Establishing a therapeutic relationship: An initial stake in psychotherapy with young psychotic adults

Although psychosis and psychoanalysis have been closely linked since the earliest Freudian theories, the psychoanalytic treatment of psychotic states still presents major difficulties. The establishment of a therapeutic situation allowing the deployment of psychic work is still uncertain. The resumption of the work of S. Freud and DW. Winnicott associated with the development of the theorization of a metapsychology of the process of symbolization by the French school (Green, Roussillon) allows a revival of the reflection on the stakes of the establishment of the therapeutic situation. This theorization of representative processes makes it possible to consider the psychotherapeutic approach to psychoses from the angle of a "psychopathology of the psychic apparatus" and thus to model the psychic dynamics involved in psychotic problems which initially appear in a chaotic form. The apparent failure of the psychic processes, in their linking and transforming activity with which the psychotic states are confronted, can then be thought of as the seat of a particular psychic work that can provide essential support to the therapeutic work. Two cases studies illustrate these processes.