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Guide VIII-182

Médiations thérapeutiques and analytic creative expression

Anne Brun, René Roussillon, Bernard ChouvierLyon, France
A 37 · L 32 · M 3119 interventions in the Trinity explorer
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[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the Lyon psychoanalytic school of médiations thérapeutiques (CRPPC, Université Lumière Lyon 2) as set out by Anne Brun (2010 book on childhood psychosis; 2015 article; 2018 Santé Mentale papers; 2026 preface), drawing on René Roussillon's médium malléable and Bernard Chouvier's work on the mediating object. A French medical thesis (Villermaux, 2018) fills gaps on group format. All translations from French are my own. [source: Brun 2015; Brun 2018a, 2018b; Jung, Guénoun & Mitsopoulou-Sonta 2026; Villermaux 2018]

What it is. Médiations thérapeutiques is an umbrella term, not a single therapy. It covers individual or group care in which a medium (paint, clay, water, tales, writing, music, dance, games, photographs and many others) is placed between patient and clinician. The French psychoanalytic tradition uses it mainly for patients with limited access to verbal symbolisation: psychotic and autistic children, people who act out violently, and people with psychosomatic or borderline presentations. In the preface to a 2026 handbook, Brun calls mediations a preferred tool for care of "cliniques réputées difficiles" (difficult clinical presentations), widely used in child and adolescent institutions. [source: Jung et al. 2026, preface pp. 9–10; Brun 2010 publisher description]

"Analytic" versus "creative" devices. Brun separates two kinds of device:

  • Dispositifs à création: open creative workshops that do not work with transference and may be run by non-psychologists.
  • Dispositifs thérapeutiques à médiation: settings built on psychoanalytic psychotherapy, in which the clinician interprets the underlying psychic dynamics. Brun says these must be run or supervised by psychology professionals.

This guide covers the second kind. For Jean Broustra's creative-expression workshops, see guide 019 (Creative-expression workshops); for Photolangage, see guide 028. [source: Brun 2015 pp. 239–240; Jung et al. 2026, preface p. 12]

How change happens. The medium is not therapeutic in itself: Brun writes "L'objet médiateur n'est donc pas thérapeutique en soi" (the mediating object is therefore not therapeutic in itself). Change comes from the frame and the transference.

  • Following Marion Milner, the clinician presents and stands for a malleable medium. Roussillon developed this into the concept of an object that "symbolise la symbolisation" (symbolises symbolisation).
  • Early, unsymbolised experience (Brun cites Winnicott's primitive agonies) is re-lived in sensorimotor form with the medium. Through the clinician's echoing, doubling and interpretation, it is given form and becomes symbolisation primaire, Roussillon's move from perception to a sensory thing-presentation. Only later does it reach words.
  • In groups, transference is spread across members, clinicians, medium and setting. Brun follows René Kaës's "diffraction" here.

[source: Brun 2015 pp. 236–242; Brun 2018b; Jung et al. 2026 preface pp. 10–13]

Professional frame.

  • In the sources, therapeutic mediation devices are run by psychotherapists or psychologists, or supervised by them, and the therapeutic (interpretive) version should not be run without psychoanalytic clinical training and supervision. [source: Brun 2015 p. 240; Villermaux 2018 p. 7]
  • In France, training is offered as continuing education (for example, Lyon 2's short courses on mediation devices and its 153-hour DU Animateur de groupe thérapeutique ou d'accompagnement for health, education and social-care professionals). [source: Lyon 2 catalogue 2025; Lyon 2 DU page]
  • No source states that a protected French credential exists for "médiation thérapeutique" as such. Do not assume one exists. [uncertain]
  • Outside France, a psychotherapist who uses arts media in this way should not present it as art, drama or music therapy unless registered for that (in the UK, HCPC with BAAT, BADth or BAMT). [synthesis]

2. Framework

The sources give no manualised phase sequence or fixed session count. The framework below combines the device features the authors describe with a process sequence from Brun's case material. [source: Brun 2015; Villermaux 2018; Jung et al. 2026]

2.1 Device (dispositif) choices

  • Individual or group. Both are described. One example is Brun's individual painting workshop in a day hospital, run by a staff member with weekly supervision. Groups are the most common format. [source: Brun 2015 p. 243; Brun 2010]
  • Closed, semi-open or open.
    • Therapeutic groups are closed or semi-open, so that the group's unconscious fantasy can be worked with. [source: Brun 2015 p. 240]
    • Closed groups show group phenomena most clearly. Open groups suit activities centred on the medium.
    • A semi-open group can start before it is full and take in new members when places free up. [source: Villermaux 2018 pp. 16–17]
  • Composition. Members should be similar enough in age and pathology to identify with one another, but different enough for each to feel distinct. [source: Villermaux 2018 p. 17]
  • Duration. Either an announced end (often the school year), which lets separation be worked through, or open-ended. Closed open-ended groups produce the most group phenomena. [source: Villermaux 2018 p. 18]
  • Staffing. Co-therapy is common. In an institution, a referent clinician usually sits outside the group, and supervision comes from someone outside the group (or outside the institution). [source: Villermaux 2018 pp. 20–22]
  • Frequency and session length. Not given in the sources. Weekly sessions within an institutional care plan are the usual French practice the sources imply, but treat this as [uncertain].
  • Privacy. Productions stay within the group; they are not exhibited. [source: Brun 2015 p. 240]

2.2 Process stages (from Brun's clinical sequence, not a manual)

These stages are a reading of Brun's case of Tom (painting, autism/psychosis), which draws on Geneviève Haag, Melanie Klein and Roussillon. Use them as markers of process, not as a protocol. [source: Brun 2015 pp. 241–246]

  1. Sensorimotor engagement and adhesion.
    • The patient merges with the medium in a mirroring relation to it.
    • Sensations are relived as if hallucinated: piercing, tearing or wiping out the sheet.
    • Goal: the frame survives and the clinician receives and echoes what is done.
  2. Building a ground.
    • A "fond" (background) forms on the sheet, first as a rhythm ("premier fond rythmique", first rhythmic ground), and the patient gradually detaches from it.
    • Goal: a container for representation.
  3. Figuration. Forms appear against the ground. Turning passive into active is often the first form of symbolisation. Goal: primary symbolisation.
  4. Reflexivity and the depressive position. The patient recognises their own productions and links them to what they lived through and to the relationship. Goal: secondary, verbally mediated symbolisation.

Moving on. The sources give no formal criteria for moving between stages or for ending. Watch for signs of a shift:

  • repeated destruction gives way to marks the patient keeps;
  • a ground or rhythm is reused across sessions;
  • the patient addresses the clinician through the production;
  • words begin to accompany the gesture.

[synthesis based on Brun 2015]

2.3 Evaluation

  • Brun argues for qualitative clinical evaluation of mediation devices, using tables whose criteria are specific to each device.
  • Domains:
    • verbal and above all sensorimotor-affective associativity;
    • mimo-gestural and postural language;
    • forms of transference;
    • the material of the medium;
    • the physical setting;
    • the clinicians;
    • the group.
  • Her 2010 book has an appendix with benchmarks for assessing painting in childhood psychosis.
  • The tables and the appendix are not drawn on, so no items are given here. [source: Brun 2018a; Brun 2010 publisher description] [uncertain on content]

3. Guiding principles

  • The medium is not the treatment. Practical meaning: never expect paint or clay alone to heal. Set up a frame, a transferential reading and supervision. [source: Brun 2015 p. 237; Jung et al. 2026 p. 11]
  • The clinician stands for the medium (Milner). Practical meaning: how you present, prepare and look after the material is part of the relationship. [source: Brun 2015 p. 237; Jung et al. 2026 p. 10]
  • Malleability. Roussillon lists properties of the malleable medium: graspable, easily reachable, immediately available, animable, receptive, indestructible, indefinitely transformable, extremely sensitive, constant, predictable, faithful, enduring. Practical meaning: choose and handle materials, and your own presence, so they can be used, attacked and transformed without collapsing or retaliating. [source: Brun 2018b; Villermaux 2018 pp. 10–11]
  • Sensorimotricity is a route to symbolisation. Brun treats "la sensori-motricité comme un vecteur de symbolisation" (sensorimotricity as a vector of symbolisation). Practical meaning: treat gestures, rhythms and the order of use as communications, not as a run-up to the "real" product. [source: Brun 2015 p. 237]
  • Process over product. Brun warns that clinicians too often focus on the final production. Practical meaning: observe and note the whole sequence of actions, not just the finished picture. [source: Jung et al. 2026 pp. 12–13]
  • An adapted fundamental rule. Free association is extended to action with the medium (inspired by Haag). Practical meaning: invite spontaneity in using the material, not just in speech. [source: Brun 2015 pp. 237–238]
  • Let yourself be used. "Les thérapeutes se laissent utiliser par les enfants" (the therapists let themselves be used by the children). Practical meaning: do not ask for a representation and do not routinely make your own work. Be available as an object. [source: Brun 2015 p. 238]
  • Self-effacement and holding the frame.
    • Take an attitude of self-effacement and reflect back spontaneous, creative gestures (Winnicott).
    • Be invested in the medium without performing as an expert, so that you do not push the group to conform.
    • Keep the frame's invariants while staying open to surprise.
    • [source: Villermaux 2018 pp. 18–19, 41–42]
  • Transference onto the medium is transference onto the frame. Practical meaning: the patient's way of treating the material, the room and the routines brings back early object relations. Read these as transference. [source: Brun 2015 pp. 239–240]
  • Diffraction. In groups, transference is spread across members, clinicians and setting (Kaës). Practical meaning: co-therapists pool what each of them received in their post-session discussion. [source: Brun 2015 p. 240; Villermaux 2018 pp. 22, 30]
  • Containment, not restraint. Too little containment lets disorganising excitement in. Too much turns into restraint and blocks creativity, and Chouvier warns against using mediators defensively. Practical meaning: adjust rules and structure to each group, and check whether the medium has become a way to keep patients quiet. [source: Villermaux 2018 pp. 30, 35]
  • Interpretation belongs to the therapeutic device. Creative workshops do not interpret. Therapeutic mediation groups do interpret the underlying psychic dynamics. Practical meaning: decide in advance which device you are running, and say so to the team and to patients. [source: Jung et al. 2026 p. 12; Brun 2015 p. 239]
  • Supervision is part of the device.
    • A post-session discussion between clinicians and supervision help process countertransference.
    • Without supervision, the group drifts into routine and loses meaning.
    • [source: Villermaux 2018 pp. 20–21; Brun 2015 p. 243]

4. Intervention inventory

The sources describe clinical operations, not scripted exercises. Each entry below is either an operation the authors describe or a device-building task they require. Steps written in concrete detail are my own operationalisation and are tagged [synthesis] where the source does not give the step. All example language is illustrative unless quoted.

4.1 Choosing the device: creative workshop or therapeutic mediation

  • Purpose: decide whether you are offering a creative space without interpretation or a psychoanalytically framed therapeutic device, because this decides staffing, interpretation and supervision. [source: Brun 2015 pp. 239–240; Jung et al. 2026 p. 12]
  • Steps:
    1. Write a short device project: target patients, aims, and whether transference will be worked with.
    2. If it is therapeutic, make sure a psychologist or psychotherapist runs or supervises it.
    3. Choose closed or semi-open.
    4. Set the composition rule (similar enough, different enough).
    5. Decide on an announced end date or an open-ended course.
    6. Name the co-therapists, the referent outside the group and the supervisor.
    7. Tell the institutional team, since the device sits inside a wider care plan.
    • [source: Villermaux 2018 pp. 16–22; steps 1 and 7 synthesis]
  • Example language (illustrative, to the team): "This is a closed painting group for six months. We will work with what the children do with the paint and with us, so we will not show the pictures outside the group."
  • Watch for: a device that has slid into neither, for example an "activity" that staff interpret informally without a frame or supervision. [synthesis]

4.2 Choosing the medium

  • Purpose: match the medium to the patient's level of symbolisation and tolerance for contact. [source: Villermaux 2018 pp. 8, 13–15]
  • Steps:
    1. Assess age, developmental stage, access to language and sensory capacities.
    2. Assess the capacity to be alone in the presence of another (Winnicott) and to regulate excitement.
    3. Check the medium against Roussillon's malleability properties.
    4. Avoid a medium that demands constant relating if contact feels intrusive to the patient.
    5. Avoid enforced solitary moments (for example relaxation) if aloneness feels like abandonment.
    6. Prefer side-by-side activity for adolescents who need control over distance.
    • [source: Villermaux 2018 pp. 12–15, 35–36; Brun 2018b]
  • Range in current use:
    • painting, modelling and clay, water play, tales;
    • writing workshops, music and analytic music therapy, dance;
    • photolangage and photo-collage (see guide 028);
    • video games and role-playing games, equine mediation, Snoezelen multisensory rooms, olfactory-gustatory mediation, climbing and walking groups.
    • [source: Brun 2010 description; Lyon 2 colloquium programme 2025; Jung et al. 2026 contents]
  • Example language (illustrative, to a colleague): "He can't bear being looked at directly. Paint at a shared table, side by side, may let him come close without being asked to."
  • Watch for: choosing the medium for staff interest or convenience. Chouvier distinguishes created objects from found objects; found objects can act as embrayeurs d'imaginaire (triggers of imagination). [source: Villermaux 2018 p. 11]

4.3 Presenting the medium and the adapted fundamental rule

  • Purpose: set up the frame and invite free association in action. [source: Brun 2015 pp. 237–238]
  • Steps:
    1. Prepare the materials the same way every session, so the medium is constant and predictable.
    2. At the first session, present the materials and the rules: time, place, privacy of productions, and the safety limits (no hurting people, no damage to the room).
    3. State the adapted rule: patients may say or do whatever they like with the materials.
    4. With children, link it to what goes on in their heads.
    5. Do not set a theme or ask for a representation.
    • [source: Brun 2015 p. 238; steps 1, 2 and the safety limits are synthesis]
  • Example language: Brun quotes the adult rule as "Soyez aussi spontané que possible" (be as spontaneous as possible). Illustrative child version: "Here you can do what you like with the paint, and say what's happening in your head."
  • Watch for: patients waiting for instructions or asking what to draw. Treat this as material, and do not hand out a theme. [synthesis]

4.4 Letting yourself be used, and self-effacement

  • Purpose: be available as an object and a malleable medium. [source: Brun 2015 p. 238; Villermaux 2018 p. 41]
  • Steps:
    1. Sit near the patients at their level.
    2. Do not produce your own work, apart from occasional purposeful exceptions (see 4.9).
    3. Accept being used: handed things, ignored, made into a container, or given a role.
    4. Survive attacks on you and the materials without retaliating or collapsing (Winnicott, cited by Brun).
    • [source: Brun 2015 pp. 238, 245]
  • Example language (illustrative): "You want me to hold the pot while you pour. I'm holding it."
  • Watch for:
    • your own urge to make the session productive or attractive;
    • envy of or rivalry with patients' productions;
    • becoming the group scapegoat, which Villermaux says the therapist should accept when needed (pp. 18–19, 27).

4.5 Observing the process and sensorimotor associativity

  • Purpose: read the non-verbal associative chain: gestures, the order in which materials are used, rhythms, deformations of the medium. [source: Brun 2015 p. 236; Jung et al. 2026 p. 13]
  • Steps:
    1. During the session, follow gestures, postures, the sequence of actions and changes to the material, not just the end product.
    2. Afterwards, write process notes in sequence.
    3. Look across sessions for repetitions and transformations: piercing, tearing, wiping out, building a ground, figuration.
    4. Use Brun's evaluation domains as headings (Section 2.3).
    • [source: Brun 2015 pp. 236, 241–244; Brun 2018a; step 2 format synthesis]
  • Example language (illustrative, in notes): "Covered the sheet with water, then pressed until it tore; looked at me; repeated."
  • Watch for: sliding into aesthetic judgement or diagnostic reading. Do not treat paintings as evidence of abuse or disorder (Section 5.6).

4.6 Echoing (échoisage)

  • Purpose: turn a bodily act into a message by sending it back. [source: Brun 2015 p. 244]
  • Steps:
    1. Notice a repeated gesture, sound or rhythm.
    2. Send it back in your voice, a gesture or a matched rhythm, without adding content.
    3. Watch whether the patient repeats it, varies it or turns toward you.
    • [source: Brun 2015 p. 244; steps synthesis]
  • Example language: Brun: "Le message corporel ne devient paradoxalement un message que s'il est échoisé" (the bodily message becomes a message only once it is echoed). Illustrative: matching the patient's brush taps with a soft "tap… tap… tap".
  • Watch for: the patient showing awareness that you received it (pausing, looking, varying the rhythm). Stop if echoing feels intrusive or mocking to the patient. [synthesis]

4.7 Doubling gestures and restoring the mirror function

  • Purpose: offer a double that reflects the patient, restoring the first mirror function (Roussillon, cited by Brun). [source: Brun 2015 p. 248]
  • Steps:
    1. In tale or play work, mirror a child's gesture or posture so the child can see themselves in it.
    2. Then introduce a small variation.
    • [source: Brun 2015 p. 248; step 2 synthesis]
  • Example language (illustrative): "You made the wolf open its mouth wide, like this." (doing the same gesture)
  • Watch for: confusion if doubling is too exact with patients whose self-other boundaries are fragile. Brun describes a mirroring, undifferentiated relation between the child and the medium, following Castoriadis-Aulagnier (p. 241). [synthesis on the risk]

4.8 Transposing across sensory modalities (attunement)

  • Purpose: carry an experience from one sense into another (for example a visual rhythm into a vocal one) to help integrate sensations. Brun cites Meltzer and Stern, and the 2026 preface lists accordages (attunements), shared affect, theatricalisation and sensorimotor dialogue among the clinician's tools. [source: Brun 2015 p. 248; Jung et al. 2026 p. 15]
  • Steps:
    1. Pick up the intensity, rhythm or shape of what the patient does.
    2. Render it in another modality: voice, movement or a word.
    • [source: Brun 2015 p. 248; steps synthesis]
  • Example language (illustrative): while a child smears in long sweeps, the clinician says a long, rising "whoooosh".
  • Watch for: with autistic children, Brun aims to restore sensory integration and counter démantèlement (dismantling) (p. 248). Look for the child staying with two senses at once.

4.9 Concrete interpretation through the clinician's own production

  • Purpose: in some groups (Brun's example is writing groups), a clinician writes or makes something alongside the group. The piece offers the group a figuration of what is going on: "une interprétation concrète, une figuration destinée au groupe" (a concrete interpretation, a figuration meant for the group). [source: Brun 2015 pp. 238–239]
  • Steps:
    1. Only after discussion with the co-therapist, write a short piece in the same exercise as the group.
    2. Give it form around the shared fantasy you think is active in the group.
    3. Read it out or share it without explaining it.
    4. Discuss the group's response in the post-session discussion.
    • [source: Brun 2015 p. 239; steps synthesis]
  • Example language (illustrative): a clinician's short text about a house where everyone waits for a door that will not open, read in a group preoccupied with an announced ending.
  • Watch for: the clinician's piece overshadowing members' work, or a covert lecture. Use it rarely. In painting groups with children, Brun's default is not to paint alongside them (p. 238).

4.10 Working with transference onto the medium and the frame

  • Purpose: read how the patient treats the material, the room and the routines as transference revived from early object relations. [source: Brun 2015 pp. 239–240]
  • Steps:
    1. Note the patient's relation to the material: avoidance, greed, attack, merging, care.
    2. Note their relation to the frame: arriving, leaving, tidying up, keeping or destroying productions.
    3. Link these, first in your own mind and in supervision, to the transference onto you.
    4. Interpret in the session only once the link is clear and the patient can use it. With children who have little symbolic capacity, often interpret through the medium itself rather than in words.
    • [source: Brun 2015 pp. 239–240; step 4 synthesis]
  • Example language (illustrative): "Every week the clay gets squeezed until nothing is left of it, and then you check that it's still in the box next time."
  • Watch for: sensory features of the medium (tactile, visual, smell) shaping the transference. The 2026 preface stresses this (p. 12).

4.11 Working with diffraction of the transference in groups

  • Purpose: gather transferences spread across members, co-therapists, medium and setting (Kaës). Brun adds a "diffraction sensorielle" (sensory diffraction). [source: Brun 2015 p. 240; Villermaux 2018 p. 30]
  • Steps:
    1. After each session, each co-therapist says what they were made to feel or do and by whom.
    2. Note which part of the setting or medium carried which affect.
    3. Build a picture of the group's shared unconscious fantasy.
    4. Bring it to supervision.
    • [source: Villermaux 2018 pp. 20–22; steps synthesis]
  • Example language (illustrative, post-session discussion): "You got all the anger today; I got the clinging. The water tap got the rest."
  • Watch for: co-therapists splitting into a "good" and a "bad" object without noticing. [synthesis]

4.12 Receiving destructiveness and surviving

  • Purpose: let destructive use of the medium (piercing, tearing, wiping out) become primary symbolisation. Brun reads these acts as relived sensations and cites Winnicott on the difference between destructive fantasy and the real bond. [source: Brun 2015 pp. 241–245]
  • Steps:
    1. Supply enough material so that it can be destroyed and replaced. Indestructibility here means the material can be replaced.
    2. Do not punish or rescue.
    3. Describe or echo what happens.
    4. Keep the same frame at the next session.
    5. Draw a firm line only at harm to people, or real damage the frame cannot absorb.
    • [source: Brun 2015 pp. 241–245; Brun 2018b; step 5 synthesis]
  • Example language (illustrative): "The paper broke again. There's more paper. We're both still here."
  • Watch for: destruction becoming patterned, rhythmic or kept, which signals a move to a ground (4.13). Rising, disorganised excitement calls for more containment (5.3).

4.13 Supporting the move from ground to figuration (painting)

  • Purpose: help a patient move from adhering to the medium, to building a rhythmic ground, to figuration and reflexivity (Brun's Tom sequence). [source: Brun 2015 pp. 242–246]
  • Steps:
    1. Recognise and name early grounds: a covered sheet, rhythmic marks.
    2. Keep the productions in a personal folder so that the ground persists between sessions.
    3. Echo emerging forms.
    4. When figures appear, invite the patient to say what they are and what is happening, without pressing.
    5. Later, help the patient look back over the series.
    • [source: Brun 2015 pp. 242–246; steps 2 and 5 synthesis]
  • Example language (illustrative): "There's a whole blue floor now. Something is standing on it."
  • Watch for: the patient recognising earlier works as their own and linking them to experiences. This marks movement toward the depressive position in Brun's (Kleinian) reading.

4.14 The tale (conte) group

  • Purpose: use tales to supply primary sensorimotor forms of symbolisation. Role-play of the tale lets destructiveness be transformed. [source: Brun 2015 pp. 246–249, citing Brun 2012]
  • Steps:
    1. Choose a traditional tale whose themes fit the group.
    2. Tell it with the same wording over several sessions.
    3. Let the children take roles and play scenes.
    4. Clinicians double gestures (4.7) and transpose across senses (4.8).
    5. Close with a short time to talk.
    • [source: Brun 2015 pp. 246–248; steps 1, 2 and 5 synthesis]
  • Example language (illustrative): "Today the wolf wants to be played by you. Who will be the little goat behind the door?"
  • Watch for: a child stuck in one role, especially the destroyer or the destroyed. Offer a role switch. In a 2025 colloquium, a tale group was presented in a prison service with violent long-sentence patients, which shows the method also reaches adults. [source: Lyon 2 colloquium programme 2025]

4.15 Reflecting surprise and the creative gesture

  • Purpose: support Winnicott's creative gesture by reflecting back surprising or unexpected uses of the medium. [source: Villermaux 2018 pp. 41–42]
  • Steps:
    1. Avoid rigid instructions.
    2. When someone uses the medium in an unforeseen way, notice it aloud without judging it.
    3. Keep the invariants of the frame.
    4. Do not reuse activity formats from elsewhere by rote.
    • [source: Villermaux 2018 p. 41]
  • Example language (illustrative): "You've used the brush handle to scratch. That makes a different line."
  • Watch for: novelty-seeking by the clinicians themselves. Surprise should come from patients.

4.16 Relaunching early games

  • Purpose: Roussillon proposes relaunching typical early-childhood games that could not be played, for example presence and absence, or appearing and disappearing. [source: Jung et al. 2026 preface p. 15]
  • Steps:
    1. Spot a game the patient seems to start: hiding a mark, covering and uncovering, throwing and retrieving.
    2. Join it as partner without taking it over.
    3. Repeat it as long as the patient wants.
    • [source: Jung et al. 2026 p. 15; steps synthesis]
  • Example language (illustrative): "Gone… and it's back."
  • Watch for: the game developing variation, or the patient taking the active role (turning passive into active). [source: Brun 2015 p. 241]

4.17 Verbal time and interpretation of group dynamics

  • Purpose: in therapeutic (not creative) devices, put into words the conscious and unconscious meanings revealed through production. [source: Brun 2015 p. 240; Jung et al. 2026 p. 12]
  • Steps:
    1. Set aside time, usually at the end, for each person to speak about what they did or felt. The sources do not specify this time, so treat it as [uncertain] standard practice.
    2. Clinicians link individual productions to the group process.
    3. Interpret at the level of the group's shared fantasy rather than exposing one member.
    • [synthesis drawing on Brun 2015 p. 240]
  • Example language (illustrative): "Today everyone built walls around their picture. Maybe since we said the group ends in June, it feels safer to keep things in."
  • Watch for: patients without words. For them the interpretation can stay in the medium and in action (4.6–4.8).

4.18 Post-session discussion (temps de reprise) and supervision

  • Purpose: process countertransference and keep the device alive. [source: Villermaux 2018 pp. 20–21; Brun 2015 p. 243]
  • Steps:
    1. Right after each session, co-therapists spend dedicated time together: sequence notes, felt experience, diffraction (4.11).
    2. Hold regular supervision with someone outside the group. In Brun's day-hospital case it was weekly.
    3. Report to the institutional referent.
    • [source: Villermaux 2018 pp. 20–22; Brun 2015 p. 243]
  • Example language (illustrative): "What did today's session do to us?"
  • Watch for: skipped discussions, which lead to routine, drift and burnout. [source: Villermaux 2018 p. 21]

4.19 Ending the group

  • Purpose: use an announced end to work through separation. [source: Villermaux 2018 p. 18]
  • Steps:
    1. Announce the end date at the start.
    2. Remind the group of it a few sessions before.
    3. Decide in advance, with the patients, what happens to the productions: kept by the patient, kept by the institution, or destroyed.
    4. Look back over the series with each patient.
    • [source: Villermaux 2018 p. 18; steps 2–4 synthesis]
  • Example language (illustrative): "Three sessions left. We could look at your folder together and choose what goes home with you."
  • Watch for: regression, absences or destructiveness near the end. Read these as separation material.

5. Handling problems

The sources deal with these difficulties mainly through the frame, containment and supervision. Concrete responses beyond that are my own synthesis and are tagged.

5.1 A stuck device: routine, emptiness, "just an activity"

  • Signs: the same productions every week, clinicians bored, sessions running on autopilot.
  • What the sources say: without supervision the group drifts into routine and loses meaning. [source: Villermaux 2018 p. 21]
  • Responses:
    • Reinstate the post-session discussion.
    • Bring the sequence notes to supervision.
    • Ask whether the medium is serving as restraint rather than containment. [source: Villermaux 2018 p. 35]
    • Check whether the device is creative or therapeutic in practice (4.1).
    • Consider whether the composition no longer allows identification. [synthesis]

5.2 Refusal, withdrawal, not touching the material

  • What the sources say: a medium that demands constant relating can feel intrusive, and enforced aloneness can feel abandoning. [source: Villermaux 2018 p. 13]
  • Responses:
    • Allow simply being present beside the material.
    • Keep the material on offer every session (unconditional availability).
    • Echo the smallest gestures.
    • Offer side-by-side positions rather than face-to-face. [source: Villermaux 2018 pp. 35–36]
    • Do not coax with themes or praise.
    • If refusal persists over several sessions, review the indication and the medium with the referent. [synthesis]
  • Example language (illustrative): "You can watch today. The paint will be here next week too."

5.3 Overwhelm, disorganising excitement, acting out

  • What the sources say: too little containment lets disorganising excitement in. [source: Villermaux 2018 p. 30] Mediations may reactivate primitive agonies (Winnicott). [source: Brun 2015 p. 241; Jung et al. 2026 p. 13]
  • Responses: [synthesis]
    • Reduce the amount of stimulating material: fewer colours, less water, smaller amounts of clay.
    • Slow the rhythm and put actions into words.
    • Lend a calmer co-therapist presence.
    • If someone is at risk of harm, pause the activity and give one clear limit; keep the frame and the next session.
    • Afterwards, think it through in the post-session discussion and in supervision rather than excluding the patient on the spot.
    • If excitement repeatedly overwhelms the group, consider a smaller group, an individual mediated setting (as in Brun's day-hospital case) or a less sensorially intense medium.

5.4 Destruction of others' work, conflict within the group

  • Responses: [synthesis]
    • Protect each person's production, with personal folders and separate spaces.
    • Destroying your own work is acceptable material (4.12). Destroying someone else's crosses a frame limit, which you name calmly.
    • Interpret at group level what the attack may carry, for example envy or an imminent separation.
    • Repair practically (new material) without forcing an apology ritual.

5.5 Ruptures with the clinicians, and splitting between co-therapists

  • What the sources say: therapists accept being the group's scapegoat when needed, and supervision processes countertransference. [source: Villermaux 2018 pp. 18–21, 27]
  • Responses:
    • Use diffraction (4.11): each co-therapist reports what they received.
    • Treat persistent "good therapist and bad therapist" splits as material for supervision before acting on them.
    • Repair openly with the patient when the clinician really did fail, for example by changing the room or forgetting the materials. [synthesis]

5.6 Reading productions as diagnostic evidence

  • What the sources say:
    • Brun reads productions in their process and transference, within a psychoanalytic frame.
    • Her published evaluation is qualitative and specific to each device, aimed at care processes rather than diagnosis. [source: Brun 2018a; Brun 2015]
  • Responses:
    • Never present a painting, model, tale enactment or game as evidence of abuse, trauma or a specific disorder.
    • In reports, describe the process and the relationship, not hidden content.
    • The sources report no validity or reliability data for using these productions diagnostically. [synthesis; uncertain on any validation data]

5.7 Children and young people: safeguarding, consent, parents

  • Responses: [synthesis]
    • Consent and assent. Before a child joins, get consent from parents or carers and assent from the child, explained at the child's level.
    • Explaining privacy. Explain to parents why productions stay in the group (a frame principle per Brun 2015 p. 240) and what feedback they will get, which is process-level only.
    • Safeguarding comes first. Privacy of productions never overrides safeguarding. If a child discloses harm in words, play or a tale, or if what you see raises concern, follow your local safeguarding and mandatory-reporting procedures straight away and record verbatim what the child said. Do not use the medium to question the child or to look for evidence.
    • Age-appropriate adaptation. Villermaux notes that children tend to put the adult in a parental position, while adolescents organise against the adult and look for peer relations. Plan adolescent groups with more peer focus and side-by-side positions. [source: Villermaux 2018 pp. 31–32, 36]
    • Parent work. Run parallel parent work through the institutional referent rather than inside the group. [synthesis]

5.8 Materials and physical safety

The sources do not address this. All of the following is synthesis.

  • Paints and modelling materials:
    • Use non-toxic materials labelled for children.
    • Remember that young or very regressed patients may mouth or eat them.
    • Avoid solvent-based products and aerosols.
  • Clay:
    • Clean up wet: wipe surfaces and do not sweep dry clay, which raises dust.
    • Store clay damp.
    • Ask about latex or other allergies if you use gloves or certain materials.
  • Water play:
    • Mop up spills straight away to prevent slips.
    • Use warm (not hot) water.
    • Change the water between sessions.
    • Keep electrical equipment away from it.
  • Sharp and other risky items:
    • Use round-ended scissors.
    • Count tools in and out with patients at risk of self-harm or violence.
    • Avoid cutters and glass.
  • Food in olfactory-gustatory mediation:
    • Check allergies, swallowing safety and dietary rules first.
    • Follow food-hygiene rules.
  • Movement, climbing, walking, equine work:
    • These need staff trained in that activity, a risk assessment and the institution's insurance.
    • Do not improvise them.
  • Music and video media:
    • Keep volume moderate.
    • Watch for sensory overload in autistic patients.

Touch. Doubling gestures (4.7) and body-based media bring physical closeness. Ask before any contact, keep it to hands or the shared material, offer a no-contact way of doubling (mirroring at a distance), accept a refusal at once, take cultural and trauma histories into account, and never use sexual or genital touch. [synthesis]

5.9 Problems specific to the modality

  • The clinician over-invests the medium or performs as an expert. This pushes the group to conform. Step back and invest in the medium without displaying your skill. [source: Villermaux 2018 pp. 18–19]
  • Focusing only on the end product. Go back to sequence notes (4.5). [source: Jung et al. 2026 pp. 12–13]
  • Confusing creative and therapeutic devices. Interpreting in a workshop set up as non-interpretive breaks the contract with patients. Stay within the device you announced, or redesign it with the team. [synthesis based on Brun 2015 p. 239]
  • Running the method without the required training. Using the interpretive version without psychoanalytic training and supervision falls outside what the sources describe. Run a creative workshop instead, or work under supervision. [source: Brun 2015 p. 240]
  • Adult and forensic groups. Tale and other mediations with adults who act out violently are presented in the Lyon network. Plan for extra safety measures and for coordination with the prison service or ward. [source: Lyon 2 colloquium programme 2025; safety measures synthesis]

Sources

Sources:

Further reading (not drawn on directly):

  • Brun, A., Chouvier, B. & Roussillon, R. Manuel des médiations thérapeutiques. Dunod. The title appears on the Dunod page; edition and year were not verified. [uncertain]
  • Chouvier, B. et al. (2002). Matière à symbolisation, as cited in Brun 2015. [uncertain]
  • Milner, M. (1955); Roussillon, R. (2001, 2008); Kaës, R. (1976); Haag, G. (1995); Winnicott, D. W.; Castoriadis-Aulagnier, P. (1975); Brun, A. (2012) on the tale. All are cited via Brun 2015 and are not drawn on.

Related guides: 019 Creative-expression workshops (Broustra); 028 Photolangage.

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