The great merit of this book is the acknowledgement that adolescence, like many aspects of our society, has changed. Therapists, however, have been slow to give up their traditional ways though they should also change to connect empathically to the new adolescent. The author, an experienced clinician, writes in a personal, friendly and pragmatic way with plenty of clinical examples. A simple common-sense wisdom permeates this book, despite a number of contradictions (e.g. kids are behind a “wall of silence” (page 20)/ “it is a myth that teens do not open up to parents” (page 194)). Paradoxically, such contradictions give credibility to the author as they add to the felt complexity and authenticity of the work with adolescents. He describes a relational-behavioural therapy that stresses the importance of an empathic connection with the adolescent along with behavioural change. While the author’s clinical approach is very elegantly illustrated by numerous examples, it doesn’t essentially differ from the new wave of therapies that are symptom focused in contrast to those that focus on the hidden causes of symptoms. The author specifically advises not to ask why and not to look for hidden motivations (page 221) but rather what, who and when. There is no mention of earlier upbringing or childhood experiences, but rather is focused on the here and now. I agree that the therapist must often be rather concrete and present-focused in the interaction with many adolescents, but if the therapist doesn’t project on the adolescent, a live and unique internal world based on history, who will?
According to the author, chronic and habitual lying is a major characteristic of the new adolescent and one of the elements of this “wall of silence” behind which he hides from the adult world. Interestingly, the author doesn’t consider this lying as being delinquent or even symptomatic but “something very different than it did in post-Victorian United States” (page 128). He adds that “dealing with non-conflictual, chronic lying is an essential part of teen treatment” (page 128). Typically, he ends the first session with a patient by asking: “on a scale of 1 to 10, how much of your life have you been honest about with me?” (page 45). I think that it is excellent advice not to be naïve with our patients, however by considering chronic lying as normative, adults run the risk of colluding with aspects of today’s teen’s life that have become clearly dangerous and problematic. In my opinion, this kind of lying is a symptom of what he later describes as a “divided self” (page 74) and should not be trivialized. The new adolescent comes with new “culturally induced anxiety” (page 11) related to competitiveness and overstimulation, and new anger accompanied by verbal brutality and violence. He is also defined by the importance of the peer group which he calls “the second family,” a concept that I find enlightening to understand how alienated he may be from the first family. The author promotes in the work with adolescence a “flexible confidentiality” (page 148) based on the need to talk to parents and to peers. Youngsters who refuse are referred to colleagues. This is understandable in situations of danger but when generally applied, it dilutes the sense of inner boundaries that defines intrapsychic work in contrast to counseling and case management. While clearly non-analytic, the author – though very briefly and with no elaborations – refers in his discussions to fundamental authors like Donald Winnicott, Margaret Mahler, Melanie Klein, and Heinz Kohut, and devotes his last chapter to counter transference. Surprisingly, there is no mention of founding authors on adolescence like Peter Blos, Erik Erickson or Moses Laufer. Even though this is unequivocally a non-theoretical pragmatic know-how book, there is a lack of inner coherence.
My greatest criticism of this book is the author’s obviation of the intrapsychic world. Have we altogether given up attempting to work psychodynamically – let alone analytically – with this age group? But how then will our theory building and consequent interpretative work be informed? Akin to our patients and their parents, we are driven by strong external pressures out of our thinking mind. Despite these shortcomings, I strongly recommend this book for anybody working with this age group. In fact, the authenticity, humility and genuine care of the author constitute an experience of empathic connection with the reader: you are not alone to find it difficult. I agree with Ron Taffel when he says: “I cannot tolerate the arrogance of clinicians who think they have all the answers,” (page 5) and he doesn’t make that claim.