Adolescence, a recent category peculiar to the West, tends to disunite puberty as a universal physiological event. It is not so much the disappearance of rites that is in play here, as the extenuation of the bond of solidarity between the phenomenon of puberty and the social designation – and treatment – of adolescence. Using the example of self-harming practices in adolescence, I would like to hypothesize an increase in acts/symptoms is fed by this separation and tends, paradoxically, to reduce it – i.e., reassert a social and private recognition of identity of the forms of otherness engaged by puberty – and at the same reject these same forms of otherness.
François and his father, sharing a first name, form a duo with paranoiac functioning. With the onset of puberty, this system broke down. François was treated in a day hospital. The institutional psychoanalytic psychotherapy offers necessary flexibility, especially salutary opportunities to adapt the treatment setting. This work carried out as a team helped to develop a particular approach to this family.
This article is a reflection on the institutional treatment of adolescents, but essentially on the place of adults who are involved in it. My practice as a therapist with adolescents in an institution has served as the basis for it; but it is mainly the difficulties that we have encountered with one of the adolescents that have given rise to this initial work. Indeed, this adolescent, with his set of problems, brought out institutional flaws that have to do with the difficulties encountered by social workers in their practice and to their own position within the institution. What do they do within the institution, and what place to they hold in relation to these young people ? The question had barely been raised when it began to create worry and even some aggressiveness. Indeed, it is often a matter of « straightening out » or « correcting » of deviant behavior after an overwhelming demand that the medical-psychological corps « abrade » the symptoms because « you’re not the one who has to deal with them all day ».This response, which is supposed to be swift and thorough, is also one held by politicians in the field of mental health and it is what led us to undertake this work.
The aim of this article is to offer some thoughts about the place of the pharmacological prescription within the framework of the institutional treatment of children and adolescents who present severe psychological disorders. Far from being a simply technical approach, prescribing medication to an adolescent within an institution corresponds to the construction of a transitional space which is the fruit of the encounter between the adolescent and the staff. The action of the psychotropic drugs must be inscribed in the overall psychical economy of the subject, taking into account the relationship between medication and the question of dependence and the inevitable issues of mastery and control that this engenders in adolescence, which are amplified by the institutional setting. Lastly, it is important to emphasize that this problematic must not be seen as confined to the specific institution which receives the adolescent, but applies more widely to the different institutions and referents which deal with the adolescent in the perspective of a multi-focus treatment among institutions and a longitudinal and parallel conception of treatment.
On the one hand, institutions for adolescents accept all sorts of demands; on the other hand, the extension of delinquency has the effect of socializing crime. Consequently, the therapist may accept situations at the crossroads where the penal, the clinical and the social meet, as in the case of a young criminal we received. There is a jarring of usual clinical practice, as the practitioner must be able to cope with the possibility of recidivism. We give an account of the clinical perspective adopted in this case, one which emphasized fantasy rather than drives, and which seemed to us a more honest way of accepting our social responsibility. Adolescence, 2013, 30, 4, 945-956.
Since June 2007, a medical-psychological staff (UCSA-SMPR) has been practicing in the juvenile penitentiary of the Rhône-Alpes region. A psychiatrist and a psychologist propose to review this experience as a way of investigating temporal aspects of treatment and the issues specific to this institutional setting. What are the goals of treatment ? How should we conceive of the care-providers’ position within an incarcerating structure, where treatment is supposed to be an « auxiliary » to a repressive disciplinary system ? How can we enable an elaboration of the subject’s and the institution’s acts ? These reflections are at the heart of a practice wherein professional identity is often mishandled. Adolescence, 2013, 30, 4, 869-879.
The confinement of minors is the starkest image of punishment, and for minors the most damaging in terms of mental health, development and recidivism. Can modifications undertaken in penal institutions for minors reduce the affiliating and stigmatizing effects of incarceration ? Do the educative detention centers that have been constructed offer a favorable outlook for a pedagogical undertaking ? Can this be envisioned without taking into consideration the psychical dimension of the anti-social act ? We will examine these questions in this article after an examination of the supposed etiology of delinquency. Adolescence, 2013, 30, 4, 783-796.
The arrival of the « Maisons des Adolescents » in an already well provided-for landscape of places providing support and care brings us to rethink the way that we cater to adolescents’ clinical needs. The orientation of an adolescent to a specific care facility is never easy. Some « Maisons des Adolescents » have decided that the reception would be carried out by social workers who facilitate the transference both onto the institution and onto its members. The clinical meeting, a highlight in the Maisons des Adolescents’ organization, enables all of the team members to start working with the teenagers. The Clinical meeting also allows for an original clinical experience together with the social workers.
Psychoanalytical psychopathology sheds light on the technique of packing. But recent neurophysiological, developmental, psychopathological and institutional studies have come together to enable this treatment practice to construct a psychotherapeutic setting for autistic and psychotic children and adolescents, as long as this is part of a complex institutional structure that takes into account all aspects necessary to the care of the patient in question. The vehement attacks of its detractors are put into perspective by the good clinical results it produces, about which a program of clinical research will issue a report in the coming months.
Il est classique de dire que le travail psychique que doit accomplir l’adolescent est un travail de séparation en particulier avec les objets de l’enfance. Il semble plus juste en fait de parler d’un ajustement des liens entre parents et adolescent. Ceux-ci doivent être ni trop lâches pour éviter le sentiment d’abandon, ni trop serrés pour ne pas empêcher l’individu de se construire un espace psychique propre. Un temps institutionnel dans lequel chacun, adolescent comme parent, pourra trouver sa place peut aider à trouver cette bonne distance. La mise en place d’un groupe de parents en même temps qu’une mise en institution pour l’adolescent permettent de travailler sur cet ajustement des liens.
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