Readiness for Psychoanalytic Treatment in Late Adolescence: Developmental and Adaptive Considerations

Clinical experience during two and a half decades in a university mental health service suggests that late-adolescent college students do not readily avail themselves of the opportunity for longer term psychoanalytic psychotherapy, even when such treatment is quite accessible. At the same time, late adolescents do make significant use of psychological services for briefer contacts. The psychoanalytic literature is generally cautious about the possibility of involving adolescents in treatment. In addition to the intrapsychic dynamics described in the literature, this article addresses the impact of the unique relationship the late adolescent develops toward the adult environment on readiness for treatment. An adaptive framework is proposed that outlines the interwoven influences throughout development of environmental adaptations and intrapsychic dynamics. It is suggested that these intertwined, adaptive–intrapsychic changes engender a particularly charged, transference-like relationship that detracts from the kind of internalization of conflict necessary to engage in psychoanalytically oriented treatment. Given this developmental context, the type of clinical services that are most suitable for late-adolescent patients are discussed, including problems inherent in time-limited treatments and the importance of establishing a collaborative alliance with the late-adolescent patient from the outset of the initial evaluation.