Peer-Impact Diagnosis and Therapy

Front matter

eer-Impact Diagnosis and Therapy

Vivian Center Seltzer iii i 7

Peer-Impact Diagnosis and Therapy

Introduction

Forces of Adolescent Development

Dealing with Development: Four Domains of Adolescent Growth

Dynamic Functional Interaction (DFI): A Revisionist and Sequential Theoretical Model of Adolescent Psychological Development and Behavior

Societal Designations: Adolescents Who Are Minorities Societal Designations: Adolescents Who Are Gay

Defensive Glitches Defining and Detecting Defensive Glitches

The Peer Arena Retrospect (PAR) Protocols

Getting to Know the Adolescent: An Introduction to the PAR Protocols viii Contents

PART IV 12 13 14 Peer Arena Lens (PAL) Group Therapy Working Together

PAL Group Therapy in Action: Two Case Studies PAL and the Professional: Davey’s Story

Index

About the Author

Acknowledgments

Library materials, domestic and cross-cultural research findings, clinical experiences with adolescents and families, teaching graduate and undergraduate students and interacting with talented colleagues from many countries of the world, counsel with statistical consultants, exchange with professionals in my field, and raising three adolescents all in some way contributed to the ideas found in this volume. Although I make no specific designation, I am very appreciative and thank all of you. However, there are colleagues at the University of Pennsylvania from fields other than my own whom I acknowledge for special kinds of support: Louis A. Girifalco, university professor of materials science; Marion Kant, senior lecturer in dance history; Jonathan Steinberg, Annenberg professor of history; and Richard Waterman, a past professor and current adjunct professor of statistics at the Wharton School with whom I collaborated on early cross-national studies; and Robert Cosner, former director of youth protective services of Bucks County Pennsylvania and lecturer at the School of Social Policy and Practice, for his assistance in the third replication of my early study, and to those staff and volunteers at Philadelphia Young Playwrights whose cooperation was invaluable. Ellen DeMarinis, research librarian at the Van Pelt Library was very helpful and gracious in assisting me. I also acknowledge the assistance of two students, Orkun Sak, Ph.D. student at the Wharton School, for statistical work on international findings that supported anecdotal and clinical findings with adolescents, and Sara Flanagan, for work-study assistance in accessing library materials and retyping initial drafts. I am most appreciative for the permission granted me by John Wiley Publishers to cite my work in The Psychosocial Worlds of the Adolescent: Public and Private (1989).

I was privileged to have Jennifer Hammer serve as my editor. She was a part of the of the project from initiation to end. Her brilliance in carrying out her role was evident at all periods—first draft through to completed manuscript. In addition, I also thank you, Jennifer, for prompt responses x Acknowledgments so crucial to keeping the travel energized. I am appreciative of the work of the production staff at New York University Press.

I value the concern and the implicit encouragement from my three adult children, Jonathan, Francesca, and Aeryn, and from my in-law children, Andrew, Bruce, and Liza, their spouses. Of course, there is a last but not least acknowledgment, this time to my partner in life, my husband Bill, whose meaningful and quiet support was ever present despite the demands of this project. For all I am most grateful.

Introduction

This book is meant to aid professionals in understanding their adolescent clients by offering a theory and method of practice with adolescents. It differs from books in current circulation in connecting both normative and troubling behaviors to development and growth dynamics. With perhaps the exception of methods influenced by psychoanalytic theory, most current practice with adolescents has not been anchored in a theoretical road map. Yet without such a road map, it is not possible to determine which behaviors are deviant and which are not or what the therapeutic task is. Thus, this book fills an empty space in the professional literature on adolescents. It offers information with which to construct an imaginary road map of the adolescent’s journey from puberty to psychological maturity: attaining psychological identity and arriving into early adulthood.

Kurt Lewin, considered a brilliant social psychologist and the individual who led development of the field of group dynamics, convincingly argued for a seamless relationship between theory and practice—that theory informs practice and practice informs theory (Lewin 1939). This book takes theory about adolescent growth and behavior and translates it into practice principles and methods for you to use. It offers reformulations of customary thought about adolescent dynamics and discussion of deviant family and environmental influences and whether such influences are significant; it also provides instruments to inform your practice more quickly about issues with which adolescents are dealing and provides a group therapy model exclusive to adolescents.’

The contents of this book derive from a theoretical model entitled Dynamic Functional Interaction (DFI), a theory of adolescent psychosocial development that blends pertinent adolescent theory and literature together with social psychology theory and experiment. It sets the adolescent task as individuation and the age-mate peer as the most relevant “other” of the stage. In doing so, it veers away from popular notions of adolescent rebellion and parent-child difficulties as the primary explanations of adolescent behavior. Indeed, regardless of the nature of the problem, many professionals immediately ask adolescents about their home life and issues of family. What do they fight about? How often? What are their feelings about the outcome? Unless an adolescent’s behavior is extreme or dangerous, a common approach is to interpret rebellious behavior as normative and use appropriate strategies to reduce conflict between adolescents and parents/family. Some strategies succeed, but not enough. By assuming family dynamics to be the root cause of many behavioral problems, and crafting treatment plans accordingly, professionals are likely to miss the central role played by peers in shaping adolescent behavior, thereby failing to address real problems and failing some clients in treatment.

In contrast, the DFI model sets the core of adolescent behavior as flowing from responses to psychological interactions with peers. Comparison dynamics, as adolescents assess and evaluate themselves in relation to their age-mates in order eventually to settle on the self they wish to have, forge the axle of the adolescent wheel. Inevitably, cognitive and emotional aftermaths, as adolescents rank themselves against their peers, affect their changing system benignly or harshly. To be unaware of these processes is to miss the essence of the stage. Professionals must understand the crucial influence peers have on adolescents’ development as arbiters of what works and what does not, both in the present and in contemplation of their future life. In so doing, professionals will also understand the pressure that adolescents feel about conforming and about maintaining an acceptable status relative to peers. The goal of this book is to help professionals attain that knowledge so they will possess the keys to successful practice with adolescents.

Not Rebellion but Work

Adolescents are not rebelling when they resist being with family and relatives. They are merely trying to do their jobs. They are trying to grow up. They are trying to individuate. They do so by looking around and comparing with other adolescents to see how they are doing, what they are doing, what they are singing, how they dance, what they read, what they watch on television, what is the latest gadget they are carrying round, what they talk about. This process is adolescents’ developmental school. It is their informal instruction. They carry out these comparisons about everything important to them at the moment. As they review the outcomes, they find out that by comparison they are at times quite superior, at other times quite inferior, and sometimes right in between. Of course, it is only logical that when one comes out superior one is happy and when inferior it is bad news. If the latter occurs too often, an adolescent may take flight to defensive glitches, which are sometimes visible in problem social behaviors and at other times not readily discernable. These glitches are traced to unbearable feelings of failure in adolescents’ perceptions of how they rank relative to their attachment figures—peers.

The purpose of this book is to help readers understand adolescents better and to be better equipped to work with them. Issues of rebellion against parents are not the most important when it comes to adolescents. Behaviors that may be considered rebellion are often more properly regarded as individuation. Or an adolescent may be communicating, “I am having some difficult times, and the only folks I can really take it out on are the people with whom I feel the safest.” Or it might be something far different. As professionals, it is our job to find out, and not to assume ahead of time. To understand what confronts the adolescent who is seeking help, we must have a good idea of what point an adolescent has reached in his or her development and compare it with the normative growth level at the adolescent's age. By assessing where each adolescent is in relation to these norms we are able to evaluate the suitability or unsuitability of externally observable behaviors. Furthermore, with the knowledge that adolescence has a psychological goal—maturity—professionals can ask adolescents where they are along the road to putting together something of a “self” We need to recognize when the perception of their progress is overblown and exaggerated purposely to make them feel better about themselves and when it is authentic.

This book deals with what adolescents are like just prior to adolescence, what changes in four domains of growth take place, how adolescents manage these changes, and how the changes are reflected on the outside, when important integrations in each of the domains take place, as well as when all the domains catch up to one another and maturity is reached. This road map provides benchmarks as to what can be expected and when, as well as how to identify whether development is behind or ahead for a particular individual. Each pace may be manifested outwardly in observable behavior, which may make an adolescent appear smart or dumb when he or she is neither. Rather, what is happening is that the adolescent is either an early or late developer, a factor that we readily recognize when it is displayed in physical height but that we do not recognize as easily with regard to cognitive and emotional development.

Many books cover children and adolescents, thus subtly reinforcing the notion that the two groups are similar except for variations in height, weight, and physical sexual characteristics. But this conflation between children and adolescents may contribute to our so often failing to reach adolescents or to their feeling misunderstood. Until professionals truly grapple with the “why” behind strong adolescent desire not to be regarded—and related to—as a child, results of efforts to be helpful will often last only a brief time or keep failing. The essence of adolescence is a quest for maturity. So long as an understanding of adolescents’ goals and perceptions continues to elude professionals and parents alike, we will not be able to help adolescents’ anomie and social problem behaviors.

Adolescents are a unique group, different from all others in any period of the life span. Since the developmental tasks of children and adolescents are not the same, each group needs very different therapeutic planning.

Development Brings a Difference

Puberty brings highly significant changes in four domains of growth: physical/biological, cognitive, emotional, and social. It marks the onset of adolescence. A good example of how distinct adolescence is from childhood is cognitive growth. Prepubertal children must see an object before they can think in the abstract about it—for example, once they see a chair, then they can imagine all different kinds of chairs. But they must see it to think about it. But, only several years after puberty, adolescents no longer need to see the object before they can think in the abstract about it. Once they achieve the last stage of cognitive development, formal operations, they are able to hold up to 16 combinations or permutations of thought in their heads at the same time.” Adolescents can ponder about abstract principles and unseen concepts such as civilization or altruism, whereas children are restricted to enlarging on what they view. With adolescents, it becomes possible to discuss benefits and consequences of actions in the abstract, whereas children must see them actually occur. This difference is stunning, and it opens broad doors for professional practice.

Unique to adolescence is that choices in relationships and activities look casual but are developmentally deliberate. They are geared to a central goal: growing up. This process involves unearthing “who I am” and connecting that discovery to “who I wish to be” in future life. This aspect of adolescence is what makes it so different from any other period of growth.

Benchmarks of development provide a road map to the adolescent's growth into maturity. Professionals will find their task more certain if their practice road map takes this sequence into account. What happens internally influences external behaviors in the same manner that growing taller makes shooting a basketball into the basket easier.

Psychological outcomes of peer interaction are the bricks and mortar of reaching each benchmark. The benchmarks are not automatic or easy for anyone to recognize, and they need to be examined and assessed, as is covered more thoroughly in the chapters to come. Adolescents are extremely sensitive to similarities and differences between self and other, and they are concerned about the implications not only for their popularity but for their getting ahead. How and why peers play such an important role in their development is central to understanding adolescent psychology and to practicing efficiently.

The well-renowned epistemologist of the twentieth century Jean Piaget introduced the world of cognitive development to the literature.’ His work is influential to a considerable degree to the basis for this book’s insistence that without a real understanding of the course of normal development from childhood to maturity, valid insight cannot follow into why and when maladaptations in development occur or how they morph into real deviations. Investigations should be focused on the point in development at which the problem behavior began to occur, not on chronological age alone. At a certain age, behavior may be troublesome and unpleasant, but it may not necessarily be a maladaptation or deviant. An abbreviated case study serves as an example:

A sixth-grade, 12%-year-old female with whose parents I had a general acquaintance was displaying problem behavior in school. Meghan was seen by a school psychologist, who worked hand in hand with a consulting psychiatrist. They agreed on prescriptions of Ritalin to reduce her restlessness and Prozac to ease her “depression.” Out of parental need for reassurance, the situation came to my attention as a friend of the family. Meghan was different from the rest of the class, and she was often annoying to them. She laughed at the wrong things and not at what the others considered funny. Her classmates told the teacher that she was weird. Meghan’s parents, a puzzled set of professionals who were respectful of other professionals, were planning to proceed with the directives of the psychologist and psychiatrist, but they intuitively felt mystified. The child was not unhappy at home, nor was she destructive. And it was not a case of an overly strict household leading to acting out in school. Using a developmental perspective, some deviations from the norm became clear. This cognitively advanced new adolescent was bored in school. She was making life as interesting for herself as possible in many antisocial ways to garner attention and make friends. The attempt failed, and she was very unhappy at school. Meghan had no friends, saying, “no one likes me.” She expressed this feeling to her parents, who had consulted the school administrators. Diagnostically, it was clear that Meghan was developing physically right on time with the general norm, since she reached menarche shortly after her 12th birthday. Yet she was emotionally behind. There was some emotional deprivation, not expressed, due to lack of attention by busy parents and an overabundance of responsibility because she was very capable. Cognitively she was well ahead of the norm, which interfered with appropriate socialization. Her responses were so complicated that she could not find a way to connect with age-mates. To summarize the outcome of Meghan’s case, her mother was guided in how to make private time a regular daily occurrence, tasks were reduced or made joint efforts, and conversations about and strategies for making and keeping friends were inaugurated. Within less than six months, Meghan had friends, and the attention-getting behaviors were for the most part dropped. It could be that she was adept enough to take on the new social mannerisms that she had been taught, that she was no longer attention hungry, that counselors had coached teachers to praise rather than ridicule her, or very simply that her classmates caught up. In three years, she was elected president of her class.

This case study, in which a youngster might have been unnecessarily treated with powerful drugs, illustrates the importance of a multidomain developmental lens when diagnosing and treating individuals who are still not full grown. This emphasis might be new, even to experienced professionals. Much primary emphasis in current practice and graduate preparation is still on emotions—an artifact of early 20th-century Freudian psychoanalytic theory and the later 20th-century introduction of its variants. Certainly quantity, quality, and direction of emotions is highly important to functioning well. Valid arguments can be made for the effectiveness of treatments that focus on emotions when such treatments are used appropriately. However, because there are four domains of development that are en route to completion, each of the four types of growth must be taken into account, as well as their interrelationships.

Erik Erikson, who amended his psychoanalytic training with an emphasis on the importance of social factors, introduced to the literature just how important the peer is in the adolescent period.* From the field of social psychology, followers of Leon Festinger, the father of social comparison theory, studied what people do when they are uncertain.’ Among these followers of Festinger, social psychologist Stanley Schachter identified what people who are uncertain do to judge the validity of their uncertainty. His findings revealed that they look to others who are uncertain about the same matter—similar others—and engage social comparison behavior to judge the correctness of the extent of their own uncertainty.® Who is more similar to adolescents than their age-mate peers?

In early adolescence, immediately after puberty, a condition that I term frameworklessness surfaces. It is the result of psychological distancing from parents, which adolescents’ new physical, emotional, and cognitive condition stimulates. They wish to think on their own—to individuate. But, having abdicated guideposts of past times, they are left without familiar reference points, which creates a sense of helplessness and lack of a framework in which to exist comfortably.

The British physician John Bowlby, who observed infants closely during the London bombings of World War II and subsequently authored his conclusions about what he saw, posited an instinctual need in infancy: attaching to the mother. This psychological attachment is accomplished through use of all the senses. Bowlby further held that the degree and quality of attachment would be prototypic of the depth of future relationships. Very simply, infant anxiety is relieved by food from the mother’s breast, which resolves painful hunger, and by the warmth from her body, which approximates the warmth of the womb. Rooting to the source of nurturance begins and is reinforced by frequent daily repetitions.” Bowlby connected with the work of the ethologist Konrad Lorenz, who studied imprinting behavior in ducklings and chicks, observable as instinctually lining up directly behind the first creature they see upon hatching, usually the mother, and following her wherever she goes.* Lorenz's work inspired Bowlby’s development of his formulation of instinctual attachment behavior in infants to their mother. Infant attachment is reciprocal: a mother offers milk to satisfy an infant's hunger drive; the infant's sucking milk out of the breast in turn reduces the mother’s pain of swollen breasts. Each also experiences mutual emotional satisfaction. It is achievement of a solid attachment to mother that gives young children security to venture away for increasingly longer amounts of time, freed to investigate their world and others in it.°

Bowlby’s work lays the foundations for the importance placed on peer attachment in this book. Peer attachment is a response to the depth of precariousness that frameworklessness sets off in early adolescence. Psychoanalyst and author of respected books and articles Anna Freud and her followers regard adolescents as so unsteady that they caution that adolescence could be likened to near-psychosis.'° The pubertous adolescent may be seen to experience reactivation of the intense defenselessness of the neonate. This sense of helplessness, combined with increasing social pressure to individuate, to be oneself, leads to a “rooting instinct,’ similar to that in the Bowlby formulation, to resolve the pain of vulnerability. Adolescents are thus inspired to find a new attachment figure.

In adolescence, the drive is not for actual food to feed the hunger to grow but for others who supply the food of psychological growth: information. This food is supplied by a nurturer who is not the parent but the age-mate, and it does not come from the breast but from developmental “food” to try out: physical appearance, mannerisms, habits and speech, characteristics, talents, opinions, values, and attitudes. Peer attachment works reciprocally: each is actor and audience member simultaneously. It is a back-and-forth relationship, just as in the relationship between infant and mother. These exchanges can both yield information and bring the comfort of relational back and forth.

Adolescent attachment is not decided on consciously but driven internally by urgent motivation from within to be with peers. Once there, comparative acts begin. The more data, the better. To gain information about one’s place on the continuum and thus understand the value of an action, there need to be sufficient numbers of others with whom to compare." Comparing with just a few peers is insufficient.

Attachment in infancy and in adolescence thus differ as to numbers necessary. Infants need a solo attachment other—far better for emotional purposes if it is always the same person. Adolescents require many others. Early adolescent months and years are fed by modeling and feedback from peers on almost everything to do with one another. As adolescents advance cognitively to play with ideas, they see that they must function without direction from parents, no matter how deep their love for one another. This parting is one of growth. Peers stand for the present and future. That realization increases pressure to be around age-mate peers and learn from them, and it is outwardly expressed in an all-consuming drive to be with one another.” Just as the infant instinctively seeks the breast for nurturance to guarantee survival, so adolescents seek nurturance from one another. There is no leader as there is in the Lorenz model of mother duck and duckling followers. Adolescents all are followers.

Indeed, adolescents are motivated by internally driven, attachmentbased imperatives to affiliate with their peers in order to be able to watch them, see what they do, listen to them, hear their thoughts, and understand why they make the decisions they do. They watch the outcomes to judge what brings success or failure. It is an all-consuming task. In adolescence, it is peers who nurture development. Adolescents need data on what works in life, and they do not want answers from parents and elders. Age-mates are seen as the only ones who understand enough about the quest to offer functional information. Adolescents have little desire to spend precious time in nonfunctional company. They wish to be at home for short periods of time, primarily to refresh. This desire is not a rejection of parents. Contrary to Freudian theory, the action is not “to be away from” but is positive, “to be near to? Parents can be fine, even great, but adolescents want updated contemporary models. Most of what they want from parents is support for their desire to be with peers. There is a goal to reach— getting to adulthood—and time is limited. Or so it seems to them.

Ironically, contemporary parents of very young children concern themselves with making sure that their children get together with other young children to satisfy socialization purposes. Conversely, when offspring reach adolescence, parents often become concerned by the “excessive” time offspring devote to peers and peer issues. They fear a negative impact of too much time with peers. Yet in order to fulfill legitimate developmental needs, all adolescents need to attach to peers.

Straight from Adolescents

A primary reason that practice with adolescents fails is that, commonly, actual adolescent concerns are not addressed. Rather, professionals have been addressing matters they believe are as important to adolescents as they are to mental and public health professionals. Findings from a small study completed several years ago reinforce this position. My colleagues at Philadelphia Young Playwrights and I examined what 354 adolescent high school students living in Philadelphia and its suburbs were worried or concerned about by studying the themes from their original plays. Among other fascinating findings, one was most stunning. The central themes were not about matters clinicians and public health professionals tend to consider important such as adolescent pregnancy, drug abuse, or dropping out of school. The central themes in the plays of a statistically significant number of the adolescents focused on relationships with one another and on their futures. The leading characters were adolescents." This outcome reminded me of the first directive from professors in practice seminars in the early days of my graduate education: “start where the client is.” This advice referred to knowing a client's options, plans, conditions of life, past goals, disappointments, parents’ positions and reasons, and friends, if any, and the gender and significance of those friends. Clients’ beliefs about reasons for their behaviors and problems are always important, as are whether they have supporters, who those supporters are, and why they support them. Finally, one must also assess clients’ current status, their dreams and goals, and their plans, if any.

Adolescent Rebellion Examined

For quite some time, “adolescent rebellion” has been firmly engrained in the minds of professionals and laypeople alike. It also is found in academic literature and pop psychology books. Most parents besieged by confusion, hurt, and frustration welcome an explanation: “That’s it! Adolescents rebel!” Because this proclamation refers to all adolescents, parents can feel relieved that it is not only their own child that is acting out the worrisome behavior and that rebellion is to be anticipated since it is “normal to rebel.”

This perspective has become an expectation, so that parents start preparing for problem behavior years in advance, do not worry too much when the behavior occurs, and have confidence that the behavior will pass. In addition, parents are enabled to engage with other parents in socially permissible complaints and to read popular magazines for tips or quick fixes.

Sigmund Freud’s theories introduced the notion of adolescent rebellion early in the 2oth century. Its popularity has diminished only slightly in spite of new approaches such as behavioral and family therapies.'* Centuries ago, prevailing preformationist notions of infants coming into the world fully formed except for physical height and weight thus regarded adolescents as small adults, who were expected to meet rigid prescriptions for proper behaviors. In Rousseau’s time, at the other extreme, there was a focus on the natural playfulness of youth, combined with a plea to support natural but harmless behavior.”

Why has the notion of rebellion persisted for so long? A major reason is that adolescent clients/patients are quite clever. They join the back and forth of this type of emphasis because when they do, they are viewed as cooperative, the therapist feels progress is under way, and most important the real subject is never touched. So, the idea of rebellion is a good deal for adolescents and it rarely hurts. By buying into the idea of rebellion against parents, adolescents can continue to keep their defenses intact and untouched, while the professional feels competent in mastering application of complex theory. Parents hear their adolescents willingly engage in the back and forth. In fact, adolescents exhibit “signs of trust” by revealing painful problems with parents and family members. Professionals continue to be pleased. Therapeutic sessions gain focus. When sessions with parents follow, parents’ frustrations are listened to and supported. In the end, all meet together to try to “work it out? It feels good to both parent and professional to appear to be getting to the root of it all, though from the adolescent's perspective his or her true concerns remain hidden and private.

In fact, adolescent life is not confined to—or even primarily located in, in most cases—the home but takes place in interaction with others just like themselves—similar others. These others are found in school and in other group gatherings. Most adolescent group members look very engrossed and appear to be having a good time. They are good actors and only occasionally fail to hold back fears about how all this change and changing is going to end. In the early adolescent years, most insecurity is about chances of “making it” day by day with one another. All this is generally kept verbally hidden but is evident in nonverbal tenuousness and hesitation. Uncertainty and insecurity in our society are not admired. Their existence is certainly a well-kept secret of adolescence.

A Note on Terms: Reformulated Concepts

Almost 50 years have passed since the British educational psychologist John Coleman advised of an “adolescent society,’ one quite separate from the society of adults.“ The past 10 years have seen an expansion of communication options that extend Coleman’s observation exponentially. Separate mores and values in this adolescent society are implicit, and the rising numbers and varieties of social problem behaviors among adolescents make the sloughing off of outmoded methodologies imperative. The time has come to adopt orientations to practice that are relevant to contemporary adolescence, just as the time arrived in the early 60s and ’7os for the introduction of cognitive therapy” and family therapy.® In order to adopt this new relevant lens, the model for practice espoused in this book includes reversals in thought, exchange of new functions for old, strict adherence to stage-specific developmental theory bases for diagnostic planning and therapeutic management, creation of pertinent protocols for diagnosis and unique adolescent-only group therapy.