This paper was originally published in Funzione Gamma magazine. Copyright and permission the authors.
Adolescence is a period of change. An existential change that is a change in the sense of who one is, a change in one’s identity. It may be a catastrophic crisis in identity, so that there is an uncertainty about being a person at all. Adolescence is a process of learning a new identity without knowing clearly where one will get that new identity from. The authors reflect on these issues that nowadays increasingly involve schools, social stakeholders and mental health services when a treatment response is needed for problematic adolescents and their families. They provide examples of functioning of both the staff and adolescents group as they interact daily in a therapeutic community.
Key words: adolescents, therapeutic community, unconscious attitudes, emotional distance, containing anxiety, provocation, roles and boundaries, authority
The gang identity
Typically adolescence is a time of gang-life. Hanging out with other like-minded adolescents. There is a solidarity to be gained by being part of a peer group who have the same problems, anxieties and dynamics. But for adolescents it is more than solidarity of that kind. The gang offers, in implicit ways, the identity of being an adolescent, at least temporarily. Joining the group is a rescue from not knowing who you are, so you become someone who is part of that gang. Membership of a gang in adolescence is an example of Basic Assumption oneness, as described by Turquet (1974). The adolescent typically is very welded into the gang, and is literally identified with it. His own identity is bound up with the existence of the gang – rather than with the existence of himself. ‘Hanging out’ is a term that literally implies the dependency of hanging from something. The adolescent is driven to that kind of dependency by having the anxiety that he no longer knows who he is.
What is that anxiety? First and foremost it comes about from the loss of the identity of a child. Or it would do if the adolescent had given up that identity. But is no easy thing. He/she is expected to become an adult with full responsibility for himself, almost overnight, at the age of 18 or sixteen, or earlier in some cultures. A particular rite de passage marks that moment – the barmitzvah for instance, or amongst the aborigines of Australia they are required to ‘go walk about’ to demonstrate they can survive in the desert on their own. Today we merely have parties, when the youngster is showered with presents, but often a special one, possibly a car to indicate the new and adult life style he is moving into.
As we say, the deep meaning of this transitional state is an acute existential anxiety. It is the knife edge poise between childhood dependency and the largely unknown responsibilities of being an adult. Prior to the modern period, this transition was expected to be accomplished in the one ceremony. Today we recognise the process as one that requires time. That time is extended probably throughout the period of education, and maybe for some years after that as well. This is now regarded as a working through period, and became steadily more significant from the nineteenth century onwards – in Western culture – when the notion of the discrete stand-alone individual person also became the standard view of an adult.
Like all working through processes, it is difficult and has its ups and downs. The gang identity is something to fall back on. But as a common psychological device it is not a simple support. The gang identity is supported and built up on the basis of an opposition – especially an opposition to those adults who have already accomplished the transition. In an almost delusional way adolescents may claim to know everything that is needed, and to be superior to the adults in their families who attempt to instruct them. This leads to typical friction with adults. This friction is precisely between the adolescent and those who the adolescent needs to develop an identity with. And so sometimes intractable problems exist in working through the identity problems and achieving the status of the identity that one is in opposition to. The difficulty is that the adolescent identifies him and his group through recognising those people he is not like. This is a kind of negative identity. The adolescent has the support of his group/gang so long as the other group are different from him and his peers. He depends for his sense of who he is on being different from the other’s identity. This is in the end no less of a dependency, and leads most adolescents to move out of that oppositional ‘negative identity’.
Now, added to this negative identity is, in some cases, another major problem which affects the capacity to move out of the dependent position of childhood. This is when childhood has entailed dependence on others who are actually problematic, unreliable, or abusive. And perhaps this is the most crucial problem seen by professional helpers, working with adolescents. That is to say, there has, for many adolescents in trouble been an abusive component in the relationship between them – as the child and the carer. Then there is a double problem, the ordinary identity problem of adolescence combined with overcoming the trauma of past abuse.
This presents the adolescent who has had special disadvantages in early life with a particular difficulty, and one which some do not overcome. They need specialist help. But receiving that specialist care is troubled by the past problems with care. Unfortunately, carers are often not aware of the especial difficulties such people provoke when working with them. There are two issues about providing help for these casualties: (a) the problem with carers as abusers, and (b) the emotional impact on the carers.
Survivors of abuse: There is no doubt that having the “right parents” is the greatest of advantages in life, and having abusive ones is a serious handicap. But that is not the only factor. It is clear that some people survive the most awful experiences as babies and children and go on to become quite ordinary, productive, and happy adults. That is only a proportion. Many live instead with their past suffering in the forefront of their minds, and miss out on much they could benefit from later on. These are known as survivors of abuse; they only survive, they do not flourish.
What makes the difference between those who survive, and those who flourish? I’d suggest that there may be inherent factors within the genetic make-up of the individual which determines the resilience to hardship, suffering and abuse. However, the really important factor is the actual experience that carers have been abusers in the past, and care cannot be trusted in the future. This is the experience they bring with them to help. The common result from all the factors is that these persons have a characteristic pattern of suffering and relating. And this specific kind of condition creates special problems for carers.
This point needs a great deal of discussion – and often does not get it. The relationship with carers is paradoxical. This impacts on those who do the caring.
The core problem is that the adolescent client views help with considerable suspicion. For internal reasons perhaps, and from their experience with past carers, help is viewed as something that is easily confused with abuse, and it may be the helper will be viewed as a prison guard, demanding obedience to rigid rules. Troubled adolescents from some backgrounds may to quite unused to limits on their behavior. On the surface, this appears not so different from the ordinary adolescent in opposition to people, parents and adults. In the adolescent world, parents are an alien group who keep on caring. For the survivor of abuse, carers are sinister agents who will mix abuse with care in bewildering confusion. These two views of care may appear much the same, when the common attitude in both is the same – opposition. But they are not the same. Despite this common opposition, on the one hand care has in fact been sufficiently solid and consistent in the past for the adolescent to eventually realise he can allow himself to become like his parents. But on the other hand, the kind of distress – from early abuse – means that either the adolescent cannot risk continuing with care, which might be abuse; or if he does become like his abusive carer, he is likely to become an abuser of others. It is well know that the victim of abuse later becomes an abuser.
The difficulty is to distinguish between those who are painfully exploring a new identity and existence in society and the family; and those for whom abuse is the issue, so that dynamics of blame and revenge reside behind the opposition. Perhaps the most important distinction, though it is not apparent on the surface, is that one group is oriented to the future and the threatening challenges and responsibilities of what they will become. The other group remains stuck in their orientation to the past and the threatening things that were done to them then. However, both categories tend to present in the same oppositional way.
Reaction to opposition
Now these varieties of internal dynamics are brought to a therapeutic unit, and as in all human relating, inner conflicts and issues get played out in the interpersonal world of relations with actual other people. We then have to take an interest in group dynamics.
Within the units there are of course many group dynamics. But where people with similar problems collect, there will be some commonality, some constant dynamics, across the membership. In the instance we are talking about, the prevalent dynamic is the ‘us-versus-them’ group rivalry, competition and opposition. Me and my group are right, and they in that group are wrong. It is the group equivalent of what is called ‘narcissism’ in individuals. It is as if individuals can pool their separate narcissisms with their fellows in their group to idolise themselves and demonise another group. It is a very common dynamic between groups, and accounts for a lot of the prejudice between races, genders and social classes. Here it is the clash between generations.
Forces in our culture are able to organise coherent prejudices in a group. There is a plasticity within individuals which allows this social coherence, and which thereby supports each individual’s narcissism. This kind of dynamic of course goes right to the heart of the adolescent’s anxious uncertainty about who he is – dependent child needing others or independent adult, responsible for each other.
Within the adolescent unit then, in general terms, the oppositional, us-and-them dynamic can be easily played out between the clients as a group and the staff. The important aspect is that, however much the dynamic is driven by the position of adolescents, the professional carers will feel the opposition, and react to it. Carers react in three typical ways which are also group dynamics in the sense that they are coherent sets of attitudes shared within the group. These sets of attitudes take the following forms:
- Pathologising: First, and in common with many health related services, staff take a view of the patients as suffering from some sort of pathology. In this instance it is mental health pathology, and it is customary to consider it medically, like physical health problems. Then the staff role is seen as correcting the problems, perhaps with medication, or perhaps with re-educational methods based on the staff’s superior experience on how to live life – a kind of physiotherapy of the mind.
It is of concern that this kind of attitude often develops even in the everyday life of a therapeutic community for teenagers. It happens when the staff member unconsciously generates a distance from the teenager that feels unbridgeable; the distance appears to be between a person who knows and another one who doesn’t know (“the professor chair syndrome”). All this feeds the teenagers’ lack of confidence in the adult workers due to their personal history of deprivation and abuse. Technically speaking, it is necessary that staff keep in mind how counter-productive and non-therapeutic such an attitude is, and in the end how unfortunate that attitude is however much it produces a kind of containment.
- Reacting to the suspicion: The second reaction of carers is more specific to the way their clients use help. This as I have argued is, for one reason or another, oppositional, and specially in cases where help is viewed with suspicion as abuse. Carers find this a particularly difficult situation. Most carers go into the role, and training, to become staff because they have their own need to care for, help, and restore others. For their own purposes they require an acknowledgement that their caring is good. Instead, so often they get the message from adolescents that it is not good. There is a great deal of rudeness and offence giving in adolescents. And the coherent cultural attitudes of the adolescent group assume anyone not of the adolescent group is alien, interfering, sub-standard, and abusive. Caring staff find this attacks their own benign self-image. The problem for a professional carer is that the job and the very choice of career is intended to boost their own sense of being benign and virtuous. We believe in ourselves as beneficial people, we need to believe in ourselves. So, we are thereby especially challenged when those who should be confirming our benevolence characterise us as abusers.
Though staff may have considerable resilience in withstanding the undermining effect of the adolescent group’s assumptions, regular and long shifts on duty in face to face contact with their clients is a continually taxing job. In the long run they can tire of it, often called burning-out. Then the carer has to leave, perhaps some vague sick leave or a change to another job or another career. Or alternatively, the staff member in the end becomes retaliatory. The attacks eventually provoke him or her to become attacking and undermining of the adolescent. At that point of course the staff member does take on the role, for the adolescents, of an abuser. The adolescent is then justified in his suspicion and his accusations. The group dynamic and the personal internal dynamic have been established in reality.
This situation deals with the highly frustrating reality of the work in a therapeutic community for teenagers, which is one of the first things to say to potential workers during recruitment interviews. The constant devaluing attacks by adolescents towards staff are a sort of unconscious provocation in order to test, all the time, the operators’ emotional stability and their ability to contain their anxieties. As we can imagine, our clients often argue that everything “is disgusting”, asserting that workers are not capable, are crooks and treat them badly.
When selecting and managing new staff in Therapeutic Community Rosa dei Venti, we actively involve the youngsters – not in decision-making, but asking them to say what they think about people applying to work there. This kind of involvement brings an appreciable reduction in the devaluating attitude towards the staff.
- Joining them: There is a third reaction that is common specifically to adolescent units. In order to protect himself from the attacks of the adolescents he may actively align himself with the adolescent group, adopting their attitudes to responsibility, indulging in their activities and lifestyle, perhaps even taking drugs with them. This is on the familiar basis that ‘if you can’t beat them, join them’. So that the helper puts himself on the same level as the adolescent, and, as such, steps out of his role. There is a certain amount of relief for the carer. And indeed there may be for the adolescent group to recruit a staff member, who will no longer be an abuser. However there is also a loss for those adolescents trying to work through to a more comfortable identity as an adult. The staff member who ‘goes native’ as it is sometimes called, confirms the crisis of the adolescent.
These various dynamics are not the only ones of course, but perhaps they are the most common ones. The most pernicious of these is the second, the one that involves the undermining a carer until he becomes a manifestation of an abuser. This makes a reality of the fear that care and abuse go together.
These services and the therapeutic communities for adolescents demonstrate institutional dynamics which act, like a mirror, to show the internal world of these disturbed adolescents. The identifications of the carers combine with the strong projections from the young patients. The unconscious fantasies that result influence the tasks of these institutions to become mirrors of what happens in the mental life of the clients. In this sense they represent an institutional countertransference. If the countertransference feelings can be available to the awareness of the team, and managed in a good enough way, they can become potentially an instrument of care.
There is also a specific characteristic of adolescents who enter a therapeutic community, that shows a clear difference from adult therapeutic communities: being a younger age group (under 18), they are usually sent to a therapeutic community without a real choice, others having decided for him/her. This method of entering a therapeutic community is another trauma that adds to the others in his/her story. So the therapeutic community for adolescents also has the task of caring for this new trauma (and certainly also the other ones) in a co-managed way.
This type of attitude it is complete contrast to the first point, where we dealt with the problem of excessive emotional distance. We can see that in a therapeutic community for teenagers it is almost impossible for staff to keep the “right” distance, because of the length of the shift that staff work every day, which is a specific characteristic of the work such treatment contexts. In smaller and measured ‘doses’, and hopefully in a conscious way, the attitudes of mutuality and appropriate closeness have a great value for the real educational and therapeutic aims. Unfortunately, it often happens that unconsciously the worker struggles to face the exhausting demands by teenagers, and goes out of his/her role to become inappropriately close to the adolescents’ roles. At this point, the staff member behaves as a peer, conceding and giving unacceptable permission, and fails to find his necessary authority to express disagreement and demand a respect for boundaries. These types of problematic adolescents are very astute at confusing roles, and consequently rules, so that the therapeutic community swiftly becomes an anti-therapeutic space.
What to do
What can be done about this complex and interactive state of affairs, where emotional influences go back and forth until the adolescent’s fears may be self-fulfilled?
One strategy that carers often take is that unremitting love, tolerance and forgiveness in the face of opposition will in the long run win through. Perhaps it is not unexpected in a country with a Christian tradition of turning the other cheek. But it causes confusion if we meet aggressive opposition, with saintly tolerance.
A second approach is the currently acceptable notion of containment. Here the adult’s role is the very important function of ‘managing the boundaries and rules’ of living together: the absence, the weakness or perversion of this function allows and even facilitates a disorganization of the unit, as well as impulsivity and destructive violence, so well described in William Golding’s novel, Lord of the Flies.
It involves defining and picking out as precisely as possible the negative as well as the positive components of the caring engagement. To stare unflinchingly at abuse, care and the difference between the two is at least clarifying rather than confusing, although it is none too easy, and it requires considerable support from colleagues. In addition, such ruthlessly careful observation is often more acceptable if it comes from peers, from other patients, something the therapeutic community is particularly good at providing.
Finally, if the staff can cope without going to pieces, the adolescent can draw a strong integrating force into himself as well. The group dynamic discussion has given an idea of the way organisations can pull apart. So an integrative dimension that can look at all sides of a situation in an organisation, could be introjected as a therapeutic core by the patient.
We have drawn attention to the identity problems that underlie the issues for adolescents. Whereas for an ordinary adolescent these will largely concern gender identity and sexual relations, for many – perhaps most adolescents who require professional help – the identity problems concern help and abuse, the intrusive relations between helper and abuser, and so concern confusions rather than differences in identity. We need to be aware that so often people who work on the staff of such units, often do so out of a need to reinforce their own sense of a benevolent identity.
We have tried to map some of the dynamics that adolescents bring to a care unit, and how they become organised unconsciously as a group dynamic. Perhaps we have not described a full catalogue of the individual and group dynamics. But we have addressed those that seem most important to me. Perhaps in the discussion to follow, you will amplify – and maybe correct – my account of these identity dynamics.
Turquet, P.M. (1974). Leadership: The individual and the group. In Gibbard, G.S., Hartman, J.J. and Mann, R.D. (eds.) The Large Group: Therapy and Dynamics. San Francisco: Jossey Bass.
About the authors
Robert D. Hinshelwood: is Professor in the Centre for Psychoanalytic Studies, University of Essex, and previously Clinical Director, The Cassel Hospital, London. He is a Fellow of the British Psychoanalytical Society and a Fellow of the Royal College of Psychiatrists. He has authored A Dictionary of Kleinian Thought (1989; Italian edition 1990, Dizionario di Psicanalisi Kleiniana) and other books and articles on Kleinian psychoanalysis. He has written on the application of psychoanalysis to social groups and culture, What Happens in Groups (1987; Italian edition, Cosa accade nei Gruppi, 1989) and Suffering Insanity (2004). In 2013 he edited jointly with Nuno Torres, a book Bion’s Sources: The Shaping of his Paradigms. Italian Edition 2015, Le fonti di Bion. And also in 2013, he authored Research on the Couch: Single Case Studies, Subjectivity and Psychoanalytic Knowledge. Italian Edition 2014, Ricerca nel setting. He has written on the professional ethics of psychoanalysis – Therapy or Coercion: Is Psychoanalysis Brainwashing? (1997), and his Chapter on ‘Introjection and projection: The Uses and abuses of paternalism’ is in the Oxford Handbook of Psychiatric Ethics.
Luca Mingarelli: President of Foundation Rosa dei venti, a non-profit organization, social entrepreneur, psychologist, director of Therapeutic Communities for teenagers, organizational consultant. Professor of psychosomatic medicine. Vice president of the NODO Group and member of OPUS. Co-founder and director of GR innovative events such as Energy, creative collaboration and wellness in organizations and Learning from Action. Director and consultant in national and international GRC. He wrote the book Adolescenti difficili, autobiografia di una CT (Ananke, 2009). National basketball coach and member of Italian Order of Journalists.
 Paper written for the International Conference organized by CT Rosa dei Venti nov. 2012