panel discussant: crouching tigers, hidden dragons
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Journal of Infant, Child, andAdolescent PsychotherapyPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/hicp20
Panel Discussant: CrouchingTigers, Hidden DragonsMarsha H. Levy-Warren Ph.D. a b ca New York University, Postdoctoral PrograminPsychoanalysisb New York Freudian Societyc Institute for Child, Adolescent, and Family StudiesPublished online: 01 Jul 2008.
To cite this article: Marsha H. Levy-Warren Ph.D. (2005) Panel Discussant: CrouchingTigers, Hidden Dragons, Journal of Infant, Child, and Adolescent Psychotherapy, 4:2,192-195, DOI: 10.1080/15289160409348497
To link to this article: http://dx.doi.org/10.1080/15289160409348497
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Panel Discussant
Crouching Tigers, Hidden Dragons
Marsha H. Levy-Warren, Ph.D.
IRECENTLY WORKED ON AN APARTMENT RENOVATION WITH A WONDERFUL
architect, whose talent, I later realized, is much like that of a good psy-
choanalyst. She could look at a space and see its potential—how to
maximize the light and the interesting angles and also how to problem solve
in the moment as we went along with the construction.
These are talents that are critical to adolescent treatment, and all three
of our speakers highlight certain aspects of this architectural process.
Dr. Cohen demonstrates how valuable it is to think in a multitheo-
retical fashion when conceptualizing an adolescent treatment—and how
critical it is to be open to employing various theoretical models in the same
case at different points in the treatment. She particularly focuses on the
role of the parents in an adolescent treatment, as does Dr. Rubin, al-
though whereas Dr. Cohen makes clear that it is, at times, necessary to
bring the parents into the treatment, even when the treatment may be pri-
marily an individual one, Dr. Rubin aptly shows us how important it may
be to keep the adolescent’s treatment individual, for the presence of the
parents may be an impediment to the adolescent’s growth. He also re-
minds us of the necessity to remain flexible—perhaps more flexible than
we might be in working with adults. I might take issue with this particular
aspect of Dr. Rubin’s presentation; I believe that work with adolescents
does require flexibility, but I also believe that work with adults requires a
similar flexibility. Indeed, it is often in the midst of adolescent issues in
Journal of Infant, Child, and Adolescent Psychotherapy, 4(2):192–195, 2005
192 © 2005 The Analytic Press, Inc.
Marsha H. Levy-Warren, Ph.D. is Faculty and Supervisor, New York University Post-
doctoral Program in Psychoanalysis; Training and Supervising Analyst, New York Freudian
Society; Associate Director, Institute for Child, Adolescent, and Family Studies; Author,
The Adolescent Journey (1996). She sees adolescents and adults in her private practice in
New York City.
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adult treatment that such flexibility is called for—especially with regard
to our therapeutic stance and our treatment structure.
In some sense, the thematic link among the three presentations that we
heard today is if, how, and when to bring parents into an adolescent treat-
ment. Dr. Aronson describes a form of adolescent treatment that does not
include the physical presence of the parents, even though the presence of
the parents is felt in other ways in his therapeutic groups. He eloquently de-
scribes the way adolescents may help each other in the context of group
therapy, with the facilitation and interpretive involvement of the adult
therapist. In so doing, he describes a number of key factors in adolescent
work—both with regard to the attributes of the therapist and the develop-
mental issues of this time of life.
As a whole, the three papers point out how important it is to make an ini-
tial assessment of what seems to be the most effective treatment structure
for a given clinical situation, but how equally important it is to remain open
to the possibility of a transient or permanent change in that structure. We
may, for example, start working in an individual treatment with an adoles-
cent and then realize that peer issues are so critical that a group therapy situ-
ation may be necessary as either an adjunct to individual treatment or even
a substitute for it. We may, as in Dr. Cohen’s examples, begin work in an in-
dividual treatment structure and find that it is necessary to look at the sys-
tem in which this individual adolescent is embedded, with that system
present in the consulting room. Or, as Dr. Rubin points out, we may find it
necessary to try to keep parents out of the consulting room to allow the ado-
lescent the greatest potential for growth.
In each of these instances, it is important to keep in mind that adoles-
cence is not a monolithic developmental period; it is a period made up of
three subphases, with developmental tasks that are critical to each of these
subphases, and the treatment structure must reflect the means by which de-
velopmental impasses may be overcome.
In early adolescence, which begins with puberty, young people are
struggling with separating from their sense of themselves as children and
their childlike relationships with their caregivers. Assessing the appropri-
ate kind of treatment must take into account what form of treatment will
best aid them in this process of separation. In my experience, in most in-
stances, adolescent treatment with this age group requires ongoing in-
volvement with parents—either collaterally, or with the adolescent present.
It is a time of great tension between these young adolescents and their
caregivers in which both are mourning the loss of their prior relationships
with one another, while simultaneously bracing themselves for a future
Panel Discussant: Crouching Tigers, Hidden Dragons 193
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that is as yet undefined. At this age, kids are focused on the present as it re-
lates to the past.
In middle adolescence, kids are living in the moment. A good deal of the
physical development of puberty is finished, and adolescents are most fo-
cused on their relations with their peers, especially with regard to how they
see themselves as gendered and sexual beings. In their identity-formation
process, they seek out group affiliations for the purpose of refining a sense of
who they are, including what is important to them, what they are good at,
and who they care about. It is often a time in which caregivers feel their ado-
lescents are at some remove from them, for it is period of heightened narcis-
sism, a self-focus that is actually quite necessary for them to accomplish
their monumental developmental tasks. Group treatment is often particu-
larly helpful at this time, and the involvement of caregivers in the treat-
ment, for the most part, is extremely problematic.
Late adolescents are living in the present but are able to look ahead. In-
deed, they are often preoccupied with their futures as independent beings.
This is the subphase in which treatment is most often strictly individual.
Kids at this age often resent the involvement of their parents in the treat-
ment relationship, even though it is extremely important that the therapist
find a way to forge a relationship with the parents.
Defining the relationship between adolescent therapists and their pa-
tients’ caregivers is probably one of the most difficult aspects of doing the
clinical work. At any moment, the involvement of the parents may disrupt
the treatment or keep it from being disrupted. For the most part, the adoles-
cent’s process of separation and individuation takes place while still living
in the family home and while the parents are supporting the adolescent.
The parents are usually the most important adults in the adolescent’s life,
their adolescent child is usually one of the most important people in the par-
ents’ lives; if the adolescent is struggling, the parents want to know how,
they want to know what they can do to help, and they may feel competitive
with the therapist who is now becoming so important to their child, espe-
cially in the context of that child’s upcoming physical separation. All are
aware of the comparative fragility of the family relations—it is easy to mis-
step in attempting to assess when and how to involve the parents, in terms
of what both the adolescent and the parents can tolerate.
In Dr. Cohen’s first case, the 13-year-old Barbara, the therapist realized
in retrospect that it would have helped enormously to include the adoles-
cent’s caregiver in the treatment. I certainly agree. In this early adolescent
treatment, as in most others, I think that involvement with caregivers is
necessary. In her other two cases, which were middle adolescent cases,
194 Marsha H. Levy-Warren
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sporadic parental involvement was called for; this, too, squares with the
bulk of my experience with this developmental group, unless the issues are
so much with peers that group treatment of the type that Dr. Aronson de-
scribes seems preferable. In Dr. Rubin’s middle-to-late adolescent case, the
parental involvement seemed ill advised, as is often the case in late adoles-
cent treatments, when we are working to aid the adolescent in establishing
his or her autonomy.
The assessment of what treatment structure is called for, with regard to
parental involvement or an individual, group, or family format, is like that
of the architect that I described as I began: how do we let in the most light?
How do we get to see the most interesting angles? How do we help the ado-
lescent to achieve the most potential growth, with particular regard for the
issues of his or her subphase? To be architects of adolescent growth, we, too,
must problem solve as we go along, with a willingness to be open to struc-
tural changes as they are called for, as well as a willingness to be open to the
strong feelings that are often engendered in adolescent work, as Dr. Rubin
has noted. With their identities and ego structures as yet somewhat un-
formed, we are often, in Bion’s terms, the containers of adolescents’ strong
feelings, impulses, and fantasies—their “wild things,” as Dr. Aronson notes.
We temporarily house these wild things, until the adolescents themselves
are able to hold them. In so doing, we hope to aid them in looking at their in-
ner and outer spaces, and their potential to fill them with the light and the
angles that are most to their liking.
666 West End Avenue, Suite 1A
New York, NY 10025–7357
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