Adolescence

Psychotherapy and the Emergent Self

Mark McConville

• Publisher: Gestalt Press
• Year: 2013
• Print ISBN: 9780881632910
• eBook ISBN: 9781134900411
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

Many therapists can attest to the fact that adolescents can be difficult and frustating clients-problems are seldom well defined, clearly delineated symptoms are more exception than the rule, and troubling situations often involve the entire family.

Gestalt therapist Mark McConville draws on his more than twenty years of professional experience to offer clinicians an effective model for understanding and treating adolescents. He outlines the Developmental Tasks Model, which describes adolescents' struggles, "temporary insanity," and ultimately, triumph of development. He clearly demonstrates that the Gestalt therapeutic model bridges the theoretical and clinical gap, and offers an indepth exploration of the various aspects of clinical work.

Adolescence offers valuable nuts-and-bolts advice on initiating therapy with adolescents who are not yet ready to do the self-reflective, exploratory work. In addition, the book examines the therapeutic method of engaging and cultivating the adolescent's emerging inner world. With perception and sensitivity, McConville explains how the clinician can guide the adolescent in the very personal and subjective process of birthing and existential self.

The book details the process of the creative reorganization of the self during adolescence and explores the changes that take place in the adolescent's relationships with peers, parents, and others in the adult world. The author also tracks the interplay of intrapsychic and interpersonal boundary development and shows how this interplay manifests itself in relationships and evolves from early through late adolescence. The Gestalt model of therapy allows the clinician to make sense of the confusion of the adolescent world and map out the multiple possibilities of clinical interventions.

PART I

Adolescent Development: A Tasks Model

CHAPTER ONE

A Framework for Adolescent Development

In adolescence, modes of interpersonal relatedness undergo dramatic change. Friendships are more personally and intensely invested so that peers are no longer playmates but become self-mates. Friendships, romances, and rivalries all play a major role in shaping and defining the adolescent’s experience of self and sense of worthiness, attractiveness, viability, acceptability, and so forth.

Relationships with parents change, in many instances dramatically, and these changes are certainly instrumental in redefining the adolescent’s existential posture in the world, toward the past, and toward the future. These relationships may become more distant, more subject to challenge, and more characterized by conflict and disaffection. Entirely new themes—rejection, rebellion, abandonment, the struggle for emancipation—may emerge. But, by the same token, a new capacity for closeness and connecting may also emerge, a heightened interest in the other precisely as an Other. Adolescents by and large, in spite of their sometimes intense denials, care much more desperately about what their parents think of them, and about whether their parents accept their newly evolving differences, than younger children do. In general, relationships between teenagers and their parents undergo a gradual transformation in the direction of becoming more negotiated, rather than simply being conferred by parental expectations and family traditions. We usually witness a transformation from the unquestioned, hierarchically organized relation- ships of preadolescence, so that years later, perhaps between the ages of seventeen and twenty-five, we find a greater approximation of equality, with a capacity for relatedness, between comfortably separate persons whose differing outlooks, ambitions, and interests present (potentially, at least) an opportunity for more interesting and mutually rewarding relationships.

The Evolving Contact Boundary

Gestalt theory is uniquely suited, for a number of reasons, to talk about the comprehensive nature of the changes observed during adolescent development. For one thing, Gestalt theory is essentially a field model of human experience and behavior. As such, it encourages us to address the pieces of the developmental puzzle as constituents of a larger, sense-making whole. All human psychological phenomena, according to Perls, Hefferline, and Goodman (1951), must be understood in terms of the dynamic interactions of the organism, or person, and his or her environment, by which is meant above all the social world: “There is no simple function of any animal that completes itself without objects and environment…. Let us remember that no matter how we theorize about impulses, drives, etc., it is always to such an interacting field that we are referring, and not to an isolated animal” (p. 228). The ways in which the organism or individual connects to and forms its relationships with the surrounding world is of central importance to Gestalt theory.

In Gestalt language, we speak of such relationship phenomena in terms of contact between the individual and the environment and between the individual self and other selves. Contact, to be precise, is the “functioning of the boundary of the organism and its environment” (Perls, Hefferline, and Goodman, 1951, p. 229). And boundary, in this context (although it is certainly a physical, spatial metaphor), refers to the processes of interconnectedness. These processes join the individual to his or her surroundings but simultaneously separate or “bound off” the self from others, “limiting, containing, and protecting” the self (Perls, Hefferline, and Goodman, p. 229) so as to ensure its organizational integrity and identity. In everyday language, my contact with you joins us as a “we” but also separates us as two I’s. The organizational structure of our encounter makes up our contact boundary.

The Gestalt meaning of the term boundary is worth emphasizing because it will play a central role in what we will find to be true of adolescent development. In ordinary parlance, the term boundary is used to refer to the barriers that people erect to limit their involvement with others. The Gestalt notion of boundary—or, more precisely, contact boundary—is much richer and dynamic, for it is an expression of our essence as beings whose nature it is to interact with our surroundings: assimilating and incorporating, accommodating and adjusting.

Boundaries do separate, to be sure, but they are also the place of our meeting. Thus the term boundary expresses the fundamental dialectical structure of contact itself: it is a two-stroke process: one stroke is the capacity to join and merge, give out and take in, influence and be influenced; the other is the capacity to separate and bound, resist influence and maintain one’s unique and essential characteristics.

These concepts, contact and boundary, are uniquely suited to the project of describing adolescent development, for this development is essentially an evolution and a reorganization of the child’s modes of relating to (that is, contacting) its environment. In this connection, it is perplexing that Gestalt therapy has not produced a more substantial theory of human development. Gestalt therapy’s primary emphasis has always been on adult functioning, and specifically on supports for and interferences with lively contact. But this very capacity for lively contact is, to state the obvious, a developmental achievement, and adolescence plays a major part in creating both abilities and limitations for making contact in adult life. We might say that developing the capacity for contact (that is, for establishing boundary conditions that support both joining and separating) is what adolescence is all about. We could even (if we wanted to take a teleological view of development) go so far as to say that the capacity for contact is the primary underlying organizational and motivational purpose of adolescent development.

This reorganization of relationships and evolution of interpersonal contact boundary processes is only part of the larger picture of adolescent development, as anyone who works closely with adolescents knows. Blos (1979) and other psychoanalytic writers have also emphasized the change and reorganization that goes on in the recesses of the adolescent’s private experience. In other words, there is a revamping of the adolescent’s relationship to self. Private experience becomes notably intensified and more complex, and much about it gathers up and absorbs the adolescent’s attention. The body comes alive in exciting, confusing, sometimes frightening ways. Sexual arousal, acute body consciousness, concerns over physical strength and attractiveness, sudden storms of anger, strange sensations of heaviness and emptiness—all of these conspire to alter the internal landscape dramatically. Intense new experiences, some painful (loneliness, shame, poignant vulnerability and hurt) and some delicious (exhilarating freedom, intense excitement, seemingly unbounded power), arrive unsolicited. They are deranging and confusing, but they also render the adolescent’s inner world alluring, even hypnotizing.

The effect of all this change is to disrupt and reorganize, chaotically at times, the adolescent’s relationship to self. In fact, it is here in adolescence that we can really speak with phenomenological accuracy of the child’s having such an internalized, reflexive relationship—an experienced relationship of self with self. That is, there is an opening up of new boundaries of contact, internal or intrapsychic boundaries, and these become the vehicle for what will eventually be differentiated adult experience and the depth, subtlety, and complexity of the adult personality. This expanding and sometimes exploding inner world of private experience is what adolescents are so often intent on keeping bounded off from adults. It is also what therapists (in one-to-one therapy, at least) work so hard to gain access to. It readily finds its way into fantasy and reverie, diaries and journals, sometimes into English papers and graffiti—but not often or easily enough into the conversations of psychotherapy.

The Gestalt Notion of Self

This private, inner world of experience has usually been designated by the formal term self, or inner self, in psychological theory. Conversely, self has been conceptualized as an internalized, encapsulated structure, something residing on the subject side of a dichotomized subject-world relationship. Adolescents certainly undergo a radical transformation in the experience of self, which opens inwardly to become more complex, more confusing, more ambivalent, and more deeply felt. Later in adolescence, this experience of self will become more stable and solid, more consistent over time, and more capable of providing the individual with autochthonous support and management. It would be acceptable to say, along with Erik Erikson, that healthy development involves the “successful alignment” of inner life with outer opportunities, an achievement that Erikson calls “ego synthesis” (Erikson, 1959). But this formulation is acceptable only if we set aside the limited psychodynamic notion of the ego as an intrapsychic structure and adopt a Gestalt formulation of the self and its development.

The Gestalt conception of self is spelled out in the work of Gordon Wheeler (1991, 1994). Assaying the contribution of Paul Goodman, the principal architect of Gestalt therapy’s seminal work, Wheeler notes that self is located neither in the internal world of private experience nor in the outer world of interpersonal events but precisely in the “creative tension” between the two. To put this another way, the operation of the self lies in its organization of contact processes, “the more or less satisfying resolution of the ‘external’ world of resources, obstacles, perceived threats, and sought-after goals, with the ‘internal’ world of felt needs and known desires, memories, aims, past learning and future hopes” (Wheeler, 1994, p. 17).

When we understand the concept of self in this way—no longer as something purely internal to the organism or psyche but as the “system of contact functions” (Perls, Hefferline, and Goodman, 1951, p. 373) organizing the organism’s relationship to its environment—we arrive at a somewhat different way of thinking about human and specifically adolescent development. Development, from a Gestalt perspective, involves both the reorganization of interpersonal relationships and the differentiating of internal experience. But in the Gestalt approach, no domain of change is prior to another; both of these are expressions of a more comprehensive reorganization of the field, an evolution of the contact functions and boundary processes that define the very meaning of self.

Intrapsychic and Interpersonal Contact Boundaries

If we agree to think of the self as the organ and process of integrating the inner and outer worlds of experience—or, again, as the structure of the field that allows us even to make this distinction—and if we think of human development as the evolution of this self over time, then adolescence emerges as a singularly interesting and important phase. Adolescence is the period when most individuals begin to segregate the inner (or intrapsychic) and outer (or interpersonal) worlds precisely as phenomenologically distinguishable domains of personal experience.

For many adolescents, this distinction becomes a salient phenomenological reality. They lose the fluid, preadolescent sense of belonging to the world, of fitting in with their families and playmates, and begin to experience themselves as standing out from or apart from the world and having an inside that does not always match up with what is expected or required on the outside. Many teenagers can describe this differentiation of intrapsychic and interpersonal experience quite vividly and, in fact, they may experience the self quite differently when it is for themselves and when it is for others.

Adopting the language of Gestalt therapy, we might say that in adolescence there is a sorting out of the intrapsychic contact boundaries from the interpersonal contact boundaries and, in this sorting, a working out of their relationship. This is really nothing more than another way of saying that the underlying and unifying theme of adolescent development is the maturation of contact functions and boundary process.

If we read the literature on adolescent psychotherapy published over the last thirty years, it is perplexing not to find more emphasis on the interrelatedness of the intrapsychic and the interpersonal. Typically, clinicians writing on the subject have emphasized one domain or the other. Therapists in the psychoanalytic tradition generally look at developmental struggles as fundamentally intrapsychic, and only secondarily as interpersonal. Therapists in the family therapy tradition, on the other hand, emphasize the interpersonal processes that contextualize the individual adolescent’s intrapsychic process, typically giving little if any attention to the internal experience of the adolescent.

Consider the following clinical vignette. A fifteen-year-old girl has become very difficult for her parents to manage. She is openly defiant of their rules and authority, challenges them at every turn, and comes and goes as she pleases. She makes it no secret that she has become sexually active. She makes herself as attractive as possible and intensely invests herself in heterosexual relationships, much to her parents’ consternation. Perhaps she is openly flirtatious, even promiscuous. Perhaps she leaves home and shares an apartment with an older boy or young man. Does this scenario express intrapsychic conflict projected onto the family field? Or does it express a breakdown in family field functioning, which inhibits the incorporation of internal superego structure?

Similar vignettes are offered in the clinical literature by both John Meeks (1971) and Charles Fishman (1988), who can be regarded as master therapists in the psychoanalytic and family therapy traditions, respectively. Meeks describes the inpatient treatment of Pattie, a fifteen-year-old whose rebellious acting out and sexual promiscuity pushed her parents to seek psychiatric hospitalization for her (his description is paraphrased here). On the ward, her behavior and dress were outrageously seductive and provocative, stirring up her peers and generating much concern among the hospital staff. She was being seen in “emergency” individual therapy sessions on a daily basis. In one of these sessions, Pattie leaned over her therapist’s desk and provocatively asked, “Do you see anything wrong with these clothes?” The therapist paused and then replied, “I think you feel terrible about yourself.” Pattie stormed from the session in a rage. Within several days, however, her behavior became more controlled, and she remarked to a ward nurse that the therapist “was pretty sharp.” As her therapy proceeded, it developed that Pattie’s extravagant delinquency was “simultaneously an effort to disclaim and escape a rigid superego, and an unconsciously calculated effort to force others to control her behavior” (p. 27). This became clear to her therapist and, presumably, to Pattie also. This is a wonderful example of a conceptual approach that emphasizes underlying intrapsychic conflict, and its emergence into the adolescent’s awareness, as the essence of therapeutic intervention.

In contrast to psychoanalytic approaches, family therapists as a rule stress the family field processes that underlie adolescent behavioral patterns. Fishman (1988) tells the story of Maria, an extraordinarily beautiful fifteen-year-old who left home after a major fight with her parents and went to live with her eighteen-year-old boyfriend. She had been living with him for about a month when family therapy began. Maria agreed to attend the sessions but refused to move back home.

Fishman’s therapeutic focus was on the marital and decision-making dynamics of Maria’s parents. In the first therapy session, he discovered that the parents were inveterate avoiders of conflict. They vacillated between presenting themselves as powerless and making authoritarian pronouncements. They failed to communicate with each other, and each invariably undermined the other’s attempts to negotiate with Maria. As a team, as an externalized superego structure, they were thoroughly ineffective. It is interesting and noteworthy that Fishman was not particularly interested in Maria’s possible or potential conflicts about her own behavior. Instead, he directed his attention to the broader family field and asked Maria’s parents about their fears for her. Maria’s father confided his fantasy that her behavior, left unchecked, might evolve into prostitution. What is also noteworthy is that in this therapy the theme of sexual excess or exploitation—the fear that Maria might become a prostitute—surfaced in the parent’s fantasy rather than in the child’s and, by contrast with what happened in the case described by Meeks, was understood as an organizing theme of interpersonal rather than intrapsychic boundaries. Maria’s behavior was contained, and she moved back home, only after her parents managed to organize themselves as an effective and realistic superego structure within the family field.

The polarity dynamics in these two cases—the tension between impulse indulgence and realistic impulse containment—are essentially the same. In Meeks’s psychoanalytic approach, the focus is on the emergence of this polarity in Pattie’s intrapsychic field, at the boundary of her relationship with herself. In Fishman’s family therapy approach, the same essential polarity emerges in the broader field of family experience and interpersonal relatedness. This is not a matter of discovering which conceptualization is correct; both, as far as they go, are accurate descriptions of the phenomena.

To draw a distant but useful analogy, in physics in the early 1900s the question arose of whether light is a particle or a wave, because it was found to behave sometimes like a particle and sometimes like a wave. The answer provided by quantum mechanics seemed paradoxical: light is both a wave and a particle, although the definition of each seems to exclude the other; its properties at any given moment depend on the instrumentality of the observation. The same can be said of many adolescent psychological structures. The conflict that an adolescent experiences between impulse and superego, between the wish to act out sexually and the capacity to contain and limit that impulse, is both an intrapsychic and an interpersonal field process. But at any given point in adolescent development, or in any given adolescent, the conflict may se...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• Preface
• Acknowledgments
• The Author
• Part I: Adolescent Development: A Tasks Model
• Part II: Adolescents and Psychotherapy: Application of the Tasks Model
• References
• Index