Author: Brodie, Bruce R.
Publisher: Jason Aronson
Reviewed By: Anthony Tasso, Volume XXIX, No. 4, Fall 2009, pp. 31-34
The mainstream view on interventions with acting-out adolescents is that only behavioral and cognitive-behavioral modalities work. Manualized, step-by-step protocols and modules clearly delineating the treatment process are a must. Anger management, feeling charts, and assertiveness training are the "gold standard" techniques. Attention to insight, meaning, and the unconscious are anathema. There are many mental health professionals promulgating this notion that delinquent adolescents cannot benefit from psychoanalytically informed treatments. Or at best, that insight-oriented approaches are untested.
The problem with this aforementioned viewpoint is that adolescents, delinquent or otherwise, are humans; complete with idiosyncratic feelings, fears, and fantasies. Developmental processes, complicated in any teenager, are even more challenging with hostilely acting-out ones. Manualized interventions aimed at addressing behavioral change generally ignore structural pathology. Not surprisingly, these treatment protocols run the risk of leaving untouched the child’s destructive patterns of relating to the self and others. Since no one disputes the severity of delinquent pathology, "deeper" therapies should make intuitive sense. Thus, delinquent adolescents, just as others, need to be treated as individuals, and not merely a set of symptoms or a collection of behaviors.
Adolescence and Delinquency brings a broader, more complex perspective to adolescent treatment. Bruce Brodie reflects on his 20 years of clinical work at "the Center," a comprehensive residential treatment facility for delinquent boys and girls, those typically considered "the worst of the worst." One would think such a setting would shun psychodynamic interventions. The opposite is true. Brodie spells out how psychoanalytic theories, and object relations in particular, are utilized with this highly disturbed population. In a densely packed book, Adolescence and Delinquency shows how to effectively apply theory and practice to the most difficult adolescents.
Chapter 1 opens by reporting on the relative lack of attention traditionally devoted to adolescent psychology and psychopathology. Brodie argues that terms like "transitional periods" and "puppy love" denote transient (and worse, insignificant) periods in a teenager’s life. He states this stems from the dearth historical significance given to this developmental stage. Brodie further contends that this minimizing has severely handicapped our abilities to proactively intervene with delinquent teens. He cogently explains the significance of this period, and how adolescence serves as a template for later life. In other words, teenage years are crucial. Chapter 1 also tackles the adolescent’s experience of boredom. Brodie explains that the ability to tolerate boredom often portends good impulse control, while the unhealthy aspects of boredom (e.g., passive complaining behaviors) commonly signify an unconscious desire for excessive nurturance. This can manifest as an untoward wish to be cared for by the more powerful other, in concert with a wish to prevent others from straying. Brodie explains how pathological boredom acts as a passive-regressive buffer against the fear of abandonment. What does the mean clinically? Therapists quick to offer suggestions aimed at remedying boredom accomplish little more than colluding with the pathology of the adolescent. Specifically, the suggestions establish evanescent adult-child connectedness, but at the cost of proactive individuation. Based on this, the author further asserts that behaviorally focused, problem-solving therapies can be (and often are) counterproductive. Chapter 1 sets the stage for the ethos of analytically informed delinquent therapies: holistic, comprehensive, and mindful of intrapsychic processes, not simply attempts at behavioral modifications.
Chapter 2, Adolescence and Part-Object Thinking covers Melanie Klein’s paranoid-schizoid position. Brodie walks the reader through the normal, healthy psychological developmental progression from the paranoid-schizoid, or part-object position to the depressive, or whole-object, position. He explains in some detail how the part-object position consists of viewing the world in black and white terms. Here, a person is good or bad: there is no in between. When she (originally mom, or more specifically, her breast) is good (e.g., providing a good feed) she is only good. However, when she/her breast is bad, she is categorically bad. There is no gray area; no ambivalence. To be ambivalent is to view others as complex and multilayered. The ability to experience the object of love as also the object of hate is a momentous developmental achievement. In other words, ambivalence is the sine qua non of the depressive position. To be without ambivalence is to be without concern. Adolescence and Delinquency explains how the part-object tendencies of splitting (rather than ambivalence), belief in a just world (rather than awareness of injustices), powerless-omnipotence, magical thinking, and a restricted range of affect (mainly that of envy and rage) are firm markers of delinquency. Brodie further links part-object phenomena with delinquency by demonstrating how these above-mentioned concepts fuel hostility, ruthlessness, and destruction—typically in the absence of empathy and remorse. The author’s lively prose and lucid examples clarify tenebrous theoretical concepts, making Adolescence and Delinquency a user-friendly read.
Chapter 3, Identity Formation, describes, in some detail, the general processes of identity development. From Freud’s superego, Klein’s multiple internalized part objects, Ronald Fairbairn’s central ego, libidinal ego, and anti-libidinal ego, to Otto Kernberg’s object relational units (ORU), the author concisely provides a backdrop for the disperse but interrelated psychoanalytic factors thought to underlie identity development. Brodie then turns his attention to identity formation in delinquency. He explains how children who experienced an abundance of abandonment, rejection, and criticism develop corresponding internalized punitive objects. He articulates how these experiences—far beyond a learned pattern of behavioral responses—become the lens through which the individual views the world (e.g., angry and hostile) as well as him or herself (e.g., worthless and despicable). This topic goes well with Brodie’s earlier discussion of the link between adolescent identity formation and gang affiliation. He states that an inchoate sense of self leads to an insatiable need for acceptance, rules, and boundaries. Therefore, gangs, though destructive, provide the pathological substitute for that which was absent in young childhood.
Chapters 4 and 5 first discuss the all-too common occurrence of adolescents relapsing following termination of "successful" treatment. Whether it’s a return to drug use, crime, or gangs, Adolescence and Delinquency illuminates how internalized abusive or critical objects account for such experiences. Brodie describes how these phenomena represent an unhealthy attachment to significant others while simultaneously "punishing" these same individuals. This dangerous dynamic validates their status as horrible children in their parent(s)’ eyes, while "confirming" the negative self-concept in their own. It also keeps their parents culpable for their destructive behaviors. In other words, the delinquent adolescent remains cathected to the despised other(s). Brodie also distinguishes hopelessness from helplessness. Specifically, he states that determining whether a patient is the former or later is important diagnostic data. Hopelessness is the more pathological state due to its denotation of perceived ineptitude and powerlessness, while helplessness implies hope is not yet lost. The author emphasizes how careful assessments allow for the tailoring of psychotherapeutic interventions. The collective information here provides theoretical and practice information on how to address relapse before it happens. This text provides the clinician with a breadth of assessment and treatment options, all aimed at addressing the broad domain area of adolescent delinquency.
Chapter 6 begins with a working definition of intersubjectivity: the interactive processes between therapist and patient. Both patient and therapist convey to one another a continual flow of verbal and (the more powerful) non-verbal information. Subsequently, therapeutic growth is born out of this dialectical interaction between doctor and patient. Though mutually influential, Brodie elucidates how such processes, when carefully minded by the clinician, do not obfuscate, but rather redefine, analytic neutrality. Of particular interest is the author’s discussion of the counterproductive effects of a therapist working too hard to "fix" the adolescent; how this inadvertently undermines respect and ultimately leads to an empathic failure. Adolescence and Delinquency underscores the analytic adage of listening more and "doing" less.
Later chapters cover the different types of object relations treatment modalities for delinquent teens. Brodie begins by discussing the concept of primary maternal preoccupation: Winnicott’s evocative term describing the powerful mother-infant bond. Brodie contends that psychodynamically oriented treatments mimic this most primary relationship. Specifically, he argues how the protracted experience of empathic attunement is a mutative factor in both of these intimate relationships. Though the emphasis on the maternal components of analytically informed treatment is considered to be an overreach by many, the author provides thought-provoking theoretical and clinical material examining this putative phenomenon. This discussion provides, if nothing else, food for thought. Brodie identifies advantages of group treatment for delinquents. He explains how psychodynamic group modalities are able to facilitate peer bonding and proactively address interpersonal conflicts: two processes germane to group therapy, but less accessible via individual therapy. Also notable is Brodie’s list of common mistakes made by group therapists working with delinquent adolescents, such as proscribing profanity as well as in-session expressions of anger. He then reiterates the only therapeutic "musts" of group work with adolescents: maintaining group safety and keeping teens from straying off topic. He then discusses family therapy explaining how difficult it is to utilize this important modality with delinquent adolescents due to the exorbitantly high prevalence rates of broken homes and blended families. When possible, however, family therapy becomes a powerful treatment vehicle. Family treatment provides a window into parent-child connectedness, as well as the parents’ ability to tolerate hostility. It also allows for an opportunity to view familial dynamics, triangulation, and to check the pulse on the nature of parental transgressions, all of which provides pertinent information regarding the healthiness (or lack thereof) of the core family unit. These treatment chapters thoroughly integrate theory with practice techniques. Brodie uses detailed clinical data, often revisiting several patients discussed earlier in the text. The reader will be impressed by the author’s skillfulness in demonstrating compassion without losing necessary therapeutic boundaries and parameters, all of which are especially imperative with this highly destructive population.
Chapter 10 briefly describes salient topics that occur in the treatment with the delinquent adolescent. Concepts like fatalism (e.g., "I’m gonna die soon so who cares"), ruthlessness, and exploitation of women and girls (even amongst delinquent females themselves) are swiftly connected with overarching object relational themes. The author also reconnects themes of adolescent delinquency with the paranoid-schizoid position, and how certain part-object tenets such as a limited personal reflection, lack of prudence, an inability to see self or others as multidimensional (e.g., everyone’s untrustworthy), and a compromised capacity to discern cause-and-effect links (e.g., "shit happens") are cornerstones of delinquency. Brodie reasons that facilitating insight leads to a recession of destructive, acting-out behaviors. Therefore, when the teen is able to view him or herself as a multifaceted individual—capable of both good and bad, love and hate—one can infer that the painstaking treatment process is working. He again revisits the potential of hope within the delinquent teen. Here, Brodie relies on Winnicott’s assertion that certain elements of antisocial behaviors often imply a modicum of hope. Though counterintuitive, their pathological behaviors may represent a desperate attempt to regain that which is lost. This "taking" (e.g., stealing, robbing, violence) often represents a striving to reclaim (or obtain for the first time) the lost object. The author also discusses the delinquent teen’s lack of experiencing affective and behavioral containment from parents. Due to the paucity of containment during their formative years, Brodie emphasizes how therapeutic boundaries and parameters provide the delinquent child with the much needed experience of safety. Perhaps most significant here is the author’s ability to demonstrate a very real therapeutic window into this highly destructive population. Peripheral in this section (though central throughout the text) is Brodie’s provision of hope to the clinician working with these patients: a belief that maybe, just maybe, real change can occur.
Adolescence and Delinquency closes with a discussion on psychoanalytically informed supervision. The author reports on a common supervisory process: the parallels between the supervisee’s professional development and the adolescent’s identity development. Feelings of fraudulence, desire for competency and mastery, and the vacillation between identification and individuation are common to both supervisee and adolescent. Brodie also discusses the delicate balance between teaching the supervisee and delving into his or her countertransference. The author elucidates the ways in which psychoanalytically based supervision transcends the mere teaching of skills and techniques and impact an individual holistically. In other words, analytically informed supervision, when done well, facilitate the supervisee’s development as both clinician and person.
Adolescence and Delinquency provides a wealth of theoretical and practical information for therapists working with difficult and highly disturbed adolescents. Brodie immerses the reader in the often scary and, for many, unknown world of adolescence criminality and delinquency. Though daunting, the author illuminates the dark world of serious teenage pathology. He also spells out comprehensive, detailed, insight-oriented treatment methods.
Adolescence and Delinquency is a worthy read for any clinician working in the trenches of delinquency. Well-written, it provides a brief yet thorough overview of object relations theory. From aspects of Freud, to primarily British and American object relational theorists, Brodie highlights theory vis-à-vis delinquent adolescents. While some texts fall heavier on either the theoretical or practice side, Adolescence and Delinquency covers both, and does so thoroughly and efficiently. The author links theory with clinical vignettes throughout. He does so with patients within the delinquency center, as well as non-delinquent adults seen in an outpatient setting. Brodie’s approach exemplifies how one can work with the most aggressive individual, hold him or her accountable, and do so without compromising compassion. To read this book is to truly step into the consulting room with a highly skilled therapist, one who expresses an appreciation for, and comfort with, this highly disturbed (yet often treatable) population.
Today most therapists reflexively dismiss psychodynamic therapy as a viable treatment for delinquent adolescents. This sentiment might even extend to some identifying themselves as psychoanalytic. This is so despite the fact that psychoanalysis is, by definition, a developmental theory. This is what makes Adolescence and Delinquency important: it lends theoretical support to psychodynamic interventions with delinquents. Brodie emphasizes the necessity for appreciating the humanness of delinquent teens. He compellingly argues that, as with all persons, disturbed adolescents are in dire need of sophisticated treatment—that simply teaching the cannon of skill-building techniques (e.g., empathy training, anger management, assertiveness training), or merely applying punishments are thoroughly insufficient. One could argue that the conspicuous absence of insight-oriented components within mainstream delinquency treatments could, in part, account for the extraordinarily high recidivism rates. At the very least no one can deny that more is needed to bolster treatment effectiveness with this population. Therefore, an assessment and treatment approach that starts with a well-formulated conceptualization, followed by an idiographic (and humanistic) intervention designed to treat the whole person is, if nothing else, a good start. Adolescence and Delinquenc is a helpful aid for those clinicians tagged with the intimidating yet often rewarding task of treating delinquent boys and girls.