Page - 54 - in Psychoanalytic Perspectives on Puberty and Adolescence - The Inner Worlds of Teenagers and their Parents

54 Psychosexual development in puberty initial consultation. The adolescent is asked whether meetings with the parents should be regularly held or confined to minimal exchanges of information. If the adolescent explicitly wishes no contact between therapist and parent, the therapist attempts to discuss his or her reasons for this, aiming to establish at least a written communication with the parents with the adolescent’s consent. The particular situation of adolescents – their emotional step away from the parents – often makes it difficult for them to establish a truly reliable relationship to the therapist. The urge for independence is often manifested in the adolescent skipping sessions. A wavering or damaged self -image can lead to a contrary reac- tion on the part of the patient, in turn demanding a careful and respectful approach. Melanie Klein speaks of the particular inhibitions and difficulties of patients in puberty (Klein, Inhibitions and Difficulties in Puberty, 1922, 54ff), since the strongly ambivalent feelings towards the father are transferred to the teacher, and the teacher becomes the object of extravagant love and admiration – but also the object of unconscious hostility and aggression. This applies to interaction not only with teachers but also with psychotherapists. The adolescent patients’ skipping or tardiness from scheduled sessions raises a vexing problem for therapists, since the analyst weighs the privacy of the analytic process with the parents’ help in ensuring the patient shows up. In some cases, this failure to show up or showing up too late constitutes a kind of communication. It is difficult to generalize, but I understand a patient’s tardiness – even to the point of 20, 30 or 40 minutes – as a message, and then try to interpret it as such. However, it is most important to wait for the patient, even if the session ends up only lasting five or ten minutes. Important insights or developments can often emerge during this short time. If the adolescent does not show up for the entire hour without any explanation, I also wait for them at the next scheduled session, paying especially close attention to indications from the analysis as to why they were absent. If they do not show up for two sessions in a row, I contact them by text message or letter, casually men- tioning their absence and asserting that I expect them at their next scheduled ses- sion. I always inform the patient from the outset that if he misses three sessions, I must inform his parents. One boy with Asperger’s syndrome, who in the five -year course of his analysis often appeared exceedingly late or not at all, was able to receive my written notifications without his parents learning of them. He seemed to need my written “invitation” to his next session. The therapist’s goal – helping the adolescent to reflect on his inner conflicts and fears in a manner previously unfamiliar to him – is sometimes contradicted by the adolescent’s impulse to act instead of think. Waddell describes this situation in the following way: Inner conflicts and anxieties are aroused, which many seek to avoid . . . some seem to stop thinking independently altogether and submerge themselves either in the shared mentality of group life, and/or in activities that can be literally mindless or self -destructive – drugs, alcohol, substance abuse, or the