Clinique des dispositifs « aux limites ». Co-construction et subjectivation

Abstract

ObjectivesThe author proposes to explore some of the characteristics of clinical practices and setting “at the limits.” Particular consideration is given to the underlying logics of co-construction and their implications for clinical work and the process of subjectivation. MethodClinical settings “at the limits” are defined as practices that are situated at the limits of psychological care or at the limits of the usually identified setting. They are specifically aimed at subjects with boundary problems and difficulties in subjectivation. Based on several types of setting, the dynamics of co-construction at work between patient(s) and therapist(s) and between setting and institution are studied, leading to the identification of some clinical benchmarks for the specificities of these treatments and the issues they raise from the point of view of the work of subjectivation. ResultsThe identification of the dynamic of co-construction specific to these clinical practices highlights the necessary congruence of these devices with the psychic needs of the subject, which implies a particular attention paid by the clinician to the effects produced in the therapeutic relationship by the setting. Three major characteristics of clinical settings “at the limits” are identified: unconditional welcome; appropriation of the setting; and sharing as a major organizer of the clinical encounter. DiscussionTaking into account the dimension of intersubjectivity and the singular use that the patient will make of the device makes it possible to underline the transitional virtues of the work of co-construction, notably in relation to the transference/counter-transference dynamic. ConclusionNowadays, clinical settings “at the limits” constitute a particularly heuristic and rapidly expanding field of research, contributing to refining and remodelling our clinical practices and theoretical models.