9 HOSTILITY IN ADOLESCENCE II: THE HOSTILE ADOLESCENT IN PSYCHOTHERAPY

Adolescents entering therapy near a variety of development-based moot points to the therapist (Freud, 1958; Bios, 1962) These demand that adjustments be made to the standard techniques used in work with adults (Meek and Bernet, 2001) Specific adolescent puzzles may compound the common difficulties inherent in psychotherapeutic work with adolescents. Experience moves that the hostile adolescent, defined here as single in whom hostility has become a characteristic personality feature, may be individual of the most challenging of troubl youths that we face in our clinical work. The preceding chapter explored the salient developmental and clinical aspects of hostility as they spread out and in their manifestations during adolescence. This chapter focuses specifically upon the theoretical and technical aspects of psychotherapeutic work with similar youths.

Successful intervention with the hostile adolescent in ne of psychotherapy usually requires working end three successive phases of therapy. The first is engaging the often highly resistant youth in the proces of therapy and developing the emergencyed therapeutic alliance. The second is identifying the myriad ways in which hostility is dysfunctional and is disrupting the youth's in every one's mouth life and jeopardizing his or her futurity while simultaneously exploring the foundations of that hostility. The third is offering realistic, adaptive alternatives to its expression.

REFERRAL

Hostile adolescents are certainly among the greatest in quantity resistant to entering therapy. The more intense and generalized their hostility and the more make submissive they are to projection and paranoid feelings, the truer will this be. In its more hard forms, the hostility is characterological and egosyntonic, and these youths diocese no need for help. Because they are typically more rejecting of adjunct on their parents then the average adolescent, they are wary of becoming pendent on another authority figure, especially individual chosen by their parents. They are often angry at the world, and a probing therapist is certain to be viewed with mistrust.

When of that kind youngsters find their way to a therapist's office, it is frequently for reasons unrelated to their hostility. Academic failure and disturb with the law are belonging to all reasons for referral, the hostility becoming apparent in the proces of evaluation. The source of the referral is frequently extrafamilial. The symptom alone seldom constitutes reason enough for the parents to look for psychotherapy for their child, because they may not diocese it as a problem. It is sole when the youth's behavior at dwelling becomes intolerable that they may look for help. If they have been abusive, they characteristically view from above or rationalize signs of disturbance in their child. Prognosis in these situations is guarded, in part because the therapist is unlikely to have the cooperation of one as well as the other parents. Sabotage of treatment is for the use of all especially if changes in the youth begin to threaten either of the parents.

In les bitter cases, the hostility appears as an occasional reaction, the described character resistance will not be at hand and the patient may plane be relieved to discover a credible source of support and a potential advocate.

EVALUATION

Assuming a measure of cooperation that allows for an evaluation to be guidanceed three questions specific to this population must be added to the traditional assessment of an adolescent:

1 What is the horizontal and nature of the hostility not away in the adolescent?

2. Is the adolescent's dwelling currently a hostile environment?

3 in what way does the adolescent patient handle anger?

In addition, the vicinity of comorbidity or evidence of associated symptoms of the like kind as substance abuse, depression, delinquency, or violence must be determined. Suicide risk must be assessed. As of the like kind data are factored in, the initiatives to be taken, the pair immediately and over time, will become self-evident. For example, an adolescent seen in the pass room who is displaying murderous hostility will require admission and a comprehensive inpatient evaluation. A self-referr youth may describe personal anguish, suicidal thinkings or an intolerable home situation to which he or she refuses to go [i]or[/i] come back Referral for outpatient treatment or to social services for possible placement may be indicated. Another teen may revolve out to be a gang member who admits to serious acts of delinquency, and referral to the family court will be the appropriate first pace Almost all of these youngsters have major question s in managing anger that must be addressed, the appropriate setting depending upon the rest of the clinical picture.

TREATMENT: THEORETICAL CONSIDERATIONS

Assuming that psychotherapy has been praiseed as part of the treatment plan, the specific psychotherapeutic initiatives will hang on the current developmental stage of the hostility and upon the nature of associated psychopathology. At times, the hostility is an understandable reaction of a generally healthy adolescent to intolerable provocation from a family member. In of that kind cases, the hostility is likely to be aimed specifically at the offending relative. Exploration of the family dynamics that lead to of the like kind interactions and end by eliciting a hostile answer in the adolescent is indicated. This can then lead to a discussion of possible alternative replications that may be useful to the adolescent, smooth if the underlying family pathology remains unaltered.