An account of some moments from the treatment of an adolescent girl shows how figures of aggression follow the vicissitudes of a “sexual” whose changing forms are explored here, particularly in their reorganization between childhood and adolescence. Transference gives rise to games and traps which summon the analyst to be present in a variety of ways. While the patient wants to play the adult by identifying with the aggressor, very often it is the child she was who is demanding to be heard.
Gender incongruity in the adolescent is currently drowned out by all the questions that have arisen about gender dysphoria in general. Psychoanalytical studies on this topic are rare. Therefore, after a brief presentation of current work on gender incongruity in the adolescent, the author will investigate the psychodynamic aspects of this phenomenon using excerpts from consultations and psychoanalytic reflections on gender and adolescence.
The article reflects on the specific ways of caring for adolescents who have committed acts of sexual violence and are in court-ordered treatment. Such treatments and the paradoxical forms of subjective expression they entail require us to re-think our settings and our conceptual tools in order to construct a therapeutic environment. The cases we present show how our thinking comes to resonate with feelings of breakdown, annihilation, and the possibility of leading these patients to work through psychic experiences.
The treatment starts when the adolescent or young adult patient appropriates the therapeutic demand and formulates for himself a need to understand. This means leaving a narcissistic register that has been defensively foregrounded in the elements of discourse, which masks the suffering and the symptom. The addition to the initial psychotherapeutic setting of a monthly psychodrama session helped the object transference to manifest itself.
The word “ contract ” in the title gives one to understand that there is a clear prior agreement, or at least a mutually accepted restriction; in other words, it suggests something definitive and under control. Attaching the qualifier “ treatment ” to it opens the way to the notion of therapeutic process with all that it connotes of psychical movement towards a future subject to ambivalence, to the pairing of idealization and de-idealization, to the contingent. The working process that has been engaged offers a therapeutic setting at once spatial and temporal which creates the conditions for the emergence of a transitional space. There is a fool’s bargain when the immediate normative aim takes precedence : – treatment by medicine alone- imposture of effective symptomatic treatment without any work of elaboration (which can lead to relapses and defensive psychical readjustments that allow the problem to evolve quietly with increasing risk) ; verification ; openness in information.
The authors of this article study the implications of thinking of the psychoanalytical treatment as an adolescent process and investigate the link between this process, the political and the therapeutic arrangement. Their reflection is based on two clinical situations around the Id (in the Freudian sense), identification and the ideal are intertwined. The text first tries to show that adolescence is a relevant model for conceiving of the treatment. It then relates adolescence to the political showing that both share a certain kind of relationship with utopia, adolescence characterizing the potential flexibility between Id, identification and ideal. In conclusion, the case of Irma presents an investigation into the analyst’s place between the political, adolescence and treatment which, between repression and the demand for satisfaction, calls into question the edifice of the ideal.
The authors, all three of whom are involved in caring for adolescents in war zones as part of Doctors Without Borders, describe the traumatic semiology with reference to two parameters allowing for much variability: age and cultural context. They show the complexity of the semiology by means of a clinical history. Lastly, they analyze some parameters that must be established in order to recognize and treat the impact of trauma on these adolescents who are in pain, tragically hopeless and who sometimes conceal their suffering behind the mask of the hero, of violence and of transgression.
In an epidemiological study within a general school population, 450 youngsters in public secondary school who describe themselves as runaways were compared to 11,734 youngsters who had not run away from home.
Running away from home is associated with “ psychical malaise ” and with violence, both endured and enacted; the runaway is suicide-prone, violent, delinquent ; he abuses both legal and illegal substances. The runaway seeks help and consultation, and it is necessary to find multi-focus treatments when faced with the diversity of manifestations : running away, suicide attempts, delinquency, and legal and illegal substance abuse.
The session and its continuum in everyday life must of course be considered as a third-party relation; in it, « two people looking at each other » are brought together and compromised under the same «other» gaze ; a group is formed, trust (and illusion) shared… The lighthouse, initially unknown (a stranger), inspires exchanges that are more and more familiar: talking replaces being looked at. Thanks to this third-party construction, the interactions that define the site can henceforth be interpreted or « reconstructed ».
Adolescence puts the course of early development back into play and works towards the expansion of the psychical apparatus. At puberty, the adolescent is called to provided himself and others with a stable narration (though it may be reworked) of his history and his childhood. The elaboration of puberty entails complex and difficult psychical work, and exposes one to the organization of a psychopathology.
In the borderline adolescent especially, the needs of evolution activate anxiety and conflict in a significant way. The conflict is born of traumatic cores from the past which, on the one hand, generate the fear of re-living fragmentation and, on the other hand, the expectation of the inevitable and continual actualization of the traumatic experience.
The analyst then is responding to the adolescent’s difficult process of becoming aware of himself (his difficulty in making his affective states legible for himself and others) as well as to his perception of not having enough « auto » psychical processus (empty and chaotic feeling of self) through a lengthy self-analytical work. This is the start of knowing and transforming the therapeutic relation which is continually at risk of shutting itself up in confused unity and an endless mirroring function.
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