Getting Past Resistance with the Out-of-Control Adolescent

A growing number of adolescents arrive in the therapist's office beyond adult control. Their behavior is outrageous, they use drugs heavily, and their moods fluctuate wildly. Nothing seems to work. If they stay in treatment, they make a shambles of the process. If they terminate prematurely, therapists may feel they never really got hold of the case; worse, they are not sure how they could have done so. Therapists looking at their interactions with patients will usually notice distinct patterns. The out-of-control patient usually shows a preference for one of five pathological patterns: narcissism, masochism, the paranoid stance, the schizoid defense, and affective lability. This book studies the five patterns of interaction typical of out-of-control adolescents, showing therapists how to recognize each and introducing interventions to interrupt them. When patients are forced into new, less comfortable experiences of themselves and their therapists, more honest exchanges become possible and more conventional treatment approaches become feasible.

About the Author :
Vance R. Sherwood, Ph.D., was Clinical Director at the original Peninsula Village Residential Treatment Center near Knoxville, Tennessee, and he now consults to other adolescent treatment programs.

Review :
This book, a blend of theory and practice, offers fresh insights into the specific patterns of resistance we are likely to encounter in our clinical work. Rich in case examples that illustrate the process of challenging the defensive structure, it is well suited to analytically oriented therapists seeking to refine their skills in working with hard-to-manage adolescents. -- Neil Bernstein, Ph.D. Vance R. Sherwood has done it again! This time in the form of a riveting, profoundly original contribution to the psychodynamic literature on working with difficult adolescents. Dr. Sherwood makes a strong case for the idea that the therapist should become a problem for the hard-to-reach patient-the solution to which requires that the patient after his characteristic (pathological) modes of interacting. In fact, he argues convincingly that successful treatments involve manipulation not only by patients but also by therapists, who are encouraged to relinquish their investments in communicative interventions in favor of more experiential interventions-those that force patients to let go of their defensive postures. Sherwood offers clinical vignettes to demonstrate the power of his approach in this beautifully crafted, hard-to-put-down volume for therapists who want to expand their repertoires of effective responses to difficult patients-and who have the courage to be bold. -- Martha Stark, M.D.