The admission of Clementine to an institutional setting followed a state of intense undernutrition that led to her hospitalization in the pediatrics unit. The nine months during which Clementine was fed via a feeding tube and confined to her room are reminiscent of the length of a pregnancy; and the feeding tube echoes the umbilical cord, keeping her alive through a psychic holding strongly invested by the nursing team. This period of care serves as a “second, non-forgotten pregnancy”, a restoration of the first one. At the beginning of the therapeutic follow-up in the unit, the main questioning of the young girl revolves around her family framework, mainly when she talks about her childhood memories on the farm where she grew up, surrounded by a family within which she felt misunderstood, because deemed too young and immature to have her own ideas and opinions. We have already written that in the rural world, “actual physical closeness leads to a psychic closeness and a psychic apparatus that differentiates itself with difficulty, barely able to create something individual, remaining a whole in which the “one” can hardly appear. Some [adolescents] use defense mechanisms of varying degrees of strictness to free themselves from this influence, whereas others remain dependent on the family group without being able to differentiate themselves, subjectivate or access the external world”[
20]. Clementine seems to have mixed feelings about the prospect of growing up, and the revitalization of debt and dependency issues becomes important: “When you’re a child, as soon as you need something, your parents take care of giving it to you; when you grow up, you have to go and ask for things, and find a way of getting them yourself.” For Clementine, adolescent empowerment brings insecurity, as it becomes dangerous to rely on a fallible parental or adult base. During only a few months of follow-up, an emergence of the pubertal can be detected in the new questions posed by the young girl, mainly related to her objectal relationships. Within the unit, Clementine distinguishes between her family relationships and the relationships with the care team: “They are here to help me, not to love me”. In this way, she erases, through denial, her desire to be loved as well as the inherent abandonment risk she experienced so painfully in the past. The constraints imposed by her health, which confine her, at the beginning of her hospitalization, to isolation in her room, force solitude upon her, which she complains about. In a constant search for relationships to substitute for her family framework, Clementine explains she always had difficulties making friends: “I always felt different from the other people of my age. We don’t have the same interests. I wouldn’t say I’m gifted but… well, I certainly feel more mature than they are. Whenever adolescents know each other, they begin to know things and to say things, and I don’t like it too much. Some of them can get you in deep water”. The investment of her relationships to others demonstrates a fear of otherness
h that denotes a fundamental difficulty “to open up to oneself and to the other without losing oneself” ([
9], p. 39), which in this case originates from the experience of family and sisterly indifferentiation. Nevertheless, identification with the other adolescents in the care unit is possible, thus favoring a feeling of belonging to a group: “We are all here because we have problems”. Clementine’s relationships with the group, especially with the girls, who are “referent-reference” figures[
8], allow her to integrate quickly, but also to support some changes denoting femininity (haircut, clothes, etc.). At the same time, something akin to the transference
i of the parental object through the pedopsychiatrist emerges, enabling shoring at difficult times. “I don’t know what I should say… Things are not going very well, but I don’t want to talk to the nurses about it. I only tell Doctor M.” The transferred parental object is conceptualized on the psychoanalyst model, both “internal interlocutor and third party” ([
8], p. 206). When it is a real person, present in the environment of the subject, but exogamic
j, “it is not an object of (pubertal) desire, not a symmetrical double (adolescent narcissism), and not a mere projection of the Ego
k and Superego agencies or of the infantile parental imagoes, but instead a psychic construction, both mutable and immutable, made up of these ingredients and having a substrate of flesh” (ibid). The clinical interviews with Clementine and her parents, suggested by the pedopsychiatrist, seem to have involved the mother in an empathetic understanding of her daughter. On the other hand, the refusal to reconnect with her elder sister, as her father requested, only accentuated the decathexis
l, or even her father’s escape from the relationship. As for Floriane, until the end of her sister’s hospitalization, she remained a foreign object, excluded from the framework. For Clementine, the deferred work undertaken on her family relationships and her new adolescent status alleviates a fear of repeating her past investment in deficient parental figures, thus enabling a relaxing of her objectal representations. With regard to the distancing of all family influence in this infra-hospital framework, the care enabled her to initiate a process of “subjective elaboration”, signifying the way in which the subject “can, according to his/her psychic dynamics, allow him/herself to think, articulate and connect what determines him/herself in his/her relationships to the other” ([
21], p. 49). The therapeutic space of individual follow-up provided Clementine with an environment characterized by listening and composure, which helped strengthen the quality of the transference link. Over the sessions, the initial inhibition of her thinking gave way to the unfolding of a singular discourse, a perception by Clementine of her own person that proved extremely perceptive and curious with regard to her inner world. Being the youngest and frailest patient in the unit, Clementine was invested by the care team as a fragile little girl, but within the walls of the psychologist’s office, a very different patient/psychologist/observer relational dynamic emerged, with Clementine being rightly considered as a young adolescent. Transference is « a powerful analogy » ([
22], p. 221) and the young girl’s many questions, as well as her discourse, demonstrated transference dynamics less focused on parental substitution than on “subject supposed to know”. Exchanges of looks between Clementine and the observer evolved from distraught looks to an exchange of knowing looks and smiles, evidencing the development of the therapeutic relationship, with the perception of a containing scopic
m alliance in this three-tier relationship.