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Record: 14



Title:
Coming of Age: The Adolescent in
Psychotherapy.

Subject(s):
ADOLESCENT psychotherapy; COUNTERTRANSFERENCE (Psychology); TRANSFERENCE (Psychology)

Source:
American Journal of
Psychotherapy, Fall99, Vol. 53 Issue 4, p544, 8p

Author(s):
Braski, Karla M.

Abstract:
Psychotherapy clients in their adolescence are
receptive to self-exploration. When given the opportunity to reduce
external distractions and directives, these young individuals are serious
seekers of emotional well-being. They also seek quality and genuine
interpersonal relationships. Gentle guidance within a safe container
encourages adolescents to explore their inner world. [ABSTRACT FROM
AUTHOR]

AN:
2797301

ISSN:
0002-9564

Note:
This title is not held
locally

Full Text Word Count:

2932

Database:
Academic Search Premier

Section: REFLECTIONS

COMING OF AGE: THE ADOLESCENT IN
PSYCHOTHERAPY
Psychotherapy clients in their adolescence are receptive to self-exploration.
When given the opportunity to reduce external distractions and directives, these
young individuals are serious seekers of emotional well-being. They also seek
quality and genuine interpersonal relationships. Gentle guidance within a safe
container encourages adolescents to explore their inner world.
Beware of adolescence! Oh, what a terrible, confusing time! Oh, if one can
only get through this period of one's life! Then all is okay, one has reached
adulthood and is safe from those turbulent teen years. The worst is behind us.
The only consolation we have is that "we've all had to go through it."
Adolescence is the unfolding and the self-exposure of a life within. An inner
world that is a mystery to be explored, a process. Alas, sometimes it is also
the death of many possibilities.
Adolescent clients entering psychotherapy often come with a defensive
attitude of having to spar with yet another adult who is going to tell them what
to do, how to do it, and when to do it. For many teens, this is an accurate
assessment of their relationships with adults. After all, we all know adults
have "been through it and know better and have answers because they're older."
Carrying out, and acting upon, such an attitude in contacts with teens will
likely undermine the young persons' sense of self. Granted, age and experiences
can cultivate an acquired sense of knowing, but it does not ordain one as
all-knowing or as being able to tell others how to live their lives.
In the last decade of the twentieth century, the therapist may be seen as
replacing the all-too-often nonexistent extended family. The role models and
mentors of years past were parents, grandparents, aunts, uncles, and elders--the
wise and gentle guides that helped young people make sense of the world. At
least when there was time to talk and time to listen. Not only the extended
family but also the nuclear family is disappearing in too many instances (1,
p.12). There are increased reports that teens living in two-parent families may
not have ready access to their parents either. Acock and Demo (1) have done
extensive analysis of family structure based on data from the National Survey of
Families and Households. Correlations are made between family structure, family
process, and a child's well-being (2, p. 118). This should not be interpreted as
recommending the therapist should assume a parental role. That would confound
and limit the relationship and its potential.
THERAPEUTIC ALLIANCE
The therapeutic relationship with adolescent clients begins in a state of
fragility. The therapeutic alliance can be defined as a developing relationship
in which both participants find themselves in an unconventional mode of being
with another person. Bugental (2) describes the therapeutic alliance as "a bond
between what is best and most dedicated in the therapist and what is most
health-seeking and courageous in the client. It will have many other elements in
it at various points, but this is its essence. Each partner to the alliance will
fall short at times of being all that it demands and yet it must endure" (p.
72).
Developing a therapeutic alliance with clients of any age requires the
therapist to have a sense of presence (2, pp. 36-38; 3, pp. 156-162). The
therapist's ability and willingness to be fully attentive to the client
encourages trust and openness. There are no elaborate techniques or methods that
will replace the therapist's sincere and genuine interest in the other person's
plight. There is an interference with the therapist being present if he/she
carries preconceived notions and judgments or is preoccupied with diagnostic
checklists. Adolescents have an inherent ability to detect "fakes," people they
perceive as only pretending to be concerned or to care.
HONESTY AND TRUST
Andersen (4) exemplifies the natural honesty in children in his classic
story, "The Emperor's New Clothes." The unspoken pact of silence and denial
among the adults is exposed by an innocent child. The fairy tale reminds us of
the restrictions imposed upon people through the process of "proper
socialization." Socialization may be needed to provide a degree of order in
social groups but, simultaneously, it can teach denial and avoidance in the name
of "politeness." Hillman (5) comments on the confines placed on young people and
consequent reactions. "[Societal rules] can prevent direct experience so that
life takes on that quality called 'phony' by the young, who, because they are
still capable of immediacy, resist with violence the caging of their pristine
vision in the ready-made traps of adult avoidances" (p.168). The therapist needs
to be truly accessible for adolescents to share the perceptions of their lives
and the concerns it holds for them.
Most adolescents in the therapy office take the process very seriously. They
may not readily manifest concern but inwardly they have contemplative questions
about their lives.
Therapist and adolescent client are in a parallel process of assessing one
another. Questions passing through the adolescent's mind may be: Does this adult
really care? How reliable and trustworthy is he/she? Will he/she be able to
really understand me and, if so, can he/she help? It is common for adolescents
to carry an increased sense of vulnerability and, unfortunately, a decreased
sense of self-trust. These elements lead to the fragility of the therapeutic
relationship. Therapists need not waste time by verbal reassurances and
guarantees of trustworthiness because adolescents will make that decision for
themselves. Therapists' constancy, steadiness, and authenticity are the
hallmarks for the development of a therapeutic alliance (6).
TRANSFERENCE AND COUNTERTRANSFERENCE
When discussing the therapeutic alliance one must highlight the dynamics of
transference and countertransference. It could be said that therapy could not
exist without the processes most frequently referred to as transference and
countertransference. These concepts are often presented in the shadow of
cautions and "red flags." There is valid reason for therapists to be cognizant
of their own inner processes. Therapists' memories and, more saliently, the
affective response to such memories of their own adolescence can be helpful but
are not necessary to share with the adolescent clients. Adolescents need to
experience our presence in their adolescence, not in the memories of our own.
Here again adolescents will sense whether the adult therapists are really "with
them" or just passively listening and waiting to give directions of "how to get
through this phase of life." Empathy is a positive outcome when therapists
constructively use their awareness of transference and countertransference.
LEARNED RESISTANCES
Psychotherapists working with teenagers may see the following ways utilized
to resist the therapy process:
A learned defense to controlling situations and other people is the "silent
treatment." How many parents have forewarned me that the youngster said he/she
would come, but was not going to talk. So if, in fact, the adolescent chooses
this mode, we sit quietly together. I remind myself that I do not need to fill
the silence with what would most likely be meaningless words. Therapists can
easily fall into this trap, the trap of doing what the adolescent expects:
telling, lecturing, "getting in their faces."
As we sit quietly, the dynamics shift. The usual power of the "silent
treatment" over others, over the external world, is failing to operate. Instead
there is a shift to inwardness. As we sit in silence, we both have an
opportunity for thought and reflection on what is occurring within each of us
and between us. The alliance is in process.
Sometimes we need to remind ourselves of the special power of silence, as
extolled by the essayist Justin Isherwood (7): "Silence is how great emotions
work. Silence is why we can go to a funeral home and just sit there. The place
is so quiet you can hear the ticking of a wristwatch, and somebody's sob catches
on something deep inside us.
All the awful feelings a person can have are silent: sadness, melancholy,
hatred, disillusionment, despair, pity. Silence is not the only way to carry
hurt, but it's the most common.
Silence also is the core of wilderness. Silent is the night, the stars, the
crossing planets, the fiery meteor, the patient moon. Why then is humankind so
noisy, when to our witness all that is eternal and powerful, is
so...so...quiet?" (p. 25).
Another common defense of the adolescent client is to be argumentative. Being
disagreeable can be an effective defense and self-protective measure. Usually,
this method has kept people at a distance and has proven to be quite an
effective control method. The DSM IV (8, pp.91-94) label of oppositional defiant
disorder might be assigned if the adolescent has used this defense for a
designated period of time and has alienated authority figures.
For the adolescent client, the silent treatment or the oppositional mode may
provide protection but at the same time can create a sense of loneliness and
isolation, and inhibit growth.
The therapist and client need to become aware of the defensive patterns
already well developed by the adolescent. Bugental describes these as the
individual's "resistance" patterns. "Resistance is the impulse to protect one's
familiar identity and known world against perceived threat" (9, pp. 173-175).
Each individual develops a unique manner of getting around as safely as possible
in his/her world. We all develop a view of the world which is uniquely our own.
Upon this construction, we formulate patterns that will aid us in negotiating
our way through life. These patterns can be figuratively referred to as a
spacesuit (Bugental, in unpublished lecture, 1990). This spacesuit is a
protection from being totally vulnerable to the world. The same spacesuit that
protects one's life can also limit and restrict it. Being in the spacesuit
becomes comfortable due to its familiarity. We lose sight that there may be more
beneficial and fulfilling ways of interacting with the world.
THE EMERGING SELF
A brief background of the emergence of the self may shed light on the
adolescent's dilemma when in the therapy. George Herbert Mead postulates on the
"genesis of the self" in his posthumously published, Mind, Self and Society
(10). Among Mead's most notable achievements is his account of the genesis of
consciousness and of the self through the gradually developing ability in
childhood to take the role of the other and to visualize his own performance
from the point of view of others. In this view, human communication becomes
possible only when "the symbol [arouses] in one's self what it arouses in the
other individual" (p. 149). Mead correlates the development of the self to
relationships with those significant others surrounding the child. The essence
of the self is its reflexivity. The individual self is individual only because
of its relation to others (p. 134).
Children develop self-definition by interactions with significant others in
their world. They learn the language of symbols (verbal and nonverbal) that are
necessary for interpersonal relationships. During this process children are
developing a sense of who they are (i.e., the self-concept) and how they fit
into their relatively small world.
Adolescents are in a process of adapting to an everchanging world, both
internally and externally. The external world (e.g., family, peers, school, and
community) changes its expectations of adolescents. The fixed definition of a
child-self is being challenged to adapt to an expanding world. Adolescents may
suddenly feel that their usual and customary ways of relating are no longer
socially acceptable or appropriate. This contributes to the confusion and
uncertainty of the adolescents' internal world. Life is no longer as
predictable, and questions arise regarding the self and the interconnectedness
with the world. Bugental refers to this as the self and world construct (9, pp.
178-180). Adolescent psychotherapy often addresses this sense of
loss, the loss of identity. Psychotherapists can be guides in the exploration
process of adolescents redefining and expanding their identity.
THERAPEUTIC CONTAINER
The therapist's task is to be constant in maintaining a therapeutic container
(6). Within this container, the therapy occurs. The therapeutic container is
formed by clarifying limits and responsibilities of therapist and client. This
is done verbally and experientially. The therapist and client are developing a
mutual respect and trust. Respectfulness of the adolescent provides an essential
ingredient in the development of the therapeutic alliance. Within the respectful
environment the adolescent may, for the first time, realize self-respect; a
glimmer of being a separate individual worthy of respect and of having inherent
value. The container is crucial in providing a safe haven for self-discovery.
The adolescent needs to feel respect, trust, and safety in the therapeutic
process. Respect is a prelude to trusting and with trust comes a sense of
safety.
We have all heard the declarative statement: "That kid needs a good talking
to." I prefer the following: "Every kid needs a good listening to." As
adolescents are being listened to, without interruption or interpretation, they
begin to hear themselves, possibly for the first time, by listening to what is
emerging from within. During the "listening" sessions, adolescents have the
opportunity to let the noise and chatter quiet within. They are learning to go
inward and to discover the potential that lies within themselves.
When adolescents get a sense of their internal power they can alter part of
their spacesuit, old patterns and defenses are no longer relevant. This is the
emergence of self-identity and self-esteem. They can visualize themselves as
separate human beings with a unique identity. This is the process of
individuation. A healthy separateness can exist once adolescents acquire a sense
of self. Behaviors labeled as oppositional can be re-interpreted as attempts to
individuate from significant others. These may be the only means accessible to
adolescents to extricate themselves from a world of dependency. In therapy,
adolescents can open themselves to self-discovery as well as examining how they
effect their world. Adolescents are searching for what is meaningful in their
lives and simultaneously are trying to ascribe meaning to an evolving world.
Adolescents experience growth and enhancement in their lives by the process of
inward searching.
Psychotherapy with adolescents means holding a belief in the goodness of the
human spirit. Therapists guiding young people need to see beyond the colorful
costuming; to hear beyond, or in spite of, the loud booming music; and to feel
the excitement of the adventure of being an adolescent. The world is fresh
unexplored territory for each developing adolescent.
The therapeutic process with adolescents is not to teach conformity to
societal rules and roles nor to perpetuate complacency. The psychotherapist is a
guide, by the side of the adolescent, in a search for what will make life
meaningful to this unique individual, as well as learning to live in accord with
his/her world. Not to live by what should be, but by what is. A privileged seat
we hold, to be entrusted with the inner world of an individual on the threshold
of tapping unknown potential.
CONCLUSION
In my clinical practice of 23 years, many adolescents have shared their
private lives with me. In my personal life, my sixteen-year-old daughter, Sasha,
and her wonderfully alive friends have also taught me much about this time
called adolescence.
Adolescents present with concerns about their emotional health, as well as
interpersonal concerns. It is encouraging to witness their awareness and
motivation, which is manifested by their willingness to self-explore. An
existential-humanistic approach is applicable with many adolescent clients who
are searching for meaning and harmony in their lives. This therapeutic
orientation provides them with an opportunity to develop coping skills and to
enhance their capacity to participate fully in their lives. They have the
opportunity to recognize that taking responsibility for their lives means taking
responsibility for their happiness.
A therapist who can listen to the adolescent client without judgment or
prejudice encourages self-acceptance. Many young people lack role models or
mentors who can teach them about their humanness. This means to acknowledge the
joy and sadness; attributes and fallibilities; the aloneness and affinity of
being human. The polarities of life are tension-producing and can be more easily
accepted once recognized.
Psychotherapists need to be aware and preferably awake, in the Buddhist
sense; to have their senses open and to be mindful of what is present in the
moment. Adolescents naturally carry the capacity of aliveness, being in the
moment and being spontaneous. These are attributes that establish a foundation
for living a full and meaningful life. I've recently pondered the possibility
that adolescents are nature's gift to us, reminding us that life does not need
to be restrictive. Therapists need to revere life rather than imply that "it is
something to get through" one stage at a time.
REFERENCES
(1.) Acock A, & Demo D (1994). Family diversity and well-being. Thousand
Oaks, CA: Sage.
(2.) Bugental JFT (1978). Psychotherapy and process: The fundamentals of an
existential-humanistic approach. New York: McGraw-Hill.
(3.) May R (1983). The discovery of being: Writings in existential
psychology. New York: Norton.
(4.) Andersen HC (1837). The emperor's new clothes. Eau Claire, WI: Hale.
(5.) Hillman J (1965). Suicide and the soul. Dallas, TX: Spring.
(6.) Bugental JFT (1984). A pou sto for therapists. (Available from the
author, 24 Elegant Tern Road, Novato, CA 94949).
(7.) Isherwood J (1994). On silence. Wisconsin Natural Resources. Madison,
WI.
(8.) American Psychiatric Association (1994). Diagnostic and statistical
manual of mental disorders, 4th ed. Washington, DC: American Psychiatric
Association.
(9.) Bugental JFT (1987). The art of the psychotherapist. New York: Norton.
(10.) Mead GH (1934). Mind, self and society. Chicago, IL: The University of
Chicago Press.
~~~~~~~~
By Karla M. Braski, M.S.S.W., Private Practice. Mailing Address: 421 Third
Avenue East, Washhburn, WI 54891
Adapted by M.S.S.W.

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download, or email articles for individual use.Source:
American Journal of Psychotherapy, Fall99, Vol. 53 Issue 4, p544,
8p.Item Number: 2797301