Page - 205 - in Psychoanalytic Perspectives on Puberty and Adolescence - The Inner Worlds of Teenagers and their Parents

Lost by the wayside – overstepping limits 205 his doubts about whether he can really trust me. He smiles a bit, says, “Hmm”, but after that he slowly leans back and seems more relaxed. When his eyes rest on the white drawing paper on the table, I tell him that it is like the openness of our relationship and that he seems to be wondering how it might develop. I get an intense look of agreement. My countertransference is that sometimes I would like to press him to talk by asking him questions and later, that I would like to hold him like a baby. I ask him whether he wants me to share with him what I imagine about what he is thinking. He seems delighted and nods. I then describe the whole session, the way he came in and his way of sitting silently that gives me the impression that he wants to be understood without words, like a baby. The expression on his face becomes filled with pain. He reminds me of an American Indian who sits still in order to control pain. I ask him whether it’s possible that he thinks that what goes on inside is less painful if he holds still and whether he might also be uncertain that he can share it with me, that he can trust me. We sit in silence. As it is close to the end of the session, I try to find out whether he would like to come again. (His mother had told me he would never do anything he does not like.) His face is completely neutral, as if he were thinking. So I wait for a few minutes. Then I suggest that his thinking could partly mean that he would like to extend the session and partly that he would like to leave it to me to decide. I continue, “We should come to a decision. Even if I suggest meeting again next week, nobody but you can say whether you would like to come.” His face seems to express his wish to come but also his wish to find out whether I want to see him again, so I ask whether he wants me to make a suggestion, and he looks at me and nods. Then he agrees to come. We say goodbye and arrange to meet next week at the same time, if he wanted me to share my observations and hypotheses of what he was thinking. He seems glad at this and nods. Reflections on the first session It was important to show Mark I accepted his silence – a silence that caught me unawares, since his parents had not mentioned it or his refusal to speak (mutism). The relationship he offered me was that I take the initiative in his therapy: appar- ently, his silence was meant for me to pose him questions. He showed me how difficult it was for him to establish contact to me and to other persons. I parsed his body movements for their possible significance; through Esther Bick’s technique of Infant Observation, I had learned to observe and empathize with the slightest expressions of a baby’s body and face. I posed hypotheses as to what his move- ments could mean. When I first spoke of his fear of being with an unfamiliar person in a strange room, he looked directly in my eyes. Could his quick eye contact with me mean that he was surprised I understood him? When I compared his reactions to my voice with a baby’s, he twitched painfully; it was presumably a mistake to compare a 13 -year -old to a baby. His direct reaction of (physical)