“You’re Just Going to Have to Practice a Lot of Acceptance”: Playing with Recovery in Residential Treatment

Abstract

This paper uses mentalization theory to describe a style of intervention with adolescents in short-term, mandated residential treatment. The externalizing defenses—projection and projective identification—on which these adolescents tend to rely function as a barrier to engagement in treatment. Mentalization theory posits that these defenses originate from early experiences of unmarked, realistic mirroring. During childhood and adolescent development, individuals exposed to unmarked mirroring are more likely to deploy externalizing defenses, experienced in the mode of psychic equivalence, to regulate affect and manage interpersonal conflict. In their relationships with authority figures, this tendency can lead them to become stuck in a negative cycle of estrangement, frustration, disruptive behavior, and disciplinary intervention. When these youth are mandated into treatment, they are liable to externalize an alien-self representation of a critical and inconsiderate authority figure onto their treatment providers. Clinical material from a residential treatment setting demonstrates how encouraging playfulness with the treatment frame assists in marking these adolescents’ externalizations. Marking externalizations relaxes externalizing defenses, resulting in these youth being more open to treatment.