Empiètement, rejet ou tempérance : l’adolescence en pédiatrie au risque de la surviolence

Abstract

ContextThe work of the clinical psychologist in pediatric hospitals aims to promote the subjective appropriation of the experience by the child, by ensuring a feeling of continuity and security. It is particularly important to ensure the quality of the relation between subject, entourage, and caregivers. However, a certain amount of violence exists in the relation between caregiver and patient. We suggest that beyond the violence of caregiving itself, there is an “over-violence” (Tomkiewicz, 1991) which risks undermining the patient's feeling of security. ObjectivesWe believe that this over-violence arises when caregivers are confronted with intolerable experiences in the face of the vital risk incurred by the patient. This article aims to examine the emergence of this over-violence and its modes of expression. MethodThis work is based on several situations encountered in different pediatric wards, based on three cases of adolescent patients who put their caregivers in difficulty and required the intervention of hospital psychologists to understand the issues at hand. ResultsThrough these different clinical cases we identify two mechanisms of over-violence. First, encroachment, in the form of excessive control of patients’ behavior, which echoes the control that exists over the bodies of sick children. second, rejection, as an attempt to evacuate that which is violent, despite the needs of the patient, sometimes justified by the imperative of freeing hospital beds for other patients. We also identify the effects of a paradoxical over-violence in the oscillation between these two poles. DiscussionFaced with potential death and the anxiety it arouses, caregivers confronted with violent affects deploy unconscious defense mechanisms that can undermine the professional-patient relationship and can produce over-violence in care. Faced with this phenomenon, reflecting together as a team allows for the regulation of affects and promotes temperance in the professional-patient relationship. Psychologists practicing in somatic hospitals are instrumental in the setting up and maintaining of spaces for regulation or analysis of professional practice in services in which psychological care is not the primary task.