Page - 203 - in Psychoanalytic Perspectives on Puberty and Adolescence - The Inner Worlds of Teenagers and their Parents

Lost by the wayside – overstepping limits 203 adolescents. For the adolescents– and their parents – such a crisis certainly seems threatening. In addition, during this phase serious symptoms can become visible in an incipient form, calling for precise observation. Thus, it is important for parents, teachers and other persons in an adolescent’s environment to remain open to both possibilities: symptoms as a sign of a serious illness or as a passing phenomenon. Flynn (2004, 215) proposes three levels for distinguishing whether symptoms are pathological or normal: 1 A capacity for reality testing: in both normal and pathological adolescent functioning, primitive defensive operations such as splitting, denial and projective tendencies come into use, and there can be the lack of an inte- grated sense of self and a differentiated concept of others. It is the presence or absence of reality testing in a strict sense that permits diagnostic differentia- tion, especially with adolescents with the more severe types of narcissistic personality who may come for assessment. 2 A capacity for recognition of the ‘other’: this is a central capacity that can help to differentiate normal adolescent turmoil when coming up against a combination of omnipotent control, grandiosity and devaluation with violent rebelliousness against the parents in the adolescent. 3 A capacity for experiencing guilt and concern: this is important in working in particular with adolescents who are suicidal or engage in severely destructive self -harming behaviour. (Flynn 2004, 215) Several elements from these three levels are important in starting a psychotherapy. In the chapters on the body ego, emotional development and identity, I have described developmental crises in the “normal” context that nevertheless elicit fundamental insecurity and threaten adolescents. Parents also become uneasy when their child’s character changes from a cheerful, trusting son to a lugubrious, withdrawn adolescent, causing them to feel rejected and devalued. In two case studies, I will now show how such crises manifest themselves. In the first case study, the adolescent Mark managed to conceal his deep paranoia, hallucinations and desperation behind his withdrawal and refusing to speak. Only through his total refusal to speak in analysis did his deep disturbance become evident and addressable, and only when his behavior at school and in the family normalized did his parents recognize how ill he had previously been. Whereas Mark was in analysis for four years, the second patient, Chrisse (who was referred from a psychiatric ward), was treated in the framework of a brief crisis interven- tion for several months. Case study: Mark Mark was 13 years old when he was referred to me from Child Guidance with the diagnosis that he had “major problems with himself and others”. I saw his parents,