The Art of Working with Anxious, Antagonistic Adolescents

Ways Forward for Frontline Professionals

Nick Luxmoore

• Publisher: Jessica Kingsley Publishers
• Year: 2019
• ISBN:
  9781784509781
• Topic: Education
• Subtopic: Behavioural Management

1

INTRODUCTION

Young people can’t escape. They’re in daily contact with their parents, siblings, friends, enemies and teachers at the same time as their brains are changing, their bodies are changing, the way they see themselves and the way they’re seen by other people are changing. They bring a multitude of stories to the professionals they encounter, and they present these stories in a multitude of different ways. Counsellors, teachers, youth workers, social workers, mental health workers and other professionals are always having to think on their feet: adapting, adapting, adapting, developing individual approaches alongside theoretical perspectives because each young person requires a different response.

Young people are usually more chaotically defended than adults and less practised at managing social conventions than adults because they haven’t had so long to get used to the ways of the world. They don’t necessarily understand the ‘rules’; they don’t necessarily have words to describe their experiences, and because their defences are less reliable, they’re more likely than adults to act out their anxieties. Some shuffle, others burst into the room. Some struggle to speak, others are unable to contain themselves… All of them are living with developmental issues over which they have little or no control. The pressure is on professionals to fix things quickly or, failing that, to come up with a diagnosis that’ll lead to treatment elsewhere (assuming that ‘treatment’ exists).

But however lurid their symptoms, most young people are living through developmental crises for which there are no quick fixes. They have to carry on living with imperfect parents and imperfect professionals in an imperfect world, learning to bear the disappointment of that world, learning how much agency they can and can’t have. If they’re lucky, they’ll have the support of someone who understands these things and doesn’t panic, the containment of someone who doesn’t immediately reach for a quick fix.

I’ve worked with young people and with the professionals who support them for 40 years as a teacher, youth worker, counsellor and psychotherapist. More recently, I’ve concentrated on supervising and training frontline professionals, all of them working hard to understand, support and empower young people to live less anxiously, less antagonistically. It’s often said that the pressures on young people are greater now than ever before, and certainly young people are happy to believe this. Why wouldn’t they? They’ve never been through adolescence before and it undoubtedly feels more turbulent than childhood. It’s also true that the world does change. Technology brings new opportunities but also new problems. Capitalism raises some people up but keeps many people down. Circumstances do change.

The developmental tasks of adolescence don’t change, however, and for professionals struggling to support anxious, antagonistic young people through all manner of personal crises, it’s important to remember that these real – and really serious – crises are taking place within a developmental context. A boy is dealing with his parents’ separation and the fall-out from that at the same time as he’s dealing with puberty. A girl is dealing with her friend’s overdose at the same time as she’s re-negotiating her relationship with her parents, caught between wanting to stay close to them and wanting more independence.

This book describes the conversations and the thinking that takes place in supervision sessions as professionals work out how best to respond to a whole range of dilemmas and crises, as they try to ease young people through developmental impasses, offering relationships wherein young people can explore a range of underlying issues at the same time as addressing all the bad stuff they originally came to talk to the professional about.

As soon as one of these professionals begins to tell me about a particular young person, I ask the young person’s age because, although bad things will undoubtedly have been happening in that young person’s life, things that’ll need to be talked about in order to make sense of the young person’s (often unspoken) thoughts and feelings, these bad things will always have been happening within a developmental context…

A bereaved 11-year-old, for example, will also be about to start (or will recently have started) secondary school, will be looking backwards to childhood and forwards to adolescence with mixed feelings.

A bullying 12-year-old will typically be starting to push the boundaries at home in a quest for greater independence. He or she will be busily trying out different roles in relation to friends and enemies. Sex will be in the air.

A 13-year-old, furious with school, will be coming to talk about that fury at the same time as his or her relationships at home will be changing. Puberty will have kicked in. There’ll be sexual curiosity and a preoccupation with agency: ‘How much control do I have in my life? How much control do I want?’

A self-harming 14-year-old will be trying to make sense of his or her strong feelings about other people, just as school is launching its rhetoric about exams with much talk of ‘your future’ and no talk of failure.

A 15-year-old presenting with ‘anxiety’ will be carrying these residual issues and adding some more: ‘What’s going to become of me? Will I ever be loved? Part of me wants to start all over again! People see me as a certain kind of person but I’m no longer sure if that’s really me.’

A 16-year-old will typically be beset by existential questions in the build-up to exams and in their aftermath: ‘What’s the point of anything if we’re all going to die? Does any of this matter? Do my friends really care? Do I really care, or are we all just pretending?’

And so it goes on, all through life. Our age always affects how we see the world and how we see ourselves in relation to the world. We’re always at a particular stage in our lives characterized by certain developmental issues. Adolescence is effectively a compression of stages or, as Jones (1922, p.41) argued long ago, a recapitulation of infancy where ‘the precise way in which a given person will pass through the necessary stages of development in adolescence is to a very great extent determined by the form of his infantile development’.

That infantile development will be characterized – in part – by the need to be interesting. A baby needs to interest its mother or carer and urgently (‘Waaaah!’) because unless she recognizes her baby and is interested, the baby’s in trouble: an uninterested mother might abandon her baby. The need to be interesting is a matter of survival. However, if the baby gets enough regular, attuned attention from its carers, it internalizes a sense of being intrinsically interesting, no longer needing to act out its anxieties but able to take its own worth for granted. Unfortunately, not all babies get this quality of attuned attention. Years later, having grown up, many babies now present themselves to professionals as young people with similarly urgent ways of getting attention, still effectively yelling ‘Waaaah!’ – and the more dramatically the better. They’ll do anything to interest those around them because to be uninteresting still feels dangerous, still feels like being worthless, still feels like not existing. So if nothing else seems to be working, they’ll take all sorts of risks: violence, drugs, drinking, fighting, getting into trouble with the police, suicidal threats, pregnancy… Whatever it takes to get someone’s attention.

Once they start meeting with professionals and getting the attention they need, their presenting problems usually become less urgent. This is a critical moment. The professionals can now send them on their way – six sessions, symptoms diminished, job done – but so many of these young people come back sooner or later (or move on to another agency) because their underlying need to interest other people hasn’t gone away: life still feels like a matter of survival.

My point is that many young people need to continue working with their counsellor, teacher, youth worker, social worker, mental health worker or other professional after the crisis has passed in order to prove to themselves that they’re still interesting, even without the drama of a presenting problem. Of course, with long waiting lists, there’s tremendous pressure on under-resourced professionals to work quickly, but until young people have internalized a sense of being intrinsically interesting without needing to conjure up yet another presenting problem, sending them back out into the world is likely to be a false economy. Sessions might well become shorter and less frequent, but frontline professionals need to demonstrate that they’re still interested, even now that things are going relatively well. I think this work is just as important as any work done in a crisis.

We often talk scornfully about young people behaving childishly and ‘only’ seeking attention, as if the rest of us didn’t also need attention. Yet, at times of crisis, even the people we think of as ‘adults’ or ‘professionals’ experience an eruption of old uncertainties: ‘Am I loved? What’s the meaning of my life? Do I necessarily want to continue with things as they are?’ The only difference between young people and adults is that adults have usually found more sophisticated ways of hiding their anxieties. Their anxieties may no longer be so blatant, but they’re just as powerful.

Of course, I’m generalizing, simplifying. Of course, there are exceptions to every behavioural tendency or developmental rule. Sometimes there are particular cultural expectations affecting a young person’s development and, of course, professionals need to take these into account. But in my experience it’s always important to keep a broader developmental context in mind because a young person’s presenting issue – however urgent, however anxious, however antagonistic – is likely to be the tip of a developmental iceberg.

One of the purposes of supervision is to contain the anxieties of frontline professionals who must be all things to all people: attending to the presenting problem while keeping a developmental perspective in mind; reducing waiting lists without saying goodbye to young people prematurely; listening to everyone else’s problems while bearing their own.

Whether it’s with a line manager or with someone from outside the organization, we all begin supervision as novices, learning from someone with more experience. At first we’re happy to be told what to do, but good supervisors will quickly start giving us back responsibility for our own learning: ‘What do you think?’ they ask. Before long, supervision becomes more of a collaboration – two people thinking together, getting stuck together, working it out together – until eventually we internalize a sense of our supervisor, knowing roughly what he or she would be likely to say without necessarily needing to ask. Now we’re on the way to developing a reliable ‘internal supervisor’ (Casement 1985), an independent part of ourselves able to observe and think about what’s happening, able to judge where conversations with young people need to go, even as we’re in the middle of them.

The stories in this book are all about young people who, in one way or another, might be described as anxious or antagonistic. Or both. They’re stories about frontline professionals – many of them counsellors, all of them with counselling skills – trying to understand and make things better for these young people and for various conscientious, hard-pressed colleagues whose own development and well-being matters as much as anyone else’s. Supervision aims to support the work of professionals forever thinking on their feet as they find ways of responding to all these people personally, practically and theoretically. This book describes a miscellany of conversations taking place in supervision as – together – the professionals and I try to puzzle things out.

2

THE POINT OF
ANYTHING

Bella says she’s had a terrible week. ‘It’s made me wonder about the point of anything. Whether any of it makes really any difference…’

This week she’s had to put up with more than her fair share of the trials and tribulations that beset counsellors working in schools: losing her room at short notice to a French oral exam, blamed by one of the deputy head teachers for effectively not having a magic wand, discovering that her school email account had accidentally been deleted by an IT technician and told to fuck off by an irate father on the phone. All this, while dealing with a sick child of her own at home.

‘But I can cope with all that stuff,’ she says. ‘I’m used to it. What really got to me was my session with Andrew.’

Andrew has an inoperable brain tumour, which, in the absence of a miracle, will kill him. He’s 14 years old. He comes to school most days as long as he’s well enough, and comes to see Bella once a week for counselling.

‘I don’t know what to say to him. He’s got to go back to hospital this week to get the results of tests to see if the latest treatment has made any difference. But he knows the chances are slim. So by the time I see him, he’ll probably have had bad news from the hospital, and there’s going to be nothing I can say that’ll make any difference.’

She’s right. Counselling will make no obvious practical difference to Andrew’s situation.

‘He’s so brave,’ she says, becoming tearful. ‘I don’t know how he does it. He’s pissed off with all the doctors who are supposed to know about brain tumours but who can’t do anything. He’s pissed off that all this is happening to him, but still reckons that there are people who are worse off.’

I ask if Andrew always feels so brave.

‘Not always,’ she says, ‘which makes it even worse because he admits how scared he is and how pointless it is, coming to school. Also, he gets really pissed off with his so-called friends who – when he was first diagnosed – all reckoned they were going to be there for him, but now that the novelty’s worn off, they’re no longer interested.’

She pauses. Breathes. Breathes some more.

‘I don’t know what I should be saying to him. I don’t want to pretend that everything’s going to be okay when it isn’t. I mean, I could ask about his family or about school – the usual stuff – but that just seems a bit pointless when he knows perfectly well that he could be dying. I really need some help here!’

I say I’m glad that Andrew gets angry because his anger probably does a good job of holding him together. ‘But I wonder, Bella, about the times when he can’t be angry? When the despair kicks in and he feels like giving up? Because if he’s supposed to be brave, it must be tempting to hide those despairing feelings from other people, especially from the people in his family who are probably trying hard to be cheerful and optimistic. He might worry that they won’t want to hear all the despairing stuff in case they get upset themselves. And so then he’s on his own with it, despairing and scared and looking into the pit. And that’s where you might come in. You might be the person prepared to share his despair with him, keeping one hand on the ladder – as it were – wh...

Table of contents

• Cover
• Title Page
• Contents
• 1. Introduction
• 2. The Point of Anything
• 3. Useful Strategies
• 4. Living with Disappointment
• 5. Defining the Therapeutic Task
• 6. Resilience
• 7. Loving Young People
• 8. The Rebel
• 9. Counselling Staff
• 10. A Girl Not Eating
• 11. A Professional’s Own Experience
• 12. A Moral Purpose
• 13. An Outbreak of DNAs
• 14. Suicide
• 15. Pornography
• 16. Disliking Young People
• 17. Running a Training Session
• 18. Aggression
• 19. Telling Lies
• 20. Caring Barometers
• 21. A Boy with No Feelings
• 22. Challenges, Interpretations, Insights
• 23. Responding to Parents
• 24. Counselling the Head Teacher
• References
• Index
• Join Our Mailing List
• Acknowledgements
• Dedication
• Copyright
• By The Same Author