In adolescent psychotherapy, professionals are often confronted with complex manifestations of distress that vary in pattern, intensity, and duration, and are sometimes worrying. Among the sudden pathological manifestations at this stage of life in adolescents, some of them are thought to be related to the so-called "borderline state" of adults.
However, when clinicians receive such difficult adolescents, they may find themselves in a relationship full of empathic projections that are influenced by strong psychopathological dynamics. This hard-to-make connection is often plagued by idealization, can quickly collapse and is accompanied by the emergence of identity anxiety and dependency anxiety, as well as sudden destructive behavior. These challenges at the spiritual level not only pose a threat to many methods, but are often accompanied by a common risk: the abrupt interruption of the process ......As a result, we have to think about what adjustments need to be made, both from the clinician's standpoint and from the environmental side, to ensure that this connection can survive the devastating separation.
There are a number of possible approaches to consider, but here we focus primarily on one technique that is often used in psychodramas: the "dual role" technique. After several sessions with these teenagers in individual psychoanalytic dramas, we found that games that specifically deal with "dual roles" help to promote the establishment of ** alliances. Through the case of Nadia,This article will tweak the techniques when dealing with edge issues in and why dual techniques are particularly well-suited to the environment where edge issues are handled.
Edge issues and the so-called "dual role" stage.
What we are talking about here is not a "limbic state" in the traditional sense, but rather a concept of a "limbic problem" as a response to the psychopathological entity as a reference point, but this does not imply a presupposition of a fixed fate in the development process (Knaffo et al. 2014). This view echoes the "limbic functioning" of adolescence (Gicquel et al., 2011) and focuses more on the analysis of mental processes than on the symptomatic division of fixed problems.
In particular, we highlight a common point in the fringe issue: the difficulty, even the impossibility of establishing a so-called "internal dialogue". For these teenagers, it may seem impossible to talk to themselves. This leads us to focus on one aspect of the problem of narcissism, namely the lack of an internal interlocutor, a complex psychological operation capable of ensuring an effective connection between emotions and the appearance of the "ego to the ego".
In understanding this problem of difficulty (or poor establishment), we find three theoretical proposals interesting. The first, rather classic, deals with a major flaw in the identification with the image of the mother. This makes it difficult to delineate the scope of the mother figure, making it appear ethereal, which in turn affects the "ability to be alone" (Winnicott, 1958). In this context, solitude means facing emptiness and not being able to communicate with an internal object that can provide comfort, whether it is a mother figure or a possible alternative self, that does not function as a mirror image (Winnicott, 1971).
The second proposal introduced rRoussillon (2012) works on the symbolic process and the symbolic itself as a necessary "meta-level" object betting. r.Roussillon (2008) emphasizes that the completion of these processes depends on the subject's capacity for self-reflection, allowing it to "think about itself as it thinks". However, the situation we are discussing shows precisely the inability to enter into this complexity of processing appearances and emotions.
Closer to our consideration of these issues is, oMoyano's (2010) contribution to the stade du double is foundational. The author proposes that the dual problem can manifest differently in these stages, taking into account several stages of early development. First, the mirror connection between mother and child is understood as a kind of dual space, a single and two-dimensional space that lies in a dynamic of mutual inclusion:"The double space is the same space, the space where the subject contains the object, and the object in turn contains the subject. The identification in it is absolute, and no distance is allowed between the faces of the child and the mother. The dual space, as a whole encompassing the subject and its object, excludes any possibility of conflict due to the existence of this fundamental complementary relationship". This theoretical proposal complements the analysis of the problems associated with the anxiety of the eighth month, which the authors consider to be more of a depersonalization anxiety than separation anxiety, a clinical sign that shows a process of leaving the double space that is linked both to the original duality and to its own differentiation, with all the disturbing strangeness. It is this moment, strictly speaking, that marks the beginning of a double phase. We can compare these proposals with RRoussillon (2012) describes the connection between the underlying narcissistic identity and the concept of "dual perceptual positioning".
In this new phase, two sub-phases are envisaged. o.Moyano distinguishes the "narcissistic dual", the stage of identity shaking, which is related to the emergence of the infant from the primitive single period; Then there is the "mirror duality" phase, in which the subject projects the double to the outside and then throws itself into it in the form of a real appearance:Here, all the problems of the mirror phase are articulated in a new perspective, which reflects the establishment and composition of the internal space, "containing the possibility of representing the self".
We propose to extend these theoretical hypotheses to a higher "meta-level" unfolding of these processes, thus constructing a dual image as an internal interlocutor, an image that is the dynamic successor of the previously described and that combines narcissism and the object problem from the very earliest stages of mental life. In terms of psychopathology, what we consider is that at the heart of the fringe problem, it is not the absence of a certain stage beyond it (this view is too simplistic for us), but the simultaneous and chaotic summoning of a double space and a double phase. This situation creates a tension and oscillation that hinders access to more mature structural forms, especially those related to what we call the "construction of an internal interlocutor". While there is a possibility for limbic functions to transcend these stages, the subject always seems to go through a chaotic journey through these stages. This discontinuity in operation can be described by the following metaphor: the individual's relationship to his own image and to the mother figure is carried out in a strobing fashion, according to an alternating pattern of polarization, and the continuous experience of reunion and loss produces a pathological depersonalization anxiety. This idea could partially explain the relationship instability in the clinical picture. It reflects the endless quest for the primordial mother object to reconstruct the dual space, which, although the subject has indeed begun to enter in the early stages of development, does so in an incomplete way. However, even if partially beyond this stage, returning to this space causes a disintegrating anxiety that in turn leads to an unconscious escape from this space.
On the dual technique of individual psychoanalysis.
The dual technique is one of the interventions that are classically used in the field of psychodrama (Ron, 2010;salem，2013）。At the suggestion of the director, at the direct request of the visitor, or introduced by the director in an ongoing scene, a co-master can play a dual role.
There are usually two possibilities for playing this role. In the first case, the person playing the double stands next to or behind the visitor. This duality can then evoke manifestations of emotions or fantasies that the client ignores or is not aware of, even though the client may unconsciously perceive the outpouring of these emotions. This approach includes both derepression and or denial, as well as **. It is important to note that this technique can lead to unexpected effects and sudden revelation of significant problems in the unconscious, so it must be used with caution. This treatment can quickly become ** and invasive. For edge issues, we think it's best not to use this type of dual technique, at least in the early days.
The other two-fold approach is slightly different. Whether presented to the visitor before the scene or introduced in the late game, this double appears as a double identity and is somewhere between "face-to-face" and "side by side". It begins in the form of a dialogue that does not involve mirror repetition or an overly obvious imitation of the mental functioning of the adolescent. Its positioning often leads to the use of "I", "we", and "people" to present their own ideas, or to maintain a resonance with the visitor. As such, it represents both oneself and others, and ultimately both, like a translator who tries to express and inspire emotions and representations in dialects. However, it is still very sensitive to the visitor's verbal and non-verbal feedback in order to accommodate the visitor. The important idea of this technique is that the dematerialized form of the same conversation can eventually lead to its internalization so that the client can "talk to himself". As long as this process can take root, the subject can eventually transition from a "double-you" to a "double-game", as in FA vivid formulation proposed by de Lanlay (2013). c.The case of Annabelle, described by Chabert (2008), provides a typical clinical example of these problems. The second processing of this dual technology can deal with some special cases of edge functions. However, we should not see the effect of this as a fix for the problems that were difficult to unify in the early dual phases by mobilizing a simple return movement, but rather as a new call to these problems.
Some important clinical elements led us to believe that it was appropriate to introduce dual techniques into the framework of our work. First of all, it is undeniable that adolescents with borderline functions are often shocked during the first few sessions of psychodrama. Faced with this situation, we propose to have him interact with a dual character in multiple ** sessions, usually starting with the first session. We found that the persistence of the double is integral in every session and in every game, and its absence may trigger anxiety manifestations in adolescents. We also note the importance of fixing the same common division to play a dual role, because although this exclusivity is not usually involved in the use of this technique, here this arrangement seems to be crucial. This allows the adolescent to rely on a well-defined dual role and rely on him for a long enough period of time. As a true narcissistic guide, his stability can counteract the lethal dynamics triggered by narcissistic flaws and anxiety.
Technically, the double sits between the two positions, alternating in a dynamic way. First, it can invite visitors to a face-to-face conversation. We note that the duo scene is particularly important in the early stages, especially due to the fact that the double is able to immediately point out the strangeness that the frame can bring and its sexual dimension. Here we can find a key concept proposed by the Klein School in the early days of the Klein School. However, maintaining this exclusive dialogue between the client and the collaborator can have a deleterious effect in the form of narcissism or excessive idealization, which can quickly lead to a heated rejection. The two participants will then fall into a dilemma that isolates them from the rest of the group. Luckily, we have the role of director and can re-establish the necessary triple relationship by bringing in other common divisions.
When these third parties are present in the game, the role of the dual role is the same as dw.Winnicott's (1971) proposed "presentation of objects" is very similar. The dual role is now next to the visitor and acts as an intermediary to meet the new participant. The role played by the co-mentor here seems to actually derive effectiveness from his back-and-forth with his colleagues and with the client again, such as asking the client what he or she thinks or feels. Here it seems to be dealing with the rhythmic structure of the earlier object relation (Haag, 1993), which is somewhat similar to O.*Ron (2010) describes the rhythm of empathic participatory character: the co-teacher briefly leaves as the dual character goes outward, and then the adolescent experiences a reunion with the dual role, who asks and cares about his feelings. The visitor was neither abandoned for a long time nor forced to interact, and he gradually became involved in this arrangement.
The first few sessions of the psychodrama with Nadia were very similar to the scenes we had during our initial meeting when she was admitted to the hospital for adolescent behavioral problems. The atmosphere is very tense and "intense", and we gradually feel that the young girl's impulsive violence and strong self-destructive tendencies are gradually coming to the surface. Nadia seems to be troubled by this arrangement, but she views it with a certain humorous contempt that allows her to suppress her aggression and anxiety.
In the beginning, the teenager did not come up with any idea of cosplaying, falling into a defensive posture that was difficult to get rid of. The proposal initiated by the theater leader led to some very peculiar situations at that time: despite the efforts of the co-masters (usually the scenes of some youth group), Nadia often leaned against the wall, crossed her arms, and looked at them contentedly, and these glances made them feel how ridiculous and meaningless their move was. In this case, the scene cannot unfold and the drama leader needs to stop the play. Any subsequent attempt to understand how she went through these scenarios is met with a solid wall, and she remains silent, with a mocking smile and a brief answer. At the end of the meeting, the team felt relieved, devastated and haunted by the fear and rejection she generated.
Against the backdrop of this "overheated" empathy, the drama leader proposes that at the beginning of a meeting, Nadia play with a double character - a double character on the table in order to find a way out of this impasse. Nadia seems to have been surprised by such a proposal. The formulation proposed by the dominant person ("Yes, you know, a dual role, kind of like when we're talking to ourselves in our heads. It seems that this time a curiosity was aroused. After casting a cold eye on the whole team, she finally chose a young colleague who had just joined our team. She seems to be particularly proud of her choice. However, despite the uneasiness of the chosen colleagues, a form of meeting took place. The initial alliance relied heavily on dual roles to be able to accurately name and play hatred and contempt. There was no real dialogue at this stage, but some advice was given to Nadia. My colleague mentions the intolerable nature of our working framework, all these "psychiatrists" who are eager to know what's going on in her head, this game for children and meaningless psychological drama. It is also mentioned that she can only rely on herself because others don't seem to care about her feelings and are unreliable. The desire to destroy, to kill, and to harm oneself is also explicitly mentioned, as well as to feel one's own existence through this excessive hatred. The quality of the colleague's performance then established a strong empathetic connection with Nadia, which led the dominant to suggest that the co-worker become her "official" dual role. The teenage girl seemed relieved that her colleague was able to put her feelings into words. Thus, what comes into play here is not a sympathetic or narcissistic restorative attitude, but an interweaving of symbols that are closest to the lethal manifestation.
However, the solidarity nature of this bond may turn into an obsession with primary homosexuality and**. Although necessary during the unfolding, this connection may be regulated by the setting of the psychodrama itself, as well as by the introduction of other characters in the two-player game. Regardless of their identity, Nadia looks at the arrival of the other characters with suspicion. In these cases, she keeps a close eye on the reactions of her dual role. Initially, the colleague would periodically turn away those who walked to the playing field to meet them, dismissing the intrusion as intolerable, emphasizing that only he needed it: "We don't need you", "You're useless", "We're fine now" are common expressions used by this colleague. She often turns to Nadia to ask her what she thinks, and of course her answers are always on the side of her colleagues. Despite the tension in these episodes, in which a strangely strong conflict is presented, and new manifestations are categorically rejected, the teenager seems to be gradually relaxing. Her eyes became more lively, and she smiled more often at the almost expected reaction of the dual role. She also began to observe the other collaborators more intently. This strange combination is both symbolic and violent, but also has an open-ended effect, which can also be felt in the interaction between Nadia and the game's protagonists. She can now reluctantly describe her daily life events or the family structure she is in when asked.
Nadia was visibly aware of the change in the situation after a few weeks of **, and she may have felt that she was "lowering her vigilance". In the face of this change, she developed a tendency to retreat and even interrupt. One day, she came to us with a thick bandage of her hand and told us that she had injured her hand in a new outburst of rage, and that she had taken her anger out on the furniture. When invited to talk about how to deal with this violence, she showed a strong sense of omnipotence and great anxiety: "It's better not to happen here**. Subsequently, she carried out several actions on the framework of our work. During one of her work, she mentions her violent tendencies again, and Nadia, who is sitting next to the game's dominant player, suddenly stands up and says she doesn't want to stay here anymore and leaves the room. The game leader then followed her back to where she was hospitalized. Later, after another emotionally stressful job trip, the teenage girl simply refused to attend the next meeting; However, when the game leader comes to pick her up again, she returns. Each of her returns gives the opportunity for a dual role that allows him to accompany what happens, a role played by this colleague, mainly by naming the role that these actions could play. She often starts like this: "When the heart feels too much", "When it overflows", "When we are going to destroy everything". She also mentioned that "here we finally showed them the emotions in our hearts", which seemed to deeply move the young girl. The dual characters will also be surprised at the way the team doesn't fight back: "It's weird, they're completely unresponsive!" They could have chased us away like we did. Do you think this will work for them? At the same time, she also mentioned that these interruptions are a way of self-protection for Nadia and for the whole team, and she made a nuanced explanatory suggestion that aroused the interest of the teenage girl. This thoughtful accompaniment will gradually lead to the disappearance of the behavioral disruptions related to our working framework and trigger significant changes.
After some time, Nadia's condition seemed to be good enough to end her hospitalization**. She continues to come in for psychodrama sessions, and it's very regular, although we fear that she might use the opportunity to break the coherence. There are several clinical signs that she has changed in the way she invests in our work. She can discuss her daily life or career projects (caring for teenagers) with the theatre lead. In her speech, the family structure was revealed, and parents and siblings kept coming back in some memories. When Nadia spoke, we (and obviously herself) felt very lighthearted. However, the possibility of making better use of these discussion times is accompanied by a significant change in Nadia's relationship with her dual role (and for good reason). In the past, she was quite cooperative in front of the co-op ** who played this role, but now she is more active in her conversations with this ** master, and even sometimes shows an attitude of opposition or the opposite, as if suddenly she has changed as a person.
For example, when the playwright puts multiple co-workers into the scene, each of them shows an emotional confronting the duo of Nadia and her dual roles. When the duo rejected the new characters in their entirety, Nadia actively objected: "No, we reserve our anger. The dual character then warns her of the dangers that may come with re-internalizing this emotion, but the teenage girl insists on her opinion. This was the first time Nadia had supported another co-op to join, and it wasn't long before the game leader sent a colleague who was playing a psychological drama to them. Again, the dual character takes an aggressive, contemptuous approach to this new character ("And you? You can't do anything anyway. But Nadia took a different stance and questioned her dual role in a slight voice: "Not really, she helps us. Our colleague felt a little caught off guard and felt a strange sense of strangeness, she told us. This change in tone made her feel less "resonant" with the girl, feeling a little "hurt", and the part of the narcissism that the co-facilitator described as both charming and terrifying was disappearing. She also felt that she carried the more primitive side of Nadia's functions, as if these primitive functions were placed in her own mind, which seemed to provide Nadia with space to experience other emotions and **other appearances. This became a real turning point in the process, providing Nadia with a better way to express her own words and emotions, and began to distance herself from the dual role.
The use of the dual role technique, is a common technique in analytic psychodramas and that we believe is worth highlighting in the approach to dealing with the borderline of adolescents. In the individual process of using psychodrama as a means, this technique (which is completely clear from the very beginning, as we have described) seems to be able to mitigate the risk of disruption that may arise in the program. It provides sufficient self-satisfaction and stimulation, but also the possibility of conflicting representations and emotions. In the best case, it can also facilitate the establishment of internal dialogue. Here, the staged problem of dual roles (Moyano, 2010) forms the basis of the inner mental process. It is still crucial to visualize the dual characters on the game stage, visualizing the dynamics that may be internalized in the realm of perception. The detachment and separation of adolescents from this image is indicative of the progress of this process.
Although we have only considered one clinical scenario, the hypothesis we present here appears to have been confirmed in multiple successive cases that are currently underway, which may require continued reflection at a broader level involving a more representative population.
The course is recruiting
Note: Le double au psychodrame et les adolescents limites "Double Techniques and "Marginal" Adolescents in Psychodrama
Jér Me Boutinaud, Philippe Chabert by Jerome Boutino, Philippe Chapelle.
dansaaddoolleesscceennccee 2018/1 (t.36 n°1), pages 171 à 182 published in Adolescence Magazine, Vol. 36, No. 1, 2018, pp. 171-182
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Publisher: Greupp Press.
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