The transferential constellation, a puzzle of the projected psychic reality of the patient

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What is the transferential constellation? What is its purpose and what are the benefits for the patient? Nurse in child psychiatry, Kevin Peiro details in our columns its application and the tools necessary for its analysis, but also the role of the nurse in its implementation in mental health care service, in particular in children and adolescents.

Shortly before his nursing studies, Kevin Peiro first heard of Transferential Constellation in the book by Pierre Delion and Patrik Coupechoux My fight for human psychiatry ⁽¹⁾ . Working as a caregiver in UHTP (Full Time Hospitalization Unit) the concept seems to him at first sight to belong to the past despite its interest. In his second year of studies in IFSI, however, his internship in child psychiatry made him move from theory to practice and he changed his mind about the interest of the approach. He tells us why.

Puzzle metaphor

The Transferential Constellation is defined by Pierre Delion as … projected fragments of a psychotic subject. It is a question of bringing together what could have been the object of a partial investment of the subject in question, (…) so as to approach the different levels which constitute the projected psychic reality of the patient ² . Metaphorically, we could imagine the patient's psychic reality as a puzzle. A puzzle whose pieces would be the fragments of this so-called psyche. The distribution of these by the patient to the people around him (family, friends, doctor, nurse, etc.) would be more a matter of transferential relationships than hierarchical. Therefore, the reconstruction of this puzzle would go through the recovery of the different pieces from the people who own them. In fact, it is no longer the hierarchical position in the common sense of the term that takes precedence over the decisions to be taken for the patient, but the sum of the knowledge acquired. This new hierarchy is named by Pierre Delion: the Subjectal Hierarchy ¹ , which is however not there to replace the statutory hierarchy, but indeed to complete it.

Legitimacy of the nurse

In his work, P. Delion defines the Transferential Constellation as: a moment when we bring together all the people who carry, for each of them, a fragment of the discourse - not only that of language, but also that of the body - of that person ^. If we go back to our puzzle metaphor, it is as if five people, for example, each had five pieces of a 30-piece puzzle, some of which remained with the patient. Individually, it seems difficult to guess the purpose of the score; but the pooling of each person's pieces allows, even if some elements are still missing, to have a more precise idea of ​​the final drawing. The Transferential Constellation then makes it possible to obtain an image of our patient as a whole, and therefore a holistic approach to the latter. Still according to Delion, the transferential constellation would induce a containing function , which consists in thinking that the medical team would understand what the patient is going through while his family, the school, etc. would not have succeeded. This to finally bring to the interested party a support, a support, a control, a matrix, allowing him to experience himself as a unified and coherent whole ³ . The Transferential Constellation is constructed by and within the multidisciplinary team. As a result, each actor in the care of the patient can be the initiator or the contributor. The nurse, as a member of this team, is just as legitimate in its establishment as in its perpetuation. The approach can therefore be set up by a care plan drawn up by nurses: numerous within the teams, they can fulfill their role of mediator between the medical and paramedical team on the one hand and the institutions and institutions on the other. the parents. The privileged contact that they can show with a patient, as is often the case, is also an essential element in the analysis of this transferential constellation.

In the field

Let us illustrate the approach for a moment with an example from the field. The Ado 93 unit is a full-time hospitalization unit made up of 9 beds. It welcomes, on medical prescription, adolescents from 12 to 18 years old suffering from psychological or behavioral disorders. Unlike the general psychiatric units, it is not subject to sectorization. The large number of staff working on site in relation to the number of patients allows support in small groups or individually. Indeed, the structure operates on a ratio of one nursing staff for three patients. The unit has a team of many fixed professionals, which is made up of psychiatrists, nurses, caregivers, educators, a social worker, two part-time psychomotor therapists , a secretary and ASH (Hospital Service Agent). In addition, the structure welcomes three external contributors to lead workshops (an actor for the theater workshop, a photographer for the photo workshop and a singer for the music workshop). Finally, the structure has many partners such as the CMP (Centre Médico Psychologique), the Institut Médico-Educatif and the ASE (Aide Sociale à l'Enfance). The implementation of the Transferential Constellation cannot be done without tools, which make it possible to build the architecture of this very specific support. Here are the ones observed in this service:

Towards an adult constellation?

The Transferential Constellation allows a new approach to the patient with the aim of proposing a containing function to the psychic reality of the latter. Widely used in child psychiatry, in particular because it is based on a psychoanalytical approach to the patient, it would be completely appropriate to adult psychiatry and in particular in the management of psychotic patients. However, it would seem that she does not meet with the same success there because the neuro-scientific shift taken by adult services does not seem to play in favor of the consideration and analysis of the Transferential Constellation.

Ratings

1. DELION Pierre, COUPECHOUX Patrick My fight for human psychiatry . ALBIN MICHEL.DL2016.P272.
2. http://hypocampe2011.over-blog.com/
3. https://www.cairn.info/

Kévin PEIRONurse in child psychiatry

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