Adolescent Psychoanalysis

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Adolescent Psychoanalytic Allies

Chapter 4

One absolute key to accomplish the difficult feat of analyzing an adolescent is that the analyst must have an ally in the patient. No ally equals no analysis. This is very difficult but accomplishable with adolescents.  As analysts, we all know that what we can analyze is the material brought to us by our patients. Many of us stray, however, widely from that practice. If one is able to limit his analytic work to investigating that material, chances of successful ally creation, with adolescents at least, escalate dramatically.

For example, in a first visit, a patient brought to me for analysis by his mother, said to me “my mother is a whore”. Such a statement could bring forth a wide variety of responses, depending on one’s theoretical school. If one were, on the other hand, to assume that in ‘truth’ the meaning of this statement needs to be found out. One possible piece of material at hand to examine is to try to find out what ‘whore’ meant to that patient. I said “I’ve certainly heard the word ‘whore’ before. But ?? shrug. “Well not a whore, but she’s really into telling me what to do, all the time. “Telling you?” “yeah. I mean about everything—where I go, what I can do, every-thing”.etc. “here?”. “yeah, I suppose. But at least you’re listening”.

I give this example to illustrate what I mean about forming an alliance. In this very brief interchange a number of things have happened. A dialog started, AND I’m not telling the patient what he means, AND I’m not arguing with the patient AND I’m not colluding with him. An environment of arguing with an adolescent makes ene-mies not allies. Telling him that what he thinks isn’t what he thinks, especially if what we tell him is based upon one our theories, in general, is ruinous.

Another example, this of how not create an ally but an enemy. (please remember that the content I say happened, is hearsay. My comments about that alleged session are my comments. The content of and comments about the second session are directly from my contact with the patient.)

A 14-year-old girl was sent to see a psychologist for ‘analysis’. According to the father, the patient had been caught sniffing ‘white out’ at school. The family also thought that she was not attending school. Moreover, she was rude to her parents. And, her parents were having many marital problems. Because of these factors and others, her father took her to an analyst. However, she didn’t want to go to any therapist, let alone an analyst.

She attended one session. In that session, the first and only session, she entered the consulting room and sat down. The doctor, in his first foray with his patient, told her that he was told by her parents that she was not taking care of herself. He, however was peeling and eating a banana. She told him that he was the one who was not taking care of himself inasmuch as he was eating a banana, which, she said, was full of pesticides. They argued about that, the therapist disagreeing with her assertion. She then told the therapist that she did not want to be there. (at the session) The therapist then said to her, in spite of what she had said, that “she was there because she wanted to be there”. His evidence was that she was still sitting there. She told him that she was only there because her father made her come. He said ‘no, you’re here because you want to be here because you are still here’. She asked ‘does that mean I am free to leave if I wish’? He said ‘yes’, but you’re not going to leave because you want to be here. She said I am not here be-cause I want to be here and walked out. He followed her out into the corridor saying ‘you’re not going to leave, since you don’t want to leave’. He kept saying that as he followed her down the hall to the elevator. And as the elevator door closed, he said, once again, ‘you’re not going to leave because you want to be here’. The closing doors nearly got him in the nose. The 14 year old never returned even though ‘she wanted to be there’.

To not investigate the “ride” of this patient was obviously crucial, and did not happen. The above example, while sadly sophomoric, illustrates that problem. This girl was eminently treatable. This analyst, probably unintentionally created an immediate and unnecessary debate and impasse. He was, if you will, telling the patient what she actually meant, ignoring what she actually said—-a fatal mistake with most adolescents.

This same girl was then brought to see me by her father as a last resort. The patients ‘ride’ at that moment was that she did not wish to be ‘there’ which she stated and as apparently she had stated before with the previous analyst. She said that there was nothing wrong with her. I said “‘Assuming that being the case, nothing wrong with you, why in the world did he bring you? (A question like this usually has a number of virtues. Firstly, and by far of greatest importance, it is a question about exactly what the patient has said. Secondly, it indicates that I was listening openmindedly. Thirdly, such a question does not inspire an argument nor is it argumentative. Fourthly, this question is not artificial, but respectful. I sincerely wanted to know why she was there. Fifth, such a question will almost always lead to the patient explaining their version of events, their ‘ride’. And, finally, such a question virtually always cements one’s relationship with the adolescent, for all of the above reasons.) She said that her father had said, “because we have serious trouble at home”. serious trouble?, I asked. My parents fight and argue all the time and my father is having an affair(s). Affair?. We are always hearing about them at home”. “?” “I don’t know. The stories are sickening. The fact that we even talk about them is more sickening”. Part of ‘serious problems?’ ‘For sure’. Others?. “They say I am always the problem”. Always? She says ‘they say I’m a drug addict, that I never go to school, am failing, etc.” “A real flop, eh?” “No, I sniffed some white out once. I never use drugs or smoke. I also attend school regularly and am getting all A’s”. “confusing” ?Absolutely, if you’re confused, you can imagine how I feel”.

In the second encounter of this adolescent, in this instance with me, I encountered the same or similar pronouncement—“I don’t want to be here”. Differently, however, I did not challenge this pronouncement, but asked about it. I had an ally and a patient, virtually on the spot.

These ideas are extraordinarily important in the analysis of an adolescent, and I wish to pay special attention to them. The statement by the patient is the ‘truth’ of the patient at that point in time. I think it is crucial to understand that idea. By ‘truth’ I don’t mean the actual truth of the content of the statement. In the model that I am discussing, such a truth, at that point in time, is irrelevant.

This first analyst apparently made two serious and treatment ending mistakes. He ignored the initial ‘truth’ altogether, and guessed, somehow, the actual meaning of the content of the statement. As I imagine it, he decided that her initial statement was false, was a pack of lies, or meant to be provocative and, therefore, ignored it. Then, he told the patient what the content of her statement really meant—that she actually wanted to be there which was shown by the presence of her body on a chair

To not investigate the “ride” of this patient was obviously crucial, particularly with adolescents. The above example, while sadly sophomoric, illustrates that problem. This girl was eminently treatable. This Dr. unintentionally created an immediate and unnecessary debate and impsse. He was, if you will, telling the patient what she actually meant which was not what she was saying, a fatal flaw with most ado-lescents even though an accepted analytic technique of most of us analysts with ‘grown-ups.

In the second encounter of this adolescent, in this instance with me, I encountered the same or similar pronouncement—“I don’t want to be here”. Differently, however, I did not challenge this pronouncement, but asked about it. I had an ally and a patient, virtually on the spot.

These ideas are extraordinarily important in the analysis of an adolescent, and I wish to pay special attention to them. The statement by the patient is the ‘truth’ of the patient at that point in time. I think it is crucial to understand that idea. By ‘truth’ I don’t mean the actual truth of the content of the statement. In the model that I am discussing, such a truth, at that point in time, is irrelevant

Traditional interpretations virtually always have the effect of interrupting or perverting the expression of and understanding of the ‘ride’. Further, to adolescents, they sound contrived. They sound theoretical, which they are. Further, and particular importance, is that there are obviously many “rides” in each session, part of each session, about each session, a concept that is often forgotten.

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