TRIADD
Teletraining Research and Information around Dual Diagnosis
TRIADD Case Studies
Case 4
CASE STUDIES PRESENTED DURING THE FRENCH TRAINING COURSE PARIS, JULY 2003
Presented by a training participant
Miss D is 30 years old. She was brought up by her father, her paternal grand-parents, pre-school assistants at the ASE (Aide Sociale à l’Enfance Socia Aid for Children)). Her life has been chaotic and she has also suffered mistreatment. Miss D has attained the CAP level (Certificat d’Aptitude Professionnelle – Certificate of Professionnal Aptitude) of administrative agent. She was recognised as a disabled worker. She has physical malformations and health problems. Miss D has had social support (suivi social) for several years provided by a support service. She has broken this support off several times.She presents with a depressive syndrome and ideas of persecution and visual/auditory hallucinations. She often has aggressive excesses. Miss D has made several suicide attempts this year. She is seen by a psychiatrist from the CMP. She tries to keep up an image of herself : a certain normality which « costs her dearly ».. She shows suffering. Miss D is very demanding : you have to be at her service, she can be disrespectful and very critical. She can be very pleasant and sociable. She demands her autonomy loud and clear, she doesn’t want to be mothered but demands 100% care/support.Miss D has changed `guardian´ (curateur) and educator several times.
She often says she has been abandoned but she makes demands very quickly and is often in conflict with professionals..She wasn’t able to keep her job at the workshop because of her very frequent absences. Her demands are ambivalent in all areas..
Miss D is under reinforced guardianship (curatelle renforcée) for reasons of her poor financial management which is very hard for her to accept. Today Miss D wishes to put an end to her social support. If she comes back, the team asks itself the question: which conditions and which proposals it could put to her?
Résumé of the issues
The psychological problem is predominant. This enormous `demanding’ is a core part of her personality.What we have here is the problem of the psychosis added to a very significant narcissistic wound (une blessure narcissique très importante…) from which comes the exponential demand for repair from the Other (d’où une demande de réparation à l’Autre exponentielle !) It is therefore a spiral without end.The question of limits comes up.This case study poses the question of limits in the support relationship. What is characteristic in this story is the ambivalence in the demand for help which translates itself into support offered by various services not working out (mise en échec) .
Questions discussed during the training
How to help her formulate a request for help and support ?Is it not important at a certain time to let one’s limits be known ? (from the point of view of professionals)
In this case, would it not be more constructive to reduce or rather to clearly define the offers of help ?
The person is not « stabilised », is ambivalent and the framework moves, also at her doing. Is this normal ? Is it not the problem of multiple services and one of overall coherence ? …hence the need for reinforced partnerships !
Without wishing to deny the possible positive evolution of this person, is it reasonable to let her knock at all doors and carry on running away? For once should we not reduce the choices on offer ?
What is the main problem ?
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