Adolescent Psychoanalysis

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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?