Tag Archives: young people

Working in Therapy with Adolescents and Young People: What is different? Key points of understanding.

On 25th April, a group of 16 therapists of varying disciplines and experience attended a seminar presented by Professor Stephen Briggs (whose books include: Working with Adolescents and Young Adults: A contemporary psychodynamic approach (2008).

We had had the opportunity to download 26 of his slides which offered a framework for the discussions.

In the process of working with this age group, we understand that we have to do things differently from our work with child and adult populations, outlined as follows:

THERAPEUTIC STANCE:

  • Providing a combined containing and exploring space..(containing anxieties and exploring meaning).   This combines taking in the feelings, making sense and feeding back whilst ‘holding’ urgency and anxiety.  Also, enabling the young person to tolerate the ups and downs, extremes of excitement and depression;  facilitating feelings of overwhelm and omnipotence, and taking these things seriously.
  • Being ‘adolescent-centred’..trying to understand the adolescent ‘world view’, without making assumptions about the adolescent’s knowledge or experience of the therapy process.  This includes noticing how quickly adolescents can change and how stuck they can be in the developmental process. The therapist is required to take on the ‘in-between-ness’ of the client, moving responsively between more adult/more childlike states as they occur.  Working with the ‘yes’ adolescent and the ‘no’ adolescent.

WORKING WITH DEPENDENCY:

  • Stephen Briggs explored the delicate issues around the adolescent’s potentially fragile sense of independence where the offer is to share with the therapist what is his, what can he share? What does the therapist need to know; what can be private and acknowledged as private?
  • The therapist needs to work out what the adolescent can and can’t bear, adapting to the fragile sense of separateness from parental figures, his aloneness in the world and the responsibility of his own thoughts and actions.

BECOMING A SUBJECT IN ADOLESCENCE:

  • ‘Being subject to’:  things happening, re-enactments and repeated patterns through change…(puberty, relationships, peer groups).
  • ‘Being subject of’: something that’s going on emotionally and rationally – relating to experience, learning from experience.
  • ‘Becoming a subject’ – the process of gaining ownership..new adult, sexual body, ownership of one’s own thoughts. Ownership of drives, sensations, impulses, feeling and powers. With ownership of bodily changes comes both power and the power to enact. Power relationships evoke different capacity to enact thoughts and feelings.
  • Increased separateness from parental figures at the above levels.
  • From neuroscience, we’re told that with brain development, the slowest capacity to develop is the capacity to reflect.
  • For Separation and Individuation at one end of the axis and Regression on the other, there are transverse opposites:

Self -esteem and competence.   Vs.  Fear of failure
States of mind (subject to).          Vs. Subject of
Power.                                              Vs. Dependence
Life.                                                   Vs. Death

So the binaries in the adolescent process are:
– Excitement v Loss
– Love v Hate
– Life v Death
– Online v Offline
– Powerful v Dependent
– Competence v Fear of Failure

The retreat from death can lead to omnipotence and/or the need not to fit in with convention.  Online/offline ambivalence engenders both omnipotence (with the provision of answers to problems) and the defeat of omnipotence (when the adolescent can’t solve the problem).

An example:
Exploring on line = securely attached
Looking for ‘belonging’ online = less securely attached.

These are part of the dichotomies to be held in mind through the therapeutic intervention in adolescent work.

We had a further three case studies to consider, discuss and apply the learning from the presentation as well as from our own experiences.

WORKING WITH TRANSFERENCE AND COUNTER-TRANSFERENCE:

In the transference:

  • drawing attention to connections between the social world and the therapeutic relationship.
  • making formulations about relatedness, maternal and paternal transference.

In the counter-transferential space:

  • what are we picking up as therapists of the adolescent feelings? What feelings are we evoking?
  • what about me is getting in the way of this work?

So what is both going on in the therapist and what from the adolescent is stirring up feelings in the therapist?  Much of the rich discussion from the case studies surfaced transference and counter-transference explorations.

Appropriately we talked of endings, particularly from the last case study where breaks in the therapy and missed sessions brought important material for therapeutic thought.

Stephen said ‘there is always something about separation with adolescents…in the therapeutic relationship, we replay through separation from the therapist, those other issues of separation’. ‘We are introducing the adolescent to him or herself’.

By: Angy Man, March 2017