From the personal experience of the author, the several outcomes of psychoanalytic treatments at adolescence (from the breakdown to the working-through of their termination) are here examined with reference to the specificity of their criteria and modalities according to that age.
Rather than authentic ends of treatments, what is to be elaborated is the liability of giving the experience of treatment the quality of a good-enough experience within a difference accepted by both partners. Thus the possibility of a return, however uncertain it may be, towards a time and place which the youth will have made his.
The specificity of psychodrama as compared to other kinds of treatment is here questioned and mainly with regards to difficult adolescents. The author shows how the method being original in terms of setting, intervention technique and interpretation and their effects on transference has a major impact and therapeutic efficiency on those adolescents who wouldnÕt use the traditional approach. On top of that, psychodrama appears to be a very useful clinical and metapsychological tool.
The author suggests a detailed analysis of how to set up a true group analytic psychotherapy setting both as far as the preparation and selection of its members, its composition and its first session. Numerous examples are here called forth to illustrate the internal dynamics of the group and the impact of exterior influences.
After having described the specific evolution gone through by both the adolescent and his family, the author presents the choice of the setting for the family therapy. The original approach of an ÇÊintegrated therapyÊÈ is here offered to adolescents with very serious clinical disturbances, associating both individual treatment and family- or couple-treatment.
Resting on the uniqueness of the psychoanalytic process, the author presents the multifold modalities of cure liable to be used with the psychotherapy of adolescents. He analyzes the several implications towards a therapeutic action of the new discoveries on the development of the new born, and on attachment, as well as in the field of neurosciences.
Besides, the author insists on the assessment phase and the best adaptated indications as well as the goals mainly centered on the rehandling of self-reorganization processes through a research on the psychological representations.
The authors claim that psychoanalysis is the best treatment for severely ill adolescents. Their approach is centered on the developmental breakdown having taken place after puberty transformations leading to a pathological state. Such a breakdown prevents the adolescent from integrating gradually the sexually mature body in his psychological reality, thus conditioning a breakdown in his relationship to reality. These adolescents behave in a defensive psychotic behaviour without its being a true and definite psychosis. The developmental breakdown were to be re-lived along the analysis in the form of a ÇÊtransference breakdownÊÈ offered to severely ill adolescents.
Several modalities of the psychoanalytic treatment of adolescents exist, yet it necessary to be aware of both their limitations and advantages in order to orientate young patients in the best way possible.
The orientation rests on the assessment of the psychological functioning, it follows a goal that should be reached by means of the chosen treatment (traditional cure, individual psychotherapy, group or family therapy, psychodrama). Such are the general principles adopted by the author in his paper.
Lacan never isolated adolescence as a concept as such.
Only for the past few years did some of his followers start some new pondering over the metapsychological status of adolescence. The creation of the Institute of Psychoanalysis of Adolescence, i.e. ÇÊLe BachelierÊÈ, evidences their demands for a theoretical approach of adolescence and for the necessary training of such analysts.
Both differences and resemblances between FreudÕs and KleinÕs theories on infantile sexuality will here illustrate the vision their followers have on adolescence.
Even if theoretical positions diverge, they may become richer for a better understanding of adolescent processes and their pathologies. The author here gives an example of such a situation by quoting the importance of Moses and Eglé LauferÕs theoretical points of views on the breakdown and experience of bodily transformations at adolescence and of those of the post-KleiniansÕ about the projective and introjective identification processes and the analysis of unconscious fantasies dealing with introjected objects.
In order to answer such a question, the author wishes to ponder over the evolution of the specificities of both children and adolescents in the past fifteen years in the Western countries and in France in particular. She concludes in stressing a progressive wiping out of the several specificities of the latency period, of puberty and of the second period of adolescence. Such a conclusion is loaded with consequences since it questions in a totally new approach the whole erection of repression and biphasism of post-Oedipian identifications as they were described by Freud.
From the point of view of the present training of the psychoanalyst roughly speaking, she suggests that the pattern of child psychoanalysis should remain the princeps pattern, thus being followed by adolescent psychoanalysis without opposing the one to the other in any other way but the very psychological structures of the subjects to which such patterns are meant to refer.
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