Silence in Adolescent Psychotherapy

Therapists are often frustrated when they work with adolescents who do not talk about their experience. This article presents a way of working with these teens. The underlying theory assumes that most teenagers (including those who are often silent in therapy) are capable of being mutually engaged with someone else. This capability is seen as a self-state that can be dissociated by anxiety and replaced with another self-state that is withdrawn and unengaged. Three clinical vignettes describe silent teenagers with whom the therapist eventually can activate self-states that allow for engagement; in these cases, through mutual help, fair play, projective identification, controlling or sadomasochistic connections. Other self-states are withdrawn and silent. For a long initial period, the family and developmental histories that create these self-states are usually more unknown than known, and the shifts in self-states are dealt with in the therapist-patient interaction more than in psychodynamic interpretation...