Kids these days

How can a therapist help a teenager get out of her head, the prison of self-consciousness and thought?

"So basically today was the first day of school and I think I have targeted the number one issue I have and why I'm unhappy at school (or why I was last year). I feel like the reason I am unhappy is because I don't really feel like I have a strong sense of self and I feel like my personality changes based on who I am with. I am really exhausted after today because I honestly always feel like I am a chameleon, and I change how I act depending who I am with. Also I feel like my friends aren't the perfect match for me and it's hard for me to make friends who I more relate to. What can I do to develop my sense of self and stop feeling so empty at school? I also feel like this feeling is why I attach so obsessively to other people who I get along with because I like the way they make me feel and I never feel like that, so I get obsessed. I also notice ever since last year that I always feel 'unsatisfied' after school and I feel like I'm always missing out on other people or places I could be, but when I talk to the people I want to talk to I just feel like super uncomfortable and out of place and socially anxious. How do I get past this?"

This wasn't a new client, soon to be 18. I'd been seeing her for three years. She was as in-her-head now as she had been at the first session. By now, you could say "Sarah" was a favorite, and, in time, a mild source of frustration. We had worked on her depression, social anxiety, self-esteem. Many sessions were like girl conversations, had I been a 16-year-old girl instead of a 70-year-old man: what to do about this acquaintance, that friend group that seemed to be ostracizing her, a problematic mom. While I grew in sophistication about early identity emptiness and its manifestations in the teen world, she could never undo her inner-dwelling, extinguish it, black out and wake up outside the prison walls of her head. I got a bit exasperated:

"Dearie-Pie Sweetie-Potato, I think that if I were to print out all the progress notes from your sessions over the past three years for you to read, you'd say: 'All this worry and anxiety and social uncertainty and depersonalization and parent problems and awkward friendships and neediness and super-neediness and boredom and inferiority and superiority -- Enough! Let me just live and get out there and feel bad and good, and let me cry when I need to (which will probably be a lot) and feel more able to deal with my problems at 17 then 18 (". . . Everyone is fighting a great battle") and let high school then college carry me along and find really interesting things to learn and do (and maybe lean on old Fred when truly lost). Good is better than bad and I can find it because I want to.'"

She took that fairly well: "Thank you, I am trying to work on making me believe it and not feel like the world is ending all the time lol."

There was a young man in the same state. The other 16-year-olds thought him "icky" and he didn't know why, but I thought he had a fair idea. He was not 16: He was 5 and 30, a cynical sophisticate carrying a starved little boy. Nothing was more important than finding a girlfriend. He didn't have teenage feelings, only neurotic ones. I found him easy to talk to, but not for the best reasons: He was open to listening to me because he felt heard, and we were both comfortable being in the realm of thought. I tried to get him into the world, to "black out" and come to, to where an interest was more important than his need, his global prejudices. A lot of this was silly. I sent him Gary Larson cartoons, the old "Son of Fountain Pen" ad, music for an adolescent to choke on like Barry Manilow and Vaughan-Williams' Loch Lomond.

I believe there is a psychological capacity where a young person can partially dissolve his inner sanctum-sanctorum by being disturbed by something in the real world, startled, then stuck in it. If a flying saucer were to land in front of him, would he disappear in and become the amazement, or would he think: "Just some other alien who doesn't want to be my friend"? If she goes to college and finds Oceanography, Theater, or Japanese history and culture, would she become transported by them or just circle back to her room and resume her text-message search for connection?

I have thought that terminating therapy might be the answer. Quit leaning on me for answers and soothing. Sink or swim out there in the ocean. But I can't picture leaving the young man without an empathizing source, the only one he has. He'd be alone with wolves in the desert.

Sarah is in the National Honor Society and Key Club. And she has no interests. What she really needs, or needed, was a mom and dad.