Using the term “openness” the author will focus his reflection (illustrated by two clinical vignettes) on the conditions that can foster the engagement of older adolescent patients in psychotherapeutic work. To protect against the fear of submission on the one hand, and the fear of loss of identity on the other, the analyst’s overture to a certain measure of flexibility concerning the setting, while maintaining his neutrality, helps establish of useful distance, both for the analyst and the patient.
This article presents the beginnings of the treatment of an adolescent who has experienced early trauma. The disconuity reestablished from the very start of treatment by repeated absences will bring the analyst face to face with the primary object relations. Constant disruption of, or even attacks on, the setting will have to be constructed around the patient’s psychic possibilities.
The beginnings of adolescent treatments must take into account how difficult it is for them to invest in speech directed at the analyst, and the perpetual crisis state they are living in when they cannot rely on personal corporal representations and when no internal conflict organization has been able to form. The two-stage clinical history of a long treatment through therapeutic consultations illustrates this double process.
The Center for Psychoanalysis of ASM 13 is part of a district psychiatric facility specialized in non-neurotic pathologies. This particularity has caused it to develop distinct treatment techniques and to elaborate certain theoretical concepts (transference investment, third party, interpretation of function or process…) that take into account the necessity of adapting the psychoanalytic approach when using it with this type of patient.
The beginnings of adolescent and young adult treatments are tested by transference feelings that are highly mobilized from the outset. Drive excitation and ambivalence characterize the analytical situation and the resistances reinforced by the fear of betraying primal love objects. The treatment of a twenty-three years old obsessive man, examined in the light of the Rat Man case, supports this hypothesis.
Adolescence, 2017, 35, 1, 9-20.
Revue semestrielle de psychanalyse, psychopathologie et sciences humaines, indexée AERES au listing PsycINFO publiée avec le concours du Centre National du Livre et de l’Université de Paris Diderot Paris 7