Continuities, discontinuities and transformations in the psychotherapy of a psychotic adolescent during the time of coronavirus.

The author describes the evolution of the psychotherapy of a psychotic adolescent in the period when the pandemic induced their national authorities to impose lockdown. The difficulty of coming to terms with an ever-present reality that proved to be distressing for both the patient and the analyst, as well as with the violence and rapidity with which the external situation developed, leading to a change in the therapy setting, are at the heart of the reflections in this paper. The "choice" of whether to continue the sessions over the phone determined the emergence of some distinctive issues related to discontinuity and to the impossibility of relying on visual perception. However, to the analyst's surprise, it also favoured the possibility of working through the meaning of some autistic mental areas which, up to that moment, had never really been accessible to verbalization. Questioning the meaning of these changes, the author develops a broader reflection about the way that, for analysts and patients, modifications in the frames of our daily lives and clinical practice have enabled the deployment of undifferentiated parts of the personality which had previously been secretly deposited in the "body" of the setting and therefore were inaccessible.

A Body of One's Own: From Self-Cutting to the Cuts of Separation in an Adolescent Suffering From Traumatic Early Abandonments.

The treatment of adolescents suffering from early traumatic experiences inescapably involves the encounter with patients' concrete use of their bodies and actions. The clinical history of an adolescent girl reveals the relationship between traumatic transgenerational abandonments and self-cutting in the transference-countertransference relationship. Initially the patient's body and actions were the only way to communicate experiences that could not be conveyed in words and represented: the "skin for two" of the original psychosomatic envelope needed to be wounded, cut, broken concretely. The establishment of a boundary between internal and external, self and other, is the result of a complex process with roots in the quality of the encounter with the object. Gradually, in the encounter with the analyst, the young patient may construct a tenuous possibility of differentiation and begin to access the first outline of a representation of loss.

Working With Severe Borderline Patients: A Clinical Study of Destructiveness and Its Communicative Potential.

Destructive behavior is one of the most challenging aspects when treating severe borderline patients because both the therapist and the psychotherapeutic method are called into question. Drawing on three in-depth psychoanalytic sessions of a severe borderline patient, the authors present and discuss the communicative potential of destructive behavior in the transference relationship during treatment. A step-by-step analysis and the working through process of the therapist's countertransference led the authors to recognize several complex dynamics of the patient's pathological organization and to the containment and first representation of unsymbolized early anxieties generated during the original encounter with the object.

Reading Winnicott: return to the concept of regression to dependence.

Drawing on Winnicott's renowned concept of regression to dependence, the author elaborates on both the creative potential and limitations of this notion, examining some theoretical and clinical contributions from his own psychoanalytic practice with neurotic and psychotic children. First, the author questions and discusses the theoretical difficulties that arise in the conception of regression to dependence. In particular, he analyses the matter of psychic temporality and passivity. Second, the author considers how analysts can receive and foster the regression to dependence, and examines the use of limited physical contact in the treatment of severely disturbed children.

Towards and beyond the Pillars of Hercules: Integration and transformation of destructiveness in child psychosis (the case of Amine).

Drawing on detailed clinical material taken from the first two years of the psychotherapy of Amine, a six-year-old psychotic child, the author shows how the destructiveness of the most extreme clinical realities can be transformed and integrated in the course of the treatment. During the first period of the treatment, the patient's continuity of being was missing and he could not control his body and actions. In this situation, destructiveness was Amine's only way to express and communicate the devastation of his inner world. Amine's mind sought a container that might be able to receive, tolerate and symbolise his destructiveness. Thanks to the stability and reliability of the setting, together with a careful work of binding, a first border between inside and outside and between self and other could be developed. This led to the emergence of intrusion and persecutory anxieties and Amine's original destructiveness was transformed into hate and rage. Separation was furthermore experienced as intolerable and ultimate abandonment. Only through a thorough process of working-through pertaining to the analyst's countertransference could this impasse be overcome. Eventually, Amine could symbolise, through a dream, the possible acknowledgement, acceptance and integration of the borders that substantiate the existence of otherness.

The dead part: An overfulness of emptiness-Some reflections on psychotherapy with young psychotic patients.

Drawing on his experience of psychotherapy with psychotic children and adolescents, the author puts forward and discusses the idea that a psychically "dead part," "an overfulness of emptiness," lies at the core of the psychotic self. Through the presentation of his clinical work with Aldo, a psychotic adolescent, the author shows the deep sensorial, perceptive, presymbolic, and consequently preverbal nature of these originary psychic nuclei, together with the hard work that allows them to emerge during treatment. Moreover, the article focuses on regression-to-dependence phenomena and analysis of the primitive bodily features of countertransferential dynamics in work with these patients, which may be linked to the emergence of the "dead part" in the analytic relationship. The analyst's psychosomatic experience that characterizes the encounter with these intense anxieties, together with the complex work of figurability that the analyst has to perform, is examined and discussed.

Pliable Media as Transitional Space: From Psychotic Indifferentiation Toward The Construction of Meaning in Schizophrenia.

Clinical material from the treatment of a highly destructive schizophrenic patient is used to demonstrate the role and function of therapeutic mediations in promoting transformation and symbolization. Use of the Squiggle Game as a therapeutic mediation is shown to sustain the therapeutic process and to facilitate working through of the obscure and complex dynamics commonly seen in the treatment of psychotic patients. The Squiggle Game presents a first transitional space entailing both the concreteness of psychosis and the potential for symbolization provided by psychoanalysis. The game becomes the first meeting ground for the progressive encounters of the therapeutic couple, primarily because in it the violent destructiveness of psychosis is partly deflected in a way that fosters development of the transference relationship. Step-by-step emotional transformations gained through the Squiggle Game are reported and discussed, together with the patient's need to rely on nonverbal communicative modes to bring early traumatic experiences that never reached verbalization into treatment. This working through process furthered development of the dyad's intense transference-countertransference dynamics, which stimulated construction of a link between here-and-now and there-and-then in sessions, leading to the patient's integration and a sense of the life-historical significance of her experience.

ON BECOMING ABLE TO PLAY: INDIVIDUAL CHILD PSYCHOANALYTIC PSYCHODRAMA AND THE DEVELOPMENT OF SYMBOLIZATION.

In this paper, the authors analyze the relevance and transformative potential of individual psychoanalytic psychodrama in the treatment of children with severe impairments in symbolization. Central features of this modality, including promoting the representation of early traumatic experiences, are presented and discussed. Specific features include double-envelope containment of the co-therapists' group and play leader, consequent diffraction of the transference-determining portrayal, gradual integration, and initial figuration of coexisting split-off fragments. Drawing on in-depth clinical material, the authors show how psychodrama tempers the potentially traumatic effects of the encounter with the object, allowing these patients to access the transitional area of play.

On Interpretative Experiences: Unconcious-to-Unconcious Communication Through Reverie, Language, and the Setting.

Interpretation has been looked upon for decades as the analyst's central tool to promote transformation, and it was intended as a synonym for making the unconscious conscious. Nowadays, work with patients with unrepresented mental areas has become more common and the classical conceptualizations require broadening. Reflecting and retrieving the original acceptations of Freud's word Deutung, we suggest the existence of "unconscious-to-unconscious" communications that we shall call "interpretative experiences," which can promote transformation through nonverbal communicative modes, thus getting in touch with more primitive mental functioning. Drawing on case material, we discuss the transformative function of reverie, language, and the setting within the framework of the post-Kleinian and French psychoanalytic model.

On "free associative activities".

Free association has been at the heart of the analytic process for decades, though nowadays the work with borderline and psychotic mental functioning has become more common. We discuss and compare contributions from the Kleinian and the French psychoanalytic models regarding the role of free association and the analyst when working with these disorders. Drawing on case material, we suggest a broader conceptualization of free association--free associative activities--which encompasses communications that cannot be expressed through verbal modes because of their primitiveness. Their working through in the analytic couple could allow a first representation of unsymbolized early psychic traumas.