Adolescent Psychoanalysis

Along Came Andrea

Chapter 15

Part 1

Andrea — about 5 years ago.

Andrea was not one of my analytic patients, but was one of the many adolescents with whom I had spoken frequently, in the hallway, briefly in my office, and with whom I had a very good relationship. The following incident furnished the inspiration for this book:

At Linden Center, amongst numerous other meetings, a Quarterly Meeting is held every three months. This meeting is attended by the adolescent, his/her parents, the residential staff, their supervisor, the family therapist, the individual psychotherapist, the patient’s teacher, usually someone from the Department of Mental Health, and myself. Because of the myriad of other meetings that occur during the 3 months prior to the Quarterly Meeting, there are usually no surprises at the Quarterly Meeting, the content that will form the basis of this meeting having been discussed frequently. This is the only meeting, however, where all members of the treatment team for a particular adolescent meet in the same room at the same time. This particular meeting took place in early 2003—one of Andrea’s Quarterlies.

In these meetings verbal reports are given by a staff person representing his/her and each part of the program. The meeting is run by me. There are reports from the Residential staff, Social Worker, Family and Group Psychotherapist, Special Education teacher and Psychotherapist. Once the staff reports are given, I ask the parents and then the adolescent for their evaluation of their child’s progress, lack thereof, likes, dislikes, of the program, of Linden Center, the staff, the school, me, etc.

In this particular meeting, the reporting having reached Andrea’s mother, I, having asked her some open-ended version of the questions listed above, get no response. It was at that time that I departed significantly from my usual discussion with the parents and directing this meeting. Andrea’s mother, in spite of numerous, numerous efforts from all parts of the staff, had simply never followed any of the interventions that were recommended to her regarding her home life with Andrea. The large majority of parents do follow what they are asked. My departure, however, was this. Speaking directly to Andrea’s mother, very politely, I listed for her all the things that although having been asked frequently, she had not attempted nor achieved while her daughter was a patient at Linden Center. My motive, probably questionable, but well meaning, was a last ditch, hope against hope, that her lack of awareness and action vis a vis the treatment plan for her daughter could be brought to life. She had nothing to say.

Next was Andrea. My expectation was that when I got around to Andrea, who was next, she would be angry at me, angry at what could be taken as me interfering with her discharge, and therefore have nothing much to say. Nevertheless, I asked Andrea how she thought things were going, saying something like “what’s up?” She was, surprisingly to me, not at all angry, but friendly as always.

What then ensued profoundly affected me.

“Pretty good”, she said.

“Pretty?” I asked.

”, She said.

“Really?” I asked

“My mother doesn’t trust me,” she said.

“How so?” I asked.

“Like when I go out. Like when I go to parties—she thinks I’m irresponsible” she said.

“Why that?” I querried.

“She thinks that I use drugs and drink, like in the past,” she said.

“Drugs?” I asked,

“I have been responsible, except for having a little marijuana and a beer at one party, once. Compared to what I used to do, nothing”, She said.

“?”. I gestured.

“Yeah. And mother drives me crazy. Always asking, just like the staff, did I do this, did I do that? I can’t stand it. I do virtually everything right”. But I am not a Saint”, She said.

“Asking?” I asked.

“No. Nagging. She asks did you go to a party? Was there alcohol? Marijuana? And then, after all that, she’ll never do anything about it. She doesn’t ask before, ever. She doesn’t do the things that the staff ask her to do. Like what you asked her. She does none of them. She never asks about AA. I know it’s up to me, but at least some asking or supporting, from her would be nice” she said.

The Linden Center

Chapter 14 

 A number of friends have told me that they think the contents of this chapter, Chapter 15, should have been Chapter 1.  They argued that I should focus my thoughts about adolescent psychoanalysis around my experience with the analysis of adolescents at The Linden Center.  However, the chapters are ordered in the way they came to me. Not to run this principle into the ground, but psychoanalysis, particularly with adolescents, is exactly the same.  Things come the way they do. They can’t be planned. 

It was at the beginning of 1980 that I, along with talented partners Jane Hays, Lee Shershow, Marilyn McKnight, and Shirley Phillips founded Linden Center, a residential/day treatment center for very disturbed children and adolescents.  I was the main force.

At The Linden Center, children and adolescents were and are offered Residential Treatment, Special Education, and considerable Individual and Family Psycho-Therapy and Psychoanalysis. Approximately 3300 children and adolescents have participated in 3 day programs, 3 special education schools, residential treatment, as well as individual, group and family psychotherapy, and psychoanalysis over the past 28 years.

The original founders, with the exception of myself, have gone on to a variety of other areas in the fields of mental health and special education.  Lee Shershow, M.D., long time friend, is a graduate of the Los Angeles Psychoanalytic Institute and Member of the American and International Psychoanalytic Association, is board certified in Psychiatry. His practice is in Oregon.

I have been Director of Linden Center since it’s inception.  During that time, in addition to my duties as Director of The Linden Center, I have continued a full analytic practice, my focus changing more and more to analyzing adolescents.  My contact and participation with the various Institutes in Los Angeles has been progressively more limited and non-existent at present.

I get along with adolescents, both in and out of the consulting room, which has always been a considerable advantage to me. I have given only passing attention to this fact, until the last 5 years. Prior to that, I had considered rarely and briefly, such exotic (sic) explanations as my ‘sterling’ personality, my particular position and experiences socially and academically in grammar school and middle school, being one of the ‘boys’ in High School, a member of a highly social, ‘wild’ fraternity at Berkley, etc. as a possible explanations. Further, I do identify heavily with adolescents.  I also knew that I did and do work very differently than many of my analytic colleagues, in spite of my very broad range of traditional training. And, possibly un-relatedly, have had far too many to count or remember non-analytic experiences with adolescents at The Linden Center, their teachers, therapists, counselors,  parents, etc.

I have analyzed approximately 80 adolescents, largely with seemingly helpful results.  Then, for a variety of reasons, about five years ago,  I became much more interested in trying to understand my work, it’s seeming uniqueness and it’s relationship to psychoanalytic theory and practice as I knew it and know it now. 

The Deconstruction and Construction of Adolescents and Their Analysts

Chapter 13

Addendum

(The following is a partial reprint of an early paragraph of this chapter, (part 1) re-formulated to address the mental health, education, ongoing development of Adolescents as well as Psycho-analytic Candidates, Senior Analysts, and Psycho-analytic Institutes. The successful analysis of adolescents requires skills that are very similar to what should be the skills we bring to each other in our development as analysts.

The majority of us are Type A analysts, and therefore, but for rare exceptions, were Type A Candidates.  Our adolescent patients are very often Type B. They often reach quick, rapidly changing solutions, are saturated with certainty, often bolstered by idealism and energy and usually clearly aligned against those who think fundamentally differently from they.

Some candidates and analysts resemble adolescents.  Only some. For us to not have the patience to tolerate and nurture the thoughts and hopes of these groups, be they quick, having thoughts that are not well thought out, or omnipotently certain, means that there will be no development. For those of us who hope for the usefulness and preservation of Psycho-analysis, in my case particularly for adolescents, the absence of such tolerance is a recipe for disaster.

Most of us Analysts’, Candidates’, and Institutes’ ‘hopes’ are more mature, more grounded than adolescents and more attached to what we call reality.  Or so we think. A key issue, however, is that often our maturity and our ‘understanding’ of reality functions not as an asset, but as an anchor chain.  Our views of reality very often contradict, sometimes virtually completely, the ‘realities’ of adolescents.  Our views applied to adolescents cause our views to be anchor chains not assets.

The set of Adolescents, Psycho-analytic Candidates, Analysts, and Psycho-Analytic Institutes, surprisingly, is a logical set. Ideally, the atmosphere in which this set should reside, should resemble as closely as possible that which is suited to a Type B adolescent. The members of this set would seek a fresh, full of life, experimenting, questioning, doubting, etc., environment, in the midst of appropriate structure.  Adolescents, as part of this set, are both living and embarking on a new and what should be a formative and fulfilling epoch in their life. The others of this set should settle for nothing less for themselves.

In talking to a colleague the other day, he listed a group of Los Angeles and Southern Psycho-analytic Institute graduates, who were well known to him, who had simply disappeared or who moved on elsewhere.  He had little or no idea where the ‘where’ was. The reasons for their departure are undoubtedly as many as there are individuals who left.  Most of them have nothing to do with any of the numerous fledgling analytic ‘Institutes’ now in Los Angeles which have replaced what used to be the two major Institutes in Los Angeles. I, like some of the ‘disappeared’ colleagues, have had no attachment, formal or informal, to any Los Angeles Institute for many years. 

The Los Angeles and Southern California Institutes no longer exist as they were, from my point of view, a tragic development.  The fighting over who bore the ultimate truth, was obviously a major cause of their demise.  Economics and lack of interest of potential candidates undoubtedly contributed as well. Unlike the Asian girl written about above, we never escaped our brand of A track, or modified it.  We ‘never looked down’.

Bearing in mind that this book is about the analysis of adolescents, this attitude, not looking down, is exactly what makes the analysis of adolescents so difficult.  If one approaches an adolescent with such an attitude, ‘looking up‘, failure is virtually guaranteed.