Throughout my professional career I have been impressed by individual differences across the lifespan. It is my belief that, at any given time, an individual reflects the cumulative interactions of genetic, biological, experiential, social, and other factors across the lifespan. Accordingly, an individual who requests treatment is more than a diagnosis or a set of symptoms. He or she is an individual and the “symptoms” which bring the individual to my office must be understood within the context of that individual’s life, as well as the strengths and positive coping strategies the individual already has. In order to gain an initial understanding of the life context of the adolescent, I often ask parents to complete my Child and Adolescent History Questionnaire. (To Download a copy, please click here.)
An understanding of adolescents requires consideration of several developmental factors. Major developmental goals include separating from parents and the family unit, developing one’s own identity, developing the capacity for intimacy, establishing a stable sexual identity, developing character structure, and committing to long-term goals. Contrary to popular beliefs, not all adolescents display a tumultuous adjustment to this developmental period.
During adolescence, young people experience rapid growth and the development of secondary sexual characteristics which may result in the young person feeling different and very self-conscious. He or she begins to think beyond the present and to worry about the future. Hormonal changes may result in a Dr. Jekyll and Mr. Hyde appearance which is often as scary to the adolescent as it is to the parents. Relationships start to become collaborative and will involve competition and compromise as adolescents develop the capacity to reciprocally meet each other’s needs. As they develop a greater awareness of and sensitivity to others, they begin to develop the capacity for empathy and the capacity to love. Peer relationships take on even greater importance since, for the first time, the adolescent receives consensual validation of his or her worth, and the young person finds he or she can share anxieties and receive support. The opportunity for closer relationships also brings the risk for rejection and how the young person protects himself or herself from potential rejection can strongly influence the depth and nature of future relationships. Younger adolescents need to feel secure and often times they test limits not to defy boundaries but to find out where they are.
As the adolescent progresses, he or she needs to come to terms with a new body image and one’s sexual identity. A variety of media present ideal stereotypes which most adolescents don’t meet which can lead to feelings of insecurity and which can impact one’s self-esteem. In order to cope with feelings of loneliness the adolescent may try to cope through over-eating, excessive idleness, excessive work, or other means. As the peer group takes on greater significance, the young person often finds the values of the peer group are in conflict with the values of the parents. The young person may not be sure what is expected which can result in more limit testing. To resolve conflicts between peer values and parental values, many young people develop relationships with adults outside of the family in order to obtain necessary support and guidance. Thus, adolescents may develop intense “crushes” on teachers, coaches, older peers, and celebrities. However, adolescents are often uncomfortable when a relationship becomes too close so relationships and idols frequently change. Separation from parents is often made easier by perceiving parents to be uninformed, “hopeless”, or even entering early dementia. As adolescents see their peers to be the primary support group, the adolescent will adopt the music, the language, the dress, and other customs of the peer group since external appearances are very important for acceptance. The customs pursued one month may be disdained the next so the interests of adolescents frequently change. Due to a desire for closeness but fearing rejection, the adolescent is likely to spend hours communicating by phone or through various social media which allow for a safer level of intimacy than does face-to-face contact. As the young person becomes more interested in heterosexual relationships, the adolescent is often as afraid that a potential partner will accept an offer for a date as the adolescent is afraid the potential partner will reject the offer.
Toward the end of adolescence, the adolescent begins trying to clearly define who he or she is and to define some type of notion of who he or she wants to be. The adolescent is likely to engage in excessive role experimentation in order to clarify the types of long-term commitments one wants to make with respect to career, relationships, and lifestyle. Sometimes, this stage extends into middle age or even later.
I will use my understanding of the adolescent’s unique life context, as well as my knowledge of normal developmental issues, to develop a treatment plan to try to achieve the desired and agreed upon outcome(s).
