Psychodynamic Assessment of Psychosis in Adolescence

Abstract

Abstract. This article illustrates the 4-month follow-up projective case study of John, a 16-year-old boy hospitalized for below-threshold psychotic symptoms. Emphasizing the relevance of a psychodynamic approach to emerging psychosis, the authors briefly describe the psychoanalytical framework of the adolescent process theory as well as the French School projective method. The aim of the study is to show that this method of assessment does not fall into the criticized standpoints of naïve complacency or of excessive zealotry against early detection and intervention. On the contrary, the complementary use of both the Rorschach and the Thematic Apperception Test, alongside clinical interviews, was valuable in uncovering the complex heterogeneity of adolescent functioning. Results revealed core psychotic impairments of self-representation and thought processes as well as non-negligible psychological changes and transformation, which allowed for engagement in therapeutic treatments and reinforced a more positive prognostic outcome. Limitations regarding the short-term interval and the qualitative analysis of discrepancies are discussed.