Résumés
Résumé
S’il est généralement admis que le traitement des troubles de la personnalité constitue une entreprise souvent parsemée d’embûches, les connaissances sur les défis et obstacles de l’intervention associés au traitement des troubles du groupe A du DSM demeurent limitées. Le présent article se propose d’illustrer ces difficultés à partir de l’étude du suivi d’un patient présentant un trouble de personnalité schizoïde, qui a bénéficié pendant plus d’un an d’un traitement psychodynamique. Les vicissitudes de ce suivi permettront d’explorer les angoisses relationnelles profondes qui peuvent compliquer le traitement de ce trouble, et comment ces angoisses doivent être prises en considération dans les interventions. Les enjeux contre-transférentiels puissants suscités par ces patients seront approfondis, en particulier ceux générés par les silences prolongés et la gestion constante de la distance thérapeutique optimale. L’article propose également une réflexion sur les limites de la conceptualisation actuelle du trouble par les modèles catégoriels comme celui du DSM, et fait ressortir comment une compréhension dynamique qui fait appel aux notions d’angoisse et d’ambivalence relationnelle peut enrichir le traitement.
Abstract
While treatment of personality disorders in general is often described as difficult and filled with many obstacles, knowledge is still limited regarding the specific treatment challenges for DSM’s Cluster A individuals. The purpose of this paper is to explore these challenges, as illustrated by the case study of a schizoid patient who underwent psychodynamic therapy for over a year. Deep and unconscious interpersonal fears that complicated treatment, and how these fears had to be taken into account in therapeutic interventions, will be explored. Strong countertransference reactions, especially those evoked by long silences and constant management of optimal therapeutic distance, will also be discussed. This paper also proposes some reflections on the limitations of DSM’s conceptualization of the schizoid personality disorder, and how a dynamic understanding of relational fears and ambivalence in these patients may be crucial to treatment.
Parties annexes
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