In him to do: how does a child and adolescent psychoanalytic psychotherapist effectively understand and negotiate risk of further harm occurring when working with an adolescent who has sexually abused?

2017-01-31T00:12:04Z (GMT) by Dwyer, Olivia
The internal world of an adolescent who has engaged m sexually abusive behaviors is complex and requires more than a one size fits all approach for effective understanding and assistance. In recent times research and therapeutic treatment models have shifted from an adult focus to models that better conceptualise the developmental stages of children and adolescents. This has also included a move away from punitive approaches to ones that keep in mind the likely trauma, broken or difficult attachments and/or exposure to pornography these adolescents have likely had. This shift has encouraged greater focus on attachment theory and familial relationships in the development of relational templates. This thesis utilises psychoanalytic psychotherapeutic principles to examine case material and relevant literature to better conceptualise how an adolescent boy came to sexually abuse his sister. This examination informs the negotiation of the risks of an adolescent further harming, including self harming, sexually abusing a sibling or other children, stalking the therapist or harming his family and the community. The case material used is of an adolescent boy named Sam who was eleven years old when he sexually abused his eight year old sister. The case material used is presented in themes of; the adolescent's high risk behaviours, broad family history, overview of the adolescent's presentation, the therapist's countertransference responses and themes of her interpretations. Psychoanalytic principles discussed are of sexual development, the Oedipal Complex, intersubjectivity, pathological hatred, parental unconscious transmissions, projections, interpretations, transference and countertransference. The discussion of these principles provides insight into the complexities of trauma, sexually abusive behaviours and how these can be understood and negotiated in high risk children and adolescents in psychotherapy. Psychoanalytic psychotherapy can be an effective treatment for adolescents who have sexually abused. This thesis will discuss how an adolescent boy was able to engage in psychotherapy and, through this process, integrate and awaken previously split off and unawakened parts of the self. Through integration the adolescent was able to develop a capacity to form a cohesive self image, recognise self as distinct from other and reach the depressive position. Sam had experienced trauma and broken attachments that he reenacted, communicated and attempted to process in his psychotherapy sessions. Sam did this through high risk behaviours, creating a dynamic where the containing function of the therapist was paramount. This psychotherapy work needs to be safe enough for the client and the therapist, so discussion and recommendations of safety considerations are made.