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Inside The Consulting Room. Episode 9. The Exploding Adolescent · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: This is Kim Lee, Child and Adolescent Psychotherapist, and this is episode nine of Inside the Consulting Room.
• 0:08
  SPEAKER_00: In the final episode, I want to try and bring everything together in a way which hopefully links certain themes together so as to culminate in how it is possible to bring about change in children and young people who are struggling.
• 0:31
  SPEAKER_00: This episode is about a young person who really was struggling and created a good deal of struggling for others.
• 0:41
  SPEAKER_00: When I began my career, I started in my first professional post working with adolescents, and it was something of a baptism by fire.
• 0:54
  SPEAKER_00: They were unpredictable, hostile, aggressive, sometimes violent, outrageous, and all the things that we know about adolescents.
• 1:07
  SPEAKER_00: But these young adolescents were from environments that had been incredibly damaging and depriving and neglectful and abusive.
• 1:19
  SPEAKER_00: So it required a good deal of learning on my part, where not just managing the behaviors, but actually trying to create meaningful relationships with these young people was concerned.
• 1:36
  SPEAKER_00: It stood me in really good stead because that was a very long time ago, and I've worked with goodness knows how many adolescents since, and I really enjoy working with them.
• 1:47
  SPEAKER_00: And one of the reasons why is because I frequently learn, I'm frequently reminded of the fact that no man, no matter how outrageous their behavior and comments may be, and sometimes directed towards me, what I see is here is a young person who is caught in a volatile cocktail of neurobiological change, massive brain activity, hormonal change, interpersonal, social difficulties, pressures, and goodness knows what.
• 2:28
  SPEAKER_00: And the thing they most require is constance, someone who is constant, someone who is unchanging, someone who is unflinching, not in an uncaring way, but in a considered way.
• 2:42
  SPEAKER_00: And in every case, what I notice is that over time the behaviors will begin to regulate, they'll begin to calm.
• 2:53
  SPEAKER_00: Why?
• 2:54
  SPEAKER_00: Because they internalize the calmness of the therapist, which of course reflects on what it is that they need outside of the room, which is where my work with parents becomes so important.
• 3:11
  SPEAKER_00: And a lot of that work is about reassuring parents that no, what's happening isn't confirmation that you're poor parents and you're getting it wrong.
• 3:22
  SPEAKER_00: It's actually a process that's taking place which can be managed once we let go of the abiding desire to correct.
• 3:35
  SPEAKER_00: There's nothing wrong with that because it's underpinned by good wishes.
• 3:39
  SPEAKER_00: However, it doesn't sit easily with young people who experience it as invasive, intrusive, and controlling.
• 3:50
  SPEAKER_00: So this episode is dedicated to a young man who I will call the exploding adolescent.
• 4:01
  SPEAKER_00: When he arrived, he just opened the door quickly.
• 4:07
  SPEAKER_00: Didn't ring the bell, just came straight in.
• 4:10
  SPEAKER_00: And he walked in ahead of his parents, who I could hear saying to him through gritted teeth, ring the bell.
• 4:22
  SPEAKER_00: I thought this is gonna be interesting.
• 4:25
  SPEAKER_00: He came straight in and dropped into a chair, folded his arms and legs, and just started turning away.
• 4:35
  SPEAKER_00: He was very restless and very impatient and agitated.
• 4:40
  SPEAKER_00: And he looked at me briefly and then just looked away, and then looked at me full in the face and said, Can we just get this over with?
• 4:48
  SPEAKER_00: Ah, I thought, we're off to a good start.
• 4:53
  SPEAKER_00: Now, as I've said, adolescence is a time of profound psychological change because the child is no longer a child, but part of them is.
• 5:04
  SPEAKER_00: But clearly they're not yet an adult.
• 5:07
  SPEAKER_00: Their emotions are intensified, their sense of identity begins to shift, and their internal world can feel quite unstable.
• 5:17
  SPEAKER_00: Now, for some adolescent, this instability just becomes visible through mood and behavior, sudden and unpredictable emotional reactions, and this episode is really about an adolescent whose inner world seemed just to erupt without warning.
• 5:35
  SPEAKER_00: Ethan was fifteen years old, and his parents had been describing increased volatility, which was reaching quite powerful proportions.
• 5:47
  SPEAKER_00: There were constant arguments and conflicts at home.
• 5:52
  SPEAKER_00: He had physically attacked his father.
• 5:56
  SPEAKER_00: There was a refusal to engage in anything that had to do with school.
• 6:02
  SPEAKER_00: There was significant periods of withdrawal followed by explosive outbursts.
• 6:08
  SPEAKER_00: And at school, teachers reported similar patterns, and it was like he could appear calm one moment and then suddenly become angry, swearing, walking out of class, just arguing, and at times just being completely disengaged.
• 6:26
  SPEAKER_00: And he went through the kind of usual consequences of this, but actually all of the consequences were about the behavior, and typically they lacked insight into what was driving it.
• 6:41
  SPEAKER_00: Now, this is not a criticism of school staff because they have a lot of young people and a lot of children to deal with.
• 6:49
  SPEAKER_00: Nonetheless, it does, in my mind, always raise the question how those people who teach children are able to understand the invisible processes which affect behavior and learning.
• 7:09
  SPEAKER_00: In a way, trying to put a clinical formulation together was a bit tricky at first because it occurred to me that perhaps there might be something else going on that of course I was unaware of.
• 7:24
  SPEAKER_00: But on the face of it, it looked to me as if what was happening was a developmental, developmental difficulty, and characterized by what we call affect dysregulation, which in simple language means an inability to regulate feelings, which then found explosive expression.
• 7:49
  SPEAKER_00: Now during adolescence, the brain undergoes significant change, and the limbic system, which is responsible for emotional intensity, becomes highly active while the thinking part of the brain, known as the prefrontal cortex, is still developing.
• 8:10
  SPEAKER_00: So the capacity for the thinking brain to intervene can be compromised just by that.
• 8:17
  SPEAKER_00: So this creates a period where emotions are strong, regulation is less reliable, and reactions are immediate and overwhelming.
• 8:28
  SPEAKER_00: But neurobiology alone doesn't necessarily explain meaning.
• 8:35
  SPEAKER_00: Ethan's behavior also suggested some degree of internal conflict around autonomy and belonging.
• 8:45
  SPEAKER_00: He'd always been described as a sensitive child, thoughtful, quiet, but as he entered adolescence, something began to shift because expectations increased academically, socially, within the family.
• 9:04
  SPEAKER_00: And his parents, understandably, began encouraging independence and responsibility, but for Ethan, this transition felt confusing.
• 9:14
  SPEAKER_00: Part of him wanted autonomy, another part still needed containment.
• 9:20
  SPEAKER_00: And when those two positions collide, the result is very often explosion.
• 9:28
  SPEAKER_00: Inside the consulting room, Ethan was very guarded, and his responses were both brief and at times dismissive.
• 9:38
  SPEAKER_00: So if I asked him any kind of questions, he just might respond with I don't know, which is, you know, my fault for asking questions, or it's just annoying.
• 9:49
  SPEAKER_00: And everything was annoying.
• 9:52
  SPEAKER_00: Everything was pointless.
• 9:54
  SPEAKER_00: So I decided that really this approach was pointless.
• 10:02
  SPEAKER_00: And so we talked about other things, things that weren't contentious, things that were interests.
• 10:11
  SPEAKER_00: He was able in a couple of sessions to talk about things that were aspirations.
• 10:16
  SPEAKER_00: And on one or two occasions, he was curious about me.
• 10:21
  SPEAKER_00: And he said, something like, Have you any ever met anyone like you, like me before?
• 10:30
  SPEAKER_00: And I said, Like you in what way?
• 10:32
  SPEAKER_00: He's someone that gets angry all the time.
• 10:34
  SPEAKER_00: And I said, I've worked with lots of people, yeah, and some of them do get angry.
• 10:40
  SPEAKER_00: And he said, How do you do it?
• 10:42
  SPEAKER_00: And I said, Well, I guess being angry is a is a way of saying something that you can't put into words.
• 10:49
  SPEAKER_00: And I suppose being here means that together we can maybe find the words, because probably the words aren't going to have the same kinds of consequences as the angry the angry Ethan tends to experience.
• 11:06
  SPEAKER_00: And he looked at me as if I'd just spoken to him in Swahili.
• 11:12
  SPEAKER_00: So there was me trying to offer him a thoughtful, sensitive therapeutic interpretation, and it was pointless.
• 11:24
  SPEAKER_00: But actually it wasn't.
• 11:26
  SPEAKER_00: And the reason it wasn't is because in that moment he experienced something of me.
• 11:34
  SPEAKER_00: It wasn't the words, it was something else.
• 11:37
  SPEAKER_00: And those words conveyed, I can't be phased, I'm not alarmed, I'm not here to control, I'm here to understand.
• 11:51
  SPEAKER_00: In another session, he said, Everyone just expects stuff from me all the time.
• 11:57
  SPEAKER_00: And I said, stuff like he said, homework, like doing what my parents tell me to do.
• 12:04
  SPEAKER_00: I could do what, I can do anything, I can do what I want.
• 12:08
  SPEAKER_00: And I said, Yeah, it's difficult, isn't it?
• 12:10
  SPEAKER_00: Because it sounds like the people around you don't agree.
• 12:14
  SPEAKER_00: And he said, I just I just can't be bothered with it.
• 12:17
  SPEAKER_00: And there are a few colourful words that I'm not sure that I'm allowed to say, but you could fill in the gaps.
• 12:24
  SPEAKER_00: I said, you know, it sounds like it just feels too much, and then you hold it all in, and then it all comes out at once, and then when it does, you can't control it because you don't know how to.
• 12:37
  SPEAKER_00: And he looked at me, and there was just what seemed like a moment of recognition, and then he stopped.
• 12:46
  SPEAKER_00: He didn't say anything, but it's like he was trying to digest what I'd said.
• 12:54
  SPEAKER_00: In the following session, he said it almost word for word, it's sometimes like I keep it all in and then it comes out.
• 13:06
  SPEAKER_00: Now that that doesn't that happens quite a lot in therapy, it doesn't happen normally quite as quickly as this or as that did, but what it indicated was that he'd taken something in, made his own sort of sense of it, and now it was his.
• 13:27
  SPEAKER_00: That is not a time when therapists say, Well, I told you that last week, because that's not the point.
• 13:34
  SPEAKER_00: The point is what we want is for our patient to take in something that's new and make it their own.
• 13:44
  SPEAKER_00: So that was a a really important shift.
• 13:51
  SPEAKER_00: Some sessions later, though, he described an incident at school where a teacher had asked him to redo a piece of work, Ethan said no, or words to that effect.
• 14:03
  SPEAKER_00: There was an argument, Ethan walked out throwing something as a parting gesture, and all hell had broken loose.
• 14:15
  SPEAKER_00: And I said to him, Can you can we just go back a bit to before it happened?
• 14:22
  SPEAKER_00: Tell me what was happening before that, and he said, I don't know.
• 14:27
  SPEAKER_00: And I said, Well, let's just go back, and I so I walked him back sort of step by step to the point at which he became angry, and I said, What were you doing?
• 14:41
  SPEAKER_00: And he said, I was trying to do a piece of work, and I said, Okay, and how was it going?
• 14:46
  SPEAKER_00: And he said, I just couldn't do it properly.
• 14:49
  SPEAKER_00: And I said, You mean you didn't understand?
• 14:53
  SPEAKER_00: And he said, Yeah, and I I everyone else could.
• 14:58
  SPEAKER_00: And I said, So my guess would be that you couldn't ask for help because that would make you feel what?
• 15:07
  SPEAKER_00: And he said, Stupid.
• 15:10
  SPEAKER_00: I just don't want to look stupid.
• 15:13
  SPEAKER_00: And I said, No, I can see that.
• 15:17
  SPEAKER_00: And I said, Do you think you do you think you feel and look stupid here?
• 15:21
  SPEAKER_00: And he said, No, I did at first.
• 15:23
  SPEAKER_00: And I said, Yeah, um and then you were quite hedgehold-like, you were quite spiky, weren't you?
• 15:29
  SPEAKER_00: But you've changed.
• 15:31
  SPEAKER_00: Now, like Marcus in earlier childhood, Ethan's anger was masking something much, much more vulnerable.
• 15:41
  SPEAKER_00: But now, in that vulnerability, it had become tied to identity, self-worth, competence, belonging.
• 15:52
  SPEAKER_00: And anger allowed him to avoid feeling exposed and it in his own way to regain control.
• 16:01
  SPEAKER_00: And he was therefore rejecting others before being rejected, because that's what he anticipated, because he was stupid, he'd get it wrong, he annoyed people, he and so on.
• 16:15
  SPEAKER_00: But the other thing that was imperative here was the parallel work with his parents, and we focused on understanding the nature of adolescent development and helping them recognize that volatility is often a part of neurological development, and the emotional containment remains essential even as independence increases, and that responding to behaviors requires understanding the feelings beneath it as opposed to reacting to what you see and what you feel as a parent, and it's hard.
• 16:55
  SPEAKER_00: They were helped to reduce reactive escalation at home and to maintain boundaries calmly, remain emotionally available without becoming intrusive.
• 17:12
  SPEAKER_00: In a sense, I took them to a different position of taking a step back but not stepping away.
• 17:20
  SPEAKER_00: And what they began to find over time was that he began to approach them more openly, not consistently, but occasionally.
• 17:32
  SPEAKER_00: And in one session he said, I sometimes I just don't feel like I or I feel like I just don't know who I'm supposed to be.
• 17:42
  SPEAKER_00: And I said, Well, I'm not surprised, you know, because when you're going through this stage in your development, just like lots of people, that's what it's like, and it can feel really confusing and difficult not knowing.
• 17:57
  SPEAKER_00: And he just leaned back and he was less tense.
• 18:01
  SPEAKER_00: It was almost like what he had heard me say was what you're experiencing is typical, and it's okay.
• 18:13
  SPEAKER_00: Exploding adolescents are often not trying to create chaos, they're trying to manage the internal instability because their minds are in transition, and they are a becoming a self that's not yet fully formed.
• 18:33
  SPEAKER_00: And when that process is understood by others, the explosions begin to make sense.
• 18:42
  SPEAKER_00: Inside the consulting room, the adolescent who seems out of control is often standing at the edge of something much deeper.
• 18:51
  SPEAKER_00: They're trying to work out who they are and whether it's safe to become that person.
• 18:57
  SPEAKER_00: Inside the consulting room, the task is to try and enable that.
• 19:03
  SPEAKER_00: Just a closing thought.
• 19:09
  SPEAKER_00: And it's called The Adolescent Psyche.
• 19:12
  SPEAKER_00: I think I've referred to it in another series, but I think it is probably one of the most informing pieces of work that's been offered in my profession.
• 19:23
  SPEAKER_00: And if it's something you do look into, I would advise you not to pay close and intrinsic attention to the first four sections of the book, not because they are in any way uninteresting or irrelevant, but I think it's written more for clear uh for clinicians and theoreticians.
• 19:46
  SPEAKER_00: It's good stuff if you're somebody who understands the language and wants to look at the comparisons he makes.
• 19:56
  SPEAKER_00: But actually the real beauty of this book follows that because what it does is to normalize adolescence rather than pathologise it.
• 20:07
  SPEAKER_00: I'll be back with episode ten, the final in the series shortly.
• 20:13
  SPEAKER_00: And this will uh precede the next series which has to do with uh the psychology of criminality in adolescence.
• 20:23
  SPEAKER_00: Thank you for listening.