Playing Hard at Life brings contemporary relational thinking to bear on the psychodynamic treatment of a notably difficult group of young patients. Working with New York City teenagers who have survived the wars of inner-city life and Israeli teenage soldiers who have survived the wars of the Middle East, author Etty Cohen documents the extraordinary challenges of forming a treatment alliance with these shattered youngsters, of engaging them psychodynamically, and of working toward a viable termination. The result is not only a poignant record of courage and committment (on the part of patient and therapist alike), but also a valuable extension of modern trauma theory to adolescence as a developmental stage with its own challenges and requirements.
The heart and strength of Cohen's book is her vivid documentation of hands-on encounters with her adolescent patients, seen both individually and in group. Cohen makes plain that, with young people so horrendously traumatized, treatment assures a necessarily improvisational character. And yet, she argues, even in the type of pragmatic encounters dictated by massive and repeated trauma, contemporary relational theory provides a compass with which to navigate through the rocky shoals of the clinical work.
Again and again, the reader is shocked by just how much happened to these adolescents, astonished at how resilient they proved to be, and, finally, moved by how much Cohen was able to accomplish with them. Her relational approaches to these treatments, teamed with her realization that work with multiply traumatized adolescents cannot be structured in the manner of conventioanl therapy, makes this book an invaluable, timely, and deeply sobering contribution to the literature.
Table of Contents
Prologue. Part I: On the Road to Survival. Secrets and Self-Disclosure in the Therapeutic Relationship. Enactments: The Language of Therapy with Traumatized Adolescents. Dreams: The Royal Road to Trauma. Dissociation and Cultural-Social Difference. Part II: The Evolution of the Transference-Countertransference: Engagement, Safety, and Erotic Phases. Engagement Phase: Resistance and the Antitherapeutic Alliance. Safety Phase: Mutual Tenderness. Erotic Phase: Confusion Between Tenderness and Passion. Part III: Finding a Treatment Plan. Gender in the Dyad. Treatment Planning: Is it Possible? Contact with Parents. Termination: Traumatic for Whom? Epilogue
Etty Cohen, Ph.D., received professional training in clinical social work (Haifa University) and psychotherapy (Department of Psychiatry, Rambam Medical Center) in Israel. She received her doctorate from New York University's Ehrenkranz School of Social Work and completed psychoanalytic training at New York's Postgraduate Center for Mental Health, where she now serves as a faculty member and supervisor in the Child and Adolescent Psychoanalytic Training Program. She is also a Training and Supervising Analyst at the American Institute for Psychoanalysis of The Karen Horney Psychoanalytic Center and an adjunct professor at the NYU Ehrenkranz School of Social Work. A former major in the Israeli Defense Forces, Dr. Cohen is currently in private practice in New York City.
"This is a book about bravery, the bravery of the young people courageous enough to face histories of multiple trauma and the bravery of the author courageous enough to work with young people who have survived Middle East wars or the wars of inner-city New York. Etty Cohen gives those of us who work with adolescents renewed hope in the power of a psychoanalytically-oriented treatment approach. Adolescent therapists of all persuasions will find something new and exciting in her synthesis of relational and classical psychoanalytic writings on adolescence, and their own techniques will be enhanced by following Cohen's work through her detailed and moving case histories. Playing Hard at Life will be a major resource and support for all therapists brave enough to undertake the psychodynamic treatment of traumatized adolescents."
- Jack Novick, Ph.D., Clinical Associate Professor of Psychiatry, University of Michigan
"Etty Cohen has written an invaluable guide to psychotherapeutic work in the trenches with traumatized adolescents. Drawing heavily on Ferenczi, her predecessor in taking on the most difficult clinical situations, Cohen weaves together theory and vivid, real-world clinical examples to create a work that is thoughtful and ultimately hopeful in the midst of overwhelming, unbearably painful human situations."
- Neil Altman, Ph.D, Co-Editor, Psychoanalytic Dialogues
"With moving detail and remarkable emotional honesty, this book depicts one psychoanalyst's heroic attempts to construct a potential space for hope amidst the jagged shards of adolescent lives shattered by multiple traumas. Etty Cohen achieves brilliant integration of the developmental adolescent literature and the relational perspectives on trauma, constructivism, and therapeutic change. She takes us to the very edges of what we know as analyts and invites us to abandon our therapeutic omnipotence and journey with her into uncharted regions. Somehow greater than the sum of its parts, this work takes an imaginative leap that is, at times, nothing short of inspirational."
- Jody Messler Davies, Co-Editor, Psychoanalytic Dialogues