The Impact of Psychological Trauma on the Adolescent’s Journey

by Bronagh Starrs

Adolescence is a process of intrapsychic and interpersonal boundary development; and the therapist works to support the growth and integration of these realms of experience. There is one dominant level through which the adolescent organises his/her experience, and within that there is a perpetual movement between the inner and outer worlds. An underlying process of self-definition is at the heart of much of the behaviour and choices of the adolescent, even those which are blatantly self-destructive. De-pathologising adolescent behaviour and seeing symptoms as interrupted development creates the potential for establishing a meaningful relational connection with the adolescent.

Often adolescents who have experienced psychological trauma will become frozen in either the intrapsychic or interpersonal world and the therapist’s task is to support the young person in moving into a more balanced way of organising experience. As the adolescent develops a more solid presence in the world and establishes a growing sense of ownership of experience, he can risk a more mature style of contact without threat of the self’s disintegration. He becomes more engaging whilst maintaining a sense of himself. His quality of contact is enriched and he is able to relate to others and to himself in more differentiated ways.

Boundary Development

During adolescence, there is a psychological impulse to liberate oneself from the embedded experience of childhood and move towards the establishment of a more grounded, embodied sense of self. Typical adolescent behaviour, including not letting parents know exactly what he is doing, reluctance to participate in aspects of family life, engaging in forbidden activity etc. is powerfully effective in generating an experience of boundary between teenagers and adults. It is behind this boundary that the adolescent’s relationship to himself and to the world will be reworked and reorganised. This reworking and reorganising is also dependent on the extent to which relational connections are possible from behind this boundary.

The adolescent has not yet developed the ability to trust and own his experience, nor has he the ability to articulate his feelings and reflections. Instead he reveals himself to himself and to the world through self-symbolism: a distinctive dress style, musical tastes, choice of best friend etc. These self-symbols are projections of self onto the environment and the adolescent’s way of organising his experience of self and environment. His experience is likely to be full of inconsistency and discontinuity and his capacity for reflection quite limited. This projection is a protective mechanism which defends his precarious sense of self from awareness or contact that might prove too intense or too threatening to his level of identity integration.

Projective Framework of Experience

The adolescent begins to create and organise meaning in his world, which includes reinterpretation of his view of parents and family history from his own perspective. Sometimes he discovers deeply upsetting realities that he would prefer to ignore and this is too much for him. Often the impact of this awareness remains firmly bounded off from the adolescent’s awareness and development of an inner world becomes too threatening a possibility, particularly where there is inadequate environmental support. The young person becomes caught in acting out through blatantly self-destructive behaviour patterns, choosing a lifestyle which is often dangerous, involving high-risk and/or criminal activity.

For these adolescents, the heightening and expansion of boundaries leads neither to growing contact between the parts of self, nor to a richer contact boundary between self and others, although the psychological impulse is to do just that. With these young people it is necessary to create sufficient environmental support so that they can begin to tolerate their painful reality and move out of this frozen way of being in the world.


Conor, age 16, was referred by his father. He is the middle child of nine siblings and was placed in care aged 8 when it emerged that his uncle had been sexually abusing him and other members of his family. Conor was separated from most of his family and spent the next seven years in care, often running away, getting into trouble with the police and vandalising property. Conor’s parents separated and his mother lives abroad. He has not seen her since he was 8. He has supervised contact with his younger siblings and occasionally sees his older brothers.

Around 18 months ago Conor came to live with his father who referred him to me because of his ‘out of control’ behaviour. He had been joyriding, then bashing up the cars and setting them alight. During arguments, Conor would inevitably threaten to set his father’s car alight, which understandably alarmed the dad who was concerned about the sincerity of the threat.

It is difficult to imagine the extent of hurting which Conor has experienced in his young life. It also quickly became clear that I was merely the next in a long list of professionals he had encountered along the way. He had no expectation of being met with understanding or respectful interest. When Conor first came to see me he was drinking heavily and getting into trouble. After a while he told me about getting drunk and stealing cars. He would drive into walls at around 30/40 mph wearing no seat belt. He loved the buzz and feeling of being alive that it gave him, which, according to him, was well worth the pain of the injuries he suffered. Often he would then smash up the cars and set them on fire.

He talked of feeling dead or asleep in his body most of the time and it seemed he could only feel alive whilst engaging in high risk activity. (It interests me how when there is trauma in a family system, very often the adolescents can only feel really alive when there is adrenaline coursing through their veins and making contact means being in crisis.) He felt extremely angry when he watched the flames of cars he had set alight and felt there were flames inside him too. We worked with embodying the flames and Conor began to attend to the fire which was raging within.

Making contact with Conor is a delicate and sensitive art. On his 17th birthday I decided to send Conor a text to wish him a happy birthday as I guessed my wishes might be the only ones he received. Sadly I was right. This however marked a significant turning point in the work with Conor as texting became an important means of relating for us –it is safer and less threatening than the face to face encounter and afforded him the space to articulate the unspeakable. He began to tell me about the deep sadness and loneliness he felt at not seeing his mother and having little or no contact with his siblings. He described his anger and shame at having been sexually abused and his shame of having been placed in care.

Sometimes during sessions we would talk about the texts and sometimes we would not, although it has become easier for Conor to articulate his experience to me face to face. He brought a CD of his favourite song to the session once (at his request) and we explored the meaning of the lyrics for him. It was a useful device for helping him articulate his own experience and further appreciate his struggle:

The Rose that Grew from Concrete
You try to plant somethin in the concrete, y’knowhatImean?
If it GROW, and the rose petal got all kind of scratches and marks, you not gon’ say,
“Damn, look at all the scratches and marks on the rose that grew from concrete”
You gon’ be like, “Damn! A rose grew from the concrete?!”
Same thing with me, y’knahmean?
I grew out of all of this
Instead of sayin, “Damn, he did this, he did this,”
just be like, “DAMN! He grew out of that? He came out of that?”
That’s what they should see, y’knowhatImean?
All the trouble to survive and make good out of the dirty, nasty
y’knowhatImean unbelievable lifestyle they gave me
I’m just tryin to make somethin..

When no one even cared
The rose it grew from concrete
Keepin all these dreams
Provin nature’s laws wrong
It learned how to walk without havin feet
It came from concrete.

Imagine the experience of being rooted in and attempting to disembed from concrete! Conor needed someone to believe in him so that he could begin to believe in himself. Gradually the car theft ceased and realising that alcohol fanned his flames and ignited his anger, he began to moderate his drinking. He became more and more relaxed within himself. He became more reflective, stopped stealing cars, changed his friends and went back to school. He was frozen in the impulsive acting out, denial and projection of disembedding and the work was to support his emerging interiority in a way that was not shaming or overwhelming. The work with Conor is ongoing and he is gradually and tentatively developing a sense of himself as an acceptable and worthy human being.

Interiority and Withdrawal

Once the adolescent’s psychological boundaries and a tentative sense of the self’s integrity have been established, growth and conflict which was initially staged at the interpersonal boundary is now experienced at an intrapsychic level. As the private world of inner experience is accentuated and the capacity for self-reflective awareness develops, there is now a tendency to internalise rather than externalise experience.

The stage of interiority is not a whole experience, rather it becomes more the foreground as the disembedding and projection still continues, but with less intensity. The central issue for the interiority stage adolescent is the struggle within herself for authenticity. She embarks on an intense search for meaning and integrity – working to develop inner strength, a sense of personal worth and an individuality which will in time enable a richer experience of connection and relationship with self and others. This is a time of wonderful creativity as she begins to experiment with journaling, poetry, songwriting etc. in an attempt to articulate what is inside to the world. Earlier yearnings for attachment and dependency re-emerge for the adolescent. Relationships are often intensely consuming and break-ups can be devastating to the adolescent’s emerging sense of self and identity integration.

There is a concentrated struggle between the isolation of selfhood and the urgent need to belong. The search for personal meaning through the opening up of a rich and fascinating interiority can lead to the experience of potentially overwhelming levels of abject dread and pain. With the awareness of interior experience, the fragile psychology of the adolescent begins to surface more conspicuously as her internal desperation and disorganisation become evident. The adolescent becomes highly self-conscious and keenly attuned to whether or not she is taken seriously.

It is as if there is a lack of internal differentiation between observing and experiencing aspects of the ego, which makes it easy for the adolescent to drown in her interiority. What becomes interiorised is a sense of not belonging – a sense of shame. The therapist’s role is akin to that of the life-guard: teaching her to swim and lose her fear of the water, yet at the same time, ensuring she does not get out of her depth and become lost at sea.

The therapist’s respectful presence meets the adolescent’s need for genuine human relatedness; and the connection between the two offers a sufficiently safe and accepting space for the adolescent to support the emerging and integration of her inner experience. The adolescent is particularly appreciative of sincerity in the therapist and often the work of the therapist is to encourage the adolescent to stand aside from struggles and dilemmas and regard them dispassionately and with objectivity.

The adolescent at this stage of development is often deeply confused about who she is and usually struggles with such basic issues of self-definition as body concept and sexual orientation. The process of deepening her relationship with self and others in her world is further complicated for adolescents who have experienced psychological trauma at an earlier time – they are particularly vulnerable to being overwhelmed by their pain and may have grave difficulties with identity and self-perception.


Carolyn, age 17, self-referred because she was unhappy at school. My first impression of this adolescent was that I had seldom seen anyone who looked so afraid and vulnerable. In the beginning we would often sit on the floor opposite each other, with Carolyn huddled behind a bundle of large cushions. She never, ever made eye contact with me, but said she wanted me to sit with her and not talk. She said she had a box inside her with ‘bad stuff’ in it.

She had a dream one night that we were standing at the top of a staircase. She was too afraid to descend the staircase alone. She didn’t know what she might find when she got to the basement and it helped to have me there to accompany her. I had my hand on her back. My touch felt gentle and supportive, but she was afraid that I might push her down the steps. She needed me to stay a little behind her and we must move at her pace. Her dream has been a helpful guide for me in the work. It has also been an effective way for Carolyn to manage the rhythm of what happens between us and continue to find the safety and support she needs from me. (She will often tell me how she is experiencing me and the work by using the imagery of the dream.)

We have been working together for almost three years now and about ten months into therapy she started to open the box and disclosed that her father had been sexually abusing her for as long as she could remember. Her mother knew about the abuse taking place – she walked into a room when Carolyn was being raped by her father and silently exited again. The incident was never spoken of. Carolyn also disclosed to me that her father’s friend raped her when she was eleven years old. She is sure her father consented to this and memories are emerging of others being involved in her abuse. It appears likely that she was ‘passed round’.

I intuitively sensed that the abuse by her father was ongoing, although Carolyn assured me that it wasn’t. Several months later, when she left home to go to college, she confided that this had indeed been the case. She does not go home unless she feels it is absolutely essential and that, thankfully, is a rare occurrence. During these short visits, which are never overnight, we stay in close contact. She is learning to protect and support herself in the world. I have watched her journey from wanting to be and feeling that she was dead, to finding fulfillment and enjoyment in her life (although she is still convinced that she will die soon). It has been a moving and often very difficult experience to bear witness to her unfathomable pain and support her in discovering her humanness and sense of self. Carolyn has found creative expression particularly helpful at times in the attempt to articulate her experience. The following is a description in her own words of her experience:

“I’m neither male nor female; I don’t have a gender or sexuality. I don’t exist below the waist. I’m essentially pointless and dead. I don’t feel much anymore. I don’t fit with the category of “female” because I don’t fit the definition in my mind – I’m not very feminine. At the same time I’m not masculine. It’s like I’m stuck at an age before puberty and adolescence… like I’m a child walking around in an adult world and that is scary because I spent too much time in a bad part of the adult world when I was a child. I have a space inside – it’s empty because someone got inside and damaged it. I don’t have a face because I don’t really know who I am – other people have eroded that… Sometimes my thoughts take on a life of their own – I feel almost separate from them but they are so real and so strong that I feel like I’m living in a nightmare. I cannot control these thoughts; I can’t silence them and they really affect life. These are physical thoughts too. My body remembers things my head has managed to hide. Sometimes my body just has a bad day. Sometimes the memories are so horrible I wish I could stop them – physically on days like these banging my head off a wall seems like a good idea.”

Carolyn had not so much disembedded from her family field as dissociated from herself and the world during her childhood. So, working in an embodied way has been important. She is learning to trust and care for her body and has developed well the capacity to be present in her encounters with others. Supporting Carolyn in creating a meaningful and enriching life for herself has been an important aspect of the work, as she comes to terms with and transcends her years of abuse. She is only now beginning to stop blaming herself for what happened and is experiencing a new freedom which is exhilarating for her. The co-creation of a safe and respectful connection between us both has unquestionably been the most significant and most healing feature of the work. The world of relationship is becoming safer for her now and she is finding more and more empowerment in her life.


As the adolescent works to develop an experience of self at both the intrapsychic and interpersonal levels of experience, the therapist supports the young person in finding ways that these two levels relate to each other. The adolescent has hopefully now developed a fairly grounded identity and a consistent sense of who he is becoming. This means less reliance on denial, projective identification, retroflection etc. as a response to internal conflict. There is greater consistency in his behaviour and increased continuity in his inner experience. He has hopefully developed a self-reflective capacity and a greater sense of personal responsibility for his life. Most importantly the adolescent has hopefully come to realise that support and meaningful relationship with self and other is possible in the world as he journeys onwards towards the next stage of emerging adulthood.

I suspect that there might be two potential pathways of experience for adolescents: a model of adolescent process for the child who emerges from a relational field and another suitably adapted blueprint for the child who emerges from a field of isolation, the latter essentially to do with survival. The relational field provides the necessary support and resistance from which to disembed and begin to move off into the world. A field in which trauma is part of the ground of experience often seems to result in more dissociation than healthy boundary making at the disembedding stage. The development of interiority, as well as bringing the adolescent into deeper contact with the self, may, for the traumatised adolescent, prove overwhelming as he confronts directly and personally, the impact of his trauma. Many adolescents I make contact with have a brittle sense of self and sometimes no real sense at all, so finding someone home inside is the principal focus. These adolescents need to be supported in discovering that they are more than their pain and that support, connection and belonging is possible in their experience.

Bronagh Starrs IAHIP maintains a private practice in Omagh as a psychotherapist and trainer, specialising in working with children and adolescents. She is a founding member of Borealis, a support organisation for Humanistic and Integrative psychotherapists working in the north of Ireland. Email:


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McConville, M. (1995) Adolescence: Psychotherapy and The Emergent Self. San Francisco: Jossey-Bass

McConville, M. (2006) Shame in Adolescent Development and Psychotherapy.  Paper presented to the Cleveland MetroHealth Conference, 2006

Song: The Rose That Grew From Concrete Album: The Rose That Grew From Concrete Artist: 2pac with Nikki Giovanni. November 2000, Interscope Records