Thursday, September 12, 2013

Teenagers are difficult

Teenagers may be the most difficult clients to help. While there are therapies for babies (corrective recapitulation of birth trauma: see William R. Emerson’s “birth psychology”) and the very old and dying (existential psychotherapy) – tough sells – I don’t think these populations seek or are brought to therapy that often. Adolescents, on the other hand, regularly come in, though often against their desires. I find that they have a unique defense: an especial aversion to feeling their past which they have just barely escaped. Many children – like the child I was – are too mired in anxiety or traumatic shell shock to, in effect, inhale and exhale time. They are lost in themselves, stuck, and don’t grow through time and experience. The strain of their impossibility won’t be severely felt during Masterson’s “umbrella of dependency” phase – latency; not until the moment when “childishhood” ends at the front door to junior high school. There, the little ballerina is plunged into a war zone, the magical thinking and whining little boy is shoved into the men’s locker room. Defenses are born and try to fill in the cracks but the cracks are too wide and defenses entirely incompetent: grades plummet, girls find young dicks, boys become angry-scared “rebels without a clue,” girls cut, boys form – as fast as a car airbag inflates – a soothing cynical philosophy, all wear black to have an identity.

The teen sits in the chair, and sometimes the most solid part of himself is his breathing: It keeps going while everything else seems to be a question mark in an incomprehensible language. I’ve seen a thirteen-year-old girl who’d been in a heterosexual relationship for four years and who talked like an old grey poet. I’ve seen a fourteen-year-old boy who had a complete nihilistic philosophy. These youngsters are often glib because they have to glide faster than the truth.

I enjoy working with teens. One reason is my nonsense: I like to think that at some place within them they can be re-parented. That is what they need. All of them.


  1. How can one re-parent someone who was never truly parented, or had to parent themselves? Based on my experience both personally and with youth who have been and are going through such situations, when someone has to form themselves entirely, while knowing that someone is supposed to help, they begin to take pride in who they have made themselves, whether it is a high-school dropout addicted to drugs, a 16 year old parent, or even the school valedictorian who feels depressed because they haven't done enough to garner the love of their parents. After some time, they merely go numb to the disappointment and no longer feel love or hate, joy or sadness, compassion or disgust. They reside solely in the gray.

  2. An answer to the unparented adult-child is perfect in theory but may be next-to-impossible in practice. That is, deep regression to childlike dependency and receptivity to nurturing is quite impractical in the real world (as I’m sure you know). Still, here’s some of what Levenkron says about it, in the context of his treatment of obsessive-compulsive disorder and anorexia: “. . . far from being overtly dependent personalities, ready to lay their burdens upon another, they consider any sort of dependency to be unvirtuous, dangerous, and competitive with the security offered by their rituals – the obsessional defenses that require emotional isolation to work. Indeed, the moment even the slightest dependency is employed, it becomes hostile dependency, for it makes the patients feel helpless and emotionally shut off from the service of their obsessive-compulsive defenses. Obsessional patients do come to therapy with what is known as the forbidden wish to be the recipient of help. But this is the wish they first denied in early childhood and have continued to deny ever since. . . .” . . . “Explicitly stating the therapist’s responsibility for the treatment and making a declaration of intent – ‘I think I may be able to help you with your problem’ or, later on, ‘We will make it our priority to length the time span of your vulnerability here’ – is implicitly providing nurturance within the therapeutic relationship as well as establishing an authoritative role.” And – “Deprived of the ability to deflect, the patient may begin experiencing the forbidden wish for dependency and trust.” And later, “If this psychotherapy is termed reparenting, it may not sound professional enough, so, instead, it can be identified by the behaviors that compensate for the patient’s heretofore unmet needs: nurturant-authoritative psychotherapy. The initial phase of this treatment is fraught with anxiety for obsessional patients because they are placed in conflict. Feeling at ease in the nurturing role themselves, they can also be effective at dominating a conversation. Now, as the therapist begins establishing a nurturant-authoritative role, the patients do not know who to be to the therapist. Since most obsessional individuals only experience trust as forbidden wish, there is severe ambivalence toward the therapist who is tempting them. But this ambivalence is valuable in treatment since it mobilizes the patient to become emotionally involved with the therapist. . . .” (Obsessive-Compulsive Disorders). In the same author’s discussion of anorexic clients, he states: “The patient must be taught to trust the therapist first, so that she may then learn to trust herself. Developing trust in another person, at the expensive of obsessive ideas, usually precipitates a crisis that ends in recovery” (Treating and Overcoming Anorexia Nervosa).

    I don’t agree with Levenkron’s theory in total, and as I mocked in one blog post, can’t see how he keeps his clients for years on end, perpetuating and increasing a ‘healthy dependency.’ Now, the primal therapy folks would probably state (very categorically) that one must burn clear through all adult defenses, expulsively, to reach the child’s pain directly. But unless that therapy has deeply humanized over the decades, it probably doesn’t deal with reparenting, and may not even endorse the concept of a healing therapist-dependency.

    A loving adult relationship – again, in theory but hopefully in practice for some people – can recapitulate the regressive dependency in an unparented child-adult, give it a solid and loving “container” in the marital partner, melt adult numbing defenses, enable old pain to outlet, re-humanize the lonely island of a person and in some ways remake the past. Primarily, I’d say, you have to want to feel again – pretty much everything.


Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.