The Psychoanalytic Study of the Child

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Dialogue with the Novicks

Scott Dowling, Claudia Lament, Kerry Kelly Novick & Jack Novick

To cite this article: Scott Dowling, Claudia Lament, Kerry Kelly Novick & Jack Novick (2013)
Dialogue with the Novicks, The Psychoanalytic Study of the Child, 67:1, 137-148, DOI:
10.1080/00797308.2014.11785492

To link to this article: https://doi.org/10.1080/00797308.2014.11785492

Published online: 09 Nov 2016.

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Download by: [UNIVERSITY OF ADELAIDE LIBRARIES] Date: 18 December 2017, At: 08:45
 Dialogue with the Novicks
SCOTT DOWLING, M.D., AND CLAUDIA
LAMENT, Ph.D., EDS., WITH KERRY KELLY
NOVICK AND JACK NOVICK, Ph.D.
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Two of the editors of The Psychoanalytic Study of the Child converse

with authors Kerry Kelly Novick and Jack Novick, Ph.D., about their
paper “Concurrent Work with Parents of Adolescent Patients.” Highlights
include the authors’ stated goal of restoring a positive relationship to the
teen-parent bond, a new extension of the work of analysis with adoles-
cents, the transference-countertransference complexities when the same
analyst works with both adolescent and parents, and the uses of the term
transformation—its traditional meaning in the developmental process
of the individual and the authors’ conceptualization of the term in their
adolescent-parent treatment paradigm.

we, kerry and jack novick, are grateful to the editors for
the thoughtful questions that follow. Each could actually evoke detailed
and lengthy responses, indeed a whole paper, to elaborate the thoughts.
Here, however, we will try to respond briefly to clarify, emphasize, or
extend particular points.
1. We know you’ve thought a great deal about the therapeutic value of working
with parents in the course of analysis with children of all ages. You describe two

Scott Dowling is Training and Supervising Analyst, Cleveland Psychoanalytic Center,

Cleveland, Ohio; Associate Clinical Professor of Child and Adolescent Psychiatry, Depart-
ment of Psychiatry, Case Western Reserve University, Cleveland, Ohio; and Editor of The
Psychoanalytic Study of the Child.
Claudia Lament, Ph.D., is Training and Supervising Analyst at the Institute for Psycho-
analytic Education, an affiliate of the Department of Psychiatry, New York University Lan-
gone Medical Center. She is Assistant Clinical Professor in the Department of Child and
Adolescent Psychiatry, the Child Study Center, New York University Langone Medical Cen-
ter. She is also Senior Managing Editor of The Psychoanalytic Study of the Child.
The Psychoanalytic Study of the Child 67, ed. Claudia Lament, Robert A. King, Samuel
Abrams, A. Scott Dowling, and Paul M. Brinich (Yale University Press, copyright © 2013 by
Claudia Lament, Robert A. King, Samuel Abrams, A. Scott Dowling, and Paul M. Brinich).

137

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 138 Scott Dowling and Claudia Lament

goals of this work. The first is pragmatic: “Working with parents . . . helps people
[individual children] enter treatment, stay and do the necessary work, and leave
in a timely fashion.” The other goal is an interesting, totally new extension of the
usual reason for child analysis: “Restoration of the parent-child relationship to a
lifelong positive resource for both.” This is a social, multiperson, long-term goal,
usually thought of as a possible result rather than as a goal of psychoanalysis.
Tell us more about your focus on the relationship itself and how this alters your
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view of psychoanalysis.

We feel that the importance of the parent-child relationship as the

context for development and the delivery system of the environment’s
impact on a child’s development is already established, both in our
work and in all modern developmental research. In the paper in this
volume we describe the pragmatic impact of actualizing that conceptual
assumption for making treatments of late adolescents work.
If we restrict the idea of child analysis only to the individual child,
then we would be denying the knowledge that psychoanalysis is about
the complexity of development and the relationships that foster both
health and pathology. If we focus only on a child’s symptoms, that is
not a psychoanalytic approach. From the beginning of an evaluation, we
assume and communicate to child and parents that the child’s troubles
are part of a larger parent-child history. For full understanding and
therapeutic change, we say that both individual and family aspects will
need attention. We note in the paper that it’s central for the analyst to
keep the parent-child relationship in mind, no matter what the treat-
ment structure happens to be.
This question also gives us a chance to revise any potential misun-
derstanding of the notion of the parent-child relationship as a “lifelong
positive resource for both.” Perhaps it would be clearer to speak instead
of a “realistic” resource. Most parents and most children and adolescents
welcome the idea of an improved and closer relationship with hope and
relief, and the outcome is usually eventually positive.
But there are some situations in which there are irreparably toxic
elements and the reality is not positive. Then the hierarchy of clini-
cal values that mandates physical and emotional safety as the highest
priority takes precedence. The realistic outcome of parent work under
such circumstances is to help the adolescent and/or the parent come
to a place where they can take what they need from the relationship for
their own good. That might, for instance, involve not having contact
with the toxic parent or meeting only under supervision.
A basic thrust of all our work has been the effort to reclaim the
metapsychological complexity of human development and functioning.

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 Dialogue with the Novicks 139

These ideas come into our answers to the other questions below and
are detailed in our 2002 paper. Rather than seeing our formulations in
this paper as a new paradigm, we tend to think of them as a return to
the original richness of psychoanalysis.
In a recent description of parent work we say that psychoanalysis is
not only directed at dealing with pathology but is equally a strength-
building learning experience. It leads to the development of mastery,
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competence, joy, and emotional muscle. Psychoanalytic theory and

knowledge attempts to encompass the full complexity of individuals
and their families. It follows then that any techniques based in ana-
lytic thought must be multimodal, flexible, creative, and individualized
(K. Novick and J. Novick 2013).
2. In your paradigm, the therapist’s agenda is to strengthen the ties between
child and parent. Are there instances in which this goal may be at loggerheads
with the adolescent’s developmental aim of separateness from her parents, as
you define it? For some, this may call for periods of time when the parents are
persona non grata. What is your thinking about this, and how do you deal with
it in the clinical situation?
We think that making one’s parent persona non grata is usually the
adolescent’s pathological solution to the healthy, realistic challenge of
establishing psychological separateness and identity and represents an
avoidance of that task. Physical separation may also be used as a patho-
logical response to that normal phase challenge.
Even in worst-case situations, for instance parental sexual abuse of an
adolescent or endangerment through drunk driving, the adolescent has
to come to a realistic perception of her parent, accepting both limits
and opportunities for parental change and the eventual nature of the
relationship.
The original adolescent stance of dismissal costs too much for his or
her development because it preserves closed-system solutions and may
perpetuate or consolidate a pathological tie. Transformation of the re-
lationship may involve a loosening of a pathologically intense tie.
We don’t think of this as the “therapist’s agenda.” Rather this is an
explicit, shared treatment goal. In the example of Kevin in the paper in
this volume, his solution for his depression, colluded with by his family,
was to go far away for college and not to speak to his father at all for
more than a year. This solution, combined with heavy-duty medication,
was destructive. One of his symptoms was severe passivity, with an inabil-
ity to make even the simplest of decisions. Once he began to do some
of the work of transforming his relationship with his father, he became
more active in other areas of his life. In this case, it was only when he

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 140 Scott Dowling and Claudia Lament

could give up the solution of making his father persona non grata and
reengage with the complexities of their interactions that ego capacity
was freed up to engage with other tasks of development, like finding a
girlfriend and working effectively in school.

3. At a number of points in the paper in this volume you write about “transforma-
tions” of parents who are reworking aspects of their relationship with each other
or with their adolescent, as well as “transformations” of your patients themselves.
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Help us to understand more explicitly what you mean by a “transformation.”

Freud and others have used the term to define the biologically inspired organiza-
tional progression in the developmental trajectory. Does “transformation” in your
approach refer to the adolescent’s step into a new hierarchical organization, or
does it imply a behavioral change in the relationships between individuals?

Freud talked in 1915 about the transformations of puberty under the

impetus of biological changes. But his position was more complex and
modern than is usually understood. Many years ago, Freud confronted
the age-old nature-versus-nurture debate by suggesting a complemental
series, where the two are in constant interaction. Erikson expanded
this to formulate an epigenetic series where development occurs from
complex interactions that continue across the life span. Psychoanalysts
from Freud on have articulated the process by which behavior is not
predetermined by brain functions or genomes alone but intersects at
crucial developmental moments to express innate factors and then in-
teract with subsequent environmental input to produce the variety of
behavior we see in humans of all ages. Recent neuroscientific work has
arrived at the same position. Most modern neurobiologists agree that
the old nature-versus-nurture distinction is obsolete.
It is in the spirit of these formulations that embrace the complexity
of interaction that we think about developmental transformations. At
the psychological and behavioral level, we posit:
• The first determinant of any current behavior is likely to be found in
the parent-child relationship, especially, as we have emphasized, in the
pleasure/pain economy of that relationship.
• Behavior evolves through phases in which current levels of psychologi-
cal and biological functioning influence and are influenced by previ-
ous phases.
• Transformation is the main characteristic of this epigenetic evolution.
• No one phase has more importance than any other, and developmen-
tal transformations continue throughout the life span.
• Each phase brings something unique to the mix, which may compen-
sate for earlier difficulties or raise prior dormant issues to problematic
intensity (Nachträglichkeit, or “deferred action”).

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 Dialogue with the Novicks 141

The adolescent has to go through this whole process to transform his

relationship to his body, his mind, his self, the realities of the world, so-
cial and cultural expectations, and other people. At the same time, par-
ents are also moving through their own developmental phases, adapting
to changes in their bodies and capacities, taking on new responsibilities
and so forth. In the culture, and particularly in our clinical population,
we find that one area of transformation that is ignored or scotomized
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is the parent-child relationship.

All these transformations manifest in behavioral changes, but they
represent psychic change at all levels of the body and mind in all the re-
lationship configurations. Psychic change in the individual patient may
bring about behavioral change in parents, which can then be invoked by
the therapist in parent work to help parents change internally. Simulta-
neously, change in parents can create an opportunity for the therapist
to work with the adolescent patient on retention of old patterns. It’s
always hard to change sadomasochistic relationships, but if a parent
can be helped to not respond in their usual sadistic ways to adolescent
provocation, it creates space for the individual work with the adolescent
on deeper levels of his need to be a perpetrator or victim.
This is not a simple picture; we are describing multifaceted problems,
conflicts, personality organizations, and resolutions. Such complexity
challenges analysts to respond with equal sophistication and engage-
ment with the vagaries of each clinical situation. What this means is
there is constant dynamic interaction of the multimodal, multilevel
work of transformation proceeding with all parties.
4. Traditionally, the parents of adolescents have been treated by a separate
therapist in order to free the adolescent therapist from being overburdened by the
inordinate complexities of individual, parental, and familial subsystems. In
your method, in which the same therapist works with both parents and teenager,
the inevitable infiltration of unconscious determinants—running bidirection-
ally—must influence the open dialogue among all four participants. How does
the therapist monitor and track the multilayered and unconscious features of
transference, countertransference, resistance, and other structural domains of the
therapeutic situation? Here are some examples of what we mean:
A. In the cases you describe, the parents have an impressive capacity to
trust in your selection of treatment details to expose to the adolescent; in
like manner, the adolescent must trust in your promise concerning the
specific nature of the communications that you transmit to the parents.
The patients you discuss don’t appear to object to your format, but have
you encountered situations where unconscious mistrust in your model’s
approach is an unspoken obstacle to the treatment?

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 142 Scott Dowling and Claudia Lament

B. The therapist’s impressions of the parents would have a subtle impact

on the way the therapist listens to the adolescent’s perception of the par-
ents. Does this affect the adolescent’s evolving perceptions and discoveries
concerning them?
C. You report conveying discoveries from the adolescent’s treatment to
the parents. Does this have an impact on the adolescent’s own agency
(or fears and defenses against it) in her allowing the therapist to take
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this role?

This question gets to the heart of the concerns and confusions sur-
rounding parent work in general and parent work in relation to ado-
lescents in particular. In this paper and in our 2005 book, we address
some of the historical, theoretical, and technical objections to the very
idea of parent work. Here, in addition, Dowling and Lament give us
the opportunity to address the issues that arise from the side of the
therapist grappling with a complex situation.
A. It has been surprising to us that parents and adolescents experi-
ence enormous relief when the dual goals are articulated. The fact
that adolescent patients usually welcome our parent work belies the
theory of “normal” adversarial adolescence, which derives from an
Anglo-American cultural tradition that predates psychoanalysis and was
unfortunately incorporated in the classical model of adolescent turmoil
and rebellion (DeVito, Novick, and Novick 2000).
This reaction from patients and parents validates the position we
state in the paper that the standard psychoanalytic model of adolescent
development is flawed. It follows then that the conventional practice
of farming out the parent work may be based on false premises and
compounds difficulties by making the transferences and countertrans-
ferences even more complicated. Then there is the possibility that far
too much is left unconscious and therefore not dealt with. We have also
often found that conscious or unconscious rivalry between the adoles-
cent’s therapist and the parent worker can lead to treatment failure.
Parents come in carrying this standard conception of adolescent de-
velopment. They expect us to confirm it and support their children in
moving away; clearly this contributes to parental fears and ambivalence
about treatment. It is often diagnostic when parents are conversely all
too willing to hand the adolescent over to the therapist and have noth-
ing to do with the treatment. This may constitute a passive-to-active
preemptive rejection of their child.
Adolescents come in thinking that they should hate their parents
and be rebelling. They assume we expect them to do so, and there is
often a preconscious or unacknowledged anxiety that we will see them

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 Dialogue with the Novicks 143

as failures because of their continued attachment to their parents. They

are often ashamed of having any attachment.
The relief that parents and patients experience around the dual goals
seems to inspire realistic trust in the analyst and the treatment method.
We think this basic trust is fundamental to the therapeutic alliance and
then allows for mutual exploration of inevitable eruptions of distrust.
Moments of distrust are markers of transference manifestations against
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the backdrop of realistically established trust.

For instance, Melinda welcomed the analyst taking some of the pres-
sure off her by talking with her mother about accurately labeling feel-
ings. But after she broke up with the boyfriend her parents were so
invested in, she was suddenly worried that the analyst would talk with
them about her sexual activities. Given the established experience
of secure communications with her parents, this could be taken up
right away as a sign that something else was going on. Eventually what
emerged was that this young woman who had been speaking with her
mother multiple times a day on the phone had been carrying on a secret
sexual life since early adolescence. So the disruption of realistic trust
marked an important opening for a shared exploration of an important
area of pathology.
We have of course also encountered situations in which the adoles-
cent actively resists or forbids any contact between therapist and par-
ents, sometimes making this a condition of treatment. A standard model
might present this as an exaggerated normal reaction. Our model allows
us to take this as a symptom of a very troubled parent-child relationship,
which needs ongoing work. In our book on working with parents, there
is an example of such a case, in which the young woman was afraid that
her mother would intimidate the analyst. The only contact for some
time was when the mother would telephone to harangue the analyst
about the iniquities of the girl. But these “conversations” allowed some
opportunity for realistic empathy with the patient’s experience of her
mother, and for some beginning contact that bore fruit in the mother’s
gradual change in attitude.
B. Psychoanalysis has taught us that people do various things with
their perceptions of difficult realities. Difficult internal realities are
dealt with by repression; difficult external realities are dealt with by
denial. Freud started psychoanalysis by describing the operation of de-
fense, which differentiated the new field from contemporary neurologi-
cal ideas of mental functioning. But theoretical excitement soon shifted
to unconscious content and its derivatives. The field was moving only in
that direction until Anna Freud enriched the discourse by pointing our
attention to the operation of defenses and their analysis as the gateway

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 144 Scott Dowling and Claudia Lament

to understanding and change. Since the death of Anna Freud in 1982

and the rise of Kleinian-derived and relational theories, the concept
of “defense” has been eclipsed, with focus returning to unconscious
content, especially early infantile relationships.
If we use the lens of defenses to look at treatment and treatment
material, we may say that repression is directed against unconscious
content, whereas denial is directed at painful, traumatic reality. Ongo-
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ing contact with parents puts the therapist in a position to see denied,
traumatogenic factors both in adolescents and their parents.
We find that actual ongoing contact with parents creates a realistic
basis for the therapist to assess positive and negative aspects of the re-
lationship between the parents and with the adolescent. The fact that
we have met with and talked with the parents, and that we have shared
some ideas about the parent-child relationship with the patient, helps
patients feel that we know what they are talking about. We actively bring
these real issues into the discourse with the patient when the material
warrants it.
Nancy, a beautiful middle adolescent, came to treatment because of
school failure, but she was actually struggling in every area of function-
ing. The analyst met with the parents from the beginning, but most of
the work centered on Nancy’s self-destructiveness. As Nancy stabilized,
her conflicts about doing well emerged. A major determinant was her
fear of her mother’s envy. This could have been discovered without par-
ent work and standard interpretations could have been made.
But the analyst knew this mother and had seen that she was grossly
obese, highly competitive, and sadistically derogatory of Nancy. On the
basis of this reality perception, Nancy’s denial of her mother’s physical
and psychological characteristics could be interpreted with confidence.
The analyst couldn’t collude with Nancy’s ego-distorting defensive pro-
tection of her mother, and therefore was in a position to address the
conflict. Nancy’s conflict between knowing and not letting herself know
came alive.
C. The dual goals include improved communication between parents
and children. From the very beginning we differentiate privacy and se-
crecy with all parties. So it’s a deliberate decision made with the patient
when we choose to convey something specific about the adolescent or
from the adolescent’s treatment to the parents. Similarly, we talk with
parents about the usefulness or importance of something they have
talked about being shared with the adolescent.
In the early stages, when the therapist is often the person opening
up the communication, we remind everyone explicitly of the goal of
eventual open discourse between parents and children. But in the ini-

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 Dialogue with the Novicks 145

tial phases, many factors can make it hard or apparently impossible for
direct conversation between them.
For example, Sarah, a late-adolescent child of divorced parents, lived
with her very disturbed mother. She had taken on parenting responsi-
bilities far too early. She started treatment in the midst of an ongoing
family crisis. She thought it was her job to solve the crisis; this interfered
with her actual responsibilities to her schoolwork and her self-care. Her
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therapist pointed this out, and Sarah tearfully said that she had been
doing this all her life and felt too guilty to think of or do anything about
it. Identifying this together as a major area needing work, the therapist
also offered to speak to both her parents about her need for them to
stop loading their emotional burdens on her. There was an immediate
improvement on all fronts, and Sarah could then settle into her analysis,
which included work on the gratification afforded her by becoming the
mother in the family from an early age.
We assume and work toward change over time in adolescents taking
responsibility for keeping their parents in touch with treatment issues
and discoveries. A year later, when someone in the extended family
died suddenly, Sarah and her parents talked together constructively
about her role and its limits, and her parents also consulted the analyst
to good end. Sarah herself said that she felt more confident that she
could do what was best for her, since she couldn’t be responsible for
everyone else’s feelings and reactions.

REFERENCES

DeVito, E., J. Novick, and K. K. Novick (2000 [1994]). Cultural interfer-

ences with listening to adolescents. Journal of Infant, Child, and Adolescent Psy-
chotherapy 1:77–95.
Novick, K. K. and J. Novick (2002). Reclaiming the land. Psychoanalytic Psy-
chology 19 (2): 348 –77.
——— (2005). Working with Parents Makes Therapy Work. Lanham, MD: Jason
Aronson / Rowman & Littlefield.
——— (2013). A new model of techniques for concurrent psychodynamic work
with parents of child and adolescent psychotherapy patients. Child and Adoles-
cent Psychiatric Clinics of North America 22 (2), April.

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