1st Edition

Transference in Institutional Work with Psychosis and Autism The Transferential Constellation

By Pierre Delion Copyright 2023

    Transference in Institutional Work with Psychosis and Autism presents Pierre Delion’s extensive experience in psychiatric institutions, focusing on the concept of the transferential constellation.

    Delion first discusses the pioneering work of François Tosquelles at the Saint Alban psychiatric hospital, which enabled psychoanalytic treatment to be applied in cases of severe psychopathologies. The book then explains how the transferential constellation can provide a deeper and more effective understanding of a patient’s needs by engaging all caregivers within an organisation over the course of the patient’s treatment history. Delion describes how regular meetings of all the team participants allow them to express different and even divergent views of the patient and to appreciate their complementary contributions to the institution. The transferential constellation is presented as an important development in the history of patient-centered psychiatric care and a touchstone for its ongoing humanistic development.

    Transference in Institutional Work with Psychosis and Autism will be of great interest to psychiatrists and psychotherapists in practice and in training. It will also be key reading for other practitioners and caregivers working in mental health institutions.


    The concept of transference in neurosis and psychosis

    Multi-referential transference and the institution

    Dissociated transference in adult patients

    Adhesive and projective transference in children

    The transferential constellation

    Historical overview of institutional psychotherapy

    Concluding remarks



    Pierre Delion is a psychoanalyst and Professor Emeritus of child psychiatry at the University of Lille, France. He is former chief of the Lille UHC Child Psychiatry Department, as well as the author of several books about babies, autism, psychosis and institutional psychotherapy.

    "This short, concise but dense book has the double merit of highlighting the essential aspects of post-war French psychiatry, and of giving us the hope of seeing it re-emerge from its quasi abandonment. The book focuses on the institution François Tosquelles set up in its initial form at Saint Alban: the transferential constellation. Pierre Delion defines it as 'the whole diversity of people involved in caring for a patient with an archaic pathology'.

    The concept of 'archaic pathologies’ was the foothold needed to introduce the transferential relation into a context of psychosis. Its extension to archaic pathologies, in adults and in children, was implemented gradually through 'multireferential transference' (Tosquelles) and the 'dissociated transference’ (Jean Oury).

    In the last chapter, the author formulates five practical propositions illustrating the psychiatric professional’s ethical position:

    • Assuming a 'desiring' position in his work
    • Ensuring the free circulation of individuals
    • Thus, promoting the free circulation of speech.
    • Inventing made-to-measure therapeutic methods for each patient
    • Promoting relative self-management of tools needed to implement psychiatric care"

    Jean-François Rey, Professor of Philosophy at the University of Lille, France, and expert on the history of psychiatry