Psychoanalytic Psychotherapy of the Severely Disturbed Adolescent

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With chapters written by psychoanalytic psychotherapists from across Europe, and from different analytic traditions, this book shows the common thread that weaves through these different traditions and the serious challenges facing psychotherapists dealing with the future adult generations of Europe. 189 pages.

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CHAPTER ONE. A mind of one’s own: introjective processes and the capacity to think

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Margot Waddell

Establishing an identity is a central task for adolescents— discovering who one is, finding a mind of one’s own—an internal analogue to the room that Virginia Woolf (1928) designates as essential not only to the capacity to create, but to the possibility of “living in the presence of reality” (p. 109). How does the internal room become structured and furnished in its own unique and idiosyncratic way—not as a prefab, identikit, design-catalogue sort of room, but as a space of one’s own?

“A mind of his own” was what “Tom”—a college student in his first year—most wanted. Although when he started treatment he was chronologically a young man, in fact he seemed locked in an entrenched and protracted adolescent state of mind from which he felt unable to emerge. Of medium stature and strongly built, with dark, prematurely receding hair, he could, at times, be strikingly good-looking. This was not a view he shared. Tremendously sensitive to his appearance, his loss of hair was a source of constant anguish; it was a narcissistic affront, fuelled by the relentlessly cruel jokes of his hard-drinking “macho” friends.

 

CHAPTER THREE. The influence of psychic trauma on adolescence and its disorders

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Dimitris Anastasopoulos

The psychoanalytic and psychiatric literature concerning the creation and development of psychic trauma is extensive and covers a wide range of approaches and interpretations, In this chapter, I deal with the generation of trauma in adolescence, exploring the extent to which this is a period of particular vulnerability to trauma and examining the impact that early or recent psychic traumatization can have on the disturbances that occur during adolescence.

It is well known that the concept of psychic trauma was originally developed by Sigmund Freud (Freud, 1895d) and involved the attribution of symptoms to the influence of an external event and in particular of the occurrence of sexual seduction of the child. The trauma itself, infantile sexuality, and the libido theory were seen as supplementary and coexisting concepts and also as significant or even decisive factors in the disturbance of the individual and in the degree of his psychic vulnerability (Freud, 1914d). Initially, Freud explained trauma as an imbalance of psychic energy resulting from a rupture, caused by intense excitation, in the protective shield of the ego (Freud, 1920g).

 

CHAPTER FOUR. Containment and the body of the analyst: on psychotic transference in adolescence. A case of dysmorphophobia

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Julia Pestalozzi

In this chapter, I would like to share my thoughts on psychotic transference, which—as I have learned over the years while losing a bit of my fear of it—is, to my mind, the chance par excellence in the therapeutic encounter with the psychotic patient. I should like to show that florid psychotic phases (with or without delusional transference) within an otherwise bland, quiet pathology can be viewed as a therapeutically prepared and even sometimes wished-for chance for structural rearrangement—on condition, of course, that it is professionally contained and answered and “dualized”, as Gaetano Benedetti would put it. It is regrettable that so often in psychiatry a defence is set up against the joint psychotic experience. Freud’s dictum about the symptom that disappears in the melting-pot of transference also applies to delusional transference. Herbert Rosenfeld draws a similar conclusion, as does Benedetti, to whom I am greatly indebted for shaping my thinking and who taught me to find meaning in the apparently meaningless.

 

CHAPTER FIVE. Therapy for adolescents in detention for violent crime

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Arnaldo Novelletto & Gianluigi Monniello

The psychotherapeutic treatment of adolescents detained for violent crimes may be based on psychoanalytic theory and technique, but it obviously cannot be called psychoanalytical treatment proper. For one thing, it is carried out in a highly peculiar setting: a juvenile prison. Our experiences can be related to those of Balier (1985) at Varces Prison in France and of Williams (1983) at Wormwood Scrubs in the United Kingdom.

This chapter springs from clinical consulting performed by both authors, at different times, for the Rome Children’s Court and from exchanges of views that ensued. The hypothesis that led us to offer this contribution is that there are substantial links between certain crimes of violence committed by adolescents who cannot be considered as clinically psychotic and a mode of psychic functioning that powerfully evokes the concept of breakdown.

Frequently, we find, this psychic functioning is decisive in the genesis of the crime but is not such as to preclude or seriously impair the subject’s possession of his mental faculties, which under Italian law is the condition for the penal indictment of adults (aged 18 and over).

 

CHAPTER SIX. An invitation to a journey: the function of the double in the psychoanalytic psychodrama of a psychotic adolescent

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Alain Gibeau It

The child was playing
with a small wooden cart
He realized he was playing
And said, I am two!

There is one to play
And another to know;
One sees me play
And the other sees me see.

I am behind me
But if I turn my head
I’m no longer where I wanted to be
Turning around does that…

F. Pessoa, “The Child Was Playing” (1977)

The double is a constitutive element of the functioning of the psyche, haunted by the repetition of oneness in hallucinatory wish-fulfilment while at the same time obliged to negotiate this quest for the absolute by accepting the repetition of sameness. It is this dialectic between the search for perceptual identity and the search for thought identity that Freud described when he wrote about dreams. It is at the centre of the human adventure that emerges from the discovery of the unconscious and of psychic conflict. From this perspective, the problematic of the double—so often described in myths and in literature—is a good illustration of the contradiction inherent in psychic life between the need to overcome death by striving for eternity and immortality and the need to accept time and finitude in order to deal with anxiety about death. Freud indicated this when he described the double as being at one and the same time “an insurance against the destruction of the ego” and a “harbinger of death” (191911, p. 235).

 

CHAPTER SEVEN. Factors contributing to the psychotic breakdown of three adolescents

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Hélène Dubinsky

This chapter looks at a constellation of emotional factors that I have observed in a number of psychotic and borderline adolescents. In the internal world of these adolescents, the mother was unable to contain her child’s emotional experience, whereas the father was rejecting and at times cruel. These young people had clearly introjected a parental couple unable to help or protect their child’s growth. Unsupported by good internal parents, the vulnerability of these adolescents was further compounded by feeling threatened and deprived by rivalrous internal siblings.

The experience of adolescence was found by these emotionally fragile young people to be overwhelming. They felt engulfed by confusion and anxiety as they were subjected to the surge of sexual feelings and the pressing need to define their identity as potential adults. Traumatic events in their external lives also contributed to their eventual breakdown.

I shall discuss the psychotherapy of three such adolescent patients. “Debbie” and “Tarda” shared a mental image of their fathers as harshly spurning them while favouring the mother and siblings. Debbie’s feelings of ill-treatment by her father left her prey to incessant thoughts of sadistic intercourse which she was increasingly unable to distinguish from reality. Tania carried her feelings of worthlessness, deprivation, and jealousy into her other relationships. Her delusional jealousy of her boyfriend brought about continual outbursts of violence. A third patient, ‘‘Thomas’’, whom I discuss in some detail, found growing into a man terrifying, indeed impossible. He was paralysed by his own oedipal phantasies in which he merged into a mother-figure, only to be attacked by a vengeful, rivalrous father and siblings.

 

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