Academic journal article American Journal of Psychotherapy

Self-Destructiveness in Adolescence: Psychotherapeutic Issues

Academic journal article American Journal of Psychotherapy

Self-Destructiveness in Adolescence: Psychotherapeutic Issues

Article excerpt

JOSEPH D. NOSHPITZ, M.D.*

* Clinical Professor of Psychiatry and Behavioral Science, George Washington University. Mailing address: 3141 34th Street, N.W., Washington, D.C. 20008-3308.

THE NEGATIVE IDEAL

Any attempt at therapy for the youngster dominated by a negative ideal is an awesome undertaking. There are a number of reasons for this. The negative ideal is always covert and largely unconscious; hence it is not easily addressed, nor can it be readily identified in order to come to grips with it. More than that, when it is addressed, it is usually unapproachable. If one says to the youngster: "You seem to be trying to destroy yourself, perhaps there is a part of you that wants to do just that," the response is likely to be: "No, I don't feel that way, what happened was all an accident," or, "I was just doing what everybody was doing," or "I just went along for the ride, I was just doing it for fun." In short, it is likely to be protected by the full gamut of defense mechanisms of the ego (denial, evasion, displacement, projection, rationalization, undoing, reversal, etc.). These are invoked to keep at bay any recognition of the presence of a functioning vector to self-destruct.

Indeed, there is a curious alliance youngsters make with this part of themselves. If they are aware of or even just sense the working of this element within themselves, they have to do something about it. They can suppress it and strive not to pay attention to it; they can drown it out with drugs, alcohol, or tobacco; or they may try to hide it by lying, dissimulating, and dissembling. When the feeling of inner badness sweeps over them, and their efforts to contain it are fruitless, some of these youngsters give in to it and accept it as their prevailing identity; in effect, they submit themselves to it, ally themselves with it, and perceive themselves as evil. They may then join a gang with a bad reputation or become members of a cult that worships the devil.

The particular adaptation chosen by a given adolescent will determine the nature of the task presently facing the would-be therapist. During the initial assessment, one must evaluate how much awareness these youngsters have of their own psychological state. To begin with, are they ready to address any kind of psychological problem In the drug-treatment setting, for example, it is common to encounter adolescents who protest that they only have an addiction problem; once they break the drug habit, they would need no further help. Theoretically, such a state of affairs could perhaps exist. Practically, as one reviews the developmental history of any given youngster, there are usually a host of self-destructive tendencies present besides the substance abuse, many of which were in evidence long before the time when the addictive behavior is said to have begun.

DENIAL

The question is, will the adolescent be able to look at what is going on within? If the denial of inner problems is total and seamless, there is no handhold for the therapist to grasp; accordingly, no further individual work is likely to be profitable at that point. Again, to continue with the drug abuser as an example, occasionally the level of denial is such, that despite a history of five years of ever-increasing involvement with substance abuse, plus the failure of a previous attempt at treatment, the presence of the addictive state is itself rejected: "I can take it or leave it, any time I want to. I just choose to take it now because I enjoy it." This is the famous state of "denial" celebrated in the annals of drug and alcohol treatment from the time AA was first founded. An interesting element that is often part of this profile is the statement some youngsters make: "I haven't reached rock bottom yet, so I don't need treatment." This implies an awareness of the inner driven need to self-destruct, along with a recognition that this state has not yet played itself out completely; things could be worse. …

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