You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
WHAT IS SCARY FOR US IN DOING CLINICAL WORK IS CLEARLY A personal matter. My near-nightmares include: I am dealing with a dangerous situation about which I have to make a judgment and I have to rely upon people whom I don't know; I find what a patient is saying or doing intolerable; I feel like what a patient is asking of me is understandable – but I don't feel I can be adequately responsive to what I experience as an incessant need for contact. I have had experience with each of these in the recent past, and have to assume that more such experiences are on the horizon. I think that what creates these situations is an expression of the fast-moving thicket that constitutes life for adolescents today.
Allow me to offer some clinical examples:
Jessica is a 14-year-old who was referred by her adolescent physician for depression, anorexia, and self-mutilation. She already has a nutritionist. In the past year, she stopped growing, stopped menstruating, and almost stopped eating. She is anhedonic, dissociated, and, at 5' 4,” weighs 100 pounds. She had started at a weight of 126 pounds.
Her former stellar grades in school had begun to drop this year, and she had been referred for neuropsychological testing. The testing revealed an
obsessive, rigid thinking style and slowed processing speed. She was put on psycho-stimulants and given extended time for test-taking. She also began to see a tutor.
She arrived with an actively involved school advisor and a psycho-pharmacologist on her treatment team as well. To me though, it felt as if Jessica came with a cast of thousands and a possible need for hospitalization.
I began seeing adolescents in treatment more than 30 years ago. At that time, had Jessica been referred to me, it was most likely that her treatment team would have consisted of me and perhaps her pediatrician. This sea-change in how psycho-pathology is addressed is emblematic of contemporary adolescent psychotherapy. I have not always found it easy to adapt.