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Shifting Levels of Communication in Treatment of Adolescent Character Disorders

Shifting Levels of Communication in Treatment of Adolescent Character Disorders Abstract That psychotherapy with youngsters tightly organized around acting-out presents difficulties of a serious order has long been recognized.1,5,6 It seems that when psychopathology manifests itself in immediate tension discharge, and forms of thought, usually intervening between impulse and action,7 are conspicuous by their absence, prognosis is poor and many treatment techniques fail.4 It becomes necessary to look for general patterns in the treatment of these young patients, in the hope of finding adequate explanations for our successes and failures. Since communication problems are particularly severe in these cases, it is the purpose of this paper to highlight these and to point to ways in which communication problems may be met. That a casual “let me be your friend” attitude on the part of the therapist at the beginning of treatment is sure to mobilize an incredible amount of anxiety in these patients has already References 1. The existence of such anemia is supported by research findings. Lourie7 compared three children showing psychopathy with others who were raised under highly similar conditions, in a child-care institution. He concluded that “whereas . . . \[others\] displayed definite evidence of ability to use fantasy beginning at sixteen or eighteen months of age, the psychopathic children were not only unable to use fantasy but were uncomfortable with it. This held true in later childhood too. . . . One wonders, too, if it might partly be this absence of fantasy that makes it easier for the psychopathic child to act out his urges and impulses since this common area of sublimation is not available to him.’ Engel8 compared Children’s Insight Test records of school boys and patients in an institution for delinquent boys and found that elaboration or restructuring was present significantly less frequently in the records of the acting-out youngsters. 2. How therapist-dynamics may interfere with his remaining calm in the face of acting-out is described elsewhere.4 3. How fully the experienced therapist is able to enter into the verbal acting-out of deep inner conflicts is shown by Ekstein and Friedman,2 in an extended discussion of the treatment of a young adolescent boy. 4. We see restructuring as the farthest end of an ability-to-fantasy continuum; restructuring is always present in fantasy, although this is not necessarily true in the converse. 5. In the setting of the nonjudgmental, relatively noninterfering mode of the therapist’s past behavior with this patient, making her do anything would have been the equivalent of acting-out on the part of the therapist. 6. Aichhorn, A.: Verwahrloste Jugend, Die Psychoanalyse in der Füssorgeeziehung , Leipzig, Internationaler psychoanalytischer Verlag, 1925. 7. Ekstein, R. C., and Friedman, S. W.: The Function of Acting Out, Play Action and Play Acting in the Psychotherapeutic Process , J. Am. Psychoanalyt. A. 5:581-629, 1957.Crossref 8. Engel, M.: Affective Functioning, Problem Solving and Delinquent Acting-Out, unpublished manuscript, Institute for Psychosomatic and Psychiatric Research and Training, Michael Reese Hospital. 9. Noshpitz, J.: Opening Phase in the Psychotherapy of Adolescents with Character Disorders , Bull. Menninger Clin. 21:153-164, 1957. 10. Pfister, O.: Therapy and Ethics in August Aichhorn’s Treatment of Wayward Youth , in Searchlights on Delinquency , edited by K. R. Eissler, New York, International Universities Press, 1948, pp. 35-49. 11. The Psychopathic Delinquent Child, Round Table (several authors), 1946 , Am. J. Orthopsychiat. 20:223-265, 1950.Crossref 12. Reference 6, pp. 231-232. 13. Rapaport, D.: On the Psycho-Analytic Theory of Affects , Internat. J. Psycho-Analysis 34:177-198, 1953. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of General Psychiatry American Medical Association

Shifting Levels of Communication in Treatment of Adolescent Character Disorders

A.M.A. Archives of General Psychiatry , Volume 2 (1) – Jan 1, 1960

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Publisher
American Medical Association
Copyright
Copyright © 1960 American Medical Association. All Rights Reserved.
ISSN
0375-8532
DOI
10.1001/archpsyc.1960.03590070096011
Publisher site
See Article on Publisher Site

Abstract

Abstract That psychotherapy with youngsters tightly organized around acting-out presents difficulties of a serious order has long been recognized.1,5,6 It seems that when psychopathology manifests itself in immediate tension discharge, and forms of thought, usually intervening between impulse and action,7 are conspicuous by their absence, prognosis is poor and many treatment techniques fail.4 It becomes necessary to look for general patterns in the treatment of these young patients, in the hope of finding adequate explanations for our successes and failures. Since communication problems are particularly severe in these cases, it is the purpose of this paper to highlight these and to point to ways in which communication problems may be met. That a casual “let me be your friend” attitude on the part of the therapist at the beginning of treatment is sure to mobilize an incredible amount of anxiety in these patients has already References 1. The existence of such anemia is supported by research findings. Lourie7 compared three children showing psychopathy with others who were raised under highly similar conditions, in a child-care institution. He concluded that “whereas . . . \[others\] displayed definite evidence of ability to use fantasy beginning at sixteen or eighteen months of age, the psychopathic children were not only unable to use fantasy but were uncomfortable with it. This held true in later childhood too. . . . One wonders, too, if it might partly be this absence of fantasy that makes it easier for the psychopathic child to act out his urges and impulses since this common area of sublimation is not available to him.’ Engel8 compared Children’s Insight Test records of school boys and patients in an institution for delinquent boys and found that elaboration or restructuring was present significantly less frequently in the records of the acting-out youngsters. 2. How therapist-dynamics may interfere with his remaining calm in the face of acting-out is described elsewhere.4 3. How fully the experienced therapist is able to enter into the verbal acting-out of deep inner conflicts is shown by Ekstein and Friedman,2 in an extended discussion of the treatment of a young adolescent boy. 4. We see restructuring as the farthest end of an ability-to-fantasy continuum; restructuring is always present in fantasy, although this is not necessarily true in the converse. 5. In the setting of the nonjudgmental, relatively noninterfering mode of the therapist’s past behavior with this patient, making her do anything would have been the equivalent of acting-out on the part of the therapist. 6. Aichhorn, A.: Verwahrloste Jugend, Die Psychoanalyse in der Füssorgeeziehung , Leipzig, Internationaler psychoanalytischer Verlag, 1925. 7. Ekstein, R. C., and Friedman, S. W.: The Function of Acting Out, Play Action and Play Acting in the Psychotherapeutic Process , J. Am. Psychoanalyt. A. 5:581-629, 1957.Crossref 8. Engel, M.: Affective Functioning, Problem Solving and Delinquent Acting-Out, unpublished manuscript, Institute for Psychosomatic and Psychiatric Research and Training, Michael Reese Hospital. 9. Noshpitz, J.: Opening Phase in the Psychotherapy of Adolescents with Character Disorders , Bull. Menninger Clin. 21:153-164, 1957. 10. Pfister, O.: Therapy and Ethics in August Aichhorn’s Treatment of Wayward Youth , in Searchlights on Delinquency , edited by K. R. Eissler, New York, International Universities Press, 1948, pp. 35-49. 11. The Psychopathic Delinquent Child, Round Table (several authors), 1946 , Am. J. Orthopsychiat. 20:223-265, 1950.Crossref 12. Reference 6, pp. 231-232. 13. Rapaport, D.: On the Psycho-Analytic Theory of Affects , Internat. J. Psycho-Analysis 34:177-198, 1953.

Journal

A.M.A. Archives of General PsychiatryAmerican Medical Association

Published: Jan 1, 1960

References