Le travail du lien comme origine du processus thérapeutique en clinique du traumatisme chez l’enfant

Abstract

IntroductionIn our clinical practice with children in very precarious physical and psychological situations, the traumatic dimension is often present. Early situations of emotional deprivation or violent experiences during the first years of life are prevalent and have an impact on their psychological construction. The need to meet with an “other-subject”, supporting and engaging in the relationship, is found in therapeutic support. For children, it is also in this relationship that traumatic experiences find their origins and are at the source of the repetition compulsion. Within the framework of a research project on the implementation and evaluation of a therapeutic system in Cambodia, we question the attempt to put the primitive bond back to work as a support for a return to psychic movement. MethodologyTen children hosted by an NGO in Cambodia were followed for a year, within a therapeutic system designed on the basis of mediation and with the help of an interpreter. The data collection consisted of observation notes linked to a common work of elaboration of the counter-transference with the interpreter. The analysis is carried out on the side of the psychic processes with the help of the EPE grid (evolution of processes and envelopes) allowing to grasp their evolution. The emphasis is placed on the work of the link within the therapeutic device by the evolution of the latter and of the psychic processes in parallel with the counter-transferential elaboration. Results and discussionThrough the presentation of two clinical situations, we questioned the intersubjective processes at play both in the clinical encounters and in the work of the primary link within the encounters. At the beginning of the encounters, we underlined a hindrance of the psychic processes. For the children, the weaving of a bond was hindered and was a source of reliving early traumas, having been played out in the primary links with the environment. The defenses were erected against the possibility of being linked and were found in an archaic register. In this respect, the link constituted the origin of this therapeutic work. It was gradually woven through the investment of the interpreter and the therapist who was himself in a situation of expatriation. For the children, these forms of connection were replayed in their relationship with their environment and on the behavioral stage, thus mobilizing the entire intersubjective stage. This primary work of the link supported the emergence of new psychic processes. ConclusionThe therapeutic issue is the need to work on the modalities of early links that are replayed in the therapeutic relationship. This work on the link originates in a specific investment of the interpreter and the therapist within the relationship. It allows a psychic remobilization opening up possibilities of elaboration in the relationship with the environment, on the behavioral and intersubjective scene.