Nr 16.  2007 sid. 40–57

  Separateness and Sharing
in the Hierarchy of Clinical Values
– Work With Parents of Adolescent Patients

Jack Novick och Kerry Kelly Novick

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Jack Novick och Kerry Kelly Novick är båda verksamma vid Michigan Psychoanalytic Institute som barn- och ungdomspsykoanalytiker samt i privatpraktik. Jack Novick är Clinical Associate Professor of Psychiatry vid University of Michigan och Wayne State Medical Schools. Kerry Kelly Novick är Child Development Director vid Allen Creek Preschool. De har vid flera tillfällen varit i Stockholm och tillsammans givit uppskattade föreläsningar och workshops. I artikeln visar de på att målet både i normalutvecklingen och i terapier med tonåringar är en transformering av föräldra-barnrelationen och integration av nya självrepresentationer. För föräldrar är målet att förändra relationen till sin tonåring, så att förhållandet kan innefatta förändringar både för den unge och för paret.

Jake was a high-school senior preparing to leave for a prestigious university, his father’s alma mater. He was in turmoil, determined to leave, but clearly unready to do so. His parents took it for granted that Jake would follow in the family tradition and wanted treatment to help him “pull himself together and get on with his life”. As the work proceeded it became apparent to Jake and me that removal of the obstacles to his further development would require much more than self-control and immediate effort. When Jake and I met together with his parents to discuss this, the par-ents expressed concern and support, but, at home, they told Jake they were profoundly disappointed in him and expected him to try harder.

The parents’ need to maintain their initial treatment goal of getting Jake to college was a theme in the parent work and in Jake’s treatment through the first year. He changed sooner than his parents did and the conflicts with them became more intense. Jake was increasingly hurt and angry, but shifted his rage to his girlfriend, whom he had encouraged to go out with another boy, and to me, whom he characterized as “a stereotypical Jew only interested in money and taking advantage of helpless people like the Palestinians”. He raged for weeks, broke up with his girlfriend and began hinting at thoughts of killing himself. I noted this and asked Jake if he was planning to kill himself, perhaps to punish his girlfriend and me. Jake said he had been having the thought of using one of his father’s guns to blow his brains out against the windows at the entrance to my office, “so everyone will see how terrible and useless you are”!

Jake had an active suicide plan and I was especially con-cerned when he mentioned using his father’s gun. I told Jake that I thought he was in danger of killing himself and asked what could be done to help him stay alive. Did his parents know that he was suicidal? “Hell no”, Jake shouted, “and if you tell them I’ll have you sued for breaking confidentiality. You promised me that everything I say is confidential. So now you’re a liar too!”

The process of developing our ideas most often starts with our experience of clinical problems. Wherever the difficulty arises, whether in the treatment of a child or an adult, examining the issue always leads to thinking about patients of all ages in a new way. In this paper we propose to describe how we have wrestled with the problem of meeting the sometimes apparently oppos-ing needs of adolescent patients and their parents for autonomy and privacy. This, in turn, led us to thoughts about a hierarchy of clinical values that applies to patients of all ages.

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2011-10-29

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