Adolescent Psychoanalysis

Leading and Following

Chapter 16

Part 1

Sergio Contardi: Journal of European Psychoanalysis: “Psychoanalysis can be defined as a practice of listening. Freud himself defined this listening as floating or “evenly suspended,” that is, a listening aimed not at unveiling the hidden meaning of what the patient says, but rather at grasping and freeing a new signification.”

A supervisee recently presented a case. She was explaining a story told to her by an adolescent patient. She seemed to be following her patient, a 16 year old very hardened inner city girl, asking questions that clarified the material that was presented. The material, gradually expanding, became more and more sexually and violently explicit. The therapist became more and more agitated by this material, initially internally, then suddenly explained to the patient ‘that the patient should understand that the dangerous behaviors she was engaging in could have severe consequences on her—pregnancy, AIDS, death, etc.’ The session went immediately awry and an argument ensued.

The therapist’s statements abruptly changed her position from follower to leader (in this instance, angry educator). Up to this point, the material offered by the patient was being followed by the therapist and the patient was the leader. By ‘leader’ I mean the person, the patient, presenting the material. By ‘follower’ I mean the therapist who was following the patient’s material about which she is curious, seeking clarifications and NOT directing the material in any particular direction. The session now became a debate between the patient and the therapist. “I know, I know” the patient said (referring to her dangerous activities). “Then why don’t you do something about it?” said the therapist. The flow of the material had changed dramatically. Instead of the material continuing to expand, as it had been, it shifted and stopped. The patient had been leading and was now debating with the therapist, who became the ‘leader’. Both insisted that they were the leader. Both were ‘right’, according to them.

This shrinking away from the curiosity needed to elucidate the adolescent’s way of thinking, his meanings, is a great problem for many of us. So much of what many adolescents think radically deviates from standards we have all developed as we have grown and matured into adulthood. The temptation to cease ‘Following’ the oftentimes seemingly inscrutable or unacceptable associations (including but not limited to verbal free associations) and begin ‘Leading’ (teaching truths known to be the ‘truth’ by the analyst) is immense. I have intentionally titled this chapter “Leading and Following”, to call attention to these phenomena. It is my intent that the material both before and after this paragraph, will illuminate the importance I attach to these practices.

The material of the adolescents must lead us to clarify their associations. This practice is as old as psychoanalysis and one of Freud’s seminal contributions. The Basic Rule for the patient: “say whatever comes to mind, without censorship”; for the analyst: ‘without memory or desire, listen to these associations, and determine their meaning, if possible’. If free associations form a basic foundation of psychoanalysis, they are of even greater importance in the analysis of adolescents. The ‘free’ associations of adolescents are ‘freer’ than those of adults. It is not that the ‘meanings’ of associations in adult patients are fixed, patient to patient. It is that for a variety of reasons (age, experience, brain structure, social influence, etc.) the associations of most adolescents are often ‘wider’, less coherent, less ‘rational’, less arithmetic, etc. Therefore, determining the ‘meanings’ of associations of adolescents is usually more or vastly more difficult than the same determinations in adults.

If an English speaking analyst were to try to analyze a French speaking patient, the first task would be to learn to speak French. In this situation should the analyst be unable to learn French, there could be no analysis (unless the analyst spoke very loudly and much more slowly—a technique many Americans use in exactly this situation). The same situation often applies to adolescents. One must learn, on an ongoing basis, ‘Adolesentese’, comparable to the English speaking analyst having to learn French, with the caveat that French has a certain stability, while ‘Adolesentese’ doesn’t. In the latter, the meaning of words change and can be added or deleted at a moments notice. As a simple reminder, the meaning of ‘talking’ today can mean ‘hanging out’ tomorrow and ‘hooking up’ the day after. The meaning of ‘hooking up’ today can be ‘meeting’, such as at the mall. Tomorrow, ‘hooking up’ may mean having sex (the current meaning of ‘hooking up’).

From the position of the analyst, ‘Clarification’ of these associations, therefore ‘understanding’ of the adolescent, is an ongoing process, from the very beginning to the absolute end of the analysis. By ‘clarification’ I mean methods which often, but not always, take the form of ‘free’ listening and seeing and feeling, illuminated by ‘curiosity’. “Psychoanalysis can be defined as a practice of listening. Freud himself defined this listening as floating or “evenly suspended,” that is, a listening aimed not at unveiling the hidden meaning of what the patient says, but rather at grasping and freeing a new signification.” (Dr. Sergio Contardi: “Journal of European Psychoanalysis” (citation incomplete)).

In this model, ideally, ‘an association’, inspires ‘curiosity’ in the analyst leading to a necessarily incomplete ‘clarification’ in the analyst, which spawns curiosity, and curiosity expressed to the patient, inspires a new association. And so forth. All these elements, ‘association’, ‘clarification’, ‘curiosity’, and ‘expression’ are interactive processes, not objects nor facts. The sum of these processes–“Grasping and freeing a new signification”– constitutes learning.

For this process to have any particular use, the analyst must think or learn something new, usually about his patient, so that his clarifications can show the patient something new about himself, a new ‘signification’. If the analyst learns or thinks nothing new, he can grasp and free nothing. If that is the case, the analyst will only find what he is looking for, that which supports what he has previously determined to be true. That being the case, all due credit to Kant, the analyst either believes that he knows ‘the thing in itself’ of the patient, or that all patients are identical.

Many, if not most adolescents, react very badly to ‘classical’ interpretations, unless these interpretations are very firmly grounded in the material at hand, don’t interrupt the flow of the material, and are made in a fashion useful to the patient. By useful, I mean in terms of language, expression, etc., that can be ‘digested’ by the patient.

‘Adolescentese’, albeit difficult to learn, is the language of choice. Ordinary epistemological standards usually don’t apply. Insistence on adult standards and measurements of thinking, e.g., ‘rationally justified true beliefs’, is usually both impractical and foolish. ‘Adolescentese’, for example, is highly idiosyncratic and changeable and seemingly or actually irrational. My experience is that at least trying to learn this ‘language’ carries a good deal of weight with most adolescents. We usually get credit for trying. Nevertheless, obviously, we are not adolescents and pretending to be one usually often causes serious problems. For example, the question of ‘who is the patient?’ arises. There is something to be said for being an adult, behaving like one, etc. The adolescent, in the last analysis, didn’t come to see a peer, which can be done in numerous ways, but an adult who doesn’t expect them to be one.

There are a number of major benefits that flow from the use ‘Adolescentese’ communication technique. If one is asking an adolescent, using their language, if they can tell more about their thought, there is usually little cause for a debate. Everyone, or nearly everyone, adolescents included, likes to talk about what they say, their truth. Challenging their truths as opposed to trying to discern and understand them, should be left to debaters. Debating should be left to debaters. Accumulating associations, clarifying and understanding them, and communicating curiosity and understanding, is our work. Particularly with adolescents, making judgments and debating truths should be left to others.

There is another and perhaps greater advantage to this practice. The material is simply rarely artificially narrowed, or limited by theories. A ‘classic’ interpretation, no matter how close it may be to the truth, is always wrong (Kant—“thing in itself”), and breaks the continuity of the material of the session and spawns arguments, or worse, sycophants. Saying ‘always wrong’ is not a comment on the quality of the theory that forms the basis of a classic interpretation. It is, however, a comment on the fact that no interpretation can be any better than close (yet another example of the usefulness of Kant and ‘the thing in itself’). The material it purports to illuminate is, at best an ‘emanation’ from the ‘thing in itself’—the actual personality of the adolescent. That being the case, realistic modesty about ‘interpretations’ and their worth or accuracy has a great deal to be said for it.

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.

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.