The Challenges of Potential Destructiveness in Designing a Therapeutic Framework for Adolescents with Anorexia Nervosa

Abstract

The authors begin by presenting the epistemological foundations that enabled them to design a therapeutic mediation framework aimed at enhancing the treatment of hospitalized anorexic patients. This unique framework utilizes bodily exploration through sound and music vibration. The authors were inspired by a method of dynamic structuring of the body image through clay modeling, created by Gisela Pankow, and by the bodily aspects of the subject’s relationship with the object in transitional phenomena and in playing, as elaborated by Donald W. Winnicott. A detailed account of a clinical experience with a young female patient highlights the way in which the framework helped reveal destructive fantasies linked to scenes of psychic conflict.¹

Keywords:

• Anorexia nervosa
• aggressiveness
• destruction
• drive
• body
• object
• therapeutic mediation
• music
• vibration

Notes on Contributor

Gabriela Patiño-Lakatos is a clinical psychologist and a postdoctoral researcher both with the Lutheries-Acoustique-Musique team (LAM) at the Jean Le Rond d’Alembert Institute, Sorbonne University-CNRS, and at the Transversal Research Unit in Psychogenesis and Psychopathology (UTRPP), University of Sorbonne Paris Nord, France.

Cristina Lindenmeyer is a psychoanalyst and professor of psychopathology at the Transversal Research Unit in Psychogenesis and Psychopathology (UTRPP), University of Sorbonne Paris Nord, France.

Irema Barbosa Magalhaes is a clinical psychologist and postdoctoral researcher, Center for Research in Psychoanalysis, Medicine and Society (CRPMS), University of Paris, France.

Aurélie Letranchant is a child psychiatrist, Adolescent and Young Adult Department of Psychiatry, Institut Mutualiste Montsouris, France.

Hugues Genevois is a researcher with the Lutheries-Acoustique-Musique team (LAM), Sorbonne University, France.

Benoît Navarret is an Assistant Professor, Institute for Research in Musicology (IReMus), Sorbonne University, France.

Maurice Corcos is a professor, University of Paris, and a psychiatrist and the Director of the Adolescent and Young Adult Department of Psychiatry, Institut Mutualiste Montsouris, France.

Acknowledgment

The authors would like to thank Dr. Pablo Votadoro for his support and fundamental contribution to carrying out this research at the Adolescent and Young Adult Department of Psychiatry of the Institut Mutualiste Montsouris in Paris.

Notes

1 This work was partially supported by a grant from the Fondation de France.

2 This project was coordinated by Professor Cristina Lindenmeyer. It was approved by the Ethics Committee of the University of Paris (CER-PD: 2019-39-BARBOSA). All mandatory safety procedures have been complied with in the course of conducting this research experience. Patients and their parents have given written consent to the inclusion of material pertaining to themselves without being identified via this article; they are protected through anonymization.

3 At the Institut Mutualiste Montsouris, the separation stage generally denotes the first phase of hospitalization in the treatment contract. During this period, the patient is not allowed visits by friends or family.

4 Since the psychologists were both of South American origin, associative references to the tribes of the Amazon and to the countries of Southern Europe—linked to sounds and music—included places that aroused desirous curiosity and enjoyment for several patients. These themes did not emerge with our patient Kate; it was not easy for her to enter the room and she draped herself in her solitude. However, the psychologists were sensitive to the insistent (eye-to-eye) gaze of this patient, who in this way sought the attention of one of them. The other psychologist served as a more silent and distant physical presence, bringing to mind a third party who sometimes intervened in the two-person relationship. Certain difficult situations with patients who expressed psychic inhibition of the capacity to play (“I don’t know what to do”) or an attack on links (“it isn’t satisfying”) were interpreted by the psychologists as unconscious requests addressed to them, asking for reassuring intervention (e.g., “Can you do it for me? [play sounds]” a patient asked as she lay in a fetal position). The fact that most of the patients continued to come to the sessions indirectly expressed a link with the psychologists.