Historically, adolescence has been referred to as a time of “sturm and drang,” translating into “storm and stress”. Accurately capturing the magnitude of transition that the adolescent experiences during this period, those words have been used to describe this developmental stage. The transition, which does not only exist in the physical aspect but also the psychological one, is a complex one. Ideally, the child will experience simultaneous physical and psychological growth, however this is not always the case. There are several factors that could impede the adolescent’s development. Those factors include, but are not limited to biological processes, cultural practices and environmental stressors.

Research indicates that trauma, abuse, neglect, and exposure to violence could have significant impact on development, affecting the individual’s ability to form secure attachments, regulate emotions, and process information. As a result, the individual might experience overwhelming feelings of anxiety and anger which in some cases, can manifest as dissociation and/or self-harm. When the trauma is relational (originates within the family system), the child may develop distorted worldviews based on extreme fear and terror. This forces the child to be in “survival mode” for most of his/her developing years. In such situations, the ego functions are compromised, and the child will often fail to navigate the instinctual conflicts and drives. This can later also result in extreme compliance or defiance in behavior during adolescence. Further, children and adolescents growing up with experiences of relational trauma and domestic violence may develop a warped perception of the world as their sense of basic trust is affected by the trauma. Often, the effects of trauma register on an unconscious level of awareness, which makes it difficult for its victims to recognize that their developed beliefs blur the lines between actual threat and imagined threat.

In treatment, it is challenging to differentiate the effects of disorganized attachment from those of relational trauma; more often than not, those effects are intertwined. Therefore, as a clinical consideration, it is crucial to incorporate the context in which the adolescent’s transformation is occurring. In therapy, the adolescent treatment must be seen through multiple lenses as the external stressors in the child’s environment often translates into internal belief systems. Ultimately, there is a necessity for the continuity of the ego in order to avoid ego fragmentation, which often is a by-product of trauma.

In art therapy, we often notice a reveal of inner state of defenses, fears and need for protection. Feelings about stability, safety and loss can also emerge through verbal and non-verbal communication. Those themes are often typical ones associated with the relational trauma of family dysfunction and abuse. Art therapy can be used as a safe space in which the adolescent can exercise needs for retrieval of control, exploration of identity aspects and developmentally appropriate individuation. As clinicians it is therefore essential to hold a safe space and prioritize the establishment therapeutic alliance when working with adolescents. It is important to consistently formulate and re-work treatment goals and perceived trajectories in treatment in order to incorporate the adolescent’s unique developmental and transformative journey.

References:

Levy-Warren, M. (1996). The Adolescent Journey. Jason Aronson, Incorporated.

Riley, S. (1999). Contemporary Art Therapy With Adolescents. London: Jessica Kingsley.

Van der Kolk, B.A. (2005). Developmental Trauma Disorder: Towards a Rational Diagnosis for Children with Complex Trauma Histories. Psychiatric Analysis, 35, 401-408

Van der Kolk, B.A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York: Viking.

Helpful resources:

https://childmind.org/our-impact/trauma-response/guides/

https://www.apa.org/pi/families/resources/task-force/child-trauma

Artwork:

“Confusion” by Mariam El Halawani