A male teenager, 18 years old presented for counselling having suffered significant trauma at age 13 with bad wounding to the neck and arms through an accident leaving significant scarring. He had suffered some bullying along the way in relation to this from peers at school.
As we know in the teenage years, physical presentation is especially important. Teenagers spend time and effort on their appearance and it is particularly important during this stage of life. The timing of the wounding could not have been worse for this teenager.
The treatment plan in such circumstances is usually clear.
1. Trauma debriefing through the “Facts and feelings” approach.
2. Identifying the idealised body and the wounded body through drawing work. Looking for any body dysmorphia.
3. Showing the wounding to the therapist either directly or with photographs.
4. Goodbye work with the pre injury body.
5. Mirror work to observe the body for integration.
However as I say in my book – The teenage mind – male teenagers can be especially hard to work with.
“Unlike the female the male adolescent sets about developing another set of skills. Male adolescents are generally learning how to be tough. They engage in activities that develop their ability to be tough, unemotional, aggressive and so forth rather than focussing more on relationship and emotional skills”.(p 5)
The male teenager often thinks he can just tough it out. If he does not think about it, it will just go away, is a common viewpoint for the male teenager. As we know when there is significant feelings this does not work in the long run. The problem with the teenager is there has yet to be any ‘long run’. Because of their age they have not had the experience of carrying around problem emotions for some time. They don’t know that this simply creates other emotional problems because the problem emotions don’t just go away, instead they hang around and cause other psychological symptoms to develop. Such as depression, eating disorders, anxiety, self harming and so on.
What does the therapist do? He can tell the teenager all this and he will understand but they are just words, the teenager does not have the first hand experience of not resolving strong problem emotions. In addition the male teenager may be quite reluctant to address his emotions because one of the developmental goals at that stage is to learn how to be tough and unemotional.
A difficult therapeutic scenario to deal with. Sometimes you just have to wait until they get to their mid to late 20s when they begin to realise the unresolved problem emotions do not just go away and now they have other difficulties as well. The concept of counselling and psychotherapy is not amenable to the mind of the male teenager so one needs to be quite skilful if the teenager will remain engaged to the therapy process. Sometimes one can address non emotional side issues for the teenager that are not directly related to the presenting problem. For example instead of addressing the trauma of the body injury directly one talks with the teenager about his work, peers, drugs and alcohol and so forth. If one can engage with the male teenager enough through doing this one can then eventually get to the original issue and work through that emotionally at least to some degree.