Adolescent Psychoanalysis

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The Adolescent- As Whole Person

Chapter 7

The concept of ‘defense’ (negatives) in and of themselves is both confusing and, confining.  ‘Offense’ (positives) should also get proper billing, be seen, and noted.  Even a casual observation of life certainly shows that there are genuinely reality-based positives in life, perhaps particularly for adolescents.  Adolescents generally find a good deal more joy in life than most of us, some of which are and some not reality-based.   Not all their happiness is the product of delusion and grandiosity. In fact, many would argue that in life, including those of adolescents, positives far outweigh negatives. For adolescents the mass and volume of experiences of pleasure vastly outweigh negatives, most of which are based in reality.  Most people, including adolescents, live to find ‘positives’. Moreover, positives may also be the fuel to knowing the patient and to discovering problems that would otherwise go unnoticed.  Having both positives and negatives to search out would at least broaden the scope of our work—we would then have two categories in our patients’ associations on which to focus our attention—100% more.

Expanding our purview to include positives would make our work more realistic and broader.  If a ‘defense’ is designed to obscure, then it would follow that an ‘offense’ (positive) would be designed to illuminate.  All ‘defenses’ are not negatives. They certainly can be ‘positives’ in disguise. There are clearly times when a ‘defense’ has positive results.  There are also times when a seeming ‘positive’ is in fact a negative, and so forth. These various combinations and permutations of these states of mind can realistically only be determined by analyzing the patient.

These two categories, even if they could be usefully defined, are still limiting.  There are elements of adolescents and other humans experience, that cannot  be defined as positive or negative.  For example, there are elements that involve nei-ther the negatively or positively ‘valenced’ aspects of a person. They are ‘neutral’ but clearly important.  This area is probably where we live most of our lives. Further, clearly, what is neutral may become a negative or a positive.  Unfortunately, in our largely problem-oriented world of psycho-analysis, attention would be drawn to those elements only if they turned ‘negative’.  In present day analysis, we would be drawn to them only if they suggested that although they appeared neutral or positive, they weren’t. They could be deemed a resistance, a defense, denial, etc.  In that sense, our view of people is psycho-analysis decidedly negative.

We, therefore, are not treating the whole person, only their drawbacks (negatives).  This is, I hope, a further clarification of Dr. Grotstein’s earlier statement, roughly put, that we must treat the whole person.  A patient seen as only ‘negatives’ (problems) is simply not a whole person.  Neutrals and Positives must be included.  If all three are included, theoretically at least, we are analyzing the whole person.  There is no way to overstate the importance of this view when it comes to the psycho-analysis of adolescents.  If we fail to see what are positives and neutrals in adolescents, there can be no treatment.  The insistence on the ‘negative’ being both present and supervening defeats the analysis of adolescents. There really is more to them.  We don’t spend much time analyzing ego strengths, only weaknesses.

Our goal should be to analyze the ‘whole person’.  Of course, from a practical and philosophical point of view, we should not think in terms of categorizing the elements of an adolescent’s personality at all.  They are not good, bad and indifferent, although such divisions may be tempting.  Many find such divisions mandatory to be able to stand the thoughts and actions of adolescents. To think of them as a unified being is often unbearable since that ‘unified’ being is so uniquely unified. To see adolescents as fractured into parts makes the treating of them more palatable. We can hide behind the parts and not have to see the whole.  ‘That’ was done by the ‘bad’ part, not ‘that’ was done by the whole adolescent.

These parts can be integrated into a whole. If, contrarily, we divide people’s personality into parts, and look for parts we will then find evidence to support that theory. As said before, we are very good at finding evidence to support our theories. As Darwin put it, “judgment obscures observation”. This same Darwinian prin-ciple applies to ‘expectations’ and ‘pre-conceptions’, which are both judgments prevalent in our work.  If one knows what to look for, it will be looked for and found.  If we look for parts, we will find parts. Careful listening to an adolescent, based on our pre-conception that they are possessed of a severe and ‘unfathomable’ illness, will affirm our opinion.  They sound ‘crazy’ to us, they are known to be ‘crazy’, therefore they are ‘crazy’.  We must remember that we have all been cautioned for many years to make no diagnoses of adolescents, on the grounds that they were too disturbed to be diagnosed.

We all know of people who are “negative”.  They can find something wrong in anything.  We, as analysts, can find problems in anything.  We can find evidence of our ‘right’ thoughts in anything.  If we look for a ‘defense’, we will find a ‘defense’. If we learn and then look for examples illustrating our learned explanations of mental mechanisms, we will find them.  Hence, we will always find material supporting our theoretical stance.   Wedded to our theories, we have no chance to make observations, only confirmations.

These are some session notes from a very disturbed young girl.  One, in terms of a segmented her, would be tempted to think or her as a drug addict, who is promiscuous, brain damaged (from Meth), mistreated and misunderstood by her mother, having accused a drug puchaser of rape, and ‘slow’ but ‘bright’ young girl.  If she is looked as a part-object adolescent, the essence of her total self is missed.  She could be seen as a ‘bad’ girl, based on her history, more suited to ‘treatment’ in the justice system.  In the course of this book, there are other sessions of hers that are presented, giving many other perspectives on her.

This adolescent girl, 16 y.o., in two consecutive sessions with me, amongst other topics, told me material on one day which she ‘repeated’ the next day, but the content was considerably different. In session 1, she stated that her boyfriend was adamantly opposed to her bartering sex for drugs.  In fact, she said, if he knew he would probably kill her.

During the second session, the next day, the same topic arose - her talking about the same boy friend she had talked about earlier and the same topic which was him not being willing to allow her to barter sex for drugs. The content was considerably different, however. Now, he would ‘allow’ her to have sex with up to two boys for drugs.

When this topic arose again, I asked.

…………..“Did you notice that what you said about xx today was different than yesterday?” I asked.

Long pause

“yeah, probably, but I don’t remember” , she said

“What’s with that?”, I asked

“I have a lot of trouble remembering”, she answered.

I shrugged

Long pause

“I can’t get a picture of things any more. Like in class today.  I used to be able to have a picture of things.  I can’t do that now.  Everything is blurry. I have no picture of what the classroom looks like today.”, she said.

“picture” ? I said.

(a place where she would hang out/live and use lots of “yeah. You know, how things ‘look’.  Just before I came here today, I was leaving class and had no picture of how the room looked. I can remember things that happen,  I just can’t put them in order.  Like at the xxxxxmeth, amongst other drugs).  I remember things that happened there, but I can’t put them in order” she said.

“long time”?

Long Pause

“yeah.  I don’t know why?. Could it be drugs”  she asked.

“drugs” I asked.

“yeah.  Does meth do that?” she said.

I looked at her quizzically

Long Pause

“I’ve heard it does.  Lots of people at the xxxx really seemed weird.  They were crazy and couldn’t remember anything”

Long Pause

“When we talk, does it seem to you that there are long times between a question and an answer”  I asked.

“I know. That’s right. Lots of people, especially my mother, say that and speak for me.  They say that my mother and I are ‘enmeshed’ because she talks for me.  She can’t wait for me to talk”  She said.

“Wait?” I asked.

“Yeah, like doesn’t give me a chance to say what I think. I really do think, but slower” She said.

“slower?” I asked.

“yeah.  It may take me a long time”, she said

“Is what she says what usually what you were thinking?” I asked

“no” she said.

“do you argue?” I asked.

“No”, she said.

“Why do you think?” I asked

“I don’t know.  I just don’t do it” she said.

“Especially since you don’t argue, is there any way that I could tell if I’m doing the same thing you say your mother does—-not giving you enough time to put your thoughts together before I speak, perhaps seeming that I am speaking for you”? I asked.

“I don’t think so.  I only know when my thoughts come together when they have come together.  I don’t think you could tell until then” she said.

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Omnipotence and the Adolescent

Chapter 6

Part 2

Psycho-analysis tends to deal in defenses and confessions.  By ‘confession’ I mean that the unadulterated truth is acknowledged or revealed.  If confessions occur, then defenses are not considered relevant or present. Confessions are considered ‘real’ and the patient who ‘confesses’, ‘real’.  There is no repression, denial, etc.  Where id was, there ego is.  A patient caught up with defensive maneuvers, is not yet ‘real’, but neurotic.  The not ‘real’ person has not been released from the patient who is bound by neurosis, defenses, etc.  Hence, defenses are indicators of a not ‘real’ patient. ‘Positives’ and ‘neutrals’ (please see below) are of interest only insofar as they contribute to the emergence of the ‘real’ patient. The ‘confessions’ are occasionally acknowledged, but not analyzed. This state is the desired goal and end of analysis and therefore not analyzed. Realistic reality based pleasure is not analyzed. That state of being is not considered a problem and hardly contains the problems that the patients brought to us.  Freud’s Two Principles of Mental Functioning, the pleasure and reality principle, are only relevant to a point, that point being the successful analysis of the delusional pleasures of the neurotic patient.  Once the patient is successfully analyzed out of his hallucinated pleasures, neuroses and neurotic pleasure, the reality principal and genuine pleasure principle are no longer of concern. Termination can’t be far away.

Perhaps part of our problem, even though we may claim otherwise, is that we are doctors and they are patients and we and they subscribe to the medical model. We treat the illness of our patients, cure them, and send them along their way. We don’t treat non-problems, much as any other physician.  If a general practitioner is consulted for an upper respiratory infection, the consultation ends when the symptoms are relieved. 

For the most part, however, all of the above rarely, if ever, occur in an adolescent.  The adolescent, unlike his adult cohort, does not believe his analyst, accepts no theories, feels misunderstood, not listened to, and often ‘votes with his feet’ and departs. 

There seem to be numerous reasons why an adult would accept most of the statements and theories that adolescents won’t, is multi determined. The adult comes voluntarily.  The adult comes because they have problems. They seek us out for a variety of reasons.  We are regarded by many as the experts.  Further, we have status, education, the mantel of authority, are thought of as curative, etc.  All of qualities are both appealing and hope giving to our adult patients.

Each of these qualities from the adolescents’ point of view are not only not admired, but are regarded as monumental negatives.  Unless we can depart from our status, ignore our education, discard our mantel and give up on the idea that we are curative, no analysis of the adolescent can take place.  However, an extremely important point must be made.   Doing all these things must not be collusive, must not make us a ‘friend’.   We are and must remain mature psycho-analysts with unique qualities.

One might reasonably ask, how can one talk to an adolescent, who may very well have neurotic problems, without mentioning problems. For the most part adolescents do not come saying they have problems.  Thus, from there point of view, there are no problems to discuss. If an adolescent says they have problems, the problems are almost always contained elsewhere—mother, father, analyst, etc.  Strangely enough, though, the identification of problems is primarily the duty of the patient, helped by the analysis, which in and of itself seems wildly inconsistent.  As above, the patient identified one of their problems, discussed it somewhat, and then criticized me because of my being smart and educated, for not having pointed all this out to her before.  After all, she said, that is my job. They are not ‘defensive’ and usually only want to talk about their pleasures, which to them are real, not some hallucinatory part of delusional pleasures.

The challenge then is to talk with adolescents as they talk and not try to force upon them our understanding of their various pathologies in our language.  Principles that we hold dear, repression, denial, omnipotence, etc., even if correctly seen in adolescents as well as everyone else, are rarely directly addressable.  Direct approach often leads to a standoff between adolescent and analyst.  We think they are crazy.  They know we are crazy.  Hence, a battle of two ‘crazies’ ensues.  This battle takes place, as well, with no common language available.  Statements by the adolescent are both foreign and known to be signs of severe mental illness, and are therefore ignored or ‘interpreted’ not in adolescent language, but in our language—perhaps like French to a culturally challenged American. The statement, for example, from above, “I like to have group sex”, is unfathomable, wrong, dangerous, agitating, immoral, threatening to us. etc., and clearly a sign of severe mental illness, immorality, dangerousness, foolishness, amongst other things.  The vast majority of us will be horrified. If we can, in addition to the above activities, leave our horror aside, we do have a chance to discuss matters that horrify us. 

Before departing this section I would like to review an above statement: “Strangely enough, though, the identification of problems is primarily the duty of the patient, which in and of itself, seems wildly inconsistent”.  That this is so, as seen in some of clinical vignettes that have been given, requires a variety of qualities: the quality of the relationship is crucial; modesty; attention; listening to; open mindedness; empathy; sense of humor; curiosity and so forth.  (I will have a good deal more to say about each of these qualities later in this book.( Once self-diagnosis, in whatever form is made, the conversation shifts dramatically.  There is now an identified by the adolescent issue.  Discussion and clarification are asked for, not by us, but by them.  If debates ensue, for example, the debate will be originated by them.  They may wonder, for example, what are our issues.  Why don’t we get it right?

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Omnipotence and the Adolescent

Chapter 6

Part 1

Ordinary ‘defenses’ with which we are all familiar, are often seen in these dialogs. They are explored as with any other part of the dialog. It is on this very issue, however, upon which the analysis of adolescents often founders. How material is addressed, to adolescents at least, is crucial. The temptation for many of us to identify defences presence directly to the adolescent is great. For many of us, this is why we went to school. Defenses, mental mechanisms, transference, psycho-analytic theories, what the patient ‘really’ means, etc. were our lessons and are as seductive to us as can be imagined. Perhaps our lessons can be envisioned as Sirens beckoning to us, demanding we use our lessons, concretely, lest we be blinded. No Siren worth its salt beckons us to use these elements of our training as only a background to our work. However, what makes the experiences and ideas that are put forth in this book unique, is that the Siren’s song is relegated to a very useful but background position. That this is so is a most difficult task for all of us to either understand or support or follow. We have been taught that the identification of these issues is what we are supposed to do. Our teaching also holds that once identified, they are ‘interpreted’ according to ones analytic school.

For example, ‘omnipotence’ may be seen in the patient as seen in the ‘dialog’. The concept of omnipotence is well known to all of us. Yet, the meaning is different in some degree to all of us. The meaning to a Kleinian of that concept is different than to followers other schools. Knowledge of that concept, our ‘knowledge’, must be relegated to our background. We know what we think it is. We must determine what they think ‘it’ is. Our task is not to accuse a patient of ‘it’, whatever ‘it’ may mean to the analyst, but to find out what ‘it’ means to the patient. To the adolescent, ‘it’ may have no unique meaning. Or, alternatively, ‘it’ may have a unique meaning which is entirely unrelated to the meaning attached to ‘it’ by us.

One of the great advantages of exploring the dialog, the ride, etc., of the adolescent is that we find out what the adolescent means, not what we think they should mean. This is a simple but profoundly difficult task. We ‘know’ what people mean, or at least suppose that we do. Adolescents and others are constantly re-teaching us how to be an analyst of them, how to determine what they really mean and how to talk about that with them. This ‘teaching’ goes on and on, from moment to moment, session to session, patient to patient, forever. To enthusiastically look forward to and welcome this ‘re-teaching’ is difficult in ways that are beyond my descriptive abilities. I was trained as a Kleinian by many experts on that subject here in Los Angeles. To work as I suggest means that I have to abandon the certainties that were attached to my training. I ‘knew’ what patients meant and told them so. I no longer know, except insofar as I try to find out what each patient ‘means’ from that patient. Certainty, which I possessed, is gone. Uncertainty has taken it’s place.

One encouraging thing can be said, however: Sessions become infinitely more interesting, inspirational and meaningful.

The following vignette is from the treatment of a very grandiose 16 yo girl.

“I really fooled my mother. She thinks that I was at my girlfriends last night” she said.

“Fooled?” I asked

“Yeah. I made up some stupid story and she believed it” she said.

“Is she really stupid or are you a world class liar?” I asked.

“Both. I can get away with lying to anyone, especially my mother” she said.

“Is this a skill that you have developed, learned, studied?” I querried

“It’s just natural to me. But I have been caught a few times” she said.

“How in the world did a world class liar get caught?” I asked.

“Well, I’m only human” she said.

“ That’s disappointing. Can’t count on anything much anymore” I said.

“Well, I exaggerate a lot” she added

“My disappointment increases and increases” I said (laughing)

“You have to be realistic” she smiled..

“Oh no. Not realism. How boring” I said. (again laughing)

“Yeah. But that’s the way things really go. You’re the one who is supposed to be telling me that” She laughed.

“Well, I probably missed the ‘realism’ class. Or, possibly am just slow. Or both” I said (laughing)

“Yeah, right” she said, (again smiling)

(In discussing vignettes, of which there will be more and more, I am afraid that I will come across as grandiose and self-important sounding to those who don’t think I’ve slipped a cog. That is certainly not my intent. However, I have no real source for my material other than sessions in which I have participated and need to use as examples. As an undesirable consequence of that, there are lots of “I” statements, which I prefer not to use. Such statements, however undesirable, as well, are not reflective of how I think.)

In this interchange a number of things occurred. Her ‘omnipotence’ was seen. We might call ‘omnipotence’ a prominent mental mechanism of hers. What, if anything our term, ‘omnipotence’, might mean to her, however, is unknown. What she did say was: she, a world class liar, likes to lie to mother, who for the most part is both stupid and gullible, that she gets caught occasionally, but that is the way life goes and why is it she is explaining the way life goes to me, which, after all, is my job, which I should certainly do since she thinks I am smart. Perhaps these elements should be added to the definition of our concept ‘omnipotence’. It appears that we would be adding and adding new meanings to our concept ‘omnipotence’ until that concept would lose all meaning except, perhaps, as a reminder of the good old days.

There was no direct identification of her supposed problem except as put forward by her. This discussion was conducted in such a way that it was not offensive to her. She was able to discuss these issues and did not take these discussions as an assault on her character. She willingly and cooperatively participated in this discussion. An appropriate sense of humor was present both from me and her. And, finally, as often happens, she ended up debating with herself, ‘criticizing’ herself and criticizing me for doing such a bad job. A little realist modesty often goes a long way. In this instance, she ends up both laughing at and with me, and defending me against her.

Sessions like this one so seem to have the effect, however, of bringing the adolescent and myself even closer. Perhaps it can be described as a human to human contact.

A serious subject, addressed lightly, but deeply, and our being an ally of each other and the analysis continuing.