Adolescent Psychoanalysis

Leading and Following

Chapter 16

Part 2

(revised 6/3/10)

Agent of Whom?

A supervisee was presenting material from sessions with an adolescent at Linden Center. The 17 yo boy complained, according to the supervisee, that there were too many rules at Linden Center, many of which were ‘unfair’. The supervisee, who had been following the material very well, stopped following and started leading, abruptly. “Of course there are more rules. This is a treatment center into which you have gotten yourself and has to have more rules in order to help you”. I was surprised, to say the least, and asked the psychologist why he had taken that position with his patient. He said, “well, I am an agent of Linden Center. They pay me”. It was easy enough to point out to him that he was not hired to be an agent of Linden Center, but of his patient. He was somewhat shaken, but could easily see the point I was making.

This same principle applies to all patients, especially adolescents. Treating an adolescent, when the analyst is agent of third parties, i.e. parents, hospital clinicians, outside clinicians, friends, AA sponsors, educational reports, written hospital records, and the Department of Mental Health assessment, etc. makes analysis difficult at best, impossible at worst. This is usually a difficult situation, but one must be the agent of the child, participating ‘appropriately’ with outside agencies, and trying to cleanse one’s mind of the content of those meetings.

The same principal of agency, applies to the ‘history’ of the patient. If the analyst is an agent of the patient’s ‘history’ he will serve that master and will be in a position to analyze the ‘history’ of the patient, not the patient. The same principle applies to psychoanalytic theories. If the analyst is the agent of a set of psychoanalytic theories, the theories, not the patient, will be the available object of analyses. The theories will be the object of the analyst, and will become the new ‘patient’.

The concept, ‘history’, presents many other problems. I cite one of the many in particular. The patient’s ‘history’, at best, is heresay, no matter who is saying it. Descriptions of an event usually say a great deal more about the observer than the event. Cluttering the landscape with elements of the mind of the observer is obviously a cluttering that inaccurately, but for coincidence, says little or nothing about the actual patient. The account presented by the patient is also ‘hearsay’, but is the ‘truth’ of the patient, which changes frequently.

The account presented by the patient purports to represent exactly the meaning attempting to be conveyed by the patient. If the patient ‘leads’, what he presents can be considered his version of himself, and the analyst can be the agent of understanding or integrating those elements of the patients account. If the patient ‘follows’, his associations will reflect those of the analyst’s beliefs and desires.

This account presented by the patient of and by the patient is analyzable. This is the stuff of psychoanalysis. Another function of this process is that it forms memories in the mind of the analyst, ideally unconscious. Elements of these memories are derived from the sessions and nowhere else. These ‘memories’ are fragments of thoughts that may emerge spontaneously, in the present or future, in the mind of the analyst and in the actual analysis, stimulated by the associations of the patient. These may be usable in giving further meaning to the adolescent’s associations and memories. They represent the analysts equivalent of Freud’s Basic Rule for the patient, that of ‘free association’. The analyst as well as the patient must be able to free associate in analytic sessions. They must be able as well to think about these associations lest meaning be derived from these associations. These thought or feeling fragments are free associations of the unconscious of the analyst drawn to consciousness by the associations of the patient.

Ideally the material of the session should be ‘forgotten’ by the analyst so that he may continue his analytic work. This is particularly true of adolescents. The material with adolescents is particularly changeable and often very charged. By charged I mean that the material is often laden with ideas that are ego-dystonic to most analysts. These ideas may be particularly obstructive to the analyst, if allowed to be dwelled upon. Nevertheless, all of us know that there is no way for us to cleanse our minds of all conscious memories, and desires and hopes for ‘cure’. One major source of aid to the analyst, perhaps the only source available, is the analyst’s own analysis. The best we can do is be well analyzed and try hard, knowing that we will ultimately fail.

All this being said, below I will present a series of sessions from a 16 year old adolescent girl. What, retrospectively, turned out to be the case, is that these sessions seemed to fit together in what seemed to be a sequential order. This week of sessions, again retrospectively, had the quality of being one long session, one seemingly building on the previous and leading to the next, very unusual in my experience. The sessions of this week also contained the first direct mention of sexuality.