Introduction

The families of troubled teenagers encounter institutions that are responsible for helping them and caring for them. One approach, which is more and more common today, consists of taking into account all the effects that will be produced in the encounter of one group with another (familial and institutional) and not just the effects produced on specialists through contact with a troubled teenager. Accepting the idea of a group matrix assumes that one acknowledges that at an unconscious level there are alliances, denial pacts (R. Kaës, 1989) and narcissistic contracts (P. Aulagnier, 1975) that orientate and partly influence the place that each will be able to occupy as much within the family dynamics under consideration as at the level of the kinds of 'inscription' of each specialist inside the institution. Those pacts and unconscious contracts articulate and combine themselves with the reasons adduced from the legal texts prescribing the institutional mandate and also recompose themselves using theoretical and even ideological data that justify the institutional organisation and position. Once defined, that position alone is not enough to maintain the professional aspect of affective manifestations that are heightened by the suffering and the narcissistic stakes inherent in the separation and individuation experiences that occur in the family situations encountered. Several authors have already devoted themselves to modelling the effects of these encounters between the suffering of the patient and his family and the institutional environment in order to decipher their transferential modes. These modes concern the unresolved family data that presents itself

to the professionals and the conditions of its decoding by the teams on the basis of what was activated in them. In particular, I think of Raymond Cahn (1991), Xavier Jacquey (1988), Bernard Penot (1987), with for the last two the concept of "subjectal transfer", a type of transfer requiring one to go through the construction of the emotional states of the professional in contact with the patient in order to obtain a sufficient transformation and representation of what is offered as raw and rough experience. Another step in a "meta" position obviously appears necessary, when several institutions are summoned around the same family, in this gap between the family and the institutions. Let us notice first of all that the very idea of a gap can be reduced to nothing when the thought assumes the form of binary logic. In binary logic, there only exists one thing or the other, only one or zero, but in the small interstice between these two figures, one can insert a whole universe, vague at first, then open and prone to favour bridging, connections, and why not, to accommodate a progressive approach. The consideration of the space between the families and the institutions responsible for helping them, calls for the third-party function and obliges one to confront a network of complexity, far from the hasty and reductive simplifications of binary reasoning, in which family defence mechanisms, as well as our institutional affiliations, sometimes mislead us. If we observe the deployment of so-called "expanded" commissions, which bring together the different social workers who intervene with the same family in serious difficulty, one can track down "atmospheres", tonalities corresponding to the diverse degrees of congruity and coherence between the various actions taken by the partners in attendance, such as providing accommodation, remedial teaching, or even financial support, and finally organising care.

Many "things" occur when professionals encounter one another. There can sometimes be open conflicts, superficial and polite consensus to avoid them, or finally a tacit alliance to build a satisfactory representation for all that is dysfunctional in the family under consideration. In these large, networked partnerships, each party can invest or disinvest, and the logic of each institution can unfold. Consequently, the vision of the care workers cannot be superimposed on that of the body which manages the finances or on that of the institution which provides for educational measures. At first, one may think that these differences result from the specificity and the logic of every social mandate, but it is nevertheless necessary to relate them to what every family hands over and transfers onto such or such an institution, such or such a social worker, of its sufferings and of what it was not able to elaborate itself. That is why every extended commission of professionals should be seen from the point of view of a psychodramatic scene in which the entrusted institutions attempt, very often without their knowledge, to represent and have represented the risks of the ways in which they are affected by the family problems. In doing so, these institutions form a group acting as a "prosthesis" intended for what cannot be either differentiated or articulated from within the family. The network can thus be thought of as an intersection that carries transferences, and considering it that way makes it possible to moderate the surprise felt in the face of the confusion that very often overcomes the medical and social arrangements developed to treat family sufferings and dysfunctions. If one accepts the hypothesis that the family problems encountered are transferred into the institutional logics that are summoned up, then the experience of one institution encroaching on another, the feelings of discouragement, of abandonment, of conflicting overinvestment or generalised defensive collusion become clearer. What those institutions experience between them, tells us both about themselves but also, about the way each of them in its own logic is mobilised towards the family and in a dynamic way with all the other professionals.

Limits and divisions

Let us take an example in order to illustrate what can occur between two institutions: one dedicated to educational and medical initiatives, which provides residential care, and another that is dedicated to consultations, screenings and care, as are the medical and psychological centres (CMP, Centres Médico-Psychologiques). This example makes it possible to investigate what is being deployed and staged in the gap between them and what is lacking in the family representation. It's about a mother who has lived in an institution since she was very young. Abandoned very early, she built herself a potential environment by "adopting" the "professional family" of counsellors, with whom she appears gladly familiar and very quickly in contact. She raised her own son, a pre-teenager who is gifted in terms of intellectual performance, but has serious difficulty regarding respect for limits and the law. It is well known that during the teenage years there is a concern with the issue of limits. These limits put to work during adolescence are of course those between the ego and the non-ego, between the sexes and between the generations.

For a few months, I see the mother and son for counselling. The young boy actually shows important behavioural difficulties, identifying himself happily with the "bosses" of the neighbourhoods while taking great pleasure in frightening his mother about the criminal acts which he would be led to commit. He also suffers from psychosomatic disorders, from violent headaches that he would like to end right away, and at the end of the first consultation he tells me how incompetent I am because his headaches haven’t stopped.

A few months after the first consultations, the mother herself suggests a stay in an institution, because she is faced with his increasing behavioural problems, and because he is approaching adolescence: indeed, she does not feel able to resist his demands and maintains with him emotional habits which are the same that one would have with a toddler. She manages to find a place in one of the most renowned establishments of the region, even though the waiting list is very long, this exploit testifying to her skill and good knowledge of the mysteries of the educational system. I continue consulting mother and son at the same time as the educational placement, one Saturday a month, when the son returns home, so that a follow-up is organized during the placement, something that they both anxiously request for fear that I might abandon them.

Approximately one year after the beginning of the placement, the psychiatrists and the psychologists of the residential centre want to meet me. Used to the links with institutions, I go to the establishment along with the social worker of the CMP where I see the family. Justifiably expecting their questioning, we find ourselves faced with a silent court which, although it summoned us, places us in the position of the patient who made an appointment and asks us: "so what do you have to say?"

From this rather staggering meeting, we gather that the establishment is in trouble with the child but also with the mother who uses what I am supposed to have have said to her as a cover for opposing certain suggestions by the institution. The professionals of this establishment question the relevance of the continuing monthly consultations with the mother and her son at the CMP and refuse on that day to consider any question regarding the difficulties that could arise from within their establishment: if the son no longer attends my consultations, things should get sorted. The solution to their internal difficulties therefore lies outside of themselves, in a movement which we are tempted to assimilate quickly to a projection mechanism. The next week, I receive a letter demanding that I interrupt the consultations with the child and restrict myself to consultations with the mother only. This letter is crisp and definitive; it is an order. I show it in passing to the CMP's department head who, not tolerating that anyone lays down the law in his own environment, proposes, if I give my agreement, to answer this establishment in the same tone.

Shame in the gap

In view of the scale of this affair, hurt and worried about my own skills, and about what I might have neglected in the organisation of my system, I suggest talking to the mother about it during the following consultation. She arrives and declares herself "ashamed for them", because the establishment anticipated me and has already made her read the letter which they sent me. This shame is immediately a source of interest because it is not far from the feelings aroused by the reprimanding letter that I received like a caught-out child. The shame questions what I have done that is reprehensible and unorthodox for this institution by continuing to see a teenager now under their responsibility. The gap, in that case, is not negotiable. An all-or-nothing logic prevails as well as a logic of objective separation of spaces, revealing how little hope is placed in a symbolic separation process. Besides, an external space like that of the consultations, appears responsible for what occurs regarding the child's personal experiences in the institution.

Questionings and multiple surges of anger crossed my mind during this period and especially towards these professionals with an excellent reputation, whom I ended up thinking I was usurping. Resumed work was showing that links were possible between the shame I felt and the story of this mother, very often excluded, victim of sexual violence in her adolescence, and who always appeared with her abandonment as a calling card. According to the young man, the shame attached to the establishment which welcomed him and whose skills he strongly and thoroughly questioned, just as he had previously questioned my own skills.

During a consultation, he shows, not without a touch of perversion, that he could clearly see their game: as he took part in a psychodrama group and particularly enjoyed staging holdups and attacks, the psychodramatists had suggested he should play the ransacked cashier. You see how "stupid they are over there" with their obvious trick he said to me, looking for a possible complicity.

One knows that shame depends more on the ideal of the ego than on the instance of the superego. The mother feels exposed as if the contents of her mind had been revealed without her knowing. Maybe she tried to incite the rivalry with this establishment by giving a veryidealised image of myself in order to counterbalance what she saw as a more restrictive educational regime. Basically, she was sheltering behind my image to run counter to the suggested educational principles. The space of the family consultations therefore became the place of resistance to the institution's care while the latter took a stand on the issue of limits: in this family, the missing third-party had to be compensated for by an absolute tight separation between the spaces of the mother and the son. The tone of the letter sent was on a par with the sense of diqualification felt by the institution, whereas the family’s experience of abandonment (abandonment renewed by the mother's parents and also by the father of the child) gave way to the staging of two confronting groups competing to keep them, an indisputable narcissistic advantage!

Beneath shame, the issue of the law

During the consultation regarding the letter from the institution, the mother is waiting to see the effects of what she activated, she is waiting for my reaction. The tone of the letter from the institution is that of an order which cannot be discussed. The issue of the paternal law appears central to me here. With relatively little conviction, because it looks as though this situation could have been worked through more beforehand, I decide however to put an end to the conversations with the son, given that it is the manager of the establishment who asked for it. The respect of this decision appears to me strategically more important than a more detailed reflection (which was refused by the establishment anyway), about the difficulties encountered with this family. The mother and her son both appear disappointed, but comply with my decision. In spite of the narcissistic wounds and the persistent conviction that another outcome is possible, this incident makes it possible to go back with the mother over her paternal images and the issue of the law. Consequently, she starts personal psychotherapy with a therapist of her choice, meets the child's father again for some brief conversations and finds the records and pictures of her own parents. Transmission is back at work, the spaces gradually differentiating themselves and I only see son and mother together at the end of the placement to assess the situation. Note that the difficulties inside the establishment continue in spite of the arrangement we agreed on, and are solved by a change of unit and school.

Epilogue

I have the opportunity to come across this establishment much later and in another context. We are able to discuss things together more calmly. They tell me about their feeling of being invaded by this too familiar, too close mother, and feel very touched when I remind them that the educational institution, for this mother, was her family. This established fact, about which we could have spoken at the time without the virulence of the countertransferential effects, made it difficult to distinguish between what is caused by the mother's possible incestuous operations and what is due to its affiliation. Free from the influence of family transfers, we could find a space of communication and mutual understanding which had disappeared during our collaboration. The misadventures in the individuation of this family had activated on both sides an ideological hardening between the advocates of "individual care" and those of "family care". The need to find limits was more in the area of the disagreement (on the very treatment model of the family) than over the model for working out the conflicts linked to the separation and the individuation.

This situation highlights the complexity of the family transfers, their contagiousness with respect to acting on the adolescent model. It also questions the decoding conditions of the restaging of these family data for the professionals. These stagings, as can be seen clearly in the example given, pass into the emotional and ideological commitments of the institutional interlocutors. They are all the more difficult to set into action as they can be the cause of narcissistic harm for each agent: imaginary rivalries, feeling of incompetence, of non recognition and of disqualification by the other, if we take the example of the manager's letter sent to me or of the violence felt by the institution towards the family consultations which I had set up.

A methodological postulate of the gap?

It seems to me that one possible way to bring out and think through these inter-institutional phenomena is to choose a methodological approach that consists in considering these emotional experiences not as a commonplace expression of reality, but as a working tool. In these situations where the narcissism and the limits of each party are going to be called into question by confusion (of places, persons and generations), the exhibition of objective differences can mask the failure to even think about the idea of difference. There is a high risk of confining families and other professionals within images which rigidify and reify them. In that case, these images become judgments of reality and are no longer the vectors of a possible symbolisation. Families, and in particular those concerned by adolescence, raise the question of our limits, of our theoretical, ideological differentiations and make us live moments of confusion. The pain of differentiation and its resolution in rifts are what people have to live through when they encounter one another within an institution and between institutions. When I comply with the manager’s proposition, rather than oppose it with intervening instructions, it seems as if I offer one of the possible forms of castration in reality and also in a symbolic way. This position seems to me to be the most relevant at this precise moment of the follow-up, considering that the institution was closed to any interaction at the time. Living it successfully supposes that this attitude does not appear to have to do with resignation but with an adaptation to the family conditions at work. The peculiarity of this follow-up is that the family was able to take back a part of what it had activated in the caring environment through this shame which actually appears like a transformation of the infantile situations of distress. The "shared shame" might have evolved into the expression of a culpability that organizes reunions with the past and objects until then put aside by the mechanisms of intra-family split.

Conclusion

Institutional and inter-institutional scenes provide the opportunity to bring out fears as well as family data not yet that have not yet been metabolised and also offer the possibility of transforming them into psychic experiences that can be represented. The detour and transit through the psyche of the professionals in the institutions and their agreement to take on subjectively certain psychic positions make it possible for the patients and their families to regain their thinking capabilities. In the gap between the family and institutions, the potential disqualification that we feel when no progress is made, in our comparative use, conflicted or not, with other colleagues, other theoretical currents, should be put in the background with regards to the necessity of supporting a symbolisation process. Indeed, the competing theories and practices, the splits between the various fields of medicine or between the various social actors, may at any moment form a single part and encyst, without their knowing, the splits of the families which use them.

Consequently, the way every medical, psychological or social agent will agree to let himself be "worked on" by the encounter with families depends on the thought process already undertaken in the institution, on the training of the medical staff and on the working mechanisms which will make it possible to work as a team on whatever arises. To do that, it is however important to consider what comes from the family as a central element of the mechanism and not as an element disrupting the care of the child or the teenager considered individually.

BIBLIOGRAPHY

AULAGNIER P. (1975) La violence de l’interprétation, du pictogramme à l’énoncé, Paris, Puf.

CAHN R. (1991) Adolescence et folie : les déliaisons dangereuses, Paris Puf.

JACQUEY X. (1988) Les transferts subjectaux in La psychiatrie de l’enfant , XXXI, 2, Paris, Puf. 643-695.

KAES R. (1989) Le pacte dénégatif dans les ensembles transsubjectifs in Missenard A. et al, Le négatif, figures et modalités, Paris, Dunod, 101-136.

PENOT B. (1987 ) Figures du déni. En deça du négatif , Paris, Dunod.

Published on Divan familiale n.21, 2008, with the title:"la question des limites dans l'entre-deux des familles et des institutions autour de l'adolescence".

Summary

Drawing on a clinical situation that brings together a family affected by adolescence and two institutions, the author considers the interaction between families and institutions and, more precisely, the psychic material brought into play following the cooperation set going in networking. Analysis of the clinical case makes it possible to consider whatever acts across both institutions as the psychodramatic staging of the family scene on the verge of symbolisation. The ideological rifts, the experiences of encroachment, the limits on the work and competence of each professional will be strongly mobilised. These effects, conflictual or not, are unlikely to be acknowledged in their counter-transferential form because, as they harm each party's professional narcissism, they very often give rise to ideological rigidification and the reification of the other's positions. The author suggests using as a methodological a priori the consideration of interactions between institutions as working tools for the transmission of the family, particularly during adolescence, when the issue of the limits of the law is brought into the foreground.

Kay words: Istitution , work in network, family transmission process, adolescents, making psychodramatic scene.

Evelyn Grange-Ségéral psychotherapy and family therapy (ADSPF-SFTFP-AIPCF). Professor of clinical psychopathology CRPPC. University of Lyon 2.
18, Rue des Tourelles
69,005-Lyon
France

Translated from French by Jean-Luc Relave