Psychotherapy is seldom a “one size fits all” proposition. The tale of the two teenagers illustrates that point very well. In both situations two adolescent boys were brought into therapy by their parents because their grades had dropped precipitously; they were hiding out in their rooms too much; and they spent inordinate amounts of time playing computer games. There was an important difference between them however which I hope to illustrate. It resided in the health and resilience of their core identity—their sense of who they were.
Last week I talked about Ethan and his situation. His therapy was completed in a matter of a few months. We terminated because he felt ready to do so—with the caveat that he could return if things started to “go south” again. Ethan had a relatively healthy core identity and lived in a stable home with caring parents. He was no longer “stuck” developmentally and had good coping strategies for the next phase of his life.
Steven, the second example, also came into therapy because he was failing out of school. He attended a small private academy with a lot of individual attention but was not doing his work and was not turning it in if he did. He had few friends at a school and when he got home he stayed in the house playing computer games. It was a challenge to get him to talk to me at all.
Steven lived in two homes—a week with his father and a week with his mother. Both parents had remarried but his mother had also divorced her second husband whom Steven hated. When he was at his father’s home he seldom came out of his room because he thought his father or stepmother would criticize him. In fact they did have a running battle with Steven at the center. They lived in a new and beautiful home and the step-mother was afraid that Steven would ruin something. Actually he had, at one point, kicked a hole in the upstairs hallway when he was angry.
I seldom interacted with Steven’s mother. His father and sometimes his step-mother brought him to sessions. As I became aware of the level of conflict in their home I asked them to come into the sessions with Steven. The step-mother was of another ethnic background in which women are encouraged to be subservient to men. She felt that the father always took his son’s side over her. She would be quiet for a while and then erupt in a rage that seemed chaotic and out of control. As I observed them in the sessions it became clear that the father was quite dominating and felt that his opinion should prevail—even to the point of interrupting everyone including me. We worked on communication patterns, making it clear that everyone deserved a chance to speak their mind in a respectful manner. The treatment progressed in the sense that communication within the family improved. The parents found more effective ways to talk to Steven. He began doing and turning in his homework and eventually graduated from high school.
But his inner world remained a mystery. I attempted to gain access to that private space by listening carefully to intricate accounts of his online battles where he spent so much of his time and energy but it was a fool’s errand. His identity remained grounded in the mind-numbing world of computer games and online battles. It provided a refuge from the hurts that he had suffered in the real world but it failed to offer either a vital confirmation of his identity or the skills he will need to negotiate that identity in relationships with others. Steven found refuge in the computer world to which he had retreated—not as a means of enhancing his own inner workings but as a repetitive and hypnotic addiction.
Ellen Toronto is a clinical psychologist in private practice in Spring, Texas and has been practicing since 1980. In 2017, she was elected a Fellow in Psychoanalysis by the American Psychological Association. In 2016, Dr. Toronto's practice was recognized as one of the top Ann Arbor Psychology practices. She received her Ph.D. in Psychology from the University of Michigan. Dr. Toronto is married to Robert Toronto, Ph.D., and together they have four sons and eleven grandchildren.