Objective. - This article offers a reflection on the foundations, principles, modalities, and limits of the uses of video games in psychoanalytically inspired psychotherapy. Method. - We begin with a review of the literature concerning the use of video games within psychoanalytic-oriented therapeutic settings in France. Then, we recall the foundations and guiding principles of the psychodynamic approach to therapeutic mediation developed by the Lyon School. Finally, we provide an analysis of the publications consulted. This allows us to identify the foundations, principles, modalities, and limits of digital mediations and to discuss the parallels and divergences with the model of therapeutic mediation. Results. - Digital mediation is presented with a demonstrative, even didactic style. The presentation of the video game occupies a significant place, while the setting and methodology are presented in varying ways. The clinical material, sometimes dense and brought in late, is used for informational or illustrative purposes or to confirm a point of view, which is not conducive to analysis and discussion. With rare exceptions, there is no counter-argument and self-criticisms are sparse. The video game is presented as an object of speech and a support for the projection of psychic life facilitating the expression of unconscious conflicts, but also as a cultural object, close to the younger generations, which would make it an appropriate object for therapy. In mediation, it is thought of as a pretext for a therapeutic encounter and as a solution to the therapeutic impasse. The publications refer to the writings of Anglo-Saxon psychoanalysts, to those of Anzieu, as well as to the contributions of cognitive psychology and developmental psychology. The video game is then thought of as an object that can contain, transform, and integrate anxiety, legitimizing the expression of the life drive without risk of reprisals. It is a support for pluralistic symbolization, a vector of learning and subjectification through action, the use and reflective properties of which reveal the patient's skills and resources. Digital mediations are techniques aimed at helping the patient to mentalize their conflicts and traumas, to restore their ability to play, to renarcissize them, to restore self-esteem or to support their capacity to be alone in the presence of another. They operate by updating the experiences of mother-baby sharing and attunement. There is a transference on the therapist, by diffraction if it is a group, but also on the video game, or on digital figures, in particular the avatar that the player controls. In therapeutic mediation, the video game would be an accelerator of the transferential relationship. Discussion. - The style, the important place allocated to the video game compared to the methodology, the way of using the clinical material and the absence of counter-argumentation contribute to an apparently psychoanalytic approach as well as to a certain imprecision, which does not allow for a discussion of the specificities, the limits, and the gray areas of digital mediations. The use of video games is justified by their status as a cultural object and as a pretext for encounters rather than by the adequacy between their materiality and the patient's problematic. Besides the pitfall consisting in over-investing verbalization and group dynamics to the detriment of the materiality of the object, the question of the therapist's desire and the meaning of this mediation arises. We find common references with the model of therapeutic mediation. However, we identify a risk of fetishization of the game model as well as the pitfall of focusing on the sensorimotor and the properties of the mediating object, to the detriment of intersubjective issues. The reference to Anzieu's work in digital mediation invites several comments. It can lead to a metonymic shift, making the screen an equivalent of the skin. In addition, this theorization can mask the absence of thinking about the issues underlying the video game experience. The practices reported reveal a certain variability and points of divergence with the model of therapeutic mediation, in particular through the focus on objectives and on the way of thinking the setting, but also with certain borrowings from non-psychoanalytic models. This raises questions about the effects of these choices, the positioning of the therapist, and the absence of consensual evaluation methods. We notice a tendency to reduce the transference to what is played out on the screen, in particular with the avatar, which raises the question of a possible marginalization of the intersubjective relationship and of certain forms of negativity, just like pre-figurative elements which constitute the primary forms of symbolization. In addition, the negative transference is very little discussed and not analyzed. Finally, the acceleration of the transferential relationship recalls the problematic of hypnosis with a temporary bypassing of the defenses before their recovery after the video game. Countertransference is hardly mentioned, much less its bodily manifestations. Several elements could constitute indications of countertransference, but they are mostly neither identified, nor analyzed, nor discussed. Except in a few writings, the analysis of the transfero-countertransference dynamic remains very succinct. These elements invite us to question the differences with the model of therapeutic mediation. Conclusion. - The literature review reveals a diversity in practices, which leads us to discuss the relevance of the therapeutic mediation model for this analytical work. We suggest several points that would increase interest in the psychodynamic approach to therapeutic mediation through video games. First, the setting and methodology could be presented in more detail. Then, the initiative of such therapeutic mediation would gain in quality if the authors specified how they reflected on the link between the patient's problem and the materiality of the mediating object. Finally, the reference to psychoanalysis implies that the clinician's work focuses more on the transfero-countertransferential dynamic, rather than on the presentation of the software and the narration of what is happening on the screen. (C) 2020 Elsevier Masson SAS. All rights reserved.
