The Home for adolescents between 13 and 17 years of age, which has been functioning for 15 years, is an externalised treatment/study center attached to the Vallée Foundation. The treatment program has been progressively modified as the profiles of patients have changed over time. Our desire is to keep these adolescents – all of whom present serious personality disorders – as well integrated as possible in the ordinary milieu so that they will accept the intensive psychological treatments which had been previously refused. The contrast between a concentrated therapeutic set-up (this home for 13- to 17-year-olds is a ward featuring full time hospitalisation) and a weak constraint for the patients to stay (each patient comes and goes from the ward many times a day) is quite well adapted to borderline troubles, but it can cause numerous difficulties for the health care team. While conceiving of a framework which would be acceptable to recalcitrant patients, we have often gone beyond our expectations: the young patients « burrow into us » until they make a « hole » in the health care team. How far should such a regressive movement be accompanied? When does it become necessary to impose the outside rules to calm the always latent disorganization within? These are among the questions which remain unanswered during our institutional reunions and they will be presented here.
- borderline personality disorders
- therapeutic home
- healthcare staff
- institutional therapy