Adolescent Psychoanalysis

The Deconstruction and Construction of Adolescents and Their Analysts

 

Chapter 13

Part 3

 

There is yet another crucial issue that must be recognized and addressed.  This issue goes as follows: B analyst, of which I am one, has to be able to ‘switch’ and function as an A analyst, an analyst who can deal appropriately with A material.  By A material I mean material with which many of us are familiar, especially in our work with adult patients. Specifically, adults often bring material specifically lending itself for analysis, such as dreams, specific conflicts and neuroses, depression, anxiety, etc.

One of the great benefits of having created a working, positive relationship with a difficult B adolescent, who usually operates in a B fashion, is that when they ‘switch’, B adolescent, often consciously or unconsciously, and usually abruptly, is working with A material.  By A material, I mean material which is not based on Adolescent/Analyst BB relationship formation, although strongly supported by that relation, but on actual symptoms, such as pain, anxiety, guilt, obsession, depression, etc.

An example is this: a 15 yo extremely B girl, who both required a great deal of trust building and relationship formation. Much of the time she liked to joke, mock, laugh at both herself and me, her parents, her teachers, friends, etc.  She had little or no interest in boys, partially because she reportedly had been raped not long before her analysis began and for other reasons. This joking was not malicious in this girl’s instance, but bore a great deal of humor—characterological, not neurotic.  She had a very appealing and pithy sense of humor.

For the moment, I am ignoring Freud’s admonition, ‘behind every joke ……’ by not being concerned with the meaning behind the joke.  ‘Behind’ means what the joke ‘means’ or ‘represents’ psychologically. Conceptually this means to ‘participate’ in the joke—-to take the joke for what it is, at face value and to talk of the joke material presented by the patient, concretely.  For example, pretend a patient said to me, “Why did the moron tip toe pass the medicine cabinet?”  Taking the riddle for what it is, I might respond laughingly and jokingly, “To not wake up the sleeping pills. What a stupid joke.  I’ve heard it a thousand times and each time I’ve heard it, it seemed stupid. Try to do better next time. Maybe you just think I’m moronically stupid?”

In this example, this lead to participation in her joking. On more than one occasion, she would joke about the stupidity of her mother, particularly if there was a disagreement between them.  Her mother, based on previous material presented by the patient, was not ‘stupid’, whatever ‘stupid’ may mean.  One could discuss this material as we usually do with adults, and try to determine why she ‘hated’ her mother so that we could interpret that meaning to her.

In most circumstances, with adolescents, this is exactly the wrong thing to do. The ‘meaning’ to the adolescent is that her mother is stupid.  As with the ‘joke’, the ‘thing in itself’ of her ‘stupid mother’ is the subject. However, in this instance, she and I investigated the qualities of her mother as provided by the patient, that ‘showed’ mother to be stupid.  The level of that ‘asshole’ mother’s ‘stupidity’ expanded and expanded during that session, helped along by both her and me.

(Collusion was not the basis of this expansion.  As we all know, collusion ends analysis, on the spot, and starts another process, the name of which I don’t know.   At a minimum I would have aligned myself with the daughter against the mother, placing my weight on the side of the daughter and ending her analysis)

The actual interaction in this example and many others was much more like improvisational theater than what we could call traditional psychoanalysis.  The usual goals in improvisational theater are: 1) never disagree and 2) to expand whatever was just said.  For example, if one actor asserted that the President was really horrible, the improvisational theater partner response might be, “yes, and stupid as well”. The response from the original actor might then be, “you’ve got that right.  I don’t think ‘stupid’ adequately describes him.  Worse than stupid.”  And so forth. Anyone who has devoted much time to arguing with an adolescent in treatment about much of anything will understand.

If you’ve done a good job, at some point the patient will bow out of the ‘improvisation’.

“Well, she’s really not that stupid.  You’re exaggerating. We (mother and her) just disagree sometimes.” She said.
(The growing ‘exaggeration’ has passed beyond the adolescent’s point of credulity.) Where we had been united, we were suddenly split. At that point she had aligned herself with her mother and against me.   The pair (mother and daughter) have now become the analyst, and me the misguided, defensive patient, a role which I find both entertaining, and extremely useful in building a constructive relationship.

At this point I reacted to her, not with great seriousness, but by joking, which she really enjoys.
“Now you’ve got me confused.  First you said that she was stupid, now it was only because of a disagreement and now I am exaggerating.  This seems to me to be unfair.  I may be slow, but not that slow.” I responded.

“If I hear you say you’re slow one more time I’m going to throw something at you,” she said laughing.

“Now this is really getting extreme.  First slow, misunderstanding and now a target! What will you throw?” I asked.

“I think you’re twisting things like you usually do.  You need help,” she said laughing.

“I think I’m beyond help.  You’ve said so yourself.  Although I have one asset—twisting things”. I said.

“Yeah.  Now you’ll probably say you think I’m stupid. Go fuck yourself,” she laughed.

“Things are really getting bad now.  You say I call you stupid, you say I’m a target, twist things and now I’m supposed to go fuck myself—however that is done.  All this because you said you’re mother is stupid.” I said.

“Alright, alright, I give.  But I’ll get you someday when you least expect it. You remember things too well.  What you need is some amnesia and a lot less education,” she said.

With this same patient, there were sessions where the essence of the material would change dramatically. For example, this patient came to one session as follows: humor was absent, seriousness was the mood, topics much more dramatic, much crying, anguish, etc. In this instance the material was about her parents, and most particularly her mother. She was anguished that her divorced parents hated each other so much that it made it impossible for her to deal with either one of them. That they were so immature caused great anger in her. How was she supposed to live her life normally

if she really had no real parents?

She told me this dream:

A little girl was walking down a path that she loved and encountered two people, a man and a woman lying on a blanket and kissing each other, openly, in the field that she loved on the right of the road. The little girl became extremely angry and started throwing rocks at the couple, causing them to run away.

Her associations were as follows: She didn’t think she was the girl with the black hair since she had dyed her hair black. The girl in the dream’s hair was blond, although the patient allowed as how she wished that her hair was blond. She didn’t recognize who the little girl was, she said. The path reminded her of a path she had often followed at a park near her mother’s home. She couldn’t recognize the couple although, she added, that her parents often walked along the same path. She was very angry at the couple but didn’t know why. Earlier that day, she said, she was at the mall and hates to see couples walking hand and hand. She said it looked phony. They made her sick, she said. She said that she never threw rocks at anything but trees. She couldn’t imagine herself throwing stones at people and this little girl threw rocks at the couple, who ran off in two directions. She said the stones came very near the woman. She said that the little girl ran off as well, in a different direction, scarred, crying and terrified at what she had done. The patient also said she couldn’t understand the little girl being so upset since she hadn’t hit anyone.

I interpreted that the little girl probably was her and even though she wished her parents would get along so she could talk with them, in this dream at least, she didn’t want to be able to talk with them, but wanted to split them up, perhaps killing her mother. But she felt very guilty about that, in spite of the many times she joked about her.

She reacted to this interpretation with anger at me and at her mother. Yeah, she said, she had often wished her mother dead since she liked her father much more and mother kept him from her, but hadn’t ever told anybody about it. And, she added, that that I reminded her of her father even though she was throwing rocks at him/me, she supposedly wanting to be close to her father/me.

The Deconstruction and Construction of Adolescents and Their Analysts

 

Chapter 13

Part 2

 

Christine is a Type B adolescent. The following notes are of an early session and are divided into sections. Christine illustrates a very complex Type B adolescent. These sessions notes are presented for a variety of reasons, the primary one being to illustrate a Type B adolescent. That she is a Type B adolescent says nothing about the severe difficulties she has. Christine is a scattered, sometimes delusional, funny girl, who is socially experienced, has a history of both a casual sexual life, a large amount of drug use, all wrapped in a very ‘hip’ personality. She also has immense problems with her mother and other relatives. Nevertheless, I apparently formed, early on, a constructive and open relationship with Christine. She does seem to be able to relate to me well and is not self-conscious about discussing herself.

 

 

 

“So what’s up?” I asked.

 

“I had family therapy yesterday and we went to after to go eat and I got to talk to my best friend and my girl friend on the phone”, she said.

 

“Are they the same people?” I asked

 

“No. My best friend’s a guy. His 18^th birthday’s coming up and he’s going to come over on one of my home passes so we can go out. My girlfriend just came back from Provo on Saturday, so I’m going to see her this weekend.” She said.

 

“Is this girlfriend girlfriend or a friend who’s a girl?” I asked.

 

“Girlfriend girlfriend. (pause) I don’t know. I love the house.” She said.

 

“I’m a bit confused. How did we get from girlfriend to house. Anything in particular to account for that?” I asked.

 

“What do you mean?” She asked.

 

“I have an idea, and this will probably sound weird. You love the girlfriend and she is like the house?” I suggested.

 

“I don’t know. I love how it’s so homey and everyone gets along so much. The staff are not rude or stuck up or power hungry. I really like it here, she said.

 

“At XXX residential program the staff were just not too good?” I asked.

 

“Yeah.” She said.

 

“Or power trippers? Or…” I said.

 

“Just bitches all around.” She said.

 

“Did you meet your girlfriend there?” I asked

 

“Yeah. We got in trouble for being in a relationship which is kind of retarded because you’re allowed to have relationships with guys on the guys campus, but girls aren’t allowed to have relationships on the girls campus. We’re not supposed to be in relationships. We got in trouble for it.” She said.

 

“So if you hooked up with some guy, that would be okay?” I asked.

 

“Well, hooked up, I don’t know. But if we’re going out and considered boyfriend and girlfriend, then that’s okay. But if I have a girlfriend, that’s not okay.” She said.

 

 

Silence

 

“You’re my therapist aren’t you? I heard that you’re my therapist. I also heard you’re a doctor. I heard you do it all.” She said.

 

I laughed.

 

“That’s what they said.” She said laughing.

 

“Okay, let’s say I do a lot of things. I also do the windows, …” I joked.

 

She laughed.

 

“Maybe I come across to you like one of the staff you hated at XXX residential program, or something like that, or secret power-tripper?” I said.

 

She laughed.

 

Silence

 

“By the way, last night J  (social worker) called me up, which she pretty much had to. Usually what we do is confidential unless I was convinced you wanted to knock somebody off or off yourself, or get hurt by someone—-then what we talk about is different. However, the reason J called me had to do with you telling her stories of you getting raped at one point or another. What was with that? If you don’t mind my asking?” I asked.

 

“I don’t know. She asked my mom and my mom was like … it’s because some on the guys at school have been touching me and hitting on me, and it freaks me out because I have been raped. It freaks me out and I told my mom about it. I went to the bathroom and when I came back and they were just talking about it. I was like where did this conversation come from? Then J asked if XXX residential program reported it? I said. I don’t know. I told them. I didn’t really talk about it. We had a trauma group and one of the therapists was like you have to share your story with the group. It took me a really long time to do it, but I did. I’ve never shared it with my therapist, my individual therapist because it was the same thing. I didn’t trust him. I didn’t like him at all.” She said.

 

“What kinds of things made you not… I know you gave me examples, but were there any particular things?” I asked.

 

“Just, he didn’t listen. Whenever I told him something. I would tell him something that’s bothering me and he’d be like ‘Okay, that’s interesting.’ You know what I mean? He didn’t listen to me. If staff brings something to him, then he’ll talk about it. We’d have to talk about it. I didn’t like him.” She said.

 

The Deconstruction and Construction of Adolescents and Their Analysts

Chapter 13

Part 1

(Re-Titled and revised 4/6/09)

 

“Youth is easily deceived, because it is quick to hope.” Aristotle.

The relevance of this pithy statement by Aristotle to the subject(s) at hand is multi-faceted. For the sake of our adolescent analysands, to understand the impact this principle has on their lives is crucial. Some are too quick to hope, which is one of the reasons that hopes, quick solutions, saturated with certainty, are so prevalent in many adolescents, often bolstered by boundless idealism and energy. To not have the patience to analyze these hopes, be they quick, not well thought out, or blessed with certainties, is a recipe for disaster. Our ‘hopes’ are often quite different than our adolescent brethren. Our ‘hopes’ are more mature, more grounded, and more attached to what we call reality. Or so we think.

I intend to construct a somewhat naïve categorization of both psycho-analysts and adolescent analysands. I have a distinct purpose in mind for this division, which will hopefully become evident. These distinctions are largely different from aspects of the self that we study in traditional psychoanalysis. The elements we study are, nearly universally, elements of psycho-pathology. For example, it may be clear in the analysis of a patient that he suffers from envy of his father and acts out by having sex with as many ‘mothers’ as possible. His analysis is later said to be successfully completed and some diagnosis or another will be attached to him.

But, although supposedly well analyzed, this practice of this ex-patient continues, but under a different guise. Although the actions are the same, they are this time not considered a ‘problem’ by the ex-patient, but as an expression of his identification with ‘sad’ woman, whose days he can ‘brighten.’ He might even receive a diagnosis, perhaps Narcissistic Personality Disorder.

Another example I can cite is this. A patient, who is an analyst, fancied himself as a pillar of moral judgment, thought, and action, but who functioned in life as anything but. He frequently had sexual relations with supervisees and married two others. He is very unlikely to see these activities as pathological, perhaps only as matters of appropriate judgment. In any event, in the divisions you will see below, I am much less interested in the ‘causes’ of these personalities, but the actual functioning of these personalities.

All hopes and desires of adolescents are not omnipotent exercises in wild minded fantasy. Many adolescents, however, lean far in that direction. These adolescents are far and away the most difficult, yet enjoyable, to treat, show boundless portions of the characteristics listed above and are often laden with large amounts of energy, omnipotence and otherwise. And, as their two adult brethren described above, are expert at rationalizing their activities. These adolescents are arbitrarily labeled by me as personality Type B adolescents.

Type A adolescents, however, show few of the above characteristics. Type A adolescents often are the population that fit most easily into our ordinary, adult, theoretical and treatment backgrounds and approaches, usually quite different than the examples given above. Their symptoms are often of withdrawal, depression, schizoid, a or anti-social, etc. In many ways, they are ‘grown up’ adolescents.

Again, making another, yet similar, arbitrary distinction, I wish to divide analysts and their personalities as I did adolescents. These are analysts who attempt to analyze adolescents. Therefore, there are Type A and Type B analysts. A and B analysts bear many of the same characterological traits as their corresponding adolescent brethren, but from a ‘grown up’ point of view. Type B analyst is more social, more socially experienced, more an adolescent at heart, personally familiar and comfortable with the lives of adolescents, their habits, their foibles, and skilled at relating to and forming relationships with adolescents, tolerant of rationalization, all while being a well-trained, mature Psychoanalyst. Type A analyst is also a well-trained, mature psychoanalyst. He is also very serious, formal, usually less social and with less social experience, is often very uncomfortable with some adolescent activities (e.g. language, sex, drugs, rationalization) and not good at forming relationships or identifying with adolescents.

There are many useful distinctions between Analyst Type A and B. All analysts, as well as everyone else, are part infant, child, adolescent and adult. The crucial question is this: what kind of infant, child, adolescent and adult are we or have we been? Further, what have we done with those aspects of ourselves? Or put another way, how have A and B analysts been Constructed?

All of us, including both Type A and B analysts, are clearly different genetically. Further, we have also been raised differently, from infancy forward. We have had different types of parents, different mothers, parenting styles, levels of humor, love, social values, interests, levels of encouragement, empathy, understanding, passion, openness, generosity, structure, predictability, rigidity, etc. Some of us were raised in households which lack most of the above characteristics being more cold and distant, more formal, less love-filled, less empathetic, less humor-filled, withholding, disrespectful, demanding, etc. And, of course, most families are mixtures of the above. We all believe, with extensive evidence, in the formative effects of nurture. While there are many sources of nurture, ordinarily the family leads the way.

(I am intentionally leaving out ‘intelligence’ as a distinguishing part of the nature/nurture equation yielding Type A and Type B analysts and adolescents, be it genetically created or environmentally stimulated or both. For the purposes of this discussion I am assuming that intelligence or Piaget’s Intelligences, or whatever intelligence measurement is used, to be equal.)

Further, again narrowing the field of discussion, I wish to focus on the relatively new distinction that many now make between the “right” brain and “left” brain. The concept of “right” brain and “left” brain thinking developed from the research in the late 1960s by an American psycho-biologist Roger W Sperry. He discovered that the human brain has two very different ways of thinking. One (the ‘‘right” brain) is visual and processes information in an intuitive and simultaneous way, looking first at the whole picture then the details. The other (the “left” brain) is verbal and processes information in an analytical and sequential way, looking first at the pieces then putting them together to get the whole. Sperry was awarded a Nobel Prize in 1981, although subsequent research has shown things aren’t quite as polarized as once thought (nor as simple), perhaps a saving grace for us.

I am assuming that the prominence of these two entities is genetically determined and is present in both Adolescent Type A and B, and Psychoanalyst Type A and B. No one is all of either, but these are genetically determined brain functions and not modifiable by experience, teaching, etc. Most, however, show prominence, sometimes dramatically, of one or the other. With respect to adolescents we treat, the prevalence of “right” and “left” brain are random, as are this distribution amongst analysts.

Analysts, both type A and B clearly have to have and have had access to superior “left” brain functioning. Without our “left” brain, we would never have achieved the skill levels that we have. Being a good surgeon is largely a “left” brain function. Achieving a high GPA in college in scientific subjects is yet another illustration. On the other hand, some other skills are not as ‘scientifically based’, but are based on the “right” brain. The prominence or lack of ‘‘right” brain functioning varies as widely from analyst to analyst, as adolescent to adolescent.

The importance of these differences, the ‘balance’ between “left” and “right”, cannot be over emphasized. A largely “left” brained analyst, with little or minimal support of “right” brained functions, is narrowly “left” brained. Many characteristics, empathy and compassion, for example, will be at a minimum, as will humor, love, understanding of adolescent social values and interests, levels of encouragement, empathy, openness, generosity, etc., will all be at a minimum. Worse yet, those of us who were raised in households mirroring the above characteristics, possessing most of the above characteristics, being more cold and distant, more formal, less love-filled, less empathetic, humorless, withholding, disrespectful, demanding, biased, etc., will also be doubly unblessed. Social experience and ordinary relationship formation, bolstered by little “right” brain strengths, will be at a minimum.

Many of us have not earned our reputation as ‘strange’ people, ‘weird’ people, and people living in an ‘ivory tower’, by accident. Perhaps this is because of the relative lack of influence of our “right” brain, dominance of “left” brain and the consequences of this division. Minus considerable “right” brain support, many of us can’t tell the difference between ‘science’ and ‘not science’, theoretical love from actual love, anxiety from panic, etc. The ability to be ‘social’ and to be ‘socialized’ is not a course offered in medical school, cannot be learned from a book, but is an ‘intelligence’ that is innate, or at a minimum a ‘potential’ space of our mind waiting to be filled (Piaget). Or not. “Piaget thought that intelligence develops in all children through the assimilation of new information into existing cognitive structures, including, for example, common sense, [judicious, level-headed, prudent, reasonable, sagacious, sage, sapient, sensible, sound, well-founded, well-grounded] and the accommodation of those structures themselves to the new information” (Neisser et al., 1996, p. 80).

There may be great wisdom in some of Piaget’s theories. However, Piaget apparently never encountered the near impossibility of teaching mathematics to an artist or painting to a mathematician. Or perhaps didn’t consider the possibility that supposedly existing cognitive structures of the “left” brain may not exist in the “right” brain. Or the fact that we are not all born with a full complement of cognitive structures, or that there might be other structures present that are not cognitive, not A but B, not cognitive but different. Or, for that matter, that ‘cognitive structures’ of the “left” brain may be fundamentally physically different and function in profoundly different ways than the “right” brain.

The deconstructed adolescent shows many differences, one to another. This same principle also applies to analysts. Re-constructed adolescents will yield a variety of adolescents, much as analysts. Matching reconstructed A analyst with A adolescent will have a great chance of success, although numerically there are far less Type A adolescents brought for treatment. Type A analyst matched with type B adolescent simply will not work. B analyst matched with B adolescent has an excellent chance of working. Type B adolescents are the group most often brought for analysis. In the absence of AA and BB, B analyst matched with A adolescent has at least some chance of success. (more on this topic later. I would like to remind the reader that what I mean by ‘work’ has to do with personality types of analyst and adolescent melding constructively.