Separation Anxiety in Adolescence: How to Grow A Healthy Teenager

Published in Issues in Psychoanalytic Psychotherapy, Vol. 38

During adolescence, teens confront complex feelings toward their parents and find themselves caught in an anxiety-fueled dilemma: the wish to reject or distance themselves while they are unavoidably dependent on them and yearning for their approval. This clash of impulses fuels adolescent separation anxiety.

What is the criteria for a fostering healthy separation-individuation during adolescence? And how parents can support their teenagers wish for greater autonomy and independence?

The Battle Zone of Adolescence and Separation

The concept of separation-individuation was developed by Margaret Mahler (1979) as a way to chart the psychological birth of the infant. If birth represents the physical separation of the child and parent, separation-individuation represents the child’s quest for independence and identity. The child’s wish to individuate is accompanied by aggression toward the parent. For example, toddlers aggressively reject their parents’ help after they have mastered a task. Once they learn to feed themselves, they no longer want to be fed; once they learn to walk, they no longer want to hold hands. In every phase of life, children’s hunger for self-mastery fuels conflict with their parents.

This instinctive drive for independence in adolescence is a the heart of many battles. Children are quick to celebrate freedoms without the awareness of potential dangers. Which places parents in the unpopular position of restricting their children against their will. Any good parent eventually must make unpopular decisions.

During early childhood these conflicts are manageable. Toddlers can be strapped into strollers or carried off; privileges can taken away, and toys can be banished to high shelves. But by adolescence the battle for greater independence heats up and the relationship between parents and their offspring becomes infinitely more complex — and challenging.

The Adolescence Struggle

Blos (1979) suggests that a second phase of separation-individuation occurs during puberty, marking the end of the latency period. As pre-teen years approach, a grieving phase emerges, a developmental depression, or what Anna Freud described as a “developmental disturbance”; a time when the “entire defensive system of the ego is overstrained and breaks down.”

During this time children start to mourn the loss of their childhood self. It is not unusual for pre-teens and teens to engage in unsettling meditations about death, brought on by a new awareness of mortality. This grieving process represents the symbolic death of innocence and the sorrowful end of childhood.

As teenager’s childhood identity falls away, they experience an emotional and psychological crisis. Rapid physical changes, surging hormonal, accelerated brain development; If teenagers no longer feel like themselves, they have good reason. In a startlingly short amount of time, they are transformed into a new beings, with new drives and impulses that didn’t exist before. Thus puberty ushers in a period of great change and emotional instability.

Complications in Separation-Individuation During Adolescence

Without a healthy resolution of the separation-individuation process, children can not achieve a stable sense of identity. They enter their teens years, incomplete, mired in early childhood behaviors, emotionally dependent on their parents through compliance or defiance, they are unable to foster mature relationships. These immaturities can remain throughout adolescence or their entire adult lives. Until the objectives of the separation-individuation process are met, gaps in maturity endure. Rather than obtaining greater autonomy and independence, they remain emotionally tethered to their parents.

Role of Parents in Helping with Separation-Individuation

Complications in separation-individuation during adolescence occurs for a variety of reasons. Family disruptions, health problems, or developmental delays can make children fearful of separating or cause them to cling to their parents. Unstable parents may become dependent on their children and discourage separation, as they experience it as a form of abandonment. Such parents may unconsciously undermine their child’s drive for independence or perhaps encourage dependency. Frequently, parents of this nature were unable to emotionally separate from their own parents, and transfer their dependency from their parents to their children.

Depending on the child’s temperament, disruptions in separation can result in anxious dependency, depressive withdrawal, or hostile defiance in teenagers. Such disturbances are at the root of enduring delays in maturity.

To mend disruptions in separation, activities that strengthen identity, foster autonomy and discharge emotional tension are encouraged to help teens along the path to greater independence, maturity, and personal responsibility,

The five activities I recommend during adolescence are:

1. Tension Outlets. Teenagers have more feelings than words, and are often unable to express their emotions in words. Such unrelieved emotional stress results in chronic psychic and muscular tension. Without a way to discharge this tension, teens are more likely to suffer bouts of anxiety or depression, or engage in self destructive activities such as drug or alcohol use or cutting. Studies have shown that 30 minutes of cardio exercise, three or more times a week, reduces anxious and depressive symptoms up to 70 percent (CITE). Teens think more clearly, are more mindful, and sleep better after workouts because they discharge tension that they can’t express in words.
2. Esteem-building activities. Under the best circumstances, teens should have three to five sources that contribute to positive self-esteem and foster a healthy sense of identity. Helping teens develop his unique talents, skills, and abilities, such as creative abilities or athleticism, helps to stabilize their new emerging identity. Teenagers with too few sources of self-esteem are plagued with insecurities that hinder the separation process and are less insulated against emotional stress. Teens who have numerous sources of esteem are fortified and strive naturally toward healthy independence.
3. Social Skills: During adolescence, teenagers frequently seek to resolve their unmet emotional needs through relationships with their peers. Positive peer relationships enhance and strengthen social identity. Teens are best supported when they have three separate friend groups: friends at school, friends in their community and friends within their extended family, such as cousins.
4. Models and mentors. Nothing is more powerful than providing teens with a positive relationship with an adult who inspires and motivates. An uplifting teacher, an encouraging coach, or an inspiring family friend — such models and mentors have the power to undo dependency behaviors and foster greater self-reliance. These new parental introjects stabilize and sure up the adolescent ego. As children internalize the mentor’s confidence in them; they develop great self-confidence. Their future is brighter and sense of purpose is clearer when they have someone outside the orbit of their family to support their new emerging identity.
5. Learning diagnostics. Academic success is vital during adolescence and key to developing a positive sense of self. When I hear teens described as lazy or apathetic about their schoolwork, I always consider the possibility of nonverbal learning disabilities. Slow processing speed, executive functioning troubles or attention disorders generate chronic tension in kids, which causes mood problems. Failing or Low grades are demoralizing and negatively impact identity. A good psychologist can help identify learning issues and recommend support and accommodations that teens with NVLD need to succeed.

Case Presentation: Mimi

Thirteen year old Mimi was referred to me by her middle school guidance counselor. She was absent from school very often and recently started having panic attacks during exams.

Mimi looked unusually old of her age, tall with a thick mop of hair, she easily passed for 16 years old. Mimi’s mother, who immigrated from Italy to the New York, suffered from postpartum depression, and was hospitalized for several weeks after Mimi’s birth due to anorexia, a recurring issue since she was a teenager.

During that time, Mimi’s father did his best to cared for Mimi. During work hours, he had to resort to leaving Mimi in the care of his family. Mimi spent much time passed around among grandparents, aunts, uncles and neighbors.

Mimi’s father would pick her up after work and take her home. Exhausted, he often did not hearing Mimi’s cries at night to be fed. On several occasions, the neighbors expressed concern about the endless wailing they heard from the apartment. One neighbor, who had keys to the apartment, recalls opening the front door and finding Mimi’s dad asleep on the couch, with Mimi laying on the floor crying. He had fallen asleep with Mimi in his arms and she appears to have slid to the floor unharmed.

Despite these difficulties, when Mimi entered elementary, her mother described her as a “low-maintenance” easy going child. Throughout her latency period, Mimi made friends easily, had a passion for fashion, and walked to school unaccompanied.

All that changed with the onset of puberty. In middle school, Mimi started experiencing intense bouts of anxiety. She had trouble sleeping at night, and often in the morning her parents found her sleeping curled up on the floor at the foot of their bed.

Soon Mimi could not tolerate being alone and refused to leave her side or sleep alone anymore. As Mimi’s mother explained with growing frustration:

“If I take out the trash, Mimi comes with me. If I am in the shower, Mimi sits in the bathroom. Wherever I go, Mimi follows. She’s driving me nuts.””

During our first individual session, Mimi’s mother sat on the couch beside her with Mimi clutching her hand. She described, with increasing irritation, her resentment about Mimi’s dependency on her. Mimi explains:

“I hate being alone. I feel like I’m going to disappear.”

Unlike most teenagers, Mimi loved therapy and attached to me immediately. She spoke non-stop about friends at school, her parents, etc. Unlike her mother, who responded with impatience and irritation, I welcomed all of Mimi’s feelings. From the start, my countertransference toward Mimi was that of a loving, nurturing parent. I looked forward to seeing her, I enjoyed her humor. Mimi had an infectious laugh and looked forward to her sessions.

Soon she was able to tolerate having individual sessions alone, but only if her mother brought her to and from office and sat in the waiting room. Sometimes during session, Mimi would text her mother, “Are you still there?” Her mother would respond with hastily, “Yes, I’m here. Where else would I be?”

It occurred to me that Mimi was using text as a game of peek-a-boo with her mother to achieve object constancy and incorporate her parent. She was attempting to close the gaps in her development that derailed her ability to separate.

Eventually Mimi joined one my adolescent groups and was an instant success with her peers. Mimi related well and often poked fun at herself, “I seem normal, right? But I’m really crazy.” Sure enough, as the session came to an end there was an upsurge in Mimi’s anxiety. She would frantically call her mother to come to the office.

In a few weeks, Mimi agreed to let a babysitter take her to the office. A few weeks later, she announced she could come to the office alone if she could bring her dog. And so Mimi’s dog, Baltimore became the first canine member of the group. Mimi’s ability to self sooth was evidenced by her descending order of attachments.

Next Mimi started to text me instead of her mother., I welcomed Mimi’s contact and engaged in some healthy mirroring.

Mimi: My mother isn’t home yet. I’m scared.

Therapist: It’s scary to be alone.

Mimi: I’m worried about school tomorrow

Therapist: Exams are tough, but you’re tougher.

Anytime anxiety flared up, Mimi text me. I responded by comforting, soothing, and encouraging her. Within several months, Mimi’s panic attacks stopped completely. She was able to be alone at home, as long as her dog was with her.

Next she started to show signs of separating by expressing irritation with me. Small children and teens most commonly uses anger as a means to separation. Unlike her mother, I embraced Mimi’s anger. As Mimi became more self-reliant, the tone of our texts evolved:

Mimi: I’m alone. I’m scared. What should I do?

Therapist: I don’t know. What do you want to do?

Mimi: You’re the therapist! You should tell me.

Therapist: Well, maybe have a snack.

Mim: Seriously? That’s so stupid. What use are you?

The more Mimi’s dependency on me weakened and the more I trusted her to manage her own feelings. And the more Mimi became infuriated with me.

Mimi: I was going to ask your advice, but then I thought, Why bother? What did they reach you in therapy school? How to sit in a chair?

I welcome Mimi’s attacks on my competence with good humor and warmth. No matter how abusive, my positive feelings for her never changed; I was able to provide her with a corrective emotional experience.

After three years in group, all of Mimi’s symptoms related to separation-individuation had vanished. And for the first first time, she was also able to express disappointment and aggression toward her parents.

Mimi to her mother: Why did you have me? You had no clue how to raise a baby!

Mimi to her father: Why are you still married? To continue to torture me?

Mimi to her therapist: My dad is trying to give me advice. LIke I’m going to listen to him? What a train wreck his life is!

Today Mimi is twenty-threes years old, lives in Soho and works for a graphic design firm. She texts me or comes by for occasionally for individual sessions and still enjoys devaluing me.

“You know, Sean, I don’t know why I come to talk to you. Guess it’s just a bad habit.”

The week that her dog Baltimore died, she booked a session and we both had a good cry.

From Separation to Identity in Adolescence

When therapists working with teenagers strive to meet maturational needs, the separation-individuation process is revisited and unmet needs are re-awakened. Adolescence offers a second chance to satisfy those primitive needs and engage in re-parenting. After all, what is a therapist but an ideal parent. www.seangrover.com

References:

Blos, P. (1979). The adolescent passage. New York: International Universities Press.

Blos,P. (1967). The second individuation process of adolescence. Psychoanalytic Study of the Child, 22,162–186.

Frued A. (1966) Normality and pathology in childhood: Assessment of development. London, England. The Hogwarth Press

Grohol, J.M. (2016, May 16). An introduction to depression. Retrieved from PsyCentral.com

Grohol, J.M. (2015, October 6). An introduction to ADHD. Retrieved from PsyCentral.com

Mahler, S. and Pine, M.M. and F., Bergman, A. (1973). The Psychological Birth of the Human Infant: Symbiosis and individuation. New York: Basic Books.

Published in ISSUES IN PSYCHOANALYTIC PSYCHOLOGY, 2016, Vol. 28, Pg. 52

Sean Grover, LCSW maintains one of the largest group therapy practices in the United States. He served as Program Designer for Brooklyn Psychiatric Centers, an expert witness for adolescents for the NY State Supreme Court, a Board member of Creative Alternatives at Mt Sinai , a Clinical Supervisor at the Harlem Education Arts Fund, and a member of the Brooklyn District Attorney’s task force on youth violence. Sean’s new book, WHEN KIDS CALL THE SHOTS: How to Seize Control from Your Darling Bully–and Enjoy Parenting Again, received an Publishers Weekly Editor’s Pick for Best New Nonfiction, and was featured on The NY Times recommended reading list for parents. Sean was guest on The Today Show. and has been featured in articles by the Associated Press, Psychology Today, Newsweek and elsewhere. Additional information is available at www.seangrover.com