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Five cases are presented of adolescent girls with severe problems in leaving home. Though the psychodynamics were similar (preoedipal conflicts in the separation-individuation phase), the psychopathology and underlying causative factors were different in each case.
Factors to be considered in the initial diagnostic assessment are outlined. These include constitutional and congenital factors, the developmental history, maternal emotional illness, and gene-environment interactions. Various treatment modalities are described and illustrated. In four of the cases specific parameters were necessary, particularly behavioral technics and conjoint family therapy.
The manner in which the analyst may serve, in cases amenable to psychoanalytic treatment, as transference object plus real object is discussed and illustrated.
One of the most common problems confronting the psychoanalyst who works with adolescents is that posed by the late-adolescent girl who is unable to leave home. The following five vignettes are illustrative of the initial “chief complaints” of the distraught parents of such girls.
Ann — last year 17-year old Ann was a charming vivacious A-student. She was vice president of her class, but ever since she was accepted by an Ivy League School out of town, she
had been tearful, seclusive, and preoccupied with thoughts of death.
Naomi — aged 17, was referred by a neurologist after a comprehensive work-up for headache and vomiting proved completely negative. A brilliant senior in high school, she had become withdrawn and depressed, and had began to express deep concern about going away to college.
Marcia — 18-year old Marcia, who had been an excellent high-school student, dropped out of college and returned home after three months of pre-examination panic. This symptom along with insomnia and suicidal ruminations had followed a brief homosexual encounter, her first sexual experience of any kind.
Caroline — aged 171/2, was a bright girl with a variable s