REFLECTIONS

Coming of Age: The Adolescent in Psychotherapy

KARLA M. BRASKI, M.S.S.W.*

Psychotherapy clients in tbeir adolescence are receptive to self-exploration.

"When given the opportunity to reduce external distractions and directives,
tbese young individuals are serious seekers of emotional well-being. They also
seek quality and genuine interpersonal relationsbips. Gentle guidance within
a safe container encourages adolescents to explore their inner world.

Beware of adolescence! Oh, what a terrible, confusing titne! Oh, if one can
only get through this period of one's life! Then all is okay, one has reached
adulthood and is safe from those turbulent teen years. The worst is behind
us. The only consolation we have is that "we've all had to go through it."
Adolescence is the unfolding and the self-exposure of a life within. An
inner world that is a mystery to be explored, a process. Alas, sometimes it is
also the death of many possibilities.
Adolescent clients entering psychotherapy often come with a defensive
attitude of having to spar with yet another adult who is going to tell them
what to do, how to do it, and when to do it. For many teens, this is an
accurate assessment of their relationships with adults. After all, we all know
adults have "been through it and know better and have answers because
they're older." Carrying out, and acting upon, such an attitude in contacts
with teens will likely undermine the young persons' sense of self. Granted,
age and experiences can cultivate an acquired sense of knowing, but it does
not ordain one as all-knowing or as being able to tell others how to live their
lives.
In the last decade of the twentieth century, the therapist may be seen as
replacing the all-too-often nonexistent extended family. The role models
and mentors of years past were parents, grandparents, aunts, uncles, and

* Private practice. Mailing address: 421 Third Avenue East, Washhburn, Wl 54891.
AMERICAN JOURNAL OF PSYCHOTHERAPY, Vol. 53, No. 4, Fall 1999

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elders—the wise and gentle guides that helped young people make sense of
the world. At least when there was time to talk and time to listen. Not only
the extended family but also the nuclear family is disappearing in too many
instances (1, p.12). There are increased reports that teens living in two-
parent families may not have ready access to their parents either. Acock and
Demo (1) have done extensive analysis of family structure based on data
from the National Survey of Families and Households. Correlations are
made between family structure, family process, and a child's weU-being (2,
p. 118). This should not be interpreted as recommending the therapist
should assume a parental role. That would confound and limit the relation-
ship and its potential.

THERAPEUTIC ALLIANCE

The therapeutic relationship with adolescent clients begins in a state of

fragility. The therapeutic alliance can be defined as a developing relation-
ship in which both participants find themselves in an unconventional mode
of being with another person. Bugental (2) describes the therapeutic
alliance as "a bond between what is best and most dedicated in the
therapist and what is most health-seeking and courageous in the client. It
will have many other elements in it at various points, but this is its essence.
Each partner to the alliance will fall short at times of being all that it
demands and yet it must endure" (p. 72).
Developing a therapeutic alliance with clients of any age requires the
therapist to have a sense of presence (2, pp. 36-38; 3, pp. 156-162). The
therapist's ability and willingness to be fully attentive to the client encour-
ages trust and openness. There are no elaborate techniques or methods that
will replace the therapist's sincere and genuine interest in the other person's
plight. There is an interference with the therapist being present if he/she
carries preconceived notions and judgments or is preoccupied with diagnos-
tic checklists. Adolescents have an inherent ability to detect "fakes," people
they perceive as only pretending to be concerned or to care.

HONESTY A N D TRUST

Andersen (4) exemplifies the natural honesty in children in his classic story,
"The Emperor's New Clothes." The unspoken pact of silence and denial
among the adults is exposed by an innocent child. The fairy tale reminds us
of the restrictions imposed upon people through the process of "proper
socialization." Socialization may be needed to provide a degree of order in
social groups but, simultaneously, it can teach denial and avoidance in the
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name of "politeness." Hillman (5) comments on the confines placed on

young people and consequent reactions. "[Societal rules] can prevent
direct experience so that life takes on that quality called 'phony' by the
young, who, because they are still capable of immediacy, resist with
violence the caging of their pristine vision in the ready-made traps of adult
avoidances" (p. 168). The therapist needs to be truly accessible for adoles-
cents to share the perceptions of their lives and the concerns it holds for
them.
Most adolescents in the therapy ofifice take the process very seriously
They may not readily manifest concern but inwardly they have contempla-
tive questions about their lives.
Therapist and adolescent client are in a parallel process of assessing one
another. Questions passing through the adolescent's mind may be: Does
this adult really care? How reliable and trustworthy is he/she? Will he/she
be able to really understand me and, if so, can he/she help? It is common
for adolescents to carry an increased sense of vulnerability and, unfortu-
nately, a decreased sense of self-trust. These elements lead to the fragility of
the therapeutic relationship. Therapists need not waste time by verbal
reassurances and guarantees of trustworthiness because adolescents will
make that decision for themselves. Therapists' constancy, steadiness, and
authenticity are the hallmarks for the development of a therapeutic alliance
(6).

TRANSFERENCE A N D COUNTERTRANSFERENCE

When discussing the therapeutic alliance one must highlight the dynam-
ics of transference and countertransference. It could be said that therapy
could not exist without the processes most frequently referred to as
transference and countertransference. These concepts are often presented
in the shadow of cautions and "red flags." There is valid reason for
therapists to be cognizant of their own inner processes. Therapists' memo-
ries and, more saliently, the affective response to such memories of their
own adolescence can be helpful but are not necessary to share with the
adolescent clients. Adolescents need to experience our presence in their
adolescence, not in the memories of our own. Here again adolescents will
sense whether the adult therapists are really "with them" or just passively
listening and waiting to give directions of "how to get through this phase of
life." Empathy is a positive outcome when therapists constructively use
their awareness of transference and countertransference.

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LEARNED RESISTANCES

Psychotherapists working with teenagers may see the following ways

utilized to resist the therapy process:
A learned defense to controlling situations and other people is the
"silent treatment." How many parents have forewarned me that the
youngster said he/she would come, but was not going to talk. So if, in fact,
the adolescent chooses this mode, we sit quietly together. I remind myself
that I do not need to fill the silence with what would most likely be
meaningless words. Therapists can easily fall into this trap, the trap of
doing what the adolescent expects: telling, lecturing, "getting in their
faces."
As we sit quietly, the dynamics shift. The usual power of the "silent
treatment" over others, over the external world, is failing to operate.
Instead there is a shift to inwardness. As we sit in silence, we both have an
opportunity for thought and reflection on what is occurring within each of
us and between us. The alliance is in process.
Sometimes we need to remind ourselves of the special power of silence,
as extolled by the essayist Justin Isherwood (7): "Silence is how great
emotions work. Silence is why we can go to a funeral home and just sit
there. The place is so quiet you can hear the ticking of a wristwatch, and
somebody's sob catches on something deep inside us.
All the awful feelings a person can have are sUent: sadness, melancholy,
hatred, disillusionment, despair, pity. Silence is not the only way to carry
hurt, but it's the most common.
Silence also is the core of wilderness. Silent is the night, the stars, the
crossing planets, the fiery meteor, the patient moon. Why then is human-
kind so noisy, when to our witness all that is eternal and powerful, is
so. . .so. . .quiet?" (p. 25).
Another common defense of the adolescent client is to be argumenta-
tive. Being disagreeable can be an effective defense and self-protective
measure. Usually, this method has kept people at a distance and has proven
to be quite an effective control method. The DSMIV (8, pp.91-94) label of
oppositional defiant disorder might be assigned if the adolescent has used
this defense for a designated period of time and has alienated authority
figures.
For the adolescent client, the silent treatment or the oppositional mode
may provide protection but at the same time can create a sense of loneliness
and isolation, and inhibit growth.

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The therapist and client need to become aware of the defensive patterns
already well developed by the adolescent. Bugental describes these as the
individual's "resistance" patterns. "Resistance is the impulse to protect
one's familiar identity and known world against perceived threat" (9, pp.
173-175). Each individual develops a unique manner of getting around as
safely as possible in his/her world. "We all develop a view of the world which
is uniquely our own. Upon this construction, we formulate patterns that
will aid us in negotiating our way through life. These patterns can be
figuratively referred to as a spacesuit (Bugental, in unpublished lecture,
1990). This spacesuit is a protection from being totally vulnerable to the
world. The same spacesuit that protects one's life can also limit and restrict
it. Being in the spacesuit becomes comfortable due to its familiarity. We
lose sight that there may be more beneficial and fulfilling ways of interact-
ing with the world.

THE EMERGING SELF

A brief background of the emergence of the self may shed light on the
adolescent's dilemma when in the therapy. George Herbert Mead postu-
lates on the "genesis of the self" in his posthumously published. Mind, Self
and Society (10). Among Mead's most notable achievements is his account
of the genesis of consciousness and of the self through the gradually
developing ability in childhood to take the role of the other and to visualize
his own performance from the point of view of others. In this view, human
communication becomes possible only when "the symbol [arouses] in one's
self what it arouses in the other individual" (p. 149). Mead correlates the
development of the self to relationships with those significant others
surrounding the child. The essence of the self is its reflexivity. The
individual self is individual only because of its relation to others (p. 134).
Children develop self-definition by interactions with significant others
in their world. They learn the language of symbols (verbal and nonverbal)
that are necessary for interpersonal relationships. During this process
children are developing a sense of who they are (i.e., the self-concept) and
how they fit into their relatively small world.
Adolescents are in a process of adapting to an everchanging world, both
internally and externally. The external world (e.g., family, peers, school, and
community) changes its expectations of adolescents. The fixed definition of
a child-self is being challenged to adapt to an expanding world. Adoles-
cents may suddenly feel that their usual and customary ways of relating are
no longer socially acceptable or appropriate. This contributes to the
confusion and uncertainty of the adolescents' internal world. Life is no
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longer as predictable, and questions arise regarding the self and the
interconnectedness with the world. Bugental refers to this as the self and
world construct (9, pp. 178-180). Adolescent psychotherapy often ad-
dresses this sense of loss, the loss of identity. Psychotherapists can be guides
in the exploration process of adolescents redefining and expanding their
identity.

THERAPEUTIC CONTAINER

The therapist's task is to be constant in maintaining a therapeutic container

(6). Within this container, the therapy occurs. The therapeutic container is
formed by clarifying limits and responsibilities of therapist and client. This
is done verbally and experientially. The therapist and client are developing
a mutual respect and trust. Respectfulness of the adolescent provides an
essential ingredient in the development of the therapeutic alliance. Within
the respectful environment the adolescent may, for the first time, realize
self-respect; a glimmer of being a separate individual worthy of respect and
of having inherent value. The container is crucial in providing a safe haven
for self-discovery. The adolescent needs to feel respect, trust, and safety in
the therapeutic process. Respect is a prelude to trusting and with trust
comes a sense of safety.
We have all heard the declarative statement: "That kid needs a good
talking to." I prefer the following: "Every kid needs a good listening to." As
adolescents are being listened to, without interruption or interpretation,
they begin to hear themselves, possibly for the first time, by listening to
what is emerging from within. During the "listening" sessions, adolescents
have the opportunity to let the noise and chatter quiet within. They are
learning to go inward and to discover the potential that lies within
themselves.
When adolescents get a sense of their internal power they can alter part
of their spacesuit, old patterns and defenses are no longer relevant. This is
the emergence of self-identity and self-esteem. They can visualize them-
selves as separate human beings with a unique identity. This is the process
of individuation. A healthy separateness can exist once adolescents acquire
a sense of self. Behaviors labeled as oppositional can be re-interpreted as
attempts to individuate from significant others. These may be the only
means accessible to adolescents to extricate themselves from a world of
dependency. In therapy, adolescents can open themselves to self-discovery
as well as examining how they effect their world. Adolescents are searching
for what is meaningful in their lives and simultaneously are trying to ascribe
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meaning to an evolving world. Adolescents experience growth and enhance-

ment in their lives by the process of inward searching.
Psychotherapy with adolescents means holding a belief in the goodness
of the human spirit. Therapists guiding young people need to see beyond
the colorful costuming; to hear beyond, or in spite of, the loud booming
music; and to feel the excitement of the adventure of being an adolescent.
The world is fresh unexplored territory for each developing adolescent.
The therapeutic process with adolescents is not to teach conformity to
societal rules and roles nor to perpetuate complacency. The psychothera-
pist is a guide, by the side of the adolescent, in a search for what will make
life meaningful to this unique individual, as well as learning to live in accord
with his/her world. Not to live by what should be, but by what is. A
privileged seat we hold, to be entrusted with the inner world of an
individual on the threshold of tapping unknown potential.

CONCLUSION
In my clinical practice of 23 years, many adolescents have shared their
private lives with me. In my personal life, my sixteen-year-old daughter,
Sasha, and her wonderfully alive friends have also taught me much about
this time called adolescence.
Adolescents present with concerns about their emotional health, as well
as interpersonal concerns. It is encouraging to witness their awareness and
motivation, which is manifested by their willingness to self-explore. An
existential-humanistic approach is applicable with many adolescent clients
who are searching for meaning and harmony in their lives. This therapeutic
orientation provides them with an opportunity to develop coping skills and
to enhance their capacity to participate fully in their lives. They have the
opportunity to recognize that taking responsibility for their lives means
taking responsibility for their happiness.
A therapist who can listen to the adolescent client without judgment or
prejudice encourages self-acceptance. Many young people lack role models
or mentors who can teach them about their humanness. This means to
acknowledge the joy and sadness; attributes and fallibilities; the aloneness
and affinity of being human. The polarities of life are tension-producing
and can be more easily accepted once recognized.
Psychotherapists need to be aware and preferably awake, in the Bud-
dhist sense; to have their senses open and to be mindful of what is present
in the moment. Adolescents naturally carry the capacity of aliveness, being
in the moment and being spontaneous. These are attributes that establish a
foundation for living a fuU and meaningful life. I've recently pondered the
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possibility that adolescents are nature's gift to us, reminding us that life
does not need to be restrictive. Therapists need to revere life rather than
imply that "it is something to get through" one stage at a time.
REFERENCES

L Acock A, & Demo D (1994). Family diversity and well-being. Thousand Oaks, CA: Sage.
2. Bugental JFT (1978). Psychotherapy and process: The fundamentals of an existential-humanistic
approach. New York: McGraw-Hill.
3. May R (1983). The discovery of being: Writings in existential psychology. New York: Norton.
4. Andersen HC (1837). The emperor's new clothes. Eau Claire, WL Hale.
5. HillmanJ (1965). Suicide and the soul. Dallas, TX: Spring.
6. Bugental JFT (1984). A pou sto for therapists. (Available from the author, 24 Elegant Tern Road,
Novato,CA 94949).
7. Isherwood J (1994). On silence. Wisconsin Natural Resources. Madison, WL
8. American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders, 4*
ed. Washington, DC: American Psychiatric Association.
9. Bugental JET (1987). The art of the psychotherapist. New York: Norton.
10. Mead GH (1934). Mind, self and society. Chicago, IL: The University of Chicago Press.

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