La psychothérapie psychanalytique des psychoses selon Gaetano Benedetti : illustrations au travers de quelques situations cliniques

Abstract

Objective

The psychotherapy of psychotic patients is the subject of much debate and discussion, with two underlying factors: firstly, the fear of making situations worse rather than better, and secondly, the need to flush out the underlying ideologies likely to aggravate the implicit discrimination of patients under the mask of benevolence, which in reality is rejectionist. Roughly speaking, there are three main approaches: containment of jouissance, which allows the patient to elaborate (with the risk of psychic sclerosis); cognitive remediation, with the risk of ideological normalization; and finally immersion in the psychotic world (with the risk of propping up delirium and the suffering it brings about). In this paper, I will discuss this third possibility, drawing on the thinking of Gaetano Benedetti, and consequently on a psychoanalytical basis. It is neither a question of proselytizing Benedetti's thought, nor of ostracizing other approaches.

Method

The main principles of Benedetti's thinking will be taken up again, at the same time as I propose clinical illustrations from my own practice. A brief reminder of the difference between psychoanalysis and psychotherapy will be offered, as well as the impossibility of psychoanalysis with a psychotic patient, which is why my title refers to “psychoanalytic psychotherapy”.

Result

It appears that Benedetti's theses, and the praxis that follows from them, do not concern all psychotic patients or all psychoanalysts; they require a kind of special nature that Freud was already talking about in his day. The crucial point is, on the one hand, “positivization” (considering that the delusional patient is telling the truth because it is his reality). The other aspect concerns an attitude of “partial identification”, i.e. identifying with the patient in her psychosis and working in solidarity with her on the basis of his truth.

Discussion

Psychoanalytic psychotherapy of psychotic patients using (partial) identification can be an interesting way of gaining access to the patient's most intimate psychopathological mechanisms, in order to offer help as an architect rather than an archaeologist (in Freud's sense of the typical cure).

Conclusion

Benedetti has devised a way of approaching psychosis that may prove useful in a number of cases, while putting the possibility of success into perspective. Success results in the construction of an undecidable structure combining unconscious elements of the patient and others of the analyst as a result of identification effects causing a form of unconscious hybridization.