About Adolescent Psychoanalysis
By Kimberly Scholefield Kleinman and Elizabeth Wasson
The patient reclining on a couch is the archetypal symbol of psychoanalysis. People who are familiar with child analysis know that the child patient expresses fantasies and thoughts through play and action. With adolescents, psychoanalytic treatment takes place at an in between stage, so some adolescents use play and action, and some adolescents may intermittently elect to lie on the couch. Mainly, adolescent treatment takes place face to face and the analyst talks with the teen about what he or she is passionate about. This is not only a great way for the analyst and teen to get to know each other, it is also helpful in promoting the crucial developmental transition towards using language – symbolic thought expressed through verbalization – to manage our feelings, and ways of relating to ourselves and others.
In normative development the preadolescent child is usually concerned with bodily changes which lead to questions about how they will feel about themselves in their emerging adult bodies. What kind of man or woman will they become? What would it mean to be short or tall? Will they be attractive? Will they feel attractive? Will their body perform the way they want it to in the sports they pursued in childhood? How will the changes in their body impact relationships with family and friends? How will they be viewed by the world at large? Along with their concerns about personal gender expression is a concern for a partner: who will want me; who do I want?
Friends become important in a way that they weren't before. In a younger child’s life the most important relationships are with people in authority: parents, teachers, sometimes even older siblings. The younger child may demonstrate his connection to these authority figures through compliance. The preadolescent, however, is beginning to make a shift towards feeling connected to people who will not dominate him or her. In striving for greater independence will the teen have to be rebellious and out of control in order to demonstrate that she is no longer her “little,” compliant self? Will the younger adolescent allow himself to be dominated by overbearing peers? Will he find comfort in mutuality and equality? The transition to a world of peer relationships can be fraught with the dangers of finding opportunistic others who wish to dominate, or by the teen trying to dominate others, which may result in frustrating and isolating rejection.
Most parents immediately recognize a palpable change in their relationship with their youngster as adolescence is approached. Whereas the younger child frequently thinks in terms of “super heros” or other ideals, the adolescent recognizes that ideals are a goal, not a reality, and this can lead to a great sense of dislocation and loss. Adolescents without the prerequisite skills or strengths to face the changes in their bodies, the increased complexity of their relationships, their altered outlooks on their expanding world – including their increasing responsibilities – will run into conflict and may become symptomatic. Social withdrawal, academic problems, self-harm, fighting, and other kinds of acting out are common indicators of this predicament. At this juncture consultation with a psychoanalyst would be appropriate to try to understand what will be helpful in getting the adolescent back on track.
Frequently a recommendation will be made for treatment a few times a week. Many parents and teenagers feel this recommendation is an indication of extreme psychopathology. It is not. The recommendation is made because learning is more durable and efficient with consistency and frequency -- the reason, for example, that youngsters attend school five days a week. The psychoanalyst understands the teen’s need to be back on track as soon as possible in order to moderate the distress experienced when teens feel different and isolated from their peers. As Malcolm Gladwell’s book “Outliers” highlighted, the more hours put towards a goal, the higher the likelihood of success. Success in psychoanalysis is measured in the capacity to think about oneself in a realistic way and to express oneself in words in a way that promotes self-regulation, connection and self protection. Psychoanalytic sessions are individual workshops to achieve these capacities.
Another aspect of adolescent psychoanalytic treatment is working together with parents. Parents are an important source of information about the difficulties their child is struggling with. The analyst can help parents think about the typical developmental tasks that teens need to master. Together the analyst and parent team can integrate the parents knowledge about their child and the analyst’s knowledge about how the unconscious mind works. Together they can craft a narrative that accurately describes the complexity of the internal struggles the teen is facing, and this is instrumental in helping change take place. Often it is not only the teen that benefits from this process, but parents as well, as they become more clearly aware of how they conceptualize their child. More often than not, the struggles of a teenager stir up the struggles the parents themselves experienced in their own adolescence. Distinguishing between who their adolescent is and who they may fear the adolescent to be, as well as coming to terms with whose struggles are whose can alleviate much distress for parent and teen. In this way, psychoanalytic treatment becomes an opportunity for parents and their children to understand their family in a deeper way and thereby creates new pathways for change.