Facing It Out: Clinical Perspectives on Adolescent Disturbance

192 Pages·1998·6.55 MB·English

by  Robin Anderson

Facing It Out
I
Tavistock Clinic Series
Nick Temple, Margot Waddell (Series Editors)
Published and distributed by Karnac Books
Other titles in the Tavistock Clinic Series:
Assessment in Child Psychotherapy
Margaret Rustin and Emanuela Quagliata (editors)
Inside Lives: Psychoanalysis and the Growth of the Personality
Margot Waddell
Internal Landscapes and Foreign Bodies:
Eating Disorders and Other Pathologies
Gianna Williams
Mirror to Nature: Drama, Psychoanalysis and Society
Margaret Rustin and Michael Rustin
Multiple Voices: Narrative in Systemic Family Psychotherapy
Renos K Papadopoulos and John Byng-Hall (editors)
Psychoanalysis and Culture: A Kleinian Perspective
David Bell (editor)
Psychotic States in Children
Margaret Rustin, Maria Rhode, Alex Dubisky,
Helene Dubinsky (editors)
Reason and Passion: A Celebration of the Work of Hanna Segal
David Bell (editor)
Surviving Space: Papers on Infant Observation
Andrew Briggs (editor)
Therapeutic Care for Refugees: No Place Like Home
Renos K. Papadopoulos (editor)
Understanding Trauma: A Psychoanalytic Approach
Caroline Garland (editor)
Orders
Tel: +44 (0)20 8969 4454; Fax: +44 (0)20 8969 5585
Email: [email protected]
www.karnacbooks.com
Facing It Out
Clinical Perspectives on

Adolescent Disturbance

edited by
Robin Anderson
Anna Dartington
K A R N AC
LONDON NEW YORK
First published in 1998 by Gerald Duckworth &c Co. Ltd.
Second impression 1999
This edition printed in 2002 by
H. Karnac (Books) Ltd,
118 Finchley Road,London NW3 5HT
Tel. [phone]
Fax.+44 {0)20 8969 5585
A subsidiary of Other Press LLC, New York
© 1998 by Robin Anderson and Anna Dartington
All rights reserved. No part of this publication
may be reproduced, stored in a retrieval system, or
transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise,
without the prior permission of the publisher.
A catalogue record for this book is available
from the British Library
ISBN 978 1 85575 967 1
Edition amendments by The Studio Publishing Services Ltd, Exeter EX4 8JN
Printed in Great Britain by Biddies Ltd., Guildford and King's Lynn
Contents

Preface
Nicholas Temple andMargot Waddell vn
Acknowledgements vm
Foreword
Arthur Hyatt Williams IX
Contributors x i
Introduction
Robin Anderson and Anna Darlington
1. The Intensity of Adolescence in Small Families
Anna Darlington 7
2. 'How Does It Work Here, Do We Just Talk?': Therapeutic
Work with Young People who Have Been sexually Abused
Steve Briggs 23
3. Psychotherapy with Learning Disabled Adolescents
Lynda Miller 37
4. Confrontation, Appeasement or Communication
Jonathan Bradley 53
5. Suicidal Behaviour and its Meaning in Adolescence
Robin Anderson 65
6. Reflections on Some Particular Dynamics of Eating
Disorders
Gianna Williams 79
7. The Fear of Becoming a Man: a Study of Two Adolescents
HeUne Dubinsky 99
8. *Is Anyone There?': the Work of the Young People's
Counselling Service
Elizabeth Oliver-Bellasis 113
9. The Scapegoat
Margot Waddell 127
v
Contents
10. The Heat of the Moment: Psychoanalytic Work with
Families
Richard Graham
1 L Play, Work and Identity: Taking Up One's Place in the
Adult World
Paul Upson
Index
vi
Series Editors' Preface
Since it was founded in 1920, the Tavistock Clinic has developed a wide
range of therapeutic approaches to mental health which have been
strongly influenced by the ideas of psychoanalysis. It has also adopted
systemic family therapy as a theoretical model and a clinical approach
to family problems. The Clinic is now the largest training institution in
Britain for mental health, providing postgraduate and qualifying
courses in social work, psychology, psychiatry, and child, adolescent,
and adult psychotherapy, as well as in nursing and primary care. It trains
about 1,400 students each year in over 45 courses.
The Clinic's philosophy aims at promoting therapeutic methods in
mental health. Its work is founded on the clinical expertise that is also the
basis of its consultancy and research activities. The aim of this Series is to
make available to the reading public the clinical, theoretical, and research
work that is most influential at the Tavistock Clinic. The Series sets out
new approaches in the understanding and treatment of psychological dis­
turbance in children, adolescents, and adults, both as individuals and in
families.
This book is based on the wealth of experience gathered in the forty
years of the life of the Adolescent Department at the Clinic. It covers a
full range of clinical work with some of the most difficult areas of
adolescence, but it also gives a conceptual framework of normal adoles­
cence and traces the difficulties that arise when this goes wrong. Facing
It Out presents new work which has not previously been fully described.
The book will be vital reading for clinicians whose practice includes
work with adolescents, and will also be of fundamental value to others
studying the processes of adolescence, such as parents, teachers, social
workers and probation officers.
Nicholas Temple and Margot Waddell
Series Editors
vii
Acknowledgements
The editors would like to express their particular thanks to Jocelyne
Phiniefs and Sandra Masterson for their patience, support and admin­
istrative expertise. We are also grateful to the Adolescent Department
collectively for their interest and encouragement in our endeavours.
Our thanks to Faber and Faber for permission to reproduce excerpts
from the poems 'Lady Lazarus' and 'Daddy' from the Sylvia Plath
collection, also to the Institute of Psycho-Analysis for permission to
publish a revised version of Gianna Williams' paper 'Reflections of
Some Dynamics of Eating Disorders: No Entry Defences and Foreign
Bodies', first published in the International Journal of Psychoanalysis
1997, Part 4 VoL 78.
Finally but foremost our thanks to our patients who put their trust
in us.
Robin Anderson
Anna Dartington
viii
Foreword
'Facing it out' is a challenge and a history. It sounds determined and
'Churchillean' in tone in that it inspires enthusiasm and effort which
will be revealed as the book is read.
Many times during my work in a forward area in the Burma Cam­
paign in the early 1940s, doing what was called Forward Psychiatry, I
met senior colleagues who told me about the Tavistock Clinic. I was
interested in the psychodynamic approach and by then had realised
already the fact that an emotional breakdown was made more chronic
for every 100 miles the psychiatric casualty needed to be evacuated
away from the battle area and the comrades he knew and liked. I was
impressed that the Tavistock medical staff seemed to know how to deal
with the complicated therapeutic task with which we were confronted.
They seemed to be interested in understanding and solving these
problems both from a scientific and human perspective.
After the war was over it was many years before I managed to obtain
a post at the Tavistock Clinic, and was then a 'foiled circuitous wan­
derer'. This was in 1962. In 1966 the large modern building was built
and consequently projects and work with patients were greatly facili­
tated. Thus it was possible for the Adolescent Department to have a
proper home of its own.
In 1969 my work in the Tavistock Clinic was increased and I was
based in the Adolescent Department. From then until I retired in 1979
was the happiest professional time in my life. 'How can we do it' was
the question, not 'How can we avoid doing it'. In the three departments
and the closely associated Tavistock Institute of Human Relations, there
was a constant flux of creative enthusiasm dynamised by a devotion to
both intrapsychic work and work on the complexities of interpersonal
relationships. This attention both to the external struggles in the world
of adolescents and the significance of their deepest inner feelings is what
is special about the Tavistock Clinic and the work of the Adolescent
ix