Some practical considerations in the assessment and treatment of adolescent girls with separation problems

Five cases are presented of adolescent girls with severe problems in leaving home. Though the psychodynamics were similar (preoedipal conflicts in the separation-individuation phase), the psychopathology and underlying causative factors were different in each case. Factors to be considered in the initial diagnostic assessment are outlined. These include constitutional and congenital factors, the developmental history, maternal emotional illness, and gene-environment interactions. Various treatment modalities are described and illustrated. In four of the cases specific parameters were necessary, particularly behavioral technics and conjoint family therapy. The manner in which the analyst may serve, in cases amenable to psychoanalytic treatment, as transference object plus real object is discussed and illustrated.