The holding environment and family therapy with acting out adolescents

The pathology of the holding environment in families of borderline, schizoid, and narcissistic adolescents is reviewed. A model for family therapy is described in which this pathological family environment can be examined. In this model, the family therapists function to contain displaced, projected, and acted-out affects and impulses. A clinical example illustrates how a therapist's capacity to acknowledge, bear, work through, and redirect these impulses in the family treatment offers family members an opportunity to reestablish previously severed communications, allowing for continued family support at a critical period in the adolescent's development.