Actualisation de la notion de psychoses infantiles dans un dispositif psychothérapique : la place de la honte dans le transfert avec l’enfant aux portes de l’adolescence

Abstract

Aims

We examine the alienating and structuring aspects of shame in a psychotherapeutic setting. The aim is to determine its place in the construction of identity from the latency phase through puberty where psychotic movements are present.

Method

We will base our study on the case of Augustin, a ten-year-old whose presentation suggested a form of psychosis, with social withdrawal, psychomotor agitation, social communication disorders, and behavioral problems. We were able to see him for three years in a medical and psychological center for children. We describe the development of symptoms, the family configuration, and the main stages of his treatment. We sketch out the main features of this case, interpreting the particularities of Augustin's contact and his destructive movements as relating to a struggle against psychic invasion by an alienating family logic.

Results

This clinical work led us to identify psychotic manifestations that surpass a simple and exclusive structural distinction. We were able to highlight the family component in the psychopathological expression of Augustin's case, based on the father's paranoid logic. The specific relationship with language is revealed as an instrument of the transferential logic that allows a form of subjectivation of the risk of psychic invasion by shame.

Discussion

The clinical picture required us to move away from the DSM's logic of piling up diagnoses in order to shed light on psychic functioning, revisiting the notion of psychotic disorders in children and adolescents so as not to confine Augustin's case to a single trajectory. It was necessary to avoid the temptation to read into the family configuration the ‘causes’ of the child's disorders, rather than some of their coordinates. By working on the child's experiences and the malleable medium, the individual therapeutic mediations we implemented enabled us to co-construct a therapeutic space that facilitated access to play by taking into account the development of the affect of shame in the transferential relationship.

Conclusion

The aim of the psychotherapeutic process was to create a space that could accommodate the destructive movements of the object and thus offer the possibility of symbolizing the destructive and invasive elements of the family scene, and the fragilities of the ego specific to the psychotic movements in place. On the basis of an analysis of these elements, the psychotherapeutic work enabled the sensations of contamination and invasion of the psyche to be recaptured in order to construct a form of psychic containment that prevented movements of confusion between the self and the other. Augustin's case illustrates the symptomatic modulations specific to psychotic elements, highlighting the fragility of contact in the psychic construction of children and adolescents.