Maria Papadima is a child and adolescent psychotherapist based in London, UK. She trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA) and works in an NHS crisis adolescent team in London, as well as privately, with young people and their families. Rachel Acheson is a child and adolescent psychotherapist based in Holywood, Northern Ireland. She trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA).Nikolaos Tzikas is a child and adolescent psychotherapist based in Athens, Greece. He trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA) and is a member of the Association of Child Psychotherapists (ACP) and the Hellenic Child and Adolescent Psychoanalytic Psychotherapy Society.

• Editors x List of contributors xii Preface xvi Acknowledgements xviii Introduction 1 PART 1 1 Adolescence at the intersection of inner and outer realities: A conceptualisation 7 FLAVIA ANSALDO 2 The search for identity: Working therapeutically with adolescents in crisis 34 RACHEL ACHESON AND MARIA PAPADIMA 3 ‘Too late for me’: The adolescent mental health crisis in time 62 JOCELYN CATTY PART 2 4 Considering crisis and risk in psychoanalytic work with adolescents 85 MARIA PAPADIMA 5 Meanings of adolescent overdose 106 HILLEL MIRVIS 6 The multifaceted meanings of a symptom: A psychoanalytic exploration of self-harm in contemporary culture 120 MARIA PAPADIMA 7 Moving towards a psychoanalytic formulation when assessing the risk of suicide in adolescents in crisis 149 NIKOLAOS TZIKAS PART 3 8 Reconfiguring adolescent–parent psychotherapy: Empowering relational dynamics to promote adolescent health and growth 171 RUTH SCHMIDT NEVEN 9 Reaching for the unreachable: Working with parents of adolescents who struggle to engage 187 VICTORIA HAYWARD AND PAUL BELL 10 Working with schools to support adolescents in crisis 206 RACHEL ACHESON AND CATHERINE CAMPBELL 11 Ripples of containment: How CAMHS teams manage anxiety in the midst of adolescent crisis 227 REBECCA BOLAM 12 Cries in crisis: Holding looked-after adolescents and their networks in mind 241 EFTYCHIA APOSTOLIDOU, VICTORIA NICOLODI, AND NIKOLAOS TZIKAS PART 4 13 Brief psychodynamic psychotherapy for adolescents and their families in crisis: A pilot study 265 MARIA PAPADIMA, CATHERINE CAMPBELL, NIKOLAOS TZIKAS, AND FEMBE NANJI-ROWE14 Playing with fire: Or how do we play when we’re scared? the nature and function of play in psychotherapy with high-risk adolescents 293 KATE MILLS 15 ‘To dream is to live’: The therapist’s function for representation in work with at-risk adolescents 309 NIKOLAOS TZIKAS Index 330

‘This book provides a most welcome and admirable addition to the Independent series and should reach audiences far beyond those already involved in offering psychologically-informed treatment to troubled adolescents. In a way that is often scholarly but always accessible it considers adolescence from many different viewpoints, offering new ideas about risk, self-harming behaviours and how to help the young person and their families engage with those offering services in a way that enhances their capacity to think and be less destabilised by the struggles of adolescence. The authors state "Psychoanalytic work in this field requires two things that at first glance appear opposite: immediacy and depth". The ideas contained in this book, brought vividly to life through composite vignettes, show this principle in action. While taking a wider, systemic approach, recognising that culture, language, and social pressures shape the form crises take, this book is firmly rooted in psychoanalytic thinking, yet many of the chapters will also be inspirational to those working with adolescents in a wide variety of settings.’Dr Janine Sternberg, child and adolescent psychotherapist‘This is psychoanalytic psychotherapy at its best – creative, grounded in clinical experience, and grappling with the many urgent problems that adolescents bring to the clinician. The papers are written in the main by psychoanalytic child and adolescent psychotherapists who draw on the Independent psychoanalytic tradition to develop new ways of working. The urgency of the risk-laden problems that their patients bring to the consulting room, make the depth of understanding and experience that come from the psychoanalytic tradition all the more significant.These are clinicians working within the severely overloaded Child and Adolescent Mental Health interdisciplinary teams of our times, but still managing to find new ways of helping their patients and their families.This ground-breaking collection of papers is a major contribution to clinical practice which will be enormously helpful to clinicians for many years to come.’Monica Lanyado, PhD, child and adolescent psychotherapist

Maria Papadima is a child and adolescent psychotherapist based in London, UK. She trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA) and works in an NHS crisis adolescent team in London, as well as privately, with young people and their families. Rachel Acheson is a child and adolescent psychotherapist based in Holywood, Northern Ireland. She trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA).Nikolaos Tzikas is a child and adolescent psychotherapist based in Athens, Greece. He trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA) and is a member of the Association of Child Psychotherapists (ACP) and the Hellenic Child and Adolescent Psychoanalytic Psychotherapy Society.

• Editors x List of contributors xii Preface xvi Acknowledgements xviii Introduction 1 PART 1 1 Adolescence at the intersection of inner and outer realities: A conceptualisation 7 FLAVIA ANSALDO 2 The search for identity: Working therapeutically with adolescents in crisis 34 RACHEL ACHESON AND MARIA PAPADIMA 3 ‘Too late for me’: The adolescent mental health crisis in time 62 JOCELYN CATTY PART 2 4 Considering crisis and risk in psychoanalytic work with adolescents 85 MARIA PAPADIMA 5 Meanings of adolescent overdose 106 HILLEL MIRVIS 6 The multifaceted meanings of a symptom: A psychoanalytic exploration of self-harm in contemporary culture 120 MARIA PAPADIMA 7 Moving towards a psychoanalytic formulation when assessing the risk of suicide in adolescents in crisis 149 NIKOLAOS TZIKAS PART 3 8 Reconfiguring adolescent–parent psychotherapy: Empowering relational dynamics to promote adolescent health and growth 171 RUTH SCHMIDT NEVEN 9 Reaching for the unreachable: Working with parents of adolescents who struggle to engage 187 VICTORIA HAYWARD AND PAUL BELL 10 Working with schools to support adolescents in crisis 206 RACHEL ACHESON AND CATHERINE CAMPBELL 11 Ripples of containment: How CAMHS teams manage anxiety in the midst of adolescent crisis 227 REBECCA BOLAM 12 Cries in crisis: Holding looked-after adolescents and their networks in mind 241 EFTYCHIA APOSTOLIDOU, VICTORIA NICOLODI, AND NIKOLAOS TZIKAS PART 4 13 Brief psychodynamic psychotherapy for adolescents and their families in crisis: A pilot study 265 MARIA PAPADIMA, CATHERINE CAMPBELL, NIKOLAOS TZIKAS, AND FEMBE NANJI-ROWE14 Playing with fire: Or how do we play when we’re scared? the nature and function of play in psychotherapy with high-risk adolescents 293 KATE MILLS 15 ‘To dream is to live’: The therapist’s function for representation in work with at-risk adolescents 309 NIKOLAOS TZIKAS Index 330

‘This book provides a most welcome and admirable addition to the Independent series and should reach audiences far beyond those already involved in offering psychologically-informed treatment to troubled adolescents. In a way that is often scholarly but always accessible it considers adolescence from many different viewpoints, offering new ideas about risk, self-harming behaviours and how to help the young person and their families engage with those offering services in a way that enhances their capacity to think and be less destabilised by the struggles of adolescence. The authors state "Psychoanalytic work in this field requires two things that at first glance appear opposite: immediacy and depth". The ideas contained in this book, brought vividly to life through composite vignettes, show this principle in action. While taking a wider, systemic approach, recognising that culture, language, and social pressures shape the form crises take, this book is firmly rooted in psychoanalytic thinking, yet many of the chapters will also be inspirational to those working with adolescents in a wide variety of settings.’Dr Janine Sternberg, child and adolescent psychotherapist‘This is psychoanalytic psychotherapy at its best – creative, grounded in clinical experience, and grappling with the many urgent problems that adolescents bring to the clinician. The papers are written in the main by psychoanalytic child and adolescent psychotherapists who draw on the Independent psychoanalytic tradition to develop new ways of working. The urgency of the risk-laden problems that their patients bring to the consulting room, make the depth of understanding and experience that come from the psychoanalytic tradition all the more significant.These are clinicians working within the severely overloaded Child and Adolescent Mental Health interdisciplinary teams of our times, but still managing to find new ways of helping their patients and their families.This ground-breaking collection of papers is a major contribution to clinical practice which will be enormously helpful to clinicians for many years to come.’Monica Lanyado, PhD, child and adolescent psychotherapist

Maria Papadima is a child and adolescent psychotherapist based in London, UK. She trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA) and works in an NHS crisis adolescent team in London, as well as privately, with young people and their families. Rachel Acheson is a child and adolescent psychotherapist based in Holywood, Northern Ireland. She trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA).Nikolaos Tzikas is a child and adolescent psychotherapist based in Athens, Greece. He trained at the Independent Psychoanalytic Child and Adolescent Psychotherapy Association (IPCAPA) and is a member of the Association of Child Psychotherapists (ACP) and the Hellenic Child and Adolescent Psychoanalytic Psychotherapy Society.

• Editors x List of contributors xii Preface xvi Acknowledgements xviii Introduction 1 PART 1 1 Adolescence at the intersection of inner and outer realities: A conceptualisation 7 FLAVIA ANSALDO 2 The search for identity: Working therapeutically with adolescents in crisis 34 RACHEL ACHESON AND MARIA PAPADIMA 3 ‘Too late for me’: The adolescent mental health crisis in time 62 JOCELYN CATTY PART 2 4 Considering crisis and risk in psychoanalytic work with adolescents 85 MARIA PAPADIMA 5 Meanings of adolescent overdose 106 HILLEL MIRVIS 6 The multifaceted meanings of a symptom: A psychoanalytic exploration of self-harm in contemporary culture 120 MARIA PAPADIMA 7 Moving towards a psychoanalytic formulation when assessing the risk of suicide in adolescents in crisis 149 NIKOLAOS TZIKAS PART 3 8 Reconfiguring adolescent–parent psychotherapy: Empowering relational dynamics to promote adolescent health and growth 171 RUTH SCHMIDT NEVEN 9 Reaching for the unreachable: Working with parents of adolescents who struggle to engage 187 VICTORIA HAYWARD AND PAUL BELL 10 Working with schools to support adolescents in crisis 206 RACHEL ACHESON AND CATHERINE CAMPBELL 11 Ripples of containment: How CAMHS teams manage anxiety in the midst of adolescent crisis 227 REBECCA BOLAM 12 Cries in crisis: Holding looked-after adolescents and their networks in mind 241 EFTYCHIA APOSTOLIDOU, VICTORIA NICOLODI, AND NIKOLAOS TZIKAS PART 4 13 Brief psychodynamic psychotherapy for adolescents and their families in crisis: A pilot study 265 MARIA PAPADIMA, CATHERINE CAMPBELL, NIKOLAOS TZIKAS, AND FEMBE NANJI-ROWE14 Playing with fire: Or how do we play when we’re scared? the nature and function of play in psychotherapy with high-risk adolescents 293 KATE MILLS 15 ‘To dream is to live’: The therapist’s function for representation in work with at-risk adolescents 309 NIKOLAOS TZIKAS Index 330

‘This book provides a most welcome and admirable addition to the Independent series and should reach audiences far beyond those already involved in offering psychologically-informed treatment to troubled adolescents. In a way that is often scholarly but always accessible it considers adolescence from many different viewpoints, offering new ideas about risk, self-harming behaviours and how to help the young person and their families engage with those offering services in a way that enhances their capacity to think and be less destabilised by the struggles of adolescence. The authors state "Psychoanalytic work in this field requires two things that at first glance appear opposite: immediacy and depth". The ideas contained in this book, brought vividly to life through composite vignettes, show this principle in action. While taking a wider, systemic approach, recognising that culture, language, and social pressures shape the form crises take, this book is firmly rooted in psychoanalytic thinking, yet many of the chapters will also be inspirational to those working with adolescents in a wide variety of settings.’Dr Janine Sternberg, child and adolescent psychotherapist‘This is psychoanalytic psychotherapy at its best – creative, grounded in clinical experience, and grappling with the many urgent problems that adolescents bring to the clinician. The papers are written in the main by psychoanalytic child and adolescent psychotherapists who draw on the Independent psychoanalytic tradition to develop new ways of working. The urgency of the risk-laden problems that their patients bring to the consulting room, make the depth of understanding and experience that come from the psychoanalytic tradition all the more significant.These are clinicians working within the severely overloaded Child and Adolescent Mental Health interdisciplinary teams of our times, but still managing to find new ways of helping their patients and their families.This ground-breaking collection of papers is a major contribution to clinical practice which will be enormously helpful to clinicians for many years to come.’Monica Lanyado, PhD, child and adolescent psychotherapist