Facing It Out

Clinical Perspectives on Adolescent Disturbance

Robin Anderson, Anna Dartington, Robin Anderson, Anna Dartington

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367324452
• eBook ISBN: 9780429913518
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Based on the wealth of experience gathered in the forty years of the life of the Adolescent Department at the Clinic, this covers a full range of clinical work with some of the most difficult areas of adolescence, but it also gives a conceptual framework of normal adolescence and traces the difficulties that arise when this goes wrong. Facing It Out presents new work which has not previously been fully described. The book will be vital reading for clinicians whose work includes work with adolescents. The Adolescent Department of the Tavistock Clinic in its long history has been engaging with young people and their families when the strains prove too great. In this book, staff of the Adolescent Dept examine in accessible language different clinical aspects of adolescent disturbance, exploring in particular the impact on the family. The chapters look at a range of severity of disturbance from adjustment crises to anorexia nervosa and psychosis as well as aspects of adolescent development in small families and in the formation of a sense of identity. With the exception of infancy, adolescence is the most radical of all developmental periods.

1
The Intensity of Adolescence in Small Families

Anna Dartington

This Chapter is about small family groups and how they manage the disturbance of adolescence. I am defining a small family as a group of two or three people who live together, sometimes two parents and a single child but, increasingly commonly, a single parent alone with one or two children. The experience of smallness is intensified when, for various reasons, there is an emotional or geographical distance from a wider family membership.

The thoughts that are gathered here are based on my experience of working with adolescents who are struggling with their parents and parents who are struggling with their adolescents. I will not be discussing family therapy as such in this paper. This is a fascinating subject in its own right and is covered elsewhere in this book (Chapter 10). I will be discussing individuals who seek help alone. This is often because they are feeling seriously misunderstood and hopeless about being heard in the family context. Some present themselves as refugees from an emotional intensity in the family which they find unbearable. Small families are inevitably more vulnerable to intensity because more is expected of a few. When they are also required to accommodate the emotional and behavioural experimentation of adolescence small families may become under considerable pressure.

Perhaps these introductory statements have already suggested something of a paradox. Surely a small family provides an opportunity for everyone to have more attention? This is undoubtedly true. The fact is that most adolescents, particularly in the middle teenage years, do not want to be the focus of attention. At least they do not want attention in the way that adults ordinarily understand it, that is, for example, the attention that entertainers want of their public or lovers want of the beloved or even the attention that small children want from their parents. In the family context most adolescents prefer to be a significant but understated presence, a presence that does not invite comment or scrutiny but at the same time reserves the right to observe and comment on the behaviour of others, most particularly the parents.

This combination of the wish to be inconspicuous and at the same time assuming an attitude of ‘knowing best’ can be particularly infuriating for parents, particularly if they are themselves unsupported or too stressed to mobilise a sense of proportion, or more to the point, a sense of humour, always the best antidote with which to confront adolescent grandiosity.

What Do Adolescents Really Want From a Family?

I would like to share some of the themes that adolescents and their parents have highlighted when asked what they hope and expect from a family life. The following are examples of some frequently recurring themes.

Protection from Public Shame

Richard aged 15: ‘I had a nasty argument with my parents because they found out that I took a chocolate bar from a shop without paying for it. It was a really stupid thing to do. I expect they will keep bringing it up. They may even insist that I go back to apologise to the shopkeeper. At least I can trust them not to tell the neighbours and stuff. If they did I swear I would run away.’

Protection from Unnecessary Humiliation

Mrs B, mother of Ian aged 14: ‘We had some new friends round for supper and one of our guests, who is feeling rather beleaguered with two small children at the moment, started to talk about her 4-year-old daughter’s bed wetting problem. Unknown to her Ian had experienced the same problem when he was the same age. I saw Ian growing red in the face, obviously desperately worried that somebody would make the connection. I managed to signal to my husband who changed the subject while I found a job for Ian in the kitchen. It all sounds a bit melodramatic in retrospect but I can still remember how painfully self-conscious I felt as a teenager.’

The Capacity for Negotiation

Mr D, father of Vanessa aged 16 and Janet aged 17: ‘Having two girls of this age there is inevitably an enormous issue about staying out late, especially now that the girls are wishing to go to different parties with different friends. My wife and I have had to be very firm at times, despite the odd tantrum that has ensued, nevertheless we do try to remember what it was like at their age.

When I do pick up my daughters from a party we have what we call a ‘mutual promise pact’ which is that if they promise to be ready to leave at the time we have agreed, that is not to keep me waiting, I will promise to be careful to park around the corner out of the sight of their friends!’

Somewhere to be Private

Julia aged 14: ‘Mymum read my diary. I know she did because it was moved to a different place. She won’t let me clean my own room even though I want to. If she does it again I’m going to ask my father if I can go and live with him.’

Opportunities to Observe How Adults Talk and Relate to Each Other

Helen aged 18: ‘I hated it when my parents separated, they said it was mutual but I knew my mother was very upset. She has a new man friend now but he doesn’t come to the house because my brother is rude to him.

When I visit my dad’s now I quite like it. I like the way that he and his partner laugh together and also the funny things they disagree about. They have a new baby too so now I have a sister which is quite nice. What I like most is the way they include me in things so I can see the way that couples work. I can’t remember that with my own parents, probably because I was too young. I really hope that I don’t have to go through a divorce.’

The Space to Retreat from Parental Wishes and Desires

Mrs J, mother of Nigel aged 17: ‘Nigel and I have always been so close. He was an unexpected baby conceived at the end of an unsatisfactory affair. I can remember the moment when I felt we had begun to separate. When he was 13 he began to smell different, that’s when he was starting to become a man.

I have my career and my friends but I dread the time when he leaves for university. My love for him now has to be the love that lets him go. It sounds good in theory but I know it’s going to be hard.’

Each of these vignettes present a miniature window into family life, commonplace situations that most of us will recognise. It will be immediately apparent that some of these adolescent concerns, ordinary as they are, have the potential to be more explosive in small families.

Protection from unnecessary shame and humiliation is something that all adolescents need at some time, particularly in their phases of intense self-consciousness. Adolescents can be very difficult to live with in their moods of self-preoccupation and self-doubt, when they are likely to be reclusive at one moment and argumentative at the next. Elder siblings and grandparents can be extremely helpful at such times, providing necessary distractions and helpful mediation in heated family debates. It can be very hard for single parents, particularly if they are distanced from other family members, to be the sole representatives of an adult viewpoint.

Somewhere to be private is a necessity for all family members. In a small family there are more opportunities for this but paradoxically it can be a problem for only children who are often too much the centre of parental attention. This centrality which younger children can find so pleasurable becomes, at adolescence, something of a mixed blessing.

The Only Child: Mario’s Story

Mario referred himself to us when he was 17 on the advice of one of his teachers at his private day school. He wrote a short letter to us saying that he was finding it difficult to concentrate on his A level work. He also mentioned that he was sleeping badly and had been having some bad dreams.

It is our custom in the Adolescent Department to offer a series of four appointments initially. The idea is to create an atmosphere in which the young person is invited to join the therapist in a mutual process of assessment, which is designed to unravel the immediate emotional tensions and to mobilise some new ways of thinking about the problem. It is a simple and straightforward process in which the therapist may ask questions that are so obvious that nobody, including the patient, has thought of asking them before. When I asked Mario ‘who is in your family and what is it like at home?’ he said he would have to think about it. After a minute or so he said that his parents were Italian and that he was their only child. His parents ran a restaurant and they were very busy. After a few more minutes he added ‘they argue quite a lot but the worst thing is that they argue about me’. He looked tense and tearful at that point and I said that he seemed to be experiencing a lot of pressure as if he was in some way to blame for the unhappiness in his family. This seemed to offer him some relief as if it might be possible for him to make sense of his feelings.

In retrospect it did seem important that I had not asked him immediately about the bad dreams he had mentioned in his letter. He came across as a boy who needed space and privacy, so much so that I imagined it had been quite difficult for him to come to the clinic at all. However, in subsequent meetings, and in his own time, he told me about an experience which had been very frightening for him. A business colleague of his father’s had been to his house and they had a conversation which had become extremely heated. Mario was in his room watching television. He had heard his mother scream and the front door slamming. His parents had started arguing. Mario heard the Italian words of abuse exchanged between them. He heard his mother cry bitterly. He thought he heard her say ‘it’s all your fault, you didn’t care, you didn’t think about me’ and then he thought he heard his father say ‘why do you talk to your friends about something that is private’. That was all Mario could remember but it was this experience that had led to the bad dreams, dreams which he could not now recall. What Mario did remember was feeling deeply ashamed that he had not gone downstairs to help his parents. That night he had realised that something was terribly wrong, that he was almost afraid of his parents and that deep down he felt he hardly knew them.

This rather mysterious incident was never mentioned again, Mario seemed to want to distance himself from it and I was left simply with Mario’s own reflection on the experience which seemed to be a mixture of embarrassment and weariness almost as if he was responsible for these volatile parents.

It was not until much later, after Mario and I had agreed to work together once a week for six months, that he told me about a very significant aspect of his life. He had been born in the Italian countryside when his parents were themselves teenagers. Mario was now the age that his father had been when he was born. When Mario was three years old his parents had, in discussion with other family members, decided to come to England to build a new life, hoping to work hard and become prosperous, both for themselves and also to provide a good life for Mario when he was older. Mario lived with his maternal grandparents in Italy until he was six, when his parents, who visited every summer, took him back to London with them. In London Mario was sent to the best private day schools and it seems was given everything his parents thought that he needed. Every summer holiday he returned to visit his grandparents and sometimes his parents came too when they could free themselves from their work. When I heard that Mario had spent so many early years in Italy I was surprised since he spoke English without any trace of an Italian accent.

One day Mario said to me that he had been thinking that he had been called Mario because it was his birth that led to his parents’ marriage. He said this with a wry adolescent smile but nevertheless it helped me to understand the way in which Mario had experienced himself as a child, on the one hand as a very important person ‘the centre of their world’, on the other hand someone who was ‘just born by mistake’. Mario was of course mindful of the fact that it was a ‘mistake’ that his parents did not make again. Mario said ‘if I had younger brothers and sisters my parents certainly wouldn’t have the time to keep fussing about my homework’.

It would of course be a cliche to say that all only children are lonely. Many of them, if they are naturally sociable, appreciate the respite from other children in their own home. Mario it seemed had only one ‘real friend’, another Italian boy of his age.

During this work with Mario I often felt quite sad on the parents’ behalf and in this sense felt myself in a rather grandparental role. Clearly Mario was not particularly grateful for his parents’ sacrifices. He told me that he thought they worked too hard, that they should go out more to enjoy themselves and furthermore that he was not particularly impressed by his English schoolboy status.

My work with Mario became centred on the separation experiences from the two mother figures early in his life, the loss which had never really been recognised by anybody because the family, understandably, always experienced themselves as always being there for him. An ‘extended family in the mind’ is a manageable concept for adults but of course for children people are just there or they are not. These issues are often acutely painful for the immigrant and refugee families that we see.

All children are born with different personalities and propensities and some have the capacity to adapt more easily to separations and the challenge of new locations and languages, particularly if there are concerned and loving parental figures to support them. Mario pleased his parents by doing well at school, he conformed but emotionally he could not or would not adapt. His dream was to live in Italy where he told me that he had ‘lots of friends’.

In the final two months of our work together Mario was beginning to realise that he had to relinquish some of his resentment and grandiosity. I had been pleased to hear that he had attempted some sort of apology to his parents for his previous reproachful behaviour. Apparently his mother had taken an evening away from the restaurant to talk to Mario about his early life with her and his father. Mario found all this extremely embarrassing and painful but also a relief. In a reflective moment he said to me ‘I suppose we are all feeling guilty about something but we couldn’t talk about it’. In the following weeks some sort of compromise had been struck. Mario’s parents agreed that he could take some special exams which would enable him to go to University in Italy, meeting up with his parents in the holidays.

To put it simply, what Mario had to do was what most of us have to do in order to grow up; that is to relinquish the dream of the childhood we longed for and to acknowledge the reality of the childhood we actually had despite all its shortcomings.

Lone Parents of Adolescents

Traditional and mythical literature is full of warnings about what happens to children who are separated from the idealised, balanced, containing parental couple. Lone parenting is certainly something of a balancing act at the best of times and it would probably be true to say that there are very few single adults who would make the choice to parent adolescents alone, if circumstances did not require them to do so.

There are at least three categories of lone parents: bereaved parents, divorced parents and single parents. Each of these groupings represent distinctly different life experiences and there is understandable indignation when they are treated as one large homogenous group. According to a report from the Office of National Statistics, the number of children living with one parent has trebled since 1972. The figures show that in 1993 nearly 19% of children (more than 2 million) lived with the mother alone and a further 2% with their father alone.

Mrs C requested an appointment at our clinic. She had been divorced for six years and had two children, Carol aged 16 and Peter aged 14. Peter had committed his first serious misdemeanour of adolescence. He had been threatened with suspension from school for setting off a fire alarm as a dare. In the consulting room Mrs C quickly dissolved into tears, feeling that she could not cope; she said she felt helpless. Her daughter Carol, usually very supportive of her mother, had brushed away her worry, saying, ‘it’s all right mum, it’s only a one-off thing’. Peter had said, ‘It was just a joke mum, I didn’t think about it’. Neither of these laconic adolescent statements consoled her; in fact she experienced her son as becoming shockingly different and felt that he was tur...

Table of contents

• Cover
• Half Title
• Series Page
• Title
• Copyright
• Contents
• Preface
• Acknowledgements
• Foreword
• Contributors
• Introduction
• 1. The Intensity of Adolescence in Small Families
• 2. ‘How Does It Work Here, Do We Just Talk?’: Therapeutic Work with Young People who Have Been sexually Abused
• 3. Psychotherapy with Learning Disabled Adolescents
• 4. Confrontation, Appeasement or Communication
• 5. Suicidal Behaviour and its Meaning in Adolescence
• 6. Reflections on Some Particular Dynamics of Eating Disorders
• 7. The Fear of Becoming a Man: a Study of Two Adolescents
• 8. ‘Is Anyone There?’: the Work of the Young People’s Counselling Service
• 9. The Scapegoat
• 10. The Heat of the Moment: Psychoanalytic Work with Families
• 11. Play, Work and Identity: Taking Up One’s Place in the Adult World
• Index