Kathleen Sciacca, Founding Executive Director
Sciacca Comprehensive Service Development
for Mental Illness, Drug Addiction and Alcoholism
Written in 1981.
Not for reproduction in whole or part.
Copyright ©1990, Kathleen Sciacca
The research that will be presented in this paper is representative of the writers' view that the process of the adolescent separating from his or her family and childhood dependencies is a crucial developmental stage. Environmental conditions during the time of adolescence are highly significant in enabling a successful development from youth to adulthood and maturity. This developmental stage requires more understanding and attention paid by parents, families, psychologists and educators who take part in the adolescent's life. The theoretical position of Dr. Peter Blos is that individuation and the potential freedom to individuate are contingent upon some degree of success in resolving adolescent conflicts and separating from internalized infantile object dependencies. His position is supported by other pertinent research in this area. Dr. Blos' research findings will be presented in this paper along with research on adolescent suicide; and an empirical view of adolescent group process. Suggestions for treatment and prevention of the psychopathology each theorist addresses will also be included. Some clinical implications of adolescent separation from a psychoanalytic perspective:
Dr. Peter Blos is a psychoanalyst who has made adolescent analysis his field of research. He received his doctorate degree in biology in 1934 at the University of Vienna. His acquaintance with psychoanalysis "brought discipline and order to the confluence of the two sciences." He thus made psychoanalysis his profession and adolescence became his major interest.
In his early writings in 1943 (1) Dr. Blos made the following statements concerning adolescent development.
"The direction of adolescent development can most succinctly be described in terms of three goals, representing the three fold task the adolescent must accomplish in order to move onward to maturity. Foremost among them is the emancipation from the family. In accordance with his sexual development, the adolescent must be able to free himself from his childhood dependency upon parents and other intimate persons in the home and reorient his relationships within a wider social framework. A part of the affection that he formerly directed toward his parents must now be redirected toward people outside the family. The second task, the attainment of sexual maturity also demands that the individual discover and assume an appropriate role in relation to the opposite sex and to his own as well. The acceptance of the sex role and the establishment of a code of ethics and expectancies is a second pervasive task which can be studied in action. Finally the achievement of economic independence at least for the boy, is a requisite for emotional maturity...Econo mic independence allows the freedom of movement and privacy which the child is denied and for which the adolescent strives. If he wishes to become a recognized member of society vocational and social identification must be formed, and self direction must be progressively developed in terms of an economic goal. These three tasks do not exist as external demands nor as separate entities. They represent the directive components positively or negatively discernible in adolescent behavior. Positively, if the individual proceeds toward maturity; and negatively if he fails to reorient himself in terms of the new goals." Through the empirical study of adolescents Dr. Blos formulated the three tasks as a focal point of reference. He continues: "To these objectives the adolescent related his adaptive responses, prompted by the many forces which challenge his life....They are essentially interrelated, closely bound up with the attainment of physical maturity and to a large extent dependent upon it."
In his later theoretical formulations, in 1979 (2) Dr. Blos reports on the outcome of years of research. He emphasizes the impact of environmental influences upon children and adolescents. He includes the abstract environment such as institutions, shared symbolizations, value systems and social norms. He states that psychic autonomy and emotional maturity are achieved through the selective use the child and adolescent make of their particular environment and constitutional givens that accrue over time, to distinctive adaptive patterns. According to Blos, whatever the adaptive pattern may be at a given level, it is actively, although not necessarily consciously and deliberately chosen and organized by the growing child to protect his psychic integrity, his sense of well being, his keeping physically intact as well as mentally responsive and alert. Whenever emotional disturbances preclude the nutritive use of the environment, normal functioning and development are impaired to a critical degree. Dr. Blos points to the biological analogue, namely the ingestion of life sustaining substances and their conversion into living tissue. This process if working well in all of it's stages can be considered the most essential indicator and guarantor of normality and health. Concerning adolescents we can say that with the advent of sexual maturation and new physical capabilities, a thrust away from infantile family dependencies into a wider social milieu becomes not only feasible but mandatory. According to Blos, the adolescent's broadened and new and unfamiliar surround inherits functions and meanings that once belonged to the family matrix of childhood. These become subjected to modifications by rejection, either partial or absolute, transient or permanent. Blos refers to this process as the "critical selectivity" of the adolescent. Only with the use of the wider social surroundings in continuation of, rejection, or revision of customary family patterns, does the adolescent acquire stable, durable, ego-syntonic patterns of his own, and in effect becomes an adult.
In Dr. Blos study which is entitled "The second individuation process of Adolescence," regression is the central theme. He states that "adolescent regression brings the advanced faculties of the ego to bear on those childhood vicissitudes that could only be dealt with inadequately during the early years of life." According to Blos the developmental progress of the adolescent is predicted on the capacity to regress. It is a normative, non defensive form of regression which he calls "regression in the service of development." This seemingly backward step can only be taken successfully when supportive influences and facilitation are available in the environment. Facilitation referred to in this context comprise not only tension reducing or gratificatory supports, they comprise equally the exposure to age specific conflicts, external and internal, which by their very nature promote progressive development. It is therefore not in the best interest of development to sidestep the conflict between the generations or between the adolescent and his environment. It remains a challenge to the parent generation and the social planners to know how to best keep the ensuing stress constellations within the boundaries of adolescent tolerance and adaptability. According to Blos, the potential dangers of obligatory regression render adolescents most prone to the outbreak of emotional illness. The two extremes: 1. Regression avoidance/ flight into adultomorphic roles; and 2. Perseverance on the regressed level/psychosis, are both representative of well-known pathological states of adolescence. In both instances the function of the adolescent-specific regression has miscarried. In effect, the successful disengagement from infantile internalized objects depends on the completion of the psychic restructuring through regression. The dilemma of either viewing adolescent emotional states and behavior as normal aspects of adolescent development or in contrast, identifying them as signs of pathology is perplexing. Dr. Blos has made the discovery of differentiating criteria a desired outcome of his research.
Dr. Blos likens adolescence as the "second individuation process" to Mahler's theory of the individuation of the third year of life and it's resulting attainment of self and object constancy. Both periods of individuation have in common a heightened vulnerability of the personality organization; the urgency for changes in psychic structure consonant with the maturational surge forward; and both periods should they miscarry are followed by a specific psychopathology that embodies the respective failures of individuation. What in infancy was a "hatching from the symbiotic membrane to become an individuated toddler," becomes in adolescence the shedding of the family dependencies, the loosening of infantile object ties in order to become a member of society or simply of the adult world. It is not until the termination of adolescence that self and object representations acquire stability and firm boundaries or are they resistant to cathectic shifts. The oedipal super ego in contrast to the archaic super ego loses in the process some of it's rigidity and power while the narcissistic institution of the ego ideal acquires a more pervasive prominence and influence. The maintenance of the narcissistic balance is further internalized. These "structural changes" render the constancy of self esteem and of mood increasingly independent from external sources or dependent on external sources of one's own choosing.
According to Blos, the disengagement from internalized objects opens the way in adolescence to the finding of external and extra-familial love and hate objects. The reverse was true in early childhood separation where the child gained psychological separateness through the process of internalization. The process from symbiotic oneness of child and mother to that of separateness from her is marked by internal regulatory faculties which are assisted and promoted by maturational and cognitive advances. This "pendular" process happens again in the second individuation process of adolescence. Regressive and progressive movements alternate in shorter or longer intervals and can easily give the casual observer a lopsided maturational impression. Blos points out that only observation over a period of time enables us to judge behavior as to it's normal or deviant nature.
Adolescent individuation is the reflection of those structural changes that accompany the emotional disengagement from internalized infantile objects. Without successful disengagement the finding of new, extra familial love objects in the outside world is either precluded, hindered or restricted to replication and substitution. The ego is intrinsically involved in this process. Up to adolescence the parental ego has been selectively available to the child as an ego extension. This condition is an integral aspect of childhood dependency in the service of anxiety control and self esteem regulation. With the disengagement form infantile libidinal dependencies in adolescence, the accustomed ego dependencies of the latency period are repudiated as well. Therefore at adolescence we observe relative ego weakness due to the intensification of the drives, as well as an "absolute ego weakness" due to the adolescent rejection of parental ego support. Both kinds of ego weakness are enmeshed in clinical observation. Recognition of these disparate elements of adolescent ego weakness is of practical usefulness in treatment.
The disengagement from the infantile object is always paralleled by ego maturity. The reverse is equally true, that adolescent inadequacy or impairment of ego functions is symptomatic of drive fixations and infantile object dependencies.
During adolescence unique and new ego capacities and faculties appear, for example, that advance in the cognitive sphere. Blos questions the primary autonomy of these functions and their independence from drive maturation. He postulates from his experience that whenever drive development lags critically behind adolescent ego differentiation the newly acquired ego functions are without fail drawn into defensive employ and lose their autonomous character. Conversely, an advance in drive maturation effects ego differentiation and functioning favorably. The interacting stimulation between drive and ego proceeds most effectively if both operate and progress within proximity of each other. The loosening of infantile object ties not only makes way for more ego adequate relationships, but simultaneously the ego becomes increasingly antagonistic to the re-establishment of outmoded and partly abandoned ego states and drive gratifications of childhood. The intensity and extent of object directed drive manifestations or inhibitions should not obscure the radical alternatives in ego structure that take place during this time. The total of these structural changes are what survives adolescence as enduring personality attributes.
According to Blos there is a particular character of psychic restructuring in adolescence when shifts in object libido bring abut ego alterations which in turn give the process of object losing and object finding (pushing away and holding on) not only a greater urgency but also a broader adaptive scope. The circular response has normally diminished by the close of adolescence with the result that the ego has acquired a distinct and definitive organization. Within this organization there remains a wide scope for elaborations during adult life. The ego ideal effects these elaborations.
In studying this process much has been learned from those adolescents who sidestep the transformation of psychic structure and replace disengagement from internalized objects by a polarization of them. In such cases social-role and behavior, values and morality, are determined by being demonstratively different or exactly the opposite of the internalized imago (usually parental). Ego disturbances apparent in acting out, learning disorders, lack of purpose, procrastination, moodiness, and negativism are frequently the symptomatic signs of crisis or failure in disengagement from infantile objects and they represent a derailment in the individuation process itself. An example is the adolescent's complete rejection of his family and his own past which can be recognized as the frantic circumvention of the painful disengagement process. These avoidances are usually transient and self liquidating. In the example of the adolescent who runs away, drives off in a stolen car, leaves school, turns to drugs, Blos sees that in all of these cases the concreteness of the action stands for the achievement of a developmental task. For example when geographical removal from home substitutes for psychological distancing from childhood dependencies. These adolescents have usually removed themselves with finality from their families convinced that no useful communication is possible between the generations. Blos sees this as an emergency measure of a violent rupture with childhood and family continuities to escape from an overwhelming regressive pull to infantile dependencies, grandiosities, safeties, and gratifications.
According to Blos the adolescent longs for the comforts of drive and ego gratification but fears reinvolvement in infantile object relations. Paradoxically only through regression can the residues of infantile trauma, conflict and fixation be modified by the ego's extended resources that draw support from the developmental momentum of growth and maturation. This forward movement is made possible through the ego differentiation or ego maturation which is the normal heritage of the latency period. The reality bound and self observing part of the ego is normally kept at least marginally in tact during the regressive movements of adolescence. The danger of regression is reduced or regulated and the danger of regressive loss of self is averted. Hartmann laid the foundation for these developmental considerations in his formulation of the regressive adaptation. What Blos emphasizes is that adolescence is the only period in human life during which ego and drive regression constitute obligatory components of normal development.
Blos emphasizes that regression as a defense mechanism operates along side of regression in the service of development. These two forms of regression are not easy to differentiate during clinical work. Adolescent regression which is not defensive in nature constitutes an integral part of development at puberty. This regression induces anxiety. If the anxiety becomes unmanageable, then secondary defense measures become mobilized. Blos postulates that there is both drive regression and ego regression during adolescent separation. Ego regression is always in evidence in the adolescent process. If it works purely defensively it works against the evolvement of the second individuation. Only when drive and ego regression reach the immobility of an adolescent fixation does progressive development come to a standstill. For example, ego regression is the re-experiencing of abandoned or partly abandoned ego states which either constituted special ways of coping with stress or a sense of safety and security. Adolescent ego regression puts the ego to a severe test. It lays bare the intactness or defectiveness of early ego organization derived from the first separation individuation process. Regression to a seriously defective ego of early childhood will turn a developmental impasse (typical of adolescence) into a temporary or permanent psychosis. For example, a characteristic of adolescence lies in the frantic effort to keep reality bound, to be active, move about, and to keep doing things. There appears to be a need in the group experiences or individual relationships for acute involvement and affectivity. Sharpness of affect is being sought along with the emotional agitation it evokes. Behavior such as doing things for kicks thereby escaping loneliness, dullness and boredom belongs in this realm. According to Blos we can look at this affective condition as a restitutive phenomenon that follows in the wake of internal object loss and concomitant ego impoverishment. The subjective experience of the adolescent expressed in the quandary of "who and I" reflects what is conceptualized as ego loss and ego impoverishment. Object hunger and ego impoverishment find relief in the group, the gang, etc.. Blos sees the peer group as often a literal substitute for the adolescent's family. The group permits identifications and role try outs without demanding any permanent commitment. Furthermore, the group shares and alleviates individual guilt feelings that accompany the emancipation from childhood dependencies, prohibitions, and loyalties. Whenever peer relationships simply replace childhood dependencies, then the group has miscarried it's function. In such cases the adolescent process has been short circuited with the result that unresolved emotional dependencies become permanent personality attributes.
The work of the adolescent individuation is related to both parental object representations, infantile and contemporary. This tends to confuse the relationship the adolescent has to his parent who is experienced partly or wholly as the one of the infantile period. The confusion is worsened whenever the parent participates in the shifting positions of the adolescent and proves unable to maintain the fixed position as an adult in relationship to the maturing child.
Blos sights a syndrome which he calls prolonged adolescence. In prolonged adolescence a developmental phase which is intended to be left behind becomes a way of life. Instead of the progressive push which normally carries the adolescent into adulthood, prolonged adolescence arrests this forward motion with the result that the adolescent process is not abandoned but kept open ended. The adolescent crisis is adhered to with persistence, desperation and anxiousness. There is a clinging to the unsettledness of all of life's issues. This leads to the contrivance of ingenious ways to combine childhood gratifications with adult prerogatives. The adolescent struggles to by pass the finality of choices and options that are exacted at the close of adolescence. When these adolescents attempt to rupture childhood dependencies they soon realize that this move is accompanied by a narcissistic impoverishment which they cannot tolerate because they are not prepared to do so. Thus, they continue to live in the self image which their parents, sisters or brothers have created for them. Prolonged adolescence presents the paradoxical picture that there is no conflict to deal with because no conflict is experienced.
Psychic restructuring may be more representative of the adolescent who surrounds himself in a room of posters of idolized persons. Here he not only repeats a childhood pattern that once gratified narcissistic needs but simultaneously takes part in a collective experience that makes him an empathetic member of his peer group. Sharing the same idol is tantamount to being in the same family. The difference is that the new social matrix at this stage of life promotes the adolescent process by participation in symbolic, stylized ritualistic behavior. Regression under these auspices seeks not simply to reestablish the past but to reach the new, the future via the detour along familiar pathways.
Adolescent separation anxiety:
Dr. Henry G. Hansburg developed a method for the study of adolescent separation anxiety. (3) He conferred with Dr. John Bowlby to discuss the material in his research. He reports that Dr. Bowlby responded favorably to his separation anxiety test. In Dr. Bowlby's review of the literature on separation anxiety (4) he summarizes that Freud was leading up to the formulation of a theory similar to his own theory on separation anxiety in his later writings on the subject. Dr. Bowlby's own theory consists of a true relatedness of separation anxiety, mourning, and defense. The sequence is as follows: anxiety is the reaction to the danger of loss of object; the pain of mourning a reaction to the actual loss of object; defenses protect the ego against instinctual demands which threaten to overwhelm it and which can occur all too readily in the absence of the object. Bowlby believes that this formula is not commonly adopted by theorists. He does not regard that separation anxiety is in the nature of signal anxiety (a warning signal against something worse) though it may subsequently come to have that function. Instead he thinks of if as an elemental experience and one which, if it reaches a certain degree of intensity, is linked directly with the onset of defense mechanisms. He terms it "primary anxiety" and distinguishes it from states of anxiety dependent on foresight. Primary anxiety is built in and inherited as opposed to acquired through the process of learning. In the young child (one to four years old) Bowlby sights their behavior when removed from the mother and put into the care of strangers as falling into three categories. Protest, which is the problem especially of separation anxiety; despair that of grief and mourning; and detachment, that of defense. The three types of response, separation anxiety, grief and mourning, and defense are phases of a single process and when treated as such one illumes the other two. In Bowlby's study "Attachment and Loss" (5) he shows evidence for the significance of the attachment need in determining the future capacity for object relations as well as the capacity for separation. Bowlby points out that the attachment need goes through periods of decrease and increase depending on stages of development. He also refers to the continuity of attachment behavior into adolescence and adult life. Bowlby states: "During adolescence a child's attachment to his parents grow weaker. Other adults may come to assume an importance equal to or greater than that of the parents and sexual attraction to age mates begins to extend the picture. As a result individual variation, already great, becomes even greater. At one extreme are adolescents who cut themselves off from parents; at the other are those who remain intensely attached and are unable or unwilling to direct their attachment behavior to others; between the extremes lie the great majority of adolescents whose attachments to parents remain strong but whose ties to others are of much importance also. For most individuals the bond to parents continues into adult life and affects behavior in countless ways."
Dr. Hansburg's research and development of the separation anxiety test (3) demonstrates the attachment need that Bowlby refers to. It also demonstrates that adolescence is a time of intensification of this need. Dr. Hansburg also supports Dr. Blos' theory of the "regressive pull" on the basis of his findings in the identity stress area of his test results.
Dr. Hansburg came upon evidence of the strength of the contact need through an empathetic response he included in his earlier model of the test. He found that the empathetic responses were nearly equal to the anger reaction on mild separation stimulus. On the strong stimulation pictures the empathetic reaction had multiplied three times while the response of anger multiplied only twice. He repeated the test with a constellation representing each empathy and hostility and got nearly the same response. This evidence suggested to him that attachment need or desire for contact was more primary and that strong contact reactions to separation were to be expected in adolescence. He later discovered that where hostility responses predominated over the attachment need there was greater pathology. He also concluded that it is the intensity of separation rather than who induces the separation that produces the contact need.
The separation anxiety test can be likened to a more structured version of the Thematic Apperception Test(TAT). Pictures are shown to the subjects, they include captions of the event, i.e., the boy is going away to camp. The drawings and respective captions range from mild to strong separation situations. For example, a mother putting a child to bed, and the death of the mother. A list of statements which specifically relate to the what the child in the drawing may be feeling is presented along with each picture. Each statement is part of a constellation of a category of a response, i.e. or is a category of a response in itself. The subject is instructed to select as many of the responses as he or she believes the child feels and is also provided space for responses that do not appear on the list. The list opens with the questions "has this ever happened to you?", and "if it never happened to you can you imagine how it will feel if it did happen?". Both questions ask for a response of yes or no. Dr. Hansburg constructed his choices of responses based upon the predominant literature in the field which characterized the adolescent response to separation. These theorists include Anna Freud, Dr. Bowlby, Dr. Blos, etc.. These were largely those which could be conceptualized as ego functions, including object relations, regulation of drives, adaptation to reality, thought processes, defenses and synthetic functions. Certain super ego functions were considered of special importance. For example, self esteem.
In the study reported upon here, Dr. Hansburg tested eight groups of adolescents from ages eleven to fourteen. The groups included adolescents living in child care centers as well as children from relatively normal school settings in the community. Of the community school groups nuclear family ties varied in strength with religious and socio-economic factors.
For the purposes of this paper only the findings relative to the study of attachment/separation needs and of identity stress will be included here.
The constellation of responses defined as representative of the attachment need were loneliness, rejection and empathy. Through the attention he paid to the analysis of this response, Dr. Hansburg discovered a relationship between the attachment need and individuation. The individuation/a utonomous constellation included response items of adaptation, well being, and sublimation in the face of separation. He refers to the relationship of these two response constellations as the attachment individuation balance, or the attachment-separation needs balance. Further, he formulated the idea that the other response pattern constellations included in the test, i.e. hostility, are defenses against the stress on this balance. Another response pattern, painful tensions (overt anxiety reactions, phobias, etc.) are considered to occur as reactions to interference with this balance. Other defensive reactions include reality avoidance, loss of self esteem, imbalances in intellectual functioning, etc..
To begin with Dr. Hansburg reports that loneliness as an individual response was most frequent of any other response on the test. This was true in all groups. Dr. Hansburg states: "I suspect that such loneliness is a manifestation of the second individuation as was described by Blos, a repetition of the primary individuation process of infancy, and a perpetuation of the clinging instinct described by Bowlby. This intrapsychic development is a necessary break in the fusion of mother and child even at the adolescent level."
Dr. Hansburg developed an attachment need index and an individuation index. He concluded that on the whole better adjusted children showed lower individuation than attachment indexes. An excessive individuation over attachment index is usually an unhealthy sign in the direction of excessive self sufficiency, therefore increasing difficulties in object relations. The institutional settings contained more underprivileged children and among this group there was greater evidence for self sufficiency in the face of separation, although the attachment need may be just as strong. Hansburg concludes that the attachment needs were not adequately met, with the consequence of the intensification of emotional disturbance.
There is an opposite relationship that exists between attachment and individuation indexes. On the mild separation pictures the attachment need is less and the individuation reaction is stronger. On the strong separation pictures the attachment reaction tends to be high and the individuation reaction low. The difference between the total of each should be slightly in the direction of the attachment reaction. This relationship is referred to as the attachment-separation needs balance.
Dr. Hansburg found an outstanding factor of his data to be the fact that two groups from a Junior High school population were least stimulated by the strong separation pictures. The attachment-individuation balance of the institutionalized groups was much better than these public school groups and the best scores were made by children at a summer camp and at another day school. Through discussion with the leadership of the better groups Hansburg concluded that those adolescent's had closer family ties and that there were more nuclear families in the neighborhoods. From this material he began to formulate the theory that more definitive structure in the environment but not excessive structure, as well as a degree of permissiveness, but not excessive permissiveness produces the best kind of attachment-individuation balance. The next best is produced by the most structure and the least permissiveness, and the poorest is produced in those environments in which there is the least structure and the most permissiveness. In the best of these groups, reactions to separation are strong but capacity to recover is also strong, not so self sufficient as to exclude attachment potential. Even strong structure does not balance, but it does tend to increase self sufficiency at the expense of object relations. Dr. Hansburg suggest that a loose environment tends to disturb the relationship between the attachment and individuation needs and results in difficulties in discrimination between these needs where relationships of adolescents to adults is concerned. Hansburg believes this is indicative of the situations of many adolescents in our society who are living in rather loose environments. This has impaired their relationships to adults and the result has been a lack of leadership, a loss of integration and increasing alienation. Hansburg continues that despite success with peer groups the need for adult contact is still retained. The significance being the availability of contact which can be used in moments of crisis or when the adolescent feels moved towards it. This adult contact is not in the form of early infantile experience as is evidenced by the need for privacy which develops in the face of separation. Dr. Hansburg stresses the idea that the availability of surrogate figures to provide contact need is essential to maintain the balance of individuation. In some of the cases studied contact need was so overwhelming that individuation drives were blocked and pathological behavior ensued. In the test the balance seems largely to be maintained by the two responses of loneliness and adaptation. Hansburg sights the limitation in the peer group's capacity to fulfill both the contact need and the individuation need (the need for privacy and self development).
In conclusion, Dr. Hansburg's evidence indicates a balance of activity between the drive for contact and the drive for individuation, alternating and depending upon the degree to which the individual feels separation. The test also demonstrates that increased intensity of emotional reaction to separation reduces the capacity for adaptation and individuation and increases the attachment need.
Dr. Hansburg also studied the response of identity stress as it is set up in connection with separation experiences. The crisis is often expressed in a feeling of being a different person or a threat to change in one's personality. Not only is self actualization threatened, but the nature of who the self is appears to undergo some disorganization. Hansburg theorizes that an important part of the love object is felt to be needed and is now threatened with loss. Losing it surfaces a very vulnerable part of the self, endangering it's integrity. This is essentially the identity stress that is set up in connection with separation experiences. Much depends upon what there is in the potentially lost object which the adolescent consciously or unconsciously identifies or considers essential to his sense of identity.
Dr. Hansburg also studied the response of identity stress as it is set up in connection with separation experiences. The crisis is often expressed in a feeling of being a different person or a threat to change in one's personality. Not only is self actualization threatened, but the nature of who the self is appears to undergo some disorganization. Hanshurg theorizes that an important part of the love object is felt to be needed and is now threatened with loss. Losing it surfaces a very vulnerable part of the self, endangering it's integrity. This is essentially the identity stress that is set up in connection with separation experiences. Much depends upon what there is in the potentially lost object which the adolescent consciously or unconsciously identifies or considers essential to his sense of identity.
Dr. Hansburg states: "the greatest threat to identity in adolescence comes from what Blos has described as the regressive pull, which is obviously related to the intensity of infantile attachments" Hansburg continues that the maintenance of identity must come through all the techniques used to defend against internal regressive pull. Responses such as "he wont be the same person anymore" are taken to be indicative of a change in identity. Older adolescents in the groups tended to show a heightened frequency in this response, showing that identity stress increases at least until age fourteen. The strongest separation picture the death of the mother induced the greatest amount of identity stress responses. The lowest amount came from a mild picture, that of a mother putting her child to bed. The identity stress responses were strongly correlated with the reality avoidance complex. Hansburg relates this to the theory that a sense of internal change produces a sense of unreality. He continues that the feeling of unreality may then be displace and proceeds to consider the response to be more of a confusion in identity which creates a wish to temporarily withdraw from reality or to avoid it in some other way. One group which showed excessive identity stress, was correlated to the fact that the group seemed severely threatened as had been evidenced by the very low attachment individuation balance they displayed.
Dr. Hansburg concludes that the evidence of identity stress strongly suggests that all children in all kinds of groups show strong feelings of concern about internal personality change which takes place in the face of separation. it is a strong indication that in the process of giving up infantile love object (s), the majority of adolescents experience a disruption of the self-image and a confusion in identity. This seems to be strongly associated with reality avoidance and to a lesser degree with other emotional complexes including attachment need, tension and hostility.
Adolescent separation and the family:
The study of families has disclosed that families as units to through cycles and stages which introduce additional stress to the family system. One of these developmental stages is the child's adolescence and beginning of separation. It is theorized that familial imbalances are given a final opportunity to be corrected or to reach greater harmony. Identified patients are frequently adolescents who have not been successful during the adolescent separation process, thereby bringing the family's problems into view through the resulting psychopathology.
Extreme cases of this are psychosomatic families, specifically those where the identified patient (usually female) has developed a syndrome known as anorexia nervosa, or self starvation. When a therapist deals with a seriously disturbed psychosomatic patient, there is an additional, more dramatic dimension, that of dealing with children whose lives are in danger.
Dr. Salvador Minuchin, psychologist, along with a research team consisting of a pediatrition, and a psychiatrist, conducted ten years of research on families with psychosomatic children of all ages. Also included was a large treatment team who conducted family and individual sessions. The researchers stated that they were drawn into psychosomatic medicine by the severity of the problems that were posed by patients who came under their care. Their research project grew out of a disappointment with the therapeutic results of individually oriented approaches. They developed a clinical model, from this model four characteristics of overall family functioning emerged. A cluster of these transactional patterns was felt to be characteristic of a family process that produces somatization.
The first characteristic, that of enmeshment, refers to an extreme form of proximity and intensity of family interactions. It has implications on all levels, family, subsystem, and individual. On an individual level interpersonal differentiation in an enmeshed system is poor.
The boundaries that define individual autonomy are so weak that functioning in individually different ways is radically handicapped. Excessive togetherness and sharing bring about a lack of privacy. Family members intrude on each others' thoughts and feelings. Problems of enmeshment are reflected in the family members' poorly differentiated perceptions of each other and of themselves.
The second characteristic that of over protectiveness shows in the high degree of concern of family members for each others' welfare. This concern is not limited to the identified patient or the area of illness. Nurturing and protective responses are constantly elicited and supplied. Family members cue the approach of dangerous levels of tension or conflict. The parents over protectiveness retards the children's development of autonomy, competence, and interests or activities outside the safety of the family. The psychosomatically ill child feels great responsibility for protecting the family. The experiences of being able to protect the family by using the symptoms may be a major reinforcement for the illness.
The third characteristic, rigidity, is found in families who are heavily committed to maintaining the status quo. In periods when change and growth are necessary they experience great difficulty. When a child in such a family reaches adolescence the family insists on retaining the accustomed methods of interaction. Issues that threaten change, such as negotiations over individual autonomy, are not allowed to surface to the point where they can be explored. Such families are highly vulnerable to external events, any event may overload their dysfunctional coping mechanisms precipitating illness.
The fourth characteristic is that of conflict resolution. Usually a strong religious or ethical code is used as a rationale for avoiding conflict. As a result problems are left unresolved and continually activate the system's avoidance circuits. Family members quickly mobilize to maintain a manageable threshold of conflict. They achieve this control through position shifts or distractive maneuvers that diffuse issues. The age specific adolescent conflicts that Dr. Blos postulates are so important to adolescent individuation and growth are never given an opportunity to surface in such families.
Viewed from a transactional point of view the researchers state that the patient's symptom acquired new significance as a regulator in the family system. It became apparent that the key factor in supporting the particular symptom was the child's involvement in parental conflict. This is the fifth characteristic of the psychosomatic family. The patterns in this realm include triangulation, the child cannot express herself without siding with one parent against the other; the parent child coalition, the child moves into a stable coalition with one parent against the other; and the third pattern is an ostensibly united parent dyad, the parents submerge their conflicts in a posture of protecting or blaming their sick child who is defined as the only family problem.
The researchers reported that the most obvious and inevitable source of disequilibrium comes from the growth of family members. Family therapy deals with a field that is larger than the individual symptom bearer. The process of change occurs through the activation of alternative modalities of interpersonal transaction in the family which creates the experience of new realities for all family members.
In accordance with the theoretical positions presented in this paper, analysis of the data of a seven year study of anorexia nervosa has yielded the following findings. To begin with out of the 53 patients seen, the population was essentially adolescent. It also included some pre- adolescents ranging from nine to twelve years old and some young adults, ages seventeen to twenty one years old. Slightly more than half of the patients were hospitalized at the beginning of treatment, usually for about four weeks. All patients were involved in family therapy which typically took place at weekly intervals. The median course of treatment was six months. Therapy was conducted by sixteen different therapists, social workers, and psychiatric residents. All treatment was conducted in the broad systems framework. The formal characteristics and specific goals of treatment varied with the developmental status of the child in the family context. According to the survey conducted among therapists a different trend emerged in the treatment plan for each age group. For pre-adolescents and their parents they stated almost universally that their primary goal was increasing parental effectiveness and parental control and strengthening the parental coalition. These patients were not seen individually. For children in the adolescent age group the therapists' goals were to develop autonomy, individuation, and independence. Occasional individual sessions took place with patient and with sibling sub groups in addition to seeing the entire family and spouses alone. For the older adolescents the therapists focused on issues involved in the separation from the family which was impending or had been attempted and failed.
In the treatment process itself, essentially, the family therapist challenges enmeshment by supporting the hierarchical organization of the family system, supporting subsystem definition, and by supporting the individual's life space. All operations that challenge enmeshment are also operations that increase the possibility of autonomy. Challenging conflict avoidance is done by creating boundaries that help the disagreeing family members to discuss and resolve their conflict. The therapist blocks the attempts of other family members to help or intervene, thereby challenging the family's tendency to form coalitions, as a mechanism of conflict avoidance. Specific to the anorexia adolescent is that he or she tends not to develop the skills necessary for dealing with her own age level. Her over involvement with her family hinders her involvement with the extra-familial world, and thereby causes a developmental lag. She becomes overly skilled in observing and transacting with adults. With the child's entrance into adolescence she finds herself in a crisis. Her wish to participate with a group of peers conflicts with her orientation to the family. The normal adolescent individuates by beginning to view her parents with the expanded viewpoint created by contact with extra-familial others. The anorectic cannot see herself as separate. She turns her expanded view point back into focusing on her parents. She tries to help to change them. This over focus and the parents' response strengthen the boundaries that keep the adolescent over involved with the family. The anorectic family is a closed family system with diffuse individual boundaries within the family.
The researchers report that the results of their treatment had a very high success rate. Success was evaluated in terms of physical recovery as well as over all psycho-social functioning. Many of the adolescents had become more independent and age appropriate in their social relationships and activities than they had ever been prior to their illness. Results were followed up for substantial periods of time. The researchers compare and sight their results as a challenge to the sense of hopelessness that has accompanied many follow up studies on the anorectic patient.
According to the report on adolescent suicide which was studied and researched by Dr. Jerry Jacobs, (7) in 1971 suicide was the fifth leading cause of death among adolescents in the fifteen to nineteen year old age range. He sighted that there had been an increase of 67% in the suicide rate between 1954 and 1964.
Dr. Jacobs paired 31 adolescent attempted suicides with control group adolescents who were matched very closely on many demographic variables. The sample of individual attempted suicides was acquired the emergency room of Los Angeles county general hospital. These adolescents and their parents, generally mothers, were interviewed within forty eight hours of the attempt. All of these cases were placed on a 72 hour voluntary hold for observation. As a rule the adolescents who volunteered were generally cooperative and there was a general reluctance among the mothers in volunteering information. In general fathers did not participate in the study. The control group was more difficult to acquire than the experimental group. Most schools or agencies feared that one of the participants might commit suicide and create a stigma or blame on the agency. A high school was acquired when it was discovered that one of the psychiatrists who took interest in the study was a friend of a principle of a high school.
It is Dr. Jacobs hypothesis that adolescent suicide attempts result from the adolescent feeling that he has been subject to progressive isolation from meaningful social relationships. The formal aspects of this process are outlined by Dr. Jacobs as follows: 1. A long standing history of problems (from early childhood to onset of adolescence); 2. The escalation of problems (since the onset of adolescence) above and beyond those usually associated with adolescence.
Dr. Jacobs supports the first two aspects of the process with the following findings: Comparison of events that had occurred throughout the lifetimes of both groups were viewed from two time periods. With a mean age of these groups being sixteen years old, the first time period would have been that of one to eleven years old, and the second period from twelve to sixteen years old. The suicide attempters were found to be subject to a more extensive long standing history of problems. However, the control group had not shown such a marked difference in the quality and quantity of these experiences in the first time period as they did in the second. For the suicide attempters the original problems did not tend to diminish in the second period. At the same time old problems were extended or reappeared, new ones were added. The control group benefited from a stabilizing effect in the second time period that the suicide attempters had not.
The third factor in the process of progressive isolation is "the progressive failure of available adaptive techniques for coping with the old and new increasing problems which leads to the adolescent's progressive isolation from meaningful social relationships." Here four categories of adaptive techniques were employed by the suicide attempters in the order of least to most drastic. They are: rebelling; withdrawing; running away from home; and attempting suicide. The majority of suicide attempters utilized the same sequence of behavior patterns as the control adolescents, least to most drastic. Having tried unsuccessfully to use the techniques used by "normal" adolescents to solve their problems, the suicide attempter finally resorted to whatever techniques remained. The parents tended to see these techniques exclusively as "behavior problems" where as the adolescent saw them both as behavior problems and adaptive techniques. The adolescent was hopeful that the parent would share his dual perspective and recognize the act-- not just as another misbehavior, but as an indication that a problem existed. In short, there was established and maintained between the adolescent and parent, a lack of "reciprocity of standpoints and relevances."
The fourth stage of this process, "a chain reaction dissolution of any remaining meaningful social relationships in the days and weeks preceding the attempt which leads to the adolescent's feeling that he has reached the "end of hope," finds much support in the comparison data. Situations such as no longer being enrolled in school, broken romances, being sent to juvenile hall or jail, physical illnesses, were high among suicide attempters in the recent weeks or months preceding the attempts and very low or non existent in the control group. Dr. Jacobs concluded that the effects of these experiences led to the isolation of the adolescent from meaningful social relationships. These separations occurred abruptly and unexpectedly. The same is true for the events sighted in the first and second time periods. Dr. Jacobs emphasizes that in the calculus of despair it is not any particular event that is important but the extent to which the suicide attempters were subject to a set of events in a particular order which constituted a process of progressive social isolation.
One of the major suggestions Dr.Jacobs makes in the area of prevention is that the initiation of preventive measures in themselves will require that school personnel re-orient their goals, at least in part, to better achieve what the adolescents saw as the schools main virtue, i.e. to provide a place for them to meet and socialize with each other. If the school personnel had realized the importance of the school to the adolescent in his search for meaningful relationships, and done something to help implement the adolescent's efforts through a planned program of events, it would have gone a long way towards reducing suicides and suicide attempts among the school age children of this study. According to Dr. Jacobs, programs designed to increase and extend interaction between troubled students and their peers and teachers, apart from increasing the potential for establishing meaningful interactions, and reducing the potential for suicide, would serve the additional purpose of reducing the number of "drop outs." About one third of the suicide attempters had dropped out of school shortly before making the suicide attempt.
Adolescent group process:
Dr. Barry Sherman(8) was a psychologist who began his career working with adolescents. He conducted marathon groups for adolescents which generally lasted an entire weekend beginning on Friday night.
Dr. Sherman distinguished two age groups as engaging in demonstratively different group process behaviors. The younger group was aged fourteen to seventeen with a mean age of sixteen. The older group ranged from seventeen to twenty with a mean age of eighteen and a half. Dr. Sherman believed that the major purpose of the marathon experience is confrontation with the maladaptive aspects of a person's defensive structure. he postulated in accordance with Dr. Blos that in the younger group individual defenses have not yet crystallized. The major task of this group is to separate from parents and establish an autonomous identity. The traditional way to do this is to move from nuclear family to the peer group setting. This provides transitional supports and allows for psychic borrowing--an upsurge of transient imitative behavior. This is an anxiety evoking time and the adolescent relies on the peer group to bind his anxiety. He can focus on the group rather than his internal turmoil. According to Dr. Sherman the group itself and the activity of grouping become the major defense at this age.
The older adolescents are at a different stage. They have found a more distinct way of being themselves and no longer depend on the peer group to the same extent for safety and identification. Generally, their major preoccupation is how to validate the role each has adopted. Each tends to exaggerate the statement "this is who I am." At this point it is loudly and ultimately acclaimed as the definite and ultimate me. Dr. Sherman compare these feelings to first love, it is vibrant and alive and unlike any previous experience. If it is painful, it is painful to extreme degree and if it is beautiful, it is most beautiful.
In the initial part of the marathon experience, the younger group are aided from anxiety by their ability to group. This is the major defense. There is an appearance of sharing, ease and openness. As the leader Dr. Sherman frequently felt left out during this time. Except for questions such as "how many are coming," he was ignored. He felt that it was essential for him to remain apart and not interfere. Dr. Sherman felt that the best possible goal for each young adolescent during the course of the marathon was to move closer to individuation and to be less dependent on peer group identification. In the second stage of the marathon the youngsters are usually caught between a need to comply with the implicit demand for honest self expression and their reluctance to express anger toward one another and the leaders. This conflict brings about anxiety, nervousness or boredom. Since the group is new and does not have much autonomous strength the group defense collapses under this increased pressure. Individual contributions began to characterize the second stage. The underlying theme of these statements is always the question "who am I."
After the group has shared the individual statements there is no coming together as a group as a result of this expression. Instead tensions and vague uneasiness pervade the room. This state leads to the third state of the marathon, experiencing and expressing anger. The youngsters are angry that they do not feel change and disappointed at the leaders for not having changed them. At first there is a tentative expression of this anger and the leaders encourage fuller expression. Release of physical tension can be achieved by throwing a pillow, lying down and kicking one's heels, etc.. Explicit permission is given for them to express their feelings. Dr. Sherman did not press for information concerning the underlying causes of anger. Some of the content comes out spontaneously. Initially he was apprehensive about using techniques and exercises to help the expression of anger. He thought the adolescent would experience this as games or phoney. However, he found the experience to be positive to the degree that one participant after another may ask if he can yell and scream also. These feelings are so close to the surface that it is a liberating experience to express them. Tension decreases markedly after the ventilation of anger and a sense of the group develops again, less defensive than in the first stage. Participants share personal information and ask factual questions. Some express that they feel different, like a new person, etc.. In the fourth stage of the cycle there is a closeness, a sense of something enriched having happened and a sharing of biographical information. The unique feature of the young adolescent group is that the entire cycle of the four stages happens within four or five hours and repeats itself several times over the course of the weekend. According to Dr. Sherman a cycle is in a sense an experiment in moving toward maturity. This may account for the lack of a sense of authenticity in the enthusiastic statements such as 'boy do I feel different." Usually problems which have been identified in the first cycle will continue to be worked on in the later cycles and adolescents who did not make contributions in the first cycle will do so in the second. Each time a youngster deals with his problems they become less frightening. Each time the fourth phase of biographical sharing occurs it provides an opportunity to try out more comfortable adaptive defenses. At the very end there is a feeling of warmth and having shared an adventure. With each successive cycle Dr. Sherman became more directive in encouraging individual statements and after the first cycle he focused less on the expression of anger if it did not arise spontaneously. With each cycle he felt the communications had more depth. Dr. Sherman made the following suggestions concerning this age group. For one, it is essential not to probe. The goal for younger adolescents is not to dig down into the unconscious for material which had made behavior go awry or lead to anxiety, fear, or unhappiness. The adolescent in the throws of puberty is more in touch with his unconscious than he wants to be. His job is not to tear down maladaptive defenses, but to develop adequate defenses. The younger adolescent marathons lack some of the intensity of the older adolescent groups. They are more tiring and less immediately rewarding for the leaders. Dr. Sherman believed that this is what the young teenager needs.
In conclusion: Adolescence is a developmental stage which requires more understanding and sensitivity from the adult environment in which the adolescent finds him or herself. I am in accordance with Dr. Jacobs suggestion for suicide prevention that the educational system is an appropriate place for the provision of opportunities that may help fill the adolescent's social needs. The availability of trustworthy adults can also be included in this realm as was suggested by Dr. Hansburg. The regulation of the amount of stress and tension placed upon the adolescent is of great importance at this stage. Too often the amount of stress and responsibility placed upon the high school student is negating of important developmental needs. Downward spirals can occur when the adolescent experiences inability to cope with these demands while attempting to develop and maintain an identity and a maturing self image. This can be most detrimental to adolescents with a great deal of potential, and have long lasting effects upon their future opportunities and development.
Adolescent separation is a major developmental stage which can result in life and death measures in extreme oppositional environmental conditions. This has been clearly evidenced in the studies of anorexia and adolescent suicides. To a lesser degree a great deal of adult psychopathology ensues as the result of unresolved conflicts of this stage as Dr. Blos so clearly pointed out. Prolonged adolescence takes it's toll in many forms with the same results. That is, the interference with the individual's potential freedom for self actualization and individuation. Eric Erickson's postulation of development and individuation throughout the entire life cycle rings with accuracy, hope, and promise in the face of the difficulties that can arrest this process during adolescence.
Copyright, 1990 Kathleen Sciacca
1. The Adolescent Personality, Dr. Peter Blos, Appleton-Century-Crofts, 1941
2. The Adolescent Passage, Dr. Peter Blos, International Universities Press, 1979
3. Adolescent Separation Anxiety, Dr. Henry Hansburg, Pub. Charles C, Thomas, 1972
4. Separation Anxiety: A critical review of the Literature, Dr. John Bowlby, Child Psychology and Psychiatry, Vol. 2, pp. 251-269.
5. Attachment and Loss, Dr. John Bowlby, New York Basic Books, 1969 Vol 1
6. Psychosomatic Families, Dr. Salvador Minuchin, Harvard Univ. Press. 1978
7. Adolescent Suicide, Dr. Jerry Jacobs, Wiley-Interscience Books, 1971.
8. Marathon Groups: Reality and Symbol, Dr. Barry Sherman, auth. Dr. Mintz, 1971.
Copyright ©1990 Kathleen Sciacca