Contenu du sommaire : L'adolescence en contexte

Adolescence is a process that concerns the entire family system. Its specificities and consequences will vary along the place and function of each family member and the way they interacts with each other, amplifying or reducing new family troubles.

Through child psychiatric consultation we face daily the clinical manifestations of the psychic struggles of adolescence: struggle with feeling low and struggle to feel real, to quote Winnicott; struggle to be recognized to use the terms we have presented from what we have called “fits of madness in early adolescence”, in reference to a demand which has been growing for some years to respond to the alarming behaviors of very young teenagers.The therapeutic approach of a suffering child or teenager confronts the clinician with various aspects of the same reality: the one concerning the specificity of his mental functioning which comes under his identity; and the one concerning his place, his functions in his natural environment, that comes under his belonging. Identity and belonging are in dialectical relation, building themselves from one each other.

In this paper, the authors deal with the problem of adolescence under a double point of view: the one of the adolescent individual, whose psycho physiological development allows an increasing process of autonomy and identity, and on the other side, family system which shall go through a difficult phase of its life cycle, deeply reorganizing roles, functions, relationship, particularly in the marital couple.

The dialectic theory of personality developed by Boszormenyi-Nagy, one of the pioneers of family therapy and the founder of contextual therapy leads to a relational definition of autonomy and to a new understanding of family loyalties. The article is divided in four sections: A presentation of the dialectic theory of personality and its implications for our understanding of family relationships and its relational determinants; for the first time, a detailed presentation of the ontic dimension of relational reality; a presentation of the relational modes as they present for the adolescent ; a discussion of the clinical implication of the ontic dimension for the treatment of adolescents and their families.

It was usual to consider the adolescence as a second phase of the separation-individuation process necessary to get on the infancy's parental images. The attachment theory allows viewing the adolescence's stakes by another side: the one that allows do keep ties to the caregivers who are the parents, and to reach autonomy thanks to these attachment's qualities. We emphases then the relational dimension of that process and on the articulation between behavioral realities and representations of the way of being related. This paper shows the evolving attachment during adolescence and the characteristics that bring the adolescent to get in dialog the present attachments with those of his infancy.

This paper emphasises the adolescence's autonomy process. This process is partly defined by the emotional separation from the parents. When this emotional separation is associated with individual and contextual troubles and becomes dysfunctional, one can label it as detachment.

Developing the theme of culture among friends accentuates the shared ideals that are constructed at this time. In a first part, this “adolescens or intersubjectal culture” is differentiated from the intergenerational “psychology of fathers and mothers”. It helps to construct adolescent communities whose references are a-familial.Groups of couples should be distinguished from communities of friends. The first have a class dialectic with institutions. The second have intercommunity relations which are inter and intra-generational. These theoretical points of view will conclude with the analysis of the adolescent friendship of Paul Cézanne and Émile Zola and its outcome.

The goal of this article is to describe the intervention we do among the network of friends of the patients referred to the eating disorder clinic. This approach is one of the components of our intervention program. We present the rationale of this type of intervention. Then, we illustrate the whole program to appreciate the place occupied by this specific intervention in the whole process. Afterwards, we describe in details the intervention among the network of friends and we present two specific interventions done with two patients at the clinic. In conclusion, we discuss the impact of that intervention on the course of illness for anorexic teens.

When facing an outbreak of their child, the parents usually confess their powerlessness and call the urgency psychiatrist who seem to be the competent person to deal with the crisis. In contrast with such a natural attitude of the parents, the mobile emergency service ERIC makes a counter-contention: the latter are the first and only competent. Consequently the teenager is not to be isolated from his or her familial context but must be kept at home. Three clinical situations show the paradoxical practice of the ERIC urgency team: creating a new (counter-natural) parental attitude, making the parents confident again about their authority, in short: restoring their functional hierarchies.

Everyone agreed on the fact that adolescence is a particularly significant time. But, what happen when adolescents and their parents are branded by designation? The terms and classifications coming out of efforts of diagnostic precision enter in a more enlarged context that unavoidably takes them over for recycling. Beyond their most beautiful claims, institutions that translate adolescents and parents difficulties and conducts in clinical, administrative and judicial categories, can provoke particularly alienating effects. Therefore, the diagnosis made on the adolescent modifies his/her self representation, influences his/her family and social relations, and feeds at the same time the logic of the institutional ways to structure and manage their offering services. In this paper, we describe some consequences of using diagnosis without doing a critical analysis of this practice.

After describing the teenage crisis correlated with the familial and the social crisis (reference points, limits, accepted ways of authority...), the auteur shows through a clinic case how the teenage violence is caught in external histories and discourses who pollutes, saturates, excludes and are located beyond the teenager.How to deconstruct and then, reconstruct more supporting narrations that allows re-authoring identity construction based on constructionists paradigms, mainly the therapy of Michael White is the object of the present article.

The authors present a project of prevention inside the process of repression, when teenagers are received in the police station. Parents are invited with the children to meet a team of family therapists who work full time in the station and who try to manage the family disorder with a systemic approach.

The living conditions of young generations changed deeply along these last decades. Because of modifications of family statute through more equality, promotion of young people as partners in exchanges and not anymore as minor, closeness of parents who became more good friends than parents, higher numbers of remarried families or single-parent family, transmission is more difficult than before. Number of youths is not supported by any personal necessity because their parents never gave it to them, and they are than carried to high-risk behaviors, suffering, all as long hardships that they impose to themselves to go trough adolescence and enter in adult age.

Self-mutilation studied here in its superficial or non-deadly forms is a relatively frequent symptom in adolescence. Involving the skin as physiological barrier and essential mediator between inside and outside, this often compulsive and violent behavior is highly relational as it implies the limits of the self in relation to the other. The author first refers to the concept of Ego-Skin as elaborated by Anzieu to analyze psychic phenomena associated to self-injurious behavior, arguing that this symptom be envisaged in the context of adolescence as a temporary solution held by the subject to survive to distress whichever may be its cause and origin of concerns. At a clinical level, self-mutilating conduct may indicate a fundamental lack of protection and past neglect of the child's needs, this capacity for self-care and self-protection being internalized by the child after the care provided by the parents during infancy and childhood. While considering the discomfort and possible fascination provoked in clinicians the intervention with these adolescents is discussed in the light of the many functions and adaptive role of the symptom in each specific dynamic.

An attempted suicide indicates certain latent difficulties of a family system to adapt when confronted to the departure of one of its members. It happen within a framework where autonomy is experienced as a threat to the whole family. The suicide in itself reveals the family inability to evolve and to adapt itself to the surrounding ecosystem that constitutes a dynamic space in constant evolution. In such cases, autonomy is equivalent to death implying an impossible adaptation of the family to a world in perpetual motion.

Multiple psychoactive substance use among adolescents is a major public health problem that concerns about 15 % of 17 to 18 year olds. Based on a review of the literature and various ongoing studies, the author presents a summary of the specific management of these problems in adolescents. Early detection of multiple psychoactive substance use and evaluation of the factors of severity can help adolescents to identify and deal with the problem earlier. In this context, motivational interview techniques, completed if necessary by brief therapy, family therapy and adapted psychosocial support can be particularly useful.