Working With Adolescents and Young Adults

A Contemporary Psychodynamic Approach

Stephen Briggs

• Publisher: Bloomsbury Academic
• Year: 2008
• ISBN:
  9781350305984
• Edition: 2
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

The first edition of this popular book won praise for successfully exploring the inner world of contemporary adolescence. The new edition now also examines issues including self-harm, depression and body image disturbance. Drawing on a flexible psychodynamic approach, it gives evidence-based guidance for both experienced practitioners and students.

1

CONTEMPORARY ADOLESCENCE:
STILL THE ‘AGE BETWEEN’?

Contemporary adolescence is organised now around two distinct phases. The transition from childhood to early adolescence, through the impact of puberty, is a period of intense growth and far-reaching changes – physically, cognitively, emotionally. This is followed by a long transition into adulthood, which, though inclusive of diverse ‘pathways’, is usually extended, lasting approximately for a decade from mid/late teens until the mid-twenties. Primarily affected by social changes, this long transition to adulthood severely tests traditional thinking about the adolescent process, particularly the central concept of identity formation. Upheavals in the social world and the changing contexts for young people mean that a new sense of turbulence has become apparent, evidenced by concerns about increasing adolescent mental health problems and the emergence of new kinds of problems.

This chapter elaborates on emerging new ways of characterising adolescence and explores the meaning of the two distinct ‘phases’ of development. This leads to an evaluative discussion about the limits of some traditional theories and provides some newer ways of orienting to adolescence from a psychosocial perspective. Linking with this are considerations about ways of working therapeutically with young people in difficulties. Bion’s theory of container-contained is applied to thinking about ways in which anxieties of contemporary adolescence can be understood and addressed.

From the ‘age between’ to a central life stage

In the middle decades of the twentieth century, adolescence – though recognised as an important period for growth and development, and often a troublesome one for adolescents and those in contact with them – was treated as a kind of passing phase. Derek Miller (1969), one of the founders of the Tavistock Clinic’s Adolescent Department,¹ described adolescence as ‘the age between’, a relatively short period of transition between childhood and adulthood, characterised by rapid changes and growth and playing a very significant role in the maturation of the individual. The ‘age between’ was divided into three stages: early adolescence, organised by the experience of puberty; mid-adolescence, when there may be a short period of opposition to authority, ‘lasting 6 months or so’, following which the adolescent entered late adolescence, left school and became ‘adult’. In late adolescence, the preoccupation was with ‘trying out’ the inner resources that had been developed over childhood as the adolescent entered adult society.

The idea of the ‘age between’ positions adolescence as a transient state, preoccupied with leaving one age – childhood – and entering another – adulthood. The space in the ‘age between’ is therefore filled by loss and expectation, which intermingle to generate the particular tensions and turbulence of adolescence. The period in which Miller wrote – the 1960s – was a fertile period for theorising adolescence, but – almost imperceptibly initially, and then unavoidably obviously – changes in the context for and experiences of adolescence have become so great that a yawning gap now exists between these early theorisations and the actual experience of adolescents today. Despite some reports to the contrary,² the beginning of adolescence has changed very little in the past 50 years, in that puberty starts at around the same time and extends over the same period of 4–5 years (between the ages of 10 and 15); the period of transition to adulthood has lengthened significantly. Gluckman and Hanson (2006) show that the age at which adolescent to adult transitions are completed – using marriage and parenthood as indicators – is as late as 29/30 today, against 23/24 in the middle of the twentieth century.³ Whereas, to use Miller’s work again as an example, adolescence was thought to end with the teenage years, contemporary views consider adolescence as extending to the mid or even late twenties. There is evidence that adolescents today who complete the transition to adulthood by the end of the teenage years are disadvantaged and at risk of social exclusion (Jones, 2006). The length of adolescence is one key factor that suggests that the idea of the ‘age between’ inadequately conveys the meaning of contemporary adolescence; a period lasting for a span of 15–20 years is impossibly long to stay ‘between’.

Along with the extension in time, the adolescent process is thought of as increasingly complex; this is accompanied by some fierce debates. Firstly, there has been controversy over whether the early adolescent period is inevitably turbulent and characterised by conflict between adolescents and their parents. Secondly, it has been asserted that the problems of adolescence are getting worse and the mental health of young people is deteriorating. Thirdly, it has been disputed whether the problems of adolescence are ‘cured’ by the passing of time, or whether interventions are required to prevent the onset of psychosocial difficulties that endure into adulthood. These debates are indicative of the changing nature of adolescence and initiate the need to reconceptualise based on the emergence of greater knowledge – from different sources – about both the early adolescent experiences of puberty and the later sojourn in the long period of role transition to adulthood. We can begin to explore these issues through a case example:

Case example: turbulence or transition?

Maria requested a therapeutic consultation when she was 21, because feeling depressed and having a lack of self-confidence in herself increasingly troubled her. In her consultation, Maria was very tearful and said that she felt ‘stupid’ for being so easily moved to tears. She felt she should be stronger, but that she is ‘pathetic’. She said she is very close to her parents, especially her mother, with whom ‘she could talk about almost anything’. Her mixed-race parents got on OK too, though they had had some difficulties when she was younger, when they had argued a lot about her older stepbrother, mother’s son.

Maria said her adolescence had not been particularly difficult or traumatic. There had been very little conflict between her and her parents. She had got on well at school, had progressed to university, continuing to live at home, and was nearing the end of her course. She had many friends, enjoyed a ‘going out’ lifestyle and had boyfriends. One of these had been serious for a time, but though she is still keen on him, he wants ‘some space’. Now, in comparison with her teens she is ‘very up and down’, and she described within herself feeling ‘wobbly, not at all solid’. She felt others around her were more secure and more confident. Her brother in particular ‘made her feel stupid’. He and his friends could talk about things – like chaos theory and complexity – but she felt she had nothing to say. She wished she could talk like them. She felt she ought to be more independent, especially that she ought to be more separate from her mother, but she did not like being alone and did not know what she wanted to do in the future.

Maria’s situation illustrates some of the key features that need to be taken into account when thinking about contemporary adolescence. She lives in a mixed-race reconstituted family and lives at home while going to university. She is asking for therapeutic help at the age of 21, when, in traditional terms, she would be considered ‘adult’ rather than ‘adolescent’. She is depressed, uncertain as to why, and she comments on the closeness and openness of her relationship with her mother and her lack of conflict in her teens.

Maria’s is one narrative about adolescence, and one of the crucial features of contemporary adolescence – and thinking about adolescence – is that there is considerable diversity. It is misleading to think, still, about a single normative experience of adolescence. Thus the case example introduces – but cannot inclusively represent – some key issues.

Consistent with the idea of the ‘age between’ was the view that, though inevitably turbulent, the adolescent’s need and drive towards development led to the resolution of the problems of adolescence. Time was the cure:

Whilst this is a time of turbulence, disturbance and struggle, often of inner uncertainties and chaos, the adolescent’s growing discovery of his [sic] own sexually maturing body and physical strength, alongside his developing mind and intellect, usually enables him to move from dependence to independence.

(Wise, 2000, p. 7)

Ruggiero (2006, p. 550) describes how thinking about adolescence has veered between ‘a historical opposition between “sitting on the fence” (A. Freud, Winnicott, Meltzer) and being more interventionist (prevalent today)’. In ‘sitting on the fence’, there is faith in development trusting ‘to the vis medicatrix naturae (healing power of time)’.

The more interventionist approach focuses on the way that adolescent difficulties transform into adult psychosocial disorders, for which a preventive, interventionist approach with adolescents is needed. Yet this is not simply a debate about whether either view – intervention or trusting to nature – is ‘correct’, for lying beneath the surface is a conflict about whether the emotional impact of adolescence can be tolerated, or not, by others in contact with adolescents. The non-interventionists seem, today, to have a touching faith in development, which is perhaps contrary to the evidence that difficulties first occurring at adolescence persist into adulthood. Contained in the non-interventionist approach, though, is a greater willingness and capacity to tolerate adolescence, not to be made unduly anxious by it, nor ‘phased’ by the intense emotional impact adolescents can exert on anyone close to them. The interventionists, on the other hand, are preoccupied with identifying risks. Two approaches towards risks are available: they can be either modified, through thought, or avoided, through risk aversion. This distinction is important for the delivery of services to adolescents, as we shall see later (Chapter 5).

The view that intervention is necessary is particularly influenced by recent epidemiological studies that show that most adult disorders begin in adolescence, between the ages of 12 and 24,⁴ though often these are not detected until adulthood. Between one in four and one in five adolescents have a recognisable mental disorder in any year (Patel et al., 2007). Of course this fact can be looked at from two directions. The vast majority of adolescents (four in every five) do not have mental ill health. It is not true, therefore, that all adolescents fit the stereotype of being unstable (Graham, 2004). It is important to recognise that some adolescents succeed in negotiating adolescence: understanding why and in what circumstances is possible once this is accepted. On the other hand, a significant minority of adolescents have a recognisable mental disorder, and this implies that the risks and hazards, to which adolescents can be exposed, leave them vulnerable to the development of psychosocial disorders, which peak during the adolescent years. Suicide, self-harm, substance misuse, offending behaviour, depression and eating disorders are among the risks. Rather than growing out of these problems, if untreated, they can persist into adulthood and have detrimental effects on adult functioning (Smith and Rutter, 1995; Graham, 1986; Achenbach, 1998; Patel et al., 2007; Toumburou et al., 2007).

The mental health of young people is enormously vulnerable because of the many, diverse challenges they face in adolescence and also because of a propensity to engage in at-risk behaviour. Some young people are also exposed to harmful circumstances which affect their mental health … Singly or more usually in combination, these at-risk behaviours and adverse circumstances increase the vulnerability of young people to psychosocial disorders.

(Baruch, 2001, p. 3)

From this perspective, adolescence is a highly vulnerable period, which requires intervention; just allowing maturation to take place would neglect the opportunities for intervening to reduce risks and at worst condemn the adolescent to long-term problems. Moreover, mental health problems have implications for other aspects of adolescent development, including education achievements, substance use and abuse, violence and reproductive and sexual health (Patel et al., 2007).

We can apply these different views to our case example. Maria’s depression, her tearfulness and her feelings of low self-worth – as she puts it, feeling ‘pathetic’ and ‘stupid’ – seem central to her difficulties. The causes, however, are not clear. Do they indicate longer-term problems arising out of adolescent difficulties? Or are they responses to the immediate process of change and transition she is encountering? Is she, in other words, still in a process of change and development? Is her ‘identity’ still being formed?

Some adolescents find that the social transitions expected of them are overwhelming. Both the transition into adolescence from childhood, which requires experiencing the powerful changes of puberty and, usually, changing schools and the late, long transition into adulthood create conditions of uncertainty and change. Maria can be identified as someone who is experiencing anxiety about the late adolescent transition, but who, in reporting that her teenage years were not particularly full of conflict, seems to fit with the view that

There is little evidence to support the notion of wide ranging conflict between the generations. … findings from research are unequivocal. Serious conflict between parents and adolescents is true only of a small minority of families, which should bring some comfort to those parents who contemplate the onset of adolescence with trepidation.

(Coleman and Hendry, 1999, p. 80)

Some adolescents, it is argued, make a smooth transition through adolescence, while others have a more stressful and turbulent experience. Parents and teenagers, like Maria and her mother, can remain connected to each other rather than becoming estranged. They can spend as much time together in adolescence as in earlier childhood, and although adolescents spend less time in total in the family, there can be a compensating sense of increased communication between them. Since adolescence is often thought of as synonymous with turbulence, it can come as a surprise that some accounts of adolescence refer to the continuity of relationships between parents and adolescents, the absence of communication breakdown with parents, the absence of symptoms of psychological distress and difficulty in relation to peers and adults (Coleman and Hendry, 1999, p. 209). Turmoil may be located in a minority of adolescents, a highly significant minority from the point of professional practice, since these are more likely to be the adolescents who are encountered by professionals.

These accounts caution against a normative approach to adolescence in which turmoil is assumed to be universal. In fact turmoil may be thought of as denoting a particular social construction of adolescence, and therefore an adult-centred approach (Roche and Tucker, 1997). As Van Heeswyk points out, the ‘stormy’ view of adolescence ‘is the theory that underpins the commercial exploitation of young people’ (1997, p. 29), who are characteristically represented as ‘inherently deviant or deficient’ or, more specifically,

presented as either actively deviant or passively at risk and sometimes as both simultaneously. In general young men are more likely to be presented as actively deviant, especially in aggressive forms and especially if they are working class and/or black. Young women are more likely to be constructed as passively at risk.

(Griffin, 1997, p. 18)

From this perspective, it is not just individual differences that determine whether adolescence is turbulent or proceeds in a smooth transition to adulthood, but the social context, in which some groups are more vulnerable than others, especially in terms of race, gender, class and sexuality. The contextual differences of individuals – and the availability of resources, primarily in the form of reliable and trustworthy relationships with adults – are extremely significant in whether adolescents succeed in working through the impacts of adolescence or succumb to stressful experiences, with a consequent risk to long-term mental health. The capacity within relationships between parents and adolescents to manage conflicts, understand emotionality and have adaptive strategies for resolving difficulties when they arise is fundamental; these relationships are founded on a bedrock of stability throughout childhood and reflect the integral nature of qualities of negotiability and trust on both sides. When there are problems in the parent–adolescent relationship, these can be sorely tested by the intensity of emotionality in adolescence – again this is likely to be experienced on both sides. This is experienced in different ways during adolescence, and to take this discussion further, it is necessary to think separately about the two distinct phases of contemporary adolescence.

The impact of puberty

It is widely accepted that the growth and change initiated by puberty heralds the start ...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword
• Acknowledgements
• Introduction to the Second Edition
• 1 Contemporary Adolescence: Still the ‘Age Between’?
• 2 Becoming a Subject in Adolescence
• 3 Ethnicity and Identity in Adolescence
• 4 Parenting Adolescents
• 5 Containing Adolescence in Organisations
• 6 Adolescents as Temporary Outsiders: Antisocial Behaviour
• 7 Adolescent Difficulties in Achieving Separateness
• 8 Psychotic and Suicidal States in Adolescence
• 9 Emerging into Adulthood
• Notes
• Bibliography
• Name Index
• Subject Index