The fragile, delicate, often amazingly well-hidden by the adolescent world can be psychotherapeutically approach with a kind of discretion and caution, based on therapeutic alliance. At the same time, as analysts, our role is to make a deep work through the difficulties, the unconscious conflicts, the neurotic or psychotic structures, the personality disorders etc. On the other hand, we can not neglect, also, the so called social aspect of this problematic: the adolescent belong to a relatively specific close family setting and he has to get into a complex and large social environment, that he has to adjust to and he will be finally integrate in.
Therefore, our effort is essentially focused on the adolescence psychopathology and, beyond the aspirations, ideals and values of the adolescents, that we can perceive, understand and manage in the therapeutic setting, we are also trying to “cure”, namely to attenuate or dissolve the inner adolescent’s conflicts, caught between his instinctual urges and those of the external world, and of his/her Superego; we have to restore, to re-build and to strength his/her fragile Ego, allowing a further more harmonious development and a way to his independency.
Acting-out – passage a l`acte – fform the psycho-analytic view, it represents actions that have often an impulsive trait, somehow disrupted from the usual motivations of the subject, somehow different of his activities, and having an auto- or hetero-aggressive manifestation. In acting-out, the analyst identifies the sign of the repressed material. The “acting-out” is also one of the transference vicissitudes, in opposition with verbalization and rememoring.
One of the most important contributions of the psycho-analysis was the correlation between an impulsive act, the dynamic of the analysis and the transference. This direction was enlightened by Freud, when he speaks about the tendency of some patients to “act out” (agieren), beyond the analysis, the instinctual movement vivid in the analysis. Freud specifies that the transference is also one of the forms of acting-out.
The adolescent is overwhelmed by excitation, violence, agressivity, by anguish, sexual and aggressive drives, body metamorphosis, and this internal and intense activity is hard to be verbalized, to be metaphorized or mentalized. He is often submitted at the external impulsive behavior, explosive manifestation of rage and fury, limits transgressions, revolt against the authorities. He will try, from the first interviews with the therapist – another adult that interferes in his psychic space – to test him, to put him in difficulty, for defending himself to be rejected, or dominated, or judged by the therapist, or even to…. the attention on the conflictual dynamic, on his inner life/reality. The acting-out is also for the adolescent an expression of his mechanism of defense, it has an restorative function for the Ego. It is in the benefice of the Ego adaptative functions or, as Peter Blos said, of the “reality testing”. Another aspect of the “acting-out” in adolescence is this kind of defense against the affects, the representations and conflicts that couldn’t be accepted by the conscious, as Freud enlightened when he made the link between act-transference-resistance. The repetition of the acting-out in the cure perturbs and even blocks its process and makes impossible the insight and the consciences.
Daniel Marcelli considers that the de-fusion of the drives is very important in acting-out, especially in adolescence. In his acception, the acting-out is often one the consequences of the sexual and aggressive drives de-fusion. Thus, the adolescent is defending of pains, suffering, conflict, but un the same time, the fantasmatic and cognitive functions are blocked.
A clinical reflection of these first perspectives on the acting-out in adolescence was configured in an attempt to present some illustrative fragments from the therapies with the adolescents. The confidentiality does not allow to detail personal histories. We can illustrate some aspects from these therapies, relevant enough to give shape materiality to the above presented.
Case illustration
I will present now two sessions from an adolescent psychoanalytical therapy, which seems to illustrate – in the winnicottian sense of the rapport between deprivation and deviant behavior, and which reflects the impulsivity, the acting-out, and the adolescent’s difficulty to confide in an object, to invest him with affection and love. This case also involves some difficulties to manage the setting and to find an accurate way to approach the symptoms, the actings, and to give a valid interpretation according to all the clinical material and the inner/psychic adolescent’s reality.
Silviu, a 13 years boy, was recommended to me by one of his master teacher. The boy’s mother had solicited psychotherapy for his child, because he had a scholarship failure and he was in danger to loose one year. He had very bad results almost in the last months.
Miss B called me and she began to complain about her son. She spooked to me with a kind of anxiety, very precipitated and she was trying to explain to me that she can’t manage her son scholarship situation and she is feeling that she is more and more exceeded by all the problems that Silviu is doing every day. She added that the worst is that he began to lying and steel more and more. I was wondering in my mind, since she was told me all these problems: what’s missing in this picture?
Since this phone conversation with me, Mrs B. was spoken in the same time with his son and she was trying to establish both with me and with him a day for the first interview. She was asked me if it wouldn’t be necessary for the first time that she came to me alone, without Silviu, because she want to tell me all about her boy. I told her warmly and firmly that is important for both of them to come together at the first consultation. She approved this without satisfaction.
First session
An hour before the programmed session, I received a phone call. It was Mrs B, who, in a very polite way, was told me that they will be in late for some minutes. After that, she called me once again to confirm that they were arrived but she can’t find the exactly address.
When I was opened the door, I had a strange impression that I have in front of me two adolescents, brother and sister: both of them, the mother and her son, they were small, very nice dressed and so alike. The boy looked at me directly – and also all around him – with a great curiosity; he was so relaxed and in a good appearance. The mother seems to be tensioned, worried, and somehow nervous.
She began to speak about the last months, since when Silviu was uncontrolled and they were a lot of problems and disputes between them. She related the facts very pressed: he refuse to do his homework, he didn’t go to school, he spend all the time at the internet Coffee in a bad environment, he’s always fighting with someone at school, and concerning the classes, he likes just mathematics and he skip the other classes. The teachers are calling her at school and they have all the bad things to tell her about his lonely child.
Silviu seems to approve his mother; sometimes he looks instigated by his mother words, somehow amused by all he was hearing. There were also some moments when he was tried to protest, to cut the mother speech.
So, at this moment I decided to let him speak about all of that: “What are you thinking about all these situations? She’s write, your mother?”. They were looked one at each over and the mother was very curious to listen him.
He answered by recognize that his mother is write, but he justified him-self by saying that he really hate to change always the school, the teachers, the schoolmates and friends. For an instant, I didn’t understood what was about, and the mother specified me that they were frequently changed their address, and so Silviu was often changed a school for another.
He added that he dislikes to stay in the same place with the stupid boys, and for that he’s stressed and he can’t learn. And, of course, there were also some teachers very unbearable.
So, the reason for that they came to see me is to find the “right way”, told the mother. And she continued by saying that she’s a jurist counselor, and it was so difficult to her to be “both, mother and father” for his son. Silviu was obviously touched by this, and he took the mother’s hand in his hand, by giving her a sweet smile.
“But what about your father?”, I answered him, because I really understood that he was missing from this picture.
I felt that this is a dynamic moment in this first interview, and that the boy is able to speak about his father. He seems to be confused, and he send a look towards his mother: “Mum, can’t you explain this, it’s so complicated…”.
And so I find that there were “2 fathers”: in fact, his mother wasn’t married with his father, at that time, they were separated after his birth, his father didn’t tried to carried about his education, he was married 3 times in 13 years and he has 4 children with different women. The mother was never married, but now she had a lover, named “Daddy”. Silviu loves so much his new Daddy, but that entire family story is so strange for him.
Miss B added that the things are worst because Silviu had begun to steel money from her bag but also from his Daddy. The boy was punished, and she recognized that she frequently beat him, when he’s transgressing all the limits.
Silviu was ashamed about all these, and he told me that he sword on the Bible that he will never steel again. The session was finished at this moment, but Miss B was leaving by send a few words: “Maybe always his father was missed to him”.
It must be mentioned that Miss B related that her father was dead when she was adolescent, and her mother was a very authoritarian woman, and they where always in conflict, even now. Silviu also doesn’t like his grandmother, and not his uncle (the mother’s brother), too.
The second session
Silviu came 10 minutes earlier. He was sure that he’s in late, and he entered by saying “I’m really sorry.” I didn’t understand for what he’s apologized himself. He began to speak fast and incoherent, trying to explain that he’s going better at school (in only one week!), he took a very good result at mathematics, and all his colleagues are anger for that.
I asked him to clarify me how did it happen, because I felt his exaggeration. He told me that this week he proposed him self to amaze everyone and to prove them that he’s the best. I felt instigated of something; it was so incredible and I supposed that he hind something or he’s lying. I asked myself what’s happened with him, way is he so obstinate to prove something that I didn’t asked.
Beyond his story, there were revealed some narcissistic features, a great anxiety and an effort to show something else (false Self). He glossed forward to his anniversary, and this subject was another clue in his story. He said that it was an ugly day, because he didn’t felt well in the company of his friend. And also he didn’t received his present this day, but just now, today, and he is happy… Daddy brought him a computer “little and smart” (like he, Silviu, really is!). It’s the best computer, better than those of his colleagues. But is something he doesn’t like: his mother is using it, too. And the worst is that he hasn’t he’s own room, in fact that apartment doesn’t belongs to them.
He continues by describing his anniversary and he added that all that day he was hurting him self, accidentally, and it seems so strange for hin. “Why do you think that is strange?” He said: “Well, I’m hurting my self, as I am punishing for something.” “For what were you punished your self?”. “Oooh, for all the steels and bad thing I did.”
I told him about his attitude towards the rules, the authorities, the teachers, the lows, and I noticed that usually a father makes the rules in a family and maybe his behavior is a manner to pretend a father figure, someone who could well manage his adolescence.
He was very surprised, he looked at me with a kind of ambivalence and he said: “You know, my mother had always saved me from troubles, and Daddy was her first manager!”. So he told me that they have a chief in their family and they didn’t need a father. Daddy isn’t his father, but is the lover of his mother and is a very good person because he sustains and he loves them.
But suddenly he added that he’s sad because he had stilt the money and he’s very ashamed for that: “I promised yet to Daddy that it was for the last time.” He related that he had stilt money for the first time 3 years ago, because he wanted to buy moderns roller… And than this had continued until now, he couldn’t stop him-self to steel and all are angry on him.
I risked an interpretation at his moment, because I felt that he’s able to give a sense of his feelings: I think that you ask me to tolerate you like you are, because nobody around you can’t do that. And you really need to be understood, and loved, and appreciated for all what you are and what you do.”
He seems to think at my interpretation and he suddenly said: “You know, once I steel 20 dollars from my mother bag, and I was proud to show them to my friends. But I didn’t know that these money belongs to a client of my Mum…She was so angry!”
All the session turned on this subject: to steel for obtain admiration, but also to be punished by his mother, his Daddy, his colleagues. Does the father deprivation has marked him and gave to his personality a deviant feature? It’s a transgression of an interdiction (his mother is a lawyer!)? These are questions that will be clarified in the further analytic process.
The difficulty in this therapy is the management of the transference, in order to stabilise a constant object world, that could give to Silviu such a strength of his Ego for setting up his identity, for assuming his own rules and values, but respecting, in the same time, those of the others. Silviu had defended by a false good self-image, trying to assure me that he’s not so bad and violent that his father was. The mother’s lover (called “Daddy” by Silviu) represents actually for him a positive male figure; but he constitutes also a kind of lack of poise, because “Daddy ” has an internal role of Ego Ideal, and not one of Superego. Moreover, the relation with his mother was characterized by an intense ambivalence that was founded also in the therapeutic relationship. Silviu perceived his mother very warmly and lovely, and he felt himself like a baby, who wants to be carried by and also to satisfy his mother; in contrast, sometimes he was revolted against his mother, because she made him a hard program, she quarrelled him every day, she didn’t allowed him to do what he likes, she’s always busy and didn’t spend enough time with him.
Silviu displace the aggression against himself or against the parental objects towards the scholar environment, where he become violent, he arouses conflicts with his mates, followed by beatings, in witch he or the others are hurt. This behaviour is always followed by a double punishment: from the part of the school, and from his mother. Moreover, the mother is representing for him the law (and not the father, an absent father…), so his tendency is to broke up any rules, any setting. In therapy this is manifested by early or lately arrivals, or confusion about the day when the session was programmed. But working through the inconstancy of his internal objects, especially on the father absence , on the ambivalent relation with his mother, and also on the false image about himself (and his false self), gradually, Silviu became to have trust in the therapeutic setting, to look more sincerely at all that happened with him, to recognise his facts, to ask himself what is determining him to be different than more others on his age, and, besides, to re-construct his internal world.
The main therapeutic goal in this case was to allow to the patient a secure environment – which was absent in his early childhood – and thus the passing through the adolescence crisis not amplify the deviant behavior already existent. This clinical experience was very enriching and instructive for me, especially by the transference-countertransference analysis, by the importance of the feelings revealed in patients against his parents, of the intense anguish of separation and abandon, but also by exploring together all that it was beyond the his act, acting and impulsive behavior, and all that means for this adolescent “to steel his mother, to search his father, to test his therapist”.
(Daniela Luca, textul conferintei prezentate la ISAPP, octombrie 2006)