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In order to help real kids and real families living in the real world, we need to bring sophisticated, multidimensional, integrative, psychoanalytic thinking to our clinical work. Dr. Lisa Director's paper is a paradigm of how a clinician well-versed in two separate clinical territories (substance abuse and psychoanalysis) can effectively operate in the busy intersection between the two—trafficking in teenage culture, public policy, human development, biology, ethics, family dynamics, the law, individual character, and I would add as well, strategies for adolescent engagement, techniques for individual treatment, parent guidance, and countertransference management, among others.
There is so much food for thought in Dr. Director's paper that it has been hard to choose from this rich intellectual banquet, but I would like to underscore some of the special issues that have altered the experience of adolescents in today's world:
The fact that while children are reaching puberty almost two years earlier (so that 9- and 10-years-olds have already embarked upon their adolescent journey), their psychological and emotional preparedness does not match their physical precocity.
The fact that life is more perilous for teenagers today (the drugs are more varied, the sex is more dangerous, and access to guns is relatively easy) has made the ordinary impulsivity and volatility of adolescent mood swings much more deadly.
The fact that parents are working harder than ever means that parents are spending more hours away from their teenagers at a time when close observation and communication are crucial.
The fact that the high divorce rate in our country has produced a large population of single parents or remarried or recombined families has put new emotional pressures on teenagers at a time in their lives when they are least prepared to manage them.