Waiting on the threshold: an exploration of the experience of adolescent patients of breaks or holidays in the treatment and its possible modifications along the course of intensive, long-term psychoanalytic psychotherapy

The aim of the present qualitative study is to capture the possible reactions of adolescent patients to a break and how this might vary over the course of long-term therapy in order to formulate some hypothesis in relation to risk factors and acting out. Another area of interest is relative to the way the therapists might react to the challenges posed by the break, as it emerges from not only their direct interpretations but also their stylistic choices in the writing up of the sessions. To this end, existing psychotherapy session write-ups of two adolescent patients who have received five times weekly psychoanalysis for around 8 years have been analysed using Discourse Analysis. The notes analysed were relative to the eight weeks preceding and following the first summer break and the last in the analysis. The Kleinian and Post- Kleinian theoretical background of the research is discussed, in reference to the specific issues posed by working with this age group. The links between failures of containment, their impact on the developing of object constancy and the parallel capacity to hold onto an object in its absence are also explored; as well as its effects on the development of a sense of identity evolving in time and rooted in the body. The literature search conducted revealed a limited number of studies that analysed the effects of breaks on patients, and none relative to adolescent patients. The clinical implications of the study include that for both patients and therapists, the first break in the therapy elicits particular anxiety; material relative to the summer breaks tend to emerge from five weeks before the holiday; patients’ experience as helpful interpretations of the possible effects of variations in the timeframe of the therapy on them, also in relation to processes of separation and individuation.