Restoring Meaning to Quantity: the Psychodynamic Clinical Approach to Addictions

Abstract

This interview with Professor Sébastien Yougbaré outlines the psychodynamic approach to addiction, viewing it not as a mere vice or molecular dependence, but as a deep unconscious mechanism. Drawing on Freudian thought and Gérard Pirlot’s definition, addiction is conceptualized as a self-therapeutic attempt to process through the body an excess of undifferentiated excitations that the mind fails to symbolize (alexithymia). Clinicians rely on structural failure models (borderline states, Winnicott’s theories, the Paris Psychosomatic School) and the new PDM-3 diagnostic manual to create a three-dimensional clinical formulation (Personality, Mental, Symptoms) centered on the patient's mentalization and agency. Finally, the interview emphasizes the need for a synergistic multidisciplinary approach (psychologist, psychiatrist, addictologist, and support network) and highlights the dynamics of transference and countertransference during therapy, where reenacting the addiction ultimately helps transform raw acting-out into stable internal regulation.