Page - 254 - in Psychoanalytic Perspectives on Puberty and Adolescence - The Inner Worlds of Teenagers and their Parents

254 Lost by the wayside – overstepping limits terrible place where terrible things had been done to her were quite mixed up with her sense that this was her family and included even her father, and this confusion was experienced with anyone else who behaved in a parental way towards her. She did not know whether to love or hate, to stay or go. (Anderson 1998, 68) In addition, the intensity of the concern she elicited in therapists through her high - risk behavior seems to have been her only form of a close emotional relationship – where Anne staged the same confusion experienced by an abused child. Sexual abuse does not only damage corporal integrity, but also causes grave mental con- fusion when the foundations of security are hurt and perverted by parents. It was hardly possible to create a therapeutic space between Anne’s life -and -death themes, where her mixed feelings, ideas and fantasies concerning sexual abuse could be investigated and worked through. Anne could not directly ask for help: Anne could not seek help straightforwardly. As soon as she found something good that might put her in touch with the family that she had lost, she became persecuted and had to escape though escape was usually to a false haven. Often it was a group of friends who would share her wish for oblivion and they would sniff gas together, as she had done with her brother, as though this group of young people in trouble like herself were turned to in preference to the adult world which had let her down so badly. What particularly struck me about Anne was that unlike so many young people in London, she really had been offered good help; she had not been treated with disdain by the hospital which had admitted her unconscious from the local train station, she had been assigned a social worker who had worked tirelessly with her, she had been offered a whole range of help but somehow, all this seemed either to make no difference or to make her worse. (Ibid, 68ff ) This sadistic approach to offers of help, which elicited a corresponding reaction on the helpers’ part, is important in understanding the dynamic of Anne’s inner world. This process often has a sadistic overtone; there is gratification as well as punishment in the self -destructive activity and this sense of revenge and tri- umph that also accompanies much suicidal behavior is another reason why we find it so disturbing to become involved. (Ibid, 70) This particularly affected the social worker actively engaged in Anne’s case. Anne kept coming back to her. We can assume that Anne was trying to estab- lish the same cruel emotional relationship with her that she had experienced with