Adolescent Psychoanalysis

Along Came Andrea

Chapter 15

Part 2

The happenings that occurred both in the first part of this discussion with Andrea and the portions that followed, are difficult to understand, yet easy to write, if writing is analogous to transcribing a tape recording. The dialog was much like one would have in an ordinary conversation, but in an extraordinary venue, a sort of dialog in which I have participated many times. My way of talking with her was very much as I would in an analytic session.  By this I mean that I consider her statements to be free associations. My elucidation of these associations yielded further associations, both from the further ‘building’ of her my understanding of her and further associations and questions associated with these associations, etc. My elucidations (questions, clarifications, statements, etc.) are interpretations. (I intend to explain further the meaning, free association, interpretation and transference as used by me in the following 2 chapters. What I mean to her in the transference is not clear, whether I be father, confessor, idealized listener, etc.)

To grasp the drama of this conversation, the situation in which it took place and the staff who were present, must be kept in mind. This meeting included a number of people who had a great deal to say about Andrea’s treatment, including when Andrea would be discharged from the Linden Center Program. I, for obvious reasons, make it a point to stay out of such decisions as much as I possibly can, an example being date of discharge, for a variety of reasons. If I put myself in a position of ‘power’ over my patients, such as when they will be discharged, the obvious would happen.  Any ‘free’ associations would cease to be ‘free’, but constricted and contrived, consciously or not. Nevertheless, to deny my position, is, of course, laden with problems. Were my actions direct intrusions into such issues as discharge, communications with me, in the ways that I have outlined, would cease. Nevertheless, I should add that the patients at Linden Center ‘seem’ to believe this ‘truth’.  I think usually that their belief is not a matter of denial, projective, or splitting. They believe that the confidentiality they are promised actually exists and they usually have faith in that agreement.  That faith is well placed but for one caveat. They understand that should they actually set out to hurt either themselves or another, I am legally and ethically bound to break this confidentially.  This situation, fortunately, has only arisen a few times over many years.

Andrea’s saying what she did, to me in this meeting contradicted, dramatically, statements she had repeatedly made to staff, therapist, mother, etc., e.g. not drinking or using drugs at all on any home passes.  She knew that saying what she did could materially change the time of her discharge—but she went ahead and said it.    It did.

For me, this type of experience, this sort of conversation, even in front of groups, was and is, very common.  My discussion with Andrea continued.  The fact that it continued was not at all unusual.  What was different, dramatically so, is that as this conversation continued, I gradually developed a bizarre sensation that all of the large number of people in the room disappeared, were literally gone, save Andrea and I, and that Andrea and I were speaking in ‘private’.

(Wilfred Bion, in his book, Experience in Groups, specifically dealt with a topic close to that which I have referred.  Specifically, he cautioned against having individual psychotherapy in front of a group instead of group therapy, the group being the patient.  The type of group to which he referred was a ‘therapy’ group.  The group to which I refer is obviously not a ‘therapy’ group. However, in this circumstance, I was having ‘individual’ therapy in front of no group, yet another twist on the topic of Groups.

An esteemed colleague, to whom I told this story and who knows me quite well, suggested that what happened is that I listened very intensely, hearing and seeing only her. He went on to say that since not being listened to, was such an important issue to me in my upbringing, this may be related to how I listen. There may be some truth to the latter.  Nonetheless, for whatever reason, one of the skills I have been blessed with is the ability to listen very intently and think of nothing else but what I am hearing from and seeing of a patient.  When these latter conditions are not met, I ‘know’ that something has gone wrong, although I am often not sure what has happened.  I usually, but not always, settle on the fact that some extraneous issue with me is the culprit, which often seems to be the case.  Obviously, there are other possibilities

Andrea and I continued to talk of many things beyond the above, some of which were very personal and private to her, again as though no one else were present, as if only she and I were talking.  Many of the issues that she spoke of were unknown to everyone in the program—staff, teachers, therapists, etc.  We continued having a private meeting in public.  This dialog lead to many other topics, like those listed above.

I have had and continue to have many such experiences with a large number of adolescents like the one I had with Andrea, minus people disappearing. Some, certainly not all of them, occur in public, such as in a staff meeting, in the corridor, and in my office. Whether in public or private, however, virtually all lead to a very productive dialog.

Other, and by far most, similar experiences would usually occur in analytic sessions, with adolescents who were in analysis with me, both from Linden Center and elsewhere.  The results were very similar to examples I have and will give.

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