The Obligation of Care in France

Between Legal Constraint and Therapeutic Transformation

By a Clinical Psychologist

In France, the obligation of care is a legal measure that requires an individual to undergo medical or psychological treatment, often as part of a judicial decision. This mandate, outlined in Article 132-45 of the Penal Code, can be imposed before or after a trial and applies to various conditions, particularly psychiatric disorders or addictions.

But what does this obligation represent for the therapist welcoming such a patient into their private practice, often due to the lack of available institutional placements? And more importantly, can someone truly be treated if they are forced to be there?

Statistics and Context

In 2023, healthcare spending in France reached €325 billion, with a notable increase in outpatient care. However, psychiatric institutions are struggling to meet the growing demand, leaving many patients under an obligation of care to turn to private practitioners. These patients often arrive with a phrase heavy with meaning: “I’m obliged to be here.”

The Ethical and Therapeutic Challenge

The obligation of care raises a fundamental question: can someone truly heal if they are not there by choice? The answer lies in the art of transforming this constraint into an opportunity. The therapist must welcome the patient without judgment, acknowledging the obligation while creating a space for dialogue. The goal is to evolve the obligation into a felt need, and ultimately into an active request for care.

The philosopher Emmanuel Levinas, in his ethics of responsibility, reminds us that welcoming another should be done without preconditions, respecting their individuality. This approach is mirrored in clinical practice: it is about deciphering what the obligation reveals about the patient—their resistances as well as their unspoken needs.

From Obligation to Need: A Pathway

One of the challenges of mental health conditions is that the individual often does not perceive themselves as being unwell. The law may enforce treatment, not for their benefit, but for the impact it could have on others. The therapist’s role is to refocus care on the patient, addressing their own need for healing.

Take, for instance, the case of actor Robert Downey Jr., who was mandated by the courts to undergo treatment for his addictions. This initially imposed pathway eventually became a personal journey of rehabilitation, demonstrating how obligation can be transformed into a process of self-betterment.

Legal and Ethical Considerations

The obligation of care brings forth complex issues:

• Respect for Individual Freedom: A mandated medical intervention can be perceived as an infringement on fundamental rights.
• Collective Responsibility: The measure aims to protect society, but the therapist must ensure the patient is not reduced to merely a “case to be managed.”
• sProfessional Confidentiality: Practitioners often find themselves navigating between judicial requirements and the medical confidentiality owed to the patient.

Conclusion: The Art of Therapy Under Constraint

Transforming an obligation into a voluntary process is both a challenge and an opportunity. By welcoming the patient with compassion and working on the meaning of this constraint, therapists can help them progress toward an authentic request for care. As Carl Rogers once said, “The curious paradox is that when I accept myself just as I am, then I can change.”

Thus, the obligation of care, far from being an obstacle, can become a lever to uncover a deeply buried need. This is the art of therapy: turning constraint into openness, and obligation into suggestion.

Sources:

1. Code pénal français, Article 132-45. (Dernière mise à jour 2023). Législation sur l’obligation de soins en France.
2. Levinas, E. (1961). Totality and Infinity: An Essay on Exteriority (A. Lingis, Trans.). Pittsburgh, PA: Duquesne University Press.
3. Levinas, E. (1974). Otherwise than Being or Beyond Essence (A. Lingis, Trans.). Pittsburgh, PA: Duquesne University Press.
4. Rogers, C. R. (1961). On Becoming a Person: A Therapist’s View of Psychotherapy. Boston, MA: Houghton Mifflin.
5. Aron, E. N. (1996). The Highly Sensitive Person: How to Thrive When the World Overwhelms You. New York, NY: Broadway Books.
6. Americans with Disabilities Act (ADA). (1990). Federal Law to Protect Individuals with Disabilities.
7. Mental Health Parity and Addiction Equity Act (MHPAEA). (2008). U.S. Legislation on Mental Health and Addiction Coverage.