyes become free to explore.

4.21 Extending stereotypies

Purpose / when: Repetitive tapping or sensory stereotypies. [source: Kloeckner et al. 2009]
Steps: Offer different surfaces, for example metal, for the same tapping, so the sound changes. Then gradually open the repetitive pattern into exchange: echo it back, vary it, take turns. [source: Kloeckner et al. 2009; turn-taking: synthesis]
Watch for: Distress when the pattern is interrupted. Extend it; do not suppress it.

4.22 Sensorimotor feeding workshop ("croque en bouche")

Purpose / when: Oral hypersensitivity, food selectivity, difficulty chewing. [source: Kloeckner et al. 2009]
Steps: Run in a small group: (1) relaxation for postural availability; (2) sensory experiences, smell first, then touch such as massage; (3) bring food to the mouth, then explore, chew and swallow. Expose gradually across sessions. [source: Kloeckner et al. 2009]
Watch for: Choking risk; coordinate with the team, including a speech therapist or physician, about swallowing. [synthesis] Avoid targets on amounts or weight.

4.23 Visual and auditory orienting work (Bullinger)

Steps:
- Visual: use textured panels to steady the gaze, then tasks to locate and point.
- Auditory: use resonant objects (a microphone, metal bins) to start exchanges, then sound-locating games that combine hearing and vision.
- Tactile defensiveness: use active stimulation the client controls (seeds, airflow from a fan), and loose clothing to reduce unpredictable contact. [source: Kloeckner et al. 2009]
Watch for: Being alerted without then orienting means the stimulus is too strong. Reduce it.

4.24 Bimanual and girdle-dissociation work

Steps: Use large objects that need a two-handed grip, and tasks that separate shoulder and pelvic movement (for example, turning the upper body while the hips stay still on a bench). [source: Kloeckner et al. 2009; example: synthesis]

4.25 Gentle sensory stimulation (Snoezelen, sensory integration, basal stimulation)

Purpose / when: Bed-bound, polyhandicapped or very ill clients. [source: Onconormandie slides; SFETD] These are separate methods with their own training, named but not described in the sources. [uncertain] Use them only within that training.

4.26 Psychomotor work on chronic pain

Purpose / when: Chronic pain, including in people who cannot report it (infants, autism, multiple disability, after a stroke). [source: SFETD]
Steps:
1. Map the pain's history and its emotional, behavioural, cognitive and sensory dimensions. Use intensity scales suited to the patient, including observational scales for non-verbal patients.
2. Use relaxation (4.4–4.8), touch (4.17) and movement to help the patient make sense of sensations and build their own coping tools.
3. Aim to restore a "corps plaisir".
4. Reassess regularly. [source: SFETD]
Watch for: Body work must not replace medical pain management. Coordinate with the pain team. [synthesis]

4.27 Early education and psychomotor stimulation (infants, toddlers)

Purpose / when: Developmental delay, at-risk infants. [source: Decree 1988] Steps are not given in the sources. [uncertain] In practice [synthesis]: sessions with the parent present; floor play that supports rolling, sitting, reaching and crawling; carrying and holding positions; and guidance to parents on tonic dialogue: reading the baby's tone and adjusting how they hold the baby.

4.28 Mediations for adolescents and adults

Purpose / when: Engaging adolescents. [source: Onconormandie slides] The sources name music, theatre, martial arts, climbing and video games, and also animal-assisted and music mediation and adapted physical activity. [source: SFETD] Use each as a frame for tonic regulation, body image and relationship rather than for performance. Agree safety rules for martial arts and climbing. [synthesis]

5. Handling problems

The sources give only a few explicit responses to problems, and these are tagged. Everything else is [synthesis].

The client cannot let go, or relaxation makes them anxious. Common in anxious, controlling or traumatised clients. Move from stillness to movement:
- Use Dupont dynamic relaxation (4.8), or Jacobson contrast (4.5) so the client can feel the difference first.
- Keep eyes open and the client sitting rather than lying.
- Shorten exercises to seconds, as Schultz's first sessions do [source: Guiose 2003].
- Name it as information, not failure.
- Example (illustrative): "Your body is telling us it isn't safe to let go yet. Let's find how much it is ready for." [synthesis]
Overwhelm, dissociation, depersonalisation or flashback during body work.
- Stop the exercise and do the reprise: move the arms, breathe, open the eyes.
- Sit the client up and orient them: name the room, feel the feet, look at objects.
- Lower the intensity next time.
- Depersonalisation, derealisation and psychosis are named contraindications to breath-based dynamic relaxation [source: Guiose 2003]. Screen for dissociation before relaxation with the eyes closed.
- With unstabilised trauma, start with eyes-open, grounding and movement work, and refer for trauma-focused care where indicated. [synthesis]
Sensory overload or defensiveness (autism, polyhandicap). Responses from Kloeckner et al. (2009):
- Reduce the stimulus and let the client control its intensity.
- Approach from the side.
- Use loose clothing to reduce unpredictable contact.
- Give a stable support (floor, cabin, rolled-up posture).
- A stimulus that alerts without leading to orientation is too strong.
Refusal of touch, or doubtful consent.
- Always offer the no-touch version: your naming only, the client's own hand, or an object.
- Consent from children and dependent adults must be ongoing and shown in behaviour: stiffening, turning away or going quiet means stop, even if the client said yes.
- Never insist. Record it in the notes. [synthesis]
Eroticised transference, or the client "eroticising" the treatment. Named as a classic contraindication and a reason some clients avoid ending treatment [source: Guiose 2003]. Responses [synthesis]:
- Stop or reduce touch at once.
- Re-state the frame and boundaries clearly and kindly.
- Take it to supervision.
- Consider referring on.
- Never continue touch in that context.
Secondary gain, or the symptom serves a function. Named as a contraindication [source: Guiose 2003]. Explore the gain with the client, or with the family and team, before or instead of relaxation. [synthesis]
Not practising at home (Schultz, Jacobson, graphomotor work).
- Shorten the practice to 1–2 minutes.
- Link it to a daily cue such as bedtime or before homework.
- For children, involve a parent, as the graphomotor source does [source: Cheynel, secondary].
- Explore what practising means to the client: compliance, control, being "sent away" with a task.
- Remember that in the French model, weekly sessions do much of the work. [synthesis]
The child is agitated, giggles or can't stay lying down (Bergès, Wintrebert).
- Expect this in the first sessions.
- Keep the ritual and repeat the instructions; Bergès repeats the concentration instruction three times [source: Guiose 2003].
- Start with passive mobilisation, or use a sitting position.
- Treat restlessness as material for the talk afterwards. [synthesis]
The client is stuck, or progress has plateaued.
- Re-run the relevant parts of the bilan [source: SFETD on regular reassessment].
- Check whether the mediation still interests the client, and adapt it to their preferences [source: Onconormandie slides].
- Check whether the goal is too far in one step, and lower it to one variable.
- Check whether the problem is mainly emotional or relational rather than motor, and if so shift toward expressive mediation or refer.
- Discuss with the prescriber and team. [synthesis]
Resistance in play: opposition, chaos, destroying the materials.
- Hold the frame with fixed rituals and a few clear rules (safety, no hurting, materials stay in the room).
- Treat opposition as tonic-emotional communication: name the tone you see.
- Offer a form that contains the energy (rhythm, pushing against a big cushion, a circuit).
- End the session predictably. [synthesis]
Ruptures: missed sessions, anger at the therapist, a parent withdrawing the child.
- Name the rupture and explore it.
- Keep the frame steady.
- Meet parents regularly; the frame includes guidance and support for the family [source: Onconormandie slides].
- Feed changes back to the prescriber. [synthesis]
Medical red flags during treatment (new pain, fainting, breathlessness, seizures, deterioration).
- Stop the body work and refer back to the prescriber.
- Hyperventilation-based work is contraindicated in epilepsy and cardiovascular disorders [source: Guiose 2003].
- Never present psychomotor work as treatment for cancer or any physical disease. In oncology and pain it is supportive care for the experience of the body. [synthesis]
Suicidality or self-harm comes up.
- Pause the body work.
- Do a standard risk assessment: ideation, intent, plan, history, protective factors.
- Do safety planning, including lethal-means counselling (safe storage or removal).
- Contact the prescriber or crisis team according to local protocol.
- Resume relaxation or touch only once the client is stabilised. [synthesis]
Requests for packing or restrictive wrapping (team, institution). Decline. Offer dry, freely escapable containing experiences (4.18). Point to the HAS/ANESM 2012 position [uncertain: check the current text]. [synthesis]
Scope creep (teaching written language, psychotherapy beyond training).
- Graphomotor work is in scope; written language is not [source: Decree 1988].
- Refer psychological issues outside your remit; the graphotherapy source also confines itself to the writing gesture [source: Cheynel, secondary]. [synthesis]
Ending.
- Prepare it several sessions ahead.
- Reassess against the bilan.
- Move practice into daily life, using Jacobson's differential relaxation and Wintrebert's final stage [source: Guiose 2003].
- Watch for the eroticised or dependent attachment that delays ending [source: Guiose 2003]. [synthesis]

Sources

Sources:

Tried but not readable (blocked or unparseable): Érudit, Les psychothérapies de relaxation (Santé mentale au Québec, 1978); DUMAS psychomotricity theses; the Giselle Soubiran encyclopaedia page; a Santé Mentale PDF on relaxation.