The search for identity: working therapeutically with adolescents in crisis

ABSTRACT

In the news, there is frequent mention of adolescents’ mental health nowadays being ‘in crisis’. This paper offers the perspective of two psychotherapists working in a crisis service, trying to engage adolescents and their families in therapeutic work. There is an argument for a combined developmental, psychoanalytic and systemic approach to understand and work with the perceived mental health crisis in adolescence. This paper explores the desire of some adolescents today to have a mental health diagnosis and use specific, psychiatric-oriented language to frame and understand their distress. A cultural and theoretical exploration of this phenomenon is offered, viewing it as an expression of adolescents’ need for establishing their identity within peer groups, online and offline. The paper underlines the necessity for an approach where the whole network around the adolescent – the school, the parents, the therapist – work together to address the occurring crisis. The crisis this paper refers to is conceptualised as one involving developmental adolescent turmoil, expressed through mental health language.

KEYWORDS:

• Adolescence
• mental health crisis
• crisis work
• high risk
• peer groups
• adolescent psychotherapy

Acknowledgment

We would like to thank Alex de Rementeria, Catherine Campbell, Ruth Schmidt Neven, Angela Marsh, Cate Young, Dr Raj Sekaran, and Dr Mark Nathan for their support – implicit or explicit – in writing this paper. We would also like to thank the conference organising group for the 2022 ACP conference, ‘The Search for Identity’, for the opportunity to present an earlier version of this paper. And finally, we would like to thank the adolescents we have worked with over the years whose passion and curiosity have pushed us to find new ways of thinking and working.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Diagnostic and Statistical Manual of Mental Disorders.

2. The therapist will be referred to in the first person throughout.

Additional information

Notes on contributors

Rachel Acheson

Rachel Acheson is a child and adolescent psychotherapist trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA). She works clinically with adolescents in London within a school setting and has previously worked in the NHS in adolescent and generic CAMHS teams, as well as adolescent inpatient services. Her doctoral research focussed on silence in adolescent psychotherapy, and was completed using data from the IMPACT study, an RCT examining treatment for adolescent depression. She has taught on pre-clinical MSc courses the Anna Freud Centre and Birkbeck and is an editor at the Journal of Child Psychotherapy.

Maria Papadima

Maria Papadima trained as a child and adolescent psychotherapist at the British Psychotherapy Foundation (IPCAPA), after completing a PhD on trauma and psychoanalysis. She currently works at an NHS adolescent team in London. She has a longstanding interest in therapeutic work with adolescents and their families. In addition to her clinical work, she teaches at the IPCAPA training in Child and Adolescent Psychotherapy and is one of the editors at the Journal of Child Psychotherapy.