Enjeu politique et économique, l’insertion professionnelle des personnes atteintes dans leur santé mentale est également un facteur important de rétablissement. Le programme RESSORT (réseau de soutien et d’orientation vers le travail), basé sur le modèle IPS (individual placement and support), propose un accompagnement de ces patients vers leur projet d’accès à l’emploi ou à la formation. La confrontation à la réalité du marché de travail met en lumière les limitations fonctionnelles, c’est-à-dire les symptômes faisant obstacle à l’insertion. Cet article présente l’application, à trois cas cliniques, de techniques de la thérapie cognitive et comportementale dans des suivis d’insertion professionnelle. Le premier rapporte la situation d’un patient souffrant d’anxiété sociale caractérisée par des conduites d’évitement et pour lequel l’objectif professionnel a fait office de levier en favorisant l’engagement dans la confrontation à des situations anxiogènes. Le deuxième cas illustre un travail sur l’organisation et la planification pour pallier au manque de régularité et à l’absentéisme professionnel. Le dernier cas présente la régulation des symptômes anxieux, par des techniques respiratoires et des jeux de rôles, dans la situation d’un entretien d’embauche. L’utilisation de techniques de la thérapie cognitive et comportementale apparaît faisable et utile dans le contexte de la réinsertion professionnelle et leur usage devrait être développé.

The employment of people with mental health problems is a political and economic issue as well as an important factor in the recovery process (WHO, 2001). In Lausanne, RESSORT (Réseau de Soutien et d’Orientation vers le travail) helps people with mental illness to find a competitive employment or to accomplish their educational project without prior skill training in sheltered work. The Place Then Train approach is the cornerstone of the IPS program (individual placement and support) (Drake et al., 1996), which has been proved to be the most efficient vocational method to help people with severe psychiatric problems finding a job (Latimer et al., 2006). Based on the IPS program and by the direct confrontation with the labour market reality, RESSORT promotes the arising of the patients’ functional disabilities that is the symptoms or psychological barriers to employment. By means of three clinical cases, this article presents the application of cognitive behavioural therapy tools in the management of these functional limitations. The first case reports about a patient affected by social anxiety, characterized by significant avoidance behaviours. His professional ambitions pushed him to face the feared situations and also the exposure process. While contributing to the favourable evolution of the anxious symptomatology and patient autonomy, the project mobilization influenced the perception as well as the actual dimension of the difficulties. The achievement of the professional goal is now contemplated as incidental to the commitment in a psychotherapy process. The second case focuses on the lack of consistency of a patient affected by dissociative disorder. Three factors were identified as the main causes: difficulty in establishing priorities, organisational problems and somatisations. Unable to schedule her objectives, this patient tried to carry out all of them simultaneously, with consequent exhaustion and sudden interruption of any activities. The prioritisation of her goals helped her to postpone some of them and thus to promote a more functional rhythm. Concerning the organizational problem, a daily planning was made, providing concrete landmarks and improving the timetable management. Because of the somatisation problems, this patient consulted in an emergency service. Putting in perspective these somatisations as barriers to employment, encouraged the patient to follow a long-term treatment with a general doctor. The last case focuses on the management of the anxiety symptoms arising particularly during job interviews. Face-to-face with an employer, the patient found it difficult to express herself, becoming occasionally mute. Relaxation and respiration techniques were taught and practiced in role playing and imaginative exposure sessions. The symptoms decrease during job interviews promoted her functional improvement in this specific context. The presentation of these three clinical cases provides an overview of the use of CBT tools in employment support. This picture is not exhaustive; many CBT interventions might be used. These studies demonstrate the continuity between professional and personal lives, with which the functional abilities are mutually supplied. Furthermore, the direct observation of the clinical symptoms within a professional setting offers a new pragmatic overview of these problems and can occasionally promote the psychotherapy engagement. In conclusion, the application of CBT interventions to employment support seems to be feasible, useful and highlights the necessity of additional development. Further studies are needed to validate this use.