63

The aim of a “good enough” assessment of psychological functioning is to enable appropriate therapeutic approaches to be chosen. Adolescents with chronic pain seen at the pain clinic present complex pictures in which somatic and psychological data are intertwined, not without links to the new sensoriality of puberty. Psychological examination and projective tests reveal a disturbance in body image, between formlessness and overflowing, reflecting difficulties in mentalization, lack of scripting and avoidance of affects. Paradoxical defences are put in place by these patients: cleavage and dissociation, and pain as the use of a weakened organic substrate. Psychotherapeutic indications can be deduced from this, involving work on representation and symbolisation.