A Therapeutic Intervention With a Borderline Adolescent: The Inclusion in an Educational Community as a “Speaking Action”

Aims: A fundamental concept in Racamier's thought, concerning psychotic patients and their families, consists of the efficacy of speaking actions (Racamier, 1998). The speaking action acquires sense and meaning for those clinical situations in which words cannot speak, nor communicate, and interpretations hurt, attack, represent violence, or are not heard. This report aims at presenting an example of such therapeutic strategy for a 16 year old adolescent with borderline features who, becoming progessively withdrawn, has always refused any kind of intervention or treatment. This youngster's developmental history is of a relational environment saturated with “enactments” substituting for thought, determining difficulties in building significant relationships or any empathic trust with the significant adults in his life. Method: The intervention carried out by the staff started with speaking actions, rather than words. The report focuses on managing a moment of crisis in which the youngster asks to be rushed and put in a community structure. Results: The clinician, instead of interpreting the request as an “enactment” provoked by feelings of guilt or escape, considered it a speaking action” (Racamier, 1972) requiring attention without prejudices. In a personality structured by borderline characteristics, this intervention seems to confirm the necessity to find syntonic responses to the needs of the self, initially mediated by containing and affective action. This way of facing the crisis made the encounter with the therapist and the psychosocial team possible, while they offered themselves as adult models, truly interested in him and his life. This enabled him to gradually reactivate his vital functions and try out the experience of “relationship”. Conclusions: The symbolic action of accepting the request and the fact the psychosocial team presented themselves as a thinking group to the youngster, represented, for Luca and the other members of his family, the narcissistic container allowing him access his own inner world. Luca was able to start an individual psychotherapy process, opening himself up to and facing the work to be done to heal the relationship with his parents.