Brief communications from the edge Psychotherapy with challenging adolescents

Summary

This paper examines the challenges of providing psychotherapy to adolescents with severe behavioural and emotional difficulties, particularly those involved in delinquency, aggression, and dangerous or sexually abusive behaviour. Horne focuses on how primitive anxieties and bodily forms of defence can make these young people particularly difficult to understand and treat.

Using the clinical case of Matthew, a mid-adolescent who has abused a younger child and frequently engages in violent and dangerous situations, Horne explores the therapist’s role as both a “new object” and a “developmental object.” She discusses how the therapist’s countertransference and emotional responses can provide important information about the adolescent’s internal world. The paper emphasizes that before deeper interpretation is possible, the therapist may need to help the adolescent put primitive anxieties and bodily experiences into words and thought.

Overall, Horne argues that working therapeutically with highly disturbed adolescents requires patience, emotional containment, and careful attention to the therapist’s own reactions. The therapeutic relationship can gradually provide a safer environment in which acting-out behaviour and overwhelming emotions can be understood rather than simply repeated.