This article recounts the first experience of group treatment of parents of adolescents suffering from mental anorexia at the Maison des Adolescents of Calvados. The authors have chosen a faithful retranscription of productive moments from the sessions close to clinical work, emphasizing the experience of counter-transference.
Adolescence, 2014, 32, 3, 503-510.
The psychopathological context of anorexia nervosa in the adolescent brings to the forefront the consideration of the body both in its effective reality and its representations. Some body image disorders can thus be described and conceived of as different forms of symptomatic solutions through which the anorexic adolescent can try to shore up poorly established and sometimes quite fragile narcissistic foundations. The therapy must therefore take this dimension into account in order to resolve such problems. Psychoanalytical psychodrama, applied to a cohort of patients afflicted with these disorders will serve here as a methodological support, highlighting the elements of this problematic. This paper will also discuss the therapeutic effects of using this technique from various angles (analysis of corporal components of the counter-transference, dynamic of touch, use of the double and of corporal figurations).
Adolescence, T. 31 n°1, pp. 65-76.
Using the individual psychotherapeutic treatment of a thirteen year-old patient, Clementine<i></i>, we will explore the possible repercussions of a sisterly bond that is too strong, and how it may sometimes prove a hindrance to the separation/individuation process. Carried to an extreme in the fantasy of twinship, it leads to an Ego with vague contours, and the pursuit of a relation that may be harmful to a subject with fragile narcissism. There is lack of differentiation between bodies and psyches. Anorexia will burst this specular bubble when only one of the subjects reaches physiological puberty. Clinical interviews in the space for physical and psychic separation the hospital setting provides shed light on the issues and the limits of the establishment of subjectivation work.
Adolescence, T. 31 n°1, pp. 27-36.
The weight contract in hospital treatment of mental anorexia, first inscribes in the heads of the patient and her family the disavowal of concern for somatic reality and its outcome, at risk of grave complications. Then it quickly becomes clear that the question is not the fantasized one of « force feeding » through a medical technique that will make her fat, but that of the process of becoming a woman, hampered by the girl who actively and willingly aborts her adolescent process. This symbolic effect of the contract has effects on the body and thought processes of the patient, allowing for revision of identifications. The constraint experienced in the therapeutic act is always much less than the violence of primitive relations of the subject of the ego with its archaic superego and aims to ease the interior constraints at the origin of food restriction and weight loss. « External » persecution opposes an internal dictator … the conflict is displaced onto the relation with the treatment (which figures the conflicts with the parents) and allows for the emergence of new possibilities of representation. The conflict is human again and for a while disavowal, splitting and projection will occur, as defenses, before the encounter within the conflict becomes possible, an encounter which protects the patient’s narcissism (she is not humiliated by asking for help, the bond having been imposed upon her). This encounter allows for an exploration of the patient’s deep desires, and her degree of resistance in disavowal or the veneer of conformism. It is this dialectic of desire and resistance which allows a diagnosis to be made in economic terms since, fundamentally, it is desire that builds alienation. The contract is a technical artifice, which provokes a separation situation deeply feared by both the patient and her family, and which reveals the complexity (nature, intensity, ambivalence) of parent-child bonds and the fantasies they have generated. It allows us to study the central issue of separation: procrastination about the weight at the moment of separation and the weight at the moment of leaving the hospital, fetishism of a certain weight, reactivation of separation issues when the patient is discharged from the institution. Adopting the language of the symptom and placing it within the framework of the weight contract, the psychiatrist can then deploy his offer of living treatment within the psychotherapeutic space.
The author considers that the difficulties the adolescent girl encounters on her way to becoming a woman are grave symptomatic manifestations of a process of becoming a woman which may be common to all female children. The future anorexic would already be established when a little girl, a system of false-self which reaches a crisis point at puberty. Anorexia, a counter-evolutionary process which entails a risk of psychical and physical death, is a form of psychopathology that also masks an unconscious desire for emancipation and subjectivation.
Adolescence, 2008, T. 26, n°4, pp. 959-975.
There is a tendency in the systemic psychiatry of mental states to consider periods of sadness or persistent discouragement in the adolescent, or even just morose states, as signs of pathology. Following the theories of D. W. Winnicott, E. Gut, P. Fédida and Ph. Gutton, we develop the dynamic viewpoint according to which the depressive movement that is inherent to mental life plays a part in the regulation of psychical life. Set in motion by loss or abandonment, it fosters the redistribution of investments, a veritable « re-affectation ». The depressed adolescent subject needs to be accompanied, not immediately treated. Although the outcome of adolescent depressiveness is usually favorable, we will examine some possible harmful outcomes, calling depression in such cases « unproductive », « death depression » or « depression of unbinding ». Two emblematic pathological figures, mental anorexia in the young girl and addictive conducts, are seen as resistances to depressiveness, which is nonetheless a key part of a process of integration. These illustrate, following the example of the dismantling of thought in psychotic depressions – desperately expressed in artistic productions – the essential role that the body plays as a constituent and a means of psychical life.
revue Adolescence, 2011, T. 29 n°4, pp. 737-745.