The psychoanalytic view of adolescence as a phase of turbulence and reorganization occupied a central position in our understanding until about 1980. Psychopathology was considered a temporary adolescent breakdown. However, in recent years, empirical research contradicts this view, and focuses alternately on adolescence as a time in which far-reaching neurobiological and psychological reorganization is taking place, and temporary disturbed behaviour can develop into persistent psychopathology during the ages 11 to 23 or even later.
Youth experiences of trauma and traumatic stress are inherently complex and idiosyncratic, and these combined with contextual factors i.e. developmental stage, attachment and family history, biological and genetic factors result in a multifaceted, multilayered, diverse response. What we are often confronted with is not only a range of resilience-distress responses, but also a complex variety of clinical presentations, psychopathology and functional impairment in these distressed youth.
This presentation will focus on how the development of adolescent personal identity, sense of self and self - agency can be derailed by chronic trauma OFTEN RESULTING IN pathological dissociation, impacting the cellular and synaptic firing of normal brain development, and in the absence of secure caregiving do not develop heathy cognitive linkages between states i.e. a healthy integrated sense of self. Thus, dissociation creates a deviation from normal development, although serving as a protective factor earlier on, it can lead to difficulties in behavioural management, emotion regulation, self-concept, and somatic disturbances outside their conscious awareness. They become more at risk of further victimization or exposure to other forms of trauma.
Self-injurious behaviour, suicidal preoccupation and attempts, psychosis, serious depression, anxiety and related disorders, eating disorders and relationship disasters are common presentations which require an attitude of empathy and transparency from the therapist, if young people are to relate beyond the assessment session/s. The presence of substance abuse increases the difficulty not only for the young person but also for the therapist who is often less than optimistic in these circumstances.
Mental health clinicians who work with youth must acquire a level of competence to be able to reach these young people – being a young person – a peer is not sufficient if the competence to really be of help to the person is lacking. Inclusion of family therapy is a necessary factor to support the young person’s recovery to a level that is desirable. An added dimension is rendering help to those youth who are in foster placements- as it adds a further element of seriousness. An integration of treatments that are known to work is advocated in addition to dynamic psychotherapy, with or without pharmacotherapy will be discussed.