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Sessions:
Adolescent Development & Treatment
Jeffery Smith, MD
Course Overview: (Preliminary outline subject to modification)--
Reading: Adolescent Development, Psychopathology and Treatment, H Spencer Bloch, MD. IUP, Madison, CT, 1995, paperback 2007.
Written Assignments: After each session, please write a 1 page response to "What would you like to remember from this session in 7 years." Also, do you have any questions you would like to explore further? Please e-mail your work by midnight on the Friday after the session to jssmith@me.com.
Session 1, Characteristics: Characteristics, challenges, introduction to theories. See synopsis of the session. (use link at left)
Session 2, Normal Ambivalence: Focus on forces pushing forwards and those that represent holding back from growth. Clinical approach to problems of "normal" adolescence.
Session 3, Treatment Strategies: Whom to treat, How not to alienate parents, Role of therapist, Transference & Countertransference
Session 4, Compulsive Behaviors: Drugs, sex, food, self-injury, etc.
Session 5, Early Adolescence: Characteristics, Theory, Conformism, Mean Girls, Lord of the Flies, etc.
Session 6, Middle Adolescence: Puberty, Creativity, Sexuality, Confidence, Social competence
Session 7, Late Adolescence: Deepening relatedness, Big decisions,
Synopsis of Adolescence:
The defining emotional task of adolescence is the transition from borrowed values and identity to "owned" values and identity.
Simultaneously, adolescents take possession of a number of "power tools," sex, mood altering substances, automobiles, self-control, lethal weapons, social manipulation, and no doubt more. These power tools require a good deal of experience and self-mastery to use safely, effectively, and to good purpose.
Two key principles complicate the task. First, the association of shame and self-consciousness with separation. Throughout development, whenever the toddler to adult is placed in a situation of greater separateness, there is a concomitant experience of self-consciousness, shame, even paranoia. This is a natural part of the separation experience. As familiarity is gained, the intense self-observation abates. I hypothesize that the impression of being closely observed is actually the mind's way of conjuring up a negative but reassuring impression of another's close attention to the self. To put it another way, no one watches you more closely than your persecutor.
Adolescence is a time of separation, and as such, is accompanied by intense self-consciousness and proneness to shame. This is why adolescents are so sensitive about their embarrassing parents and their own faux pas. It also complicates their learning to use the power tools. They are so sensitive to shame that they tend to avoid having knowledgeable, experienced adults show them how. They make their first attempts in secret, or in view of their peers, only, who are just as inexperienced as themselves. The result is a great deal of inept fumbling and some serious accidents.
The second key principle is the adolescent non-acceptance of parental wisdom and rules. Adolescents understand that in order to take ownership of their values and identity, they must have the freedom to challenge the rules and ways advocated by parents. This further loosens the already tenuous control adolescents have over their new power tools.
So, inexperienced young people with little supervision and practically no instruction are turned loose in a shop full of power equipment. We hope they will survive.
Meanwhile, in spite of being lied to and kept in the dark, parents are expected, reliably and accurately, to interpret clues so that they know the precise point at which the adolescent is over his or her head, and needs someone in authority to put on the brakes. Otherwise, parents are expected to be loving and supportive of their children's experiments and allow them room to learn from experience as long as they don't place themselves in the way of permanent damage. As they perform this task, the parents should also remain "cool" and refrain from any embarrassing or inept behavior.
For various reasons, some adolescents take to the power tools more than others. They may be more impulsive to begin with or less well supervised, or less afraid of risk taking. In any case, they rapidly gain experience with the power tools and may enter a pattern of using them to avoid the uncomfortable feelings that are so prevalent during this time.
They may use social manipulation to gain control and avoid insecurity. These are the "mean girls" and bullies.
They may use substances to avoid facing feelings of inadequacy and shame.
They may use powerful physical sensations to avoid feeling anything uncertain or subtle or weak. These include violence, self-mutilation, food restricting and exciting but dangerous activities.
They may use all of the tools to show the world the things they feel most ashamed of in their families and themselves. This can be out of guilt, in order to avoid facing painful things about their families and to test the parents' resolve to take charge.
As they avoid experiencing feelings, they fall behind their non-acting out peers in their ability to be honest with themselves and to use empathic connections with others to heal painful feelings.
By consistently following impulses, they may fail to develop the skills of self-control or mastery. As they force others to take control and set limits, they become more comfortable with external conflict as opposed to internal conflict. They fall behind in their ability to experience internal conflict as a guiding force.
Healthy development comes from taking emotional risks, making hard choices and not running away from intense feelings. The end result of these experiences is the development of owned values, idenitity, impulse control, the capacity for intimacy, and the ability to use the power tools of adulthood in an adult way.